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MEDCOM Updates. Christopher A. Dillon MD COL, MC Accessions/Recruiting Liaison to OTSG. Current Issues in Medical Education. Increase in Medical School Enrollment AAMC reports nearly 30% from 2002 80% of MD schools 75% initiatives encouraging primary care

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medcom updates

MEDCOM Updates

Christopher A. Dillon MD

COL, MC

Accessions/Recruiting Liaison to OTSG

current issues in medical education
Current Issues in Medical Education
  • Increase in Medical School Enrollment
    • AAMC reports nearly 30% from 2002
    • 80% of MD schools
    • 75% initiatives encouraging primary care
  • 112th Congress Deficit Reduction
    • 60% reduction ($3.9B) in Medicare payments to teaching hospitals
    • ACGME concerned re: # trainees & education
current issues in medical education1
Current Issues in Medical Education
  • Control Act of 2011
    • Eliminates interest subsidies on Stafford Loans
      • Graduate & Professional Students begin July 1, 2012
      • Still have access to same amount of loans ($40,500 for medical students)
      • Since unsubsidized, estimates increase loan costs by $10,000-$20,000 per student
  • Physician Salaries
    • https://www.aamc.org/download/48732/data/compensation.pdf
current issues in medical education2
Current Issues in Medical Education
  • National Match
    • 2014- MD applicants will equal positions offered
      • GME slots up 6%/5 yrs but applicants up 9.5%/5 yrs
      • Only 52% of civilians got 1st choice
    • 14,000 non-U.S. senior applicants
    • Match will be more competitive (>900 U.S. senior medical students didn’t match last year)
  • Military Match
    • Smaller, better chance to match 1st or 2nd
graduate medical education stats
GRADUATE MEDICAL EDUCATION STATS
  • Number, specialty distribution, subspecialty options programmed to meet the needs of the Army.

- 137 Programs 72 residencies, 59 fellowships, 6 transitional internships).

- 22 Specialties.

- 11 Teaching hospitals.

- 57% of programs with 5 yr. accreditation; 20% with 4 yr.

accreditation (3.95 yr is civilian average; Army average 4.3 yrs).

  • Majority of Army physicians in GME train in in-house programs.

- 1466 in training (1355 in-house programs and 111 Army

sponsored civilian training). 30 in educational delay/FAP.

- Comprises 31% of active duty Medical Corps end strength.

  • 93% first time board pass rate.
army gme success stories
Army GME Success Stories
  • Brooke AMC and Walter Reed AMC General Surgery
    • Two of only 10 surgery programs in the country (250 programs total) to have a 100% first time pass rate on both written and oral boards over the last 5 years
  • Emergency Medicine
    • Residents at Darnall ACH, Brooke AMC and Madigan AMC have scored in the top 10 nationwide on the annual EM in-service exam for the past 11 years
  • Internal Medicine
    • WRAMC IM residents (13) achieved a 100% pass rate on the 2007 ABIM certification exam. The national average for first-time takers between 2002 and 2006 is 91%. The Walter Reed average for first-time takers for the past 10 years is 98%.
  • Ophthalmology
    • The Army had the first residency program in the US to get the virtual reality ophthalmic surgical simulator. 100% of our ophthalmology residency programs are sim-inclusive.
medical research
Medical Research
  • The U.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker, Alabama
  • U.S. Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas
  • U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen Proving Ground, Maryland
  • U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland
  • U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts
  • Walter Reed Army Institute of Research (WRAIR), Forest Glen, Maryland
    • U.S. Army Dental Research Detachment
    • U.S. Army Medical Research Detachment
    • Armed Forces Research Institute of Medical Sciences-Thailand (AFRIMS)
    • U.S Army Medical Research Unit- Europe
    • U.S Army Medical Research Unit- Kenya
regional medical commands teaching hospitals
Regional Medical CommandsTeaching Hospitals

Walter Reed AMC Womack AMC DeWitt ACH Keller ACH (West Point)

Eisenhower AMC Martin ACH Darnall AMC Brooke AMC

William Beaumont AMC Madigan AMC Tripler AMC

residencies
Internal Medicine

Family Medicine

Emergency Medicine

Pediatrics

Obstetrics/Gynecology

General Surgery*

Neurosurgery

Orthopaedics

Urology

Otolaryngology

Preventive Medicine/ Occupational Medicine*

Dermatology

Radiology

Radiation Oncology

Anesthesiology

Aerospace Medicine*

Neurology and Child Neuro

Pathology

Psychiatry

Physical Medicine and Rehabilitation

Ophthalmology

Residencies

* Specialty does not offer continuous contract; must reapply for PGY-2 year.

pgy 1 categorical specialties
Emergency Medicine

Family Medicine

General Surgery

Internal Medicine

Neurology

Neurosurgery

OB-GYN

Orthopaedics

Otolaryngology

Pathology

Pediatrics

Psychiatry

PGY-1 Categorical Specialties
designated preliminary pre select specialties
Designated Preliminary/Pre-Select Specialties
  • General Surgery*
        • Urology
  • Transitional Year
    • Undesignated
    • Designated
        • Aerospace Medicine*
        • Anesthesiology
        • Dermatology
        • Ophthalmology
        • Physical Medicine
        • Preventive Medicine/Occupational Medicine*
        • Radiation Oncology
        • Radiology (Diagnostic)

* Specialty does not offer continuous contract; must reapply for PGY-2 year.

va dod training opportunities
VA-DoD Training Opportunities
  • Intern year in Army program
  • Remainder of residency in VA-sponsored program
    • Radiology – Medical College of Georgia; UT San Antonio
    • Urology – UT San Antonio; Duke University
    • Neurosurgery* – University of Florida; UT San Antonio

*Entirety of training in VA-sponsored program

slide22
HPSP
  • 80% of all active duty physicians
  • Full assistance (tuition, books, equipment and monthly stipend of $2,088)
  • Available to: physicians, dentists, veterinarians, clinical psychologists, pharmacists and optometrists
  • Reasons to take scholarship
    • Debt free after med school (avg. debt is $160,000)
    • GME opportunities and subspecialty training
    • Unlimited practice opportunites in
reasons to apply for hpsp
Reasons to Apply for HPSP
  • Debt free after Medical school+ $20k bonus
    • Median education debt is $160,000
  • Outstanding GME opportunities in Army programs and subspecialty training
  • Unlimited practice opportunities in academic, operational, clinical medicine and research
  • Excellent benefits while on AD and retirement*
  • Selfless service
hpsp changes
HPSP Changes
  • MAC (Minimal Acceptance Criteria):
    • GPA >/= 3.2 undergrad
    • MCATs >/= 24 with no score <8
  • AAC (Automatic Acceptance Criteria):
    • NO LONGER
  • Average MCAT for HPSP matriculants is 29.3 and average GPA is 3.62
  • Waivers: 103 requests, 19 approved
    • Virtually all approved were for combined programs
more hpsp notes
More HPSP Notes
  • Residency Competition for Army will peak in 2012-2013
  • Most scholarships are 4 years
    • 3-year scholarships mostly rollovers
  • HPSP students expected to take BOLC after 1st year medical school
    • 2nd year prepare for part 1 of boards
    • 3rd and 4th years to ADT at Army hospitals
hpsp plan of attack
HPSP Plan of Attack
  • New Approach
    • USAREC and MEDCOM working together
    • Adjustments in requirements
    • Improvement in Quality
attrition rates
Attrition Rates

YearOverallAcademic

2007 5.4% 1.7%

2008 4.6% 3.3%

2009 6.4% 4.7%

2010 4.0% 3.1%

2011 3.2% 1.2%

National 4.0% 1.4%

hpsp plan
HPSP Plan
  • Target:
    • Undergraduate universities
    • Universities with large number of medical school matriculants
    • Universities with large number of matriculants to out-of-state and private medical schools
    • Pre-health clubs, Medical Honor societies, advisors & ROTC
    • Target financial aid advisors at medical schools and staff with access to accepted students
  • Provide SME at all events involving at least major universities (Top 65)
  • Provide regular training to recruiters from GME and deliver readily available POC
  • Provide visibility to leaders and AARs
medical professional career tracks

Same for

Civilian

and Army**

Medical Professional Career Tracks
  • Clinical
  • Academic
  • Research
  • Operational
    • Multiple Levels of Hooah!
  • Command – Leadership
  • Corporate Level Management

Army Unique

life cycle model is
Life Cycle Model Is:
  • Integration of Professional Medical Education and Professional Military Education as the three pillars of leader development:

-Military training/GME

-Self development

-Operational assignments

  • Designed to provide guidelines for completion of courses, career integration at specific ranks and career points
  • http://www.army.mil/usapa/epubs/xml_pubs/p600_4/head.xml
slide35

FYGME

RESIDENCY

FELLOWSHIP

Medical Corps Officer Career Progression

YEARS

0

30

6

18

12

CPT

MAJ

COL

LTC

Rank

BOLC CCC INTERMEDIATE LEVEL ED SENIOR SVC. COLLEGE

Professional Military Education

CBRNE SHORT COURSES

Additional Training

EXECUTIVE SKILLS COURSE

ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT

MPH MBA TWI ADVANCED SCIENCE DEGREE

DEVELOPMENTAL & UTILIZATION ASSIGNMENTS

Corps/MACOM

Surgeon

Commander

Joint Assignments

DCCS

MECEN Staff

Deputy Chief

Dir Med Ed

USUHS Faculty

Department Chair

Research Area Dir.

BN/BDE/DIV

Surgeon

MEDCOM Staff

DCCS

MEDCEN Staff

MEDDAC Staff

Residency Director

Product Line Mgr

Division Chief

Clinician

Successful

Completion of

Fellowship

TOE/TDA Physician

Company Commander

Clinic OIC

Teaching Staff

Research Assistant

Clinician

Successful

Completion of

Internship and

Residency

Utilization Tour

Clinician

Typical Assignments

Self Development

Continuing Medical Education / Board Recertification

License by yr. 2 Board Certification Subspecialty Board Certification

leadership opportunities
LeadershipOpportunities
  • An Army Officer
  • Training and mentoring junior soldiers/physicians in your specialty.
  • Opportunities to lead sooner than civilian practices
  • Your professional recommendations are more valued, and you have the autonomy within your practice without third-party interference
  • Full-spectrum of leadership opportunities from service/department chief to Surgeon General
the right career
The “Right” Career?
  • 4300 career “rabbit paths”
  • Clinical competence is paramount
  • Meet the requirements
  • Stack the deck in your chosen path
    • Assignments
    • Schools
    • “A” designator
    • OER Support Forms
  • Understand the consequences and accept responsibility
retention
Retention
  • MC Retention Issues
    • Deployment / Family
    • Length of deployment
      • Down to 4.5 months for physicians
    • AHLTA/admin issues
  • Initial ADSO Retention FY11=70%
    • FY10 = 63%
    • FY09 = 59%
    • 57% - 65% over the past 5 years
  • Continuation rate beyond initial ADSO > 90%
oef oif rapid integration of lessons learned
OEF/OIF: Rapid Integration of Lessons Learned
  • Force Health Protection
    • Behavioral Health
      • Interventions to Enhance Psychological Resilience and Prevent Psychiatric Casualties.
      • Pentagon Post-Disaster Health Assessment
      • PTSD
    • Immunizations
      • Vaccine Healthcare Centers Network (VHC)
      • Myocarditis and Oral Vaccine with Smallpox Vaccine
  • Battlefield Medicine
    • Training of Medics: 91W
    • Use of Blood Transfusions, Whole Blood, Factor VII
    • Hemostasis: Tourniquets and HemCon Bandages
    • Pain Control & Regional Anesthesia: pain pumps
  • Home Station/Garrison Care
    • Amputee Care & Rehabilitation: Intrepid Center
    • Deployment Health Practice Guideline
    • Community Based Warrior Transition Unit: CBWTU
    • Traumatic Brain Injury (TBI)
battlefield survival
Battlefield Survival
  • Forward surgical/resuscitation capabilities
  • Advanced evacuation capabilities
  • Body Armor
  • Advanced surgical techniques
  • Advances in antibiotic tx
slide41

Transforming for Success

Survivability (%)

WWII

ODS

SOMALIA

OEF

OIF

Survivability = 100% - (KIA% + DOW%)

army medicine
Army Medicine

Serving the nation since 1775

China 1944

44th MASH, Korea 1954

Radiology residents 1968

slide43

The Army’s Home for Health…

Saving Lives and Fostering Healthy and Resilient People

~ Partnerships Built on Trust