Graduate medical educators and infantry commanders: working together to train Army psychiatry residents

To develop Army psychiatry residents' skills in community and combat psychiatry, the 7th Infantry Division (Light) and Letterman Army Medical Center have begun a unique training program that is built on collaboration between academic medical departments and combat infantry battalions. This article outlines the program's development, its operation, and gives a qualitative assessment of its first year.     

Operational medicine experience integrated into a military internal medicine residency curriculum

The optimal training of physicians should prepare them for the environment in which they will practice. During the past several years, the practice of internal medicine has shifted from a focus on the inpatient setting to one that includes an emphasis on the ambulatory clinic. Military internists must be further prepared to practice medicine with forward units, at field hospitals, and in other operational settings. Community-based teaching programs that reflect present and future practice are increasingly recognized as essential, yet details on the structure and implementation of such programs, especially those designed to teach field and operational medicine, are lacking. The Internal Medicine Residency Program at Walter Reed Army Medical Center has developed and implemented an operational medicine curriculum that includes a field medical training exercise. The program is driven by the residents and chief resident and requires little additional funding. Resident research continues to increase, morale remains high, and the first class to complete the 3-year operational curriculum achieved a 100% pass rate on the American Board of Internal Medicine certification examination. We describe our 3-year experience of implementing this program, with an emphasis on curriculum design and execution, qualitative assessment, and initial lessons learned.     

A knowledge assessment of combat stress reaction in Army Family Practice residents

Combat stress reaction occurs when a soldier's ability to function effectively is impaired by overwhelming stressors in a combat environment. During recent wars, Combat stress reaction has accounted for 30% to 40% of all casualties. Army Family Physicians can expect to be assigned to frontline medical units in time of war and, therefore, should be able to accurately diagnose and treat combat stress reaction. This paper reports an investigation of the knowledge Army Family Practice residents have of combat stress reaction. The results show that Army Family Practice residents are deficient in their knowledge of combat stress reaction.     

Psychiatric care of the homeless mentally ill: an opportunity for military psychiatry training

This paper reviews the phenomenon of homelessness in the United States and locally in Washington, D.C. Prevalence data of psychiatric illness in the homeless is presented, as is the formation of a psychiatric service network to treat the homeless mentally ill. Additionally, the author describes the development of an innovative training program in community psychiatry, focusing specifically on issues inherent in understanding the work of the psychiatric resident in community-based training and service delivery. The relevance of this experience to military medicine involves training psychiatric residents to develop service-delivery schemes in times of rapidly expanding mental health needs, such as combat.     

Structured clinical interview guide for postdeployment psychological screening programs

Brief structured clinical interviews are a key component of the Department of Defense postdeployment health reassessment program. Such interviews are critical for recommending individuals for follow-up assessment and care. To standardize the interview process, U.S. Army Medical Research Unit-Europe developed a structured interview guide, designed in response to both clinical requirements and research findings. The guide includes sections on depression, suicidality, post-traumatic stress disorder, anger, relationship problems, alcohol problems, and sleep problems. In addition, there is an open-ended section on other problems and a section for case dispositions. Data from a 2005 blinded validation study with soldiers returning from a 1-year-long combat deployment are included to demonstrate the utility of the structured interview. Guidelines and implementation considerations for the use of the structured interview are discussed.     

Educational objectives for diagnostic radiology residency training

A method of teaching radiology residents by identification of general and specific objectives to be accomplished during each time segment of the four-year training program has been developed. The objectives are incorporated into an educational contract that is signed by the resident and rotation director at the beginning of each rotation. The objectives are specific so that attainment can be evaluated. This gives definition to both the resident and the teacher.     

Acanthamoeba keratitis in a U.S. Army soldier after unauthorized use of contact lenses in the combat theater

A 25-year-old active duty Army E-5 developed severe infectious keratitis in his left eye secondary to soft contact lens (CL) wear while deployed in Iraq, necessitating evacuation to Walter Reed Army Medical Center for further evaluation and treatment. Initial clinical examination at Walter Reed Army Medical Center was suggestive of Acanthamoeba keratitis, a serious corneal pathogen associated with CL wear. In vivo confocal microscopy demonstrated Acanthamoeba cysts in the epithelium and anterior stroma, and smears and cultures from an epithelial biopsy specimen confirmed the diagnosis of Acanthamoeba keratitis. To our knowledge this is the first reported case of Acanthamoeba keratitis in a soldier wearing CLs in the combat theater. Because of the inability to maintain proper lens hygiene in a combat or field environment, the risk of developing a potentially sight-threatening corneal infection is significant. This unfortunate case of a devastating eye infection serves as a reminder of the current Army policy, which prohibits the use of CLs during gas chamber exercises, field training, and combat.     

Part I: preparing first-year radiology residents and assessing their readiness for on-call responsibilities

RATIONALE AND OBJECTIVES: The aim of the study is to evaluate the effectiveness of an Emergency Radiology (ER) Core Curriculum training module and a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system to prepare first-year (postgraduate year 2 [PGY-2]) radiology residents and assess their readiness for taking overnight radiology call. MATERIALS AND METHODS: Institutional review board approval was obtained, and the study was compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. A dedicated month-long ER curriculum was designed to prepare new radiology residents for overnight radiology call that includes interpretation of off-hour urgent and emergent studies without immediate direct attending supervision. Lectures of the curriculum, provided by department staff, were based on the American Society of Emergency Radiology core curriculum. The lecture series was implemented after PGY-2 residents had completed formal introductory resident rotations during their first 6 months of training. A DICOM-based interactive computer-based testing module was developed and administered at the end of the lecture series. The module consisted of 19 actual emergency department cases with entire series of images, simulating an on-call setting. Tests were scored by two staff members blinded to resident identifying information. Upper-level residents also were tested, and comparison was made between first-year and upper-level resident test scores to determine the effectiveness of the test in determining first-year resident preparedness for call. Statistical analysis of results was performed by using t-test (P < .05). RESULTS: All residents in the residency program present during the month (nine PGY-2, six PGY-3, seven PGY-4, seven PGY-5 residents) attended the lecture series and finished the testing module at the end of the lecture series. Of 19 actual emergency cases on the testing module, five cases were neuroradiology, three cases were thoracic imaging, eight cases were body imaging, and three cases were musculoskeletal. PGY-2 residents scored an average of 73.0% (range, 63.2%-81.6%) of total points possible. PGY-3 residents scored an average of 76.8% (range, 68.4%-86.8%); PGY-4 residents scored an average of 77.4% (range, 65.8%-100%), and PGY-5 residents scored an average of 81.2% (range, 68.4%-94.7%). There was no statistically significant difference in scores according to level of training. CONCLUSION: First-year radiology residents who underwent 6 months of formal radiology training followed by an intensive ER lecture series before taking overnight call had scores similar to upper-level colleagues on an interactive computer-based ER simulation module.     

Residents’ Perceptions of Usage of the Current Alumni and Attending Network for a Formal Mentorship Program in an Academic Affiliated Community Hospital Radiology Residency

Mentor-mentee relationships within radiology residencies can add significant value to a resident’s overall experience. Studies demonstrate that mentorship programs can increase satisfaction for residents and faculty alike by reducing stress, easing career related decisions, increasing involvement with research, improving teaching and communication skills, and finally increasing leadership roles. In a survey of radiology program directors, 85% of program directors find such a program beneficial but only 57% have a formal program in place. Totally, 42% of program directors believe a structured mentorship program is necessary. Studies have also shown that female residents prefer female mentors. Alumni serve as an ideal group for resident mentorship as they do not face the pressures of internal faculty. No study to date in diagnostic radiology literature uses an alumni network in establishing a formal mentorship program. The objective of this study is to implement a formal mentorship program within an academic affiliated radiology residency by using program alumni and internal attending physicians for potentially increasing faculty engagement, improving resident morale, research opportunities, and networking for fellowship and job opportunities.     

Lessons learned during the COVID-19 pandemic: a single institution radiology chief resident experience

Coronavirus Disease 2019 (COVID-19) has posed incredible new challenges for radiology residency programs, including resident training under tenuous and uncertain conditions, barriers to communication, deployment-induced anxiety, and social isolation. Chief residents and program leadership play a critical role in guiding radiology residents through these unprecedented times. Best practices and creative approaches experienced in a single institution's residency program located in New York City are shared in an effort to encourage other programs struggling with similar obstacles to prioritize resident education and wellness.     

Knowledge attainment, perceptions, and professionalism in participants completing the didactic phase of an Army reserve critical care nursing residency program

Combat hospitals in today's Army demand nurses with critical care nursing "8A" additional skills identifiers. The intensity of future wars and operations other than war, together with highly technological weapons, forecast a large number of casualties evacuated rapidly from combat with wounds that require skillful and intensive nursing care. Many of the critical care nurses providing future care are positioned in the reserve components and require creative approaches to education and training concentrated into one weekend per month. An Army Reserve critical care nursing residency program was designed in one midwestern combat support hospital. The didactic course, phase I, was evaluated for effectiveness in achieving outcomes of increased knowledge attainment, enhanced perceptions of critical care nursing, and higher degrees of professionalism. Twenty-seven registered nurses completed the course, and 30 nurses from the same hospital served as controls. A repeated-measures analysis examined outcomes before intervention (time 1), at course completion (time 2), and at a 6-month follow-up (time 3). The course was effective at increasing scores on knowledge attainment and perceptions of critical care nursing; however; professionalism scores were initially high and remained so throughout the study. This research extends information about critical care nursing education and evaluates a training mechanism for meeting the unique requirements and time constraints of nurses in the reserve components who need to provide a high level of skill to soldiers in combat.     

Selecting radiology resident candidates

Radiology resident candidate selection has become a burdensome, subjective, and somewhat arbitrary process. Because the luxury of many well-qualified candidates exists, there is an obligation to select them as honestly, equitably, and objectively as possible. Two years were spent in revising and modifying the resident selection process to make it more uniform and more efficacious. An application scoring form was devised to extract uniform pertinent information from the original application form. Candidates could then be ranked according to a numerical score derived from the form. This allowed easy selection of top candidates to be interviewed. A new interviewing scoring form was developed to include desirable characteristics of resident candidate performance. This form was also devised in such a way as to be easily scored and to allow selection of the top 20 to 25 candidates. These candidates were then ranked by participating faculty members while reviewing their application score forms and their interview forms. Positions for the residency training program were offered according to the ranking. The usefulness of both new forms was evaluated and confirmed by correlating form scores with faculty ranking of academic performance of current residents in the training program.     

First-Year Radiology Residents Teaching Anatomy to First-Year Medical Students: A Symbiotic Relationship

ObjectivesOur institution has developed an educational program in which first-year radiology residents teach first-year medical students during gross anatomy laboratory sessions. The purpose of this study is to assess the impact of this program on medical student knowledge and perceptions of radiology, and on resident attitudes toward teaching.Materials and MethodsFirst-year resident pairs taught small groups of medical students during weekly 15-minute interactive sessions, and were evaluated on teaching skills by senior residents. A survey about attitudes toward radiology and a knowledge quiz were sent to the medical students, and a survey about attitudes toward teaching was sent to the first-year radiology residents, both pre-course and post-course.ResultsStudents’ radiology knowledge significantly increased between the pre-course and post-course survey across all categories tested (P < 0.001). Additionally, there were significant improvements in terms of students’ confidence in radiologic anatomy skills, perceived importance of radiology for medical training, familiarity with the field of radiology, and perception that radiologists are friendly (P < 0.001). Radiology residents felt more confident in their teaching proficiency (P < 0.001) by the conclusion of the course.ConclusionsResident-led small-group teaching sessions during anatomy laboratory are mutually beneficial for medical students and radiology residents. The program also allows radiology residents to be exposed early on in residency to teaching and academic medicine.     

A longitudinal subspecialty experience for internal medicine residents

OBJECTIVE: Market and technology innovations have greatly changed the teaching and practice of medicine in the past 10 years. This report describes an innovation in the ambulatory education of internal medicine residents: a subspecialty continuity clinic. METHODS: A subspecialty continuity clinic was developed to improve the training of internal medicine residents in caring for complex ambulatory patients. The clinic structure is discussed from the perspective of patients, residents, and subspecialists. Logistical challenges and solutions are described. RESULTS: Two and one-half years into the program, feedback from residents and subspecialists has been positive. In-training examination scores are relatively higher in the involved specialties, and residents are managing illnesses they rarely saw in an outpatient setting before this program. CONCLUSION: This experience suggests that a subspecialty continuity clinic is worthwhile and practical in educating primary care residents.     

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.     

A categorical course curriculum for radiology residencies

A categorical course curriculum was introduced at Brooke Army Medical Center to focus the content of daily conferences and lectures according to radiology subspecialties. Our goal was to improve the traditional uncoordinated conferences and apprenticeship approach to resident learning. After one-year's experience, resident performance has improved, and residents and staff greatly prefer this style of teaching. The format has been adopted.     

Retention in service of recruits assigned to the army physical fitness test enhancement program in basic combat training

Recruits are assigned to the Army Physical Fitness Test Enhancement Program (APFTEP) if they are unable to pass the final Army physical fitness test at the end of basic combat training (BCT). The U.S. Army Medical Command tasked the U.S. Army Center for Health Promotion and Preventive Medicine to examine the retention in service of individuals completing this program. To accomplish this tasking, the following data were obtained: a list of APFTEP recruits at Fort Jackson, South Carolina between January 1999 and June 2001; a list of BCT graduates from the Army Training Requirements and Resources System; and a comparison group of non-APFTEP recruits matched 3 to 1 on the basis of age, gender, Army entry date (+/- 30 days), BCT location, and active Army status from the Army Medical Surveillance Activity. We found that the proportion of recruits who successfully completed the APFTEP and graduated from BCT (85% of men, 80% of women) was lower than documented graduation rates for all recruits (93% of men, 87% of women). Retention in service after 1 year was also lower for APFTEP recruits than for non-APFTEP recruits among both men (74% vs. 92%, p < 0.01) and women (63% vs. 84%, p < 0.01). Despite the lower BCT graduation success and retention in service for APFTEP recruits, the program does assist in retaining soldiers who would otherwise be discharged for failing the Army physical fitness test. Thus, the program may be a useful tool for limiting attrition.     

Army Medical Department Lessons Learned Program marks 25th anniversary

The year 2010 marked the 25th anniversary of the Center for Army Lessons Learned (CALL) as well as the Army Medical Department (AMEDD) Center and School's Lessons Learned Division. In the aftermath of Operation Urgent Fury in 1983, the Army recognized the need to create an organization whose sole purpose was to collect, review, and analyze lessons learned and created the CALL in 1985 at Fort Leavenworth, Kansas. The AMEDD followed suit and established the Medical Information System/AMEDD Lessons Learned office under the Directorate of Evaluation and Standardization to research and compile lessons learned as the AMEDD's point of contact for the CALL program. Over these past 25 years the AMEDD Center and School Lessons Learned program evolved and underwent organizational realignments, but the overall mission continues to promote changes either directly or indirectly in the AMEDD's Doctrine, Organizations, Training, Leader Development, Materiel, Personnel and Facilities domains and capabilities to provide combat health service support on the battlefield.