An Evaluation of the Medical Training Application Service as experienced by Defence Medical Service Medical Officers

OBJECTIVES: In 2007 Defence Medical Service (DMS) Medical Officers (MOs) applying to train within hospital based specialities were selected using the Medical Training Application Service (MTAS). Recognising the problems being reported about MTAS, the Defence Postgraduate Medical Deanery (DPMD) conducted an evaluation in order to assess whether DMS MOs had also experienced problems with the MTAS process. METHODS: DMS MO applicants were sent an email questionnaire, requesting both graded (Likert scale) and narrative responses, to gauge their opinion about the application service. The questionnaire covered the technical aspects of the process, the support available and the ability to demonstrate appropriate knowledge and skills. RESULTS: Only 42 responses (32%) were received. However, having considered areas of potential bias, the graded questionnaire results and thematic analysis of the narrative responses showed a clear consensus amongst the applicants in many areas. More than three quarters (78%) of DMS applicants criticised the opportunity to record their abilities and achievements, and 91% recorded that the questions were unable to differentiate between candidates. These views were mirrored in the narrative responses, with more than 130 statements covering five topic areas highlighting areas for improvement. Strong support was recorded for the work and advice provided by DPMD in support of the candidates. CONCLUSIONS: DMS MOs presented very negative opinions of their experiences of MTAS, highlighting their perceptions that they were unable to record their particular skills and experiences and that the questions were unable to discriminate between specialties. Particular difficulties were reported in presenting non-NHS experiences and skills.     

Organization of medical support U.S. Armed Forces

The article describes the structure of the medical service of the U.S. Army, presented by seven corps,principles of planning of capabilities of medical services and their management, personnel policy of the Medical Service, that focuses on the staffing of the medical service of the officers of the possibilities. Organization of medical care during the combat theater provided by 4 echelons is represented. The first echelon "battlefield-Battalion", the second--"brigade combat team", the third is the rear of the theater of operations, the fourth--stationary hospitals outside the theater of operations. The basic direction of reducing the medical costs of all the troops: military personnel, their families, civilian employees of the Ministry of Defence, members of their families, veterans of military service and their families.     

Perceptions and practices of medical practitioners towards ethics in medical practice – A study from coastal South India

Ethics is the application of values and moral rules to human activities. Medical practitioners are expected to not only have the skills and knowledge relevant to their field but also with the ethical and legal expectations that arise out of the standard practices. The present research was conducted with an aim to study the perceptions and practices of medical practitioners towards healthcare ethics in Indian scenario and to strengthen the evidence in the field of ethics training. A cross-sectional study was carried out in three associate hospitals of a Medical College in Southern India. Medical practitioners included in the study were administered a pre-tested, semi-structured questionnaire. Data was collected based on their responses on a 5 point Likert scale and analyzed using SPSS version 11.5. The majority of the participants mentioned that their perceptions of ethics in medical practice were based on information obtained during their undergraduate training, followed by experience at work. The medical practitioners had a positive perception on issues relating to consent in medical practice. However, the same degree of perception was not observed for issues related to confidentiality and their dealing with patients during emergency conditions. The majority of the medical practitioners agreed that ethical conduct is important to avoid legal and disciplinary actions. Among the medical practitioners, the responses of specialists and non-specialists were mostly similar with major differences of opinion for a few issues. A highest level of knowledge, awareness and understanding of ethics are expected in medical practice as it is the foundation of sound healthcare delivery system.     

Changes in the traditional Korean medical sector as a result of health related legislation

The objective of this study is to determine the effect of changes in the legal systems related to traditional Korean medicine (TKM) and their effect on health care in Korea. To cope with the many changes and challenges in the Korean health care system, health law has been used as an instrument to implement national health policies and support the developments of health systems. In particular, the Medical Service Act, amended in 1951, was the key factor for the coexistence of TKM and Western medicine in Korea. For systematizing the TKM, the roles of the National Health Insurance Act and the Medical Service Act were crucial. Considering Korea's experiences, health laws related to TKM were designed to regulate the health care system and have contributed to improve the quality and safety of TKM.     

Force generation--deployment-aligned MIACs

As the pressure mounts to supply more ground forces in Afghanistan, the Defence Medical Services (DMS) are directly supporting surge activity through ensuring the provision of deployable personnel. Delivery of this goal requires a change in the practice, focus and resources of the DMS. Identification, treatment and rehabilitation of injured service personnel is a priority in improving the pool of personnel available for deployment on Operations. This paper details the drivers, process and potential benefits of aligning Multi-Disciplinary Injury Assessment Clinic's activity with a unit's formation readiness cycle, to more appropriately and proactively manage injured service personnel to improve both the quality and quantity of Force Generation.     

Critical care delivery: the experience of a civilian terrorist attack

It has been recognised for some time that a terrorist incident was threatened in the U.K. and it has been noted previously in the JRAMC that the locations for terrorist atrocities are likely to be more diverse than previously experienced. July 7th 2005 witnessed the first terrorist suicide bombing on the U.K. mainland, targeting the public transport system in London. These attacks were unprecedented in both scale and intensity but they were anticipated in London. However there were clear difficulties, relating to multiple sites, their location underground and early problems with communication (2). This article highlights some of the experiences and learning points of the Intensive Care Medicine Service at the Royal London Hospital (RLH) in the wake of the July 7th bombings. The RLH was the single biggest receiver of casualties (195); seven of whom were admitted to the Intensive Care Unit. The Defence Medical Services have tri-service representation (both regular and reserve) at the RLH in Emergency Medicine and Pre-hospital Care, Surgical Services and Intensive Care Medicine.     

Prospects for use of computers in the Air Force medical service

The article describes the questions for the formation of the Automated Control Sub-system of the AF Medical service (ACS AF MS) and shows basic trends towards its creation. The authors take into account specific peculiarities of the Air Force activities, as well as the modern standards of automated systems. The ACS AF MS must be integrated to the Joint Automated Control System of the Armed Forces Medical Service. The article gives the main functions of this sub-system, its information and program procedure, computer technique fitting out process for command installations. The main tasks of the whole chain of command of AF Medical service were also analysed.     

Humanitarian service and recruitment and retention of uniformed services medical personnel

A recent voluntary survey of 410 personnel from the U.S. Armed Forces Medical Departments and the Public Health Service indicated that humanitarian service experience has positive effects on recruitment and retention: 48% of respondents indicated that the opportunity to provide humanitarian service was a factor in their decision to join a uniformed service and 62% indicated that humanitarian service opportunities positively influenced their decision to remain in uniform. Humanitarian service requirements were a disincentive to remain in uniform for 25%. Pending further study, these preliminary implications can be applied to personnel policies and programs to recruit and retain uniformed health care professionals.     

The general practitioner trainer exchange as an innovative approach to peer review

There are various formal peer review schemes to assess the quality of primary care practices and several special approval and re-approval programmes exist for General Practitioner (GP) trainers and primary care training practices. The Defence Postgraduate Medical Deanery (DPMD) has its own General Practice Education Committee (GPEC) approval and re-approval programme. Part of this programme is related to the New Membership of the Royal College of Practitioners (nMRCGP). There is limited published information related to GP trainer exchanges as a means of peer review and as such as preparation for GPEC in the British Forces. This paper provides a review of a GP trainer exchange involving a visit of a GP trainer from British Forces Germany (BFG) to the practices of Dhekelia and Ay Nik on Cyprus in January 2010. It concludes that a GP trainer exchange is cost neutral and may be a valuable experience for both the host and visiting GP trainer, the local GP trainers' group, the practice teams and above all, for the GP trainee.     

The Defence Medical Library Service and military medicine

The Defence Medical Library Service (DMLS) supports the clinical practice and career development of military health professionals across the world. Clinical governance and the need for medical knowledge to be evidence-based means the DMLS has a central role to play in support of defence medicine. The DMLS is important for enabling health professionals to make sense of the evidence-based pyramid and the hierarchy of medical knowledge. The Royal Centre for Defence Medicine (RCDM) in Birmingham is recognised as an international centre of excellence. The information, knowledge and research requirements of the RCDM will provide opportunities for the DMLS to support and engage with the academic community.     

Joint service training for medical readiness

Medical Readiness Training is of major importance in preparing to meet the challenge of medical care during wartime and national emergencies or disasters. As an alternative to simulated casualty training, the U.S. Public Health Service and the U.S. Army joined forces to provide "real world" medical care for troops during training. Although simulated training provides insight into casualty and trauma medicine, it is felt that many aspects of real medical care are often ignored or taken for granted. Providing medical care under austere field conditions provides a realistic environment and presents situations that can not be evaluated by simulated training.     

Medical Readiness Education and Training Exercises by United States Army medical personnel in Kenya

Medical Readiness Education and Training Exercises (MEDRETEs) enable United States military medical personnel to sharpen their skills in diagnosis and treatment of common illnesses in rural third world populations. We report our experiences on MEDRETEs conducted during recent exercises in the Republic of Kenya involving United States and Kenyan forces. Respiratory, musculoskeletal, and eyes, ears, nose, and throat conditions comprised 55% of cases. In 73% of cases, the final diagnosis and the chief complaint were in the same diagnostic category. In asymptomatic patients, 17% had physical findings suggestive of significant disease. Anecdotal experiences demonstrated the importance of the local environment and social customs in the genesis of certain illnesses and symptoms.     

On medical screening of civilian candidates for cosmonauts by exposure to the head-to-pelvis acceleration profiles]

The subject of analysis was the data on +3 and +5 Gz tolerance of 130 civilian non-pilot applicants for cosmonauts (men and women, aged 23 to 55) gathered over the past 30 years. Length of the centrifuge arm was 7.25 meters and the total number of primary centrifuge runs was 309. For nearly every second of the applicants (46.7%) acceleration at +5 Gz was an ordeal causing distinct vascular or coronary decompensation. Thus, 29.7% exhibited various combinations of brief visual disturbances, tachycardia, tachypnea, and systolic arterial pressure in the shoulders; in 17%, visual disturbances and/or their precursors were combined with exaggerated cardio-vascular functional parameters, arrhythmia, and serious vegetative disorders. Most of those who had failed to endure the first centrifugation were unable to improve G tolerance during next runs; indeed, they showed negative G-tolerance dynamics. G intolerance grew in significance or was exacerbated by new disorders and their combinations. These results testify against exposure of non-pilot applicants for cosmonauts to +5 G, during the primary medical screening.     

Health risk management matrix -- a medical planning tool

This paper describes the Health Risk Management Matrix. This is a planning tool, developed at the Defence Medical Services Training Centre, to teach students how to develop and write a Medical Force Protection Plan. The tool covers 5 stages: hazard identification, identification of the population at risk, risk assessment, control measures (divided into information training and policy, medical counter-measures, and treatment) and monitoring activities. The paper provides a worked example using malaria as a hazard.     

The characteristics of the staffing of the 40th Army with medical service officers]

The officer procurement for the Medical Service of the 40th Army had some specific features which were predetermined by the character of an active service in Afghanistan. The article describes the screening process and training system of army physicians who were assigned to the 40-th Army. The authors stress the fact that even in peaceful time it is necessary to constitute a reserve of medical specialists for operational activation of units and establishments.     

An Internet-based approach to advising radiology residency applicants

RATIONALE AND OBJECTIVES: The authors created a computerized database Web site enabling radiology residency applicants to utilize the experience of recent graduates from their school in maximizing the effectiveness of the residency advisory process. Objectives of this database Web site are (a) to provide general information regarding radiology as a specialty; (b) to allow students to gauge their chances of matching based on the experience of recent graduates from their school; (c) to provide advisors with a faster, more accurate assessment of a student's matching potential; and (d) to decrease the number of residency applications submitted through the Electronic Residency Application Service. MATERIALS AND METHODS: Thirty graduates from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (UMDNJ-RWJMS) from 1999 to 2001 who applied to radiology residency were successfully contacted by telephone or e-mail. Data were gathered regarding their academic performance and activities, residency application, and final match outcome and were entered into a spreadsheet for analysis. This information, along with student-to-student advice regarding the match, was also entered into an interactive Web site for use by UMDNJ-RWJMS medical students, radiology advisors, and deans. RESULTS: The Web site model was applied to radiology residency applicants from UMDNJ-RWJMS. This database Web site provided general radiology information and allowed students and advisors to gauge their chances of matching based on the experience of past applicants from their school. CONCLUSION: This database Web site can provide a realistic comparison of a student's academics with those of previous applicants. Yearly analysis of school-specific data can help advisors follow applicant trends and modify their own advice. The database Web site can be easily duplicated and, if applied to other schools and specialties, could potentially benefit students nationally.     

A Delphi study to validate competencies required of Air Force Medical Surgical (46N3) nurses in mobilized environments

The objectives of this study were to develop competencies for wartime and operations other than war for 46N3 Medical/Surgical Air Force nurses and to validate those competencies among a group of experts in the field. The sample consisted of 109 nurses with mobilization experiences. A Delphi consensus technique was used to validate both the importance of competencies required in a mobilization environment and to determine the level at which those competencies should be practiced. A web-based questionnaire was used to collect responses during three rounds of data collection. At the end of round 3, 83% of the importance statements achieved consensus whereas 67% of the level of practice statements achieved consensus. Those importance items validated were traditional assessment and interventions skills that represented noncontroversial practices. Those items not validated were either controversial or perceived as not pertinent in an austere mobilization environment.     

The Managed Military Health System for Force Generation-project

In summary, the Managed Military Health System for Force Generation will: Allow better understanding of health issues and illness patterns in the Armed Forces. Ensure optimum health and medical fitness of service personnel throughout their military careers by: Promoting health. Protecting health. Providing timely, properly co-ordinated, healthcare from military and civilian providers. In conjunction with DMICP, provide a seamless system of patient care and administration involving all healthcare providers. Enable all military personnel to make good health decisions. Ensure a smooth transition to NHS care on completion of Service. Improve the morale of those in the Defence Medical Services through working in a high quality organisation.     

"Medical bookmarks--a virtual medical library"

How does one go about finding specific medical information on the internet? Medical Bookmarks is the name of an easily remembered website (http://www.medical-bookmarks.org.uk) set up as a virtual library by the librarian at the Royal Hospital Haslar. It is specifically designed to give easy access to all the important medical sites on the internet, doing away with the need to remember the exact addresses of other websites, and as such it is relevant to civilian and military doctors in both industrialised and developing nations. It also interlinks sites of particular relevance to military doctors, including military medical sites and a NATO Defence Medical Services site.