The American College of Physicians' Resident Abstract Competition: success of U.S. military trainees

Research is a central aspect of internal medicine (IM) training, and accreditation organizations require that residency programs show that their residents participate in scholarly activity. To better understand the research productivity and the quality of research conducted by military IM trainees, we reviewed the records of the American College of Physicians' Resident Abstract Competition from 1995 to 1997. This national competition is prestigious, blindly judged, and highly selective. We found that although military residents account for less than 2% of all U.S. and Canadian IM trainees, they author more than 11% of the abstracts selected for presentation (p < 0.001). We conclude that military IM residents are disproportionately represented compared with their civilian peers in an objective, national competitive forum. This is consistent with the higher scores on in-service examinations and higher board-certification pass rates for military IM residents.     

Patterns of accreditation performance in army family practice residencies.

Army leadership emphasizes training in all segments of its population, including family medicine. Standards for medical professional training, however, are provided by a civilian agency, the Accreditation Council for Graduate Medical Education (ACGME). In order to search for performance patterns, the authors reviewed the last two accreditation documents of each Army Family Practice residency. After independently scoring the documents against the written standards, the scores were compared with the actual written findings from the ACGME Residency Review Committee. The authors discuss patterns and trends resulting from this analysis, and recommend areas for future growth in the military training of family physicians.     

Residency training data: What do the numbers tell us?

The Accreditation Council for Graduate Medical Education (ACGME) regularly collects data on accredited residency programs that are useful for purposes of comparing resident demographics, turnover rates of program directors, and trends in program numbers and accreditation status. These data show that there are relatively fewer women in radiology residencies compared with other nonsurgical residencies. Women make up only 25% of core radiology residents. Further investigation is warranted to determine why this is so, because it will likely affect the ability to recruit female radiologists into leadership positions. Considering ACGME-accredited programs, those radiology subspecialties with the highest percentages of female trainees are pediatric radiology (45%) and nuclear radiology (44%). The turnover rate of radiology program directors is high (19%) relative to other specialties (14% on average), and this is being addressed in part by a change in the radiology program requirements. Other factors associated with this high turnover rate may also need to be addressed.     

Family practice career attrition, 1969 to 1993: a comparison of 336 civilian and military graduates of one medical school

Instability of specialty choice and career after initial residency entry will affect health personnel projections. Military physicians may differ from civilian physicians in their specialty choice behaviors during their careers. A cohort of 336 graduates who chose family medicine residency training was identified from the graduating classes of 1969 through 1993 at a large private medical school. Current specialty identification was determined, and attrition from family medicine was computed. As of 1997, 275 graduates (82%) were still in family medicine careers, defined by American Academy of Family Physicians membership or current American Board of Family Practice certification. Of graduates who entered military programs, 22 of 77 (28%) had left family medicine careers; 39 of 259 (15%) of the graduates who entered civilian programs had left. This difference was statistically significant (p = 0.007). Family medicine career retention is lower for males in military programs compared with males in civilian programs or females in military programs.     

Future trends in military graduate medical education

While on the surface the future of military GME appears uncertain, closer inspection demonstrates opportunities to achieve excellence in education. In many cases, programs will emerge with larger and more diverse faculty and increased collaboration with local institutions. On an individual level, military faculty will endeavor to blend teaching, research, and clinical excellence with unique operational opportunities and challenging assignments in and out of GME. The flexible and resourceful military physician can still count on an exciting and productive academic career.     

General aviation crashes involving military personnel as pilots.

BACKGROUND: Injuries sustained in off-duty activities are a major cause of mortality and morbidity among military personnel. Reducing these off-duty fatalities is a continuing priority of the military. METHODS: General aviation crashes recorded by the National Transportation Safety Board between 1983 and 1998 were analyzed for military pilots (n = 205) and other military personnel (n = 185), and compared with all other general aviation crashes (n = 32,807) to identify differences in the crash circumstances and sustained injury severities. RESULTS: During the 16-yr study period, a total of 45 military pilots and 52 other military personnel were fatally injured while flying general aviation flights. Military pilots who were involved in general aviation crashes were more likely to have advanced licenses and higher total flight times when compared with other military personnel and civilian pilots (p < 0.05). Among the three groups of pilots, other military personnel had the least flying time and the largest percentage of student/private licenses. Military personnel had significantly less time in type in the 90-d and 30-d periods preceding the crash compared with civilians (p < 0.05). Shoulder restraint usage was associated with less severe injuries for all groups. We estimate that general aviation deaths have cost the military at least $405 million since 1983. CONCLUSIONS: General aviation crashes are a costly source of mortality and morbidity for military personnel, particularly military pilots. Interventions aimed at improving safety of military personnel in the general aviation setting warrant special consideration.     

Institutional requirements

The residency review committee's program requirements guide the development of the details of each ACGME-accredited residency program. The sponsoring institution, however, has the overall responsibility, through the institutional requirements, to ensure that all facets of high-quality graduate medical education are available for all residents in these programs. It is imperative that there be close interaction between residency program directors, departmental education coordinators, and the GME officials of the institution, especially as ACGME regulations have become more complex.     

Sleep disturbance during military deployment

This preliminary investigation evaluated symptoms of sleep disturbance and insomnia in a group of 156 deployed military personnel. A 21-item Military Deployment Survey of Sleep was administered to provide self-reported estimates of a variety of sleep parameters. The results indicated that 74% of participants rated their quality of sleep as significantly worse in the deployed environment, 40% had a sleep efficiency of < 85%, and 42% had a sleep onset latency of > 30 minutes. Night-shift workers had significantly worse sleep efficiency and more problems getting to sleep and staying asleep as compared to day-shift workers. The results of the study indicate the need for programs to help deployed military members get more and better sleep.     

Comparison of discharge diagnoses and inpatient procedures between military and civilian health care systems.

BACKGROUND: Our goal was to compare the demographics and discharge diagnoses between civilian and military health care systems. METHODS: One year (1997) of data from the Retrospective Case Mix Adjustment System from the Military Health Services System were compared with the most recent (1994) civilian National Hospital Discharge Survey data. RESULTS: Military and civilian inpatient age (52.5 and 52.9 years), gender (54% and 59% female), and ethnic distributions (military: 71% white, 16% African American, 3% Asian American, 10% other; civilian: 65% white, 12% African American, 2.6% Asian American, 1.2% Native American, 18% unclassified) were similar. There were similar rank orderings of diagnosis-related groupings (Spearman's rank correlation = 0.72) and procedures performed during hospitalization (Spearman's rho = 0.74), although the military inpatients yielded a higher proportion associated with pregnancy and strenuous activity (traumatic joint disorders and hernias) than their civilian counterparts. CONCLUSION: The practice content of military and civilian inpatients appear to be more similar than different.     

Critique of the transitional year internship and its relationship to radiology residency

RATIONALE AND OBJECTIVES: The purpose of the study is to determine if transitional year program (TYP) requirements foster realization of standards of excellence and clinical relevance for future radiologists and to explore demographic and economic factors pertinent to TYPs. MATERIALS AND METHODS: A list of accredited TYPs were obtained from the American Medical Association's Graduate Medical Education (ACGME) Directory 2006-2007. Specialty distribution of TYP graduates was examined from statistics provided by the ACGME, and data from the 2007 Main Residency Match was analyzed. Data derived from a concurrent survey of the perception of the value of internship sent to all current radiology residents and fellows was assessed. The institutional costs of employing TYP interns versus physician assistants were also calculated. RESULTS: Forty-one of the 125 TYPs lack residencies in internal medicine (IM), general surgery (GS), or both, and approximately two-third of these lack full medical school affiliation. The interns who will graduate from these 41 programs account for 103 of the 1,128 radiology residents in their post-graduate year 2. Despite the longest elective time offered in TYPs compared to conventional preliminary programs, current radiology trainees who had participated in preliminary IM or GS internships were more satisfied compared to trainees completing TYPs. CONCLUSIONS: The requirements of the transitional internship and compliance with them need to be carefully assessed to determine their efficacy. Despite the strong economic impetus for hiring TYP interns, the availability of open slots in existing preliminary programs in IM and GS, coupled with radiology residents' greater level of satisfaction with traditional over transitional internships, makes the existence of TYPs less compelling.     

Military internal medicine resident performance on the American Board of Internal Medicine Certifying Examination

The mission of military graduate medical education in internal medicine is to produce high-quality military internists prepared to practice in military environments. Board certification in internal medicine is an important outcome of internal medicine residency training. The American Board of Internal Medicine Certifying Examination (ABIMCE) first-taker pass rate of the graduates of an internal medicine residency program is a key measure of the quality of the program. We compared the ABIMCE first-taker pass rates for military and civilian internal medicine residency program graduates. Military internal medicine residency graduates had higher first-taker pass rates than their civilian counterparts. This is likely a reflection of the high-quality residents and the faculty at military programs. These results support the notion that military internal medicine residency programs continue to fulfill their mission of training high-quality internists.     

Patients, diagnoses, and procedures in a military internal medicine clinic: comparison with civilian practices

BACKGROUND: Our goal was to compare the demographic features, diagnoses, and procedures in civilian and military ambulatory internal medicine clinics. METHODS: One year (September 1996 to August 1997) of data from the Ambulatory Data System of the Adult Primary Care Clinic at Madigan Army Medical Center was extracted and compared with the most recent (1995) National Ambulatory Medical Care Survey. RESULTS: A total of 41,374 Madigan patient encounters were compared with civilian data from the National Ambulatory Medical Care Survey. The age distribution was similar, with military patients averaging 53.5 years of age and civilian patients averaging 54.5 years. Military patients were more likely to be female (71 vs. 60%) and were more ethnically diverse (military: 68% white, 17% African American, 7% Hispanic, 7% Asian American, and 1% Native American; civilian: 78% white, 10% African American, 6% Hispanic, 5.9% Asian American, and 0.3% Native American). There were similar rank orderings of the top 189 diagnostic groups seen in each setting (Spearman's rho = 0.87). There were also no differences in the type or rank order of procedures performed between military and civilian internists (p = 0.53). CONCLUSION: The practice content of military and civilian practices appears to be more similar than different.     

Military Medicine的知识图谱分析

目的：剖析Military Medicine的2966条文献记录,宏观把握美军军事医学发展态势。方法：基于Java平台的知识图谱分析软件CiteSpaceⅡ。结果：美国军事医学与普通医学联系密切,联系对象和重点明确;美军各军事医学研究机构的分工较为明确,任务有一定交叉重叠但不特别明显;美国一些国家级机构和军队机构以及部分专家是美国发展军事医学的坚实基础;军事医学关键文献可被直观展示;美军的军事医学关注焦点主要涉及战时卫勤保障、战后及退役军人的健康维护、口腔卫生保障和军人健康促进。结论：知识图谱分析方法在军事医学领域的应用具有新颖性、必要性和适用性。     

An innovative medical civil-military operation training program

The San Antonio Military Pediatric Center has developed an innovative humanitarian civic assistance (HCA) program. Many medical HCA programs focus on short-term medical interventions and provide transient benefit. To have a more lasting impact, this program focuses on public health surveillance. U.S. military medics conduct random household nutritional surveys and train in austere settings and on rounds in Honduran hospitals. Since 2001, >200 military medics have been trained in population assessment, primary medical care in developing nations, and other skills critical for medical civil-military operations. All activities are coordinated with the host nation. Public health data are collected and reported to Honduran public health leaders, the U.S. Agency for International Development, and nongovernmental organizations, to assist with program and policy development. This innovative project is a potential model to improve both military training and host nation benefit from HCA programs.     

Description of risk and resilience factors among military medical personnel before deployment to Iraq

Military medical personnel preparing for deployment to Iraq (N = 328) participated in a survey concerning predeployment risk and resilience factors. Participants reported exposure to an average of 2.5 potentially traumatic events before deployment and 76% (n = 229) reported at least two current concerns about predeployment stressors. Military personnel also endorsed a series of positive appraisals of the military, the mission, and their unit. Fairly low levels of post-traumatic stress disorder symptoms before deployment were reported and positive affect was significantly higher than reported negative affect. Post-traumatic stress disorder symptoms that were present before deployment were most strongly associated with risk factors, whereas positive affect was most strongly associated with resilience factors. Predeployment negative affect was associated with a combination of risk and resilience factors. These findings have implications for possible interventions and preparation of medical personnel before military deployment. A better understanding of the factors related to risk and resilience in military medical personnel will allow for improved screening, educational, training, and clinical programs aimed at increasing resilience before military deployments.     

军人与非军人腰椎间盘摘除术后的疗效对比分析

目的比较军人与非军人腰椎间盘摘除术后的疗效。方法将我院收治并确诊为腰椎间盘突出症的87例军人(45例野战部队军人,42例机关军人)和87例非军人分成军人与非军人两组,均在持续硬膜外麻醉下行常规腰椎间盘摘除术。术后均随访6个月,记录所有患者个人信息、随访期末工作能力恢复情况、术后1、3、6个月疼痛VAS评分、Roland-Morris失能量表、对手术效果是否满意,并进行组间统计学分析。结果术后VAS评分显示所有患者术后疼痛显著缓解,但军人组疼痛缓解程度较差,与非军人组比较有统计学差异(P<0.05),Roland-Morris评分显示术后所有患者生活自理能力显著提高,但军人组术后恢复情况较非军人组差,两组比较,有统计学差异(P<0.05)。随访期末军人组恢复原有工作强度人数低于非军人组(P<0.05),而野战部队军人恢复原有工作强度人数又低于机关工作的军人(P<0.05);军人组术后残留腰痛症状比例较非军人高,两组比较有统计学差异(P<0.05);术后军人组对手术效果满意率为79.3%,显著低于非军人组的90.8%(P<0.05)。结论相对于非军人,军人椎间盘摘除术后整体效果较差,可能与军人职业的特殊性有关,因此,在军事训练中加强腰椎疾患的预防和健康教育尤为重要。     

Evaluation of Pediatric Radiology Fellowship Website Content in USA and Canada

PurposeProspective radiology fellows often rely on the internet to obtain valuable information regarding the application process as well as the unique qualities and aspects of different fellowship programs. The aim of this study was to analyze the content of Accreditation Council for Graduate Medical Education (ACGME) Pediatric Radiology Fellowship websites within the USA and Canadian Accredited Pediatric Radiology Fellowship program websites.MethodsAll active ACGME Pediatric Radiology fellowship websites as of October 2018 were evaluated using 26 criteria in the following domains: application process, recruitment, program structure, education, research, clinical care, and incentives. Fellowships without websites were excluded from the study. Canadian programs were compiled from a list obtained as of October 2018 from the Canadian Association of Radiologists fellowship directory. Each fellowship program was evaluated using the same 26 criteria as the US programs.Results45 active ACGME Pediatric Radiology fellowship programs and 9 Canadian programs were identified. 43 of the US fellowships (96%), and 8 of the Canadian fellowships (89%) had dedicated fellowship websites available for analysis. For US data, websites on average contained 8 out of the 26 data points (31%). Whereas, in Canada, websites on average contained 11 out of the 26 data points (41%).ConclusionMost fellowship websites demonstrate several information deficiencies. This presents an actionable opportunity for individual programs to better inform trainees, promote Pediatric Radiology, and attract the highest quality applicants.     

Factors associated with heavy alcohol consumption in the U.K. armed forces: data from a health survey of Gulf, Bosnia, and era veterans

BACKGROUND: Little is known about the patterns of alcohol use in the U.K. Armed Forces or the factors associated with heavy drinking. METHODS: Analysis of existing data from the King's Military Cohort was conducted of a large, randomly selected cohort of service personnel. The original sample consisted of 8,195 service personnel who served in the U.K. Armed Forces in 1991: a third deployed to the Gulf (1990-1991), a third deployed to Bosnia (1992-1997), and the final third, an "Era" comparison group, in the Armed Forces in 1991 but not deployed. For the purposes of this study, female serving personnel were excluded. The study used a "case-control" study design nested within the above cohort; "heavy drinkers" (those who drank >30 units/week) were compared with "light drinkers" (those who drank <21 units a week). RESULTS: Heavy drinking was associated with current military service and being unmarried or separated/divorced. Heavy drinking was more common in younger personnel who had deployed to Bosnia. Those who drank heavily were also more likely to smoke; heavy drinking was associated with poorer subjective physical and mental health. CONCLUSIONS: Certain subgroups of the Armed Forces appear to be more at risk and it may be possible to target resources to such individuals to improve detection and allow prompt treatment.     

Risk factors for foot blisters during road marching: tobacco use, ethnicity, foot type, previous illness, and other factors

Three hundred thirty-nine freshmen participating in cadet basic training at the U.S. Military Academy completed a questionnaire that asked them about their previous military experience, gender, ethnicity, injuries and illness experienced in the last 12 months, foot type, cigarette smoking habits, smokeless tobacco use, alcohol consumption, and sleep habits. They then performed a 21-km road march in about 6.5 hours. Their feet were examined for blisters before and after the march. Univariate analysis showed that risk factors for foot blisters included ethnicity (blacks at lower risk than others), a sickness in the last 12 months, no previous active duty military experience, use of smokeless tobacco, and flat feet (pes planus). Logistic regression indicated that all of these were independent blister risk factors with the exception of no previous active duty military experience.