The Relationship between the Military Medical Officer and Commanding Officer: Implications for Education and Training.

INTRODUCTION: A successful working relationship between the Military Medical Officer (MMO) and Commanding Officer (CO) is critical for mission success. However, there is a gap in the professional literature outlining evidence-based practices for teaching early career MMOs how to strategically develop this relationship. The purpose of this study, therefore, was to explore our participants' perceptions of how MMOs can foster a positive and productive working relationship with the CO. MATERIALS AND METHODS: We leveraged interpretive phenomenological design to interview 16 seasoned military physicians with extensive operational experience. We transcribed and coded each interview. Our research team determined how to organize these codes into major categories, which served as our study's themes. RESULTS: The participants described three key elements for developing a good working relationship between the CO and MMO: (1) mission-focused communication; (2) active and physical presence; and (3) expert/advisor role fulfillment. The MMO should communicate with the CO in an understandable and mission-focused manner. The MMO should likewise be present within day-to-day operations and should establish their officership during mission planning. The MMO should fulfill their role as a subject matter expert, yet advisor, to the CO. CONCLUSIONS: Communication, presence, and role fulfillment are essential elements for optimizing the MMO-CO working relationship. Learning these roles during medical school may enhance early career physicians' mission readiness.

Civilian and Military Medical School Graduates' Readiness for Deployment: Areas of Strength and Opportunities for Growth.

INTRODUCTION: Past research has examined civilian and military medical schools' preparation of physicians for their first deployment. Most recently, our research team conducted a large-scale survey comparing physicians' perceptions of their readiness for their first deployment. Our results revealed that military medical school graduates felt significantly more prepared for deployment by medical school than civilian medical school graduates. In order to further investigate these results and deepen our understanding of the two pathways' preparation of military physicians, this study analyzed the open-ended responses in the survey using a qualitative research design. MATERIALS AND METHODS: We used a descriptive phenomenological design to analyze 451 participants' open-ended responses on the survey. After becoming familiar with the data, we coded the participants' responses for meaningful statements. We organized these codes into major categories, which became the themes of our study. Finally, we labeled each of these themes to reflect the participants' perceptions of how medical school prepared them for deployment. RESULTS: Four themes emerged from our data analysis: (1) Civilian medical school equipped graduates with soft skills and medical knowledge for their first deployment; (2) Civilian medical school may not have adequately prepared graduates to practice medicine in an austere environment to include the officership challenges of deployment; (3) Military medical school prepared graduates to navigate the medical practice and operational aspects of their first deployment; and (4) Military medical school may not have adequately prepared graduates for the realism of their first deployment. CONCLUSIONS: Our study provided insight into the strengths and areas for growth in each medical school pathway for military medical officers. These results may be used to enhance military medical training regardless of accession pathway and increase the readiness of military physicians for future large-scale conflicts.

Gender and Mentorship in Military Medicine: A Survey Study.

INTRODUCTION: Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine. MATERIALS AND METHODS: We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions. RESULTS: The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($\chi _{\left( 1 \right)}^2$ = 12.92, P < .001, Cramer's V = 0.254). CONCLUSIONS: While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.

The impact of simulation-based training on medical students' whole blood transfusion abilities.

BACKGROUND: Whole blood transfusion has been found to increase the likelihood of patient survival within both military and civilian medicine contexts. However, no whole blood transfusion training curriculum currently exists within undergraduate or graduate medical education in the United States. The purpose of our study was to: (1) determine the impact of simulation-based training on medical students' abilities to conduct whole blood transfusions; and (2) determine the impact of simulation-based training on medical students' confidence in conducting whole blood transfusions. STUDY DESIGN AND METHODS: We assessed 157 third-year military medical students' ability to conduct whole blood transfusion before and after Operation Gunpowder, a 2-day high-fidelity prolonged casualty care simulation. We conducted a paired samples t-test to compare the students' pre- and post-simulation performance scores as well as self-reported confidence and stress ratings. RESULTS: There was a significant difference in students' scores at the beginning of the course (M = 20.469, SD 6.40675) compared to their scores at the end of the course (M = 30.361, SD = 2.10053); t(155) = -18.833, p < .001. The effect size for this analysis (d = 6.56) was large. There was a significant difference (p < .001) between the pre- and post-ratings for all self-reported confidence and stress survey items. DISCUSSION: Our results suggest that simulation-based training is an effective means of training medical students to conduct whole blood transfusiontraining in a limited resource simulated environment where blood inventories may be limited.

Serious bacterial infection risk in recently immunized febrile infants in the emergency department.

STUDY OBJECTIVES: Fever following immunizations is a common presenting chiefcomplaint among infants. The 2021 American Academy of Pediatrics (AAP) febrile infant clinical practice guidelines exclude recently immunized (RI) infants. This is a challenge for clinicians in the management of the febrile RI young infant. The objective of this study was to assess the prevalence of SBI in RI febrile young infants between 6 and 12 weeks of age. METHODS: This was a retrospective chart review of infants 6-12 weeks who presented with a fever ≥38 °C to two U.S. military academic Emergency Departments over a four-year period. Infants were considered recently immunized (RI) if they had received immunizations in the preceding 72 h prior to evaluation and not recently immunized (NRI) if they had not received immunizations during this time period. The primary outcome was prevalence of serious bacterial infection (SBI) further delineated into invasive-bacterial infection (IBI) and non-invasive bacterial infection (non-IBI) based on culture and/or radiograph reports. RESULTS: Of the 508 febrile infants identified, 114 had received recent immunizations in the preceding 72 h. The overall prevalence of SBI was 11.4% (95% CI = 8.9-14.6) in our study population. The prevalence of SBI in NRI infants was 13.7% (95% CI = 10.6-17.6) compared to 3.5% (95% CI = 1.1-9.3) in RI infants. The relative risk of SBI in the setting of recent immunizations was 0.3 (95% CI = 0.1-0.7). There were no cases of invasive-bacterial infections (IBI) in the RI group with all but one of the SBI being urinary tract infections (UTI). The single non-UTI was a case of pneumonia in an infant who presented with respiratory symptoms within 24 h of immunizations. CONCLUSION: The risk of IBI (meningitis or bacteremia) in RI infants aged 6 to 12 weeks is low. Non-IBI within the first 24 h following immunization was significantly lower than in febrile NRI infants. UTIs remain a risk in the RI population and investigation with urinalysis and urine culture should be encouraged. Shared decision making with families guide a less invasive approach to the care of these children. Future research utilizing a large prospective multi-center data registry would aid in further defining the risk of both IBI and non-IBI among RI infants.

Peer Teachers' Professional Identity Development During a Prehospital Simulation: A Grounded Theory Study.

INTRODUCTION: Peer teachers have been found to be effective instructors during simulation-based education. However, there is a lack of research regarding their professional identity development throughout the course of the teaching activity. The purpose of this qualitative study, therefore, was to develop a framework to illustrate how peer teachers develop as educators during a prehospital simulation. METHODS: The participants in our study were 9 second-year medical students serving as peer teachers during a multiday prehospital simulation. We selected the grounded theory tradition of qualitative research to investigate the peer teachers' professional identity development. Our research team interviewed each participant twice during the simulation. We then used open and axial coding to analyze the interview data. We organized these codes into categories and determined connections between each category to construct our grounded theory framework. RESULTS: This framework described how the peer teachers progressed through 4 stages: 1) eager excitement, 2) grounded by challenges, 3) overcoming challenges, and 4) professional identity formation. CONCLUSION: Our results revealed that simulation-based education can serve as valuable learning environment not only for medical students, but also for peer teachers. Understanding their progressive development during the simulation will help medical educators focus on maximizing the peer teachers' growth and development during simulation.

A Comparison of Uniformed Services University and Health Professions Scholarship Program Graduates' First Deployment Readiness.

INTRODUCTION: Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP). MATERIALS AND METHODS: We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian). RESULTS: The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P < .001); ability to navigate the operational environment (3.59 vs. 2.99; P < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P = .004); leading a health care team (3.94 vs. 3.43; P = .001); preparation by a medical school (3.78 vs. 2.52; P < .001); and overall readiness compared to peers (4.20 vs. 3.49; P < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P = .683); clinical preparation (3.94 vs. 3.76; P = .202); and success of first deployment (3.87 vs. 3.91; P = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d = 1.02). CONCLUSIONS: While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness.

The Impact of Operation Bushmaster on Medical Student Decision-making in a High-Stress, Operational Environment.

INTRODUCTION: Operation Bushmaster is a high-fidelity military medical field practicum for fourth-year medical students at the Uniformed Services University. During Operation Bushmaster, students treat live-actor and mannequin-based simulated patients in wartime scenarios throughout the five-day practicum. This study explored the impact of participating in Operation Bushmaster on students' decision-making in a high-stress, operational environment, a crucial aspect of their future role as military medical officers. MATERIALS AND METHODS: A panel of emergency medicine physician experts used a modified Delphi technique to develop a rubric to evaluate the participants' decision-making abilities under stress. The participants' decision-making was assessed before and after participating in either Operation Bushmaster (control group) or completing asynchronous coursework (experimental group). A paired-samples t-test was conducted to detect any differences between the means of the participants' pre- and posttest scores. This study was approved by the Institutional Review Board at Uniformed Services University #21-13079. RESULTS: A significant difference was detected in the pre- and posttest scores of students who attended Operation Bushmaster (P < .001), while there was no significant difference in the pre- and posttest scores of students who completed online, asynchronous coursework (P = .554). CONCLUSION: Participating in Operation Bushmaster significantly improved the control group participants' medical decision-making under stress. The results of this study confirm the effectiveness of high-fidelity simulation-based education for teaching decision-making skills to military medical students.

Medical Students' Integration of Formative Feedback During Simulation: A Grounded Theory Study.

INTRODUCTION: Formative feedback is critical for trainees' growth and development. However, there is a gap in the professional literature regarding the ways in which formative feedback affects student performance during simulation. This grounded theory study addresses this gap by exploring the ways in which medical students received and integrated ongoing formative feedback throughout a multiday, high-fidelity military medical simulation, Operation Bushmaster. MATERIALS AND METHODS: Our research team interviewed 18 fourth-year medical students in order to investigate how they processed formative feedback during the simulation. Guided by the grounded theory tradition of qualitative research, our research team used open coding and axial coding to categorize the data. We then used selective coding to determine the casual relationships between each of the categories that emerged from the data. These relationships determined our grounded theory framework. RESULTS: Four phases emerged from the data and provided a framework to delineate the process in which students received and integrated formative feedback throughout the simulation: (1) ability to self-assess, (2) self-efficacy, (3) leadership and teamwork, and (4) appreciation of feedback for personal and professional growth. The participants first focused on feedback related to their individual performance but then shifted to a teamwork and leadership mindset. Once they adapted this new mindset, they began to intentionally provide feedback to their peers, increasing their team's performance. At the end of the simulation, the participants recognized the benefits of formative feedback and peer feedback for ongoing professional development throughout their careers, signifying a growth mindset. CONCLUSIONS: This grounded theory study provided a framework for determining how medical students integrated formative feedback during a high-fidelity, multiday medical simulation. Medical educators can use this framework to intentionally guide their formative feedback in order to maximize student learning during simulation.

The Impact of High-fidelity Simulations on Medical Student Readiness.

INTRODUCTION: Simulation is a key aspect of the military unique curriculum at the Uniformed Services University (USU). The Department of Military and Emergency Medicine conducts rigorous high-fidelity simulations for military medical students during each year of their medical school training: Patient Experience (first year), Advanced Combat Medical Experience (second year), Operation Gunpowder (third year), and Operation Bushmaster (fourth year). There is currently a gap in the professional literature regarding students' progression through each of these simulations. This study, therefore, explores the experiences of military medical students at USU in order to understand how they learn and develop as they progress through these high-fidelity simulations. MATERIALS AND METHODS: Using a grounded theory approach to qualitative research design, we analyzed qualitative data from 400 military medical students across all four years of military school who participated in the four high-fidelity simulations during 2021-2022. Our research team used open and axial coding to categorize the data and to make connections between each of these categories, which we articulated in a theoretical framework and illustrated in a consequential matrix. This research was approved by the Institutional Review Board at USU. RESULTS: During Patient Experience, the first-year medical students described the stress, chaos, and lack of resources that military physicians face as they experienced the realism of the operational environment. Later at Advanced Combat Medical Experience, the second-year medical students practiced their medical skills hands-on for the first time in the simulated stressful operational environment. As a result, they gained confidence and began to formulate their professional identity. Next, at Operation Gunpowder, the third-year medical students advanced to more complex tactical field care as they performed prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care as a team, often revealing gaps in their knowledge that needed to be filled. During the capstone simulation, Operation Bushmaster, the fourth-year medical students closed these gaps and solidified their professional identity as leaders and physicians, culminating in a strong confidence regarding their readiness for their first deployment. CONCLUSIONS: Each of the four high-fidelity simulations impacted the students in unique ways as they were incrementally challenged to practice and build upon their knowledge, skills, and abilities related to combat casualty care, teamwork, and leadership in the operational environment. As they completed each of the simulations, their skills improved, confidence grew, and professional identity solidified. Therefore, completing these rigorous simulations progressively over the course of 4 years of medical school appears to be a vital process and foundation for the deployment readiness of early-career military physicians.

"Not for the Faint of Heart": First-year Military Medical Students' Professional Identity Formation During the Innovative Patient Experience at Operation Bushmaster.

INTRODUCTION: The role of a military medical officer (MMO) is complex. Therefore, it is essential that military medical students formulate their professional identity early on in medical school in order to prepare them for their first deployment. At the Uniformed Services University, students are challenged to progressively develop their professional identity through yearly high-fidelity military medical field practicums (MFPs). One of these MFPs, Operation Bushmaster, consists of an innovative "Patient Experience" in which first-year medical students portray patients cared for by fourth-year medical students in a simulated operational environment. The purpose of this qualitative study was to examine how participating in the Patient Experience impacted first-year medical students' professional identity formation. MATERIALS AND METHODS: Our research team used a phenomenological, qualitative research design to analyze the end-of-course reflection papers of 175 first-year military medical students who participated in the Patient Experience during Operation Bushmaster. Our research team members individually coded each student's reflection paper and then came to consensus on how to organize these codes into themes and subthemes. RESULTS: Two themes and seven subthemes emerged from the data regarding the first-year medical students' understanding of the MMO: (1) multiple roles of the MMO (educator, leader, diplomat, and advisor) and (2) role of the MMO in the operational environment (navigates hazardous environment, adaptability, and position within health care team). As they participated in the Patient Experience, the first-year medical students not only recognized the complexity of the MMO's multiple roles within the operational environment but also envisioned themselves in these roles. CONCLUSIONS: The Patient Experience provided first-year medical students with a unique opportunity to formulate their professional identity as they portrayed patients during Operation Bushmaster. This study's results hold implications for both military and civilian medical schools regarding the benefits of innovative military MFPs for professional identity formation in junior medical students, preparing them early on in medical school for their first deployment.

A Comparison of HPSP and USU Graduates' Preparation for Residency.

INTRODUCTION: Military medical students enter residency through two main pathways: (1) The Uniformed Services University (USU) and (2) the Armed Services Health Professions Scholarship Program (HPSP). The purpose of this study was to compare how these two pathways prepare military medical students for residency. METHODS: We conducted semi-structured interviews with 18 experienced military residency program directors (PDs) in order to explore their perceptions of the preparedness of USU and HPSP graduates. We used a transcendental phenomenological qualitative research design to bracket our biases and guide our data analysis. Our research team coded each of the interview transcripts. We then organized these codes into themes, which served as the results of our study. RESULTS: Five themes emerged from our data regarding the residents' preparedness: (1) Ability to navigate the military culture, (2) understanding of the military's medical mission, (3) clinical preparation, (4) ability to navigate the Military Health System (MHS), and (5) teamwork. The PDs described how USU graduates better understand the military's medical mission and are more easily able to navigate the military culture and the MHS because of their lived experiences during military medical school. They also discussed the various levels of clinical preparation of HPSP graduates, in contrast to the USU graduates' more consistent skills and abilities. Finally, the PDs believed both groups to be strong team players. CONCLUSIONS: USU students were consistently prepared for a strong start to residency because of their military medical school training. HPSP students often experienced a steep learning curve because of the newness of the military culture and MHS.

Operation Bushmaster's Impact on Military Medical Student Deployment Readiness.

INTRODUCTION: Operation Bushmaster is a high-fidelity simulation held for fourth-year medical students at the Uniformed Services University. No past research has examined this multi-day simulation's ability to prepare military medical students for the complexities of their first deployment. This qualitative study, therefore, explored Operation Bushmaster's impact on military medical student deployment readiness. METHODS: We interviewed 19 senior military medical personnel serving as faculty members at Operation Bushmaster during October 2022 in order to explore how Operation Bushmaster prepares students for their first deployment. These interviews were recorded and transcribed. Each research team member then coded the transcripts and came to a consensus on the themes and patterns that emerged from the data. RESULTS: The following themes described the ways in which Operation Bushmaster prepares military medical students for their first deployment: (1) primes them for the stress of the operational environment; (2) teaches them to navigate austere conditions; (3) facilitates their leadership development; and (4) provides them with a deeper understanding of the military's medical mission. CONCLUSION: Operation Bushmaster immerses students in a realistic, stressful operational environment, challenging them to develop an adaptive mindset and efficacious leadership skills that they will utilize during future deployments.

What to know about 2.0: Revisions to the pediatric emergency medicine milestones.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) adopted educational milestones for trainee assessment in 2013, as a key component of the Next Accreditation System. Two years later, the ACGME, American Board of Pediatrics (ABP), and American Board of Emergency Medicine (ABEM) collaborated to create specialty-specific subcompetencies in pediatric emergency medicine (PEM). Since that time, emerging data have demonstrated the need to revise specialty milestones. Consequently, the ACGME summoned a working group to revise the original PEM milestones. Methods: The PEM Milestones 2.0 Working Group convened in April 2021, comprising diverse representation from ACGME staff, PEM and EM attendings, PEM fellowship program directors, PEM fellows, and community members, overseen by the ACGME's vice president for milestones development. The group met virtually six times over 3 months, with concurrent independent and subgroup work, to draft the PEM Milestones 2.0 and supplemental guide. Results: The working group's revisions generated concise descriptions of behavioral anchors to define skill acquisition more accurately; attention to the transition from residency to fellowship training; incorporation of harmonized milestones for non-patient care and non-medical knowledge domains; and increased emphasis on diversity, equity, and inclusion. A supplemental guide was also designed to aid programs in designing programmatic assessment related to specialty-specific milestones. Conclusions: The PEM Milestones 2.0 provide an updated, specialty-specific framework to guide the development and assessment of PEM fellows and training programs. Future work may focus on faculty and learner development, advancing validity evidence, strengthening content expertise, and integrating milestones with specialty-specific entrustable professional activities.

The Military Medical Officer's Current-Day Professional Identity: An Enhanced Model.

BACKGROUND: As the landscapes of war have evolved, so too has the role of the military medical officer (MMO). Colonel (Retired) Barry Wolcott developed a "vector" model in the 1990s, illustrating the dual professional role of the MMO. Since then, propelled by the War on Terror, MMOs have adapted to treating patients in volatile, uncertain, complex, and ambiguous operational environments. This study, therefore, aimed to explore modern-day aspects of the MMO's role in order to enhance Wolcott's depiction of the MMO's professional identity in contemporary operational environments. MATERIALS AND METHODS: We used the qualitative phenomenological tradition to design our study. We interviewed military physicians from a variety of specialties in order to explore their experiences and professional identity as MMOs. Our research team then coded each of these interview transcripts. We organized these codes into categories, which served as the themes of our study. RESULTS: The following themes emerged from our data regarding the role of the MMO in the operational environment: Primary roles (officer, physician, educator, and diplomat) and aptitudes (innovation, advocacy, cultural competency, and leadership). The MMO's roles as officer and physician often intersect, with dual foci on the mission and the patient. The MMO also serves as an educator to medics and line officers. In addition, they act as diplomats both outside and within the military. Within each of these primary roles, the MMO innovatively prepares for future landscapes of war and advocates for both the individual warfighter and the unit/command. Finally, the MMO navigates both foreign and internal cultural differences and demonstrates leadership in enabling the military's mission. CONCLUSIONS: The role of the MMO is complex and multifaceted. The recognition of the contemporary MMO's unique skill set is essential for the effective education and training of future military health care leaders. The value of capitalizing on this unique skill set has been demonstrated in recent civ-mil responses. Because their intricate skill set is specialized for the operational environment, long-term retention of MMOs is key to force readiness.

Military Medical Provider Perspectives During the New York COVID-19 Response.

INTRODUCTION: The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD-a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response. MATERIALS AND METHODS: This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants' experiences while deployed to NYC. These interview scripts were then independently coded by five research team members. RESULTS: We identified four common themes and 12 subthemes from the participants' responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military-civilian liaison service, positive experience, and military support necessity). CONCLUSIONS: This study provides unique insight into the DoD's initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD's pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.

Medical Students' Professional Identity Formation During Operation Bushmaster.

INTRODUCTION: The role of the military medical officer is complex, as it encapsulates officer, physician, and leader. Professional identity formation is therefore essential for military medical students and junior military physicians to successfully execute the responsibilities of the military medical officer in their future careers. Because little is known regarding best practices for professional identity formation training for military physicians, this study explored the ways in which medical students conceptualized the complex roles of the military medical officer during a medical field practicum. MATERIALS AND METHODS: Guided by the phenomenological tradition of qualitative research, we interviewed 15 fourth-year medical students twice regarding their understanding of the role of the military medical officer, as they progressed through a 5-day high-fidelity military medical field practicum, Operation Bushmaster. Our research team then analyzed the interview transcripts for emerging themes and patterns, which served as the results of this study. RESULTS: The following themes emerged from the data regarding the participants' conceptualization of the military medical officer: (1) the scope of the role of the military medical officer; (2) the intersecting identities of the military medical officer; and (3) the adaptable role of the military medical officer in an operational environment. As they progressed through the medical field practicum, the participants articulated a clear understanding of the vast and complex nature of the military medical officer's intersecting roles as officer, physician, and leader in austere and often unpredictable environments. At the end of the medical field practicum, the participants expressed confidence in carrying out their roles as military medical officers during their future deployments. CONCLUSIONS: This study provided an in-depth understanding of the participants' conceptualization of the military medical officer. The participants described how the medical field practicum provided them with opportunities to experience first-hand and therefore better understand the roles of the military medical officer while leading a health care team in an operational environment. As a result, high-fidelity medical field practicums like Operation Bushmaster appear to be an effective tool for facilitating professional identity formation.

The development, implementation, and evaluation of a medical student peer teaching training curriculum during a high-fidelity prehospital trauma simulation.

Objectives: While peer teaching has been found to be an effective technique during simulation, no peer teaching training curriculum (PTTC) has been developed for simulation-based learning. The objective of this study, therefore, was to develop, implement, and evaluate a PTTC during a high-fidelity trauma simulation. Methods: When developing the PTTC, we combined several validated learning models for teaching and learning procedural skills. We then implemented it over 6 days in two phases: instructional (learning how to teach) and experiential (practicing teaching). Our research team conducted a qualitative evaluation to evaluate the effectiveness of the PTTC. We analyzed written self-reflections from 20 second-year medical students who completed the PTTC. Using an iterative inductive approach to data analysis, our research team first individually coded the reflection papers. We then met to define and categorize the codes into themes. Finally, we compared these themes to the PTTC's objectives to evaluate the curriculum's effectiveness. Results: The following themes emerged from the data: 1) learning through teaching; 2) self-actualization as an educator; and 3) role of physician as leader, advocate, and educator. The students described how the peer teaching experience improved their own procedural knowledge and skills. They also reported an increase in their leadership and communication skills as they effectively provided guidance and feedback to their peers, which led to their self-actualization as an educator. This self-actualization inspired the peer teachers' professional identity formation as leaders and educators in medicine. Conclusions: Based on these themes, we found our PTTC to be an effective curricular design. Our results reinforce previously described benefits to both peer teachers and learners in regard to medical knowledge and skills acquisition and furthers the academic emergency medicine community's understanding of how students' involvement as peer teachers in simulation-based education impacts their professional development.

The Impact of Medical School on Military Physicians' Readiness for their First Deployment.

INTRODUCTION: Military physicians receive their undergraduate medical training primarily by either attending civilian medical school, through the Armed Forces Health Professions Scholarship Program (HPSP), or by attending the Uniformed Services University (USU), a federal medical school with a military unique curriculum. The purpose of this study was to explore the perceptions of graduates from these two educational pathways regarding the impact of their medical school training on their readiness for their first deployment. MATERIALS AND METHODS: We conducted 18 semi-structured interviews with military physicians who attended civilian medical schools and USU and who had deployed within the past 2 years. The participants also completed emailed follow-up questions. The interviews were recorded and transcribed. The research team coded the interviews, extracted meaning units, and identified themes that emerged from the data. RESULTS: The following themes emerged from the data: (1) medical readiness; (2) operational readiness; (3) command interactions; and (4) role as a military physician. All of the participants perceived themselves to be prepared medically. However, the USU graduates were more confident in their ability to navigate the operational aspects of deployment. In addition, they described their ability to naturally build positive working relationships with their commanding officers and navigate their combined roles as both a physician and military officer. CONCLUSIONS: These perceptions of both the civilian medical graduates and USU graduates provide important insight to the military medical education community regarding the ways in which civilian medical schools and USU prepare students for their first deployment. This insight will help to identify any training gaps that should be filled in order to ensure that military physicians are ready for deployment.

Feasibility of Obtaining Intraosseous and Intravenous Access Using Night Vision Goggle Focusing Adaptors.

BACKGROUND: The optimal tactical lighting for performing medical procedures under low-light conditions is unclear. METHODS: United States Navy medical personnel (N = 23) performed intravenous (IV) and intraosseous (IO) procedures on mannequins using a tactical headlamp, night vision goggles (NVGs), and night vision goggles with focusing adaptors (NVG+A) utilizing a randomized within-subjects design. Procedure success, time to completion, and user preferences were analyzed using analysis of variance (ANOVA) and nonparametric statistics at p < .05. RESULTS: IV success rates were significantly greater for the headlamp (74%) than for NVG (35%; p < .03) and somewhat greater than for NVG+A (52%; p = .18). IO success rates were high under each lighting condition (96% to 100%). Time to completion was significantly faster using headlamp (IV, 106 ± 28 s; IO, 47 ± 11 s) than NVG (IV, 168 ± 80 s; IO, 56 ± 17 s) or NVG-A (IV, 157 ± 52 s; IO, 59 ± 27 s; each p < .01). Posttesting confidence on a 1-to-5 scale was somewhat higher for NVG+A (IV, 2.9 ± 0.2; IO, 4.2 ± 0.2) than for NVG (IV, 2.6 ± 0.2; IO, 4.0 ± 0.2). Participants cited concerns with NVG+A depth perception and with adjusting the adaptors, and that the adaptors were not integrated into the NVG. CONCLUSION: While this mannequin study was limited by laboratory conditions and by the lack of practice opportunities, we found some small advantages of focusing adaptors over NVG alone but not over headlamp for IV and IO access in low-light conditions.