File - Army Healthcare careers

January 10, 2018 | Author: Anonymous | Category: Science, Health Science, Pediatrics
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Army Medical Education

Christine F. Lettieri, MD LTC (P), MC

Deputy Director, Medical Education April 2014

1

Army Health Professions Scholarship Program • 152 medical schools  ~280 graduates annually

 Provides 80% of active duty physicians

• • • • •

Commissioned as 2LT in US Army Reserve (IRR) 100% tuition paid Required books and fees paid Monthly stipend ($2,157/month) for 10.5 months each year Military pay (about $6000) annually for 45 days Active Duty Training

• Obligation is 1 year on active duty for each year of sponsorship in HPSP (2 years minimum) or 4 years if one opts to take Critical Skills Accession Bonus

2

Army Graduate Medical Education • Largest program in the military: 1458 physicians  1341 training in in-house programs; 117 in Army-sponsored civilian training; 28 in educational delay

• All Specialties  10 training hospitals  23 primary specialties; 70 residencies; 70 fellowships

• Majority of Army physicians train in Army GME programs  29-33% of active duty Medical Corps officers are in GME at any given time

• All programs accredited by Accreditation Council for Graduate Medical Education

 Average GME program cycle length > 6 years under NAS  No programs on probation

• 94.4% first time board pass rate (civilian 85-89%) 3

Medical Research •

In addition to clinical research ongoing in our teaching hospitals, the Army conducts medical research at the following:



The U.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker, Alabama

• •

U.S. Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas



U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland



U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts



Walter Reed Army Institute of Research (WRAIR), Forest Glen, Maryland

U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen Proving Ground, Maryland

 U.S. Army Dental Research Detachment  U.S. Army Medical Research Detachment  Armed Forces Research Institute of Medical Sciences-Thailand (AFRIMS)  U.S Army Medical Research Unit- Europe  U.S Army Medical Research Unit- Kenya

4

Regional Medical Commands Teaching Hospitals

Walter Reed NMMC Eisenhower AMC William Beaumont AMC

Womack AMC Martin ACH Madigan AMC

Ft. Belvoir Community Hospital Carl R. Darnall AMC Tripler AMC

Keller ACH (West Point) Brooke AMC

5

Residencies • • • • • • • • • • •

Internal Medicine Family Medicine Emergency Medicine Pediatrics Obstetrics/Gynecology General Surgery Neurosurgery Orthopaedics Urology Otolaryngology Preventive Medicine*/ Occupational Medicine*

• • • • • •

Dermatology Radiology Radiation Oncology* Anesthesiology Aerospace Medicine* Neurology and Child Neurology

• Pathology • Psychiatry • Physical Medicine and Rehabilitation

• Ophthalmology

* Specialty does not offer continuous contract; must reapply for PGY-2 year. 6

ARMY FIRST YEAR GRADUATE MEDICAL EDUCATION: PGY-1 Programs for the 2014 Selection Board SPECIALT Y SAUSHEC Emergency Medicine X Family Medicine General Surgery X GS Neurosurgery GS Urology X Internal Medicine X Neurology Child Neurology OB-GYN X Orthopaedics X Otolaryngology X Pathology X Pediatrics X Psychiatry T ransitional X Prelim Aerospace Medicine Prelim Anesthesiology X Prelim Dermatology X Prelim Ophthalmology X Prelim Physical Medicine Prelim Preventive Medicine Prelim Radiation Oncology Prelim Radiology(DIAG) X

EAMC X X

X

X

MAMC X X X X X X X X X X X

X X X

X

X

X

X

T AMC

NCC

X X

X X X

X

X X X X X X X X X

X X

X

X X X X X X X X X

WBAMC

WAMC X

CRDAMC X X

Martin ACH VA-DoD/Civ. X X

X X X X

X X

X X X X X X X X

X X X X

X

SAUSHEC –Brooke Army Medical Center, Fort Sam Houston, T X/Wilford Hall Medical Center, Lackland AFB, T X/University of T exas, San Antonio, T X NCC –Walter Reed National Military Medical Center, Bethesda, MD/Fort Belvoir Community Hospital, Fort Belvoir, VA /Malcolm Grow Medical Center, Andrews AFB, MD/USUHS

7

Active Duty for Training (ADTs) • Training programs located on website • 1st year - Basic Officer Leader Course (BOLC). If unable to attend then, need to complete before medical school graduation; BOLC should be completed prior to any clinical rotations



2nd year - School ADT or rotation at Army community hospital

• •

3rd and 4th years - Clinical rotations at Army hospitals



Expectation to pass USMLE/COMLEX Parts I and II and CS/PE and attend BOLC prior to graduation

Any year - Research rotation at Walter Reed Army Institute of Research, Institute of Surgical Research, Armed Forces Institute of Pathology, Uniformed Services University

8

Deadlines

• USMLE Step 1/COMLEX Level 1  Score due to HPSP office by September 15

• USMLE Step 2 CK/COMLEX Level 2 CE and ERAS application  Score and ERAS application due October 15 of 4th year

• Step 2 CS/Level 2 PE  Result due February 15 9

First Year Graduate Medical Education •

Mandatory application/participation  All participants must apply for training in military residency programs.  GME beyond FYGME will always be in military programs or sponsored training (on active duty) in civilian programs.  Civilian deferral and participation in the NRMP will be limited and only if authorized by GME office to fill additional training requirements.



FYGME Letter of Instruction (LOI) and Fact Sheet released to 4th year students in July



Application via ERAS and HPSP/FYGME website: ***Potential for change this year with all applications done on Army Medical Education website- see LOI to confirm.



Army Match – computerized match similar to NRMP  Students declare specialty and rank all Army programs in that specialty  All programs will see all applicants who have identified them as a specialty of choice and will rank all applicants on their order of merit lists (OMLs). Programs are blinded to students’ rankings of programs.

 Computer sorts and matches using student’s priority and program’s OML  Applicants not matching to their specialty of choice match to a transitional year position. Some unfilled positions may be available at post-match rebuttal board.  Class of 2014: 85% of applicants selected for desired specialty  Active duty service obligation/completion date may change depending on length of residency 10

PGY-1 Categorical Specialties • Emergency Medicine • Family Medicine • General Surgery • Internal Medicine • Neurology • Neurosurgery • OB-GYN • Orthopaedics • Otolaryngology • Pathology

• Pediatrics • Prelim Anesthesiology • Prelim Dermatology • Prelim Ophthalmology • Prelim PM&R • Prelim Radiation Oncology

• Prelim Radiology • Psychiatry • Urology 11

Applications For PGY-1 Positions: Applicants Per Approved Positions SPECIALTY (Positions Offered)

2010

2011

2012

2013

2014

Emergency Medicine (30)

1.14

1.36

1.38

1.76

1.40

Family Medicine (47)

0.88

1.07

1

0.72

1

General Surgery (27)

1.80

1.65

1.26

1.38

1.41

General Surgery: Neurosurgery (4)

1.5

1.33

1

1.67

1.25

General Surgery: Urology (5)

0.57

0.71

1.29

1.29

1.80

Internal Medicine (59)

0.71

0.66

0.79

0.97

0.66

Neurology (4)

0.50

0.83

0.63

0.67

1

0

1

1

1

2

OB-GYN (19)

0.59

0.83

1.61

1.06

1.28

Orthopaedics (19)

0.89

1.21

1.68

1

0.95

Otolaryngology (7)

1.72

1.33

2.14

0.83

1.43

Pathology (9)

1

1.17

0.89

0.44

0.56

Pediatrics (28)

0.62

0.92

0.79

0.89

1.11

Neurology: Child (1)

12

Applications For PGY-1 Positions: Applicants Per Approved Positions (continued) SPECIALTY (Positions Offered)

2010

2011

2012

2013

2014

1

0

0

2

1

Prelim: Anesthesiology (12)

0.83

1.25

1.09

1.25

1.25

Prelim: Dermatology (7)

1.29

0.71

0.63

1.43

1.71

Prelim: Ophthalmology (7)

0.86

0.43

1.57

1.71

0.86

Prelim: Physical Medicine (3)

1.33

2

3.33

1

3

Prelim: Preventive Medicine (2)

0.50

1

0

1.50

0

Prelim: Radiation Oncology (1)

0

1

0

1

1

Prelim: Radiology (14)

0.87

0.87

0.94

1.14

1.14

Psychiatry (17)

0.87

0.88

0.82

0.35

0.82

2

0

0

0

2

0.13

0.13

0.13

0.35

0.10

Prelim: Aerospace Medicine (1)

Psychiatry/Internal Medicine (1) Transitional (40)

13

Board Scores for Matched HPSP/USUHS Students(class of 2014) 2011 national means for matched US students (step 1/step 2)

USMLE Step 1 Mean/Min

USMLE Step 2 Mean/Min

COMLEX Lvl 1 Mean/Min

COMLEX Lvl 2 Mean/Min

Neurology (225/231)

250/219

236/214

**

**

Psychiatry (216/221)

213/192

221/215

462/430

482/426

Internal Medicine (225/232)

226/193

242/215

509/408

530/400

Family Medicine (214/223)

213/193

229/203

493/408

508/405

General Surgery (224/231)

233/194

247/212

614/539

614/531

Orthopedic Surgery (238/241)

239/197

248/232

639/611

705/686

PM&R (214/220)

229/225

247/243

**

**

Diagnostic Radiology (238/242)

231/205

241/222

513/456

550/494 14

Board Scores for Matched HPSP/USUHS Students(class of 2014) 2011 national means for matched US students

USMLE Step 1 Mean/Min

USMLE Step 2 Mean/Min

COMLEX Lvl 1 Mean/Min

COMLEX Lvl 2 Mean/Min

OB/GYN (219/229)

232/213

240/419

500/428

544/419

Urology

245/235

244/232

538/451

534/498

Dermatology (242/251)

246/242

251/224

562/549

695/604

Anesthesiology (224/230)

227/204

241/232

536/518

518/494

Pediatrics (219/229)

221/205

220/212

492/438

583/419

Ophthalmology (235/

**

**

**

**

Otolaryngology (240/246)

241/209

252/238

632/621

640/562

(step 1/step 2)

15

Board Scores for Matched HPSP/USUHS Students(class of 2014) 2011 national means for matched US students

USMLE Step 1 Mean/Min

USMLE Step 2 Mean/Min

COMLEX Lvl 1 Mean/Min

COMLEX Lvl 2 Mean/Min

Pathology (227/230)

226/202

229/223

553/418

614/541

Neurosurgery (239/237)

248/245

256/246

Emergency Medicine (222/230)

225/193

234/206

515/440

569/463

Child Neurology

**

**

(step 1/step 2)

** Data restricted to protect student privacy

16

VA-DoD Training Opportunities

• Intern year in Army program • Remainder of residency in VAsponsored program  Radiology – Georgia Health Sciences University; UT San Antonio  Urology – UT San Antonio; Duke University

 Neurosurgery* – University of Florida; UT San Antonio *Entirety of training in VA-sponsored program 17

2014 Army GMESB Selection Summary Report Fellowship Training Selects Inservice Military

Deferred Selects

Selects Civilian Sponsored

Total Applicants

Inservice Select Rate

Overall Select Rate

Total Selects

NonSelects

Utilization/ Field

44

0

18

62

27

89

49.44%

69.66%

Interns

0

0

0

0

0

0

0%

0%

Current Deferred

0

0

0

0

0

0

0%

0%

Current Residents

42

0

30

72

71

143

29.37%

50.35%

Civilian

1

0

0

0

0

0

0

0

Totals

86

0

48

134

98

232

37.07%

57.76%

Senior residents applying for fellowships do almost as well getting selected as staff physicians.

Medical Corps Officer Career Progression YEARS

0

Rank

6

CPT BASIC CRS

Professional Military Education

Additional Training

FYGME

MAJ

CPT CAREER CRS

RESIDENCY

30

18

12

COL

LTC INTERMEDIATE LEVEL ED

SENIOR SVC. COLLEGE

FELLOWSHIP

CBRNE, SHORT COURSES EXECUTIVE SKILLS COURSE ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT MPH

MBA

TWI

ADVANCED SCIENCE DEGREE

DEVELOPMENTAL & UTILIZATION ASSIGNMENTS

Typical Assignments

Successful Completion of Internship and Residency Utilization Tour Clinician

Self Development

Successful Completion of Fellowship TOE/TDA Physician Company Commander Clinic OIC Teaching Staff Research Assistant Clinician

BN/BDE/DIV Surgeon MEDCOM Staff DCCS MEDCEN Staff MEDDAC Staff Residency Director Product Line Mgr Division Chief Clinician

Corps/MACOM Surgeon Commander Joint Assignments DCCS MECEN Staff Deputy Chief Dir Med Ed USUHS Faculty Department Chair Research Area Dir.

Continuing Medical Education / Board Recertification License by yr. 2

Board Certification

Subspecialty Board Certification 19

Army Medicine Serving the nation since 1775

China 1944

44th MASH, Korea 1954

Radiology residents 1968

Serving to Heal…Honored to Serve

20

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