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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
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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
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