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Army Medical Education

Christine F. Lettieri, MD

LTC (P), MC

Deputy Director, Medical Education

April 2014

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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

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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%)

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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 Chemical Defense (USAMRICD),

Aberdeen Proving Ground, Maryland• 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 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

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Regional Medical CommandsTeaching Hospitals

Walter Reed NMMC Womack AMC Ft. Belvoir Community Hospital Keller ACH (West Point)Eisenhower AMC Martin ACH Carl R. Darnall AMC Brooke AMCWilliam Beaumont AMC Madigan AMC Tripler AMC

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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.

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SPECIALTY SAUSHEC EAMC MAMC TAMC NCC WBAMC WAMC CRDAMC Martin ACH VA-DoD/Civ.Emergency Medicine X X X XFamily Medicine X X X X X X XGeneral Surgery X X X X X XGS Neurosurgery X XGS Urology X X XInternal Medicine X X X X X XNeurology X XChild Neurology XOB-GYN X X X X XOrthopaedics X X X X X XOtolaryngology X X X XPathology X X XPediatrics X X X XPsychiatry X XTransitional X X X X XPrelim Aerospace Medicine XPrelim Anesthesiology X X X X X XPrelim Dermatology X X X XPrelim Ophthalmology X X X X X XPrelim Physical Medicine X XPrelim Preventive Medicine X XPrelim Radiation Oncology XPrelim Radiology(DIAG) X X X X X

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

ARMY FIRST YEAR GRADUATE MEDICAL EDUCATION:

PGY-1 Programs for the 2014 Selection Board

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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• Any year - Research rotation at Walter Reed Army

Institute of Research, Institute of Surgical Research, Armed Forces Institute of Pathology, Uniformed Services University

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

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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

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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

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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

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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

Neurology: Child (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

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

SPECIALTY (Positions Offered) 2010 2011 2012 2013 2014

Prelim: Aerospace Medicine (1) 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

Psychiatry/Internal Medicine (1) 2 0 0 0 2

Transitional (40) 0.13 0.13 0.13 0.35 0.10

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Board Scores for Matched HPSP/USUHS Students(class of 2014)

2011 national means for matched US students(step 1/step 2)

USMLE Step 1Mean/Min

USMLE Step 2Mean/Min

COMLEX Lvl 1Mean/Min

COMLEX Lvl 2Mean/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

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Board Scores for Matched HPSP/USUHS Students(class of 2014)

2011 national means for matched US students(step 1/step 2)

USMLE Step 1Mean/Min

USMLE Step 2Mean/Min

COMLEX Lvl 1Mean/Min

COMLEX Lvl 2Mean/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

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Board Scores for Matched HPSP/USUHS Students(class of 2014)

2011 national means for matched US students(step 1/step 2)

USMLE Step 1Mean/Min

USMLE Step 2Mean/Min

COMLEX Lvl 1Mean/Min

COMLEX Lvl 2Mean/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 ** **

** Data restricted to protect student privacy

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VA-DoD Training Opportunities

• Intern year in Army program

• Remainder of residency in VA-sponsored 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

2014 Army GMESB Selection Summary Report Fellowship Training

SelectsInservice Military

DeferredSelects

SelectsCivilian

SponsoredTotal

SelectsNon-

SelectsTotal

Applicants

InserviceSelectRate

OverallSelectRate

Utilization/Field

44 0 18 62 27 89 49.44% 69.66%

Interns 0 0 0 0 0 0 0% 0%

CurrentDeferred

0 0 0 0 0 0 0% 0%

CurrentResidents

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.

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FYGME RESIDENCY FELLOWSHIP

Successful Completion of Internship and ResidencyUtilization TourClinician

BN/BDE/DIVSurgeonMEDCOM StaffDCCSMEDCEN StaffMEDDAC StaffResidency DirectorProduct Line MgrDivision ChiefClinician

Corps/MACOM SurgeonCommanderJoint AssignmentsDCCSMECEN StaffDeputy ChiefDir Med EdUSUHS FacultyDepartment ChairResearch Area Dir.

COL LTCMAJCPT

YEARS 0 6 12 30

Rank

Professional Military Education

Additional Training

Self Development

DEVELOPMENTAL & UTILIZATION ASSIGNMENTS

CBRNE, SHORT COURSES

Continuing Medical Education / Board Recertification

Typical Assignments

License by yr. 2 Board Certification Subspecialty Board Certification

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MPH MBA TWI ADVANCED SCIENCE DEGREE

ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT

Successful Completion of FellowshipTOE/TDA PhysicianCompany CommanderClinic OICTeaching StaffResearch AssistantClinician

BASIC CRS CPT CAREER CRS INTERMEDIATE LEVEL ED SENIOR SVC. COLLEGE

EXECUTIVE SKILLS COURSE

Medical Corps Officer Career Progression

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Army Medicine

Serving the nation since 1775

China 1944 44th MASH, Korea 1954

Radiology residents 1968

Serving to Heal…Honored to Serve