Updating the Military Unique Curriculum for a Ready Medical Force

• Published in: Military medicine 2024-05, Vol.189 (5-6), p.1181-1189
• Main Authors: Neuman, Taylor J, Johnson, William Rainey, Maciuba, Joseph M, Andrews, Mary, O'Malley, Patrick G, Wilson, Ramey L, Hartzell, Joshua D
• Format: Article
• Language: English
• Subjects: Curriculum - standards; Curriculum - trends; Education, Medical, Graduate - methods; Education, Medical, Graduate - standards; Education, Medical, Graduate - trends; Humans; Military Medicine - education; Military Medicine - methods; Military Personnel - education; Military Personnel - psychology; Military Personnel - statistics & numerical data; Needs Assessment; Surveys and Questionnaires; United States
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usad099

Previous conflicts have demonstrated the impact of physician readiness on early battlefield mortality rates. To prepare for the lethal nature of today's threat environment and the rapid speed with which conflict develops, our medical force needs to sustain a high level of readiness in order to be ready to "fight tonight." Previous approaches that have relied on on-the-job training, just-in-time predeployment training, or follow-on courses after residency are unlikely to satisfy these readiness requirements. Sustaining the successes in battlefield care achieved in Iraq and Afghanistan requires the introduction of effective combat casualty care earlier and more often in physician training. This needs assessment seeks to better understand the requirements, challenges, and opportunities to include the Military Unique Curriculum (MUC) during graduate medical education. This needs assessment used a multifaceted methodology. First, a literature review was performed to assess how Military Unique Curricula have evolved since their initial conception in 1988. Next, to determine their current state, a needs-based assessment survey was designed for trainees and program directors (PDs), each consisting of 18 questions with a mixture of multiple choice, ranking, Likert scale, and free-text questions. Cognitive interviewing and expert review were employed to refine the survey before distribution. The Housestaff Survey was administered using an online format and deployed to Internal Medicine trainees at the Walter Reed National Military Medical Center (WRNMMC). The Program Director Survey was sent to all Army and Navy Internal Medicine Program Directors. This project was deemed to not meet the definition of research in accordance with 32 Code of Federal Regulation 219.102 and Department of Defense Instruction 3216.02 and was therefore registered with the WRNMMC Quality Management Division. Out of 64 Walter Reed Internal Medicine trainees who received the survey, 32 responses were received. Seven of nine PDs completed their survey. Only 12.5% of trainees felt significantly confident that they would be adequately prepared for a combat deployment upon graduation from residency with the current curriculum. Similarly, only 14.29% of PDs felt that no additional training was needed. A majority of trainees were not satisfied with the amount of training being received on any MUC topic. When incorporating additional training on MUC topics, respondents largely agreed that simulation