Didactics can provide a foundation. However, just as the practice of medicine is learned in the clinic, the art of military medicine is learned in the field. Hands-on training in one study was accomplished through the Combat Casualty Care Course (C4), the USU Bushmaster exercise, and a field training exercise. The field exercise included components of mission planning, medical threat assessments, triage of a mass casualty situation, management of disease and nonbattle injuries, combat stress casualties, resource management, and patient evacuation.8
Another publication described a similar longitudinal curriculum with C4 after the first year of training and the Medical Management of Chemical and Biological Casualty Course during the second year. The operational curriculum 3-day capstone occurred at the end of medical training utilizing mannequins to realistically simulate combat casualty care, including emergency airways, chest tube, and tourniquets.9 Due to the current deployment tempo, just in time refresher courses like this could be valuable preparation.
While most of the operational curriculums evaluated assessed efficiency over a short time interval, one study looked at 1189 graduates from the military medical school from the past 20 years. Preparedness was perceived to be high for military-unique practice and leadership.10 The operational curriculum at USU had been purposefully structured to provide continuity. Didactics and casework were reinforced with hands-on training whether through realistic simulator training or field exercises. The authors note a weakness of many operational curriculums is inconsistency and fragmented training without deliberate longitudinal planning.
One of the more recent military GME curriculums include the creation of the operational medicine residency in 2013, which created a standardized longitudinal operational curriculum integrated along with the existing family medicine, emergency medicine, or internal medicine curriculum to create mission-ready military physicians upon graduation. Scheduled rotations include global medicine, aeromedical evacuation, occupational medicine, and tropical medicine. Completing military officer professional development and an operationally relevant research project is an expectation (Table 2).11
In addition to in-program training, other options include operational rotations offsite and military courses conducted outside the GME program.12 Some of these courses may include just-in-time training such as expeditionary medical support system training prior to scheduled deployments. Examples of experiential training are listed in Table 3.
Critical Analysis
Current gaps were identified in the military medicine training pipeline’s operational medicine curriculum and research programs. The analysis looked at specific components that make the operational medicine curriculum and research unique as well as current readiness goals, to determine how to best align both to meet the mission requirements. Some factors considered included efficiency, cost, program portability, duplication minimization, retention, and sustainability.