Medical Education- Courses

Combat Medical Skills
 
CPT Jeffery Hogue, MS, USA, Course Director
 
Combat Medical Skills (CMS) is designed to produce competence in first year medical students with regard to first-aid skills. Students will be able to demonstrate competency in select medical interventions and treatment modalities that are directly linked to decreasing preventable combat death and morbidity on the battlefield and in training. Perhaps more important than the specifics of combat skills is the creation of a systematic approach to emergencies that will be useful in a number of different contexts throughout their medical career. The approach to the scene, the primary and secondary surveys, and the life threat interventions are based upon accepted standards of pre-hospital care throughout the military.
 
The course is taught from February to March of the freshman year in medical school, after anatomy and concurrently with medical physiology. The educational goals of CMS are:

The specific learning objectives of CMS are:

The CMS course is taught in ten block schedules.
 
CMS contributes 15% to the MS-I grade, but completion and passing of the CMS component is an independent requirement for graduation from the School of Medicine. THERE ARE NO WAIVERS. The written examination for CMS consists of single-answer multiple-choice questions, which cover everything in the supplemental reading material and discussed in class. The written test is not a simple regurgitation of memorized facts. Students must be prepared to turn facts into concepts and concepts into principles for practical application to realistic operational problems. The practical examination will involve assessing simulated trauma victims and performing the basic evaluation and treatment skills learned throughout the course.

Military Applied Physiology
 
CDR René Hernández, MSC, USN, Course Director
 
Military Applied Physiology (MAP) is designed to prepare future military physicians with the ability to manage the medical demands of operational contingencies in uncertain threat environments. This requires integration of didactic knowledge gained in Introduction to Military Medicine (IMM) with the natural and man-made stressors that impact upon accomplishment of both the military and medical missions. It is taught from April to June of the freshman year in medical school, after anatomy and concurrently with medical physiology. The educational goals of MAP are:
 
Goal 1: Learn the normal physiological responses to abnormal environmental conditions such as heat and cold exposure, hyper- and hypobarics, altered work times, vibration and noise, high-G conditions, and prolonged exertion.
 
Goal 2: Apply basic physiological facts and concepts to preventive medicine in the military operational environment. This requires a multi-disciplinary approach to a form of occupational medicine called military medicine.
 
As opposed to the traditional method of examining physiology by each organ system or functional attributes, MAP examines the effects of specific environments on all affected aspects of the human organism. The specific learning objectives of MAP are:

Where appropriate, each lecture is structured to provide the following lecture format: 1) assess the threat; 2) institute preventive measures; 3) recognize clinical symptoms and signs; and 4) out-of-hospital management of the problem consistent with students' level of training through Combat Medical Skills (CMS). A major emphasis is placed on the key concepts and potential interventions that will prevent a change in physiological homeostasis of the individual; thereby delaying or preventing the onset of clinical signs and symptoms, which may cause temporary or permanent attrition from contributing to the overall military operational effort.
 
Required laboratory experiences include: 1) pulmonary function testing during exercise; 2) either a hyperbarics [diving] or hypobarics [altitude chamber] experience; and 3) negotiation of an obstacle course in personal protective equipment while carrying a casualty on a litter.
 
MAP contributes 30% to the MS-I grade. The written examination for MAP consists of single-answer multiple-choice questions, which cover everything in the supplemental reading material and discussed in class. The written test is not a simple regurgitation of memorized facts. Students must be prepared to turn facts into concepts and concepts into principles for practical application to realistic operational problems.
 
Many of the concepts learned in MAP and their corresponding preventive medicine measures will be applied to individuals and student units during a one-week field exercise [Operation Kerkesner] at Marine Corps Base Quantico, which is part of the next course called Military Medical Field Studies (MMFS) conducted in June and July of the freshman year. Together with Military Medical History; IMM, CMS, MAP, and MMFS constitute the Military Studies I (MS-I) curriculum.
 
The concepts presented and experienced in MAP also form the foundation for the Military Studies II (MS-II) course called Introduction to Combat Casualty Care (IC3) and the Military Studies IV (MS-IV) course called Military Contingency Medicine (MCM). IC3 provides initial education related to the pathophysiology of injuries sustained in the combat environment (ballistic, blast, burn, chemicals, etc.). MCM the didactic and practical knowledge and skills to practice clinical military medicine in a deployed setting.

Military Medical Field Studies
 
MAJ Daniel Johnston, MC, USA, Course Director
 
The practice of Military Medicine is a highly specialized form of Occupational Medicine; providing primary medical care and preventative medicine for those working in the unique military environment. As each USUHS medical student completes his/her formal education, internship and residency training, he/she will have spent class and laboratory time developing a firm basis for the practice of military medicine. However, this by itself is not enough. It is vitally important that each student, during the training process, actually come into contact with the environment, (people, places and equipment), for which he/she will be medically responsible during their military career.
 
The Military Medical Field Studies (MMFS) Course is composed of two components: the 7 day Field Training Exercise (FTX) Kerkesner and the Operational clerkship. During FTX Kerkesner, each student will receive extensive, hands-on field training in followership, leadership, combat medical skills, preventive field medicine, field survival skills and other related topics. During the operational clerkship, most students will become part of an organic military line unit of their parent service. In this capacity, these future military physicians will have the opportunity to view, first hand, the day-to-day operations of those military members who carry out the mission; be it a missile maintenance squadron, a light infantry brigade, a Navy Construction Battalion or a USMC recon company in training, to list a few examples.
 
1. The MMFS course is a requirement for graduation from USUHS. THERE ARE NO WAIVERS. Those first year students who are unable to successfully complete the course during the scheduled time, for any reason, must complete the course during the next year, during a fourth year elective period or during extended leave/holiday periods. Those students with prior full-time active-duty military line experience may be granted operational credit, and may therefore be allowed to participate in other activities during the period of the operational clerkship ( discussed later). Those students who have previously served on active duty, graduated from one of the military academy's, were Reserve Officer Training Corps (ROTC) graduates, were members of a regular reserve or National Guard unit or were members of the U.S. Coast Guard may be granted credit toward their operational experience, depending upon their circumstances. Those students without prior military experience as outlined above, must participate with a line unit of their parent service. These options will be discussed later in more detail.
 
The learning objectives for both FTX Kerkesner and the operational clerkship are as follows:
 
1. FTX Kerkesner. The first two days are spent in classroom instruction on map/compass reading, field communications and Nuclear, Biologic, Chemical (NBC) instruction and demonstration. On the third day, the whole class will deploy to Fort Indiantown Gap(FIG), PA . Redeployment (returning from the field to USUHS) will occur on the ninth day followed by three days of equipment clean-up and turn-in.
 
2. The operational clerkship. This portion of MMFS will be conducted the month immediately following FTX Kerkesner. The primary learning objective is for each student to understand, comprehend and be able to conceptualize the operational environment of their parent service from the perspective of a future military physician. This includes the ability to comprehend the occupational hazards of a typical operational environment; to understand in general terms the real or potential physical and mental medical consequence of this work environment and how this may impact the unit's mission; and, finally, to be able to assess what changes, modifications or new procedures may lessen the medical consequence and thereby facilitate the mission. For those prior service students who already have operational experience, the primary learning objective is broadened to comprehending and understanding a nonoperational experience that will enhance and augment the student's military medical education. Examples include research or special projects approved by the Course Director.
 
Unlike FTX Kerkesner, for which the operational planning, organizing and support have been prearranged by USUHS faculty and staff, the operational clerkship is organized almost entirely by the student. That is, the initial contacting of a prospective preceptor, determining operational requirements (e.g. security clearance, field gear, flight physical, etc), arranging billeting, planning an itinerary, arranging transportation, requesting travel orders and completion of the travel voucher upon return to USUHS, etc.. Thus, a secondary learning objective of the operational clerkship is developing a working knowledge of how to plan, organize and execute official government travel to an operational unit, to include a working understanding of travel regulations, funded vs. permissive travel, use of the personal government charge card, using the contracted government air carrier(s); correctly completing a travel voucher, etc. There are many operational clerkship options for each student. Those students without prior military experience may choose to participate with one of several funded TDY sites for each service. In the past these have included such sites as:
 
U.S AIR FORCE

U.S. ARMY

Note: the Department of the Army requires that all Army students complete the Officer Basic Course (OBC). Any student who has not completed OBC will do so in place of their operational clerkship, with the operational clerkship completed at a later time -- usually as an elective during the fourth year.
 
U.S. NAVY

Students with a prior operational military background are encouraged to gain additional line experience with their parent service, preferably in a different operational environment than their prior area of specialty. If the site selected is outside MDW, the student can be placed on permissive orders. It is the responsibility of each student to locate a prospective site and propose it to the course director for approval (discussed later). Other clerkship opportunities for prior service students have included the following:
 
The Operational and Emergency Medical skills (OEMS) Course.
 
Survival, Evasion, Resistance, and Escape (SERE) School
 
Research Opportunities
 
Outside-Continental-United-States (OCONUS)

Military Medical Field Studies
 

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Uniformed Services University
MEM Office: C1039
4301 Jones Bridge Road
Bethesda, Maryland 20814
Phone (301) 295-3720
DSN: 295 3720
Toll Free: 888 826-3126
FAX (301) 295-6773

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