Medical Education- Courses

Military Emergency Medicine
 
Lt Col Chetan Kharod, MC, USAF, Course Director
 
Military Emergency Medicine (MEM) is last required course of the four-year, integrated, medical-school education in military medicine at the Uniformed Services University (USU) and is the first half of the Military Studies IV (MS-IV) curriculum. Always taken after Military Contingency Medicine (MCM), the other required MS-IV course under the Medical Education Division of the Department of Military & Emergency Medicine; MEM is four weeks in length and is offered to approximately 30 of the senior medical-student class during each of six iterations. The latter is designed to expose USU students to the practice of emergency medicine in a military or civilian emergency department (ED) in the United States. The educational goals of MEM are:
 
Goal 1: Allow students to apply the concepts of approaching problems with expedient management in mind. These ideas were initiated in MCM. MEM applies them to a hospital ED setting. Students learn the initial approach to patients of all ages for whom the diagnosis is not already known or narrowed down to a short list of possibilities. Students will gain clinical experience evaluating and managing patients of all ages with undifferentiated complaints and problems of unknown severity.
 
Goal 2: Under the on-site supervision of practicing emergency physicians, students evaluate acute presentations of common injuries and illnesses, devise management plans, and formulate disposition decisions within a variety of healthcare systems.
 
Goal 3: Provide students with opportunities to enhance their resuscitation skills and care for critically ill and injured patients.
 
Goal 4: Enable interactions with leaders in the specialty of emergency medicine and trauma surgery.
 
The Society for Academic Emergency Medicine (SAEM) Undergraduate Education Committee made recommendations for the content of medical school curricula relevant to emergency medicine, which were published through two articles in Acad Emerg Med 1998; 5(11): 1105-1110 & 1110-1113. They listed several common patient complaints with which all physicians, regardless of specialty, should be able to initially manage. Readings from selected chapters in the provided textbook on emergency medicine, references to particularly significant journal articles, a core lecture series, and twelve small-group discussions of unknown cases by residency-trained emergency physicians prepare students for their clinical rotation.
 
These must be taken at the end of each students' MCM rotation, because the core lectures are distributed through portions of MCM and during the above three-day block specifically preparing students to work in the supervised settings of hospital EDs. There is a significant amount of overlap in topics between military medicine in larger deployed medical facilities and emergency medicine in hospital EDs. Topics discussed during students' junior year in courses through other departments are:
 
Approach to Complications of Diabetes Mellitus
 
Approach to Abnormal Behavior
 
In addition to the Advanced Trauma Life Support Course for Doctors® (ATLS®) as designed by the American College of Surgeons, topics discussed during MCM are:
 
Approach to various environmental exposures
 
Approach to Common Non-Battle Injuries
 
Approach to Toxidromes (toxicological syndromes)
 
Approach to Ophthalmological Problems
 
Approach to Vaginal Bleeding
 
Topics discussed in the specific MEM series are:
 
Approach to Undifferentiated Patient Presentations
 
Approach to Altered Mental Status
 
Approach to Respiratory Compromise
 
Approach to Cardiac Dysrhythmia Recognition
 
Approach to Cardiovascular Pharmacology
 
Approach to Non-Traumatic Shock
 
Approach to Acute Chest Pain
 
Approach to Hypertensive Emergencies & Urgencies
 
Approach to Acute Abdominopelvic Pain
 
Approach to Fever at the Extremes of Age
 
Approach to Acute Headache
 
Approach to Gastrointestinal Hemorrhage
 
Laboratory sessions introduce additional airway, dental, and ophthalmological procedures. Resuscitation skills gained during MCM are also reviewed. Students receive hands-on practice with automated external defibrillators (AEDs), manual monitor/defibrillators, and transcutaneous pacemakers.
 
Medical students may choose from a variety of sites throughout the United States to perform their clinical clerkships. The uniformed services are represented by the larger military EDs, which have accredited residency programs in emergency medicine. These are Darnall Army Community Hospital, National Naval Medical Center, Naval Medical Center Portsmouth, Naval Medical Center San Diego, and the San Antonio Uniformed Services Health Education Consortium (SAUSHEC). Madigan Army Medical Center and Wright-Patterson Medical Center are partnered with the University of Washington and Wright State University, respectively. Other military sites include Dwight D Eisenhower Army Medical Center,Naval Hospital Jacksonville [USN], and Keesler Medical Center. Local sites include many prominent medical centers close to the National Capital Area including Inova Fairfax Hospital, Malcolm Grow Medical Center [USAF],Union Memorial Hospital, and Walter Reed Army Medical Center. Two other civilian sites are Phoenix Indian Medical Center in Phoenix AZ, and Ben Taub General Hospital in Houston TX. Many of these sites have additional didactic, case-presentation, and laboratory experiences.
 
Students usually give high marks to their MEM experiences. Some choose a career in emergency medicine after learning about its unique practice first-hand. Exposure to faculty of residency programs offers an opportunity to interact with leaders who will shape the future of emergency medicine in this country. MEM also provides a conduit to post-graduate training by providing the Joint Service Graduate Medical Education Selection Board with a rotation evaluation and letters of recommendation from these same leaders.

Electives in Military Medicine and Military Emergency Medicine
 
Medical Students
 
The Electives Program enables students to select experiences that meet their needs and interests. Such experiences contribute significantly to career development by broadening knowledge and increasing skill in Military Medicine. Several students have begun research projects in their first year of medical school during Military Medical Field Studies, continued work on their projects during their second and third years of medical school, and completed their research projects during a fourth year elective. Information regarding senior medical student electives sponsored by the Department of Military and Emergency Medicine may be found using the Military and Emergency Medicine link under the Fourth-Year Catalogue on the USU Registrar's website.
 
Electives in Military Medicine include:
 
Clinical Rotations in Aerospace Medicine
 
Aerospace Physical Examinations
 
Clinical Rotations in Operational Medicine
 
Joint Readiness Training Center (JRTC) Rotation
 
Air Assault School
 
Airborne School
 
Cold Weather Medicine Course
 
Diving Medicine Course
 
US Army Flight Surgeon Primary Course (AFSPC)
 
USAF Aerospace Medicine Primary (AMP) Course
 
Aviation Psychiatry
 
Aerospace Neurology
 
Aerospace Ophthalmology
 
Electives in Emergency Medicine include:
 
Clinical Rotations in Emergency Medicine
 
Medical Toxicology
 
Pediatric Emergency Medicine
 
Opportunities exist for research in Military Medicine or Emergency Medicine within the Department of Military and Emergency Medicine. Research electives may be coordinated with a faculty advisor of the student's choice. In addition, the Casualty Care Research Center (CCRC), the Center for Disaster and Humanitarian Assistance Medicine (CDHAM), and the Human Performance Laboratory (HPL) all provide research opportunities for students. Finally, research opportunities exist in association with Army, Navy, and Air Force medical research laboratories throughout the world and with foreign military medical research laboratories.
 
Plans for electives must be started at least two months in advance of the proposed activity, particularly if it involves a clinical clerkship or sub-internship where the student will participate in the management of patients. With the exception of established military courses and schools, each medical student desiring an elective must:
 
1.) Provide the department of Military and Emergency Medicine with a copy of a complete, signed USUHS Form 114 "USU FOURTH-YEAR CLERKSHIP/SUBINTERNSHIP DESCRIPTION FORM" that includes the contact information for a point of contact (POC) at the institution where you desire to train. This form must be signed first by the training institution's POC and then by the MEM Course Director.
 
2.)Provide the Department with a copy of the front and signature pages of a complete, signed memorandum of understanding (MOU) between the University and the institution where you plan to train. Mr. Edward Hawkins, the Agreements Manager, can assist you with this. His electronic mail address is Ehawkins@usuhs.mil Travel and billeting arrangements must be made through Ms. Deborah Smith in the Registrar's Office. Her telephone number is (301) 295-9348. Be advised that you will be expected to pay for your travel and billeting during this rotation.
 
All Forms must be submitted to Ms. Mary Johnson, room C1039. Steps 1 and 2 must be completed NOT LATER THAN 30 days before the date you intend to begin training. THERE WILL BE NO GRACE PERIOD--EVEN IN THE EVENT OF A HOLIDAY. Should you fail to meet the deadline, you will be assigned to one of the institutions routinely used for MS IV Emergency Medicine Clerkships.
 
Questions may be directed to Ms. Johnson. Her telephone is (301) 295-3122.
 
Residents in Emergency Medicine
 
Emergency Medicine residents are offered the opportunity to participate in the CCRC elective entitled "EMS in Law Enforcement." The program consists of two phases:
 
1) A one-week Emergency Medical Technician-Tactical (EMT-T) course, and
 
2) An educational, operational, and administrative practicum of at least one month at the CCRC.
 
The resident receives written guidance as well as daily instruction and feedback while contributing to medical training and support programs. Learning by doing under close supervision and through participation in the actual medical support of tactical operations assists the resident in developing operational competence. The program is offered by the Department of Military and Emergency Medicine and the CCRC in fulfillment of commitments to support the medical programs of law enforcement agencies involved in high-risk tactical operations, particularly those involved in counter-narcotics and counter-terrorism efforts.

Continuing Medical Education
 
The Department of Military and Emergency Medicine provides support for continuing medical education programs diversified and far reaching in scope.
 
Within the department, the Grand Rounds lecture series features speakers including prominent leaders and experts in the field of military medicine and other related disciplines. Student and interdepartment faculty attendance is actively encouraged and continuing education credit is available.
 
The department coordinates several continuing education conferences sponsored by the University. Respected speakers are selected from USUHS faculty and other military and civilian institutions. The goal is to provide the highest caliber continuing education to military physicians throughout the world. Annual conferences include Aviation and Emergency Medicine for the Seventh Medical Command in Germany. Ongoing planning for future programs continues. The Readiness, Emergency Medicine Ambulatory Care (REMAC) course was designed by the Military Medicine faculty to provide supplementary continuing education to the smaller facilities around the world. This course is tailored for each facility through the use of a lecture "menu" provided to the interested sites.
 
Members of the Department of Military and Emergency Medicine faculty lecture at residency programs and medical conferences at prestigious institutions throughout the country. The department remains dedicated to supporting the educational activities of the University and other military institutions worldwide.

Contact Information

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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