Home Government Affairs Newsroom Meetings Publications	Shopping Cart Site Map

December 2001 Reporter

Annual Meeting Speakers Connect Past with Future

Nobel Laureates Speculate on Future of Medical Education

Women Physicians and the Pioneers who Followed Them

On the Home Front: Military Med Students

A Word from the President

Reporter Archive

AAMC Newsroom

Managing Editor
Scott Harris
sharris@aamc.org

Staff Writer
Elissa Fuchs
efuchs@aamc.org

On the Home Front: Military Med Students Find New Resonance in Their Studies

By Martha Frase-Blunt,
Special to the AAMC Reporter

usuhs students

Fourth-year USUHS students take part in "Bushmaster," a week-long exercise in which they apply their medical school training to combat scenarios, including mass and chemical warfare. Photo by Air Force Master Sergeant Raul Navas

A large number of medical students at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md., served in the Army, Navy, Air Force, or Marines before enrollment. But unlike their comrades in the National Guard and reserves who are being called up to the front lines, they will remain in place at the nation's only federal medical school. Learning, for them, constitutes "active duty."

Only after serving their internship year are military physicians-in-training able to break from their education to take an operational role in the military. Those who do typically return to complete their residency within a few years.

"Half of the residents who take these breaks for an operational assignment served in the military before they came to medical school, and many want to go back to their units for a time before completing their specialty training," says Col. (Ret.) Craig Llewellyn, M.D., director of the USUHS Center for Disaster and Humanitarian Assistance Medicine and former chair of the Department of Military and Emergency Medicine. "They wind up with a unique mix of field medical experience and specialty training."

It's not clear whether more than the usual number of residents will decide to interrupt their training to serve in America's war on terrorism - or even if it will be encouraged. The Army, for example, is scaling back on offering operational assignments to residents, opting to place more experienced medical personnel in the field of battle. Nevertheless, there is little doubt that today's military medical students and residents will see plenty of action when their training is complete. "Our grads are going to be on active duty for a minimum of 10 years, giving them a better than 90 percent chance of being deployed," reports Dr. Llewellyn. "And almost all USUHS graduates stay on after their obligated service commitment. They become the 'core of the corps.'"

Hospital Corpsman 2nd Class Isaac Jenkins treats a patient during a Bushmaster exercise scenario. Photo by Air Force Master Sergeant Raul Navas

Learning as Usual

Large-scale terrorist attacks and biological intimidation campaigns on American soil have sent shockwaves of change rippling through every layer of society. Each unexpected new challenge requires an adjustment in preconceptions and contains a practical lesson for the future.

But at USUHS, it's learning as usual. Students have been explicitly trained to provide a medical response to terrorism scenarios like the ones that are playing out in the United States and abroad today. Despite the fact that future graduates will undoubtedly be engaged in the new war on terrorism, "we won't have to make major modifications in the curriculum, since from the beginning, even in the basic sciences, we integrate military medical knowledge into the classic medical coursework," says Dr. Llewellyn.

Students are trained to treat victims of terrorism at home and of battle abroad. "They are familiar with the difference between casualties in terrorist attacks and military attacks," Dr. Llewellyn says. For example, he explains, in the aftermath of large explosions as in Oklahoma City or building collapses like the World Trade Center, there is rarely a demand for large-scale trauma care. Most victims die; survivors generally suffer only minor injuries and stress problems. "Instead, medical facilities are flooded by what we call the 'worried well,' and they must be treated. Medical personnel trained in civilian trauma - which typically involves gunshot wounds and motor vehicle accidents - are not always aware of the differing fallout of a terrorist attack."

Military medical students may be prepared intellectually and practically - but psychologically? "Medical students are an altruistic group," says Dr. Llewellyn. "Confronting the enormous loss of life on Sept. 11 and the fact that there are people in the world who might make a premeditated decision to destroy thousands of innocent lives is difficult for young people in general, but more acutely so for those in the healing arts. Students with prior military service - whether at an academy, in ROTC, or in an active unit - have a heightened awareness of the significant risks that follow an act of terrorism."

Certainly not every student entering USUHS envisioned being on the front lines one day. "The military is just a great place to start a career and get an education," says Dr. Llewellyn. "Six or eight years ago, most reservists probably thought there was little risk of being called to active duty, but Somalia and Bosnia changed that. The same holds true for military medical officers. They understand now that their career of practicing in military medical centers might be put on the back burner while they do troop military medicine. Our curriculum is preparing them for this."

'Something Bigger Than Ourselves'

Second Lieutenant Ramey Wilson is a fourth-year medical student at USUHS. Before that, the West Point graduate was a field artillery officer for the U.S. Army's 82nd Airborne Division at Ft. Bragg. The unfolding events on the morning of Sept. 11 struck him as "very surreal. It reminded me of the time I was a freshman at West Point in basic training. Here I was again, in school during a war, fresh from training but unable to use my skills. People I care about are going over there now."

However, Wilson's feelings about his current situation are decidedly mixed. Married with his first child on the way, he says his wife is relieved that for now he is in school and will do an internship next year. And he is clear that as far as learning medicine is concerned, there is no place he would rather be.

"I really enjoy being in the Army, and I believe it is one of the best places to practice medicine," Wilson says. "In the Army medical system, the bottom line isn't money. There are no insurers or third-party payers looking over your shoulder. Delivering excellent health care is the No. 1 priority."

Wilson has long planned to specialize in internal medicine, and that has not changed - nor has his hope to serve in an operational area rather than subspecialize or serve in a military hospital or clinic. "I like working with combat troops. As an internist you can really make a difference - not just treating troops in combat and accidents but helping them stay healthy. A lot of military medicine is preventive medicine. It's about keeping troops fit and fighting."

His moment is drawing closer. "Every fourth-year is starting to think that in just six months, we'll be physicians. That's exciting, and scary. Those feelings are heightened now that we are a nation at war. We are part of something bigger than ourselves."

'No Second Thoughts'

Leah Strobel, 20, is a 2nd Lieutenant in the U.S. Army. The University of Florida graduate began her military career just months ago when she enrolled as a first-year student at USUHS, but military service stretches far into her family tree, back to the Civil War. Strobel always hoped to be a doctor and found a way to combine that with her cherished family tradition.

"There is no better place for me to be than USUHS," she says. "What we are learning right now is applicable to what is occurring in the world." Strobel says that while she never envisioned the magnitude of the events that occurred on Sept. 11, "there are no second thoughts."

Strobel is particularly gratified by the sense of camaraderie she feels at the school. "Unlike a civilian medical school, once we graduate and leave, we will see each other again. We may end up serving together or protecting each other's families. It's understood that the classmate sitting next to you may save your life, so everyone wants you to succeed."

Far from being competitive and cutthroat, she explains, her fellow students go out of their way to help each other learn. "We have 'action officers' and an academic rep for each class, who pull together review materials, share notes, and set up tutoring." Recently, to prepare the class for an anatomy exam, action officers put together a practice session at the morgue to help first-years identify more than 300 body parts and structures, says Strobel.

Although she has just begun her medical training, Strobel is considering a specialty in trauma surgery. "I would like to be in an operational unit. It would be an honor to serve and support soldiers on the front line." It's also one of the more challenging jobs for a military physician. "What occurs on the front lines is just incredible. The resources are fewer. It's not as sterile as a hospital. You don't have access to the same diagnostic tools - to the MRIs and the immediate labs. It's 'survival medicine.' You have to have tremendous confidence in your own abilities, and in your comrades'."

September 11 has only reinforced Strobel's desire to serve. "It has helped me envision where I'll be in the future."

'War Is No Longer Abstract'

Ensign Tim Quast's battle against cancer shaped his love for medicine. After defeating the disease as an ROTC student at Tulane University, he spent 10 years in the Navy. During that time, while working a desk job and awaiting orders on a ship, the cancer returned. "In the nine months I spent recovering, I had a chance to see doctors at work up close," says the fourth-year USUHS medical student. "Many were inspiring. Others lacked something in their bedside manner. I found myself thinking, 'I could do better.'"

Quast never gave up his desire to go to sea, and he now knows that will be in his future in just one year. "I'm looking forward to being deployed. Other students want to be stationed in one place, but I want to be a doc in an operational role. I have a lot of friends serving in the Persian Gulf now, and I want to be with them."

He is confident that following his internship next year he will be "out on a ship somewhere," since the Navy currently deploys some 80 percent of residents who have finished their internships. Medical care on a Navy ship involves preventive medicine but is much like an ER in other ways. "It's an industrial environment, so you see electrical shock, injuries due to heavy equipment, etc.," explains Quast. And often as the only medical professional on board, a ship's doctor has absolute responsibility. "There is no insulation, like you have as an intern. You are in charge of the health of the entire crew, and are the one who must make the decision to get the ship into port if a crew member is dangerously hurt or ill. You may have to change the entire operational mission."

As a husband and the father of a young child, Quast is troubled by the events of Sept. 11. But they galvanized him as a soldier. "It has brought the things I am studying into sharp focus," he says. One change he has made is deciding to earn a diploma in the medical care of catastrophes - an additional medical qualification for treating mass casualties. "War is no longer abstract," he affirms.