AAMC Reporter: July 2007

Viewpoint:
The Present and Future of Military Health Education

S. Ward Casscells, M.D., Assistant Secretary of Defense for Health Affairs, U.S. Department of Defense

Shortly after my appointment as assistant secretary of defense for health affairs, I was asked where I would focus my attention. In response, I noted that even as we resolved problems at Walter Reed Army Medical Center and did all we could to take the best possible care of our troops and their families, we must not neglect one of our most important assets: the Uniformed Services University of the Health Sciences (USUHS). The university, located in Bethesda, Md., is a traditional U.S. academic health center with a unique emphasis on educating the next generation of health care providers and researchers in military medicine, humanitarian efforts including natural disaster responses, emerging infectious diseases, and other public health emergencies.

Congress established the university in 1972 under the Health Professions Revitalization Act. Nearly 30 years earlier, Congressman F. Edward Hébert (D-La.) first advocated the concept of a "West Point for doctors" to address a shortage of career uniformed medical officers. It was Hébert's vision and tenacity that eventually led to the founding of this military medical academy. In 1983, Congress honored Hébert by officially naming USUHS's school of medicine after him.

Over the years, USUHS has expanded its programs to meet the evolving educational requirements of the uniformed services. Today, the university offers a number of graduate degree programs in the biomedical sciences. Master's degrees are offered in areas such as public health and tropical medicine and hygiene, and Ph.D. degrees are offered in disciplines like zoology, pathology, and neuroscience. Most of these programs are open to civilian as well as military students.

While approximately 18 percent of all new physicians entering the military today are USUHS alumni, they have a disproportionate impact on military medical leadership by dint of their specialized training and preparation as leaders. One-fourth of all medical officers currently on active duty are USUHS graduates. Since the first class graduated in 1980, USUHS alumni have become integral to the military health system and public health medicine, and many are in significant leadership positions. Whether serving as a member of the presidential medical team in the White House, leading emergency medical assistance teams in response to terrorism, or providing care in support of military operations such as those in Iraq, Afghanistan, or the Horn of Africa, USUHS alumni have a direct impact on the future of military medicine and public health and are a daily reflection of the high-quality education they receive.

The university curriculum is virtually indistinguishable from its civilian counterparts; however, it incorporates real-life lessons learned from wars, conflicts, and natural disasters into classroom learning and field exercises so that students are better prepared to "practice good medicine in bad places" as uniformed physicians.Many of the faculty members have direct military experiences that extend this education further.

The military health system is facing the challenges of a nation at war, and many of these challenges are being met through the research and education efforts of USUHS. The university is engaged in basic and applied research in areas such as traumatic brain injury and post-traumatic stress disorder, and in supporting the continuum of care from battlefield to rehabilitation to return to the workforce. Researchers and clinicians are also moving forward on advancing deployment mental health for troops and their families before, during, and after deployment.

The university's school of medicine includes one of the nation's largest preventive medicine programs. The department's unique program includes research on infectious disease, tropical medicine, and vaccine development. The faculty is nationally recognized for its smoking and obesity research programs. The university values the fundamental role of health promotion and disease and injury prevention in optimizing military readiness in its mantra "prevention as the first line of defense."

While USUHS continues to educate and train the essential health care providers for today's challenges, it also is deeply engaged in envisioning its future. The university's leadership is working closely with academic medicine and with defense department leaders to redefine its role as a leader in not simply military health care but also as a key collaborator in bringing together the resources of the federal government to improve health care research and delivery to our nation's warriors and our nation at large.

With the president's recommendation, Congress has directed the Department of Defense to create a state-of-the-art academic health center on the grounds of the National Naval Medical Center that would serve the military health system. Combining USUHS,Walter Reed Army Medical Center, the naval medical center, and elements of the Armed Forces Institute of Pathology into the Walter Reed National Military Medical Center (WRNMMC) will create a world-class academic medical system that delivers the highest-quality care, distinguished health education, and exemplary clinical and global research.

The centralized, expanded capabilities of the WRNMMC will offer students, residents, and fellows the opportunity to train as they will deploy: in a multiservice environment, emphasizing and capitalizing upon the strengths and traditions of each branch of military service. In addition, the location of the federal flagship research institution, the National Institutes of Health, directly across the street provides a unique and extraordinary opportunity for federal government agencies and departments to collaborate on biomedical research, patient care, and health profession education. This vision of a unified federal effort to advance health promotion and disease prevention through fundamental and clinical research, education, and patient care is one that I hope to help nurture into fruition.

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