MILITARY MEDICINE, 180, 4:1,2015
America’s Medical School: 5,000 Graduates Since the “First Class” CDR Anthony R. Artino Jr., MSC USN*; COL William R. Gilliland, MC USA (Ret.)f; David F. Cruess, PhDf; Steven J. Durning, MD, PhD*
ABSTRACT In 1980, the Uniformed Services University of the Health Sciences (USU) graduated its first class of medical students. As a national university intended to produce “career-committed” military officers and future leaders of the Military Health System, USU functions as the service academy for military medicine and public health. More than 40 years after the school's charter and 5,000 graduates since the first class, we describe the original purpose of USU and provide an update on its achievements. In particular, we address the question of the “staying power” of the University’s alumni— the degree to which graduation from the nation’s military medical school is associated with long years of devoted service to military medicine. At a time when the MHS is confronting the challenge of extended deployments, rising health care costs, and a growing array of threats to our nation’s health, we suggest that America needs USU now more than ever.
O n M ay 24, 1980, the U niform ed Services U niversity of the H ealth Sciences (USU) graduated its first class o f m edical students. C oincident with this event, Francis D. M oore, MD, a m em ber o f the U niversity’s B oard o f Regents at the tim e, wrote an editorial entitled “First Class” in which he com m ented on the sch ool’s purpose and early accom plishm ents.1 M oore concluded his editorial by noting that the school’s success w ould be judged by the “staying pow er” o f its graduates. In the au th o r’s w ords, “ if that staying pow er involves long years o f devoted service, the school will have succeeded.” 1 Five thousand graduates later, U SU has m et Dr. M oore’s definition o f success. Forty years ago, the U.S. m ilitary faced a severe physician shortage as a result o f the V ietnam W ar and the end o f the draft. C ongress responded by establishing the H ealth Professions Scholarship Program (HPSP) to gener ate doctors who would typically serve a 4-year obligation, and a national university intended to produce “career-com m itted” m ilitary officers and future leaders o f the M ilitary H ealth Sys tem (M H S).2 Subsequently nam ed for the Louisiana Congress man w ho cham pioned its creation, U S U ’s F. E dw ard H ebert School o f M edicine functions as the service academ y for m ilitary m edicine and public health.
*Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. fF. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Preventive Medicine and Biometrics, Uniformed Ser vices University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814. The authors are U.S. Government employees. Title 17 U.S.C. 105 pro vides that “Copyright protection under this title is not available for any work of the U.S. Government.” Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-14-00562
M ILITARY MEDICINE, Vol. 180, April Supplement 2015
L ocated adjacent to the W alter R eed N ational M ilitary M edical C enter in Bethesda, M D, directly across the street from the N ational Institutes o f H ealth (NIH), USU graduates approxim ately 170 m edical students annually, som ew hat m ore than its originally projected size o f 150.1 T uition is free, and m edical students are com m issioned and paid as Ensigns or Second Lieutenants in the N avy, A rm y, A ir Force, or Public H ealth Service. Like the m ilitary service academ ies, USU graduates incur a service obligation to repay the cost o f their education. Thirty-tw o students w ere adm itted into U S U ’s first class, 9 (28% ) o f w hich w ere ethnic m inorities. Three-fourths had prior m ilitary experience, and 6 (20% ) were academ y gradu ates. In 2012, the 40-year anniversary o f the U niversity’s charter, 43 (25% ) o f our 171 m atriculants w ere ethnic m inor ities, 55 (32% ) had prior m ilitary experience, and 12 (7%) were academ y graduates. The inaugural class had 5 (15% ) wom en; today, w om en com prise approxim ately 30% o f any given class. This percentage is below the m ean for civilian m edical schools but nearly tw ice that o f fem ale com m is sioned officers in the arm ed forces.3 U S U ’s curriculum covers the same content o f civilian m edical schools and m uch more. Because U SU graduates are educated to be m ilitary officers as w ell as doctors, our students receive an additional 600+ hours o f supplem ental instruction in m ilitary history, operational m edicine, tropical m edicine, hum anitarian assistance, ethics, and leadership. At various points in their m ilitary m edical education, students participate in field exercises that em phasize problem solving, team w ork, and m edical decision-m aking under battlefield conditions. W hereas civilian m edical schools often assign students to clerkships in local com m unity hospitals, USU sends its students to m ilitary hospitals across the United States (Fig. 1). D espite the depth and breadth o f m aterial covered over 4 years, U SU students perform well on their licensing exam inations, and 93% go on to achieve board certification, com pared to 88% o f civilian graduates.4 U S U ’s unique em phasis
1
America’s Medical School: 5,000 Graduates Since the "First Class"
USU Clinical Clerkship Sites
8
o 0 9 0
© 0
FIGURE 1.
© ®
©
1 TnplerArmy Medical Center, Honolulu. Hi 2 Naval Medical Cooler. San Diego. CA 3. Naval Hospital, Camp Pendleton, CA 4. David Grant USAF Medical Center, Travis AFB. CA 5. Madigan Army Medical Center, Tacoma, WA 6 Naval Hospital, Bremerton, WA 7 Mike O'CaDaghan Federal Medical Center. Nellis AFB. NV 8. San Antonio Military Medical Center, San Antonio, TX 9. Damall Army Medical Center. Fori Hood. TX 10. 55th Medical Group, Offut AFB, NE 11 375th Medical Group. Scott AFB. IL 12 Wright Patterson Medical Center. Whght-Patterson AFB, OH 13. Walter Reed National Military Medical Center, Bethesda. MD 14. Washington. DC, VA Medical Center. Washington, DC 15 Psychiatric Institute of Washington. Washington. DC 16 Fort Belvoir Community Hospital, Fort Belvoir. VA 17 Naval Medical Center. Portsmouth, VA 18 Womack Army Medical Center, Fort Bragg, NC 19 Naval Hospital. Camp Lejeune, NC 20 Eisenhower Army Medical Centor. Fort Gordon. GA 21. Martin Army Community Hospital, Fort Benning, GA 22. Naval Hospital, Jacksonville, FL 23. 96lh Medical Group, Eglin AFB. FL 24. Naval Hospital. Pensacola, FL
Clinical clerkship sites utilized by the F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences,
Bethesda, MD.
on military medicine paid off during the recent military con flicts in Iraq and Afghanistan, when our alumni deployed around the world to treat sick and injured service members and countless civilians. Over time, USU expanded its degree offerings to include Masters and Doctorate degrees in the biomedical sciences, public health, clinical psychology, health professions educa tion, and health administration and policy. Twenty years ago, the University launched a Graduate School of Nursing, recently named for the late Senator Daniel K. Inouye. The Armed Forces Radiobiology Research Institute was formally aligned with the University in 2006. A multicampus post graduate dental college was started in 2010. Although research was not envisioned as part of the University’s original mission, it developed naturally to address urgent needs in military readiness and health. Today, USU’s departments and centers conduct high-impact research on traumatic brain injury, post-traumatic stress, combat casualty care, radiological threats, disaster medicine, emerging infec tious diseases, medical education, vaccine development, human performance optimization, and many other topics. The Department of Defense’s investment in research at USU and its other laboratories paid dividends during the recent wars in Iraq and Afghanistan, when the MHS achieved the highest rate of survival from battlefield injury in the history of the world. The value of USU’s science is increasingly recognized by the NIH and other funders. In a recent survey, the University achieved the largest gains in federal funding for research and development of any U.S. institution of higher education, with an 894% increase in federal funding from $12.5 million in 1999 to $124.3 million in 2009.5
2
Has USU met Moore’s definition of “staying power”? Moore postulated that the military would consider the school a success if a large proportion of USU graduates stayed in service 20 years or longer.1 Results from a recent analysis suggest the school has achieved this goal. In the U.S. Navy and Air Force, approximately 45% of USU graduates remain on active duty for at least 20 years.6 This 20-year retention rate compares favorably to the estimated 15% retention rate among HPSP graduates. Altogether, these results support an older Government Accountability Office study, which con cluded that “the longer expected retention of (USU) graduates is consistent with the legislative intent of providing long-term military medical officers.”2 USU was founded as a leadership academy. Since its cre ation, countless USU alumni have held senior positions of clinical and administrative leadership. For example, a 2013 analysis of Navy physicians indicated that although USU graduates represent a consistent 10 to 14% of annual acces sions, USU alumni held 27% of commanding officer and executive officer billets—positions that represent the pinnacle of military medical leadership.7 Moreover, the proportion of Navy leadership positions held by USU graduates has contin ued to trend upward over the last decade.7 More broadly, across the armed services, 27 USU graduates have reached flag rank as generals or admirals, including the recent Surgeon General of the U.S. Air Force, two Deputy Surgeons General, and the Surgeon General of the Canadian Armed Forces. The value of USU alumni to the nation extends beyond their military service. A 2012 study of 2,750 USU graduates revealed that 71% of those who had retired from the military continue to work as civilian doctors in military clinics. Veteran
M IL IT A R Y M E D IC IN E , Vol. 180, April Supplement 2015
America's Medical School: 5,000 Graduates Since the “First Class”
Administration hospitals, and other federal facilities.4 Today, USU alumni practice in all 50 states and overseas. Because “staying power” is an important metric of USU’s success, the University systematically monitors the career trajectories of its graduates through a Long-Term Career Outcome Study (LTCOS).8 The LTCOS has three primary missions: (1) collect and analyze educational data to generate evidence-based evaluations of the school’s success in meeting its educational objectives; (2) generate scientific knowledge that establishes USU as a local, national, and international leader in the field of health professions education; and (3) sup port the translation of research in health professions educa tion into improved policies and practices for the University and its affiliated educational programs (e.g., residencies and research centers). To date, members of the interdisciplinary LTCOS team have published more than 65 manuscripts on topics ranging from the effects of instructional authenticity on medical student learning to the assessment of diagnostic reasoning and clinical performance in residency training. This special issue of Military Medicine represents the “lat est and greatest” from the LTCOS team. The issue is orga nized into the three phases of medical education: “before” medical school, “during” medical school, and “after” medical school. As indicated by the diverse set of studies presented in this issue, the LTCOS has a unique opportunity to answer many challenging questions about medical education and its potential effects on clinical outcomes. Because the MHS is a closed health care system, we can monitor the progress of our graduates, and their impact on patient care, for long periods of time.8 The insights produced by this work have the poten tial to inform medical education in civilian as well as military medical centers— a benefit Moore did not envision. Forty years and 5,000 graduates later, USU has achieved its founders’ vision of a university dedicated to producing high-quality, career-committed physicians for the uniformed
MILITARY MEDICINE, Vol. 180, April Supplement 2015
services. Our graduates and faculty have not only made impor tant contributions to clinical practice but medical science as well. At a time when the MHS is confronting the challenge of extended deployments, rising health care costs, and a grow ing array of threats to our nation’s health, America needs USU now more than ever. ACKNOWLEDGMENTS The authors would like to thank Dr. Arthur L. Kellermann, Dean of the F. Edward Hebert School of Medicine, for his thoughtful reviews and sug gested revisions to earlier versions of this manuscript.
REFERENCES 1. Moore FD: First class. N Engl J Med 1980; 302: 1202-3. 2. Government Accountability Office (GAO); Military Physicians: DOD’s Medical School and Scholarship Program. GAO/HEHS-95-244. Washington, DC, GAO. 1995. Available at http://www.gpo.gov/fdsys/pkg/GAOREPORTSHEHS-95-244/content-detail.html; accessed November 17. 2014. 3. Office of the Under Secretary of Defense, Personnel and Readiness: Population Representation in the Military Services: Fiscal year 2010. Washington. DC, Department of Defence, 2010. Available at http:// prhome.defense.gov/RFM/MPP/ACCESSION%20POLICY/PopRep2010/; accessed November 17. 2014. 4. DeZee KJ, Durning SJ, Dong T, et al: Where are they now? USU School of Medicine graduates after their military obligation is complete. Mil Med 2012; 177: 68-71. 5. The Chronicle of Higher Education: Federal Science Funds Doubled at 28 Colleges, August 21, 2011. Available at http://chronicle.com/article/ Federal-Science-Funds-Doubled/128258/; accessed November 17. 2014. 6. Dietrich EJ, Kimsey L. Reamy BV, Artino AR: The Uniformed Services University of the Health Sciences: developing career-committed military medical officers. Mil Med 2015; 180(4 Suppl): 172. 7. Dietrich EJ, Kimsey L, Artino AR. The Uniformed Services University of the Health Sciences: a leadership academy for military medical officers in the U.S. Navy. Mil Med 2015; 180(4 Suppl): 171. 8. Durning SJ, Artino AR, Dong T. et al: The Long-Term Career Outcome Study (LTCOS): what have we learned from 40 years of military medical education and where should we go? Mil Med 2012; 177: 81-6.
3
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
America’s Medical School: 5,000 Graduates Since the “First Class” CDR Anthony R. Artino Jr., MSC USN*; COL William R. Gilliland, MC USA (Ret.)f; David F. Cruess, PhDf; Steven J. Durning, MD, PhD*
ABSTRACT In 1980, the Uniformed Services University of the Health Sciences (USU) graduated its first class of medical students. As a national university intended to produce “career-committed” military officers and future leaders of the Military Health System, USU functions as the service academy for military medicine and public health. More than 40 years after the school's charter and 5,000 graduates since the first class, we describe the original purpose of USU and provide an update on its achievements. In particular, we address the question of the “staying power” of the University’s alumni— the degree to which graduation from the nation’s military medical school is associated with long years of devoted service to military medicine. At a time when the MHS is confronting the challenge of extended deployments, rising health care costs, and a growing array of threats to our nation’s health, we suggest that America needs USU now more than ever.
O n M ay 24, 1980, the U niform ed Services U niversity of the H ealth Sciences (USU) graduated its first class o f m edical students. C oincident with this event, Francis D. M oore, MD, a m em ber o f the U niversity’s B oard o f Regents at the tim e, wrote an editorial entitled “First Class” in which he com m ented on the sch ool’s purpose and early accom plishm ents.1 M oore concluded his editorial by noting that the school’s success w ould be judged by the “staying pow er” o f its graduates. In the au th o r’s w ords, “ if that staying pow er involves long years o f devoted service, the school will have succeeded.” 1 Five thousand graduates later, U SU has m et Dr. M oore’s definition o f success. Forty years ago, the U.S. m ilitary faced a severe physician shortage as a result o f the V ietnam W ar and the end o f the draft. C ongress responded by establishing the H ealth Professions Scholarship Program (HPSP) to gener ate doctors who would typically serve a 4-year obligation, and a national university intended to produce “career-com m itted” m ilitary officers and future leaders o f the M ilitary H ealth Sys tem (M H S).2 Subsequently nam ed for the Louisiana Congress man w ho cham pioned its creation, U S U ’s F. E dw ard H ebert School o f M edicine functions as the service academ y for m ilitary m edicine and public health.
*Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. fF. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Preventive Medicine and Biometrics, Uniformed Ser vices University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814. The authors are U.S. Government employees. Title 17 U.S.C. 105 pro vides that “Copyright protection under this title is not available for any work of the U.S. Government.” Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-14-00562
M ILITARY MEDICINE, Vol. 180, April Supplement 2015
L ocated adjacent to the W alter R eed N ational M ilitary M edical C enter in Bethesda, M D, directly across the street from the N ational Institutes o f H ealth (NIH), USU graduates approxim ately 170 m edical students annually, som ew hat m ore than its originally projected size o f 150.1 T uition is free, and m edical students are com m issioned and paid as Ensigns or Second Lieutenants in the N avy, A rm y, A ir Force, or Public H ealth Service. Like the m ilitary service academ ies, USU graduates incur a service obligation to repay the cost o f their education. Thirty-tw o students w ere adm itted into U S U ’s first class, 9 (28% ) o f w hich w ere ethnic m inorities. Three-fourths had prior m ilitary experience, and 6 (20% ) were academ y gradu ates. In 2012, the 40-year anniversary o f the U niversity’s charter, 43 (25% ) o f our 171 m atriculants w ere ethnic m inor ities, 55 (32% ) had prior m ilitary experience, and 12 (7%) were academ y graduates. The inaugural class had 5 (15% ) wom en; today, w om en com prise approxim ately 30% o f any given class. This percentage is below the m ean for civilian m edical schools but nearly tw ice that o f fem ale com m is sioned officers in the arm ed forces.3 U S U ’s curriculum covers the same content o f civilian m edical schools and m uch more. Because U SU graduates are educated to be m ilitary officers as w ell as doctors, our students receive an additional 600+ hours o f supplem ental instruction in m ilitary history, operational m edicine, tropical m edicine, hum anitarian assistance, ethics, and leadership. At various points in their m ilitary m edical education, students participate in field exercises that em phasize problem solving, team w ork, and m edical decision-m aking under battlefield conditions. W hereas civilian m edical schools often assign students to clerkships in local com m unity hospitals, USU sends its students to m ilitary hospitals across the United States (Fig. 1). D espite the depth and breadth o f m aterial covered over 4 years, U SU students perform well on their licensing exam inations, and 93% go on to achieve board certification, com pared to 88% o f civilian graduates.4 U S U ’s unique em phasis
1
America’s Medical School: 5,000 Graduates Since the "First Class"
USU Clinical Clerkship Sites
8
o 0 9 0
© 0
FIGURE 1.
© ®
©
1 TnplerArmy Medical Center, Honolulu. Hi 2 Naval Medical Cooler. San Diego. CA 3. Naval Hospital, Camp Pendleton, CA 4. David Grant USAF Medical Center, Travis AFB. CA 5. Madigan Army Medical Center, Tacoma, WA 6 Naval Hospital, Bremerton, WA 7 Mike O'CaDaghan Federal Medical Center. Nellis AFB. NV 8. San Antonio Military Medical Center, San Antonio, TX 9. Damall Army Medical Center. Fori Hood. TX 10. 55th Medical Group, Offut AFB, NE 11 375th Medical Group. Scott AFB. IL 12 Wright Patterson Medical Center. Whght-Patterson AFB, OH 13. Walter Reed National Military Medical Center, Bethesda. MD 14. Washington. DC, VA Medical Center. Washington, DC 15 Psychiatric Institute of Washington. Washington. DC 16 Fort Belvoir Community Hospital, Fort Belvoir. VA 17 Naval Medical Center. Portsmouth, VA 18 Womack Army Medical Center, Fort Bragg, NC 19 Naval Hospital. Camp Lejeune, NC 20 Eisenhower Army Medical Centor. Fort Gordon. GA 21. Martin Army Community Hospital, Fort Benning, GA 22. Naval Hospital, Jacksonville, FL 23. 96lh Medical Group, Eglin AFB. FL 24. Naval Hospital. Pensacola, FL
Clinical clerkship sites utilized by the F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences,
Bethesda, MD.
on military medicine paid off during the recent military con flicts in Iraq and Afghanistan, when our alumni deployed around the world to treat sick and injured service members and countless civilians. Over time, USU expanded its degree offerings to include Masters and Doctorate degrees in the biomedical sciences, public health, clinical psychology, health professions educa tion, and health administration and policy. Twenty years ago, the University launched a Graduate School of Nursing, recently named for the late Senator Daniel K. Inouye. The Armed Forces Radiobiology Research Institute was formally aligned with the University in 2006. A multicampus post graduate dental college was started in 2010. Although research was not envisioned as part of the University’s original mission, it developed naturally to address urgent needs in military readiness and health. Today, USU’s departments and centers conduct high-impact research on traumatic brain injury, post-traumatic stress, combat casualty care, radiological threats, disaster medicine, emerging infec tious diseases, medical education, vaccine development, human performance optimization, and many other topics. The Department of Defense’s investment in research at USU and its other laboratories paid dividends during the recent wars in Iraq and Afghanistan, when the MHS achieved the highest rate of survival from battlefield injury in the history of the world. The value of USU’s science is increasingly recognized by the NIH and other funders. In a recent survey, the University achieved the largest gains in federal funding for research and development of any U.S. institution of higher education, with an 894% increase in federal funding from $12.5 million in 1999 to $124.3 million in 2009.5
2
Has USU met Moore’s definition of “staying power”? Moore postulated that the military would consider the school a success if a large proportion of USU graduates stayed in service 20 years or longer.1 Results from a recent analysis suggest the school has achieved this goal. In the U.S. Navy and Air Force, approximately 45% of USU graduates remain on active duty for at least 20 years.6 This 20-year retention rate compares favorably to the estimated 15% retention rate among HPSP graduates. Altogether, these results support an older Government Accountability Office study, which con cluded that “the longer expected retention of (USU) graduates is consistent with the legislative intent of providing long-term military medical officers.”2 USU was founded as a leadership academy. Since its cre ation, countless USU alumni have held senior positions of clinical and administrative leadership. For example, a 2013 analysis of Navy physicians indicated that although USU graduates represent a consistent 10 to 14% of annual acces sions, USU alumni held 27% of commanding officer and executive officer billets—positions that represent the pinnacle of military medical leadership.7 Moreover, the proportion of Navy leadership positions held by USU graduates has contin ued to trend upward over the last decade.7 More broadly, across the armed services, 27 USU graduates have reached flag rank as generals or admirals, including the recent Surgeon General of the U.S. Air Force, two Deputy Surgeons General, and the Surgeon General of the Canadian Armed Forces. The value of USU alumni to the nation extends beyond their military service. A 2012 study of 2,750 USU graduates revealed that 71% of those who had retired from the military continue to work as civilian doctors in military clinics. Veteran
M IL IT A R Y M E D IC IN E , Vol. 180, April Supplement 2015
America's Medical School: 5,000 Graduates Since the “First Class”
Administration hospitals, and other federal facilities.4 Today, USU alumni practice in all 50 states and overseas. Because “staying power” is an important metric of USU’s success, the University systematically monitors the career trajectories of its graduates through a Long-Term Career Outcome Study (LTCOS).8 The LTCOS has three primary missions: (1) collect and analyze educational data to generate evidence-based evaluations of the school’s success in meeting its educational objectives; (2) generate scientific knowledge that establishes USU as a local, national, and international leader in the field of health professions education; and (3) sup port the translation of research in health professions educa tion into improved policies and practices for the University and its affiliated educational programs (e.g., residencies and research centers). To date, members of the interdisciplinary LTCOS team have published more than 65 manuscripts on topics ranging from the effects of instructional authenticity on medical student learning to the assessment of diagnostic reasoning and clinical performance in residency training. This special issue of Military Medicine represents the “lat est and greatest” from the LTCOS team. The issue is orga nized into the three phases of medical education: “before” medical school, “during” medical school, and “after” medical school. As indicated by the diverse set of studies presented in this issue, the LTCOS has a unique opportunity to answer many challenging questions about medical education and its potential effects on clinical outcomes. Because the MHS is a closed health care system, we can monitor the progress of our graduates, and their impact on patient care, for long periods of time.8 The insights produced by this work have the poten tial to inform medical education in civilian as well as military medical centers— a benefit Moore did not envision. Forty years and 5,000 graduates later, USU has achieved its founders’ vision of a university dedicated to producing high-quality, career-committed physicians for the uniformed
MILITARY MEDICINE, Vol. 180, April Supplement 2015
services. Our graduates and faculty have not only made impor tant contributions to clinical practice but medical science as well. At a time when the MHS is confronting the challenge of extended deployments, rising health care costs, and a grow ing array of threats to our nation’s health, America needs USU now more than ever. ACKNOWLEDGMENTS The authors would like to thank Dr. Arthur L. Kellermann, Dean of the F. Edward Hebert School of Medicine, for his thoughtful reviews and sug gested revisions to earlier versions of this manuscript.
REFERENCES 1. Moore FD: First class. N Engl J Med 1980; 302: 1202-3. 2. Government Accountability Office (GAO); Military Physicians: DOD’s Medical School and Scholarship Program. GAO/HEHS-95-244. Washington, DC, GAO. 1995. Available at http://www.gpo.gov/fdsys/pkg/GAOREPORTSHEHS-95-244/content-detail.html; accessed November 17. 2014. 3. Office of the Under Secretary of Defense, Personnel and Readiness: Population Representation in the Military Services: Fiscal year 2010. Washington. DC, Department of Defence, 2010. Available at http:// prhome.defense.gov/RFM/MPP/ACCESSION%20POLICY/PopRep2010/; accessed November 17. 2014. 4. DeZee KJ, Durning SJ, Dong T, et al: Where are they now? USU School of Medicine graduates after their military obligation is complete. Mil Med 2012; 177: 68-71. 5. The Chronicle of Higher Education: Federal Science Funds Doubled at 28 Colleges, August 21, 2011. Available at http://chronicle.com/article/ Federal-Science-Funds-Doubled/128258/; accessed November 17. 2014. 6. Dietrich EJ, Kimsey L. Reamy BV, Artino AR: The Uniformed Services University of the Health Sciences: developing career-committed military medical officers. Mil Med 2015; 180(4 Suppl): 172. 7. Dietrich EJ, Kimsey L, Artino AR. The Uniformed Services University of the Health Sciences: a leadership academy for military medical officers in the U.S. Navy. Mil Med 2015; 180(4 Suppl): 171. 8. Durning SJ, Artino AR, Dong T. et al: The Long-Term Career Outcome Study (LTCOS): what have we learned from 40 years of military medical education and where should we go? Mil Med 2012; 177: 81-6.
3
Copyright of Military Medicine is the property of AMSUS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
