MILITARY MEDICINE, 180, 4:109, 2015
Career Accomplishments of Uniformed Services University of the Health Sciences Medical Graduates: Classes 1980-2001 COL William R. Gilliland, MC USA (Ret.)*; Ting Dong, PhDf; CDR Anthony R. Artino Jr., MSC USNf; Col John E. McManigle, USAF MC (Ret.)f; LTC Aaron Saguil, MC USA*; David F. Cruess, PhD§; Sharon HollandH; Steven J. Durning, MD, PhD f
ABSTRACT Purpose: To report accomplishments of graduates of the F. Edward Hebert School of Medicine who have left, retired, or are near the end of their uniformed career in several professional domains: military career milestones, medical professional education, academic landmarks, and leadership. Methods: This study utilized an earlier questionnaire that was modified to capture additional career landmarks and improve the clarity of several items. The modified survey was sent electronically to alumni who graduated from 1980-2001 in March, 2012. Results: The questionnaire was sent to 2,825 alumni for whom we had e-mail addresses. We estimate that we reached 2,400 alumni. A total of 1,189 alumni returned the questionnaire, yielding an estimated response rate of 50%. For this cohort, the board certification was 95%, over 20% obtained additional degrees, 92.8% had worked as a full-time physician, nearly twothirds had deployed for combat, 13.9% had received the Legion of Merit, and 68.6% had published at least one peerreviewed manuscript. Conclusion: Many accomplishments including board certification rates, deployment experience, academic and military leadership positions, military awards, promotion rates, and academic medicine contributions are indicators that USU is continuing to meet its unique mission.
INTRODUCTION The Uniformed Services University (USU) of the Health Sciences F. Edward Hebert School of Medicine is the nation’s only federal medical school. It was established by Congress in 1972 and was charged with educating students to become physicians committed to military careers,1 individ uals willing to lead the military health care system and serve our nation for a prolonged length of time. Tracking the professional accomplishments of military physicians is somewhat easier than tracking those of their civilian counterparts. Military physicians are expected to meet promotion standards, earn awards, and gain increasing levels of leadership responsibility within a closed health delivery and education system. As a result, USU is singularly positioned to track military career landmarks as well as other landmarks relevant to civilian medical careers. Since USU
*F. Edward Hebert School of Medicine, Uniformed Services Uni versity of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. tDepartment of Medicine, Uniformed Services University of the Health Sciences,4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Military and Emergency Medicine, Uniformed Ser vices 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. || Office of External Affairs, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U. S. Government. doi: 10.7205/MILMED-D-14-00556
MILITARY MEDICINE, Vol. 180, April Supplement 2015
graduates are uniquely expected to engage in Military Health System (MHS)-specific activities such as deployments and humanitarian assistance missions, it becomes important to track long-term accomplishments to inform the military lead ership and the civilian medical community as to whether USU is generating career professionals. Given the United States’ increasing national debt and other programs by which the uniformed service can access physicians, it is important that USU demonstrate that it is meeting not only the mandate to produce career uniformed physicians but also that gradu ates may have additional “value added” skills compared to other physician accession programs. In 2008, we reported on longer term outcomes for the classes of 1980-1989.2 In this article, we include data on another 10 years of graduates who are nearing the end of their military careers. We did this to capture outcomes that may not have been reported in the last survey since some of the graduates would have only been mid-career when it was administered for the classes of 1980-1989. We also include additional items to reflect leadership roles in the civilian sec tor. As such, the purpose of this study is to provide data on USU graduates for the first 20 years of the school’s 40-year existence. As in our prior study, we collected data on military career milestones (deployments, humanitarian assistance mis sions, military decorations and awards, military leadership roles and rank), medical professional education (completion of residency and fellowship), and academic landmarks (aca demic rank, grants, peer-reviewed publications). These mile stones were chosen to measure both conventional outcomes associated with successful medical careers but also highlight military unique outcome measurements given the dual nature of our graduates (physician-officers).
109
Career Accomplishments ofU SU o f the Health Sciences Medical Graduates
METHODS
TABLE I.
Positions Held Over the Course of Entire Career
P a rtic ip a n ts a n d P ro c e d u re s
This study was part of the larger Long-Term Career Outcome Study (LTCOS) conducted at USU which has USU Institu tional Review Board approval to administer the survey used in this article. The questionnaire was initially distributed electronically to alumni who graduated between 1980 and 2001. The survey was administered via PHP Surveyor in March 2012. To increase the response rate, we sent several reminders, both paper-based and electronically, and reached out to alumni through USU’s Alumni Affairs Office. We completed data collection in December, 2013.
C aree r L andm ark
N
%
E d u catio n al and R esearch R oles C linical C lerk sh ip or M edical School C o u rse D irecto r
155
13.0
R esid en cy P rogram D irecto r
138
11.6
F ello w sh ip D irecto r
54
4.5
R esearch D irecto r
66
5.6
M T F R oles 1103
92.8
C h ie f o f S ervice
739
62.2
C h ie f/D ire c to r o f a C linic
358
30.1
D e p artm e n t C h air/C h ief/H ea d at a M edical
380
32.0
180
15.1
230
19.3
206
17.3
54
4.5 12.1
F u ll-T im e C linician
C en ter or C om m u n ity H ospital W ithout a R esidency P rogram in Y o u r D epartm ent D ep artm en t C h air/C h ief/H ea d at a M edical C en ter o r C o m m u n ity H ospital W ith a R esidency
Q u e s tio n n a ire D e v e lo p m e n t
The questionnaire was developed through a vetting process involving LTCOS members from multiple basic science and clinical departments; the school’s Executive Curriculum Committee; and the Associate Dean of Medical Education. Some of the questions in this survey were modified from the one used in the prior survey,2 which were modified to capture additional career landmarks and improve the clarity of sev eral items.
P rogram in Y o u r D epartm ent S ervice C h ie f/D ire c to r/H e ad o f M ultid iscip lin ary S erv ice at a M edical C en ter o r C om m u n ity H ospital M ilitary T re a tm e n t F acility C h ie f o f the M edical S ta ff D eputy M ilitary T rea tm e n t F acility O p eratio n al A ssignm ents B rigade Surgeon
144
D ivisio n S urgeon
59
5.0
S quadron C o m m a n d er
69
5.8
S enior M edical O fficer
274
23.0
C o m m an d A ssignm ents 204
17.2
F ree-S tan d in g C linic C o m m a n d in g O fficer
73
6.1
B ed d ed C o m m u n ity -S iz ed H ospital
34
2.9
C om m an d in g O fficer
RESULTS The survey questionnaire was distributed via e-mail to the 2,825 alumni for which we had e-mail addresses. Although we do not have an exact denominator for the alumni group since some of the alumni to whom the e-mail was sent may have been deceased, ill, or changed e-mail addresses, we estimate that we reached approximately 2,400 alumni with active e-mail addresses. A total of 1,189 alumni completed and returned the questionnaire, yielding an estimated response rate of 50%. Of these respondents. 196 were female (16.5%) and 909 were male (83.5%), which is also similar the sex ratio of the classes studied. To assess the representativeness of our sample, we compared participants with nonparticipants on cumulative medical school GPA and found no significant dif ference between the groups (t = 1.57, df = 2,958, P = 0.12). The average GPA of the participants was 3.13 (SD = 0.36) and the average GPA of the nonparticipants was 3.11 (SD = 0.36). M ilita ry C a r e e r M ile s to n e s
Table I displays military landmarks that are grouped into several categories: leadership positions, military awards and medals, and participation in deployments and/or humanitar ians missions. Military careers typically involve increasing levels of responsibility and job complexity in conjunction with increasing rank. The medical corps is no exception to this general rule. Almost all respondents (93%) reported being full-time clinicians at some point in their career. A significant percentage of respondents reported serving as edu cational leaders such as a clerkship or course director (13.0%), residency director (11.6%), or fellowship director
110
C o m m an d in g O fficer M edical C en ter C om m an d in g C en ter
16
1.3
S quadron or S im ilar S ervice-S pecific
72
6.1
83
7.0
31
2.6
O rg an izatio n al C o m m a n d in g O fficer D e p lo y ed /D e p lo y a b le M ed ic a l U nit C o m m a n d in g O fficer O ther
(4.5%). Examples of the leadership roles in military treatment facilities (MTFs) served by the respondents included chief of service (62.2%), director of a clinic (30.1%), and chief of medical staff (17.3%). USU graduates also reported serving in key roles on operational assignments including brigade surgeon (12.1%), division surgeon (5.1%), and squadron commander (5.8%). A significant percentage (17.2%) also reported serving as the commanding officer of an MTF. Nearly two-thirds of respondents reported deploying 30 or more days. For those respondents who deployed, the number of deployments varied from one (47%), two (29%), three (14%), and four or more (10%). Over one-third of respon dents had deployed in support of humanitarian missions. For those respondents who had deployed in support of humani tarian missions, the number of deployments varied from one (52%), two (22%), three (10%), and four or more (16%). Examples of deployments and humanitarian missions include, but are not limited to, Bosnia and Herzegovina, Honduras, Iraq, Afghanistan, and those carried out by U. S. Navy Hospi tal Ships, the USNS Comfort, and the USNS Mercy.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Career Accomplishments ofUSU of the Health Sciences Medical Graduates TABLE II.
Medals
TABLE IV. N
M ed als S ilv e r S tar D e fe n se S u p e rio r S e rv ic e M edal L eg io n o f M erit M edal
% 1
0.1
35
2.9
165
13.9
First Residency Completion Areas N
%
A nesth esio lo g y
69
6.0
D erm atology
21
1.8
E m erg en c y M edicine
61
5.3
Field
D istin g u ish ed F ly in g C ro ss
1
0.1
F am ily M edicine
229
19.8
A ir F orce C ross
1
0.1
Internal M edicine
129
11.2
220
18.5
N eurology
14
1.2
6
0.5
O B /G Y N
49
4.2
319
26.8
43
3.6
178
15.0
Pathology
30
2.6
75
6.3
P ediatrics
110
9.5
372
31.3
B ro n ze S tar P urple H eart D efense M erito rio u s S erv ice M edal A ir M edal H u m an itarian S erv ice M edal* U n ited N atio n s M edal* O th e r— N o t C am p aig n M edals
Table II displays military awards and decorations earned by the respondents not only for short-, medium-, and long term achievements but also for acts of valor. The Legion of Merit and Defense Superior Service medals, typically reserved for senior officers who render outstanding service, were awarded to 13.9% and 2.9%, respectively, of respon dents. Equally impressive, almost 1 in 5 (18.5%) of the respondents were recognized with the Bronze Star, given for “heroic or meritorious achievement or service ... in connec tion with military operations against an armed enemy.” Addi tional awards included the Silver Star, the Air Force Cross, and the Purple Heart, among others. Respondents were asked to report their highest military rank achieved and whether any of their promotions were “below the zone” selections. Below the zone promotions are accelerated promotions awarded to outstanding officers who have demonstrated superior perfor mance and leadership potential. The vast majority of respon dents (86.8%) achieved a rank of 0-5 or above in their respective services (Table III).
O ccu p atio n al M edicine
16
1.4
O p h thalm ology
45
3.9
P rev en tiv e M edicine
33
2.9
P sychiatry
44
3.8
R adiology
69
6.0
Surgery
95
8.2
142
12.2
O thers
findings.3 Frequencies by first specialty are shown in Table IV. The most frequently pursued specialties for respondents dur ing the study timeframe were the following: Family Medicine (19.8%), Internal Medicine (11.2%), Pediatrics (9.5%), Sur gery (8.2%), Radiology and Anesthesia (both 6.0%), and Emergency Medicine (5.3%). These numbers are similar to national specialization trends; the AAMC 2012 Physician Specialty Data Book4 reports that internal medicine, family medicine, and pediatrics have the highest number of active physicians in the United States. Furthermore, almost half (48%) of our sample reported completing a second residency or fellowship. In terms of additional degrees beyond residency training, 18% completed a master’s degree, 1% completed a doctoral degree, and 4.6% completed a health care administration or management education certificate.
Medical Professional Education
Academic Achievement
All respondents completed medical school at USU. The majority (92%) of respondents completed their first residency at a military hospital. Over 95% reported being board certified in their first specialty, which is consistent with our previous
Nearly three-quarters of our graduates reported that they pub lished at least one manuscript in a peer-reviewed journal (68.6%) and over half had presented an article before a national or international professional audience (52.3%) (Table V). Nearly 30% served as reviewers for scientific journals and over 20% reported being a principal investigator on at least one research grant.
TABLE III.
Military Rank N
%
120/1151
10.4
04
9/1 1 6 6 144
12.3
05
464
39.8
06
538
46.1
C aree r L andm ark S ta ff P o sitio n a t s e rv ic e ’s M edical H ead q u arters (SG O ffice L evel) T h e H ighest R ank A ch iev ed to D ate 03
0 7 and A bove S elected fo r P ro m o tio n , as a Ph y sician ,
11 162/1148
0.8
0.9 14.1
B elow the P rim ary Z o n e fo r E lig ib ility 04
6 3 /1 1 8 9
5.3
05
82
6.9
06
45
3.8
MILITARY MEDICINE, Vol. 180, April Supplement 2015
DISCUSSION USU has a unique medical school mission to educate medical students who are also military officers. To meet the Congres sional charge, USU must be able to track our physician grad uates and demonstrate their progression through the ranks as medical leaders and military physicians. This article provides additional evidence to support the notion that USU is meeting its Congressional mandate and fulfilling its critical tasks in education and training, research and scholarship, leadership, national security and global health, and service. Below we discuss three categories of career milestones, military career
111
Career Accomplishments ofU SU o f the Health Sciences Medical Graduates TABLE V.
Achievement in Academia
Achievement in Academia
N
%
Published an Article in a Professional Peer-Reviewed Journal Presented Articles Before National or International Professional Groups Presented Articles Before Military Professional Groups Served as a Reviewer for a Peer-Reviewed Scientific Journal Served as a Principal Investigator on a Research Grant The Highest Academic Appointment Held Instructor Assistant Professor Associate Professor Professor Other
816
68.6
622
52.3
528 321
44.4 27.0
241
21.5
32 321 171 42 16
2.7 27 14.4 3.5 1.3
landmarks, medical professional education, and academic achievement, which pertain to these critical tasks. In terms of military career milestones, there are several notable findings for our graduates. Almost all USU graduates all have served at some point as full-time clinicians and many continue to do so today. A significant percentage have held key leadership positions within their local hospitals or at higher command levels (e.g., commanding officer and/or Surgeon General office) as well as during deployments and humanitarian missions. That our graduates have played an important role in deployments is evidenced by the number who have participated in such missions and the frequency with which they have done so. Although this is most likely multi factorial, USU’s military unique curriculum includes simu lated military field exercises that focus on leadership, interprofessional education, and team work that start in the first year of medical school and continue throughout the cur riculum. Further, our graduates have received a number of medals for their service with more than 85% achieving a rank of 05, 06, 07, or higher. Our physicians have completed a wide range of residen cies in MTFs and have achieved high board certification rates.'’ Consistent with more recent national needs, USU has trained a higher percentage of physicians in primary care fields during the second decade of its existence, as reported
112
in this article. Over 40% of respondents completed their first residency in a primary care specialty compared to 36% in Cohen’s article.2 This is important from an operational stand point, as primary care specialties often serve as flight sur geons, battalion surgeons, and general medical officers during war time missions. Nearly 20% of respondents have received additional degrees including master’s degrees in public health and health care administration which would be useful for future leaders in the MHS. Our graduates also have demonstrated achievement in a number of academic landmarks to include publications, pre sentations, peer review for professional journals, and grants. Given that academic opportunities for military physicians are often limited, it is impressive that 14.4% have achieved an academic rank of associate professor and 3.5% have achieved a rank of Full Professor. There are a number of limitations to our investigation. First, these are self-reported data and not actual performance data. As such, they are subject to the many limitations inherent to such data, including social desirability bias. That said, for measures that we can verify (e.g., board certification), our self-reported data is consistent with objective measures. Although our response rate is acceptable, particularly for such a large sample, the possibility of nonresponse bias still exists. Finally, our setting is somewhat unique, and we do not have comparative data for military physicians who have graduated from other medical school programs (e.g., Health Professions Scholarship Program students). Even without such data, the accomplishments of USU graduates are noteworthy and sup port continued national funding of this unique institution. REFERENCES 1. Moore FD: First class. N Engl J Med 1980; 302: 202-3. 2. Cohen DL, Duming SJ, Cruess D, MacDonald R: Long-term career out come of Uniformed Services University of the Health Sciences Medical School Graduates: classes of 1980-1989. Mil Med 2008; 173(5):422-8. 3. DeZee KJ, Durning SJ, Dong T, et at: Where are they now? USU School of Medicine graduates after their military obligation is complete. Mil Med 2012; 177(9 Suppl): 54-60. 4. Association of American Medical Colleges: 2012 Physicians Specialty Data Book. November 2012. Available at https://members.aamc.org/eweb/ upload/2012%20Physician%20Specialty%20Data%20Book.pdf; accessed October 1, 2014.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
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Career Accomplishments of Uniformed Services University of the Health Sciences Medical Graduates: Classes 1980-2001 COL William R. Gilliland, MC USA (Ret.)*; Ting Dong, PhDf; CDR Anthony R. Artino Jr., MSC USNf; Col John E. McManigle, USAF MC (Ret.)f; LTC Aaron Saguil, MC USA*; David F. Cruess, PhD§; Sharon HollandH; Steven J. Durning, MD, PhD f
ABSTRACT Purpose: To report accomplishments of graduates of the F. Edward Hebert School of Medicine who have left, retired, or are near the end of their uniformed career in several professional domains: military career milestones, medical professional education, academic landmarks, and leadership. Methods: This study utilized an earlier questionnaire that was modified to capture additional career landmarks and improve the clarity of several items. The modified survey was sent electronically to alumni who graduated from 1980-2001 in March, 2012. Results: The questionnaire was sent to 2,825 alumni for whom we had e-mail addresses. We estimate that we reached 2,400 alumni. A total of 1,189 alumni returned the questionnaire, yielding an estimated response rate of 50%. For this cohort, the board certification was 95%, over 20% obtained additional degrees, 92.8% had worked as a full-time physician, nearly twothirds had deployed for combat, 13.9% had received the Legion of Merit, and 68.6% had published at least one peerreviewed manuscript. Conclusion: Many accomplishments including board certification rates, deployment experience, academic and military leadership positions, military awards, promotion rates, and academic medicine contributions are indicators that USU is continuing to meet its unique mission.
INTRODUCTION The Uniformed Services University (USU) of the Health Sciences F. Edward Hebert School of Medicine is the nation’s only federal medical school. It was established by Congress in 1972 and was charged with educating students to become physicians committed to military careers,1 individ uals willing to lead the military health care system and serve our nation for a prolonged length of time. Tracking the professional accomplishments of military physicians is somewhat easier than tracking those of their civilian counterparts. Military physicians are expected to meet promotion standards, earn awards, and gain increasing levels of leadership responsibility within a closed health delivery and education system. As a result, USU is singularly positioned to track military career landmarks as well as other landmarks relevant to civilian medical careers. Since USU
*F. Edward Hebert School of Medicine, Uniformed Services Uni versity of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. tDepartment of Medicine, Uniformed Services University of the Health Sciences,4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Military and Emergency Medicine, Uniformed Ser vices 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. || Office of External Affairs, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U. S. Government. doi: 10.7205/MILMED-D-14-00556
MILITARY MEDICINE, Vol. 180, April Supplement 2015
graduates are uniquely expected to engage in Military Health System (MHS)-specific activities such as deployments and humanitarian assistance missions, it becomes important to track long-term accomplishments to inform the military lead ership and the civilian medical community as to whether USU is generating career professionals. Given the United States’ increasing national debt and other programs by which the uniformed service can access physicians, it is important that USU demonstrate that it is meeting not only the mandate to produce career uniformed physicians but also that gradu ates may have additional “value added” skills compared to other physician accession programs. In 2008, we reported on longer term outcomes for the classes of 1980-1989.2 In this article, we include data on another 10 years of graduates who are nearing the end of their military careers. We did this to capture outcomes that may not have been reported in the last survey since some of the graduates would have only been mid-career when it was administered for the classes of 1980-1989. We also include additional items to reflect leadership roles in the civilian sec tor. As such, the purpose of this study is to provide data on USU graduates for the first 20 years of the school’s 40-year existence. As in our prior study, we collected data on military career milestones (deployments, humanitarian assistance mis sions, military decorations and awards, military leadership roles and rank), medical professional education (completion of residency and fellowship), and academic landmarks (aca demic rank, grants, peer-reviewed publications). These mile stones were chosen to measure both conventional outcomes associated with successful medical careers but also highlight military unique outcome measurements given the dual nature of our graduates (physician-officers).
109
Career Accomplishments ofU SU o f the Health Sciences Medical Graduates
METHODS
TABLE I.
Positions Held Over the Course of Entire Career
P a rtic ip a n ts a n d P ro c e d u re s
This study was part of the larger Long-Term Career Outcome Study (LTCOS) conducted at USU which has USU Institu tional Review Board approval to administer the survey used in this article. The questionnaire was initially distributed electronically to alumni who graduated between 1980 and 2001. The survey was administered via PHP Surveyor in March 2012. To increase the response rate, we sent several reminders, both paper-based and electronically, and reached out to alumni through USU’s Alumni Affairs Office. We completed data collection in December, 2013.
C aree r L andm ark
N
%
E d u catio n al and R esearch R oles C linical C lerk sh ip or M edical School C o u rse D irecto r
155
13.0
R esid en cy P rogram D irecto r
138
11.6
F ello w sh ip D irecto r
54
4.5
R esearch D irecto r
66
5.6
M T F R oles 1103
92.8
C h ie f o f S ervice
739
62.2
C h ie f/D ire c to r o f a C linic
358
30.1
D e p artm e n t C h air/C h ief/H ea d at a M edical
380
32.0
180
15.1
230
19.3
206
17.3
54
4.5 12.1
F u ll-T im e C linician
C en ter or C om m u n ity H ospital W ithout a R esidency P rogram in Y o u r D epartm ent D ep artm en t C h air/C h ief/H ea d at a M edical C en ter o r C o m m u n ity H ospital W ith a R esidency
Q u e s tio n n a ire D e v e lo p m e n t
The questionnaire was developed through a vetting process involving LTCOS members from multiple basic science and clinical departments; the school’s Executive Curriculum Committee; and the Associate Dean of Medical Education. Some of the questions in this survey were modified from the one used in the prior survey,2 which were modified to capture additional career landmarks and improve the clarity of sev eral items.
P rogram in Y o u r D epartm ent S ervice C h ie f/D ire c to r/H e ad o f M ultid iscip lin ary S erv ice at a M edical C en ter o r C om m u n ity H ospital M ilitary T re a tm e n t F acility C h ie f o f the M edical S ta ff D eputy M ilitary T rea tm e n t F acility O p eratio n al A ssignm ents B rigade Surgeon
144
D ivisio n S urgeon
59
5.0
S quadron C o m m a n d er
69
5.8
S enior M edical O fficer
274
23.0
C o m m an d A ssignm ents 204
17.2
F ree-S tan d in g C linic C o m m a n d in g O fficer
73
6.1
B ed d ed C o m m u n ity -S iz ed H ospital
34
2.9
C om m an d in g O fficer
RESULTS The survey questionnaire was distributed via e-mail to the 2,825 alumni for which we had e-mail addresses. Although we do not have an exact denominator for the alumni group since some of the alumni to whom the e-mail was sent may have been deceased, ill, or changed e-mail addresses, we estimate that we reached approximately 2,400 alumni with active e-mail addresses. A total of 1,189 alumni completed and returned the questionnaire, yielding an estimated response rate of 50%. Of these respondents. 196 were female (16.5%) and 909 were male (83.5%), which is also similar the sex ratio of the classes studied. To assess the representativeness of our sample, we compared participants with nonparticipants on cumulative medical school GPA and found no significant dif ference between the groups (t = 1.57, df = 2,958, P = 0.12). The average GPA of the participants was 3.13 (SD = 0.36) and the average GPA of the nonparticipants was 3.11 (SD = 0.36). M ilita ry C a r e e r M ile s to n e s
Table I displays military landmarks that are grouped into several categories: leadership positions, military awards and medals, and participation in deployments and/or humanitar ians missions. Military careers typically involve increasing levels of responsibility and job complexity in conjunction with increasing rank. The medical corps is no exception to this general rule. Almost all respondents (93%) reported being full-time clinicians at some point in their career. A significant percentage of respondents reported serving as edu cational leaders such as a clerkship or course director (13.0%), residency director (11.6%), or fellowship director
110
C o m m an d in g O fficer M edical C en ter C om m an d in g C en ter
16
1.3
S quadron or S im ilar S ervice-S pecific
72
6.1
83
7.0
31
2.6
O rg an izatio n al C o m m a n d in g O fficer D e p lo y ed /D e p lo y a b le M ed ic a l U nit C o m m a n d in g O fficer O ther
(4.5%). Examples of the leadership roles in military treatment facilities (MTFs) served by the respondents included chief of service (62.2%), director of a clinic (30.1%), and chief of medical staff (17.3%). USU graduates also reported serving in key roles on operational assignments including brigade surgeon (12.1%), division surgeon (5.1%), and squadron commander (5.8%). A significant percentage (17.2%) also reported serving as the commanding officer of an MTF. Nearly two-thirds of respondents reported deploying 30 or more days. For those respondents who deployed, the number of deployments varied from one (47%), two (29%), three (14%), and four or more (10%). Over one-third of respon dents had deployed in support of humanitarian missions. For those respondents who had deployed in support of humani tarian missions, the number of deployments varied from one (52%), two (22%), three (10%), and four or more (16%). Examples of deployments and humanitarian missions include, but are not limited to, Bosnia and Herzegovina, Honduras, Iraq, Afghanistan, and those carried out by U. S. Navy Hospi tal Ships, the USNS Comfort, and the USNS Mercy.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Career Accomplishments ofUSU of the Health Sciences Medical Graduates TABLE II.
Medals
TABLE IV. N
M ed als S ilv e r S tar D e fe n se S u p e rio r S e rv ic e M edal L eg io n o f M erit M edal
% 1
0.1
35
2.9
165
13.9
First Residency Completion Areas N
%
A nesth esio lo g y
69
6.0
D erm atology
21
1.8
E m erg en c y M edicine
61
5.3
Field
D istin g u ish ed F ly in g C ro ss
1
0.1
F am ily M edicine
229
19.8
A ir F orce C ross
1
0.1
Internal M edicine
129
11.2
220
18.5
N eurology
14
1.2
6
0.5
O B /G Y N
49
4.2
319
26.8
43
3.6
178
15.0
Pathology
30
2.6
75
6.3
P ediatrics
110
9.5
372
31.3
B ro n ze S tar P urple H eart D efense M erito rio u s S erv ice M edal A ir M edal H u m an itarian S erv ice M edal* U n ited N atio n s M edal* O th e r— N o t C am p aig n M edals
Table II displays military awards and decorations earned by the respondents not only for short-, medium-, and long term achievements but also for acts of valor. The Legion of Merit and Defense Superior Service medals, typically reserved for senior officers who render outstanding service, were awarded to 13.9% and 2.9%, respectively, of respon dents. Equally impressive, almost 1 in 5 (18.5%) of the respondents were recognized with the Bronze Star, given for “heroic or meritorious achievement or service ... in connec tion with military operations against an armed enemy.” Addi tional awards included the Silver Star, the Air Force Cross, and the Purple Heart, among others. Respondents were asked to report their highest military rank achieved and whether any of their promotions were “below the zone” selections. Below the zone promotions are accelerated promotions awarded to outstanding officers who have demonstrated superior perfor mance and leadership potential. The vast majority of respon dents (86.8%) achieved a rank of 0-5 or above in their respective services (Table III).
O ccu p atio n al M edicine
16
1.4
O p h thalm ology
45
3.9
P rev en tiv e M edicine
33
2.9
P sychiatry
44
3.8
R adiology
69
6.0
Surgery
95
8.2
142
12.2
O thers
findings.3 Frequencies by first specialty are shown in Table IV. The most frequently pursued specialties for respondents dur ing the study timeframe were the following: Family Medicine (19.8%), Internal Medicine (11.2%), Pediatrics (9.5%), Sur gery (8.2%), Radiology and Anesthesia (both 6.0%), and Emergency Medicine (5.3%). These numbers are similar to national specialization trends; the AAMC 2012 Physician Specialty Data Book4 reports that internal medicine, family medicine, and pediatrics have the highest number of active physicians in the United States. Furthermore, almost half (48%) of our sample reported completing a second residency or fellowship. In terms of additional degrees beyond residency training, 18% completed a master’s degree, 1% completed a doctoral degree, and 4.6% completed a health care administration or management education certificate.
Medical Professional Education
Academic Achievement
All respondents completed medical school at USU. The majority (92%) of respondents completed their first residency at a military hospital. Over 95% reported being board certified in their first specialty, which is consistent with our previous
Nearly three-quarters of our graduates reported that they pub lished at least one manuscript in a peer-reviewed journal (68.6%) and over half had presented an article before a national or international professional audience (52.3%) (Table V). Nearly 30% served as reviewers for scientific journals and over 20% reported being a principal investigator on at least one research grant.
TABLE III.
Military Rank N
%
120/1151
10.4
04
9/1 1 6 6 144
12.3
05
464
39.8
06
538
46.1
C aree r L andm ark S ta ff P o sitio n a t s e rv ic e ’s M edical H ead q u arters (SG O ffice L evel) T h e H ighest R ank A ch iev ed to D ate 03
0 7 and A bove S elected fo r P ro m o tio n , as a Ph y sician ,
11 162/1148
0.8
0.9 14.1
B elow the P rim ary Z o n e fo r E lig ib ility 04
6 3 /1 1 8 9
5.3
05
82
6.9
06
45
3.8
MILITARY MEDICINE, Vol. 180, April Supplement 2015
DISCUSSION USU has a unique medical school mission to educate medical students who are also military officers. To meet the Congres sional charge, USU must be able to track our physician grad uates and demonstrate their progression through the ranks as medical leaders and military physicians. This article provides additional evidence to support the notion that USU is meeting its Congressional mandate and fulfilling its critical tasks in education and training, research and scholarship, leadership, national security and global health, and service. Below we discuss three categories of career milestones, military career
111
Career Accomplishments ofU SU o f the Health Sciences Medical Graduates TABLE V.
Achievement in Academia
Achievement in Academia
N
%
Published an Article in a Professional Peer-Reviewed Journal Presented Articles Before National or International Professional Groups Presented Articles Before Military Professional Groups Served as a Reviewer for a Peer-Reviewed Scientific Journal Served as a Principal Investigator on a Research Grant The Highest Academic Appointment Held Instructor Assistant Professor Associate Professor Professor Other
816
68.6
622
52.3
528 321
44.4 27.0
241
21.5
32 321 171 42 16
2.7 27 14.4 3.5 1.3
landmarks, medical professional education, and academic achievement, which pertain to these critical tasks. In terms of military career milestones, there are several notable findings for our graduates. Almost all USU graduates all have served at some point as full-time clinicians and many continue to do so today. A significant percentage have held key leadership positions within their local hospitals or at higher command levels (e.g., commanding officer and/or Surgeon General office) as well as during deployments and humanitarian missions. That our graduates have played an important role in deployments is evidenced by the number who have participated in such missions and the frequency with which they have done so. Although this is most likely multi factorial, USU’s military unique curriculum includes simu lated military field exercises that focus on leadership, interprofessional education, and team work that start in the first year of medical school and continue throughout the cur riculum. Further, our graduates have received a number of medals for their service with more than 85% achieving a rank of 05, 06, 07, or higher. Our physicians have completed a wide range of residen cies in MTFs and have achieved high board certification rates.'’ Consistent with more recent national needs, USU has trained a higher percentage of physicians in primary care fields during the second decade of its existence, as reported
112
in this article. Over 40% of respondents completed their first residency in a primary care specialty compared to 36% in Cohen’s article.2 This is important from an operational stand point, as primary care specialties often serve as flight sur geons, battalion surgeons, and general medical officers during war time missions. Nearly 20% of respondents have received additional degrees including master’s degrees in public health and health care administration which would be useful for future leaders in the MHS. Our graduates also have demonstrated achievement in a number of academic landmarks to include publications, pre sentations, peer review for professional journals, and grants. Given that academic opportunities for military physicians are often limited, it is impressive that 14.4% have achieved an academic rank of associate professor and 3.5% have achieved a rank of Full Professor. There are a number of limitations to our investigation. First, these are self-reported data and not actual performance data. As such, they are subject to the many limitations inherent to such data, including social desirability bias. That said, for measures that we can verify (e.g., board certification), our self-reported data is consistent with objective measures. Although our response rate is acceptable, particularly for such a large sample, the possibility of nonresponse bias still exists. Finally, our setting is somewhat unique, and we do not have comparative data for military physicians who have graduated from other medical school programs (e.g., Health Professions Scholarship Program students). Even without such data, the accomplishments of USU graduates are noteworthy and sup port continued national funding of this unique institution. REFERENCES 1. Moore FD: First class. N Engl J Med 1980; 302: 202-3. 2. Cohen DL, Duming SJ, Cruess D, MacDonald R: Long-term career out come of Uniformed Services University of the Health Sciences Medical School Graduates: classes of 1980-1989. Mil Med 2008; 173(5):422-8. 3. DeZee KJ, Durning SJ, Dong T, et at: Where are they now? USU School of Medicine graduates after their military obligation is complete. Mil Med 2012; 177(9 Suppl): 54-60. 4. Association of American Medical Colleges: 2012 Physicians Specialty Data Book. November 2012. Available at https://members.aamc.org/eweb/ upload/2012%20Physician%20Specialty%20Data%20Book.pdf; accessed October 1, 2014.
MILITARY MEDICINE, Vol. 180, April Supplement 2015
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