A joint medical training leadership panel addressed military medicine evolution, challenges faced by military doctors, and what they expect to see in the future, at the Interservice/Industry Training, Simulation and Education Conference in Orlando, Florida, Nov. 29.


Matthew Hackett, Ph.D., science and technology manager for U.S. Army DEVCOM SC STTC, moderated the panel. Participants included: Army Col. Kathleen Samsey, M.D., director of the Directorate of Simulation at the U.S. Army Medical Center of Excellence; Army Col. Maria Molina, M.D., acting director for the Defense Health Agency’s (DHA) J-7 Education & Training Directorate; Air Force Col. Brian White, Comprehensive Medical Readiness Program chair with the Air Force Medical Readiness Agency; Air Force Lt. Col. Samantha Kelpis, MEDIC-X team lead with the Air Force Medical Readiness Agency; and retired Navy Capt. Joseph Lopreiato, M.D., professor of pediatrics, medicine and nursing, and assistant dean for simulation education at the Uniformed Services University of the Health Sciences.


As each panelist made opening remarks, they all explicitly stated that their comments were based on their personal views and experience and did not necessarily reflect that of their organizations.


Samsey provided an overview on the driving forces of change in modernizations needed for simulation support to medical training. She emphasized that simulation devices are generally intended to be sustainment refresher training with medical practitioners who have already completed their required formal training, not for the initial education of entry-level students.


“Now is the time to prepare for overmatch [in large scale combat operations], and prepare for an unfair fight,” Samsey said. “We know that driving change not only helps our forces, but our nation as well. The advancements and achievements of military medicine for the last 20 to 25 years, [are usually adopted by] our civilian counterparts who validate those findings and refine them – and unfortunately mass casualty events don’t just happen overseas.”


Samsey went on to list some challenges of the future operating environment, which included (among others) the need for increased mobility in the field, higher casualty rates, and an inability to treat injured personnel within the “golden hour,” which describes a brief period following a physical trauma in which medical attention has the best chance of saving a patient’s life.


White discussed the dangers in a future conflict, and how to best prepare to support warfighters in a joint environment. He said a great power conflict would involve operating in an “immature” theater with unstable infrastructure, where leaders could anticipate food, water, sanitation and hygiene issues responsible for disease and nonbattle injuries that warranted medical concern.


“There is also the tyranny of distance, the extremes of climate – whether it’s tropical or arctic – and the effects on how our equipment works and how our people work [that we must plan for],” White said. “Regarding en route care, when we think about moving patients across an area, for the last 20 years, we’ve had the privilege of having air superiority and moving patients whenever we want to, wherever we need to. With a lack of air superiority, we may have limited opportunities for evacuation and resupply, and this may result in prolonged in-theater hospitalization.”


Molina addressed DHA’s initiatives and focused on hospital-based simulation. One initiative, the Joint Emergency Trauma Simulation, Molina described as a system of systems focused on patient movement and the required communication from the point of injury to the patient’s final treatment destination. She also reiterated a point Samsey previously made of establishing an additional skills identifier in the future for personnel who perform duties as a training simulation operator or evaluator.


“Complicated Obstetrical Emergency Simulation [is hospital-based training that] has a very standardized set of perinatal training that any staff member who works on LMD [limited dorsal myeloschisis] must have,” Molina said. “There is a DHA requirement for a certain amount of simulation training to occur that everyone must take on a yearly basis if they work in patient obstetrics. We’re in the acquisition process phase and we hope to begin this early next year.”


Since his Navy retirement, Lopreiato now trains healthcare providers in military medicine, and he spoke on gaps and innovations (such as portable task trainers and telesimulation) in academia. His organization not only teaches students to be physicians and nurses, but also how to be medical officers and nurse corps officers in operational medicine in its dual mission.


“Doing sim[ulation training] is a different animal from teaching in a classroom,” Lopreiato said in emphasizing the difference between the two learning environments. He noted that instructors tend to lecture during sim training instead of focus on providing hands-on, experiential learning, which is the intent. “It’s because that’s what they know what to do… so if you’re in the sim field and you’re teaching, go to sim school. It’s never too late, and you learn so much.”

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