Military graduate medical education in internal medicine: An outcomes study

Military Medicine, Apr 2001 by Cation, Lannie J

Military graduate medical education has come under increasing scrutiny in recent years as the size of the military medical force declines. To document the outcomes of military graduate medical education in internal medicine, a cohort of Air Force internal medicine residency graduates from Wright-Patterson Medical Center were studied and their residency performance, staff performance, and active duty retention recorded. The study cohort had an outstanding residency performance, as measured by research experience and board certification rate. They also performed well as military staff physicians, receiving numerous individual military medals while holding important administrative and supervisory positions in the military. Finally, the study cohort had a higher than expected active duty retention rate. These findings support the notion that military graduate medical education in internal medicine produces outstanding military internists.

Introduction

In this era of budget constraints and active duty force reductions, all Department of Defense (DoD) programs are being scrutinized for their value to the overall DoD mission. Military medicine has experienced a reduction in force, but the importance of keeping a competent, albeit smaller, active duty medical force has not been questioned.I Military graduate medical education (GME) has long been felt to be the foundation of a successful military medical force, and many resources have been allocated to it in the past.2.3 As the size of the active duty medical force decreases, a persistent question is the future of military GME given the resources needed to support it.1t.4 Indeed, since its peak in 1990, military GME has also experienced its own decline in numbers.3

Supporters of military GME frequently cite the superior training provided by military residency programs2; however, the outcomes of military GME have not been documented extensively. The outcomes of military GME in internal medicine that have been studied include resident research presentations,5 in-training examination scores,6 active duty retention,' and satisfaction with residency training.8 No single study has examined a large group of internal medicine military GME graduates measuring several variables over an extended period of time. To better define and document the outcomes of military GME in internal medicine, we studied a cohort of graduates of the internal medicine residency program at Wright-Patterson Medical Center (WPMC). Specific issues that were studied included the source of the residents, resident performance, staff performance, and active duty retention rate.

Methods

WPMC is a regional Air Force medical center located at Wright-Patterson Air Force Base, Ohio, that provides both primary and tertiary care to its beneficiary population. WPMC serves as the lead agent for the seven-state DoD TRICARE Region V. TRICARE was instituted in this region in May 1998. The internal medicine residency program at WPMC is a free-standing program that was established in 1978. There are 24 categorical residents in the 3-year residency program, with 8 residents per year.

During the period September 1997 to January 1998, we studied the graduates of the internal medicine residency program at WPMC from 1988 to 1997 using a graduate survey. Graduates were interviewed by phone or in person, and their residency files were located and reviewed in the residency program office. The data collected from the interview and record review included previous military service, medical school background, medical school honors, residency accomplishments, active duty assignments and awards, and active duty retention. Allopathic medical school rankings were obtained from the Gourman Reports and were used to determine how many allopathic Health Professions Scholarship Program (HPSP) graduates had attended medical schools ranked in the top 50 in the United States. Membership in Alpha Omega Alpha was used as a marker of superior performance in medical school. Board certification rate and resident research presentations or publications were used as markers of residency performance. Active duty staff physician assignments and supervisory positions held were used to gauge the ability of military GME graduates to function in a variety of clinical and administrative military roles. Individual military medals were used as a marker of outstanding performance as a military officer. Election to fellowship in the American College of Physicians while on active duty was used as a marker of superior performance as a clinician and educator in internal medicine. For purposes of the study, active duty retention was defined as remaining on active duty at least 1 or more years beyond the initial active duty service commitment (ADSC), including additional ADSC accrued for fellowship training but not time spent in fellowship training. This was calculated as of the end of fiscal year 1997.

Results

From 1988 to 1997, there were 69 graduates from the internal medicine residency program at WPMC. Sixty-seven of these graduates were interviewed by phone or in person, and all graduates' residency files were reviewed. There were 58 male and 11 female graduates. Fifty-two of these graduates were still in the Air Force at the time of the study, including four in the Air Force Reserve. One graduate was a Public Health Service physician who had graduated from the Uniformed Services University of the Health Sciences (USUHS) and elected to do his internal medicine residency training at WPMC. He is currently practicing at a Public Health Service hospital.