Military graduate medical education in internal medicine: An outcomes study

Military Medicine, Apr 2001 by Cation, Lannie J

Military GME provides more than just sound clinical skills and a good knowledge base to its graduates; it also teaches valuable clinical research skills that can be used later as active duty medical officers. Research experience as a resident is regarded as an essential and valuable skill and a necessary component of internal medicine residency training. 17,11 The superior nature of military resident clinical research has been documented by Shorr et al.,' and their findings were confirmed by our study cohort; most of the graduates we studied had presented at state, regional, and/or national scientific meetings, and several had published in major journals. These clinical research skills are invaluable to the military physician, for whom analytic and problem-solving skills are often necessary for the survival of the military force in the field.

Military GME prepares its graduates not only for outstanding clinical practice but also for successful careers as military active duty officers. In our study, receipt of individual military medals was used as a surrogate marker for outstanding officer performance. About half of the graduates at least 3 years beyond graduation had received individual military medals for their performance as medical officers. One graduate had even received an Officer of the Year award at a major Air Force medical center. Several graduates went on to lead military GME programs or serve as consultants to the Air Force Surgeon General for their specialties. Most graduates had been assigned to leadership positions during their active duty service, and several graduates had been elected to fellowship in the American College of Physicians, These findings confirm that military GME prepares its graduates for their future roles as military officers and leaders in the military medical service.

The active duty retention rate for the study cohort was high, with 39% remaining on active duty 1 or more years beyond their initial ADSC. This is consistent with the Army's goal continuation rate of 30%, which is defined as percentage remaining on active duty at 8 years beyond residency graduation.' In a study of Army internists, Zaloznik found a retention rate of 23%, with retention being defined as remaining on active duty 2 years beyond initial ADSC.7 Zaloznik also found the best predictors of retention to be previous service and attendance at USUHS or a U.S. military academy.' Of note, both of our previous service graduates remained on active duty beyond their initial ADSC. The Army has also reported that retention rates are higher for military-trained physicians than for those trained in civilian GME programs.22 This suggests that training in a military environment allows physicians to become better accustomed to the military and their future roles as military physicians. As noted, the main reasons cited by graduates in our study for staying in the military beyond their initial ADSC were opportunities for participating in GME and the camaraderie of the medical corps. These reasons are consistent with those found in a previous study.'