Military unique curriculum: Identifying and prioritizing content

Military Medicine, Sep 2003 by Cloonan, Clifford, Fauver, Howard E Jr, Holloway, Harry C, Hospenthal, Duane R, Et al

Participants in the 15th Annual Conference on Military Medicine (June 2001, Uniformed Services University, Bethesda, MD) deliberated upon the most important of anticipated relevant changes in the practice of military medicine and considered which of these should be incorporated into the continuum of military medical education, from medical school through residency and the continuing medical education of staff physicians. Emerging from this conference was a series of unprioritized educational objectives that, it was felt, would have to be met to prepare students for the practice of military medicine in the next 20 to 30 years. During this, the 16th Annual Conference on Military Medicine, in June 2002, a group of experts divided themselves into subgroups to prioritize objectives within the following areas: (1) emerging technologies, (2) emerging threats, (3) ethical considerations, and (4) changing missions and operations. The subgroups not only prioritized the previously derived objectives, but in some cases they reworked them, adding new objectives and deleting some that were repetitious. There were variations in the approach taken by different groups; for example, the emerging technologies group ranked the objectives within their purview from most important to least, while the other groups chose to divide their respective objectives into need to know, ought to know, and nice to know categories. Although the items identified in each of the four areas are not mutually inclusive, and in fact there are some areas of overlap between them, division into these four areas provides a useful framework for identification of key curricular components.

It is also important to recognize that faculty members will need to have sufficient proficiency to teach the foundations and applications of most of these new technologies. This may require hiring of new faculty and/or supplemental training of current faculty members.

Emerging Technologies

Technological advances have profoundly influenced medical practice over the course of the past few decades, dramatically expanding it's scope and capabilities. Each new technological advance has the potential to influence multiple elements of the health care system and/or patient-management process. Educational issues arise as a consequence of the applications of these technologies. Before rushing to incorporate these new technologies into the existing curriculum, it is important to critically analyze them; to determine exactly how and to what extent they will improve clinical outcomes and to completely understand the risk-benefit ratio associated with their application. For instance, until more is known about a given test's capabilities, validity, and reliability, it will not be possible to educate students on whether it is better utilized as a screening or diagnostic test.

Only infrequently will there be a "technology block" of instruction. For instance, it will be unlikely to have a lecture solely on the topic of nanotechnology and all of its current and future applications. If it becomes an important part of medicine in the next 20 years, it will more likely be taught within the context of its application in clinical practice (e.g., endoscopic procedures in internal medicine). However, it is recognized that some technologies may receive specific blocks of instruction, so students understand when a technology is useful, when it is not, and what are the limits of its utility (e.g., magnetic resonance imaging).

The ranking of the technology-related objectives that were identified in the 15th Military Education Conference1 is based on the following assumptions: (1) technology presently available is adequately addressed in the current curriculum; therefore, it was not included in this list of objectives; (2) basic skills that may be required to learn how to use these newer technologies is, or will be, covered in other areas and integrated into teaching about the management of specific conditions; and (3) technology content objectives should be broad and should not cite specific technologic tools that may be obsolete at the time of implementing a new curriculum.

Rank-Ordered Objectives [from most important to least]

* Ability to select appropriate emerging technological methods and equipment for application to military deployment.

* Effectively integrate combinations of technologies to most effectively prepare warriors for combat and harsh environments across the entire spectrum of selection, accession, training, and organization.

* Ability to effectively employ commonly used, state of the art, decision-support aids derived from advanced mathematical applications.

* A basic understanding of the role and impact of advanced mathematical applications and informatics on medical practice.

* Ability to analyze and interpret complex data patterns at a basic level using advanced mathematical techniques (e.g., neural nets).

* The ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations, with an emphasis on relevance for military readiness.