Teaching metrics and measurement, although demonstrably beneficial to the overall volume of teaching conducted, show less clear results regarding the quality of instruction. The multitude of metrics reported makes it difficult to arrive at general conclusions regarding the effects of these teaching metrics.
To comply with the request of Dr. Jonathan Woodson, then-Assistant Secretary of Defense for Health Affairs, Defense Health Horizons (DHH) examined several approaches for restructuring Graduate Medical Education (GME) in the Military Health System (MHS), aiming for both a medically prepared force and a ready medical force.
Military and civilian health care system experts, key institutional officials, and GME directors were interviewed by DHH.
Across three areas, this report proposes multiple short-term and long-term actions. Balancing GME resource assignment to meet the specific requirements of both active-duty and garrisoned troops in the military. Establishing a shared, three-service mission and vision for GME programs in the MHS, while simultaneously expanding partnerships with external institutions, is paramount to creating an appropriate physician makeup and ensuring trainees accumulate the necessary clinical experience. Refining the techniques for attracting and monitoring GME pupils, as well as the administration of student entries. For the betterment of student quality, performance assessment of students and medical schools, and a collaborative tri-service admissions method, several improvements are suggested. Aligning the MHS with the principles outlined in the Clinical Learning Environment Review is essential to fostering a culture of safety and developing the MHS into a high-reliability organization (HRO). We advocate for a multi-faceted strategy encompassing patient care improvement, residency training advancements, and a formalized system for MHS management and leadership development.
Producing the future physician workforce and medical leadership of the MHS is directly tied to the importance of Graduate Medical Education (GME). Furthermore, it furnishes the MHS with a workforce possessing clinical expertise. The study of graduate medical education (GME) fuels the creation of innovations that are essential for better combat casualty care and other significant aims of the military health system. Even though the MHS's primary objective is readiness, the investment in GME is crucial for the attainment of the quadruple aim's other elements—namely, better health, higher quality of care, and cost reduction. Epigenetics inhibitor By properly managing and adequately resourcing GME, the MHS can undergo a rapid and successful transformation into an HRO. MHS leadership, according to DHH's analysis, has ample potential to improve GME's integration, joint coordination, efficiency, and productivity. Understanding and integrating team-based care, meticulous patient safety, and a systematic approach to medicine is crucial for all military GME trained physicians. Preparing the military physicians of tomorrow to meet the demands of the battlefield, shield the health and safety of deployed troops, and provide expert and compassionate care to stationed personnel, families, and retired military members is paramount.
Graduate Medical Education (GME) is paramount in producing the next generation of medical leaders and physician workforce for the MHS. This system also contributes to the MHS by providing medically trained personnel. GME research cultivates future breakthroughs in combat casualty care and other MHS priorities. Readiness may be the MHS's paramount mission, yet GME training is equally critical in facilitating the three other aspects of the quadruple aim, including health improvement, enhanced care, and minimized costs. Adequate resourcing and proper management of GME are critical for accelerating the evolution of the MHS into an HRO. In DHH's assessment, numerous avenues exist for MHS leadership to cultivate a more integrated, jointly coordinated, efficient, and productive GME environment. congenital hepatic fibrosis Physicians completing their GME training in the military should cultivate an understanding and appreciation for team-based practice, patient safety, and systems thinking. To adequately prepare future military physicians to address the demands of the field, safeguard the health and safety of deployed warfighters, and furnish expert and compassionate care to garrisoned troops, families, and retired military, this program is designed.
Visual difficulties are a common consequence of brain trauma. Clinical approaches to diagnosing and treating visual system problems associated with brain injury demonstrate a less definitive scientific basis and a broader spectrum of application strategies compared to most other medical specialties. The majority of optometric brain injury residency programs are to be found at federal clinics, particularly within the VA and DoD systems. The core curriculum created allows for a consistent approach while permitting program strengths to be highlighted and utilized.
To establish a consistent framework for brain injury optometric residency programs, a core curriculum was developed through the combined use of Kern's curriculum development model and subject matter expert focus groups.
The educational objectives for a high-level curriculum were established through the consensus of the involved parties.
A common curriculum, crucial for a subspecialty still developing a substantial scientific foundation, can provide a shared structure to drive the progress of both clinical practice and research in this burgeoning field. To ensure broader implementation of this curriculum, the process proactively sought out expert resources and fostered meaningful community connections. Through this core curriculum, optometric residents will be provided with a framework for the complete process of diagnosing, managing, and rehabilitating patients who have suffered visual complications as a consequence of brain damage. To guarantee the inclusion of pertinent subjects, while simultaneously accommodating the specific strengths and resources of each program, is the intended outcome.
A unifying curriculum is essential in a relatively new subspecialty, lacking well-defined scientific principles, to provide a common understanding and facilitate advancement in both clinical care and research efforts. The process identified the need for expert knowledge and community involvement to effectively implement this curriculum. The core curriculum will serve as a framework for optometric residents to learn the diagnosis, management, and rehabilitation of patients with visual sequelae that stem from brain injuries. The design anticipates comprehensive coverage of appropriate subjects, while granting the necessary leeway for programs to adapt content to their respective strengths and available resources.
In the early 1990s, the U.S. Military Health System (MHS) successfully introduced the concept of telehealth in the context of deployed operations. Despite its potential, the implementation of this method in settings outside of active service had historically lagged behind comparable systems, such as the Veterans Health Administration (VHA) and large civilian healthcare organizations, due to administrative, policy-driven, and other obstacles that impeded its integration within the military health system. A December 2016 report on telehealth within the MHS reviewed past and current initiatives, encompassing the associated impediments, prospects, and policy framework. It then offered three potential pathways for broadening telehealth access in deployed and non-deployed locations.
Subject matter experts directed the compilation of direct input, presentations, peer-reviewed literature, and gray literature.
Historical and contemporary telehealth application within the MHS exhibits substantial capability, most notably in operational or deployed settings. From 2011 to 2017, policies relating to the MHS were conducive to growth, but a review of similar civilian and veterans' healthcare models illustrated the substantial advantages of telehealth use in non-deployed scenarios, specifically amplified access and decreased costs. The 2017 National Defense Authorization Act's stipulations obligated the Secretary of Defense to cultivate telehealth usage within the Department of Defense, including provisions to facilitate the removal of impediments and detailed reporting of progress on this initiative within a period of three years. The MHS's ability to alleviate burdensome interstate licensing and privileging procedures comes with the caveat of increased cybersecurity needs, exceeding those of civilian systems.
Telehealth’s strengths complement the overarching goals of the MHS Quadruple Aim, focusing on cost reduction, quality enhancement, increased access, and readiness improvement. The strategic use of physician extenders greatly improves readiness, enabling nurses, physician assistants, medics, and corpsmen to execute hands-on patient care under remote supervision, leading to optimal professional practice. Following the review, three avenues for improving telehealth were proposed. The first suggested a concentrated effort in developing telehealth for deployed settings. The second emphasized the maintenance of deployed focus while enhancing non-deployed telehealth implementation to match the VHA and private sector. The third advocated for leveraging the learning from military and civilian telehealth initiatives to overtake the private sector.
This review provides a moment-in-time perspective of the progression towards telehealth expansion prior to 2017, establishing a foundation for subsequent telehealth utilization in behavioral health initiatives and as a reaction to the COVID-19 pandemic. The MHS will benefit from further research, which is expected to build upon the ongoing lessons learned, and consequently further develop telehealth capabilities.
The progression of telehealth expansion, spanning the period before 2017, as examined in this review, established the foundation for its subsequent use in behavioral health endeavors and its critical role in reacting to the 2019 coronavirus disease. immediate delivery The MHS's advancement of telehealth capability will benefit from ongoing lessons learned and anticipated future research, enabling continuous development.