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ANNUAL REPORT OF THE SURGEON GENERAL UNITED STATES ARMY Fiscal Year 1958

TRAINING

 

Professional

 

Residencies.-Residency training programs in the various class II teaching hospitals were evaluated throughout the year for the purpose of (1) adjusting training spaces to clinical workloads, (2) increasing spaces wherever feasible, and (3) determining the impact of the Dependents' Medical Care Program on the patient load at Army hospitals.

 

The number of Army Medical Corps residents in training at Army hospitals increased from 359 to 423. In addition, the Air Force occupied 52 training spaces in Army hospitals at the end of the fiscal year, as compared to 63 a year earlier. In order that additional spaces might be made available to qualified applicants as well as meet the needs of the service, The Surgeon General sponsored residencies in civilian hospitals for 89 individuals.

 

In an effort to expand still further the number of military residency training spaces, an extensive study of class I hospitals was made to determine the feasibility of conducting residency training by correlating

 


 

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the clinical material workload, staff proficiency, and physical facilities within selected class I hospitals. This study gives a comprehensive picture of the training capabilities of the hospitals surveyed and will be helpful in determining future space allocations in the resident training program in the class I hospital system.

 

Ten Dental Corps officers completed their residency training, and five others advanced from junior to senior resident status.

 

Constant attention was given to the workload of obstetrics and gynecology in teaching hospitals since it was realized that this specialty most likely would be affected by the Dependents' Medical Care Program, with a resultant adverse effect on residency training. Affiliations were authorized between Brooke Army Hospital and the U. S. Army Hospital, Fort Hood, Tex., and between Fitzsimons Army Hospital and St. Lukes Hospital, Denver, Colo. These affiliations will assure well-balanced training programs in obstetrics and gynecology, with sufficient clinical material to maintain the high standards required for a teaching program.

 

A residency training program in obstetrics and gynecology at the new Martin Army Hospital, Fort Benning, Ga., was approved by the Professional Education and Training Committee, OTSG. This program is still subject to approval by the Council on Medical Education and Hospitals of the American Medical Association.

 

The intensive residency training program started after World War II has begun to pay good dividends by producing urgently needed specialists and by increasing the Regular Army strength of the Medical Corps. The number of Army residents in training during the year was more than 33 percent greater than in fiscal year 1957. Of the 1,555 Regular Medical Corps officers at the end of the fiscal year, 509 were board certified and 457 were board eligible. As a result of the steadily growing number of residents completing formal training each year, the percentage of board-certified specialists in the Army Medical Service will be materially increased in the next few years.

 

Two Dental Corps officers were certified by the American Board of Prosthodontics and two by the American Board of Peridontics during the year. The corps now has 23 officers certified in prosthodontics, 17 in oral surgery, 11 in peridontics, 2 in orthodontics, and 2 in oral pathology. This represents an increase of 40 board-certified specialists in the past 5 years.

 

Internships.-Of the 164 medical interns who completed their training in the Army hospital system at the end of the fiscal year, 109 applied for Regular Army and residency training, as compared to 92

the previous year. Medical intern training programs were established

 


 

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Walter Reed Army Medical Center, Washington, D. C. (Left background) Walter Reed Army Institute of Research; (center background) Armed Forces Institute of Pathology; (foreground) Walter Reed Army Hospital

 


 

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at Martin Army Hospital and at Womack Army Hospital, Fort Bragg, N. C., with initial enrollments of 14 and 12 interns, respectively.

 

Twenty-four dental interns were appointed for the academic year 1957-58. Three intern spaces were moved from Fitzsimons Army Hospital, Denver, Colo., to Tripler Army Hospital, Honolulu, T. H., because of a reduction in clinical material resulting from the loss of dependent dental care under the provisions of Public Law 569. Twenty-four individuals from 14 schools were selected from among one hundred applicants representing 27 schools for participation in the Army Dental Intern Program for 1958-59.

 

Fellowships.-Fellowship training programs for AMEDS officers were established at the Armed Forces Institute of Pathology, Walter Reed Army Medical Center, and at the Army Medical Service Surgical Unit, Brooke Army Medical Center. These programs, covering 18 professional specialties, were created to give qualified officers an opportunity to pursue graduate study in specialties required by the Army Medical Service in research and development and in the field of education.

 

In-service short courses.-In-service short (less than 20 weeks) courses were conducted at six Army medical facilities. These courses, 55 in number, embraced both professional and administrative specialties at the postgraduate level. As in past years, spaces were allocated not only to active-duty officers in the Army, but also to Air Force, Navy, Reserve, and National Guard officers, other Federal agencies, civilian professional groups, and foreign nationals.

 

A new in-service postgraduate short course in Advanced Military Preventive Medicine was established and will be conducted at the Walter Reed Army Institute of Research in fiscal year 1959. This course is designed to supplement the training given Army officers at civilian schools of public health by providing instruction in those aspects of preventive medicine and hygiene which are peculiar to the Armed Forces.

 

During the year, 47 dental officers completed career courses, 97 received training in military short courses, and 11 completed 1 year of training in various specialties at civilian universities. In addition, 23 dental officers completed short courses in various specialities at civilian institutions.

 

The first Institute for Personnel Officers was held at the Walter Reed Army Institute of Research, 31 March to 4 April 1958, with participants from all CONUS Army headquarters, class II medical installations and activities, the European Command, and selected class I activities. Its primary purpose was to present current policies and

 


 

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developments in the personnel field, afford an interchange of ideas, and provide means of solving problems through panel discussions.

 

Four other Medical Service Corps institutes were conducted during the year. Two of these, the first Institute for Executive Officers, 23-27 September 1957, and the Institute for Comptrollers, 14-18 April

1958, were conducted at the Walter Reed Army Institute of Research. The Institute for Supply Officers was held at Brooke Army Medical Center, 2-7 March 1958, and the Institute for Registrars at the Walter Reed Army Medical Center, 28 April to 2 May 1958.

 

An Army Medical Specialist Corps Institute was conducted at the Walter Reed Army Medical Center, 6-12 October 1957, following which information pertaining to career planning was distributed to officers in the field. An AMSC institute for chiefs in selected class II and class I medical installations and activities was also held there, 18-24 May 1958.

 

Foreign nationals.-Observer-type training for foreign nationals was conducted in the Army's teaching hospitals. This training, provided in the various specialty fields of medicine, dentistry, and nursing, was made available to 171 participants from many countries throughout the world. Such training has done much to enhance the prestige of the Army Medical Service.

 

Other Training Activities

 

A residency training program in hospital administration was established to follow immediately the Hospital Administration Course at the Army Medical Service School. This program, of a rotating type, will enable Hospital Administration Course graduates to become familiar with the functions of key positions in the Army hospital system. Eleven residents began this phase of their training in June 1958.

 

The revised course for advanced medical technicians (MOS 911.3) was reinstituted at Walter Reed Army Medical Center and at Brooke, Fitzsimons, and Letterman Army Hospitals. Approximately 40 enlisted men were enrolled at each.

 

A Department of the Army Board to Review Officers' Education and Training was established to study the present Army educational system and to make recommendations. In its approach to the problem,

the Board is attempting to determine the feasibility of establishing a common training pattern for all arms and services in order to provide a more integrated type of education that will meet their needs. The

Surgeon General, in presenting his position to the Board, advocated that the AMEDS be allowed to retain its presently constituted system.

 


 

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A number of conferences, attended by representatives from the OTSG, Brooke Army Medical Center, and the Medical Section of the U.S. Continental Army Command, were held during the year to study the AMEDS officer training pattern. As a result of the conferences, the following decisions were reached:

 

1.  Discontinue associate courses. Career Reserve officers who would normally attend this type of course will now attend the regular Company and Advanced Courses.

 

2.  Revise the AMEDS orientation course to provide a 6-week training cycle for Medical Corps officers (common for all corps) and such additional time as may be required for other corps.

 

3.  Enroll all Medical Corps officers in the AMEDS orientation course rather than place Regular Army officers in the Company Officer Course as in past years.

 

4.  Discontinue the Ward and Administration and Supervision Course and increase the hours for Army Nurse Corps officers in the AMEDS orientation course.

 

Military Occupational Specialty training for 911.1 (medical specialist) was transferred from the Army Medical Service School to the Medical Training Center, Brooke Army Medical Center, and was reduced to a 4-week course. This change was intended to (1) decrease the amount of time an enlisted man spent in a training status and (2) produce an increased number of individuals qualified in MOS 911.1.

 

As had been anticipated, experience has shown that the 4-week MOS 911.1 training cycle does not provide sufficient formal training for personnel in this MOS. The change was made in order to train more men in the basic principles of medical care. When sufficient time has elapsed to evaluate fully the effects of this reduced training, it may be necessary to revert to the longer training schedule.

 

Attendance at the Advanced Nursing Administration Course (8-A-3430) decreased from 100 to 85, despite the urgent need for advanced instruction in supervision and administration. The lack of applicants for the operating room courses at Walter Reed Army Medical Center and Letterman Army Hospital forced cancellation of the August course. Applications for the anesthesiology courses increased. This was encouraging since there is a need for more training in this specialty. Three new short institutes were held: Neuropsychiatric Nursing, Educational Coordinators and Instructors, and Obstetrical Nursing.

 

Emphasis continued to be placed on counseling of Medical Service Corps officers through correspondence, personal interviews, and field visits. Similarly, continuous review was made of records for the selection of officers to attend career courses, such as the Company Officer

 


 

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Course (8-A-C2) and the Advanced Course (8-A-C4). A special study was completed, indicating by military occupational specialty and specialty civilian graduate level educational requirements of the corps. A study of revised MSC career fields was also completed.

 

First Aid and Self Aid

 

Army Training Program (ATP) 21-114 governs the conduct of an 8-week basic combat training cycle which is given to all newly inducted or enlisted personnel. Since the advent of atomic capabilities, The Surgeon General has advocated that ATP 21-114 be one of the media by which Army personnel are indoctrinated in first aid and self aid. Before November 1956, basic trainees received 5 hours of first aid instruction. During November 1956, ATP 21-114 was revised to provide 8 hours' instruction in this subject; from the Army Medical Service standpoint, at least 20 hours are needed. This first aid training is not a superficial approach to the problem but rather a carefully selected and studiously presented course in the care of casualties. The instruction is given by well-qualified AMEDS officers and enlisted men who receive a special course at the Army Medical Service School before being assigned to a basic combat training center. At the end of the basic combat training cycle, each trainee is given a proficiency test to determine the effectiveness of the instruction.

 

Concerted efforts are being made to develop programs of instruction which will increase the skill of each individual assigned to the AMEDS within his military occupation specialty. This approach adds strength to the first aid and self aid training program by providing depth to the medical-team concept of furnishing necessary care at all echelons from aidman to hospital.

 

Department of the Army Subject Schedule 21-4, First Aid, published 14 June 1957, is another medium used by the Army Medical Service to promote continuous application of first aid principles. This Army subject schedule outlines the content and procedures for refresher training in first aid and self aid and is applied in a progressive pattern through advanced individual, basic unit, and advanced unit training cycles.

 

Army Training Circular 8-1, Training in Emergency Medical Care, was revised during fiscal year 1958 and is being reviewed for publication. This circular requires that all Army officers (except Medical Corps) be given 12 hours of instruction in first aid and self aid every 2 years. The 1958 version of this circular limited this instruction to AMEDS officers except those in the Medical Corps. The extension

 


 

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of this instruction recognizes the fact that in the event of a nuclear war there will be a great imbalance between corpsmen and wounded and it is vital that every military person know the few things which he can do to save his own life or that of his combat buddy.

 

Both Army Subject Schedule 21-4 and Army Training Circular 8-1 include instruction to familiarize personnel in the use of phase I and phase II packs as established by DOD Instruction 3110.2, 21 Feb­ruary 1957, subject: Standard DOD Lists of Medical Material for the Initial Emergency Treatment of Military Casualties Resulting From Nuclear Warfare.

 

Medical Education for National Defense

 

The program of Medical Education for National Defense was expanded during the year to include 10 more medical schools. Since the program was started in 1952, the number of schools participating has increased from 5 to 45. It is hoped that within a few years all of the medical schools in the country will be active participants. The purpose is to indoctrinate the future doctor early in his career with the importance of preparing himself to handle medical emergencies and to give him specific knowledge and skills which he can use. The Army, Navy, and Air Force contributed funds during the year to help support this program and also furnished other assistance, such as lectures, literature, films, and short courses for school coordinators. Participation in the program is voluntary. The manner of implementation of the program is at the discretion of each school.

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