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ANNUAL REPORT THE SURGEON GENERAL UNITED STATES ARMY Fiscal Year 1959
TRAINING OF OFFICERS
The number of medical officers in residency training in Army teaching hospitals increased by more than 13 percent in fiscal year 1959, reaching an average monthly strength of 433 as compared to 378 the previous year. The total figure included 394 Army residents and 39 Air Force residents, as contrasted to 330 and 48, respectively, in fiscal year 1958. There has been a steady decline in the number of Air Force residents in training in Army hospitals. Because sufficient spaces were not available in Army medical facilities to accommodate all of the qualified candidates, The Surgeon General sponsored residency training in civilian hospitals for Army officers. The maximum number participating in the civilian residency program was 104. Of these, 94 were still in training at the end of the year.
The former requirement that MC officers attend the Company Officer Course (8-A-C2) at the Army Medical Service School before entering residency training was eliminated in fiscal year 1959. This course lasted 22 weeks, and consequently the officers could begin their
residency training only in January or July. This year, instead of Course 8-A-C2, all candidates for residency training were required to attend the orientation course at the Army Medical Service School. Since this is only a 5½-week course, the officers were able to complete it in time to begin their residency training in September. It is hoped that eventually all residency programs can be started in September, rather than in January and July.
The curtailment of the Dependents' Medical Care Program, discussed earlier in this report, has resulted in increasing the workload in the Army teaching hospitals sufficiently to maintain a well-balanced residency training program in all specialties. The request made in fiscal year 1958 to establish a residency training program in obstetrics and gynecology at the new Martin Army Hospital, Fort Benning, Ga., was withdrawn.
During the year, 24 residency training programs were conducted for medical officers in 8 Army hospitals. The steadily growing number of residents completing formal training each year is producing urgently needed specialists as well as increasing the Regular Army strength of the Medical Corps. The latest estimated requirements, as of 8 October 1958, for specialists in the Army Medical Service was 1,670, as shown in table 13. It was estimated at that time that 1,227 of these specialists would be available in fiscal year 1959 and that the number would increase to 1,493 in fiscal year 1960. These are board-certified and board-eligible officers representing 28 different specialties. The total number of specialists actually on duty in fiscal year 1959 varied considerably during the year, since a large percentage were not in the Regular Army. Of the 1,607 Regular Army medical officers on duty at the end of the fiscal year, 502 were board certified and 372 were board eligible.
Seven DC officers completed their residency training during the year, seven advanced from junior to senior status, and a similar number was selected to begin residency training. During the year, two dental officers completed their residency training in oral surgery, two in periodontics, and three in prosthodontics.
One dental officer was certified during the year by the American Board of Prosthodontics, another by the American Board of Oral Pathology, and three by the American Board of Oral Surgery. The Army Dental Corps now has 58 diplomates of American specialty boards. These include 22 in prosthodontics, 20 in oral surgery, 10 in periodontics, 3 in oral pathology, 2 in orthodontics, and 1 in oral medicine.
A residency training program in the care and treatment of laboratory animals was approved to become operational on 1 September 1958, at the Walter Reed Army Institute of Research, with two spaces authorized per year for Army VC officers.
Applications from military interns for Regular Army appointment and residency training increased in fiscal year 1959. Of the 178 medical interns who completed their training at the end of the fiscal year, 130 applied for residency training, as compared to the 109 who had applied in the previous year.
As indicated earlier in this report, there were 178 medical intern spaces allocated for this fiscal year. Medical internships have been authorized and instituted at the Martin and Womack Army Hospitals.
Twenty-four dental interns were selected for the academic year 1958-59. Since 104 applications were received from 25 American and 2 Canadian dental schools, it was possible to select individuals of the highest caliber. Dental internships were established at Womack and Martin Army Hospitals, four interns being assigned to each. Simultaneously, the intern program was terminated at the Fitzsimons Army Hospital, and the programs were reduced at the Walter Reed, Valley Forge, and Letterman Army Hospitals.
Inadequate numbers of medical officers were available during the year in general surgery, pathology, psychiatry, otorhinolaryngology, obstetrics and gynecology, and orthopedic surgery. As a result, on-the-job training programs were continued on otorhinolaryngology, radiology, and psychiatry, but only 36 physicians participated as compared to 124 the previous year and 329 in fiscal year 1957. During fiscal year 1960, this training will be conducted only in otorhinolaryngology.
The 42 graduates of the Medical Supply Officer Course (8-A-4490) were assigned to a 12-month period of training at selected Army hospitals and medical depots.
Two new 22-week in-service courses for junior ANC officers were established to alleviate the shortages of operating-room, obstetric, and pediatric nurses. One of these courses, Maternal and Child Care, was started at the William Beaumont Army Hospital in March 1959. The other new course, Operating Room Nursing, was conducted at both Letterman and Martin Army Hospitals (table 14).
In addition to the 615 who participated in the Management of Mass Casualties courses at Walter Reed and Brooke Army Medical Centers, approximately 600 AMEDS officers attended professional specialty courses conducted at six Army medical facilities, at the Armed Forces Institute of Pathology, and at the National Naval Medical Center, Bethesda, Md., during the fiscal year. There were 32 different types of courses, ranging in length from 4 days to 52 weeks. The AMEDS participants included 123 MC, 157 DC, 7 VC, 32 MSC, 278 ANC, and 1 AMSC officers. Table 14 shows the various courses and the number of AMEDS officers enrolled in each.
Service School Courses
In order to conserve training man-years and achieve maximum use of available manpower, a new training pattern for AMEDS officers was adopted during fiscal year 1959 along with other adjustments in courses and quotas at the Army Medical Service School.
The title of the AMEDS Orientation Course has been changed to the AMEDS Officer Basic Course (8-A-C1A). This course, formerly for officers of all the AMEDS corps, is now restricted to medical, dental, and veterinary officers.
The 22-week AMEDS Company Officer Course was discontinued, effective 1 January 1959, to make more company-grade officers available for active duty. Regular Army MC officers who formerly were assigned to this course are now enrolled in the AMEDS Basic Officer Course.
The name of the Medical Service Corps Orientation Course was changed to the Medical Service Corps Basic Course (8-A-C1B), and the length was increased from 12 to 16 weeks.
A new 9-week course, Army Nurse Corps Officer Basic Course (8-A-C1C), was established for the training of student nurses who formerly were enrolled in the AMEDS Orientation Course.
New AMSC officers now attend the first 4 weeks of the 9-week ANC Basic Officer Course, instead of the AMEDS Officer Orientation Course.
A 23-week course, Advanced Military Nursing (8-A-C4C), was established for career ANC officers. It replaces the Advanced Nursing Administration Course of 27 weeks.
The quota for the AMEDS Officer Advanced Course (8-A-C4) of 22 weeks was increased from 120 to 150 for each of the two classes conducted annually to provide MC, DC, VC, and MSC officers with the branch education necessary to qualify them for senior service schools. (A few ANC officers also attend this course.) The total number of
active-duty officers attending the advanced course this fiscal year was 245. The fact that 196 of these were MSC officers is indicative of the emphasis being placed on enrolling eligible officers of that corps in this course early in their careers and thus making them eligible for more advanced civilian and military training (including the Hospital Administration Course) at a much earlier age.
Quotas for the Regular and the Associate Command and General Staff College Courses were increased from 11 to 21 and from 7 to 11, respectively. These increases will materially assist the Army Medical Service in providing more qualified personnel for staff-level positions. Nine of the twenty one selected for the next Regular course, and eight of the eleven chosen for the Associate course, are MSC officers.
The Army Medical Service conducted 15 service school courses for AMEDS officers during the year at the Army Medical Service School, the Walter Reed Army Institute of Research, the U.S. Army Medical Service Meat and Dairy Hygiene School in Chicago, and the U. S. Army Medical Optical and Maintenance Activity in St. Louis. As in previous years, spaces were allocated not only to active-duty officers in the Army but also to Air Force, Navy, Reserve, and National Guard officers, as well as to other Federal agencies, to civilian professional groups, and to foreign nationals The total number of AMEDS participants in these courses was 1,916, including 833 MC, 241 DC, 101 VC, 505 MSC, 208 ANC, and 28 AMSC officers The number attending each course is shown in table 15.
In addition, 309 AMEDS officers were enrolled during the year in service school courses conducted by other technical and administrative services. These courses, 55 in number ranged from 4 days to 2 years in length. Table 16 shows the wide variety of these courses and the number of AMEDS officers participating.
Training in Civilian Institutions
In the United States.-A revision of AR 350-200, published on 29 May 1958, and effective on 1 July 1958, prohibited any student officer from attending classes in a civilian institution until a contract had been completed. This necessitated an immediate revision of AR 350-218 (Changes 3, dated 20 August 1958) requiring that applications for civilian institution training reach the Personnel and Training Division, OTSG, not later than 90 days before the courses begin in order to allow sufficient time to process the application and to permit The Adjutant General to make the contract. Because announcements of civilian short courses are frequently not available until 90 or 150 days before the starting dates, the number of AMEDS personnel attending
these short courses was smaller than for a similar period in the preceding year. To overcome this difficulty, Changes 3 to AR 350-200 was published on 19 March 1959, which permits personnel, in such instances, to attend civilian short courses upon the approval of the training agency, with the provision that the individual taking the training pay his own tuition and be reimbursed by public voucher. There were 212 AMEDS officers enrolled in civilian short courses during the year, including 83 MC, 59 MSC, 25 AMSC, 17 ANC, 14 VC, and 14 DC officers.
Army Medical Service officers attended 39 long courses (9 months or longer) conducted in 33 civilian institutions during fiscal year 1959. The total number of participants was 116, including 47 MSC, 24 ANC, 15 AMSC, 14 MC, 9 DC, and 7 VC officers. Table 17 shows the titles of the courses, the schools where they were conducted, and the number of AMEDS officers attending each. In addition, 32 AMEDS officers participated in the Final Semester Plan, which permits them to be assigned to temporary duty for 6 months to complete education in a civilian school leading to a college degree. Enrolled in 17 colleges and universities for this purpose were 23 MSC, 8 ANC, and 2 AMSC officers.
Overseas.-To expedite the placement of AMEDS officers for training in civilian institutions in Europe, The Surgeon General requested that an exception be made to the policy of maintaining control of Army training at the Department of the Army level to the extent that the Surgeon's office in the European command be allowed to request the training space at the civilian institution concerned and thereby save time in the procedure for making the contract. Upon receipt of the application for the requested training, along with information on space availability, dates of the course, tuition, travel and per diem cost, and the name of the individual at the institution to be contacted in making the contract, the Office of The Surgeon General would notify The Adjutant General and request that contractual arrangements be made. Deputy Chief of Staff for Military Operations approved The Surgeon General's request on 24 October 1958, thus opening the way for establishing a training program for AMEDS personnel in European civilian institutions. One MC officer attended a short course in obstetrics and gynecology at the University of Vienna in January 1959.
Forty-seven executive officers from Army class II and I hospitals, from offices of army surgeons, and from USCONARC attended an Institute for Executive Officers at the Walter Reed Army Medical Center, 1-5
December 1958. The institute was designed to provide appropriate training for officers who were then assigned or anticipated being assigned as executive officers in Army hospitals or in the offices of command surgeons. Among the subjects covered were hospital organization and administration; program and budgeting; review, analysis, and evaluation of operating results; and preparation of hospital directives and reports.
Panel discussions on problems of personnel administration and management were conducted as a means of obtaining maximum participation of the 46 conferees at the Institute of Personnel Officers at the Walter Reed Army Institute of Research, 9-13 February 1959. Included in the discussions were such topics as interpersonal relationships within hospitals, personnel records, in-service education, welfare and morale services, newly developed equipment, problems of the Army efficiency reporting system, and the Army school system as it applies to officer, enlisted, and civilian personnel.
Forty-nine MSC officers engaged in comptroller activities at medical installations in Europe, the Far East, and Hawaii, as well as at the class I and II hospitals in CONUS and the medical sections of the six army area headquarters and USCONARC attended the Institute for Comptrollers at the Walter Reed Institute of Research, 16-20 February 1959. The primary objective of the institute was to provide an appropriate, practical type of training for comptrollers and for management officers. A portion of the program was devoted to separate discussion groups arranged by the various types of facilities represented by the conferees.
Forty-six AMEDS supply officers from medical installations throughout the world attended the second annual Institute for Supply Officers at the Brooke Army Medical Center, 2-6 March 1959. The institute was devoted primarily to discussion of specific problems involved in supplying medical units supporting combat units. The program included a demonstration of eight types of medical supply units for mass casualty treatment and a display of new medical equipment.
The semiannual Army Medical Specialist Corps Institute was conducted at the Walter Reed Institute of Research, 2-8 November 1958, and 11-16 May 1959, with 30 AMSC supervisors from hospitals in the United States attending each session. The purpose of this course was to develop supervisory, teaching, and administrative skills essential to effective patient care, particularly in view of the rapid professional growth and change taking place in the field of medicine.
The first conference on Nursing Research was held at the Walter Reed Army Institute of Research from 24 February through 4 March 1959. Its primary purpose was to familiarize selected ANC officers with the
components of research and how research methods and techniques may be applied, formally or informally, to determine means of improving nursing care and the health and well-being of the military patient and his family.
In cognizance of the requirement for training personnel to meet the many problems expected in the event of a nuclear attack or other major disaster, the Army Medical Service has geared its logistic support to the training of officer and enlisted personnel in the immediate care of mass casualties. Doctrinal guidance, promulgating this concept, is being incorporated into new and existing training literature, films, and aids.
Considerable progress was made in this connection during the year with the preparation and release of a number of items. Others in this series will be released in fiscal year 1960. Field Manual 21-11, First Aid for Soldiers, was revised and published, and a change was made in FM 8-35, Transportation of the Sick and Wounded. Four more training films were produced in the series being issued under the general title "Management of Mass Casualties." These films and their subtitles are TF 8-2675, Part IV-Sorting; TF 8-2676, Part VIII-Management of Mechanical Injuries; TF 8-2713, Part IX- Burns; and TF 8-2712, Part X-Management of Psychological Casualties. Two special training aids-a first aid manikin and a prototype mouth-to-mouth resuscitator trainer-were also produced.
Training of Foreign Nationals
Observer and school training for foreign nationals was greatly increased during the fiscal year. The Army Medical Service provided specialty training in medicine, dentistry, nursing, and administration to approximately 400 such personnel, while another 100 were enrolled in formal classes in various AMEDS schools. During the previous year, the total number of foreign nationals participating was only 171. This training has done much to enhance the prestige of the Army Medical Service and the United States as a whole.
Medical Education for National Defense
With the addition of 10 more schools during the year, 50 medical schools are now participating in the MEND program. This represents about two-thirds of all the medical colleges in the United States
that offer 4-year courses. Although participation is voluntary, it is hoped that eventually all of the medical schools will take part. The purpose of the program is to indoctrinate medical students concerning the application of the principles of medicine and surgery to a military situation involving mass casualties in the event of a nuclear attack or a civil disaster. The Army, Navy, and Air Force continued to contribute funds in support of MEND and to provide other assistance, such as lectures, literature, films, and short courses for the school coordinators.