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ANNUAL REPORT THE SURGEON GENERAL UNITED STATES ARMY Fiscal Year 1960

Annual Report the Surgeon General United States Army Fiscal Year 1960

TRAINING OF OFFICERS

Residencies

For the first time since the inception of the residency training program in 1947, The Surgeon General's Professional Education and Training Committee held its annual meeting for the selection of residents in January of the fiscal year, rather than in November as had been customary. The selections were delayed primarily to give the military intern in an Army hospital the opportunity to serve on more services and thus help him make up his mind as to the field in which he would like to specialize. Previously, an intern often applied for a residency in one field and then, after being rotated to another service, found that he preferred a specialty other than the one he had chosen originally. In changing the date of the selection meeting, the committee took into account the fact that there would be a number of outstanding officers who would be completing their active duty in the summer and therefore should be considered for residency training earlier than in January so that they could make their plans accordingly. Inasmuch as these applicants would normally be selected if they had an outstanding record, it was decided to consider their qualifications on an individual basis.

At the January 1960 selection meeting, the committee considered 351 applicants for residency training to fill the 157 vacancies in the various specialties. The 157 selected included 81 interns from the fiscal year 1960 group, 15 interns from the fiscal year 1959 program, 47 MC officers on active duty, and 14 who were civilians at the time of consideration. Of the group not selected at the original meeting, 32 were military interns, 5 were fiscal year 1959 interns, 68 were MC officers on active duty, and 89 were civilians, most of whom had applied for commission in the Regular Army. After their selection at the  January meeting, 30 of the selectees declined the residency training offered, and the committee selected replacements from the alternate list.

The Surgeon General's plan for affiliating certain class I hospitals with class II hospitals which are conducting approved residency training programs in general surgery is being implemented. This is to be a pilot program and, if successful, may be extended to include other surgical specialties. Applications for the following 10 affiliations of class I hospitals with class II hospitals requested in the pilot program were submitted to the American Medical Association for approval:


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Class I hospitals

Surgical program affiliation

U.S. Army Hospital, Fort Hood, Tex.

Brooke General Hospital

U.S. Army Hospital, Fort Sill, Okla.

Do.

U.S. Army Hospital, Fort Campbell, Ky.

Do.

U.S. Army Hospital, Fort Ord, Calif.

Letterman General Hospital

Walson Army Hospital, Fort Dix, N.J.

Walter Reed General Hospital

DeWitt Army Hospital, Fort Belvoir, Va.

Do.

Martin Army Hospital, Fort Benning, Ga.

Do.

Womack Army Hospital, Fort Bragg, N.C.

Do.

U.S. Army Hospital, Fort Leonard Wood, Mo.

William Beaumont General Hospital

U.S. Army Hospital, Sandia Base, N. Mex.

Do.

   

Two other similar affiliations were proposed-one, the Fitzsimons General Hospital in Denver with the Irwin Army Hospital at Fort Riley, Kans., and the U.S. Army Hospital at Fort Carson, Colo., and the second, the Letterman General Hospital in San Francisco with the U.S. Army Hospital at Fort Huachuca. These were not included in the program because of the distances involved and other considerations.

It was planned originally that the affiliated programs, if approved by the American Medical Association, would become effective on 1 September 1960. On 25 February 1960, however, the consensus of the Professional Education and Training Committee was that the first residents under this program should not be assigned to the class I hospitals until September 1961. This would allow more time for familiarizing the general surgery residents currently assigned to the class I hospitals with the details of the plan and for training them to assist most effectively in putting it into operation.

Twenty-five residency training programs were conducted for medical officers in eight teaching hospitals during the year, and the number of residents completing their formal training continued to grow. As shown in table 17, there were 1,496 specialists (board-certified and board-eligible officers) representing 28 different medical specialties on active duty in the Army Medical Service at the end of fiscal year 1960, as compared to the estimated requirements of 1,838. These specialists constituted more than 40 percent of the total yearend strength of the Medical Corps (3,644). In fiscal year 1961, the number of specialists is expected to increase to 1,514. On the basis of estimated requirements, the greatest shortages at the end of fiscal year were in the specialties of general surgery (107), internal medicine (40), psychiatry (40), obstetrics and gynecology (35), pathology (31), preventive medicine (28), and otorhinolaryngology (28). The number of spaces actually authorized for these various specialties was, of course, generally below the estimated requirements. Moreover, the total number of


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TABLE 17.-Actual and projected strengths of, and estimated requirements for, Army Medical Corps specialists (board certified and board eligible), fiscal years 1960 and 1961

specialists actually on duty varied considerably during the year, since a large percentage were not in the Regular Army.

During the fiscal year, 48 medical officers representing 13 different specialties were certified by American specialty boards, bringing the



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total certifications of MC officers in the Army Medical Service to 542. The specialties and the number of newly certified officers in each were: Anesthesiology, 4; dermatology, 5; internal medicine, 2; neurological surgery, 1; obstetrics and gynecology, 5; ophthalmology, 4; pathology, 3; pediatrics, 4; preventive medicine, 1; pulmonary diseases, 1; radiology, 1; surgery, 6; and thoracic surgery, 1.

Nine dental officers completed their residency training during the year-four in oral surgery, two in periodontics, and three in prosthodontics. Similar numbers were selected to begin their residency training in these same specialties. Five DC officers completed their junior residency training and were advanced to senior status-two in oral surgery, three in prosthodontics.

One dental officer was certified during the year by the American Board of Prosthodontics, another by the American Board of Peridontics, and a third by the American Board of Oral Surgery. At the end of the fiscal year, the Army Dental Corps had 56 diplomates of American specialty boards, including 21 in prosthodontics, 21 in oral surgery, 11 in periodontics, 2 in oral medicine, and 1 in orthodontics.

The council of the American Board of Laboratory Animal Medicine granted approval to the Walter Reed Army Institute of Research, on 2 October 1959, for a residency program in laboratory animal medicine, and one VC officer was approved for this training.

Internships

Internship training for the 182 officers who entered the fiscal year 1960 Medical Intern Program was conducted at the class II Army hospitals in CONUS, as well as at the Martin, Womack, and Tripler Army (class I) Hospitals. Ireland Army Hospital at Fort Knox, Ky., will be added to the list of class I hospitals of internship, starting on 7 July 1960. The medical intern program at the Valley Forge General Hospital was discontinued at the end of this fiscal year. The 182 interns included 72 former participants in the Senior Medical Student Program, who reported to their hospitals of internship late in June 1960. The others were ordered to report early in July 1960.

Twenty-four dental interns were selected for training during the academic year 1959-60. There were 100 applicants from 30 American dental schools for the 24 training spaces, which again made it possible to select individuals of the highest caliber. A similar number of applications were received for the 28 training spaces authorized for the program in fiscal year 1961, when the Walson and Ireland Army Hospitals will be added to the list of Army hospitals designated to conduct dental intern training.


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On-the-Job Training in Specialties

Because of the insufficient numbers of medical officers available during the fiscal year in otorhinolaryngology, radiology, and psychiatry, on-the-job training programs were continued in these specialties but on a reduced scale. The rapidly diminishing requirements for this type of training is reflected by the fact that only 15 medical officers participated in these programs in fiscal year 1960 as compared to 36 in the previous year, 124 in fiscal year 1958, and 329 in fiscal year 1957. The bulk of the training this year was in otorhinolaryngology.

In order to prevent serious shortages of MSC officers in the specialties of comptroller, registrar, and personnel management during the next 3 years when many Reserve MSC officers will be retiring from the service, formal on-the-job training programs in these specialties have been authorized. The lack of adequate school training courses in these specialties and the necessity for having officers who thoroughly understand these particular facets of AMEDS organization, administration, and functions make this type of training essential.

During the fiscal year, 13 MSC second lieutenants with college training and an interest in management activities were assigned to class II and large class I hospitals for 1 year of on-the-job training in comptroller activities. Approximately 10 company-grade officers will be assigned to CONUS hospitals of 300 or more beds during calendar year 1960 for 1 year of on-the-job training in the registrar field. A number of career lieutenants with appropriate academic background and interest in personnel management will be assigned to various AMEDS organizations in CONUS for 1 year of on-the-job training in this field.

Postgraduate Professional Short Courses

More than 1,300 officers of the various AMEDS corps participated at some time during the fiscal year in one or more of the 40 different types of postgraduate professional short courses that are designed to keep them abreast of the latest developments in their fields of specialization in particular and in the Army Medical Service in general. These courses were conducted at six AMEDS installations, at the Armed Forces Institute of Pathology, and at the Army Chemical Center.

The total number of participants included the 574 officers from all the corps who attended the Management of Mass Casualties courses conducted at the Brooke and Walter Reed Army Medical Centers. The purposes of this course are to indoctrinate officers of the military medical services in the current concepts concerning the management of casualties that would result from the employment of nuclear weapons and to


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stimulate thinking on ways to cope with the problems which might arise from such an eventuality. Since most of the AMEDS officers have attended this course at one time or another over the years that it has been given, the annual attendance is declining. This has made it possible to meet in part the increasing demands from personnel of other Army services and civilian agencies to participate in this program.

Most of the other professional short courses encompassed a variety of subjects in the specialty fields of clinical and administrative personnel of the various corps. These courses ranged in length from 2 days to 14 weeks. The 754 AMEDS participants in these included 206 MC, 124 DC, 42 VC, 261 MSC, 114 ANC, and 7 AMSC officers. Table 18 lists the courses, shows their length and where they were held, and gives the numbers of AMEDS officers by corps that were enrolled in each.

The short courses in Outpatient and Army Health Nursing was combined in fiscal year 1960 in order to emphasize the expanding workload in the outpatient services. Another short course in Physiological Basis of Nursing Practice was initiated at WRAIR. The Professional Education and Training Committee granted approval to Fitzsimons General Hospital to start a short course (8 weeks) in Cardiac Surgical Nursing for ANC officers in fiscal year 1961. The first course will be attended by four selected Army nurses. Three courses will be conducted during the year.

Conducted for the first time this year at WRAIR was a 2-week course on Veterinary Aspects of Nuclear Medicine. This course presents the most recent data on nuclear medicine as it relates to veterinary food inspection activities in support of the Army in the field. The subjects covered include radiobiology, radiochemistry, and radiopathology in reference to the radioactive contamination of food. This course replaced a similar one that was presented at the Oak Ridge Institute of Nuclear Studies in Tennessee from 1954 to 1958.

Approximately 50 postgraduate professional short courses at military installations have been approved by the Professional Education and Training Committee for fiscal year 1961. Some courses given in fiscal year 1960 will not be repeated, and some new courses will be added.

Service School Courses

As a result of recommendations made by the Department of the Army Officer Education and Training Review Board and approved by the Commanding General, USCONARC, the titles, numbers and programs of instruction were revised for five courses at the Army Medical Service School. The changes will become effective in the ensuing fiscal year. In accordance with the recommendation of the board, the


110-113

TABLE 18.-Postgraduate professional short courses for Army Medical Service officers, fiscal year 1960


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programs of instruction for the officer basic courses were revised to stress the practical training necessary to prepare officers for their initial assignments. All the basic courses will again be known by their former title of orientation courses. The following are the courses in which revisions were made:

1.  The AMEDS Officer Basic Course (8-A-C1A) becomes the AMEDS Orientation Course with a new number (8-A-C20A) and is extended in length from 5 to 6 weeks.

2.  The MSC Basic Course (8-A-C1B) has been changed to the MSC Officer Orientation Course (8-A-C20B). This course, formerly 16 weeks, was reduced to 8 weeks, the maximum length recommended by the board for basic courses.

3.  The ANC Officer Basic Course (8-A-C1C) becomes the ANC Orientation Course (8-A-C20C). This course was reduced from 9 to 8 weeks.

4.  The AMEDS Officer Advanced Course (8-A-C4) was changed to the AMEDS Officer Career Course (8-A-C22) and reduced from 22 to 21 weeks in length. The program of instruction for this course is designed to prepare and qualify career officers for command and staff duty in the Army Medical Service and for attendance at the U.S. Army Command and General Staff College.

5.  The number of the Military Nursing Advanced Course (8-A-C4C) was changed to 8-A-F14, since it is considered to be a functional rather than a career course.

The Army Medical Service conducted 18 numbered and 4 unnumbered service school courses 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, and the U.S. Army Medical Optical and Maintenance Activity. Attendance at these courses included not only active-duty Army officers but also officers in the Air Force, Reserve, and National Guard, as well as foreign nationals. The 3,221 AMEDS officers who participated in the numbered courses represented a sharp increase over the 1,916 who were enrolled during the previous year. They included 1,332 MC, 696 DC, 217 VC, 524 MSC, 389 ANC, and 63 AMSC officers. The attendance from each of these corps registered a marked gain. The number attending each course is shown by corps in table 19.

All 70 officers enrolled in the AMEDS unnumbered service school courses were Army nurses. This inservice training of junior ANC officers was continued to alleviate the shortages of anesthetists, operating-room, obstetric, and pediatric nurses. The 13-month Anesthesiology Course was conducted at the Walter Reed, Brooke, Letterman, and Fitzsimons General Hospitals. The 5-month Maternal and Child


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Health Nursing Course was continued at the William Beaumont General Hospital. The 5-month course in Operating Room Nursing was given at Letterman General Hospital and at Martin Army Hospital, while the 9-month advanced course in the same subject was continued at Walter Reed General Hospital.

The 442 AMEDS officers who were enrolled during the year in service school courses conducted by other technical and administrative services also represented a large increase over the 309 who attended such courses during the previous year. The total number of these courses increased from 55 in fiscal year 1959 to 73 in fiscal year 1960. They ranged in length from 2 days to 11 months. Table 20 shows the wide variety of these courses and the number of AMEDS officers participating in each.

Based on requirements submitted by oversea commanders, DCSLOG imposed mandatory quotas on the Army Medical Service for the training of personnel in foreign languages. Six MSC officers were enrolled during the year in the 11-month Army Language School at the Presidio of Monterey in California.

Although the AMEDS quotas for the Regular and the Associate Command and General Staff College Courses remained unchanged, one of the officers nominated for the Associate Course was unable to attend. During the year, 21 AMEDS officers participated in the former and 10 in the latter. Of the total 31 enrolled in these courses, 18 were MSC officers.

Training in Civilian Institutions

A limited number of career officers from all AMEDS corps were enrolled during the year in civilian institutions for the purpose of obtaining advanced degrees in their specialties. The Surgeon General has emphasized the importance of career officers qualifying for the master's degree, particularly in such fields as business and hospital administration, public health, bacteriology, biochemistry, peridontics, institution management, and physical therapy. He believes that while there is less need for individuals with Ph. D. degrees, there are some fields in which this higher educational qualification is needed. These include entomology, microbiology, radiobiology, social welfare, bacteriology, biochemistry, and hospital administration.

There were 270 AMEDS officers enrolled in civilian short courses during the year, including 109 MC, 63 MSC, 39 ANC, 34 AMSC, 23 DC, and 2 VC officers. This was an increase over the 212 who participated in short courses in the previous year.

Army Medical Service officers attended a total of 51 long courses (9 months or more) conducted in civilian colleges, universities, and


116-117

TABLE 19.-Army Medical Service school courses, fiscal year 1960


118-122

 


123-128

other institutions during fiscal year 1960. The total number of participants was 122, including 50 MSC, 27 ANC, 16 DC, 13 AMSC, 8 MC, and 8 VC officers. Table 21 shows the titles of the courses, the schools where they were conducted, and the number of AMEDS officers enrolled in each. In addition, 36 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 29 MSC, 1 AMSC, and 6 ANC officers.

The advanced course in radiobiology, sponsored by the Defense Atomic Support Agency and formerly held at Reed College in Portland, Oreg., has been reorganized and transferred to the University of Rochester at Rochester, N.Y. While the selection of officers to attend this course was made in fiscal year 1960, the program will not begin until September 1960. The reason for this reorganization was to make it possible for students to obtain a master's degree as well as to retain the previous desirable feature of affording the participants a wide range of practical experience. Reed College did not award a degree for this course. The length of the course was increased from 6 months to the complete academic year of 9 months.

TABLE 21.-Long courses at civilian institutions, fiscal year 1960

Training Guidance

The Surgeon General continued to place special emphasis on the training of the individual soldier for survival in the event of a nuclear attack. In this connection, Training Circular No. 8-1, Training in Emergency Medical Care, published in December 1959, further promulgates the doctrine for this phase of the Emergency Medical Care Program (AR 40-130). The circular establishes the policy for the management of mass casualties and outlines the responsibilities for the training of officer and enlisted personnel in emergency medical care and survival care (first aid and self aid). It also outlines the minimum standards of proficiency expected from both medical and nonmedical personnel.

The latest AMEDS doctrine for response to nuclear disaster was demonstrated in Operation SURVIVAL, which was conducted at Fort Sam Houston, by the Army Medical Service School, on 22 March 1960, before some of the Nation's leading civilian medical educators, top-ranking military personnel of the three military services, and AMEDS instructors. One of the purposes of Operation SURVIVAL was to underline the urgent necessity of implementing emergency medical care training for Army troops in order to provide them a means for survival on the nuclear battlefield.

The demonstration was divided into two parts. The first depicted an assumed nuclear attack on the San Antonio, Tex., area with its complexity of military bases. Through the use of "country-fair" methods, enlisted personnel who had been trained in a 20-hour program of emergency medical care as prescribed in the new training circular, demonstrated their capability of providing self aid and buddy care by utilizing the Phase I Emergency Medical Treatment Unit. This demonstration proved that (1) well-trained soldiers are capable of giving interim medical treatment until medical personnel and facilities can provide definitive care; (2) the Phase I Emergency Medical Treatment Unit, properly positioned, can provide the minimum medical supplies required for survival care; (3) a limited quantity of medical supplies can be extended through careful management and improvisation; and (4) the training program and media developed in support of the Emergency Medical Care Program are sound, if properly applied.

The second part of the program demonstrated, under simulated combat operations, the impact of nuclear warfare on the battle group and the division level of medical service. By use of narration and demonstration, demonstrators portrayed the attack of an infantry division


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against an enemy equipped with the latest nuclear and conventional weapons. Following the nuclear attack against elements of the division, a tour was conducted of division medical treatment installations. Simulated patients being treated in those installations were accurate as to volume, types of injury, and time space factors involved. Three main problem areas were highlighted. (1) In the field, as in garrison, the initial care to casualties will frequently be of the self-aid or buddy-care type; (2) the logistics burden imposed by mass casualty situations represents a serious drain on a division's manpower and equipment; and (3) a disparity exists between medical means and medical requirements within the infantry battle group.

Training of Foreign Nationals

The number of foreign nationals participating in observer and school training continued to increase. In addition to the 82 who attended AMEDS school courses (table 19), 25 were enrolled during the fiscal year in 1-week formal short courses and 425 in observer training. The observer training periods ranged from 1 week to 1 year. The training of foreign nationals is conducted under the provisions of MAP (Military Assistance Program) and also on a non-MAP basis. Representatives of approximately 70 countries participated. It is believed that this training has contributed toward a better understanding and improved relations between the United States and its allies.

Medical Education for National Defense

By the end of the fiscal year, 82 medical schools were participating in the MEND (Medical Education for National Defense) program, established in 1952, to indoctrinate medical students in applying the principles of medicine and surgery to a military situation involving mass casualties resulting from a nuclear attack or a civil disaster. All but five of the accredited medical schools in the country are now taking part in this program. Participation is voluntary, and the manner in which the program is implemented is left to the discretion of each school. The Army, Navy, Air Force, and U.S. Public Health Service contribute funds in support of MEND and provide other assistance, such as lectures, literature, and films. Each of the four services also presents an annual symposium for the school coordinators. The AMEDS symposium this year was conducted at WRAIR, 15-17 December 1959.

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