GME

Authorship and Academic Careers in the Navy

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I recently gave a talk to the Emergency Medicine residents at NMC Portsmouth about authorship and academic careers in the Navy. Here is the outline of the talk and some tips…

Academic Career Options

There are a number of options for those who are interested in establishing an academic career in Navy Medicine. Here are the ones I know of:

  • Residency programs at a medical center – Serving as teaching faculty at a residency program at Walter Reed, San Diego, or Portsmouth.
  • Family Medicine (FM) teaching hospitals – Serving as faculty at the FM residency programs in Ft. Belvoir, Lejeune, Camp Pendleton, and Jacksonville. This opportunity is not just for FM physicians, but for Internists, Pediatricians, subspecialists, etc. as the FM programs need all of those people to support the education of their residents.
  • Japanese internships – Both Yokosuka and Okinawa have internships that are structured like Transitional Internships and allow Japanese physicians to learn how American medicine is conducted. Most graduates try to obtain letters of recommendation and apply for graduate medical education (GME) in the US. Taking a leadership role in these programs can prepare you to lead GME programs when you PCS back to the US.
  • Transitional internship programs – Leadership opportunities in Transitional Internships are open to just about every specialty, and many physicians have used Transitional Internship Program Director as the stepping stone to O6.
  • Uniformed Services University of the Health Sciences (USUHS) billets – Many specialties have billets at USUHS that allow you to take a leadership role in the departments and teach medical students.

Authorship Options

The opportunities to publish have increased dramatically during my 18.5 year career. For example, you’re reading this blog and that didn’t exist when I started. Here are the opportunities to publish that currently exist with some tips listed after each:

  • Apps – This is the only thing on this list I haven’t tried, but there are articles that explain how to do it and tell stories of physicians who made money doing it.
  • Blogs – This isn’t hard to do, so there’s nothing but time and effort preventing you from putting your opinion out there for others to read. Don’t underestimate how much time this takes, though, so know what you are getting into. I have literally spent thousands of hours on this blog.
  • Books and book chapters – I’ve published 4 books (you can see 3 of them on Amazon here) by working with my specialty society, so that is one opportunity to pursue when it comes to books. The easiest way to start writing books chapters is to find someone you know that is senior to you who already writes chapters and offer to be a co-author for the next edition. If you go to your department head/chair or residency director, they should be able to tell you who writes book chapters in the department.
  • Case reports – This is the entry path to publishing and where I made most of my initial academic bones. Frankly, publishing case reports gotten me a lot of my academic reputation, fitrep impact in block 41, and subsequent promotion to O4 and O5. Nowadays, there are a lot of journals and it is easier than ever to get something accepted, especially if you are open to publishing cases on blogs or in newsletters.
  • Humanities – Many journals regularly publish 1-2 page articles about the experience of being a physician, ethics, military medicine, and other related topics. A common way to get one of these published would be to deploy and then write a humanities piece while deployed or upon returning about your experience.
  • Newsletters – I wrote a personal finance column in one of our specialty society newsletters for 7 years. If you can get a regular gig like this, it will force you to write on a regular basis and really build your CV and academic reputation. Every specialty has newsletters and “throw away” journals that arrive in the mail. Contact the editors, offer to write something, and see if this is something you enjoy.
  • Podcasts – Similar to blogs, this is fairly easy to do with some free software (Audacity), a $50 USB microphone headset, a podcast host (I host on this blog’s WordPress site but here are other hosts out there), and the time to figure out how to post your content on the Apple store. Like blogging, it is very time consuming. Personally, it is not my favorite thing to do (which is why my podcast has lagged way behind) because I have zero interest in learning how to properly edit recordings, but there is nothing preventing you from getting your voice out there.
  • Research manuscripts – If you want to do research, you should start with the Institutional Review Board (IRB) that your command is subject to. There will be resources available to help you, but in my experience it is a pull system (you have to inquire and go get them) and they are not pushed to you. Typically, you’ll find grant writers, statisticians, and sources of money to do research. You’ll also find additional military rules and regulations heaped on top of all of the already existing IRB rules and regulations. This latter fact is what dissuaded me from doing a lot of research in my academic career.
  • Review articles – Most journals solicit authors to write review articles, so it is hard to get one accepted if it is unsolicited. That said, if you shorten it a bit by focusing on a more narrow topic and build it around a case presentation, you can get them accepted as case reports.

How to Build Your Academic Career in the Navy

What is the easiest way to build an academic career? It is simple but not easy. Not that many people follow through on it. Here are the steps:

  1. Obtain a USUHS faculty appointment – This blog post tells you how to do it.
  2. Progress toward promotion

This 2nd step is the step that most people fail to follow through on. They get appointed as an Assistant Professor, and then they stop working toward promotion to Associate Professor or full Professor.

In general, an Assistant Professor is a local/regional expert, an Associate Professor has established themself as a regional/national expert, and a full Professor has reached national or international acclaim. If you touch base with your USUHS department once a year and get their assessment about what steps you need to take to get promoted, you will be forcing yourself to progress in your academic career.

For example, I’m an Associate Professor of Military & Emergency Medicine and recently applied to be a full Professor. The feedback I was given was that I needed 3-4 more peer-reviewed publications as the first author. I may or may not choose to try and get them, but at least they gave me an honest assessment of what I needed to do. If you do this annually, you’ll get actionable feedback that you can address as you build your academic chops.

6 Director Positions Available in Southern California – Merry Christmas!

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Naval Hospital Camp Pendleton will have the following leadership positions available this upcoming spring/summer:

All position descriptions are above. They are available to all Corps who are in the PCS window for next summer. This is probably clear, but you need Detailer clearance to apply if you are not already inbound or at NHCP. I’m sure an e-mail from the Detailer would suffice.

Interested applicants can submit their CV, Bio, and Letter of Intent to CDR Dave Lang (the DFA at NHCP – contact info in the global) by 31 January 2020 (for Branch Clinics and Medical Services), and 1 March 2020 for the remaining positions.

Merry Christmas!

Throwback Thursday Classic Post – Tips to Get Selected for GME

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(With GME results recently released, I figured this was as good a time as any to re-release this so that people who didn’t get selected for the GME they wanted could use this to strategize for next year. Enjoy!)

The Graduate Medical Education Selection Board (GMESB) results were released last week month with a 10 JAN deadline to accept or decline any spots you were offered.  Undoubtedly there were some people who didn’t get what they want. I’ve participated in the last five GMESBs and would like to offer tips for people looking to match for GME in the future.  We’ll cover general tips and those specific for internship and residency/fellowship:

General Tips

  • You can increase your score at the GMESB by having publications.  If you want to give yourself the best chance of maximizing your score, you need multiple peer-reviewed publications.  Any publications or scholarly activity have the chance to get you points, but having multiple peer-reviewed publications is the goal you should be trying to reach.
  • Be realistic about your chances of matching.  If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty.  There are some specialties where you can overcome a major blight on your record, but there are some where you can’t.  If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances.  Will they be honest and direct with you?  I’m not sure, but it can’t hurt to ask.
  • If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian.  By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student.  You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles.

Tips for Medical Students Applying for Internship

  • Do everything you can to do a rotation with the GME program you want to match at.  You want them to know who you are.
  • When you are applying for internship, make sure your 2nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.).  If you don’t match in your 1st choice and your 2nd choice is a popular internship, then it will likely have filled during the initial match.  This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application.
  • Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency.  For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD.  If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship.  Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can.
  • You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship.  Many of the medical students I interviewed did not have a plan if they got a 1-year deferment.  I think every medical student needs to do one of two things.  Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you.  Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does.  It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through.  If you are going to just scramble at the last minute, that is fine, but it should be an informed choice.

Tips for Officers Applying for Residency or Fellowship

  • You should show up whenever you can for conferences and journal clubs.  Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program.
  • Always get a warfare device (if one is available) during your FS, UMO, or GMO tour.  Not having it is a red flag.

National Capital Consortium Ophthalmology Program Director

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Here is the announcement/recruitment letter for the Program Director position for the NCC Ophthalmology Residency.

The memorandum to the Surgeons General requests the widest dissemination of the announcement to ensure that all physicians desiring an assignment as a Program Director have the opportunity to apply.

Here also is the DoD Policy and Selection Criteria for GME Program Directors, as well as the ACGME requirements for this position.

Please note: Applicants are required to submit a CV and Letter of Intent to apply for the position.

An applicant’s CV must include a section about faculty development activities that they have done.

An applicant’s CV must demonstrate at least 3 years of documented education and/or administrative experience, as well as ongoing clinical activity in the (sub)specialty for which they are applying.

An applicant’s CV must demonstrate current board certification in the (sub)specialty in which they are applying. Current medical licensure must also be documented on the CV.

An applicant’s CV must demonstrate current ongoing scholarly activity.

The Letter of intent must include the candidate’s level of commitment to GME and the Program Director position, including the number of years they are willing to serve, and that if selected, that they will accept the position. This program is 6 years in length.

Navy applicants must submit to CDR Melissa Austin at BUMED (contact info is in the global).

MCCareer.org – The Book – Chapter 2 – Pathways to Becoming a Naval Physician

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Note: The views expressed in this chapter are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Special Thanks to Drs. Jami Peterson and Brett Chamberlin for their revisions of this chapter.

Introduction

The military has two programs that provide financial support for medical students and one that supports residents. The Health Professions Scholarship Program (HPSP) and Health Services Collegiate Program (HSCP) are used to attend a civilian medical school. The Family Assistance Program (FAP) provides financial assistance to current residents. Each program provides various benefits in return for a contract serve as an active duty physician following completion of medical school or residency. Additionally, students accepted to the military’s medical school, the Uniformed Services University (USU) can earn their medical degree while serving on active duty. Alternatively, board certified physicians can apply to be a Direct Commission Officer (DCO) and begin service immediately upon commissioning.

Uniformed Services University (USU)

Established in 1972, USU trains future physicians in the unique aspects of military medicine while meeting all requirements for general medical licensure in the United States. Application to USU is through the American Medical College Application Service (AMCAS). In addition, applicants must also meet all requirements for active military service, including a medical screening examination and background security investigation prior to being unconditionally accepted into USU. Detailed information is available at https://www.usuhs.edu.

Each of the four uniformed services is represented at USU – Army, Navy, Air Force, and Public Health Service (PHS). While attending USU, Navy students are commissioned on active duty as an Ensign and receive military pay for that rank. All tuition, fees, medical supplies, and books are provided.

In addition to meeting all the requirements for medical education, a USU student is exposed to both life in the military and military medicine. Classes are given in military medical history, chemical and biological warfare, wound ballistics, deployment medicine, as well as many other military topics. At least two field exercises are conducted over the 4-year curriculum, giving the student a concentrated and intense introduction to medical support during simulated combat operations.

Following graduation, the new Navy physician is obligated to serve in the Navy for seven years in a non-training status following completion of the PGY1 (internship) year. Any commitment previously incurred through either the Reserve Officer Training Corps (ROTC) or any of the military academies is added to this obligated service and served consecutively.

Health Professions Scholarship Program (HPSP)

As a recipient of a HPSP scholarship, the military pays full tuition, all fees, reimbursement for required books and equipment, and a stipend of approximately $2300 per month. Participants get 45 days of active duty for training each year and are paid full entry-level officer pay and allowances during that time. At the present time, a signing bonus of $20,000 is offered. Time in the program does not count for retirement or pay purposes.

In exchange for financing the participant’s medical school education, an obligation to serve on active duty for the number of years of scholarship benefit or a minimum of three years (whichever is greater) is generated. HPSP eligibility requires that the applicant be a U.S. citizen (dual citizenship is not permitted), physically qualified for a commission in the military, and accepted into an accredited school in the U.S. or Puerto Rico. The minimum undergraduate GPA required is 3.2 and the minimum MCAT score is 500. Applicants must not have reached the age of 42 at the time of commissioning on active duty. Here is a link to the Navy HPSP website.

Periods in which officers are in a training status (such as internship, residency, or fellowship) do not count towards fulfillment of the military contract but count towards military retirement.

Health Services Collegiate Program (HSCP)

HSCP is very similar to HPSP, but with a different benefits package. Rather than commissioning into the Inactive Ready Reserve (IRR), students receive pay and benefits (including health insurance, basic allowance for housing, etc.). Medical school tuition is not reimbursed, however the time spent in HSCP does count towards the 20-year requirement for retirement eligibility. This pathway is most often used by prior enlisted students with families who attend a relatively inexpensive medical school, although having previously served is not a program requirement.

Family Assistance Program (FAP)

FAP is similar in concept to HPSP, with the exception that it applies to residency. Individuals can apply once they have been accepted to an accredited US residency program. The only caveat is that the types of residencies for which scholarships are offered may vary. Not all residencies and specialties will have a recruiting goal, so it is possible that the Navy does not offer the FAP scholarship to applicants in certain specialties.

Officer Preparedness Training

All medical officers attend 4 to 6 weeks of “Officer Development School” (ODS) located in Newport, Rhode Island. For USU students, this occurs prior to the first year of medical school. For HPSP students, this can occur at any time prior to graduation or immediately upon graduation. These courses are designed to give the new medical officer an orientation to military life as well as military customs and courtesies.

Graduate Medical Education

The typical pathways to residency training in the military are inservice programs at military treatment facilities (MTFs) or deferment and outservice programs that are completed at civilian residency training programs. For any given specialty, a graduate medical selection board is convened either in late November or early December to determine the program selection and the number of years of training for every applicant. Selection board results are published in mid-December.

Inservice Residency Training Programs at Military Treatment Facilities

Various Army, Navy, and Air Force MTFs around the country sponsor inservice residency training programs. They are all fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). While in a dedicated post-graduate training program (internship, residency, or fellowship), payback towards the initial service obligation is on “hold.” The service commitment resumes upon graduation from training. Inservice training counts toward retirement, but generally incurs additional obligated service time that may be served concurrently with medical school and undergraduate educational obligations.

Navy Active Duty Delay for Specialist (NADDS) Programs for Residency Training Programs in Civilian Institutions

Some graduating medical students are selected for deferment for their entire residency, called the Navy Active Duty Delay for Specialist (NADDS) program. This means that the student can match as a civilian intern/resident and complete his/her training in a civilian program. Upon such completion, he/she then enters or returns to military service as a civilian residency-trained physician. In some cases, a similar deferment of service obligation is permitted for Medical Corps officers who are already in the process of completing or have completed an internship, called Release from Active Duty to NADDS or “RAD to NADDS.”

Other graduating students are, however, granted only a one-year deferment to complete an internship in a civilian program. They are then expected to serve in general medical practice as General Medical Officers (GMOs), Flight Surgeons, or Undersea/Diving Medical Officers (UMOs/DMOs) for 1-3 years before applying for further in-service, out-service, or deferred training. Once completing this tour, they can apply for residency training through the military or finish their military obligation in this role and separate from the Navy.

Application to this program follows the normal civilian “match” guidelines after approval from the Navy. Using the NADDS route to post-graduate training incurs no further obligation but it does not count toward payback for the initial obligation. USU students are now eligible for deferment training programs.

Full-Time Outservice (FTOS) Programs for Residency Training at Civilian Programs

Full-time outservice (FTOS) training allows Medical Corps officers already on active duty the opportunity to train at a civilian institution while remaining on full-time active duty status. Unlike members in a deferment program, FTOS trainees continue to draw their military pay. In addition, like inservice training, time served in FTOS training counts toward retirement.

The number of FTOS training slots awarded each year varies depending on the particular need for residency or fellowship trained specialists. Graduating medical students are generally not eligible for FTOS training.

Summary of Graduate Medical Education Options

As detailed above, there are many different options available for GME. The following chart summarizes the programs available to the different programs:

Program/Status

Inservice GME

NADDS FTOS

RAD to NADDS

HPSP/HSCP

Eligible

Eligible Not eligible

Not eligible

USU student

Eligible

Eligible but rare Not eligible

Not eligible

GMO/UMO/Flight Surgeon

Eligible

Not eligible Eligible

Eligible but rare

Unique Opportunities in Military Medicine

The military offers unique opportunities not normally available in civilian medical practice and training. There is the opportunity to practice medicine in a variety of geographic locations spanning the globe. Military physicians can readily take part in both combat and humanitarian medical missions. In addition, the military offers unique training for physicians in undersea/hyperbaric, flight, tactical and wilderness medicine and other non-traditional fields. The practice environment is vastly different from civilian medicine, with near universal healthcare coverage of the patients you treat as well as significant protections of the individual physician from malpractice and litigation. Finally, there is a significant financial benefit and security to be gained from a military retirement pension with an automatic annual cost-of-living adjustment.

How to Get Published in Medical School and Boost Your CV

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Here’s a link to this article for all the medical students out there:

How to Get Published in Medical School and Boost Your CV

Throwback Thursday Classic Post – Tips to Get Selected for GME

Posted on Updated on

I’ve participated in the last four Graduate Medical Education Selection Boards (GMESBs) and would like to offer tips for people looking to match for GME in the future.  We’ll cover general tips and those specific for internship and residency/fellowship:

General Tips

  • Money is getting tight for permanent change of station (PCS) moves at BUPERS.  I think you can increase your chances of matching in GME by being local, or at least on the same coast, as the GME program where you want to train.  Keep this in mind when you are picking your Flight Surgery (FS), Undersea Medical Officer (UMO), General Medical Officer (GMO), or post-residency assignments.
  • If you want to give yourself the best chance of matching, you need multiple peer-reviewed publications.  Any publications or scholarly activity have the chance to help, but having multiple peer-reviewed publications is the goal you should be trying to reach.  Anything that is peer-reviewed counts, including case studies in Military Medicine which are, in general, pretty easy to get accepted for publication.
  • Be realistic about your chances of matching.  If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty.  There are some specialties where you can overcome a major blight on your record, but there are some where you can’t.  If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances.  Will they be honest and direct with you?  I’m not sure, but it can’t hurt to ask.
  • If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian.  By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student.  You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles.

Tips for Medical Students Applying for Internship

  • Do everything you can to do a rotation with the GME program you want to match at.  You want them to know who you are.
  • When you are applying for internship, make sure your 2nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.).  If you don’t match in your 1st choice and your 2nd choice is a popular internship, then it will likely have filled during the initial match.  This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application.
  • Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency.  For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD.  If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship.  Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can.
  • You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship. Many of the medical students I interview do not have a plan if they get a 1-year deferment.  I think every medical student needs to do one of two things.  Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you.  Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does.  It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through.  If you are going to just scramble at the last minute, that is fine, but it should be an informed choice.

Tips for Officers Applying for Residency or Fellowship

  • You should show up whenever you can for conferences and journal clubs.  Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program.
  • Always get a warfare device (if one is available) during your FS, UMO, or GMO tour.  Not having it is a red flag.