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Discussion in 'Military Medicine' started by ArmyAerospace, May 17, 2012.
Update about Army Aerospace Medicine Residency Training in Pensacola, FL.
what the hell about it??? that it's still not a real specialty? I foresee an Onion article.
Check out the following links -
Army Aerospace Medicine (AM) is actively recruiting recent graduates, junior active duty physicians, and qualified civilian physicians wanting to join and train in the Army. Our combined graduate medical education programs unite the best aspects of our Aerospace Medicine program, Occupational Medicine program and a Master of Public Health degree from the University of West Florida. The programs are located at the Naval Aerospace Medicine Institute (NAMI) in Pensacola, FL. Training leads to board eligibility in both Aerospace Medicine and Occupational Medicine with the American Board of Preventive Medicine.
Army Medical Corps Officers accepted to the training program will be stationed in Pensacola, FL for the program. The combined training program lasts 36 months after the First Year of Graduate Medical Education (FYGME or internship).
For graduating medical students, we have primary AM Transitional Program GME positions for at Eisenhower Army Medical Center (EAMC), Fort Gordon GA. New physicians accepted Army AM will train EAMC for 1 year and then be transferred to NAMI in Pensacola to complete the programs.
Individuals who have completed an FYGME (internship) will matriculate directly to Pensacola.
After graduation Army Aerospace Medicine Specialists are typically assigned as Combat Aviation Brigade (CAB) Surgeons leading and training 4 other flight surgeons, 6 Aeromedical Physician Assistant, and up to 30 Flight Paramedics and medical personnel. Combat Aviation Brigades have about 115 helicopters and 3000-5000 aviators, aircrew, aviation maintainers and support personnel. The CAB Surgeon provides direct care within a robust Aviation Medicine and Occupational Medicine Program. Army Aerospace Medicine Specialists also supervise and serve as the medical director of the CAB's Air Ambulance units. These Blackhawk Air Ambulances provide point of care medical evacuation and inter-hospital transport of the critically wounded and ill. CAB Surgeons and Army flight surgeon routinely participate in aerial flight with their units and fly critical care missions.
Requirements – Be an Active Duty Army Medical Corps Officer or be willing to join the Active Army. Civilians must meet all commission standards and requirements for the appointment as an Army Officer (see http://www.goarmy.com/amedd.html). For application to and retention in aerospace medicine training, all physicians must be able to obtain and maintain a qualified Army Flight Duty Medical Exam (2F).
More to follow but if you are interested feel free to contact me –
Samual W. Sauer, MD, MPH
Lieutenant Colonel, Medical Corps, United States Army
United States Army School of Aviation Medicine Program
@ The Naval Aerospace Medicine Institute, Pensacola, FL
More information -
The Army Flight Surgeon Primary Course (AFSPC) is NOT a prerequisite for matriculation. If needed, the course will be included during the residency.
The US Army School of Aviation Medicine and the Naval Aerospace Medicine Institute (NAMI) are now offering combined training in Aerospace Medicine and Occupational Medicine residencies completed over a 36-month program. This also includes a concurrently completed Master of Public Health degree from the University of West Florida. Army residents are assigned to USASAM with duty at the programs located at Naval Aerospace Medicine Institute (NAMI) in Pensacola, FL for the 36 months. Training leads to board eligibility in both Aerospace Medicine and Occupational Medicine with the American Board of Preventive Medicine.
The combined training program is heavily weighted in clinical medicine. These include rotations in Cardiology, Pulmonology, Orthopedics, Psychiatry, and Women's Health. Additionally residents complete rotations in at 4 different Occupational Medicine Clinics at major military industrial facilities along with Dermatology and Sports Medicine. Residents also complete unique Aviation Medicine sub-specialty rotations in Internal Medicine, Psychiatry, Ophthalmology, Neurology and Aeromedical Physical Qualifications.
The UWF Master of Public Health Degree Map:
HSA Public Health Care Policy and Administration
PHC Social and Behavioral Sciences in Public Health
PHC Epidemiology for Public Health Professionals
PHC Survey of Environmental Problems
PHC Internship in Public Health
HSC Public Health Preparedness
PHC Epidemiological Study Design and Statistical Methods
PHC Fundamentals of Occupational Safety and Health
PHC Occupational Safety in the Health Care Environment
PHC Fundamentals of Industrial Hygiene
PHC Aerospace & Occupational Toxicology
PHC Accident Investigation, Risk Management, And Mitigation
Finally, during their program residents complete military unique curriculum by attending the following courses:
Army Flight Surgeon Primary (AFSPC)
Aviation Safety Officer (ASO)
Advanced Clinical Concepts in Aeromedical Evacuation (ACCAE)
Joint Enroute Care (Critical Care)
Medical Evacuation Doctrine (2C-F7)
Medical Effects of Ionizing Radiation (MEIR)
Medical Management of Chemical and Biological Casualties (MCBC)
Global Medicine or Military Tropical Medicine (GM or MTM)
Brigade Surgeon or Division Surgeon (BDE SGN)
Army Space Cadre Basic (ASCBC)
Medical Review Officer (MRO)
Preventive Medicine Senior Leaders (PMSL)
Fundamentals of Occupational Medicine (FOM)
AMEDD Captain Career Course (CCC)
So why not do a residency in IM or FM, where you'll get better training in these sub-specialties? What exactly does an Aerospace Medicine "doctor" do, that an astute internist or FP couldn't do?
And let's not have the "pilots-need-special-care-from-special-docs" talk. We all know that most pilots are in great health, otherwise they wouldn't be flying. No one on coumadin is flying a helicopter in the military. And if they should develop a condition, who better than a Internist/FP/Orthopod/Surgeon to dx and treat that?
I'm kinda being tongue-in-cheek here, but I really would like to know (as a student applying for residency soon) why your specialty even exists.
And in so doing, you might earn the respect of your physician colleagues, who see 20 patients a day, still do inpatient medicine, are still in the OR . . . aka the real business of medicine! (emphasize might)
To answer your question about the ARMY SPACE CADRE BASIC COURSE
1. COURSE DESCRIPTION: This course will orient soldiers and civilians on the basics of space and space related mission areas as they perform their duties. It will also give them a foundation to attend other advanced space courses.
2. COURSE OBJECTIVES: At the conclusion of the ASCBC, students will;
a. Understand the building blocks of orbital mechanics
b. Understand the threats in space to include manmade and natural affects on satellites
c. Understand the different military and joint military organizations and their missions
d. Understand the mission areas and how they relate to the Army's missions
3. COURSE STRUCTURE: The course will consist of 30 blocks of instruction.
a. Command Briefing
b. Space Cadre/ Space Professional Strategy
c. Space History
d. Space Policy and Doctrine
e. Space Organization
f. Space Law
h. Orbital Mechanics
i. Position, Navigation & Timing (PNT
j. Blue Force Tracking (BFT)
k. Launch and Reentry
m. Space Environment
n. Spacecraft Subsystems/Spacecraft Payloads
o. Space Mission Operations
p. Electromagnetic Spectrum
q. Satellite Communications (SATCOM)
r. Threats to Space Systems/Space Surveillance Network
s. Military Applications of Commercial Imagery/Satellite Command and Control
t. Space Based Weather
u. US Space Lift
v. Foreign Space Lift
w. Foreign Space Communications, Command and Control
x. Missile Warning/ONIR
y. Missile Defense
z. Joint Service Components
aa. CENTCOM Space Operations OIF/OEF
bb. Space Planning Cycle (IPB Annex N)
cc. National Systems
dd. Future Systems
The only reason flyers are so healthy in the first place is because of the selection bias driven by the development, promulgation and application of aeromedical standards. The primary care plus the application of physical qualification standards is where the rubber meets the road in Army Aviation Medicine.
It's really amusing that you raised the point about Coumadin and flying. Because we had to deal with that issue the other day. An "astute" Internist actually gave an Army Aviator a clean bill of health, reported a completely normal physical and history and left out the fact of two pulmonary embolisms and that the Aviator was taking life long Coumadin. You are right, they shouldn't have been aeromedically cleared for flying. But, none the less, they were give a "full flying duty" by this ill informed Internist. Unfortunately, this is an all to common experience and I can cite numerous examples.
We routinely see crew-members treated by "Internist/FP/Orthopod/Surgeon" and recommended for a return to flying duty on narcotics, anti-depressants, and sedating medications. I've seen cardiologists recommend that crew-members return to fly after two myocardial infarctions and an ejection fraction of 36%. I've had almost every type of specialist tell me that an Army Aviator should be able to fly even when they couldn't meet retention standards for Army retention let alone aviation.
Besides primary care to Aviators, enlisted crewmembers, and aviation maintainers Aerospace Medicine Specialists serve to minimize the aeromedical risk of aviation mishaps. Our focus is on getting ill and injured crew-members back into flying while minimize the risks. We select treatments and medications that are consistent with the safety of flight.
It is also interesting that you reject the role of the aerospace medicine specialist in the "pilots-need-special-care-from-special-docs." Makes it challenging argue the point if you've already intellectually closed off the argument and rejected the answer. It also rejects the fact that every service and the Federal Aviation Administration requires a special qualification to return aviation crew-members to duty. It also rejects that almost every country in the world with real aviation services recognizes and agrees with the need for aeromedically trained physician to serve as aeromedical examiners or flight surgeons.
Also, as I described, we are a clinical speciality. Our graduates see patients with the same frequency as other Army physicians assigned to operational assignments and military treatment facilites.
For what it is worth to you, I am also an Internist. With the exception of inpatient care (which we don't need) I'll put our programs up against any other type of program to produce qualified, competent and professional physicians and Medical Corps Officers.
Yeah, that's not my definition of "astute". It sounds like what you're saying--and I would agree 100%--is that our pilots need a dedicated physician to take care of them, to watch over their flight status, to properly ground them or not, as necessary. You cant have an FP run a active duty clinic and be expected to take care of a squadron on the side, keeping in mind all of the regs for flight status. You want that FP dedicated solely to the squadron. I get that.
But why does that necessitate a separate specialty? You can take that FP, teach him/her all the regs pertaining to flight status, and they should already know how to dx the relevant pathology (Afib, PEs, MIs galore).
Then you did it the right way. Our pilots deserve good care. I'd rather see them get care by providers that first trained in a formal discipline of medicine (not doing just Aerospace medicine). I know some people don't wanna do IM/FM/Surgery etc residencies b/c of the difficulty in training/academics . . . but sometimes taking the path of most resistance can yield a better trained professional . . . I think that's very true in medicine, in my oh-so-humble opinion.
Another strength that the Aerospace Medicine specialist brings to the table, and that is often overlooked, is the "population perspective" that is gained during the MPH portion of the program.
My medical school was pretty strong in epidemiology, biostats, etc. But, it wasn't until I actually completed an MPH that I truly understood how to read (and interpret) the medical literature....as an example, we used to have a weekly journal club during the program where the presenter was obligated to find an article with flaws in the approach to the epi/statistical analysis. Having come from a "clinical" background where the common practice was to read the intro/study design and then jump directly to the conclusions/discussions without considering if the "matched-pairsT-test" was appropriate or not, the number of articles in respectable journals that included sample size issues, questionable assumptions,inappropriate matching, non-generalizable conclusions, etc was amazing. Good clinical programs may train their residents in these sorts of issues, but I'm doubtful…
Furthermore, it has been my experience that military commanders and leaders at high levels value "actionable" data that can help them make appropriate decisions. The astute clinician who can provide valid population-based data (ie, an MD/DO trained in Prev Med/Occ Med/Aero Med with an MPH) and interventions is critical to the success of our military. It lacks the media glamour of stopping the bleeding in the OR, but it's definitely necessary. A poorly-informed commander making a misguided choice that lacks a population-based foundation is a recipe for disaster…successful programs that PREVENT issues never get any credit because nothing happens! The RAM program is a valid way to gain the skills necessary to make these sorts of recommendations...
There is a difference between dedication and commitment. The chicken lays eggs all day long for your breakfast but the pig is actually committed. Our short course graduates (Army Flight Surgeon Primary Course) are dedicated and make tremendous efforts to support Army Aviation Medicine. Along with Aerospace Medicine specialists they provide impassioned professional care for our crewmembers.
But, as Family Medicine, Internal Medicine, and Pediatricians they rarely stay active in Aviation Medicine after their first assignment. Their specialty leaders consider the "FP dedicated solely to the squadron" to be an "operational tax" and a distractor from the "real" practice of medicine in the Army, a fixed base medical treatment facility. To them, this means hospital leadership positions, clinic assignments and career growth in the MTFs and specialty specific clinics. The Aviation Medicine program loses these professionals back to the hospital after about 2 years of experience. This is right at the time when they learn their jobs as flight surgeons. However, Aerospace Medicine specialists are committed to career of aviation medicine and crew-member health care.
Your post actually makes the argument for Aerospace Medicine quite handily but then continues to reject the concept. Again, besides our clinical practice we serve as the continuity specialty in the aviation medicine program and systems that protect aviation safety. You state, "You can't have an FP run a active duty clinic and be expected to take care of a squadron on the side, keeping in mind all of the regs for flight status." You are sure right on with that comment. I can't really make a stronger argument than citing your own words here. That is exactly the truth and what always happens. Right now in both Army and Navy Medicine the non-Aerospace Medicine specialist flight surgeons are routinely pulled back to the hospital to work non-aviation medicine clinics while directly assigned to the flying organizations. They don't get to work full time or stay in aviation medicine. Like anyone who doesn't routinely practice in a specialty they lose currency and competency in aviation medicine practice.
Why does Aerospace Medicine exist as a specialty? For the same reason that any specialty exists, demand for the product. Physicians need specialty training because one cannot master the full fund of knowledge and technical skills needed to cover every disease we humans suffer. Aerospace Medicine is no different. One could make a similar straw-man argument about Family Medicine (or PAs & NPs) as being unnecessary and underqualified (an opinion I don't share). Why do we need a Family Medicine specialty when we could simply see an Internist, Pediatrician, or OB-GYN. Each of those specialists are considered experts in their fields. Why not just go see the expert? No particular reason except for the high volume demand from the population seeking and needing health care. But, by definition, the Family Medicine physician is a generalist across all these fields without expert level medical knowledge. As soon as the case gets complicated the consults go out. Family Medicine specialists routinely consult me as an Aerospace medicine specialist (or as an Internist). They consult on aeromedical and "internal medicine" problems that I consider a routine. This is not a ding on the FM folks. They are driven hard by patient loads and a educational requirement to learn a broad swath medicine. I don't envy their stressors and clinical demands. Just recognizing that pathology exists in a 15-minute appointment and referring properly is demanding. (Perhaps that is why we get so many senior offers cross decking to the RAM programs?) Family Medicine works because Family Medicine patients are generally healthy. When the aren't generally healthy anymore they get sent to a specialist. Adding the complications of aeromedical safety and standards to this can lead to fatal mistakes and aviation mishaps.
cavd0c also points out an important aspect of our practice that is under reported. Take a look at the post. We deal with normal physiology in abnormal environment. We treat aerospace specific (dysbarism, special disorientation, G-forces, ect) and general medical problems in aerospace personnel. We develop and apply medical standards, grant exceptions, and facilitate the prevention, early diagnosis, and treatment of health hazards. We educate other physicians about the hazards of flight with certain medical conditions and serving as passenger advocates by promoting flight safety. We develop, identify, and institute protocols for aeromedical transport. We execute aeromedical evacuation and provide guidance for safe aeromedical transport of patients with common and critical medical problems. We advise in the development of air and space flight equipment, biomedical equipment, and vehicles for flight. We work on techniques for enhancing human performance; and techniques of crew resource management. We educate aviators, crewmembers, and commanders by providing appropriate safety information and conducting the medical aspects of any mishap investigation, including making recommendations to prevent recurrences. We also conduct aeromedical research into health, safety, human factors, and biomedical engineering aspects of the flight environment.
In a very short time you will get the chance to learn that one of the most important competencies in medicine is actually systems-based practice. The Aerospace Medicine specialty serves as the primary care physician for crew-members to coordinate their care with other specialists. This ensures that they quickly and effectively return to flying duty. The military cannot afford to make every physician, dentist, OT/PT, and psychologist a flight surgeon. Yet, crew-members often see these non-aviation providers and receive treatment. The Aerospace Medicine coordinates this care and diagnosis, treat, and determine how the disease conditions will respond in the abnormal environment of flight. This allows the Aerospace Medicine specialist to deliver clinical care with the appropriate and judicious medical knowledge required to treat aviators.
It is also interesting to see you assume we are not "first trained in a formal discipline of medicine." By definition, Aerospace Medicine is a formal discipline of medicine. But, from your post you seem to agree that training in Family Medicine as acceptable but then go on to reject Aerospace Medicine. But, we train side-by-side with Family Medicine residents and actually do more sub-specialty rotations than what is required by the Family Medicine Residency Review Committee. Additionally, "Prior to appointment in the [AM] program, residents must have successfully completed at least 12 months of clinical education in a residency program accredited by the ACGME, Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada."
On another topic, I actually trained in Aerospace Medicine first. I went back to Internal Medicine GME as a senior officer because it was always a passion for IM and the timing in my career was optimal for my personal growth and family life. In my IM program I was actually disappointed by the rotations I did in the most of the outpatient clinics. This disappointment included but wasn't limited to pulmonology, cardiology, orthopedics, adolescent, OB-GYN, and infection disease. As part of the NAMI RAM program I had already completed these rotations and I had a much better experiences. I also had much better patient contact, greater diversity of pathology, and more daily exposure time in the clinics. When you train in a busy IM program the residents are focused on inpatient care and there is no programmatic dedication to the outpatient subspecialty experience. There is a well documented, pervasive and programmatic pattern of being pulled off sub-specialty rotations for cross cover call, ICU call, IM clinic, and general IM education conferences. On a good week in any sub-specialty clinic I had about 8 total hours within that clinic seeing patients. This is typical of the Family Medicine training too.
Our residents in Pensacola share the very same rotations with the Family Medicine residents. However, we aren't forced by other requirements to pull our residents for "service obligations," call, or "continuity clinics." The Family Medicine program routinely faces this nightmare due to the ACGME duty hour rules, continuity clinics and service obligations (I know this because I attend on the FM inpatient service). We never exceed duty hours because of our curriculum design (no weekends, no call, and normal duty hours). This means our residents get a full week of sub-speciality training in every scheduled week. Personally, I had much a better outpatient medical education in the RAM program than during my IM program.
So, I truly appreciate the opportunity to address the points you've expressed. It would have made this thread a whole lot less interesting to the readers if you didn't chime in with your concerns and opinions.
I'm simply writing to remind everyone that although this is an anonymous forum one should still be respectful to the fact that you are likely a military physician (or soon to be one) and the least we can do is show respect to those around us.
You may not think a specialty should exist or any number of other reasons but at least give a poster who has self identified as an o5 a little respect. There's always room for debate and learning but some of the messages here certainly wouldn't have been said in the same manner in person.
That is all, carry on.
Yes, lets carry on. Self-identified recently separated prior flight surgeon IM subspecialist O5 here. In my experience, the docs in nonclinical jobs who came back to IM late because that had to do a residency to make O5 were often our weaker performers. And yet, the OP is quite quick to dismiss the rigor of that training. If you saw more pathology as an AM resident than a IM resident, you must have been trying hard not to find it. To hear a leader casually dismiss and belittle another specialty (not really his own despite having done the residency) is disappointing.
Also, to suggest that RAM is a clinical residency and hold up your internship as the reason is ridiculous. The same could be said for path (until recently), rads, prev med, and even for our GMOs. You brag that your residents aren't forced to do that pesky "call" and "continuity clinic". Those are critical experiences to learning to be a physician and that is incredibly out of touch.
As for executing aeromedical evacuation, thats not what I saw in theater. The docs on the daily flight leaving us from Bagram were AF intensivists.
This is a predominantly nonclinical job with limited applicability outside the service and implying otherwise is misleading.
Just to be real clear, I'm describing Aerospace Medicine in general and Army Aerospace Medicine specifically. Not Air Force and not Navy...just Army. Hence the title of the thread.
Wow... the poster offers lot of impassioned but misleading and misrepresented comments combined pseudo-quotes followed by an impressive amount of what appears to be anger. If the anger is driving the post and the facts I have been describing are ignored then it is really hard to use a rational explanations and common courtesy present a point of view. But, I'll make the effort.
First, I've never had a non-clinical job in my career. You can chose to believe or ignore that fact but that doesn't make the posted opinions of my career, my 26 years of service and one of my specialties true. It is fascinating when a person, who likely knows nothing about me, chooses to use a straw-man argument to insinuate that I was a weak resident. What a stimulating choice of tactics in an intellectual discourse. Also much opinion and very little fact.
Second, I saw much more pathology in the outpatient clinics during my AM residency than I did during my IM residency because of the time I actually got to spend time in those clinics. In IM, we spent 1.5 hours of daily morning report, a day a week in the IM continuity clinic and were on call or post call at least once every week during the outpatient rotations. This really minimizes the actual patient contact of time any resident can spend in an outpatient clinic. The math is simply the math and the new duty hours rules instituted on 1 July 2011 really increase this scope of the issue. (www.acgme.org/acwebsite/dutyhours/dh_index.asp).
Third, nowhere in any of my posts did I "dismiss the rigor of that training." That is something the poster chose interpret, wrongly. My IM program was challenging on the inpatient services because of volume, workload and time. The outpatient rotations were simply hit or miss depending on the inpatient demands. To assume I was belittling a specialty or to suggest that I dodged work simply is nonsense and just flaming. And for the poster to write what was they posted about Aerospace Medicine and then write, "To hear a leader casually dismiss and belittle another specialty (not really his own despite having done the residency) is disappointing" is really ironic humor.
Fourth, I would ask the other readers to actually read the description of the program we are offering. Holding up the internship wasn't the point. Read and take a close look at our program's described curriculum. How can a 24 month series of one to two month long rotations in Cardiology, Pulmonology, Orthopedics, Psychiatry, Dermatology, Sports, Psychiatry, Ophthalmology, Neurology, Internal Medicine, Aviation Medicine, Occupational Medicine and Women's Health not be clinical training? In total, the programs are a 12 month (internship) + 36 months of training. All well described above.
The Army Aerospace Medicine training isn't modeled after the USAF RAM training. They are very dissimilar. The USAF RAM program is very focused on aerospace programmatic efforts, general preventive care, policy, and USAF administrative leadership roles. Some people may see this as a minor split but it is an important point. Also, like the Army, the civilian RAM programs are more clinical than the USAF RAM program. Different needs drive the focuses of each program. Also it is kind of remarkable that there are civilian RAM programs but only "limited applicability outside the service." I wonder how limited something needs to be for that "limited applicability" to actually become a relevant point. Most RAMs do stay in the Army longer than say a gastroenterologist. Money and procedure based billing may be a factor in the GI folks getting out and the RAMs staying in. But, I'll also suggest that most Army RAMs enjoy taking care of Soldiers and serving in aviation units. It could be limited applicability or it could be because we enjoy our work. Oh, I did mention above that Army RAMs are also training in occupational medicine as part of the program. Since I'm hit with 2-3 direct mail job offers for OM each week I think that minimizes the limited applicability argument. Employers email and call my office weekly looking for our graduates.
Fifth, Captains thorough senior Majors in Army Aerospace Medicine are predominantly direct patient care providers in the Army Aviation and Occupational Medicine clinics. I'll agree that the workload shifts to more administrative as we become more senior. But, that is true across every Medical Corps specialty. With increased rank comes increased responsibility to ensure your organization can meet the mission. This means administration, logistics, and leadership. There is no avoiding increased administrative and leadership responsibilities unless one chooses to separate from the Medical Corps. If leadership isn't for you please don't apply to our program. In the services, leadership roles CAN be completely avoided if one separates active duty and seeks an employee role as a civilian physician. Otherwise it will happen to all of us who chose to continue serving in the role of Medical Corps Officers.
Sixth, I have over 700 hours of flight time in both OEF and OIF providing point of injury care and intertheater transfer of the critically wounded post-op patients. Three of our RAM graduates are currently in OEF providing the same. Our current residents (former GMO flight surgeons) had similar experiences. From POI, COP, or FOB to Baghram or Kandahar was almost all Army (some AF PJs) and mostly Army flight surgeons or Aeromedical Physician Assistants. This was also true in Iraq. The poster is correct about AF Critical Care Air Transport Teams being the sole source of out of theater MEDEVAC. But, since I never said that Army Aerospace Medicine specialists were flying on USAF equipment I don't really understand the point of that comment.
Finally, I wish Gastrapathy the best of luck in his civilian endeavors. I hope you find happiness.
Aeromedical Evacuation is indeed the purview of Army flight surgeons and APA's, who work closely with the flight medics to provide care from point of injury to FST/CSH and on critical care transfers. This is a rewarding mission and one I was heavily involved with in OEF. There is also the opportunity to accompany CH-47 D/F crews on Air Assault missions in order to provide a higher level of care should it be needed.
The CCAT mission is USAF and they do out of theatre transfers. I think the teams consist of a critical care RN, an Anesthesiologist, and a pulmonologist, but don't quote me on that. I had limited interaction with them.
Most Army flight surgeons at BN level are GMO's at the moment but this might change soon.
I like the idea of a BDE surgeon RAM who's an O4 or above with prior training in FP or IM for a couple of reasons. First, it is a real boon to the junior flight docs to have an experienced clinician to turn to for questions. Second, having a little more rank on your shoulders gives you more heft on the BDE staff and allows you to be proactive and influence policy somewhat. I don't envy the slick sleeved CPT new residency grads who currently get dumped into maneouvre brigade slots.
Also, the Army needs to get flight docs in the cockpit more. They're moving in the right direction, ie. the OH-58D is now a single pilot acft again (these are a lot of fun to fly) and you can front seat the AH-64 with O6 and above approval, but I don't see any reason why we can't get in the UH-60 with an instructor pilot to do some traffic patterns. How do flight docs fare on the Navy side in terms of front seat time in the helos?
NATOPS (which is like our AR 95-1) is much less restrictive for flight surgeons in Navy aircraft than the Army flight surgeon flying policies. Thers is a cultural difference too. NFSs go through a robust flight training program. it includes API (https://www.netc.navy.mil/nascweb/api/api.htm) and the stick wiggling portion at NAS Pensacola or NAS Whiting. They train side by side with the Student Naval Aviators. Note: NFS training is about 6 months long with 1/2 in medical didactics and half in flight training. The NFS (or more accurately "Aeromedical Officer Course") spends a lot of time covering extended clinical didactics and then adding the aeromedical component. The Army and USAF courses are 6 weeks and assume (right or wrong) that a licensed provider is medically qualified.
The upshot of the integrated and robust flight training coupled with a more liberal regulation = much more stick time for the Navy. Assuming they get assigned to a multiseat aircraft squadron. Ironically, the Navy rules apply to me as an Army flight surgeon when flying in Navy equipment. I'm currently crossed-decking on a Naval Air Station. But, like everything there is a lot of "who ya know" to get on the controls.
I like the idea of a dual trained RAM-FP or RAM-IM as much as any one else. More GME usually means better quality healthcare but time, costs and stakeholder needs are the crucial factors. I also agree that a combat veteran MAJ who two residency programs under the belt will have an easier time than new grad CPT. But, we simply can't get the personnel/human capital math to support the concept.
Other residency graduates sent to MTOE units are often sent as BDE SGNs without combat or tactical maneuver experience. Then, they spend 2-3 years in that unit. If they aren't "operationally taxed" than they complete a 2-3 year utilization tour in a PCM clinic. That puts the former new graduate at 6 years and promoted to Major. Most are HPSPs have a 3-4 year ADSOs. At this point we get a precipitous drop in retention as these Officers face the end of their Active Duty Service Obligation (ADSO). Their nearly complete ADSO lowers the motivation for many to apply to GME and pick up more ADSO. Many will get out. Even more will not apply for another residency. Many want assignments back in the MTFs. IM, in particular, will apply and get accepted subspeciality training. This markedly reduces the size of the applicant pool. These may be some of the reasons whe we don't see many of these type of applicants. There's no programmatic was to sustain the concept without major modifications of Medical Corps personnel policy across the Army.
A few prior trained applicants show up but all have completed at least the initial residency utilization period of the first speciality. Historically, these have been senior Majors who promote to LTC while in the RAM program. We just dont see these LTCs with prior BDE SGN assignments getting re-assigned to CAB Surgeon positions (exceptions occasionally exist). HRC doesn't like the grade mismatch when the LTCs are supposed to be DIV SGNs. it does happen so we know that HRC will tolerate some mismatch but not routinely. We do have one RAM-EM MAJ(P) at a CAB. They will promote soon and leave the CAB after 24 months. So it can happen but just not effectively.
It is true that most flight surgeons assigned to Operational Flying Duty Assignments are GMOs. Officers who end up doing GMO assignment have two choices which is either 61N (flight surgeon) or 62B (Field Surgeons). Not much wiggle room there when we are 83% manned at the CPT level and the position called for a CPT. I would love to graduate 15 RAMs every year as CPTs and fill every AVN BN and CAB slot with a 61N9B. That is why I'm posting on this form.
Thanks for the comments!
What if you already have the MPH before the start of this training? Would the entire academic year need to be completed or just certain classes pertaining to aviation?
Good question and hard to answer in a short format - a lot depends on the residents prior graduate medical education. Because of the 1 July 2011 Accreditation Committee on Graduate Medical Education changes.
1. See https://www.theabpm.org/requirements.cfm and https://www.theabpm.org/public/ComplementaryPathwayRequirements.pdf if you have a completed a prior residency and are board certified in another specialty.
2. If you are internship complete and already hold an MPH it will depend on what concentration you did. Likely the MPH "Core" courses will all be satisfied. But, in order to get complete credit you'll need to be able to prove you completed courses similar to the list below.
PHC Fundamentals of Occupational Safety and Health
PHC Occupational Safety in the Health Care Environment
PHC Fundamentals of Industrial Hygiene
PHC Aerospace & Occupational Toxicology (To my knowledge, this is the only Aerospace Tox course offered in the nation).
PHC Accident Investigation, Risk Management, And Mitigation - (This course is a wash regardless because it is "co-coded" with the Naval Aviation Safety Officer Course (ASO). Completion of ASO is required regardless of prior MPH).
So... probably 5 classes over 2 years but possible 2 (ASO & TOX).
At Pensacola for training, we are up front with the instructor in the TH-57 (roughly 7 flights). Out in the fleet, I think it totally depends on the command, but it's not common practice for most squadrons. I was with an Osprey squadron previously, and I probably could have had a flight or 2 on the stick if it weren't for a crazy deployment cycle (and some crazy motion sickness problems).
I'd like to focus on one aspect of being a RAM, the operational focus. I am a graduate of the Army program, and have not attended an additional residency. My reason for selecting this route was my desire to remain operationally focused for as much of my military career as possible. As a prior service paratrooper, I knew that I wanted to focus on deployment medicine, and I believe that being a RAM is the best way to find an career track that allows a physician to be an ARMY doctor. As discussed earlier, every other specialty I have worked with spends a short time in the field, but is quickly drawn back to fixed facilties to pay their dues in ther "parent" specialty. After specialization, I served as a Battalion Surgeon, Brigade Surgeon, and was given the opportunity to attend CGSG (the Army Masters level school for warfighting) in residence. While my FP and IM comrades rotate back to the hopital, I am on track to serve as a Division Surgeon, or possibly command a medical unit in the field.
Also, the vast MAJORITY of my practice is primary care and acute medicine, not the occupational paperwork that even flight surgeons dread. My residency more than prepared me for the task of managing the thousands of aviator and non aviator patients in my unit. Yes, most of my patients are non aviators, with all of the chronic disease of any MOS in the Army.
In general, for a medical student that wants to be an Army doctor, working with combat units for the majority of their career, I think the AM residency is a great fit.
Welcome to the forum. Were you asked to post by LTC Sauer or did you happen on this site on your own accord? Who does the dreaded occupational paperwork for the patients that you see?
I viewed rotating back to the hospital to manage sicker patients as an important part of skill maintenance.
Hopefully you will stick around and be involved in more than just this thread.
Okay, here is the deal about RAM. Now that I am out of the military, I can be somewhat critical of it.
My opinions (not the facts, just my personal point of view). I personally think that RAM is a pretty good option for those that want to do more operational medicine. Also a good opportunity to sneak in an MPH. Although not required, I think that best applicants would be those that already did a primary residency in something else.
I'll be honest, during my time in the Army, I actually considered it. So why did I not do it?
1) I did my residency and deployed immediately after residency as a GMO (I did a non-primary care specialty) with a combat unit. I dreaded the thought of having to go out and do a flight surgeon tour just so I could get into the program after I already spend enough time farting around getting my primary board certification.
2) Inconsistency!! So if I did this right out of medical school, I would have spend one year at Fort Gordon, then to Galveston, then to Pensacola. Man, one military move is dreadful enough!!
3) I am getting old (by Army standards). I just cannot be physically what I was when I was younger.
4) Realized the sad reality that if I joined, I'd have to meet all of the physical requirements, get waivers for all of my medical conditions, but if I did an aerospace program as a civilian (wright state has one), I could probably just work as a contractor and make more money than if I was on active duty and not have to worry about profiles, PT, deployments, etc.
But I will say this to all of those above wondering why flight medicine is so damn special. Forget the military for a moment. In the civilian sector, there are numerous individuals that need their FAA physicals. If you are a flight trained individual, this can create a nice bit of cash for you.
Lots of first posts...
Perhaps the LTC is trying to inrease applications to RAM
I also suspect the LTC sent an email out asking for support from current or past program members.
I wouldn't even be surprised if some of these 1st posts were from people who have another account.
Just some assumptions on my part...
The open and well described intent of this forum is recruiting applicants for Army Aerospace Medicine.
I sent out an email with the intent to generate discussion and offer additional opinions and points of view with the stated intent of increasing awareness in the specialty and recruiting applicants. So, I thank all those who chose to participate.
Regarding "Inconsistency!!" -- The current method is the Fort Gordon GA (FYGME) to Pensacola FL (PGY2-4) for non-FYGME complete applicants. When selected, FYGME complete applicants are PCSd directly to Pensacola.
bustbones26 describes our training program's old curriculum map. It was somewhat painful and we ended that before our July 2011 starts. Of note, there was also a lot of resistance to changing MPH programs from within our AM community because of loyalty to UTMB, Galveston. But, the UTMB midpoint PCS was a bridge too far for some applicants with family members to emotionally and fiscally overcome.
I'll also point out that preliminary AM Transitional Year at EAMC Fort Gordon isn't mandatory to enter/apply for PGY2 in AM. Nor is a prior GMO flight surgeon assignment.
Last week I advised a potential RAM applicant/HPSP student from San Antonio to apply for a BAMC FYGME and then apply to AM. This approach is more fiscally prudent for his family and will not effect the probability of selection with a future AM application. So, to clarify, any FYGME program (civilian or military) is acceptable for application and selection.
Regarding "a primary residency in something else" being the better applicants --- let me assure all the readers that a prior trained applicant isn't the "best" applicant. In fact, in accordance with OTSG policy a prior trained applicant is automatically placed at the bottom of the order of merit list for selection. This means a prior residency training applicant cannot be selected unless the program doesn't fill with non-prior trained applicants. I'm probably being concrete here about the bustbones26 "best applicant" comment (applicant versus future operational AM specialist) but is was worth mentioning.
As perviously described, Army AM applicants must obtain and maintain a qualified Army Flight Duty Medical Exam (2F). Aeromedical Waivers are possible in accordance with Army Regulations and Aeromedical Policy. If anyone has questions about potentially disqualifying medical conditions I will put them in contact with another Army Aerospace Medicine specialist to discuss their concerns.
There is also some physical training and capability required as part of the aviation duty qualifications (both USA & USN). Anyone who is medically qualified to enter AM training and take a three event APFT will able to physically complete all required aircrew survival training.
Again, I appreciate all the posts!
I have just about completed the first year of the Army combined Residency in Aerospace Medicine (RAM) and Occupational Medicine and now feel a bit more qualified to comment on some of the preceding posts I saw over the last year or so.
Why I chose Army Aerospace Medicine: I came from the line. My brothers kick in doors and do horrific things to people all over the world for the noblest reasons possible. Very few folks in this world are selfless enough to lift a finger for their neighbors much less give their lives for folks they do not know. These men and ladies wearing a uniform are for the most part who make the good parts of the world go 'round and drag this nation kicking and screaming in the right direction. Contrarily, some others (often specific civilians) make me wish to address them as "Mr and Ms Oxygen Thief."
Have you ever treated an ungrateful, jerk-of-a-person for an exacerbation of the exact same lifestyle-induced conditions you treated him for last month and the month before knowing your tax dollars paid for his food, his house, his gas voucher to get there, as well as his medical care? Did you ever wonder what you were accomplishing in the grand scheme of things? Good on you for doing so and bravo for those who continue to do so. I NEVER wonder that. I treat some of best folks on earth. I practice operational medicine. The most relevant residency to operational medicine by far is Aerospace Medicine.
I joined the Army to serve. Some days the bureaucracy is a bit intense, but it is a calling. Ask me what my career path will look like, where I will lay my head next year, what makes a RAM better than some other board certification, what is in it for me... I cannot answer those questions completely. Folks asking me that make me wonder in the back of my mind where their hearts are and if I they are the best folks to be treating my brothers.
If you are like me, this is probably the profession/residency for you. If not, good luck in your future plans. We need all kinds of good docs. -JH
Good for you. I felt the same way. Spent four years as an operational flight surgeon. I built incredible bonds with my aircrew. The RAM we had was awful, lazy and incompetent but he was an outlier considering the other ones I ran across.
Be an advocate for your junior flight surgeons- be a good mentor. You have the chance to be an incredible ambassador for your specialty and in doing so might convince a few GMO flight docs to join your ranks in the future.
Thank you. Yes, we have our share of poor-performers too. I am sorry you had to deal with one of those RAMs. It is somewhat curious that a position so integral to the business of training to fight and win a war relative to those solely treating the casualties would draw or accept such ineptitude. (That is not to talk down about any other specialty. I have great respect for those in casualty care specialties but find reactionary medicine less personally rewarding.) My hope would be to saturate the operational field with great docs and assure that your experience with that RAM becomes a very distant outlier. Our guys and gals still in the fight truly do (also) deserve our best. Thanks –JH
I remember physicians from the program rotating through family practice at Whiting, a decade ago. I never did know why they were there, and they didn't see many patients.
Last year Army Aerospace Medicine was authorized a one-time plus up of 5 additional GME positions. We selected and made 10 offers with 10 accepting. We will ask for another plus up this year.
According to the 2014-2015 School Year Plan, Army Aerospace Medicine will be picking up an additional PGY2 slot. This brings our official approved total to 6 per year.
We returned the one (1) FYGME (internship year) position at Eisenhower AMC in exchange for another Pensacola PGY2 position.
Medical students should not be discouraged by this decision as it actually increases the total number of annual positions for PGY2 starts. Officers accepted to the Transitional Year at EAMC had to reapply for the PGY2 year anyway. There was no realized benefit to Army Aerospace Medicine or the selectee.
Medical students interested in Aerospace Medicine are encouraged to apply for an internship that best suites their personal educational needs, lifestyle, preferred location and family. Any completed Army recognized internship will qualify for Aerospace Medicine.
Finally, the following is a quote from the Army GME MODS web page 2013 Message.
"TIME ON STATION (TOS) UTILIZATION REQUIREMENT:
Due to the present fiscal climate and Army operational needs, there are several anticipated changes to the TOS/utilization requirements; although these new policies are under review, they may result in modifications which may affect applicants to the upcoming JSGMESB. However, all individuals interested in further GME are encouraged to apply. Fulfilling the requirements for physician training for the Army MC will remain a priority. a. There are no restrictions on eligibility for current FYGME trainees in applying for further GME. b. Individuals who are current GMOs or in a staff utilization tour may be considered for selection if they have less than 24 months TOS."
So, regardless of your TOS do not hesitate to apply. You can always turn down an offer but you cannot be considered unless you apply.
Many potential applicants are contacting me and asking about the best way to be competitive. There are 5 domains considered by the board. These are performance in pre-clinical medical school years (including standardized exams), clinical medical school internship year, internship year (including standardized exam), post-internship utilization assignment (OER), and evaluator's opinion on applicant's future likelihood of success in the speciality. This opinion is based on the totality of the application. After that, research publications and prior service bonus points are assigned. Realizing that most of us have already earned what we've earned the only way to strengthening an application is series of great OERs (ACOMs) and publishing. So do well and get published.
Finally, please don't hesitate to contact me at [email protected], PM, or call 850-452-4740. This includes discussing options to get published.
Once again, think long and hard about a semi-clinical specialty for your primary residency. Military careers (even long ones) are short. The Navy FS training is fun but its awful early in your careers to take this dramatic an off ramp. The precept makes it hard to get a second residency so if you do this first, you might not get to go back for a clinical specialty. I know LTC Sauer will tell you that you see patients but ask yourself what your options are after the army. No one is going to think of you as a clinical doctor and you will be left in the occ med world.
LTC, you probably feel like I'm trolling your thread and I just wanted to say that this is not my intent. It is my opinion that you are advertising a program that has significant downsides that our potentially naive students need to understand.
Wow, just saw this one. Did you really devalue the "doctors solely treating the casualties"?!???!? That's some 140 proof cool aid.
Your posts are quite welcome and very useful. The theater is amusing and the message is useful to our recruiting goals.
Anyone considering Aerospace Medicine and subsequently dissuaded by your posts shouldn't apply. This is an unequivocally correct decision for the Officer and the Army. I am forever indebted if you successfully deterred any applicants.
Most physicians recognize that every specialty has some significant downsides. These perceived downsides all depend on an individual's point of view. Downsides may be higher depression, divorce, burnout, and suicide rates found in the surgical and psychiatry fields. For pediatricians it may be pay. It may be working in a small town with no relief from call. It may be the patient population. Or, it may be the under discussed but significant challenges of choosing to serve in a high demand/low density field with little available back up. Some people thrive in these circumstances and some burnout. This is not to suggest that Aerospace Medicine is without challenges. The challenges are just a little different and operationally focused.
Balch, et, al "There is no single formula for achieving a satisfying professional career. Each of us will have to deal with stressful times in our personal and professional lives; we must cultivate habits of personal renewal, emotional self-awareness, and connection with colleagues and support systems and must find genuine meaning in work to combat these challenges." I encourage the readers to review the infrequently discussed downsides presented in the linked article.
In reference your posted concerns about my feelings and your intent --- The two of us have simply chosen different paths, have potentially different values and obviously different opinions. I respect your posts and your apparent passion. Let's let the readers decide if you respect ours. Many thanks.
It is unfortunate to see how milmed devalues and de-emphasizes true broad clinical medical training, by siphoning potential/future medical talent into GMO/FS/Aerospace medicine, BDE/Battalion surgery, while replacing garrison residency/fellowship trained, board certified "reactive" physicians with physician extenders.
It is true that no one forced me to sign up, but as a pre-med, do you really know what you are getting yourself into?
ArmyRAM, "reactive medicine"? Really? No, really?
May I ask why the RAM residency has a preference for physicians who have just completed an Intern year? Has the community ever discussed instead focusing their recruiting efforts on board certified PCMs? Maybe even creating a 4 year dual boarded pathway in IM/FM/Peds with the commitment to an operational tour (or two) afterwards? Has the RAM community ever discussed reclassifying their training as a fellowship?
In the AF, there had a 5-year combined FM/RAM pathway previously. Looking over the HPERB results for this year, I don't see any listed. In other fields of preventive and occupational medicine, the training usually is treated like a fellowship. I don't understand why military aerospace med thinks that it should be so different.
Please see post #16 as your question is answered in detail. Also see the reply to idq1i below. Short answer for the non-scrollers...that potential applicant pool is already small and even then not interested in either operational medicine or a second residency. I don't have the statistics readily available so ask yourself how many physicians are willing to do a second residency. We had 1 board certified applicant and 15 total applicants last year. Now, ask yourself how many dual boarded physicians you know. Now, multiply that fraction by the fraction interested in staying in the Army and then again by the fraction interested in being operational. The concept briefs well if the facts are ignored.
We considered standing up a combined AM-FM program. It was considered, staffed and deemed not logistically supportable. Some politics were involved along with some very large practical barriers. If I had a magic wand...
Aerospace, occupational and preventive medicine are not treated like fellowships. Fellowships require completion of a residency program. None of these programs require prior residency training. The idea that, "the training usually is treated like a fellowship" isn't supported by Baker, A et al 2007. Their article shows only 26% of ACOEM membership's occupational medicine physicians are board certified in another speciality. If we ignore the USAF AM Program (they have a different mission) their published statistic is consistent with my experience of JSGMESB applicant demographics for AM, PM, and OM.
I'm having a very hard time understanding your post's logic. Currently, no one is "siphoned." GMOs only exist for three reasons. 1. They didn't apply for residency (personal choice). 2. They didn't successfully match (lack of competitiveness for the desired speciality). 3. They either resigned or were terminated from GME (lifestyle or competency). 4. Finally, and probably more telling, I wouldn't be posting here if I had a siphon, LOLZ. Does any one know where I can find a new doctor siphon?
Regarding physician extenders - The Army is 280(ish) physicians short this year. The stated OTSG policy is that residency trained physicians should be assigned to battalions and brigades when available. The statistics support that FP, IM and PEDs pay this "operational tax." But, if there is an operational tax then there must also be a "Medical Treatment Facility (MTF) price" to staff the hospitals. If the Army is short of physicians, still required to pay the "MTF price," and the "operational tax" don't you think a physician extender is a reasonable solution to putting a nephrologist in a battalion. Oh, last year they even began assigning sub-specailist to brigade surgeon and other operational positions. This was meet with mixed results by the speciality consultants and the receiving brigades.
General comment on reactive medicine -
Maybe a little explanation will help. The term reactive medicine isn't any more pejorative than the words preventive medicine. Please google or review the differences in primary, secondary, and tertiary prevention. Tertiary medicine is considered reactive because we are reacting to the the symptoms of a person who already has the disease. Hence, reactive medicine. The poster even wrote about their great respect for other specialties and that it was about personal rewards. Sometimes this place looks like the Huffington Post and the gotcha police. For those of you that have the time try this link. Ad Hominem Tu Quoque, folks.
Ladies and Gentlemen,
If you are eligible for the JSGMESB match you should be applying!
And, I don't mean you should be applying for aerospace medicine. We would love to have you but that isn't my message. I telling to apply to the speciality of your choice, NOW.
Every year, in the Army we have a standby board to fill any vacant GME positions. The Army would be perfectly happy without GMOs and wants to fill every residency to authorized capacity. Directors with unfilled positions review the un-matched pool to select and make offers. As needed, Army AM offered positions to un-matched applicants. For many years we've picked up great people.
Every year, I've had non-applicants calling as asking for positions when they hear about standby matches getting positions. But, to be eligible for the standby board you must have applied! There are no positions for non-applicants. You will be a GMO. Program Directors cannot accept standbys who didn't apply.
It might also help if the alternate specialty's program director knows about you, too. If you are fellow applying for cardiology but willing to do GI, you should think about giving that PD a call. Some may perceive a risk with this method. Like all investment opportunities, weight the perceived risks versus potential rewards.
My experience is that IM, FP, PEDs typically don't fill. Also, their PDs really want to fill.
Also, if you match and want to change to a different program with open positions at the same MTF you may be able to make it happen after you arrive. IAW AR 351-3 615. Program change. "Local MTF commanders do not require GME approval to switch any student in their FYGME specialty program." Typically, I've seen Transitionals switch to IM or PEDs but the regulation doesn't limit program changes to those specialties.
If your not sure you want to apply, apply anyway. You can always withdrawal the application or decline the offer. But, you can't undo the history of not applying.
Just to paraphrase you, "No one in the milmed system gets GMOed against their will." Are you sure, Sir? Letting untrained GMOs treat SMs is wrong. The sooner the states ban medical licenses for interns, the better.
As far as the last part of your email, it doesn't matter how you subdivide "prevention." It is all in the purview of a well-rounded internist or FP who is not slammed by short staffing or by patient overload
Interesting. I never saw a program switch outside of the GMESB in the Navy. We used to tailor TY years to facilitate counting them as IM, but they still had to apply for PGY2. Anyone else ever seen this happen?
The Army would be happy not to have GMOs but only on their terms. Your list of reasons for GMO focuses on the applicant side and implies that nonselects are often to blame. In many cases, specialties that are noncompetitive in the civilian world are very competitive in the military (Peds and EM being prime examples). I'm not sure where you get the data the Peds doesn't fill but perhaps the Army is very different than the Navy.
Joint Service Graduate Medical Education Selection Board...
I've seen this acronym once before, in regards to a student night hosted at WRNMMC/USUSHS by various residency programs, but can someone explain what this is if it's not the same as regular military match? I know this is off-topic from the OP, but I'd love to know.
That's the power that decides the results of the military match.
So ERAS is treated as a recommendation/guidelines and the powers that be can choose to accept or modify the results?
ERAS isn't involved in selection (maybe youre thinking NRMP)...its just a common electronic application platrorm for the civilian match...the military doesn't use it. We use a paper application submitted to all the program directors and consultants who meet annually and match us to our programs. The mikitary mach occurs months before the civilian matches.
Yeah, I was. Thank you.
Things change, obviously, but until recently Army applicants were required to apply to ERAS and send their packet to Army programs. This was on top of whatever specific documents the Army wanted, many of which were redundant (of course).
As program directors, we do review paper packets but these are generated from the electronic application system. The only originals I've seen were letters of recommendations.
Information posted here should be considered with an appropriate index of suspicion and verified from primary sources. For the sake of accuracy, the Army GME Website is @ http://mods.army.mil/medicaleducation/ Specifically, "The Army GME application process must be accessed through the Medical Education Occupational Data System Homepage @ www.mods.army.mil/medicaleducation."
The Army has been using this website to manage applications since before 2002. "This system requires all applicants to electronically submit their application and Curriculum Vitae (CV)." Applicants use the "Logon" button and either use their CAC Card or a logon id & password.
Here is a link to the 2013 Army GME Message "SUBJECT: Graduate Medical Education (GME) Residency and Fellowship Training Opportunities (School Year 2014)" which covers the necessary information to complete the applications.
It is worth noting that Electronic Residency Application Service isn't mentioned in the message. However, it may [emphasis on may] be required if applications are seeking deferred (unfunded civilian) training or a full time out service program (fully funded civilian). I encourage the readers to contact their Army MTF GME office or GME at OTSG to get these questions answered.
It's also worth noting that the link you posted is specifically for GME PGY-2 or later positions (i.e. fellowships).
Here is the link to the latest FYGME letter of instruction that I could find, which is the relevant one for medical students applying to internships +/- continuous contracts. In it, you will find extensive information information about how the Army requires its applicants to submit to ERAS.
Army FYGME applicants cannot request a civilian deferment, although one can be granted irrespective of their wishes.
Thanks for posting that message link. I'm a little myopic toward the PGY2s and I should have thought to post the FYGME details. Much appreciated.