Enlisted Medical Chalk Talks

[flightdoc09]

What are some short 10-15 minute lessons y'all do for your enlisted medical (Corpsmen/Medics)? I'm looking for things that they'll find either interesting, useful in their job, or both. This is separate from skills training. Stuff like acute pain control, back pain red flags and what they mean, the approach to a red eye, upper respiratory/sinus complaints, "it burns when I pee," etc.

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[whodareswins]

I was a FMF corpsman in charge of training before I got out to pursue med school. The training that I found generated the most interest among my fellow enlisted was teaching procedures. We would practice blood draws, IV placement, and wart removals. Our most popular session was the suture practice. We bought a bunch of oranges from the local commissary and even made a competition out of it to see who had the best technique. The icing on the cake was getting a general surgeon to stop by and teach us more obscure surgical knots.
If you are looking for something in a lecture format, I would focus on injuries and illnesses commonly seen in clinic. One example that comes to mind is teaching the HM’s about viral gastroenteritis cases we encountered during deployment. We made sure they knew how to properly evaluate vitals/history and conduct exams on these patients in order to rule out other, more serious complications such as appendicitis.

 

[flightdoc09]

Yeah, procedural stuff is always the most fun. But it's usually pretty easy and requires very little thinking. In the past I've taught them how to do digital blocks on each other, put in NPAs on each other, and suture on pigs feet that I got from a local butcher. Suturing was thoroughly enjoyed by all, from E-2 to E-6.

I need to give them more knowledge so they can critically think.

 

[pgg]

When I was a GMO I had some pocket reference ward book from internship. Not sure if it was Internal Medicine On Call ... something similar. It was organized by presenting symptom or condition and had 50 or 100 common things that an intern might be called for in the middle of the night. Short background, differential, workup, immediate actions, light on definitive treatment.

I used that for the purpose you stated. Much of the book was stuff that wasn't really useful to Corpsmen, e.g. blood gas reading, electrolyte abnormalities, but there were some sections that were great. Abdominal pain, hematemesis, headache, fever, dyspnea, that sort of thing. Stuff with broad differentials but a narrower list of "what could kill this person before rounds tomorrow morning" and a focused list of things to do. These were the sections I went over with my Corpsmen, because they were routinely out on their own in the field with Marines. I wanted them to have an inkling of the worst that could happen.


Suturing is a fun day for the Corpsmen, but none of them are going to ever do it in a situation where you're not right there anyway. Not that valuable IMO, though I did pig feet with them a number of times. It's fun but if you have an HN out there suturing wounds closed something is amiss.

 

[militaryPHYS]

I agree that applicability is key. Some (actually many) of the corpsmen I work with don't even like the medical field and have no future intentions of pursuing medicine. While they have a job to do whilst they serve in a medical capacity, I also respect that this current role for them might be a means to an end.

Therefore we focus on:
(1) Critical clinical/admin functions required of them in their current position. Required medical knowledge and skills can vary considerably based on green vs. blue side, ortho vs. anesthesia (or any other clinic they might work), seaman vs. chief, operational vs. hospital. So just focus on what will make them a solid corpsmen in their current position. Default (aside from basic clinic function) is focusing on TCCC/HMSB topics.

(2) Career (military) development aside from their current clinical role (i.e. how can we get you promoted while you are serving your means to an end).

(3) Professional/Personal development. (what will make you a better son/daughter/husband/wife/mom/dad). This includes personal finance, college/trade education, personal reflection/growth/etc.

Realistically we rarely get past #1. #2 and #3 often just comes from personal discussions when they approach me or another officer in the department during non-structured training times (I.e. open office door).

The area I struggle with the most in my current job is finding ways to effectively engage those who just have ZERO interest in being engaged right now. Unfortunately in the military (or any non-incentivized salary/employee based organization) this is rampant all the way from E1 to O5ish.

 

[pgg]

I agree with @militaryPHYS ... it's much easier to do, and there's much more buy-in from the Corpsmen, and it's much more important on the green side. FMF units are a totally different world than MTFs.

 

[flightdoc09]

Yeah, I'm greenside right now, so that's nice. But... It's with the ACE, so the motivation just isn't as good as with the ground side. Some of the best corpsmen we have in our clinic and units are all formerly with division, and HM1s. There are a few HM2/3 that are pretty solid. And then it's very hit or miss below that.

The corpsmen that were with division previously are very capable of functioning independently (relatively), and frequently surprise me with how much they know. I think it has to do with the fact that they aren't as bogged down with administrative stuff, flight physicals, etc., and are more embedded in their units.

Also, not sure how many of y'all were pre-Marine Medical Home Port, but supposedly that has been the death of quality corpsmen and training. All I know is what we have now, and I think it has its pros and cons.

 

[Matthew9Thirtyfive]

Suturing is a fun day for the Corpsmen, but none of them are going to ever do it in a situation where you're not right there anyway.

Unless they go to a CG or smaller.

 

[whodareswins]

Yeah, I'm greenside right now, so that's nice. But... It's with the ACE, so the motivation just isn't as good as with the ground side. Some of the best corpsmen we have in our clinic and units are all formerly with division, and HM1s. There are a few HM2/3 that are pretty solid. And then it's very hit or miss below that.

The corpsmen that were with division previously are very capable of functioning independently (relatively), and frequently surprise me with how much they know. I think it has to do with the fact that they aren't as bogged down with administrative stuff, flight physicals, etc., and are more embedded in their units.

Also, not sure how many of y'all were pre-Marine Medical Home Port, but supposedly that has been the death of quality corpsmen and training. All I know is what we have now, and I think it has its pros and cons.

I was MARDIV, which means we were much integrated with our patient population than the typical HM. So there were more incentives to be competent, especially if we found ourselves in a scenario in which the flight doc was engaged and we were the only ones available in the immediate area to render aid.
For your situation, I would follow the sagely advice from @militaryPHYS . I feel that the best way to get the enlisted to engage with this type of training is to establish relevance. I can recall one moment when I struggled to teach advancement material to an HM3 who had no career aspirations whatever. But when I explained how much a potential pay raise would help achieve his dream of purchasing a home, he immediately hit the books, advanced that next cycle, and re-enlisted.

 

[pgg]

Unless they go to a CG or smaller.

Isn't there usually an IDC on those vessels? Just asking, I don't know, all my time has been green side.

 

[Matthew9Thirtyfive]

Isn't there usually an IDC on those vessels? Just asking, I don't know, all my time has been green side.

There is, but they aren’t always in medical when stuff happens.

 

[Gastrapathy]

Whatever you teach, be sure you teach boundaries. They know how to suture but do they know what NOT to close?

 

[pgg]

There is, but they aren’t always in medical when stuff happens.

Those ships aren't that big. Someone can go get the IDC ...

I struggle to imagine circumstances where it's ever appropriate for a Corpsman to be suturing wounds closed solo.

 

[CABG patch]

Whatever you teach, be sure you teach boundaries. They know how to suture but do they know what NOT to close?

I agree with Gastrapathy, these guys will feel confident to do whatever you teach them to do, often times way too confident. They don't have the same hesitancy that a medical student or intern does. That's great on a battlefield, not so great in clinic or at the role 1-2 sick call triage. They don't have the diagnostic framework to know when they're in over their heads and when to ask for help. I try to teach them about all the things that can kill a healthy 20 year old and how to avoid thinking every person with abdominal pain is a malingering sick call ranger with a work allergy. I've also found a lack of basic understanding of female anatomy and pathology so I've tried to include some things specific to young women as well. Most of them have never heard of an ectopic pregnancy or ovarian torsion, especially if they've just come from a line unit so you have to remind them that half the population has a different set of anatomy and you have to treat them as well.

 

[Matthew9Thirtyfive]

Those ships aren't that big. Someone can go get the IDC ...

I struggle to imagine circumstances where it's ever appropriate for a Corpsman to be suturing wounds closed solo.

I mean an IDC is a corpsman with a little more training. And I don’t mean they’re just somewhere else on the ship. A corpsman stitched me up once. Did a good job. Whether it should happen or not is another story. But it does, and personally when I was enlisted I would prefer my corpsman to be able to do stuff like that.

 

[Gastrapathy]

@Matthew9Thirtyfive that last statement is undoubtedly how you felt but you need to reflect on how dangerous that sentiment is. It gets corpsmen in trouble. They want to be “doc”, their marines/sailors want them to be “doc” but they aren’t really.

IDCs on small boys are spread incredibly thin. They have all kinds of admin responsibilities and often delegate the medical care part of their job to the HM3. The IDC is a position from a bygone era and long since should have been replaced by midlevels.

 

[Matthew9Thirtyfive]

@Matthew9Thirtyfive that last statement is undoubtedly how you felt but you need to reflect on how dangerous that sentiment is. It gets corpsmen in trouble. They want to be “doc”, their marines/sailors want them to be “doc” but they aren’t really.

IDCs on small boys are spread incredibly thin. They have all kinds of admin responsibilities and often delegate the medical care part of their job to the HM3. The IDC is a position from a bygone era and long since should have been replaced by midlevels.

Yeah I’ve been on two small boys. Spent the majority of my enlisted career on them. That was sort of my point. They’re all over the place, and if the IDC is off the ship and something happens where someone needs a couple stitches in their finger, I don’t think it’s unreasonable to teach a corpsman to do that. I think part of that should be to let them know when it’s over their head, which really is anything other than that.

But yes I agree. I think mid levels should replace IDCs. There are enough of them that would want to practice in that kind of environment and they would do a better job imo.

 

[Gastrapathy]

Hands are a good example of not knowing what you don’t know. I made a mistake with one as a GMO and closed something that had to be reopened. I also learned from the hand surgeon who had to fix it that I shouldnt close them at all: Suturing versus conservative management of lacerations of the hand: randomised controlled trial | The BMJ

Easy for a GMO to make that kind of mistake. Inevitable for a HM3.

 

[d2305]

IDCs have their own turf, and they don't want PAs intruding. I'm sure with women aboard, things are more challenging now. I had some interesting times out there.

 

[militaryPHYS]

Board certified ED docs close stuff they shouldn’t be closing

 

[Gastrapathy]

IDCs have their own turf, and they don't want PAs intruding. I'm sure with women aboard, things are more challenging now. I had some interesting times out there.

Of course IDCs want to protect their turf. Doesn’t make it right. Look at the IDC curriculum sometime. It’s mostly admin so they can survive as a DivO.

 

[Gastrapathy]

Board certified ED docs close stuff they shouldn’t be closing

Is that meant to be an equivalency argument?

 

[Apollyon]

Is that meant to be an equivalency argument?

No, that's just an offhand specialist dig. Nothing new, that's for sure.

 

[pgg]

Is that meant to be an equivalency argument?

I think the argument was that management of hand injuries is complex, and even fully trained physicians can err. Underscoring how inappropriate it is for corpsmen to be making these kind of assessments and treatments by themselves.

 

[militaryPHYS]

What @pgg said. The most dangerous thing in medicine is not respecting that there are things you don’t know. I don’t think IDC’s get enough (or proper) training to be left alone and expected to manage things properly. Diagnose and dispo with consultation as needed? Maybe. But not independent practice which includes the actual treatment/management of the problem.

My point was even board certified physicians err when we step outside of our wheelhouse in which we were trained. Know how dangerous I would be managing complex kidney disease? So how can we expect IDC’s to be effective in management of the entire swathe of medical care?