Physician centered corpsmen/medic training

[Perrotfish]

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I tried to write this a couple of days ago and couldn't get it to come out right. Trying again:

So something that has really surprised me since starting working in a Navy hospital is how completely divorced we are from the training, management, and evaluation of our departments' enlisted personel. It seems like at major MTFs corpsmen function almost entirely independently of physicians. They report to more senior corpsmen, and to a lesser extent to the nursing staff. To me, other than a few sernior petty officers who run clinics/floors, I barely even know them. I mean, I know their names and a little bit about their personalities, but they switch in and out of jobs every day and don't seem to need me to do anything for them so I end up kind of distant. Unlike the nurses and medical students I don't even really know how I'm supposed to relate to them. If I teach them does that come off as considerate (like medical students) or out of line (like nurses). How far out of my way should I go to recognize good behavior? Other than telling their LPO, is there even a way to recognize good behavior? For lack of a better idea I usually just thank them politey for the charts they hand me and go about my business

Now I wouldn't mind this (at least not enough to say anything), except that everything that I've been told is that when I'm operationational corpsmen are going to be my main support staff, and I am not going to have any senior physicians readily available to show me the ropes of how to be an officer at that time. As it stands I have no idea what I would do for my corpsmen in terms of promoting their careers or training them, and I honestly don't really understand what they can do for me (what the limits of their training are). I hate the idea of screwing someone's career because I don't understand my role as an officer, or of harming a patient because I don't understand what my corpsmen aren't trained to do. For that matter I don't think they understand what I am and am not trained to do very well either. When I actually talk with them about anything medical I get the feeling they're learning about medicine via a game of telephone: Doctor to nurse to LPO to them. A large percentage of the corspmen I meet plan to go into nursing after they leave the Navy, I sometimes wonder if they choose that over medcine mainly because that's what we familiarize them with. If so that seems like a failure on our part.

So my question: has a different system ever been tried at an MTF? Have corspemen ever been attached to physicians, rather than floors, so that they can gain experience with us, and we can learn how to be officers as well as physicians? Has anyone ever suggested this? Just wondering.

 

[NavyFP]

I tried to write this a couple of days ago and couldn't get it to come out right. Trying again:

So something that has really surprised me since starting working in a Navy hospital is how completely divorced we are from the training, management, and evaluation of our departments' enlisted personel. It seems like at major MTFs corpsmen function almost entirely independently of physicians. They report to more senior corpsmen, and to a lesser extent to the nursing staff. To me, other than a few sernior petty officers who run clinics/floors, I barely even know them. I mean, I know their names and a little bit about their personalities, but they switch in and out of jobs every day and don't seem to need me to do anything for them so I end up kind of distant. Unlike the nurses and medical students I don't even really know how I'm supposed to relate to them. If I teach them does that come off as considerate (like medical students) or out of line (like nurses). How far out of my way should I go to recognize good behavior? Other than telling their LPO, is there even a way to recognize good behavior? For lack of a better idea I usually just thank them politey for the charts they hand me and go about my business

Now I wouldn't mind this (at least not enough to say anything), except that everything that I've been told is that when I'm operationational corpsmen are going to be my main support staff, and I am not going to have any senior physicians readily available to show me the ropes of how to be an officer at that time. As it stands I have no idea what I would do for my corpsmen in terms of promoting their careers or training them, and I honestly don't really understand what they can do for me (what the limits of their training are). I hate the idea of screwing someone's career because I don't understand my role as an officer, or of harming a patient because I don't understand what my corpsmen aren't trained to do. For that matter I don't think they understand what I am and am not trained to do very well either. When I actually talk with them about anything medical I get the feeling they're learning about medicine via a game of telephone: Doctor to nurse to LPO to them. A large percentage of the corspmen I meet plan to go into nursing after they leave the Navy, I sometimes wonder if they choose that over medcine mainly because that's what we familiarize them with. If so that seems like a failure on our part.

So my question: has a different system ever been tried at an MTF? Have corspemen ever been attached to physicians, rather than floors, so that they can gain experience with us, and we can learn how to be officers as well as physicians? Has anyone ever suggested this? Just wondering.

Hopefully you will have a good Chief or Senior Chief to hold your hand through the process. In the mean time, engage your clinic LPOs and LCPOs and try to learn about what they do and how they do it. You can initiate training for the Corpsmans and they will greatly appreciate it. I would frequently hold lunch time training and do Sick Call Screeners Classes, suture instruction (I brought in pigs feet to sew). Little things like this will go a long way.

 

[DrMetal]

So my question: has a different system ever been tried at an MTF? Have corspemen ever been attached to physicians, rather than floors, so that they can gain experience with us, and we can learn how to be officers as well as physicians? Has anyone ever suggested this? Just wondering.

Forget about a 'system'. There need not exist a system for everything. In fact, there's no real standardization of what/how much/when/where/how a doctor should teach a resident, medical student, etc etc. (I wish there was -- it would ensure that we all got the same quality education, but such a thing is probably too difficult to standardize). Moreover, any kind of 'system' would probably be more constricting than its worth.

So take a corpman under your wing. Provide mentorship, education . . .I don't think you would ever be faulted for doing this. It's especially nice to do this during deployments, when you might have a lot of downtime to teach. I know many medical professionals that have done just this, and the enlisted have always enjoyed learning from them.

[oh btw, don't get so close to your enlisted that you end up sleeping with them. That's bad. Happened to friend of mine, good doc, but now outta the military. So professional mentorship/training=good , banging=BAD! , good life lesson]

 

[Perrotfish]

Forget about a 'system'. There need not exist a system for everything. In fact, there's no real standardization of what/how much/when/where/how a doctor should teach a resident, medical student, etc etc. (I wish there was -- it would ensure that we all got the same quality education, but such a thing is probably too difficult to standardize). Moreover, any kind of 'system' would probably be more constricting than its worth.
]

But how can we mentor someone, when we only see them for a few minutes a time for a one month rotation? It doesn't seem like we have much opportunity to really interact with corpsmen enough to get any real sense of what they need from us.

 

[Kingfisher]

But how can we mentor someone, when we only see them for a few minutes a time for a one month rotation? It doesn't seem like we have much opportunity to really interact with corpsmen enough to get any real sense of what they need from us.

You will have more opportunities to do the kind of mentoring when you are no longer a resident and are in one spot for longer than a month. When you are deployed you will definitely have a closer relationship with your corpsman as you guys are working together 24/7. The time you invest in their training will make life better for everyone.

1. Toenail removal
2. Warts
3. Sutures
4. Casting
5. PFB
6. Abscess draining
7. Dressing changes

These can all be done by competant and well trained corpseman (with just your supervision) and can free up time for you to do other things. The time you spend with the floor corpsman can also benefit you as you train them to know what to look for and when to call you.

At some hospitals/commands there are formal mentorship programs for the enlisted folks. They are usually geared towards the ones that are considering officer programs. If you are interested in something like that, talk to the career counselors.

 

[DrMetal]

But how can we mentor someone, when we only see them for a few minutes a time for a one month rotation? It doesn't seem like we have much opportunity to really interact with corpsmen enough to get any real sense of what they need from us.

You're right, it's not much interaction at all. You gotta bear in mind that we're still trainees ourselves--our education/training (the constant rotations and all) is of utmost importance. Mentoring the enlisted and other extracurricular activities have to come second. (Becoming a more active mentor as an attending, as KingFish points out above--makes more sense).

Still, having said all this, do what you can. If you only mentor a corpsman for a month, a week, or or a half day, that's still better than nothing. Show 'em what you do, bring em into your world. They might do the same, we can all stand to learn a lot.

 

[cautionmaster]

[oh btw, don't get so close to your enlisted that you end up sleeping with them. That's bad. Happened to friend of mine, good doc, but now outta the military. So professional mentorship/training=good , banging=BAD! , good life lesson]

This is good advice.

 

[Perrotfish]

You will have more opportunities to do the kind of mentoring when you are no longer a resident and are in one spot for longer than a month. When you are deployed you will definitely have a closer relationship with your corpsman as you guys are working together 24/7. The time you invest in their training will make life better for everyone.
.

I guess my point is that I wish we had some way to be in charge of Corpsmen as Interns, while we still have supervision, before we have to be in charge of them as GMOs/Attendings with little supervision and minimal guidance.

We learn to be in charge of medical students and junior residents under the watchful eyes of attendings. For that matter line officers learn to be in charge of enlisted personel with the guidance of senior line officers. I think leadership needs to be taught, just like any other skillset. II feel like we're missing a step with Corspmen, and we jump right to being really in charge without ever really getting the training.

 

[Kingfisher]

I guess my point is that I wish we had some way to be in charge of Corpsmen as Interns, while we still have supervision, before we have to be in charge of them as GMOs/Attendings with little supervision and minimal guidance.

We learn to be in charge of medical students and junior residents under the watchful eyes of attendings. For that matter line officers learn to be in charge of enlisted personel with the guidance of senior line officers. I think leadership needs to be taught, just like any other skillset. II feel like we're missing a step with Corspmen, and we jump right to being really in charge without ever really getting the training.

In residency you are taught to take charge of the education of your junior residents and med students. This is very similar to how you will interact with the corpsman. You probably won't be in their direct chain of command and will fill a positional authority roll. Since you are out of direct leadership roles with them, you can simply drop little bits of medical wisdom here and there as well as teach them how to do various procedures, just like you would for a med student.

 

[DrMetal]

I guess my point is that I wish we had some way to be in charge of Corpsmen as Interns,

Your heart's in the right place, but you don't want this responsibility while you're training. The last thing you want to do on your post-call day is come in to deal with admin headaches--that you'd have to deal with if you were a division officer in the true sense. Being "in charge" of people means having to deal with a lot of personal and admin related things (in addition to formal teaching). It can be worthwhile and fun, but only if your primary job is forgiving in terms of time demands. If you're an intern or a resident, there is no such forgiveness.

For that matter line officers learn to be in charge of enlisted

Here's a little secret about most line officers (especially those that don't have a hard job, aka getting shot at or operating dangerous machinery): their jobs are kinda easy, mostly deskwork, no where near as demanding as that of medical students/residents/physicians. Thus, they have some time on their hands, and they can play the role of officer in charge, helping their enlisted through all sorts of issues (personal, professional, etc).

The fact is, you don't have that kind of time on your hands right now, b/c your job is harder and more demanding of your time. You'll get your chance tho as a GMO or during a utilization tour. Careful what you ask for. First time you have to be "in charge" and deal with an E-4 who runs up a $2K bill on a gov't credit card at a strip club in New Orleans, then you'll be glad that you didn't have to deal with such things as a resident.

 

[pgg]

I guess my point is that I wish we had some way to be in charge of Corpsmen as Interns, while we still have supervision, before we have to be in charge of them as GMOs/Attendings with little supervision and minimal guidance.

We learn to be in charge of medical students and junior residents under the watchful eyes of attendings. For that matter line officers learn to be in charge of enlisted personel with the guidance of senior line officers. I think leadership needs to be taught, just like any other skillset. II feel like we're missing a step with Corspmen, and we jump right to being really in charge without ever really getting the training.

Don't say that too loud.

If I get saddled with more mandatory Navy Knowledge Online courses and extra hours of instruction to teach me to be a better officer, I'm going to come find you and kick you in the kneecaps. 😉


The enlisted side doesn't need us so much as they put up with us. When you get away from the medical side, more toward the officer side, micromanaging and microinvolvement seems to go bad a lot more than it goes good.

As a greenside GMO it was important for me to teach Corpsmen as much as I could. Every sick call visit was seen by a Corpsman first, who wrote as much of the SOAP note as he could and made his assessment and treatment recommendations to me or the IDC. The thought process being that before long we'd all be deployed and that Corpsman would be out in the field with his Marines and needed to be able to handle basic sick call totally independently. We did suture labs with pig feet and other 'fun' stuff but the really important teaching was the SOAP notes and helping them get a feel for "needs to go to the rear to see a doctor" vs "can stay in the field a couple days and see the doctor later" ... My Chief and HM1s took care of almost everything else.


Now that I'm far removed from GMO-land, my officery leadery duties to the Corpsman in my department is even more limited. I still try to involve them in clinical work, but when 100% of what I do is anesthesia, there are limited opportunities. They help out with some procedures and inductions, but most of the useful-to-them clinical learning they get is monitoring patients in our PACU.

I've come to genuinely believe they don't need me or want me to do much at all outside the clinical realm. There's a big, overpopulated and overregulated and overenthusiastic enlisted chain of command to handle the admin stuff and tell them when and where to be. They don't need me to be another LPO. On Fridays, they don't need me to be the 4th officer to tell them not to drink and drive. When the day's work is done, I try to cut them loose early, but I do that through their LPO so as not to undermine the LPO's authority. About the only admin things I try to stick my fingers into are making sure someone gets nominated for _____ of the quarter every quarter and that awards don't slip through the cracks. And even then it's the LPO who does most of that legwork.

So, IMHO, our place is to involve junior enlisted in clinical work and teach them as much as they desire or are capable of doing, and to have our fingers in enlisted admin business juuuuust enough to be sure they aren't neglecting, gundecking, or otherwise screwing up the department. Beyond that, let the chiefs and LPOs do their job, and stay out of the way.

 

[cautionmaster]

So, IMHO, our place is to involve junior enlisted in clinical work and teach them as much as they desire or are capable of doing, and to have our fingers in enlisted admin business juuuuust enough to be sure they aren't neglecting, gundecking, or otherwise screwing up the department. Beyond that, let the chiefs and LPOs do their job, and stay out of the way.

You, Sir, are brilliant. Mil Med should be thanking their stars to have you.

After seeing it first hand when I was in, I have a lot of respect for the enlisted. One of the reasons is that It's amazing what they have to put up with. I tried to make their time in clinic as focused on clinical duties as a respite from the horrendous managers they had to put up with.

We have too many non clinical admin types who, rather than silently perform their duties well, consistently create admin problems in a self serving way to justify their existence.

 

[Perrotfish]

A follow up. When I talk to corpsmen it seems like they all want to pursue one of three career paths: Nurse, physician, or career Corpsman. Is there any kind of formal pre-nursing or premedical advising system in place for our corpsmen? Has anyone ever seen this tried?

 

[DrMetal]

A follow up. When I talk to corpsmen it seems like they all want to pursue one of three career paths: Nurse, physician, or career Corpsman. Is there any kind of formal pre-nursing or premedical advising system in place for our corpsmen? Has anyone ever seen this tried?

If you're talking about advice on getting into medical or nursing school, it would probably be better for them to seek premedical or pre-nursing advice from their own academic institutions--their junior college or 4-yr university--instead of from some non-medical E-5 type in the career counselors office (who probably doesn't know jack but talks a big talk).

It would be helpful to have someone on the mil side help you navigate through the admin of applying for the various commissioning programs, and that (I think) already exists through Career Counseling, Navy College, etc.

 

[Perrotfish]

If you're talking about advice on getting into medical or nursing school, it would probably be better for them to seek premedical or pre-nursing advice from their own academic institutions--their junior college or 4-yr university--instead of from some non-medical E-5 type in the career counselors office (who probably doesn't know jack but talks a big talk).

It would be helpful to have someone on the mil side help you navigate through the admin of applying for the various commissioning programs, and that (I think) already exists through Career Counseling, Navy College, etc.

What I was thinking is what if we established premedical/prenursing advising and/or mentoring program among the MTF physcians and nurses. We all remember college premed advisiors, and even at schools that sent a lot of people to medical school they were pretty useless. At the Navy affiliated colleges I doubt they're significantly better than those non-medical E5s.

I was just thinking that it seems like corpsmen seem to change their goal from premedical to prenursing as they spend more and more time at an MTF, and I think that's because their contact with physicians is so brief and impersonal compared to their contact with the nurses. And even the ones who want to be nurses don't seem to be making a lot of progress towards that goal, or even have a real clear idea of what they need to do to progress towards that goal. I feel like a premedical mentor, whether a staff or a resident, could do a lot to steer some of the better students towards medical school and a prenursing advisior could really help creaet a more robust education plan that that E-5 in the career counselor's office for those who want to go nursing.

Again, just thinking out loud at the moment. Not a suggestion I'd make as an Intern.

 

[Gastrapathy]

What I was thinking is what if we established premedical/prenursing advising and/or mentoring program among the MTF physcians and nurses. We all remember college premed advisiors, and even at schools that sent a lot of people to medical school they were pretty useless. At the Navy affiliated colleges I doubt they're significantly better than those non-medical E5s.

I was just thinking that it seems like corpsmen seem to change their goal from premedical to prenursing as they spend more and more time at an MTF, and I think that's because their contact with physicians is so brief and impersonal compared to their contact with the nurses. And even the ones who want to be nurses don't seem to be making a lot of progress towards that goal, or even have a real clear idea of what they need to do to progress towards that goal. I feel like a premedical mentor, whether a staff or a resident, could do a lot to steer some of the better students towards medical school and a prenursing advisior could really help creaet a more robust education plan that that E-5 in the career counselor's office for those who want to go nursing.

Again, just thinking out loud at the moment. Not a suggestion I'd make as an Intern.

Nursing is a much more attainable goal. Most of them aren't going to be doctors but they could nearly all be nurses. If there is a corspman who you think can be a doctor, the best advice to give them is to do their time and get out ASAP to go to a real 4 year college. post 9-11 gi bill is sweet.