Who teaches in Military Residencies?

[notdeadyet]

Maybe someone can clear this up for me....

From what posters have said here over the years, the majority of physicians in milmed walk after their minimum commitment is up. From my understanding, folks who stay in for any length of time get pulled away more and more from clinical responsibilities and take on more and more administrative/leadership responsibilities. Please correct me if this is incorrect.

That being the case, who runs the military residency programs? It seems you would have a shortage of clinically seasoned folks whose skills are still at their peak. In residency you aren't being mentored by folks with only 4-5 years of experience, are you?

I was thinking that for complicated surgeries or procedures, you'd have the most experienced physicians on the case with junior folks learning from the experience. But if your folks with most time in service are practicing less and less, I'm wondering how this works.

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[spicedmanna]

Maybe someone can clear this up for me....

From what posters have said here over the years, the majority of physicians in milmed walk after their minimum commitment is up. From my understanding, folks who stay in for any length of time get pulled away more and more from clinical responsibilities and take on more and more administrative/leadership responsibilities. Please correct me if this is incorrect.

That being the case, who runs the military residency programs? It seems you would have a shortage of clinically seasoned folks whose skills are still at their peak. In residency you aren't being mentored by folks with only 4-5 years of experience, are you?

I was thinking that for complicated surgeries or procedures, you'd have the most experienced physicians on the case with junior folks learning from the experience. But if your folks with most time in service are practicing less and less, I'm wondering how this works.

Don't forget the the military commissions seasoned attendings in a variety of fields to join their ranks, ones that never went through HPSP or USU. Even if a majority of HPSP and USU folks walk after their commitment, you still have physicians coming in that way.

 

[The White Coat Investor]

Who teaches? I do.

I have less than 2 years experience. The experience among the people teaching in the program I am associated with varies from less than 1 year to 15+. Some faculty are civilians, some are military. Most of the military have less than 10 years experience. We tend to be dedicated, but pulled in many different directions and frequently deployed. I think a good civilian program generally has better teaching faculty than a good military program, partially because a higher percentage of them are fellowship trained, but also because they have more years of practice and less time wasted on B.S. military things. The civilian program probably also has better pathology. That said, a good military program is probably loads better than a bad civilian program

 

[Galo]

I did.

When I got to the "center" where I had residents, I had been out of training 4 yrs. Some of my colleagues one-two years. An 0-6 with over 12 yrs experience, but he was one of the worst surgeons I have ever had the misfortune of meeting, and one fellowship colorectal surgeon who I think will have a difficult time finding a job on the outside.

While I was still perfecting my advanced laparoscopic skills, colons, etc, there was little opportunity for residents to perform advanced cases. It was a good place to be a first or second year, and do basic cases, but not much beyond that due to us still wanting to operate, and the lack of cases, and OR time. If that residency was based primarily at our "center", they would not have ACGME approval. Fortunately for them, they only were there as first years, and chiefs, the rest of the time was civilian.

 

[Gastrapathy]

Don't forget the the military commissions seasoned attendings in a variety of fields to join their ranks, ones that never went through HPSP or USU. Even if a majority of HPSP and USU folks walk after their commitment, you still have physicians coming in that way.

This cannot be borne out of any actual experience in military GME. The number of people who come in this way are very small and they typically join to get away from the grind (go be a flight surgeon, DMO, etc).

 

[spicedmanna]

This cannot be borne out of any actual experience in military GME. The number of people who come in this way are very small and they typically join to get away from the grind (go be a flight surgeon, DMO, etc).

You are absolutely correct. I have no actual experience in milmed as of yet; just second hand information. I wasn't claiming to have any milmed experience. I try to keep it clear, but I guess I failed to do so this time. My apologies if I misrepresented my experience.

On the other hand, I am well-aware that the majority of milmed physicians do not come about from this route. I was just mentioning this as another avenue by which the military obtains physicians.

Anyway, I'll refrain from further comment and leave well-enough alone, since I would be merely engaging in conjecture by going further down this road.

 

[Mirror Form]

there's plenty of older physicians in my field. A lot of people who went to USUHS end up finishing off their 20, especially if they owe additional time incurred by rotc/west point or by doing a fellowship.

 

[backrow]

I think this is almost a double edged sword for military residencies. On one hand you usually don't have staff who have been plying their trade for years and years, but on the other hand you also get an infusion of new ideas (well hopefully) on a regular basis that you may not get otherwise.

I would like to see more stability in the staff at the teaching hospitals, but I'm not sure how they will ever get this done in a military system.

 

[notdeadyet]

Anecdotally, it looks like the longer the residency, the higher proportion of more experienced people. But yeah, obviously our staff in general is younger than the average civilian program. I'm not convinced that's a bad thing.

I'm not sure I'd trade experience for youth. I can see how having a constant flow of new ideas like backrow mentions would be a strength, but I'm wondering if it would be enough to offset the fact that most of the folks teaching just haven't been physicians that long. I would think that it would be an asset to have folks who have had a broad range of experiences to teach from.

Interesting...

 

[colbgw02]

We have a monkey come in once a week to give lectures, or is it an ape? Is a chimp a monkey or an ape? We haven't gotten to that lesson yet.

 

[notdeadyet]

We have a monkey come in once a week to give lectures, or is it an ape? Is a chimp a monkey or an ape? We haven't gotten to that lesson yet.

???

 

[notdeadyet]

I guess it's all about how you view the curve of diminishing returns. Certainly the older the physician, the less likely they are to have kept up with new techniques. Everyone has had the experience of working for the 75yo doc who has never done a laparoscopic procedure and wonders why everyone is so interested in this new "Lovenox" thing. On the other hand, a totality of young surgeons is hardly ideal either.

That makes sense. I suppose the ideal is to have a token handful of the fresh out of residency whiz-bangs, a couple of old school types for perspective sake and a healthy majority of those somewhere in the middle.

I'd be curious to see what the staff folks think as well is the nice balance between experienced/stale.

 

[The White Coat Investor]

The residency I trained in had a good mix. There were guys who were residents in one of the original residency programs, guys who were faculty in one of the original residency programs, guys with 10-20 years experience and lots of research going on, and plenty of energetic young folks fresh out of fellowship and occasionally fresh out of residency. 1/3 old guys, 1/3 10+ years guys (competent practitioners), and 1/3 fresh blood would be ideal in my book.

The military residency program I'm associated with has 2/3 young guys, 1/3 10+ years guys. Not quite the same. I actually think this program is remarkable for how many experienced practitioners it has. There are a lot in the hospital with even younger faculty.

 

[WHgsurg]

I think this is almost a double edged sword for military residencies. On one hand you usually don't have staff who have been plying their trade for years and years, but on the other hand you also get an infusion of new ideas (well hopefully) on a regular basis that you may not get otherwise.

I would like to see more stability in the staff at the teaching hospitals, but I'm not sure how they will ever get this done in a military system.

This is my first post - but I'm interested in academic medicine and owe the military a very long time (service academy, hpsp, military residency, AF sponsored 2 yrs of research, and AF sponsored fellowship). Our residency is a combined program and we get "new ideas" from the fresh staff and experience from the older AF staff (not many) and the university/private faculty. It's a good blend... The AF is just not set up for it's GME responsibilities without being combined with a strong university - unfortunately. The good thing is that some of our AF faculty have offices/practices out of the university allowing for more cases/experience for them and more teaching opportunities.

 

[hidradenitis]

The problem as I (an AF FP) see it is that full-scope FP (OB, inpatient, ICU, peds, nursery) is only found at training programs.

Your faculty will therefore be:
1. Fresh out of residency.
2. Have some seniority but coming from a base where they did clinic only for 3-4 years (and likely rusty).
3. Civilian.

 

[USAF MD '05]

On a very scary note... Who teaches? In 3 months, I do. Be afraid... Steve