While establishing metrics and measurement standards for teaching appears to have a generally positive influence on the quantity of instruction provided, the effects on the caliber of teaching remain less evident. The multitude of metrics reported makes it difficult to arrive at general conclusions regarding the effects of these teaching metrics.
Based on the directive of Dr. Jonathan Woodson, then-Assistant Secretary of Defense for Health Affairs, Defense Health Horizons (DHH) explored diverse strategies for adjusting Graduate Medical Education (GME) within the Military Health System (MHS) to ensure the preparation of both a medically ready force and a ready medical force.
In the military and civilian health care sectors, DHH interviewed subject-matter experts, key institutional officials, and service GME directors.
The report proposes a range of short- and long-term actions for addressing concerns in three areas. Ensuring a fair and appropriate allocation of GME resources for active-duty and garrisoned military personnel. Developing a comprehensive, three-service mission and vision for GME in the MHS and expanding relationships with external institutions is essential to achieving an ideal physician mix and ensuring that trainees gain the requisite clinical experience. Modernizing the methodology for recruiting and tracking GME students, alongside the management of new student admissions. For improved student quality, performance tracking across medical schools, and a unified tri-service admissions strategy, we recommend these steps. The MHS's transformation into a high-reliability organization (HRO) and the advancement of a culture of safety are contingent upon its alignment with the Clinical Learning Environment Review's principles. To establish a robust framework for patient care and residency training, and a systematic approach to managing and developing leadership within the MHS, we recommend several crucial initiatives.
Graduate Medical Education (GME) is a cornerstone in the development and cultivation of the future physician workforce and medical leadership of the MHS. Clinically competent staff are also supplied to the MHS via this process. Graduate medical education (GME) research plays a vital role in generating new discoveries aimed at improving combat casualty care and pursuing other strategic priorities of the MHS. Even though the MHS's primary objective is readiness, the investment in GME is crucial for the attainment of the quadruple aim's other elements—namely, better health, higher quality of care, and cost reduction. Nevirapine To successfully convert the MHS into an HRO, proper management and sufficient resources must be applied to GME. DHH, having analyzed the situation, finds that MHS leadership possesses significant opportunities to increase GME's integration, joint coordination, efficiency, and productivity. To thrive in their medical careers, all physicians completing military GME programs must fully grasp, accept, and actively utilize team-based practice, patient safety, and a systems-oriented viewpoint. Preparing the next generation of military physicians to serve the needs of the front lines, ensuring the health and safety of deployed troops, and providing expert and compassionate care to garrison personnel, their families, and retired members is an important goal.
Graduate Medical Education (GME) is indispensable for cultivating the next generation of physicians and medical leaders within the MHS. Furthermore, it furnishes the MHS with a workforce possessing clinical expertise. Medical advancements in combat casualty care and other MHS goals are fostered by GME research. Even though readiness is the MHS's primary directive, GME education is paramount for successfully contributing to the three other key components of the quadruple aim – better health, improved care, and lower costs. By ensuring proper management and adequate resources for GME, the MHS's transition to an HRO can be significantly accelerated. DHH, based on their analysis, opines that MHS leadership possesses numerous opportunities to foster a more integrated, jointly coordinated, efficient, and productive GME structure. Nevirapine Understanding and integrating team-based practice, patient safety, and a systems-oriented viewpoint are crucial skills for physicians completing their GME in the military. Preparing future military physicians to meet the needs of deployed warfighters, protect their health and safety, and offer expert and compassionate care to garrisoned personnel, families, and retirees is paramount.
The visual system is frequently compromised by brain trauma. Brain injury's impact on the visual system presents a specialty in diagnosis and treatment marked by less definitively established scientific principles and greater variability in clinical practice than many other medical fields. The locations of optometric brain injury residency programs are largely confined to federal clinics under the auspices of the VA and DoD. The core curriculum created allows for a consistent approach while permitting program strengths to be highlighted and utilized.
Utilizing Kern's curriculum development model and input from a subject matter expert focus group, a common framework for brain injury optometric residency programs was established within a core curriculum.
A high-level curriculum, designed with educational goals in mind, emerged through a process of consensus building.
A nascent subspecialty, lacking a robust established scientific base, benefits from a standardized curriculum, which creates a shared framework for advancements in clinical practice and research within this field. The process sought out expert advice and community support to ensure broader use of this curriculum. By establishing a framework, this core curriculum equips optometric residents with the skills needed to diagnose, manage, and rehabilitate patients suffering from visual impairments due to brain injury. The aim is to cover necessary topics comprehensively, while maintaining adaptability based on the particular program strengths and available resources.
A common curriculum, crucial in a burgeoning subspecialty lacking established scientific principles, will establish a shared framework for accelerating both clinical practice and research advancements in this field. To successfully integrate this curriculum, the process actively sought out expert knowledge and nurtured community collaboration. The core curriculum will serve as a framework for optometric residents to learn the diagnosis, management, and rehabilitation of patients with visual sequelae that stem from brain injuries. Appropriate subject matter is intended to be incorporated, though with the flexibility to tailor content based on the particular program strengths and available resources.
Early 1990s innovations in telehealth deployment were led by the U.S. Military Health System (MHS). The military health system's progress in deploying this method outside of active duty settings lagged behind that of the Veterans Health Administration (VHA) and comparable large civilian systems, due to numerous administrative, policy, and other hurdles impeding its expansion in the MHS. A December 2016 report on telehealth initiatives within the MHS presented a summary of past and current programs, analyzing the constraints, possibilities, and policy context. Three alternative action plans were proposed for expanding telehealth services in deployed and non-deployed settings.
Direct input, along with gray literature, peer-reviewed literature, and presentations, were consolidated under the supervision of subject matter experts.
The MHS's telehealth capabilities, evident both historically and presently, have shown impressive potential, notably in deployed or operational circumstances. The 2011-2017 policy environment fostered MHS expansion, contrasting favorably with the civilian and veteran's healthcare systems' reviews, which showcased the substantial advantages of telehealth in non-deployed settings, including broader accessibility and reduced costs. In accordance with the 2017 National Defense Authorization Act, the Secretary of Defense had to encourage telehealth implementation within the Department of Defense. This included provisions for resolving obstacles and reporting advancements in telehealth deployment every three years. While the MHS offers streamlined interstate licensing and privileging, it necessitates a higher cybersecurity standard than civilian systems.
The MHS Quadruple Aim, emphasizing cost, quality, access, and readiness, is effectively aided by telehealth benefits. The strategic use of physician extenders greatly improves readiness, enabling nurses, physician assistants, medics, and corpsmen to execute hands-on patient care under remote supervision, leading to optimal professional practice. The review highlighted three strategic directions for improving telehealth. The first strategy focused on prioritizing telehealth within deployed settings. The second recommended maintaining existing telehealth capabilities in deployed areas while bolstering non-deployed development to achieve parity with VHA and private sector performance. The third suggested leveraging lessons from military and civilian telehealth experiences to surpass the private sector’s telehealth development.
The present review portrays the steps in the development of telehealth before 2017, underscoring its role in shaping subsequent initiatives in behavioral health care and as a critical measure in response to the COVID-19 pandemic. Ongoing learning and future research are expected to drive additional development of telehealth capabilities within the MHS.
This review examines the steps taken toward telehealth growth before 2017, which facilitated its later incorporation into behavioral health programs and its role as a solution to the 2019 coronavirus disease. Nevirapine Ongoing, learning from the lessons learned is vital, and further research is expected to shape the future growth of telehealth capability within the MHS.