Medical Education- Courses

Military Medical Field Studies
 
Lt Col Lisa Beck, MSC, USAF, Course Director
 
The practice of Military Medicine is a highly specialized form of Occupational Medicine; providing primary medical care and preventative medicine for those working in the unique military environment. As each USUHS medical student completes his/her formal education, internship and residency training, he/she will have spent class and laboratory time developing a firm basis for the practice of military medicine. However, this by itself is not enough. It is vitally important that each student, during the training process, actually come into contact with the environment, (people, places and equipment), for which he/she will be medically responsible during their military career.
 
The Military Medical Field Studies (MMFS) Course is composed of two components: the 7 day Field Training Exercise (FTX) Kerkesner and the Operational clerkship. During FTX Kerkesner, each student will receive extensive, hands-on field training in followership, leadership, combat medical skills, preventive field medicine, field survival skills and other related topics. During the operational clerkship, most students will become part of an organic military line unit of their parent service. In this capacity, these future military physicians will have the opportunity to view, first hand, the day-to-day operations of those military members who carry out the mission; be it a missile maintenance squadron, a light infantry brigade, a Navy Construction Battalion or a USMC recon company in training, to list a few examples.
 
1. The MMFS course is a requirement for graduation from USUHS. THERE ARE NO WAIVERS. Those first year students who are unable to successfully complete the course during the scheduled time, for any reason, must complete the course during the next year, during a fourth year elective period or during extended leave/holiday periods. Those students with prior full-time active-duty military line experience may be granted operational credit, and may therefore be allowed to participate in other activities during the period of the operational clerkship ( discussed later). Those students who have previously served on active duty, graduated from one of the military academy's, were Reserve Officer Training Corps (ROTC) graduates, were members of a regular reserve or National Guard unit or were members of the U.S. Coast Guard may be granted credit toward their operational experience, depending upon their circumstances. Those students without prior military experience as outlined above, must participate with a line unit of their parent service. These options will be discussed later in more detail.
 
The learning objectives for both FTX Kerkesner and the operational clerkship are as follows:
 
1. FTX Kerkesner. The first two days are spent in classroom instruction on map/compass reading, field communications and Nuclear, Biologic, Chemical (NBC) instruction and demonstration. On the third day, the whole class will deploy to Fort Indiantown Gap(FIG), PA . Redeployment (returning from the field to USUHS) will occur on the ninth day followed by three days of equipment clean-up and turn-in.
 
2. The operational clerkship. This portion of MMFS will be conducted the month immediately following FTX Kerkesner. The primary learning objective is for each student to understand, comprehend and be able to conceptualize the operational environment of their parent service from the perspective of a future military physician. This includes the ability to comprehend the occupational hazards of a typical operational environment; to understand in general terms the real or potential physical and mental medical consequence of this work environment and how this may impact the unit's mission; and, finally, to be able to assess what changes, modifications or new procedures may lessen the medical consequence and thereby facilitate the mission. For those prior service students who already have operational experience, the primary learning objective is broadened to comprehending and understanding a nonoperational experience that will enhance and augment the student's military medical education. Examples include research or special projects approved by the Course Director.
 
Unlike FTX Kerkesner, for which the operational planning, organizing and support have been prearranged by USUHS faculty and staff, the operational clerkship is organized almost entirely by the student. That is, the initial contacting of a prospective preceptor, determining operational requirements (e.g. security clearance, field gear, flight physical, etc), arranging billeting, planning an itinerary, arranging transportation, requesting travel orders and completion of the travel voucher upon return to USUHS, etc.. Thus, a secondary learning objective of the operational clerkship is developing a working knowledge of how to plan, organize and execute official government travel to an operational unit, to include a working understanding of travel regulations, funded vs. permissive travel, use of the personal government charge card, using the contracted government air carrier(s); correctly completing a travel voucher, etc. There are many operational clerkship options for each student. Those students without prior military experience may choose to participate with one of several funded TDY sites for each service. In the past these have included such sites as:
 
U.S AIR FORCE

U.S. ARMY

Note: the Department of the Army requires that all Army students complete the Officer Basic Course (OBC). Any student who has not completed OBC will do so in place of their operational clerkship, with the operational clerkship completed at a later time -- usually as an elective during the fourth year.
 
U.S. NAVY

Students with a prior operational military background are encouraged to gain additional line experience with their parent service, preferably in a different operational environment than their prior area of specialty. If the site selected is outside MDW, the student can be placed on permissive orders. It is the responsibility of each student to locate a prospective site and propose it to the course director for approval (discussed later). Other clerkship opportunities for prior service students have included the following:
 
The Operational and Emergency Medical skills (OEMS) Course.
 
Survival, Evasion, Resistance, and Escape (SERE) School
 
Research Opportunities
 
Outside-Continental-United-States (OCONUS)

Operation Kerkesner
 
CPT Jeffery Hogue, MS, USA, Exercise Director
 
On occasion, the military physician is called upon, often on short or no notice, to deploy from his or her daily practice to any point in the world, to provide medical care in support of military men and women conducting military operations. To be effective, these deploying physicians must have not only good training in the basic and clinical sciences learned in medical school, internship and specialty training, but the additional capabilities of applying these medical skills under adverse conditions, in potentially hostile environments, and without the benefit of the advanced medical technology that is now commonplace in medical centers. It is through field exercises that physicians in training develop an appreciation and understanding of the adverse mental and physical conditions under which active duty military personnel must often live.
 
During your four years at USUHS, you will have two formal field training courses in Military Medicine. The first is FTX Kerkesner and the second is a four week course entitled Military Contingency Medicine (MCM) taught during your fourth year. Successful completion of both courses is required for you to graduate. MCM is an advanced course in Military Medicine. Its primary objective is to test each student in the advanced field medical skills, advanced field leadership skills and advanced organizational/logistical skills for which you will have received many hours of classroom and laboratory instruction.
 
FTX Kerkesner's approach to instruction is directed to the basics and fundamentals of field medicine, field skills and leadership skills: skills for which you have (or will have) received numerous classroom and laboratory hours of instruction. The course is directed towards familiarizing the student with the conditions that American service men and women will typically have to live with if they are deployed under field conditions.
 
All 165 students are organized into four platoons of 40 to 42 students each. Each platoon is then divided into four squads of 10 or 11 students, each with designated squad leaders. On occasion, to better individualize teaching, these squads are broken down further into teams of 4 to 6 students each. All students are on a rotating leadership cycle, designed so that each student has at least 2 (and most have 3) periods (morning, afternoon or evening) during which they serve as squad or platoon leader, with all associated responsibilities. Those students with considerable field leadership experience may assist other students in the leadership role if help is required. However, this must be accomplished without taking away their leadership responsibility. The course is composed of 11 instruction blocks, the learning objectives and a brief discussion of each are outlined below. All students are expected to successfully complete these blocks of instruction. To successfully complete the course, each student must pass a minimum of 7 of these instruction blocks. All student evaluations are pass/no-pass. To pass, each student is expected to actively participate during each instructional block, conduct themselves as military officers, employ the field skills they have learned in Military Studies I and MMFS (for example, bandaging and splinting, litter carry, compass/map reading, etc) and successfully carry out their responsibilities as leaders when they are called upon to do so. Students having difficulty with these requirements will be individually counseled and tutored by the course director or department chairman. However, history has shown that the vast majority of students, although stressed periodically, thoroughly enjoy the instruction they receive and later rate the course as very educational and informative. The 11 instruction blocks are:
 
1. DEFENSIVE OPERATIONS: The objective of this teaching block is two-fold. The first learning objective is familiarize students with the tactical defense and movement of the combat squad in the field. Field demonstrations by a U.S. Marine Corps squad stress squad movement, position, command, communications and evacuation of wounded. The second objective of this instructional block is for students to understand the importance of sound, movement and light discipline during night operations. At twilight, the instructor demonstrates to the students how sound, movement, and light can be readily detected in the field and how difficult visual identification and recognition becomes when the natural light fades.
 
2. NUCLEAR, BIOLOGICAL AND CHEMICAL (NBC). This teaching block is very important. As long as NBC agents exist and can be used against allies of the United States, military and civilian, there must be a constant vigil to keep personnel trained. For FTX Kerkesner, students will be exposed to tear gas (simulating a chemical agent used by enemy forces) requiring them to quickly don their protective NBC cover garments and mask and continue their tactical mission. After removal of the protective suits, students will receive field instruction on how to detect NBC agents, how to decontaminate personnel (buddy decon) and equipment and how to treat patients who have been contaminated, using prepackaged rapid-use antidotes. The learning objective is for each student to understand the importance and correct usage of the specialized NBC protective outer garments and mask and to demonstrate the ability to don, maneuver in and remove NBC protective gear. It is important that each student understand, as future physicians, the medical and psychological adverse conditions military personnel must endure while conducting a mission in a full chemical protective suit and mask over a prolonged period.
 
3. DAY/NIGHT LAND NAVIGATION. Prior to deployment to FTX Kerkesner, students receive 3 hours of classroom instruction on how to read a topographical navigational map with grid coordinates, and how to properly use a compass in conjunction with the map. Once deployed to FTX Kerkesner, each platoon will complete the field portion of this teaching block. Each student will be required to plot grid coordinates to predetermined locations and then, in teams of 3 or 4, use their compass to successfully navigate to these locations and then back to the starting point. In addition, each student must navigate at night using only their compass (with illuminating dial). Although the night navigation is done while it is dark, the navigation course is much simpler. For safety reasons, students are confined to a 4 to 5 acre wooded site, bounded on all sides by roads that they are instructed not to cross. The learning objective is for each student to be able to successfully navigate to a distant point using a geological survey map, a compass and a protractor, using navigational skill taught during the didactic teaching.
 
4. PREVENTIVE MEDICINE. Each platoon will receive four hours of instruction on multiple aspects of preventive medicine in the field. Didactic instruction is provided and whenever practical, procedures will be demonstrated and hands-on experience provided. Topics covered include basic field sanitation, water potability, testing water under field conditions, field sanitation devices, methods of personal hygiene, avoiding dangerous wild animals, prevention of heat and cold injury, and how to manage personnel protection from mosquitoes, ticks, filth flies and diseases associated with insects and pests. The primary learning objective is to provide students with awareness and understanding of multiple methods available to control food/water, person-to-person and insect/animal borne diseases while deployed to the field.
 
5. CONVOY OPERATIONS. Because most field military personnel are transported from point to point using vehicles unique to military operations, it is important for military physicians to have a good working understanding of these tactical vehicles and their unique health hazards. During the Convoy Operations instruction block, each squad will be transported to a predetermined site within the exercise area in a tactical military vehicle, preferably a tracked personnel carrier, tank, 2.5/5 ton truck or other vehicle. Once transported to this point, the students are instructed to transport a (simulated) casualty by requesting a medivac (helicopter) evacuation. The student coordinates the medivac request, secures the landing zone, directs the medivac to the landing zone and at the direction of the helicopter flight crew, load the simulated casualty and all the students in the squad into the helicopter for evacuation back to their starting point. The learning objectives of Convoy Operations are to apply field leadership and organizational skills in a mobile tactical environment, to familiarize all students with the vehicles commonly used in military operations, their unique medical hazards and their usefulness in transporting patients in the field.
 
6. FIELD SKILLS TESTING (FST): While deployed under field conditions, students are exposed to as many field unique conditions as are practicable. This is not to make students proficient in these field skills, but so that each student understands the physical and psychological stress as well as the complexity associated with field operations. The learning objective is for each student to become familiar with and be able to perform the following field skills:

7. LEADERSHIP FIELD EXERCISE (LFE): This teaching block focuses on troop leadership procedures, squad movements and small unit operations, while accomplishing the squads designated mission. The 4 squads of each platoon and a faculty evaluator are transported by helicopter to a predetermined location. The squad student leader has been instructed where he or she must lead their squad along with an overall operations scenario. Using map/compass skills, radio skills and leadership skills, he/she will organize and direct the movement of the squad. The learning objectives are for the student leader to demonstrate his/her ability to apply basic leadership principles, maintain control of the patrol, communicate clear instructions, clarify and resolve troop problems, demonstrate correct sound discipline, demonstrate basic map reading techniques and navigational skills and utilize correct radio techniques.
 
8. LEADERSHIP REACTION COURSE (LRC): Located within the confines of "Combat Village", an area of fixed concrete one and two story houses constructed for training purposes, the LRC stresses the principles of leadership, teamwork, problem solving and safety within a moderately stressful environment. The LRC is divided into four stations, each with different missions but all running simultaneously while a loud recording of small arms fire, yelling, small explosions and other diversionary sounds are played. The learning objective is for the squad leader to demonstrate his/her ability to organize, communicate and implement a plan with his or her squad to accomplish the missions to be described.
 
9. BATTALION AID STATION (BAS): In real-world military operations, the BAS is the forward-most medical unit to which front line casualties are immediately taken following hostile action or mishap, and where each casualty is stabilized, emergent treatment is initiated and immediate evacuation to higher medical care is coordinated. At FTX Kerkesner, students are familiarized with the operations of the BAS. Simulated casualties will be brought to the BAS where the student leader will employ Combat Medical Skills for casualty management. (Because first year medical students have not yet received the training required for the detailed medical management of casualties, this aspect will be only briefly discussed). The teaching objectives are for students to develop a conceptual and a hands-on understanding of basic medical management of a casualty, employing bandaging, splinting and medical assessment principals, casualty triage, and echelons of care while in a tactical environment.
 
10. CASUALTY EXTRACTION: Extraction or evacuation of casualties from high risk areas is the focus of the casualty extraction instruction block. After sunset, moulage patients are placed, along with the faculty evaluator, at predetermined locations. Patient squads from each student platoon are given a scenario that identifies a wounded American pilot or soldier who has been reported to be in a general area. The student leader then organizes his or her patient extraction team to go to the area in question and search for, find, medically stabilize and extract the wounded serviceman. The learning objective is for the student leader to employ compass and map reading skills, use squad level leadership and organizational skills and utilize the squad movement/night light and sound discipline skills learned the first night of FTX Kerkesner to locate and safely extract the casualty.
 
11. FIRING RANGE AND BALLISTICS DEMONSTRATION: This instruction block occurs on the first full day of FTX Kerkesner. Its purpose is to familiarize each student with the live firing of the M-16 field rifle, the M-9 9mm pistol and the ballistics effect of these weapons on soft tissue. Following an extensive briefing on safety and the correct methods of carrying the M-16, each student, under the direction of U.S. Marine Corps firing range instructors, fires their M-16 at firing range targets. Instruction is provided on how to adjust the M-16's sights, how to clear a jammed weapon and how to change clips while firing. The learning objective is not to make the students proficient in their use, but for each student to become familiar with operating the M-16 and M-9 field weapons so the student has a better understanding of the weapons of choice that will be used by the soldiers, sailors and airmen whose medical care each future physician will be responsible. Following this instruction, there is a demonstration on the affect of high velocity bullets by firing into a watermelon and other objects that simulate human tissue. Finally, M-16 and M-9 bullets are fired into a standard issue flak vest to demonstrate how effective or ineffective this vest is to high and low velocity projectiles.

Military Studies I Travel
 
Official Government Travel can be broken down into two categories: TDY and PTDY.
 
TDY (Temporary Duty): This is funded travel (Government Expense). TDY will cover Travel and Per Diem (food and lodging) expenses. Per Diem rates are based on the cost of living in a certain area; however, those traveling to a military base will be funded at the Government Per Diem rate, which is:
 
Food: $10.50 (Dining Facility Breakfast, Lunch and Dinner prices) per day
Lodging: Current BOQ/Guest Housing rate (between $10-$40 per night)
Air Fair: Government Ticket out of BWI, Reagan, Dulles (lowest cost)
Rental Car: Not authorized for MSI/MSII travel
POV Travel: Authorized. Reimbursed lowest cost between Air vs Mileage
 
PTDY (Permissive Temporary Duty): This is NOT funded travel (No cost to the Government). PTDY is paid entirely by traveler and will NOT be reimbursed.
 
Travel Instruction for MSIs doing an MMFS Clerkships
 
Prior-Service Travel: All prior-service officer/enlisted and Academy/ROTC grads are considered prior-service. Prior-service students will travel on a PTDY status only (no cost to the government). Prior-service students that choose to do an offsite summer experience may do so at their own expense. Prior-service students are encouraged to stay local and do a research/medical clerkship.
 
Non-Prior-Service Travel: All non-prior-service personnel must do an operational summer clerkship. Non-prior-service students are also encouraged to find a local operational clerkship. If that is not an option then these personnel may travel to an offsite clerkship location on a fully or partially funded TDY.
 
LOCAL, CONUS, OCONUS Travel: PTDY (out of your pocket) may go as far as your pocket-book can take you. TDY, however, is a little more strict. Local and CONUS travel is not a problem, but the University will NOT fund travel overseas (OCONUS: Outside Continental United States). Any student that chooses to do an overseas clerkship will pay for travel out of his or her own pocket (Non-prior-service personnel will then be funded for food and lodging).
 
How to Pay:
For those going TDY, MSI and MSIIs are not authorized to use the Government Travel Card. Students will receive an advance of 80% of the estimated total cost for the TDY. This money is for purchasing plane tickets, food and lodging. The other 20% will come out of the student’s pocket but will be reimbursed after completion of travel (see Reimbursement below).
 
Reimbursement:
After completing travel each student must fill out a Travel Voucher (DD Form 1351). This form is necessary. Do NOT try to save the department some money by not filling out this form; the money has already been put aside for you and if you do not complete the process the finance office will track you down.
 
Instructions on completing the DD Form 1351-2
 
Travel Voucher
 
You will need:

OK here we go!
 
STEP 1 Download or pull up the electronic form DD Form 1351-2 Travel Voucher.
 
STEP 2 You may type in this form or use a black ink pen.
 
BLOCK 1 Payment
 
Mark how you want to be paid with an X (it is best to set-up EFT now).
 
Note: If you choose EFT (direct deposit) include a voided check or a deposit slip from your bank account to help finance put the money in the right account. (This is for travelers filing for the first time).
 
BLOCK 2 Type of Payment
 
Mark TDY with an X.
 
BLOCK 3 for D.O. USE ONLY
 
DO NOT WRITE IN THIS AREA
 
BLOCK 4 Name
 
Umm… Your Name.
 
BLOCK 5 Grade
 
Your military grade O-1 or O-1E
 
BLOCK 6 SSN
 
Your Social Security number
 
BLOCK 7 Address
 
Your mailing address
 
BLOCK 8 Daytime phone number
 
You can put your home phone here
 
BLOCK 9 Travel Order Number
 
You will find this in Block 22 of your official travel orders
 
BLOCK 10 Previous payments or Advances
 
If you were given any advances or payments for this TDY already you must state that here. If none state NONE.
 
BLOCK 11 Organization and Station
 
Write: USUHS, Bethesda, Maryland
 
BLOCK 12: Dependents
 
You may leave blank or mark Unaccompanied (regardless if you were or not..)
 
BLOCK 13 Dependents Address
 
Leave BLANK
 
BLOCK 14 Have Household Goods been shipped
 
Leave BLANK
 
BLOCK 15 Itinerary
 
Take a breath.. and ….
Write 2003 under column a. Date
 
In column a. Date
 
Write the date for each stop or event like Jul 7 or 7/7
 
Column b. Place (DEP stands for Departed ARR for arrived
 
We have all departed either our home or USUHS. Then we either went to the airport (state which one) or We drove to our destination. Then we departed (either airport or drove). Then we returned Home.
 
Column c. Means of travel
 
The codes are

If you flew (on airplane).. and USUHS bought the ticket .. use the code TP. If you bought the ticket .. use the code CP
 
Column D. Reason for stop
 
Use these codes

Column E. Lodging cost
 
Put down only the amount you are requesting reimbursement. You must have the receipt. If you shared a room and did not pay, just leave it blank.
 
Column f. POC miles.
 
IF you drove, put down the miles to and from your TDY location. (Now finance figures this out using a JTR maps, but you still need to put down mileage)
 
IF YOU NEED MORE SPACE .. USE the DD FORM 151-2c
 
BLOCK 16. POC Travel
 
Were you the owner/operator or the passenger? Mark one with an X or leave blank.
 
BLOCK 17 DURATION of TDY
 
Mark more than 24 hours.
 
BLOCK 18 Reimbursable Expenses
 
Now to be fair here, you are actually authorized to claim some additional reimbursements. Such as Parking, cab fare, ATM fees, tips, POV mileage to and from home… etc.
 
BUT.. remember we were going to try to seriously stay in our budget constraints, so we could all participate in this year’s summer clerkships.
 
BLOCK 19 Leave blank
 
BLOCK 20a Your signature and date. (important!)
 
STEP 3 DROP the form and the receipts and a copy of your orders into the box in front of room C1079 and we will take it from there!
 
Congratulations!
 
Last note on travel and reimbursement: You will be reimbursed ONLY for what is on your orders. Do not get a rental car if your orders do not authorize one; you will not get that money back.

Contact Information

Uniformed Services University
MEM Office: C1039
4301 Jones Bridge Road
Bethesda, Maryland 20814
Phone (301) 295-3720
DSN: 295 3720
Toll Free: 888 826-3126
FAX (301) 295-6773

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