Page 39 - JSOM Fall 2022

Generating Competent Special Operations Clinicians

From Military Graduate Medical Education

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Hugh Hiller, MD *; Guyon Hill, MD ; Shaun Shea, SOCM ;
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Joel Fernandes, SOCM ; Kaden Earl, SOCM ; John Knight, MD ;
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Andrew Schaffrinna, MD ; Benjamin Donham, MD ; Paul Allen, PA-C 9
ABSTRACT
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Units within the Special Operations Forces (SOF) commu­ learning and improvement, and system­based practice. Physi­
nity require medically competent and operationally proficient cian assistant training programs are accredited by the Accred­
medical providers (physicians, physician assistants, and nurse itation Review Commission on the education of the Physician
practitioners, among others) to support complex mission sets. Assistant (ARC­PA) and adhere to the same core competency
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The expectations placed on providers who successfully assess domains. While these guidelines prepare graduates to provide
for and are selected into these units are high. These providers high­quality medical care in the garrison environment, they do
are not only expected to be experts in their respective sub­ not address the operational and tactical skills a SOF provider
specialities, but also to serve as staff officers, provide medi­ must possess to be successful.
cal direction for SOF medics, serve as medical advisors to the
command team, and provide direct medical support for ki­ Recognizing the need for improved operational readiness,
netic operations. They are expected to perform these functions the Army published a regulation in 2007 requiring that all
with little oversight and guidance and when geographically Medical Corps training programs include military unique cur­
separated from higher units. Graduates from military Grad­ ricula. This was further emphasized in the Department of De­
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uate Medical Education (GME) programs are extremely well­ fense’s (DoD) response to the National Defense Authorization
educated and can provide high quality medical care. However, Act of 2017, defining the need for military GME programs to
they often find themselves ill­prepared for the extra demands “provide operational medical readiness.” In fact, the Defense
placed upon them by the Special Operations community due Health Agency (DHA) was created in part to specifically ad­
to a lack of operational exposure. The authors of this paper dress this issue, with one of its core tenants being to “improve
recognized this gap and propose that the Joint Emergency and sustain operational medical force readiness.” 4
Medicine Exercise (JEMX) model can help augment the body
of knowledge required to perform well as a provider in a Spe­ While these mandates were a step in the right direction in terms
cial Operations unit. of preparing military clinicians for operational assignments,
they merely provide a framework for operational medicine ed­
Keywords: military graduate medical education; Special Opera- ucation and provide few specifics regarding how this is to be
tions; joint emergency medicine exercise carried out. The DHA has delegated the responsibility of the
development and sustainment of an operational medical force
to the individual military department (MILDEP) level, with
the secretary of each MILDEP determining what is required
Introduction 5
to provide an operationally ready force. This in turn allows
Clinicians who graduate from military GME programs meet individual departments and programs to tailor their military
all civilian competencies and board requirements to practice specific curricula to branch and specialty specific needs. How­
medicine in their respective fields. In the case of physicians, ever, it relies heavily on the operational experience and incli­
these rigorous and competitive programs comply with strict nation of faculty at the individual program level. As such, it
standards enforced by the Accreditation Council for Gradu­ is inevitable that some programs will have more operationally
ate Medical Education (ACGME), fulfilling the ACGME core experienced faculty than others, creating an inconsistent prod­
competencies of patient care, medical knowledge, interpersonal uct for SOF units to select from. Furthermore, with far fewer
and communication skills, professionalism, practice­based deployment opportunities, programs run the risk of losing
*Correspondence to hughhiller@gmail.com
1 CPT Hugh Hiller is an emergency medicine physician at Womack Army Medical Center, Fort Bragg, NC, and has three deployments in support
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of SOCOM units. LTC(P) Guyon Hill is an emergency medicine physician at Carl R. Darnall Army Medical Center, Fort Hood, TX; is faculty
in the pediatric emergency medicine fellowship at UT Austin ­ Dell Medical School; and has eight deployments in support of SOCOM units.
3 SSG Shaun Shea is a SOCM medic assigned to A Co, 3rd BTN, 75th Ranger Regiment; and currently serves as the company senior medic; and
has four deployments within the Ranger Regiment. SSG Joel Fernandes is a SOCM medic assigned to 160th Special Operations Aviation Regi­
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ment (Airborne), where he currently serves as the medical standardization instructor; he has four deployments with SOCOM units. SGT Kaden
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Earl is a SOCM medic assigned to HHC, RSTB, 75th Ranger Regiment and currently serves as the company senior medic. MAJ John Knight is
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a former 18D/Z and now serves as an emergency medicine physician at Womack Army Medical Center, Fort Bragg, NC, and has 15 deployments
with various SOCOM units. MAJ Andrew Schaffrinna is an emergency medicine physician at Womack Army Medical Center, Fort Bragg, NC
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and has three deployments in support of SOCOM units. LTC Benjamin Donham is an emergency medicine physician currently serving as the
commander of the 261st Multifunctional Medical BN at Fort Bragg, NC, and has six deployments in support of SOCOM units. MAJ(R) Paul B.
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Allen Sr is a physician assistant and is currently a tenured associate professor and the chair of the Department of PA Studies at UT Health Science
Center San Antonio; he has 18 deployments in support of SOCOM units.
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