Page 24 - JSOM Fall 2024

in interest for students at USU. Given the known gaps across the pre- and post-transition groups, as well as three of the four
wartime specialties, our data re-emphasize the importance of most popular civilian specialties during those same years; this
addressing this issue. may imply that pre- and post-transition status may be irrele-
vant for specialties such as these, as they are commonly chosen
Our data suggest that recruitment alone may be insufficient, at similarly high rates even within the civilian sector.
and a greater emphasis could be placed on retaining physi-
cians in these critical specialties. Increasing recruitment efforts An additional unique factor for our study is that a large pro-
may not yield results if the proportion of students electing to portion of USU students will complete General Medical Offi-
enter these specialties is more static than anticipated. Reas- cer (GMO) tours, which are especially prevalent in Navy GME
suringly, our data do suggest that students were not swayed programs. Because of the lack of categorical allocated slots for
against choosing operational-based specialties following the prospective residents, it is difficult to track students interested
DHA transition, with the majority still planning to pursue op- in applying to specialties that favor returning GMOs. Subspe-
erationally relevant specialties. cialties that require an initial residency were not accounted
for. For example, students desiring to enter cardiology one day
Importantly, our data also demonstrate a stable and high were counted as students desiring to enter internal medicine.
level of satisfaction with students’ decision to attend medical The effects of DHA changes on cardiology and general inter-
school. Since our study was limited exclusively to USU stu- nal medicine may be different, however, and these should not
dents with an implied MSO, we assumed that this would cor- be treated as the same specialty for these instances.
relate to satisfaction with commitment to military service and
a potential career in the MHS. Each class year from 2015 to Finally, it is important to highlight that the DHA has not
2020 demonstrated at least 70% responding that they would formally defined the classification of specialties’ operational
attend medical school again, which is closely in line with na- relevance. Our study assigned specialties with an operational
10
tional AAMC data for this question. This suggests that, even label that best reflected the information being communicated
in retrospect, USU students did not feel that a DHA transition to students leading up to the military match, thus potentially
was a reason to avoid attending USU. influencing their career choice. The authors would also like
to emphasize that these operational labels are not intended
Limitations to devalue or ascribe lesser importance to certain medical or
While these data may suggest that graduating USU students’ surgical specialties.
specialty preferences are relatively unaffected by the DHA
transition, our study does have several important limitations. Future Research
Students graduating in 2020 were introduced to the DHA While our study exclusively examined USU graduating stu-
transition before matching, but they were not aware of this dents, it would be beneficial in future studies to attempt to
change before beginning their medical education in the mil- similarly analyze responses from HPSP scholarship students
itary system through the USU. Therefore, how more junior at civilian medical schools. While it is possible that HPSP
or pre-medical students will react to the DHA transition is students demonstrate similar tendencies to USU graduates,
unknown. HPSP students may feel fewer effects of the changing climate
of military GME due to two primary reasons: first, their rel-
Another key limitation is the timing of the AAMC GQ survey atively shorter MSOs make it more likely that they pursue a
administration. USU students take this survey after the mili- civilian residency and career following an initial payback with
tary match process. This may lead to student responses being the military (as opposed to USU students who would need to
influenced by the results of the match process, as opposed to serve multiple tours as GMOs to complete their initial MSO).
being a representation of their true desired specialty prefer- Second, HPSP students may experience more limited access
ence. Further, even by July 2021 (after all students being an- to career counseling about military GME changes; USU stu-
alyzed in this study had graduated), not all of the proposed dents have access to student affairs counselors who are active
reductions and realignments had been made. While this is true, duty and well-versed in military GME (a luxury not all civilian
the scope of this study primarily involves the perceptions of schools possess).
graduating medical students in anticipation of these reported
reductions and realignments, which may not have come to fru- Future studies could aim to compare students who initially
ition by the time they graduated. entered the military medical pipeline after these changes were
introduced, disseminated, and implemented. They may also
A further limitation of this study was that while some med- investigate subspecialty and branch-specific effects of these
ical specialties are quite large, many medical specialties had legislative changes, specifically the implications of the 2017
very few USU students applying per year, so small changes in NDAA. In addition, future studies may examine the effects of
absolute numbers appeared to create larger variations. Ad- similar DHA transitions and their effects on HPSP students
ditionally, statistical comparisons were made between entire or military physicians, regardless of their educational back-
operational groups (as described above) rather than within ground, who are at the end of their MSO rather than at the
individual specialties; while some specialties may have had ab- beginning.
solute increases (for example, student selection of emergency
medicine increased from 8.4% to 12% between pre- and Conclusion
post-transition groups), these were not analyzed individually.
Medical students at the USU, both before and after the initial
One final limitation includes the fact that three specific spe- DHA transition, demonstrated a similar preference for op-
cialties (family medicine, emergency medicine, and internal erational specialties and similar levels of satisfaction in hav-
medicine) make up the three most popular specialties for both ing attended medical school. This was in spite of the recent

22 | JSOM Volume 24, Edition 3 / Fall 2024