Cloonan Clifford, Fauver Howard E, Holloway Harry C, Hospenthal Duane R, Hutton John, Lewis Evelyn, Madrigal Vinicio E, Maliner Beverly, Nelson Michael, Reynolds Paul C, Staunton Michael, Wayne Barry A, Roy Michael J
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Mil Med. 2003 Sep;168(9 Suppl):41-5.
We have identified and prioritized a series of objectives that warrant inclusion in the continuum of military medical education. Although participants in the 16th Conference on Military Medicine also discussed whether each objective should be taught at the medical student, resident, or staff physician level, to a large extent this distinction is not helpful, since many, if not most, of these topic areas would likely require incorporation at each of these three levels to achieve the desired level of competence in staff physicians. Incorporation of new curricular elements poses a significant challenge, since it is already difficult to fit the existing curriculum into the available time. It is not reasonable to consider increasing the number of lecture hours. Therefore, it is probable that some elements of the existing curriculum will need to be pared down or eliminated to incorporate new material. In the past, when new material has been added to the existing curriculum, such as when the pathogenesis of human immunodeficiency virus was added, it has generally been done at the individual teacher or at most departmental level. Although this approach has the advantage of having a subject matter expert decide how best to insert new material within the fabric of the existing curriculum, there are a couple of problems with widespread use of this approach. First, some of these new objectives may not fit clearly within an existing course curriculum or department's educational mission. Second, such an approach may not provide the degree of coordination that is necessary to ensure that a new curricular item is adequately covered in all respects, and it may result in unnecessary overlap in instruction when different professors incorporate similar elements. Therefore, the prioritization of newer curricular items, as has been done during this conference, may serve as a useful guide in this process. However, a corresponding effort is needed to identify and prioritize existing curricular components. Decisions need to be made regarding what, within the existing curriculum, should be cut out or reduced to make room for some or all of these new objectives. Finally, a decision needs to be made regarding which of these identified objectives should be inserted and when and within which courses they should be taught. These are important decisions that should not be left to the whims of chance. As the responsible recipients of Uniformed Services University and Health Professions Scholarship Program medical school graduates, the services' Surgeons General need to take an active role in helping to make these decisions. The outcome of these decisions will have a direct impact on the capabilities that these future junior medical officers will bring to the patients they will care for and to the line commanders that they will support.
我们已经确定并优先考虑了一系列目标，这些目标应当纳入军事医学教育的连续统一体中。尽管第16届军事医学会议的与会者也讨论了每个目标应在医学生、住院医师还是在职医师层面进行教学，但在很大程度上，这种区分并无帮助，因为这些主题领域中的许多（即便不是大多数）可能都需要在这三个层面都进行讲授，才能使在职医师达到期望的能力水平。纳入新的课程内容构成了一项重大挑战，因为要将现有课程安排进可用时间已经很困难了。考虑增加授课时长是不合理的。因此，可能需要削减或删除现有课程的一些内容，以便纳入新的材料。过去，当向现有课程中添加新内容时，比如添加人类免疫缺陷病毒的发病机制时，通常是由个别教师或至多在系一级完成的。虽然这种方法的优点是由学科专家决定如何在现有课程结构中最好地插入新内容，但广泛使用这种方法存在几个问题。首先，其中一些新目标可能不太明确地适合现有课程或系的教育使命。其次，这种方法可能无法提供确保新的课程项目在各方面都得到充分涵盖所需的协调程度，并且当不同教授纳入类似内容时，可能会导致教学中不必要的重叠。因此，像本次会议期间所做的那样，对更新的课程项目进行优先排序，可能会在这个过程中起到有用的指导作用。然而，需要做出相应努力来确定现有课程内容的优先级并进行排序。需要就现有课程中应删减或减少哪些内容以腾出空间来纳入部分或所有这些新目标做出决定。最后，需要就这些已确定的目标中哪些应被插入、何时插入以及应在哪些课程中讲授做出决定。这些都是重要的决定，不应听天由命。作为军事卫生大学和卫生专业奖学金计划医学院毕业生的责任接收方，各军种的军医总监需要积极参与帮助做出这些决定。这些决定的结果将直接影响这些未来的初级医疗军官为他们将照顾的患者以及他们将支持的部队指挥官所带来的能力。
