An Officer and a Resident: Unique Aspects of Neurosurgery Training in the Military
The views expressed in this presentation do not represent the official policy or opinion of the United States Navy, Department of Defense, or the United States Government.
Although the history of the National Capital Consurtium (NCC) military neurosurgery residency program has been documented elsewhere, it is interesting to note the similarities in the origin of the Army and the Navy’s neurosurgery training programs. Because of the unique aspects of military neurosurgery that resulted from World War II, Lieutenant Colonel Roy Glen Spurling formed the first neurosurgical service in the U.S. Army. Subsequently, Army Surgeon General George Armstrong established the neurosurgical residency at Walter Reed Army Medical Center. In a similar way, because of lessons learned in Vietnam, Captain Calvin Early petitioned for the creation of a Navy neurosurgery training program; the National Naval Medical Center was established in 1975. While there have been changes over the years, including the merger of the Army and Navy training programs in 1997 under the direction of Lieutenant Colonel Richard Ellenbogen, into the National Capital Consortium, the mission has remained the same: to train neurosurgery surgery residents to be prepared for the unique aspects of military neurosurgery while also exceeding the standards set forth for all neurosurgery training programs by the ACMGE.
Currently, the NCC program is the only active duty military neurosurgery-training program, but there are military partnerships at Baylor University, University of Florida, and the University of Texas-San Antonio. As an ACGME accredited program, the NCC program is subject to the same requirements as other civilian training programs. However, the NCC program has the additional responsibility of training military officers, abiding by military requirements, as preparing for military unique situations.
These military unique duties do not count towards duty hours per the ACGME and must be completed and maintained by the residents in order to be in good standing with their respective service (Army, Navy, or Air Force). Twice a year, trainees have to perform and pass a physical fitness test. Failure to meet standards can be grounds for separation from the military, and hence termination of training. Additionally, there is a mandatory health and dental evaluation along with random urinalysis. With the recent focus on wellness, the military has been at the forefront of preventative care and maintenance of health.
As officers, promotion is not solely dependent upon our neurosurgical performance but also upon completion of officer leadership courses and collateral duties. Neurosurgery residents spend much of their training as an O-3 (Captain in the Army/Air Force, Lieutenant in the Navy) but are typically considered for promotion during their senior and chief resident years. Given that promotion is tied to salary and future opportunities, development of the military portfolio is critical; this is separate from the neurosurgery and clinical competency committee evaluations. While the evaluation systems have some overlap in regards to job performance and professionalism, they are entirely separate systems. Career-planning advice enables graduates to manage both their neurosurgery and military careers.
Our residents graduate with a minimum of 6 years of military obligation, and sometimes more. It is incumbent upon us to provide them the tools to be successful officers. Part of this is understanding and internalizing how neurosurgery has been and could be applied to past, current, and future host nation partnerships, humanitarian efforts, and conflict casualty care. While we must train our residents on the most modern techniques and equipment available, we must also prepare them to serve in austere environments where high-end technology is not available. Training to operate on military trauma is a focus of the program. We work on cross training with our head and neck colleagues as well as train others in the management of severe head injuries. Additionally, we focus our research on military unique questions. All this must be done with an attending staff complement that is ever shifting. Given the current deployment schedule, it is not uncommon to have several of our staff either preparing to deploy, deployed, or returning.
Most importantly, we instill a sense of selfless service to our residents. Our residents and staff learn the meaning of sacrifice as we set aside personal ambition for the needs of our soldiers, sailors, airmen, and marines. It is a special group of people who freely make the choice to answer to a higher calling. Being a military neurosurgeon offers a wide array of opportunities and the best patients that any physician could ask for. Training neurosurgical residents in this environment, though, requires additional forethought and planning to not only meet the needs of today, but to enable a successful military and neurosurgery career in the future.
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