Improving Interoperability between Medical Personnel in the U.S. Military

A case study of military surgical technicians

How to harmonize medical training for all types of weapons? Currently, the Air Force, Army and Navy maintain their own schools and train their own medical professionals differently. The 2005 recommendation of the Armed Forces Base Realignment and Closure Commission recommended the creation of a joint medical education and training campus at Fort Sam Houston, Texas.

The goal is to consolidate three schools and service training programs in virtually all military medical specialties and seek to combine programs where possible. Consolidation will bring both short- and long-term benefits: by reducing training costs, it will increase efficiency; by training healthcare professionals to common standards, interoperability of the services will improve over time.

The RAND Corporation was asked to (1) develop a methodology to define a common standard of practice that could be applied to any medical specialty and (2) explore ways to train individuals to that common standard or to seek out individuals who had already been trained to that standard.

A standard of practice is a set of tasks that people with a certain level of competence should be able to perform, as well as a list of knowledge and skills needed to achieve that competence. The RAND team illustrated the methodology by applying it to the specialty of surgical technician.

• The RAND team's methodology for defining a common standard of practice for a specialty involves two main tasks: (1) defining the standard of practice through military and civilian task descriptions and (2) validating the standard of practice through discussions with military and civilian experts.
• The RAND researchers compared different ways the military could acquire qualified surgical technicians, including contracting with already trained specialists, outsourcing training to civilian facilities, and integrating military training in-house.
• In the short term, outsourcing training to the military appears to be the most viable solution. In such a case, there are two options: follow the current practice of in-house training or follow best practices, i.e., use an accredited program and offer the possibility of obtaining a professional certificate (currently used by the Navy). The latter option also offers better interoperability by training personnel to higher standards.
• Since the best practice option requires a significantly longer training period than current practice in two of the three services, it is more expensive (between 14% and 33% depending on the service). At the same time, it is likely to increase labor productivity by 2-6%. It may also lead to small savings in the long run, as a more productive workforce reduces the number of people needed to do the same amount of work and fewer workers are needed to orient new professionals in entry-level positions.
• A common medical training institute would have to incur significant upfront costs to implement this option, and the benefits would only accrue over time. The problems of institutionalizing training will also require fundamental changes in service practices, organization, administration, personnel, and facilities.
• In conclusion, the Army should consider common medical training and a fully consolidated program as a long-term goal.