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Captain Lisa McNamee, military medicine trainee, provides an overview of the military medicine training scheme and describes the benefits of being a doctor with the Defence Forces
The most common question that I get asked about the military medicine scheme as a third year trainee is still ‘What is it?’ or ‘What does it actually involve?’ After intern year, I turned down a place on the surgical basic specialist training (BST) programme in order to join the Defence Forces and begin the dual qualification in general practice and military medicine. It represented a somewhat unknown choice; if I completed the training, I would be one of the first two trainees graduating as military medicine specialists. The challenges were clear, not least of which was that I would spend a significant amount of time explaining to my hospital colleagues what it is I do. Hospital life also has a certain dependable rhythm and hierarchy that is familiar to all by the end of intern year. The Defence Forces has a different professional environment, which involves working within a command structure and an explicit hierarchy while upholding medical ethics and values.
I had considered joining the army prior to studying graduate medicine, but there didn’t seem to be a clear pathway for progression. It used to be that if you joined the Defence Forces as a doctor without a postgraduate specialist qualification it became difficult to rejoin a training pathway. The military medicine scheme has changed that. It’s now possible to train as a dual specialist gaining a qualification in general practice, through the Trinity GP scheme.
In larger armies worldwide, military medical corps tend to employ specialist medical doctors and surgeons as needed for specific missions and environments.
Ireland, as a small country, does not have sufficient demand for full-time specialists and had to develop a specific programme to suit the needs of its armed forces. The specialist discipline of military medicine was formally recognised by the Irish Medical Council in 2015. General practice is a logical partner for military medicine, as the need to be a generalist is the foundation of both disciplines. The variety of presentations that appears to a GP in their daily surgery would be familiar to an army medical officer, albeit in a different patient cohort.
Military medicine scheme
Military medicine is a five-year training programme, comprising two hospital-based senior house officer (SHO) years and three years of higher specialist training. Following acceptance onto the training scheme, initially two trainees were formally commissioned into the Defence Forces at the rank of Lieutenant. This was through a formal commissioning ceremony in McKee barracks with the Minister for Defence, Paul Kehoe. We then began two years of hospital rotations, which comprised a year of emergency medicine (adult and paediatric), six months of general adult medicine and six months of psychiatry. We undertook specific military medicine ‘Shoot and Salute’ training blocks a week at a time based in the Curragh Camp. Following satisfactory completion of the BST, we were promoted to Captain and commenced GP registrar roles within the Defence Forces and in civilian practice. We are now expected to complete the MICGP exams as well as specialist examinations in military medicine as the next stage of our training.
Shoot and Salute
As part of our initial training post-commissioning, we completed two week-long Shoot and Salute courses. This involved pistol training, fitness testing, obstacle course training and lectures on army structure, history, rank structure and hierarchy. All army officers are trained to assemble a pistol and use this weapon at the shooting range and must pass an annual competency in same. We tackled the army obstacle course, used by cadets for initial training and underwent fitness testing. We were taught to march, as will be required of us as medical officers when deployed. We received an introduction to the rank structures and military etiquette to aid our transition from civilian practice.
Many interns and medical students I speak to at career events are intimidated by the idea of having to pass an entry and then an annual fitness test in order to join the Defence Forces. The annual fitness test involves press-ups and sit-ups, a timed 3.2 km run and a 10 km loaded march. My personal fitness before joining was certainly worse than it is now after three years service. The motivation and opportunity for maintaining a high level of fitness are present in the Defence Forces in a way that hospital doctors can only dream of. Fitness training is incorporated into your daily schedule through an extended lunch break and the barracks have on-site gym facilities.
Higher Specialist Training (HST) is a three-year programme, which I have just commenced. It involves rotations in military medicine posts and civilian GP, the final year of which will have more focus on military medicine. This is followed by three years service to the Defence Forces after we finish the training scheme. We are expected to undertake short deployments of three weeks duration overseas as part of the HST portion of the scheme. The standard deployment time for a medical officer (MO) overseas is six months.
Medical officers work across different environments that are often inhospitable and remote. Providing quality care in these environments presents differing challenges to an average Irish GP practice. Significant trauma occurs, but infrequently and when it does is often catastrophic. Maintaining a skillset in the areas of pre-hospital care and trauma are key. To that end, further training in this area is part of the three years of HST. This year I will complete the pre-hospital trauma and life support (PHTLS) course, advanced trauma and life support (ATLS) and join the 204 Field Hospital in Northern Ireland for Chemical, Biological, Radiological and Nuclear (CBRN) exercises. As part of our training to cope with pre-hospital trauma situations we will also return to the hospital environment for advanced intervention training.
This autumn, I will be undergoing further formal training in traffic medicine, especially relevant to an army setting where driving is not limited to civilian vehicles, but will include off-road driving of tanks/MOWAGs and specialist vehicles in an austere environment. We are also eligible for UN training programmes such as the recently completed Law of Armed Conflict course that explores the Geneva Conventions and the specific responsibilities of a doctor in a military organisation. In light of the Defence Forces’ significant role in UN peacekeeping missions abroad in the Golan Heights (UNDOF) and Lebanon (UNIFIL), this training is vital and reflects the important function doctors play in potential conflict zones.
I am currently based in the Defence Forces Training Centre (DFTC) in the Curragh Camp, but will soon undertake an aviation medicine placement with the Air Corps in Baldonnel Aerodrome. This appointment encompasses aviation medicals, familiarisation with the working environment of the air base and placements with the emergency aeromedical service (EAS) or air ambulance service.
There is a significant occupational side to the role of a MO and many of my colleagues have additional membership of the Faculty of Occupational Medicine which reflects this. Occupational assessments are undertaken by the Medical Corps for many different reasons; those attempting to join the Defence Forces, those going overseas on UN missions, flight medicals for pilots in the Air Corps, and annual medicals for serving personnel.
Prior to deployment, there is a period of ‘forming up’ where MOs will train with their colleagues in infantry, engineering and logistics to become a more cohesive force before they are deployed together overseas. As part of this, regardless of a doctor’s prior experience there is a two-week placement in a busy emergency department to refresh pertinent skills in emergency care. While overseas, it is expected that the MO will provide a primary care service to troops as well as emergency pre-hospital care to both soldiers and the local communities in specific circumstances. Ongoing training of the field medics and EMTs assigned to the medical officer is also expected.
For those interested in working with different cultures and across other languages there are many opportunities to do so due to the Defence Forces’s longstanding participation in UN missions and EU initiatives, such as the EU Battlegroup.
Comparisons with hospital life
The daily routine working in the Defence Forces is at a different tempo than the average hospital job. It is a more convivial environment where you are part of a team following shared guidelines towards common goals. The goal of the Medical Corps is always primarily to contribute to the success of the overall mission. Within the Medical Corps, in terms of supporting clinical staff, there are in house psychologists, an impressive physiotherapy department, nursing staff, pharmacists, phlebotomy and medics.
A medical officer’s role is varied, inclusive of preventative medicine, occupational medicine, primary care, training, and acute pre-hospital care with sub-specialty interests in dive medicine, aviation medicine, tropical medicine, and sports medicine highly relevant.
Though working as a medical officer for the Defence Forces is a different financial proposition than being a GP in private practice, post-qualification it does not come with the out-of-hours responsibilities that being part of a cooperative involves. For those interested in broader training and continuing professional development, as well as a fantastic work-life balance, this could be the training pathway that suits.
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