Medical Student Experiences in Operation Bushmaster 2019: “I Now See Myself as Equal Parts Physician and Leader.”

Abstract

Introduction Operation Bushmaster, a 5-day high-fidelity medical practicum bringing together fourth-year medical students, graduate nursing students, international students, and physicians and other medical professionals in emergency and operational medicine from across the world, is the capstone event of the Uniformed Services University of the Health Sciences’s Military Unique Curriculum. It is designed to simultaneously test students’ medical knowledge, leadership skills, and grace under fire. For many students, this experience represents one of the first times that they concurrently inhabit the dual roles of military officer and (soon-to-be) physician. This is likely the most “tactical” and stressful military simulation that many students have experienced. Methods In this qualitative study, we analyzed a data set of 49 de-identified reflective articles written by fourth-year medical students following the completion of Bushmaster, in order to understand what students gained from the experience. Additionally, we evaluated students’ responses through the lens of the threshold concept, looking for ontological shifts, integration, discursiveness, and troublesomeness during students’ Bushmaster experiences. Results We identified 10 themes throughout the essays that highlighted the lessons learned during the Bushmaster experience, including its importance in guiding professional identity formation and students’ deepened understanding of the unique responsibilities and pressures of the role of military physician. Conclusion One of the resulting themes, “the military physician,” met our criteria for a threshold concept, in that it was transformative, integrative, and troublesome. Before Bushmaster, many of the students saw themselves simply as medical students rather than as almost doctors. Following the field practicum, some identified more strongly with the role of military physician, while others continued to overestimate the amount of time remaining to complete the transformation from student to doctor or to integrate the roles of physician and military officer. Moreover, we identified the entirety of Bushmaster as a threshold experience. This work serves to further describe the liminal space in which military medical students reside on their journey to physician, as well as the moment of realization by many that becoming a military physician encompasses more than simply the sum of the roles of physician and military officer.

Threshold concepts in medical education: A scoping review

“…Most papers originated in the United Kingdom (n = 15 [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] ), North America (n = 11 [36][37][38][39][40][41][42][43][44][45][46] ) and Australasia (n = 7 47-53 ). Some papers focused on particular medical specialities and subject areas, including surgery (n = 5 21,23,41,47,54 ), medical physiology and biomedical science (n = 4 42,43,51,55 ), geriatric medicine and dementia care (n = 3 26,27,29 ), psychiatry (n = 2 24,35 ), general practice (n = 2 34,50 ), military medicine (n = 2 36,37 ), anaesthetics, 46 internal medicine, 39 neurology, 40 paediatrics, 38 palliative care,…”

“…Ten papers focused on identifying TCs in undergraduate medical education. 22,24,25,28,[36][37][38]42,49,53 Four papers examined TCs in junior postgraduate medical education (encompassing the roles in different health care systems of interns, foundation year doctors or core trainees) or senior postgraduate medical education (senior residents, specialist trainees, registrars or fellows). 21,23,26,48 One paper looked at both undergraduate and junior postgraduate medical education, 39 and one paper focused on continuing medical education involving senior clinicians.…”

“…21,23,26,48 One paper looked at both undergraduate and junior postgraduate medical education, 39 and one paper focused on continuing medical education involving senior clinicians. 47 A variety of data collection methods were used by the primary researchers to identify potential TCs including interviews, 21,23,24,26,39,40,47,49 focus groups and discussion, 25,28,42,48 written reflections, [36][37][38] audio-diary recordings 22,25 and questionnaires. 26,28 Data were gathered from the population of interest, 21,22,[36][37][38]42,[47][48][49] educators or experts 28,40 or from both learners and trainers to triangulate the data around possible TCs.…”

“…40,42 Potential TCs were identified in relation to physiology and biomedical science, including secondary messenger systems, pressure gradients, preload and afterload, cell membrane potential and polarity. 40,42 Ventilation-perfusion (V/Q) mismatch 46 and an X-ray being a 2D representation of a 3D structure 32 Qualitative study 16 [21][22][23][24][25][26][27][36][37][38][39][40][47][48][49][50] Grounded theory study 5 21,24,36,38,39 Phenomenological study 2 23,26 Ethnographic study 1 22 Naturalistic enquiry 1 25 No specific research design stated 7 27,37,40,[47][48][49][50] Mixed method study 6 28,29,41,51,54,55 Quantitative study 2 30,52 Mixed (conceptual analysis and qualitative study)…”

Reflective Essays During Clerkship Following a Pre-clerkship Leadership Curriculum

“…The USU leadership curriculum begins during the pre-clerkship phase (first 18 months) of medical school, with a return to small group discussions and a capstone field experience at Operation Bushmaster during the final year of medical school. Operation Bushmaster is “a 5-day high fidelity medical practicum bringing together fourth-year medical students, graduate nursing students, international students, and physicians and other medical professionals in emergency and operational medicine from across the world” 9 that is “designed to simultaneously test students’ medical knowledge, leadership skills, and grace under fire.” 9 To address a gap in reinforcing the leadership curriculum during the clerkship year, we adapted an existing reflective essay assignment on professionalism in the internal medicine clerkship to allow students to reflect on leadership experiences and apply the FourCe-PITO leadership framework.…”