Central Asia Regional Health Security Workshop
George C. Marshall European Center for Security Studies
17-19 April 2012, Garmisch-Partenkirchen, Germany
Technicians, Nurses and
Physician Assistants in the United
States Department of Defense
Major Robin Ducker
International Health Specialist
Headquarters Air Forces Central Command
18 April 2012
Introduction
• Enlisted Medical Technician Training
– Medical Education and Training Center
– Licensed Practical Nurse
• Registered Nurses
– Nurse Transition Program/Nurse Residency Program
– Nursing Specialties
– Advance Practice Nurses
– Advanced Academic Degrees
• Physician Associates/Physician Assistants
Who Are They?
• Privileged Providers: Physicians, Nurse Practitioners,
Physician Assistants
• Remote location/Limited Providers: Independent
Duty Technicians (Air Force), Independent Duty
Corpsman (Navy)
• Nurses (All have Baccalaureate of Science degrees)
• Licensed Practical Nurses (Army)
• Medical Technicians (Air Force), Hospital Corpsman
(Navy), Health Care Specialist “Combat Medic”
(Army)
Enlisted Technicians
• High School (Secondary/12 years school total)
graduates
• Perform all of the functions in the military hospital
that do not require a Baccalaureate degree (4 years of
college)
Tri-Service Enlisted Medical Training at the
Medical Education and Training Campus
•New school – fully operational just last year
•Originated by advice of Presidential Commission
formed and tasked to reduce Department of
Defense expenditures and increase efficiencies
•Forms the largest medical education and training
institution in the U.S.
•Trains 25,000 students every year (About 8,000
students at any point in time)
Dental Training
Public Health Services
Dental Specialist (Army): 7 weeks + 23 weeks in
hospital
Dental Assistant (Air Force/Navy): 8 weeks
Dental Lab (basic): 23-25 weeks
Dental Lab (Advanced) (Navy): 24 weeks
Preventive Dental (Army): 12 weeks
Advanced Porcelain Techniques: 3 weeks
Removable Prosthodontics (Navy/Air Force): 3
weeks
Animal Care (Army): 11 weeks
Veterinary Food Inspection (Army): 8
weeks
Health Physics (Army): 12 weeks
Behavioral Health: Air Force 13 weeks,
Navy 17 weeks, Army 17 weeks
Preventive Medicine: Army 15 weeks,
Navy 24 weeks
NURSING & SPECIALTY
MEDICAL TRAINING
Allergy/Immunization: 5 weeks
Cardiopulmonary (Air Force):
14 weeks
Cardiovascular (Army/Navy):
20 weeks
Hemodialysis: Army 14wks,
Navy 20 weeks
Ophthalmic Tech: Army 6 wks,
Air Force 10 weeks
Optician (Army/Navy): 23
weeks
Orthopedics: Army 6 weeks,
Navy/Air Force 12 weeks
Orthotics (Air Force): 29 weeks
Otolaryngology: Army 6 weeks,
Air Force 12 weeks
Practical Nurse (Army): 8 weeks
Respiratory Therapy: 30 weeks
Surgical Tech (Army/Air Force):
10 weeks
Surgical Tech (Navy): 23 weeks
Urology (Navy/Air Force): 15
weeks
Combat Medic (Army): 14 weeks
Medical Technician (Air
Force)/Hospital Corpsman
(Navy): 20 weeks
Surgical Technician Training
Combat Medic/Medical
Technician/Hospital Corpsman
• Army Combat Medic:
– 10 weeks Basic Training
– 8 weeks training at Medical
Education and Training Campus
– Often go on to further training
such as orthopedics and
optometry
• Navy Hospital Corpsman:
– 7-9 weeks Basic training
– 20 weeks training at Medical
Education and Training Campus
– Many go on to further training
such as radiology and
laboratory technology
– 7 weeks Field Medical Service
School will qualify them to serve
with Marines
– Are often called “Doc” by fellow
Navy and Marine personnel as a
term of respect
• Air Force Medical Technician
– 9 weeks Basic Training
– 20 weeks at Medical Education
and Training Campus
– Hospital training 45 days
– Usually don’t further specialize
right away like the Army and
Navy do
– Can later go for 12 weeks further
training as an Independent Duty
Medical Technician
Navy Corpsman Training
Independent Duty Corpsman /
Independent Duty Medical Technician
• Scope: The training program includes: (but is not limited to)
– medical history taking
– physical examination techniques and procedures
– advanced medical and surgical procedures
– environmental sanitation and preventive medicine
– pharmaceutical mathematics
– clerical procedures
– fiscal and supply management
• Often is the sole provider for a particular location, a
role that finds them stitching wounds, dispensing
medicine, performing dental care, and treating
injuries and illnesses.
What is a Practical Nurse or
Licensed Practical Nurse?
• Has undergone approximately 12 months of intensive
study and hospital experience
• Has passed a state licensure examination in Practical
Nursing
• The Practical Nurse is similar to the now defunct
State Enrolled Nurse in Great Britain (Level 2 Nurse)
• Always works under the supervision of a Registered
Nurse
• Unable to administer many intravenous medications
and blood products in most states
• Are only utilized in the civilian sector and in the Army
Does the Military Train Licensed
Practical Nurses?
• Yes!
• The Army Combat Medic applies to the program with letters
of recommendation and evidence of ability to complete the
program
• The LPN program consists of 8 weeks at the Medical
Education and Training Center and 44 weeks of hospital
training
• At the completion of the training, the soldier is qualified to
take the National Practical Nurse exam
HEALTH SERVICES MANAGEMENT
DIAGNOSTIC TRAINING
Biomedical Equipment: Army/Air Force 41
weeks, Navy 54 weeks
Medical Material Supervisor (Air Force): 3
weeks
Medical Expense Performance Reporting
System (Air Force): 2 weeks
Medical Logistics: Army 6 weeks, Air Force
5 weeks
Patient Administration: Army 6 weeks, Air
Force 7 weeks
Cytotechnology: 50 weeks
Electroneurdiagnostic: Navy/Air Force 26
weeks
Histopathology: Navy/Air Force 36 weeks
Medical Lab (Air Force): 17 weeks
Medical Lab (Air Force/Navy): 26 weeks
Nuclear Medicine: 19 weeks
Radiology/Radiography: Air Force 19 weeks,
Navy 21 weeks, Army 24 weeks
Diagnostic Medical Sonography (Advanced
Course): 1 week
Mammography (Air Force): 12 weeks
Additional Biomedical Equipment
Technician Courses (Advanced Training)
Computer Based Medical Systems: 4 weeks
Computed Tomography: 2 weeks
Mammography Imaging: 1 week
Radiographic/Fluoroscopic Imaging: 3 weeks
Radiographic Acceptance Procedures: 2 weeks
Telemedicine: 3 weeks
Ultrasound Imaging Systems: 1 week
Advanced Field Medical Systems: 2 weeks
Advanced Sterilization Systems: 4 days
Biomedical Equipment Management: 4 days
ANCILLARY TRAINING
Nutrition/Diet Therapy: Army/Air Force 7
weeks
Occupational Therapy: Army 19 weeks,
Navy 35 weeks
Pharmacy (Air Force): 14 weeks
Pharmacy: Army 22 weeks, Navy 23 weeks
Physical Therapy: 16-25 weeks
Sample Curriculum: Pharmacy
Technician Course
• Program Model
– Phase I (didactic/laboratory training)
• 12 weeks long (all 3 services together)
– After 12 week(Phase I) program:
• AF students go directly to Phase II
(experiential training)
• Army and Navy continue for 3 more weeks of
advanced training (didactic/laboratory), then
go to Phase II (experiential training)
Pharmacy Technician Training: Phase I
Breakdown
• Students must complete 11 courses
– Pharm 101(Intro to Pharmacy)/Service
Specific Training
– Pharm 102 (Admin/Supply)
– Pharm 103 (Intro to Therapeutics)
– Pharm 104 (Therapeutics 2)
– Pharm 106 (Therapeutics 3)
– Pharm 110 (Outpatient Operations)
– Pharm 120 (Pharmacy Compounding)
– Pharm 111 (Inpatient Operations)
– Math 102 (Pharmacy Calculations)
– Math 103 (Compounding Calculations)
– Math 201 (Inpatient Calculations)
Phase 1 Course Matrix
•Introduction to Pharmacy (Phar 101)
Week #1
•Administration and Supply (Phar 102)
Week #2
Week #3
Week#4
Week #5
Week #6
•Introduction to Therapeutics (Phar 103)
•Pharmacy Mathematics (Math 102)
•Therapeutics Continued (Phar 103)
•Outpatient Operations (Phar 110)
•Pharmacy Mathematics (Math 102)
•Therapeutics Continued (Phar 103 and Phar 104)
•Outpatient Operations (Phar 110)
•Therapeutics Continued (Phar 104)
•Outpatient Operations (Phar 110)
Week #7
•Therapeutics Continued (Phar 104)
•Outpatient Operations (Phar 110)
•Compounding Calculations (Math 103)
Week #8
•Therapeutics Continued (Phar 104)
•Compounding Calculations (Math 103)
•Pharmaceutical Compounding (Phar 120)
Week #9
Week #10
Week #11
Week #12
•Therapeutics Continued (Phar 104 and Phar 106)
•Inpatient Operations (Phar 111)
•Therapeutics Continued (Phar 106)
•Inpatient Operations (Phar 111)
•Inpatient Calculations (Math 201)
•Therapeutics Continued (Phar 106)
•Inpatient Operations (Phar 111)
•Inpatient Operations (Phar 111)
•Air Force Graduation
•Army and Navy Advance Course Begins (18.5 hours)
Pharmacy Technician Training Phase II
• Phase II (Experiential Training)
– Air Force (3 weeks)
– Army (5 weeks)
– Navy (5 weeks)(1 week prior math
refresher)
• Total Training Lengths:
– Air Force (15 weeks)
– Army (22 weeks)
– Navy (23 weeks)
Enlisted Training
• Aerospace Evacuation Technician – 21 days
• Aerospace Physiology Apprentice – 45 days
• Bioenvironmental Engineering Apprentice – 68 days
• Bioenvironmental Engineering Craftsman – 5 days
• Public Health Apprentice – 67 days
UNCLASSIFIED
What is a Registered Nurse?
• Has had two to four years of
college education in Nursing
• Has passed a nationally
administered licensure exam
• Is unable to make medical
diagnoses and prescribe
medication
• Army, Navy and Air Force all
require their Active Duty
Nurses to have 4 year Nursing
Degrees (The Army Reserves
still allow nurses in with less
than 4 year degrees)
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Registered Nurses
• The Air Force gets most of its new nurses every (about
60%) from the civilian health care sector.
• The other 40% of the new nurses have no experience.
They have just graduated from college.
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New Nurse at Graduation
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Air Force Nurse Transition Program/Nurse
Residency Program (Novice Nurse)
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 4 “Centers of Excellence” for training
National Council of State Boards of Nursing
 Transition To Practice Model
 Recognize value of evidence-based models in public
protection
 Phase 2 Training
Phase 2 Training
 Continues the Phase I Nurse Transition Program through
transition in a military facility
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Novice Nurse Transition Year
Month 1-2:
Commissioned Officer Training,
Communication, Team-Work
New
Graduate
Nurse
Recruited
Enrolls in
Program
Month 2-3: (Nurse Transition
Program) Clinical Skills,
Critical Thinking,
Problem Solving
Month 4-7:
Hospital and Unit Orientation
Month 7-12: (Air Force Nurse
Residency Program)
Evidence Based Practice,
Communication, Quality,
Informatics
Month 12: (Graduate)
Submit paperwork, Upgrade to full
RN categorization
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Army Nurse Specialties
After one year of service, Army Nurses attend
a clinical specialty course
Critical Care Nursing (16 weeks)
Emergency Nursing (16 weeks)
Obstetrics/Gynecological Nursing (16 weeks)
Perioperative Nursing (16 weeks)
Psychiatric/Mental Health Nursing (22 weeks)
Community Health Nursing (12 weeks)
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What is a Nurse Practitioner or Advanced Practice
Nurse or Advanced Registered Nurse Practitioner?
• Usually are graduates of a Master’s degree granting
program (Bachelor’s degree plus two years Master’s
level study)
• Require licensure by national exam
• Usually work in a clinic setting but some have
hospital privileges
• Can practice independent of a physician
• Can prescribe most medications
• All services use nurse anesthetists
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Does the U.S. Department of Defense train
Advanced Practice Nurses?
• Yes!
• Critical Care Clinical Nurse Specialist (CNS)
• Emergency/Trauma CNS
• Flight Nursing CNS
• Medical-Surgical CNS (Adult Health)
• Perioperative CNS
• Nurse Anesthesia
• Women’s Health Nurse Practitioner
• Pediatric CNS
• Family Nurse Practitioner
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Advanced Academic Degrees (cont’d)
• Psychiatric Mental Health Nurse Practitioner
• Community Health
• Master’s in Health Administration
• Master’s in Business Administration/Master’s in
Nursing
• Nurse Midwifery
• Perinatal CNS
• Pediatric Nurse Practitioner
• Neonatal Intensive Care CNS
• Master’s in Public Health
• PhD Nursing Science
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UNCLASSIFIED
Uniformed Services University of the
Health Sciences
• Graduate School of Nursing – Masters of
Science in Nursing (MSN)
– Family Nurse Practitioner
– Nurse Practitioner
– Perioperative Clinical Nurse
– Psychiatric Mental Health Nurse Practitioner
• Doctorate of Philosophy (PhD) Program in
Nursing Science
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What is a Physician Assistant or Physician
Associate?
• Usually are graduates of a Master’s degree granting
program (Bachelor’s degree plus two years Master’s
level study)
• Require licensure by national exam
• Usually works in a clinic setting
• May sometimes be unable to prescribe narcotics
• Always work under the supervision of a physician
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Does the Military Train Physician
Assistants/Physician Associates?
• Yes!
• Inter-service Physician Assistant
Program
• Medics with a bachelors degree can
apply for the program
• Program is 2 years in length (1 year
of training at the Medical Education
and training center and 1 year of
training at a military hospital)
• Approximately 180 students are
trained each year
• Graduates are commissioned and
can sit for national certification
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• 4 year service obligation
UNCLASSIFIED
UNCLASSIFIED
Questions?
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Major Robin Ducker
International Health Specialist
Robin.ducker@afcent.af.mil
803-895-3024
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