Melanie M Lazarus, Charles R McMichael, Bettina M Rizzuto, Daniel J Watson, Betty A Venth, Bradley K Blair, Christopher M Grussendorf
{"title":"Leveraging Natural Ecosystems to Reoptimize Education and Training for Great Power Competition in the Air Force Medical Service.","authors":"Melanie M Lazarus, Charles R McMichael, Bettina M Rizzuto, Daniel J Watson, Betty A Venth, Bradley K Blair, Christopher M Grussendorf","doi":"10.1093/milmed/usae401","DOIUrl":"10.1093/milmed/usae401","url":null,"abstract":"<p><p>Organizations today are complex, hyperdimensional, and continuously changing in response to the environment. Over the past decade, the Military Health System has seen continuous organizational change to transform healthcare delivery, and the Air Force Medical Service (AFMS) is currently transitioning to an Air Force Medical Command (AFMEDCOM) structure to best prepare for Great Power Competition and other challenges ahead. The current state of the enterprise involves decision making, resourcing, and execution of education and training that is largely decentralized in nature. To support these efforts, in February 2024, a team of diverse AFMS stakeholders gathered in Washington, D.C. to examine the future of medical education and training for the U.S. Air Force in a new way: through systems theory and ecosystem mapping. This ecosystem approach enables development of an organizational structure and process for change that considers how all stakeholders relate, what external factors threaten the desired transformation, and how the resulting enterprise could become more resilient with future uncertainty and change. This paper discusses the theory behind the ecosystem approach and how it was used to develop a transformed model for the AFMS to organize its education and training. Additionally, a dialogue is presented on how this unique methodology to understanding stakeholder relationships can be leveraged in the re-optimization efforts for Great Power Competition.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"192-198"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suhair Hussni Al-Ghabeesh, Gusoon Al-Taamraha, Hasan Abualruz
{"title":"Psychological Distress and Quality of Life Among Military Trauma Patients.","authors":"Suhair Hussni Al-Ghabeesh, Gusoon Al-Taamraha, Hasan Abualruz","doi":"10.1093/milmed/usae502","DOIUrl":"10.1093/milmed/usae502","url":null,"abstract":"<p><strong>Introduction: </strong>Military trauma has a significant impact on soldiers, affecting many aspects of their lives, with the highest impact on their quality of life and psychological wellness. This study aimed to measure psychological distress and its relationship with the quality of life among Jordanian military trauma patients.</p><p><strong>Materials and methods: </strong>A descriptive cross-sectional study was conducted in The Hashemite Protection Departments for military causalities in Amman, Irbid, and Al-Karuk. The authors used the WHO Quality of Life Scale-Brief and Trauma Symptoms Checklist-40 scales for assessing the quality of life and psychological distress among Jordanian military trauma patients. A total of 145 trauma survivors participated in the study and responded to all questionnaires out of 173 distributed. The study was approved by the institutional review board of Al-Zaytoonah University.</p><p><strong>Results: </strong>The result of this study revealed that military trauma survivors had high levels of psychological distress with a mean of 85.66 (SD = 19.418). The subscale of \"Dissociation symptoms\" had the highest rating (M = 19.92, SD = 5.096), while the \"sleep disorders\" subscale had the lowest rating (M = 10.000, SD = 3.501). On the quality of life scale, a moderate level of quality of life resulted among the participants with a mean of 61.620 (SD = 17.190). The \"general health\" subscale scored the highest among the other domains (M = 18.241, SD = 5.434), while the \"physical health\" domain scored the lowest (M = 4.910, SD = 2.078). Furthermore, a statistically significant negative relationship between psychological distress and quality of life was reported (r =-0.178, P < .05).</p><p><strong>Conclusion: </strong>Jordanian injured military persons had a moderate quality of life level and high level of psychological distress. A structured follow-up program is required to be developed to improve those patients' health and quality of life. Furthermore, additional research is needed to investigate the impact of military trauma and services on soldiers in Jordan and the Middle East.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"1615-1620"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Negative Social Exchanges are Associated With More Severe Depressive Symptoms Above and Beyond the Effects of Positive Social Exchanges in Male U.S. Service Members and Veterans.","authors":"Rishika V Shah, Rebecca K Blais","doi":"10.1093/milmed/usae507","DOIUrl":"10.1093/milmed/usae507","url":null,"abstract":"<p><strong>Introduction: </strong>Risk for depression is heightened among male service members/veterans relative to civilians. Research suggests social support protects service members/veterans from depressive symptoms, but most studies focus on positive social support. Negative social support, which can include unwanted emotional involvement or social negativity, could be more impactful on depressive symptoms than positive; however, this has not been examined in military samples. Moreover, it is unclear whether positive interactions buffer the effects of negative interactions.</p><p><strong>Materials and methods: </strong>SM/Vs (N = 508) were recruited online using convenience sampling and completed demographics, and measures of depression and social exchange frequencies, a metric of positive and negative social support. This secondary data analysis was drawn from a parent study that was approved by an institutional review board. A correlation comparison calculator compared the strength of bivariate associations of positive social exchanges and negative social exchanges with depression. Linear regression examined the simultaneous effects of positive and negative social exchanges, and subsequently examined whether positive social exchanges moderated the association of negative social exchanges and depression.</p><p><strong>Results: </strong>The positive bivariate association of negative exchanges and depression (r = 0.48, P < .001) was statistically stronger than the negative bivariate association of positive exchanges and depression (r = -0.40, P < .001). A regression analysis revealed that higher negative exchanges were positively associated with depression (partial r = 0.40, P < .001) and higher positive exchanges were negatively associated with depression (partial r = -0.32, P < .001) after accounting for covariates, but positive exchanges did not mitigate the association of negative exchanges and depression (P > .05).</p><p><strong>Conclusions: </strong>Decreasing the frequency of negative social exchanges is associated with lower depressive symptoms and may have a stronger relationship with depression than positive exchanges, suggesting independent pathways to depression. Longitudinal assessments are needed to determine the potential directionality of these relationships and to address the limitations associated with convenience sampling and cross-sectional data collection.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1367-e1372"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa Soto, Elizabeth Crouch, Cassie Odahowski, Emma Boswell, Monique J Brown, Paul Watson
{"title":"Challenges to School Success Among Children in U.S. Military Families.","authors":"Melissa Soto, Elizabeth Crouch, Cassie Odahowski, Emma Boswell, Monique J Brown, Paul Watson","doi":"10.1093/milmed/usae506","DOIUrl":"10.1093/milmed/usae506","url":null,"abstract":"<p><strong>Introduction: </strong>More than 90% of children in military families attend civilian schools that may lack understanding of the unique experiences and stressors of military life. School success in children of military families has important implications on future academic achievement, health outcomes, and military groups; yet there has not been an examination of challenges of school success among children of military families in the United States using nationally representative data.</p><p><strong>Materials and methods: </strong>Data captured in the 2021-2022 National Survey of Children's Health, limited to children aged 6 to 17 years, were used to examine the association between child's caregiver military status and challenges of school success: lack of school engagement measured through caring about school and completing schoolwork, school absenteeism, and grade repetition (n = 60,599). Weighted to be nationally representative, bivariate analyses used chi-squared tests to examine estimates between selected variables and caregiver military status. Multivariable regression analyses were used to examine the association between caregiver military status and challenges of school success measures.</p><p><strong>Results: </strong>In both unadjusted and adjusted analyses, we found that children of military families were more likely to not be engaged in school (adjusted odds ratios 1.35; 95% CI 1.19-1.53) and more likely to repeat a grade (adjusted odds ratios 1.33; 95% CI 1.09-1.64) than their civilian counterparts. There were no statistically significant differences in school absenteeism between children of military families and of civilian families.</p><p><strong>Conclusions: </strong>This study extends beyond previous research findings that have focused primarily on academic achievement by including school engagement, attendance, and grade repetition for a more holistic and complete understanding of school success of children in military families. Our findings can be informational for school systems and policymakers to create educational and connective interventions for children in military families to improve school success.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1621-e1628"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joel E Segel, Alison Chetlen, Mark Ramos, Nicholas G Zaorsky, Guangqing Chi, Patrick Luan
{"title":"Individual and Catchment Area Factors Associated With Breast and Cervical Cancer Screening Within the Military Health System.","authors":"Joel E Segel, Alison Chetlen, Mark Ramos, Nicholas G Zaorsky, Guangqing Chi, Patrick Luan","doi":"10.1093/milmed/usae525","DOIUrl":"10.1093/milmed/usae525","url":null,"abstract":"<p><strong>Introduction: </strong>Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS.</p><p><strong>Materials and methods: </strong>We used 2007-2019 MHS Data Repository Data to examine individual-level and catchment area-level factors associated with 1- and 2-year breast and cervical cancer screening rates. Specifically, we estimated univariate and multivariate association between 1- and 2-year probability of breast and cervical cancer screening rates and age group, marital status, rank, service branch, beneficiary type (service member vs. dependent), race/ethnicity of service members, catchment area fraction of overall care through purchased care and average per capita spending. The project was approved by both the Penn State Institutional Review Board (IRB) and the Defense Health Agency's electronic IRB.</p><p><strong>Results: </strong>Overall, we observed a 45.6% 1 year and a 65.7% 2-year mammography screening rate and a 30.5% 1 year and a 51.9% 2-year Pap testing rate. For breast cancer screening, we found higher screening rates for older (ages 50-64 years), married, service members, more senior ranked women or those married to more senior ranked members, and non-Hispanic Black women in both unadjusted and multivariate analyses. Conversely, we found higher rates of cervical cancer screening for younger, unmarried, more junior ranked women as well as for non-Hispanic Black women. We also found higher rates for both breast and cervical cancer screening in catchment areas with a greater fraction of care delivered through the private sector.</p><p><strong>Conclusion: </strong>Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1465-e1470"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Teaching of Medical Ethics Regarding Children, Death and Dying, and Research at the Uniformed Services University of the Health Sciences (USUHS) During Its First Fifty Years.","authors":"Edmund G Howe","doi":"10.1093/milmed/usae546","DOIUrl":"10.1093/milmed/usae546","url":null,"abstract":"<p><strong>Introduction: </strong>The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the first 3 of 8 class sessions involving children, end-of-life care, and research (the last 5 of these 8 sessions are discussed in a companion article). This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes.</p><p><strong>Methods: </strong>This review focuses particularly on core military medial ethical issues that were posed by others writing on this subject and accordingly introduced to students in this course. It also highlights core concepts that students were introduced to prior to their entering the clinical wards. In all these classes, the initial presentations were designed primarily to prime or involve these students personally and emotionally in these issues so that they would want to address them in their discussion groups.</p><p><strong>Results: </strong>Students achieved a grounding in leading and representative ethical conflicts arising in major medical fields. These included their considering military physician different roles, limitations genetics might pose in certain roles, pregnant person/fetal conflicts, students facing the need to confront their teachers, and students' struggles to achieve the highest moral standards they could.</p><p><strong>Conclusion: </strong>Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students to discuss and debate controversial issues in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to wa","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"1386-1390"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ethan Elkins, Yen Lee, Ting Dong, Steven J Durning, Erin S Barry
{"title":"Gathering Validity Evidence for the Bushmaster Assessment Tool.","authors":"Ethan Elkins, Yen Lee, Ting Dong, Steven J Durning, Erin S Barry","doi":"10.1093/milmed/usae549","DOIUrl":"10.1093/milmed/usae549","url":null,"abstract":"<p><strong>Introduction: </strong>The education of military medical providers typically relies on assessments with established passing parameters to help ensure individuals are equipped to care for those in harm's way. Evaluations of medical knowledge are often provided by governing bodies and are supported by strong validity evidence. In contrast, assessing an individual's leadership skills presents a challenge, as tools with robust validity evidence for leadership evaluation are not yet as widely available as clinical assessment tools. This challenge becomes even more complex in simulated environments designed to mimic intense operational conditions.</p><p><strong>Materials and methods: </strong>An instrument has been implemented to assess students explicitly in a variety of graded roles with varying responsibilities. Faculty rate each student on their character, context, leadership-transcendent skills, communication, and competence using a 4-point Likert scale. This project used confirmatory factor analyses to assess the validity evidence of the instrument used during Bushmaster with data gathered from 645 School of Medicine students and 170 faculty evaluators from 2021 to 2023 resulting in 2863 evaluations.</p><p><strong>Results: </strong>Overall, the one-factor structure was confirmed with Tucker Lewis Index >0.95, Root Mean Square Error of Approximation <0.03, and Standardized Root Mean Square Residual <0.03; student or faculty assessment had a small effect on item scores (interclass correlation <0.19) while the assigned position significantly affected the item score. The evaluation score of behavioral health officer and platoon leader was higher than the evaluation score of surgeon.</p><p><strong>Conclusions: </strong>This study provides validity evidence for the Bushmaster leader assessment tool, confirming its ability to measure leader performance in military medical education. The findings highlight the importance of standardized faculty training in ensuring consistent evaluations, as variations in scores were influenced more by evaluation conditions than by differences among students or evaluators.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1391-e1397"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ananya Tripathi, Renee Dumm, Reese Beard, Michael Pane, Dominic Smith-DiLeo, Scott Oplinger, Elyse Fiore Pierre
{"title":"\"The Youngest in the Room\": Medical Student 55-Word Story Reflections of Initial Clerkship Experiences.","authors":"Ananya Tripathi, Renee Dumm, Reese Beard, Michael Pane, Dominic Smith-DiLeo, Scott Oplinger, Elyse Fiore Pierre","doi":"10.1093/milmed/usaf093","DOIUrl":"10.1093/milmed/usaf093","url":null,"abstract":"<p><p>In the following curated selection of thoughtfully distilled 55-word stories, military medical students thoughtfully reflect on the intense and challenging patient care and professional experiences which comprise the \"hidden curriculum\" within their initial year of clinical clerkships.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"180-181"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heidi L Shelstad, Sarah J Ostrom, Matthew J Perdue, Nathan R Fritts, Danny Villalobos
{"title":"Assessing Physician Assistant Students' Ability to Accurately Identify the Regional Landmarks of the Fascia Iliaca Compartment With Point of Care Ultrasound After a Brief Training Session.","authors":"Heidi L Shelstad, Sarah J Ostrom, Matthew J Perdue, Nathan R Fritts, Danny Villalobos","doi":"10.1093/milmed/usae571","DOIUrl":"10.1093/milmed/usae571","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia, specifically fascia iliaca compartment blocks (FICB), is highly effective in managing pain, especially in military settings. However, a significant barrier to its implementation is the lack of provider confidence in performing ultrasound-guided procedures. This study evaluates the ability of physician assistant (PA) students, who are often first-line providers in austere locations, to identify the fascia iliaca compartment (FIC) using point-of-care ultrasound (POCUS) after a brief training session and assesses their retention of this skill over a 60- to 90-day period.</p><p><strong>Methods: </strong>We conducted this prospective observational study involving 10 PA students at an Air Force hospital. Participants underwent a brief training course on FIC identification using POCUS. Their ability to identify 4 anatomical landmarks (fascia iliaca, fascia lata, iliopsoas muscle, and femoral artery) was assessed immediately post-training and again after 60 to 90 days.</p><p><strong>Results: </strong>Initially, participants demonstrated a high success rate in identifying the FIC, with 47 out of 60 attempts (78%) correctly identified. However, follow-up evaluations showed a significant decline, with only 7 out of 54 attempts (13%) correctly identified after 60 to 90 days (P < .001). Identification rates for specific landmarks also declined significantly, except for the femoral artery, which remained the most accurately identified landmark.</p><p><strong>Conclusion: </strong>This study demonstrates that PA students can accurately identify the FIC using POCUS after a brief training session. However, there was a significant decline in skill retention over a 60- to 90-day period, underscoring the need for continuous education and practice to sustain proficiency. Further research with larger sample sizes and diverse settings is needed to develop effective training protocols and ensure long-term retention of U.S.-guided procedural skills.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1722-e1726"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlie Beardmore, Martin C M Bricknell, Janet Kelly, Fred Lough
{"title":"Commentary-A Military Health Care Ethics Framework.","authors":"Charlie Beardmore, Martin C M Bricknell, Janet Kelly, Fred Lough","doi":"10.1093/milmed/usae351","DOIUrl":"10.1093/milmed/usae351","url":null,"abstract":"<p><p>Ethical practice within military health care is a significant topic of professional and academic debate. The term \"military health care ethics\" enfranchises the entire health care team. Military health care professionals are subject to tension between their duties as military personnel, and their ethical duties as health care professionals, so-called \"Dual Loyalty.\" Some military health care practitioners have suffered moral injury because of the psychological stress associated with ethical challenges on military operations. It is important to define military health care ethics and also to consider how it should be taught. The essence of ethical practice is ethical decision-making. It has become self-evident from our experience of teaching military health care ethics that a simple and agreed framework for analyzing an ethical problem is required. This paper describes the development of the King's Military Healthcare Ethics Framework in support of a military health care ethics policy on behalf of the NATO Military Healthcare Working Group. There is logic to using a stepped approach to analyze an ethical problem in military health care. These steps are: \"Identify\" the problem, \"Analyze\" the problem including consideration of perspectives, \"Fuse\" the analysis, and \"Decide\". Step 1-Identify-is intended to orientate the decision-making group, and to articulate the problem specifically and clearly in order to determine the exact ethical issue and the secondary issues that arise. Step 2-Analyse-considers the problem from 4 perspectives: patient, clinical, legal, and societal/military. These reflect the breadth of perspectives that impact on health care practice within a military context. Step 3-Fuse-is the culminating step. The conclusions from the analysis of perspectives should be summarized and key references cited. This will determine the exact decision(s) to be made. Step 4-Decide-clearly articulates the decision made and provides the record of the key reasons for making that decision. This may include areas of enduring uncertainly and any planned review of the decision. The King's Military Healthcare Ethics Analytical Framework has been evaluated for content validity through iterative discussion at 4 meetings of the NATO MHCWG and a specific workshop on military health care ethics over 2022/2023. It is included within the draft NATO Standardization Agreement on Military Healthcare Ethics.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"182-186"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}