Military Medicine最新文献

{"title":"The Impact of NCO-Led Education and Training on the Development of Future Military Medical Officers.","authors":"Jonathan Shumaker, Jarryd Kase, Rebekah Cole, Laferrel Evans","doi":"10.1093/milmed/usag445","DOIUrl":"https://doi.org/10.1093/milmed/usag445","url":null,"abstract":"<p><strong>Introduction: </strong>Military medical officers (MMOs) must function as both commissioned officers and clinicians, often leading enlisted-heavy teams in austere and high-stress operational environments. At the Uniformed Services University (USU), this dual identity is intentionally cultivated through the Military Unique Curriculum (MUC), a 4-year longitudinal program that integrates non-commissioned officers (NCOs) as Tactical Instructors. Although enlisted-officer relationships are central to military operations, little is known about how sustained NCO mentorship influences medical students' professional development across undergraduate medical education.</p><p><strong>Materials and methods: </strong>We conducted a phenomenological qualitative study to explore military medical students' perceptions of NCO influence throughout the MUC. Eleven active-duty medical students from multiple uniformed services participated in semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed inductively using constant comparison to identify themes. Reflexive practices and multiple coders were used to enhance trustworthiness. Data saturation was achieved.</p><p><strong>Results: </strong>Three themes emerged. First, students described NCO mentorship as central to leadership identity formation, citing role modeling, psychological safety, and real-time feedback that supported confident decision-making under stress. Second, participants attributed substantial gains in technical and operational readiness-particularly in Tactical Combat Casualty Care and austere medicine-to NCO instruction grounded in lived operational experience and deliberate practice. Third, students emphasized NCO influence on military cultural assimilation and team dynamics, noting improved understanding of enlisted roles, trust across ranks, and effective officer-enlisted collaboration. Across themes, NCO mentorship was perceived as sustained developmental guidance rather than episodic skills instruction.</p><p><strong>Conclusions: </strong>Military medical students perceive NCO Tactical Instructors as essential to their development as future MMOs. Longitudinal NCO mentorship supports leadership identity formation, operational competence, and integration into military culture, positioning enlisted mentorship as a readiness function rather than an additive curricular feature. Adapting NCO-enabled mentorship models, particularly for commissioning pathways with limited enlisted exposure, may enhance early-career performance, team effectiveness, and operational readiness across the Military Health System.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075192","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":"Transformative Modernization and Data on the Future Battlefield.","authors":"Ryan M Leone, Mason H Remondelli, Jeremy C Pamplin","doi":"10.1093/milmed/usag434","DOIUrl":"https://doi.org/10.1093/milmed/usag434","url":null,"abstract":"<p><p>In preparing for large-scale combat operations, the Military Health System must evaluate whether or not the data it collects are both collectable and usable in dynamic environments with large casualty counts. This requires a shift from active collection to passive collection, and a focus on leveraging data for decision-making rather than just record-keeping. Such changes require a movement toward transformative modernization, which involves a comprehensive overhaul of the data ecosystem to automatically collect actionable data and analyze them, rather than just digitize it, which simply improves the efficiency of data collection and documentation. This commentary seeks to contrast these approaches and the data requirements needed to move from data for documentation and even process improvement to data for real-time decision-making and continuous learning.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081364","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":"Critical Thinking, Human Judgment, and Artificial Intelligence in Combat Casualty Care: Implications for Military Medical Education and Practice.","authors":"Jay A Yelon, Mie Augier","doi":"10.1093/milmed/usag452","DOIUrl":"https://doi.org/10.1093/milmed/usag452","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly transforming healthcare through advances in machine learning, predictive analytics, and large language models. These technologies offer substantial opportunities to improve diagnostic support, information management, and clinical decision support. Within military medicine, AI may afford a tactical advantage because future combat operations are expected to occur in contested environments characterized by prolonged evacuation timelines, degraded communications, limited resources, and increased casualty burdens. However, while AI can augment clinical performance, it cannot replace the critical-thinking capabilities required for combat casualty care. This commentary examines the relationship between AI and critical thinking in military medicine through the lens of problem complexity, learning environments, and John Boyd's Observe-Orient-Decide-Act (OODA) framework. Drawing upon the concepts of well-structured versus ill-structured problems, kind versus wicked learning environments, and the central role of orientation in decision-making, we argue that the value of AI varies with the nature of the problem being addressed. AI performs best in well-structured domains characterized by clear rules and reliable feedback, whereas combat casualty care frequently presents as ill-structured and wicked problems that require contextual understanding, judgment, adaptation, and future-oriented sensemaking. We propose that effective human-AI teaming should enhance rather than supplant clinical judgment. Accordingly, military medical education must deliberately cultivate critical-thinking skills, judgment, and AI literacy while exposing learners to uncertainty through realistic operational training. As AI capabilities continue to advance, preserving the cognitive skills required to make sound decisions under conditions of ambiguity and resource constraint will remain essential. Ultimately, human judgment remains the most important decision-support system in combat casualty care.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075158","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":"Correction to: A Preliminary Analysis of Psychological Strengths: Service Members' Well-being Post-deployment.","authors":"","doi":"10.1093/milmed/usag449","DOIUrl":"https://doi.org/10.1093/milmed/usag449","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069845","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":"Environmental Epidemiology in Military Populations: Summary and Conclusions of the First Military Environmental Epidemiology Symposium.","authors":"Jennifer A Rusiecki, Jordan McAdam, Mark P Purdue, Aaron Schneiderman, Celia Byrne, Elizabeth R Heitz, Rudolph P Rull, M Ryan Smith, Shauna L Stahlman, Kimberly Sullivan","doi":"10.1093/milmed/usag407","DOIUrl":"https://doi.org/10.1093/milmed/usag407","url":null,"abstract":"<p><strong>Introduction: </strong>On April 22, 2025, researchers from the Department of Defense (DoD) (currently referred to as Department of War [DoW]), Department of Veterans Affairs, National Institutes of Health, and other institutions convened for the inaugural Military Environmental Epidemiology Symposium (MEES) at the Uniformed Services University in Bethesda, Maryland.</p><p><strong>Materials and methods: </strong>Leading experts explored the state of research, including research resources and infrastructure, and identified critical challenges, future opportunities, and strategies for advancing the field.</p><p><strong>Results: </strong>Presentations highlighted contributions from ongoing large-scale studies, that is, the Millennium Cohort Study and the Million Veterans Program, and case-control studies nested in the DoD Serum Repository (DoDSR) cohort to understanding long-term health impacts of military service and environmental exposures. Valuable sources of data and biospecimens, such as the Defense Medical Surveillance System, Military Health System Data Repository, DoDSR, and Boston Biorepository, Recruitment and Integrated Network for Gulf War Illness (BBRAIN) were described. Exposure assessment methods, ranging from measuring key toxins and multi-omics in DoDSR serum samples to utilizing of military occupational coding, were discussed. Key exposure research areas highlighted were burn pits, per- and polyfluoroalkyl substances, polycyclic aromatic hydrocarbons, jet fuels, Gulf War exposures, and occupational hazards. The MEES focused on identifying critical challenges in the field, such as exposure data limitations, biospecimen and data access/sharing difficulties, data quality concerns, and the complexity of military exposures.</p><p><strong>Conclusions: </strong>Recommendations for future research strategies emphasized leveraging existing data and biospecimen resources, capitalizing on multi-omics technologies, advancing military exposure assessment, fostering cross-institutional collaborations, and applying new analytical tools.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062513","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":"Letter to the Editor for \"Evaluating Pharmacogenomic Prescription Data in the Military Health System\": Medication-Induced CYP2D6 Inhibition Reveals a Screening Gap in Proxy-Defined Ibogaine Candidates.","authors":"James Green, Paul Hartin, Branimir Ljubic, Michael Schulewski, J Scott Parrott, Barbara Tafuto","doi":"10.1093/milmed/usag436","DOIUrl":"10.1093/milmed/usag436","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062538","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":"Experience and Contributing Factors of Moral Injury in Military Personnel.","authors":"Riah Kim, Junggeun Ahn, Jiu Kim","doi":"10.1093/milmed/usag438","DOIUrl":"https://doi.org/10.1093/milmed/usag438","url":null,"abstract":"<p><strong>Introduction: </strong>Moral injury among military personnel is characterized by profound psychological, relational, and existential distress arising from experiences that violate deeply held moral values.</p><p><strong>Background and purpose: </strong>Moral injury may be accompanied by guilt, shame, social disconnection, and increased suicide risk, thereby threatening both individual well-being and military readiness. This qualitative meta-synthesis aimed to elucidate military personnel's experiences of moral injury and identify the factors contributing to its development, persistence, and recovery.</p><p><strong>Materials and methods: </strong>Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted using five databases (PubMed, PsycINFO, Embase, CINAHL, and Web of Science). The search targeted qualitative studies published in English until August 2025. Study selection and methodological quality appraisal were independently conducted by multiple researchers. The findings were integrated using thematic synthesis, with Litz's model of moral injury used as the analytical framework to guide the development and interpretation of the themes.</p><p><strong>Results: </strong>Of the 3,395 records identified, 19 studies were included in the meta-synthesis. A total of 5 main themes and 17 subthemes were identified: (1) contextual and vulnerability factors influencing moral injury, (2) potentially morally injurious events and moral conflict, (3) multidimensional presentation of moral injury symptoms, (4) the trajectory of moral disrepair and chronicity, and (5) existential path to recovery: moral reconstruction.</p><p><strong>Conclusions: </strong>Military moral injury involves disruption of moral meaning and may progress through moral conflict and disrepair toward moral reconstruction. Recovery does not necessarily require complete resolution of moral pain; rather, it may involve meaning-making, relational reconnection, and the integration of morally injurious experiences into a reconstructed identity. These findings highlight the need for clinical and organizational responses that address not only individual symptoms but also the relational, existential, and institutional contexts of moral injury.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062558","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":"Learning Triage in Disaster Medicine: A Comparative Study of Board and Digital Game-Based Formats Among Undergraduate Medical Students.","authors":"Sebastian Hölzl, Elian Niklas Oudintsov, Marko Hofmann, Felix Fellmer, Daniel Erichsen, Ylva Holzhausen, Harm Peters, David Alexander Back","doi":"10.1093/milmed/usag444","DOIUrl":"https://doi.org/10.1093/milmed/usag444","url":null,"abstract":"<p><strong>Background: </strong>Triage is crucial in managing mass casualty incidents (MCI) and requires training. Simulation-based approaches allow trainees to make mistakes without harming real patients. Digital methods may reduce cost and enable location-independent training. Although digital games have been compared with traditional teaching methods before, there is little research on direct comparison of non-digital and digital games.</p><p><strong>Materials and methods: </strong>This study compared an existing MCI board game with a newly developed digital beta-version of this game, assessing collaboration, game experience, and triage quality (speed and accuracy) among undergraduate medical students. Sixty students were assigned to play either the board or digital version in groups of three. One game lasted 28 minutes. Participants rated collaboration and game experience using structured scoring tools.</p><p><strong>Results: </strong>Thirty students participated in each group. Collaboration scores did not differ significantly (P = .234). Board game players rated the game experience higher than digital players (P = .013) and performed a faster (P < .001) and more accurate (P = .009) triage. Both groups showed increased awareness of organizational (board game: P = .002; digital game: P < .001) and communication (board game: P = .007; digital game: P = .002) problems in MCI situations.</p><p><strong>Conclusion: </strong>Collaboration did not differ between the formats. Although the board game yielded superior user experience and performance, both approaches improved understanding of organizational and communication issues. A digital game offers possibilities for location-independent training. The results indicate that game experience and user-friendliness should be considered when developing digital training methods.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062516","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":"Sex Differences in Musculoskeletal Injuries Among Active Duty Service Members in the United States Military From 2017 to 2022, a Retrospective Cohort Study.","authors":"Rebecca N Schulz, Bhavna Singichetti, Stanley T Zimmerman, Anna C Enge, Xiaoning Yuan, Kalyn C Jannace","doi":"10.1093/milmed/usag448","DOIUrl":"https://doi.org/10.1093/milmed/usag448","url":null,"abstract":"<p><strong>Introduction: </strong>United States (U.S.) military service members (SMs) are at unique risk for musculoskeletal injury (MSKI), which threatens health readiness and impedes SMs' ability to execute occupational duties. Female sex has been identified as a risk factor for specific types of MSKI. The primary aim was to investigate sex-based differences in MSKIs based on injury type, demographics, and occupational characteristics.</p><p><strong>Materials and methods: </strong>This study analyzed a retrospective cohort of American military service members who experienced MSKI between 2017 and 2022 using electronic health record data from the Military Health System Data Repository (MDR). Odds ratios (ORs) with 95% CIs compared associations by injury subtype (acute, non-acute, both) between sex and each demographic, occupational, and injury characteristic.</p><p><strong>Results: </strong>Of the 624,842 injured SMs, 17% were female. Female SMs demonstrated 28% increased odds of experiencing non-acute MSKIs only (OR: 1.28; 95% CI, 1.26-1.31). Female SMs in the Navy (OR: 1.12; 95% CI, 1.10-1.14) and those employed in Health Care (OR: 1.22; 95% CI, 1.19-1.25) demonstrated greater odds of MSKI, compared to male counterparts. Female SMs demonstrated greater odds of overuse/non-specific injuries and stress fractures, but reduced odds of amputations, fractures and dislocations/subluxations, compared to male SMs. Compared to male SMs, females in junior officer ranks were 78% and 56% more likely to experience acute and non-acute MSKI. Among SMs with non-acute injuries, females were more likely to serve in Administration and Executives (OR: 2.11; 95% CI, 2.01-2.16), Health Care (OR: 2.99; 95% CI, 2.92-3.07), and Occupationally Unqualified/Trainee roles (OR: 1.21; 95% CI, 1.18-1.23).</p><p><strong>Conclusions: </strong>Significant sex-based differences elucidated high risk subpopulations to inform policy, with the goal of improving medical and operational readiness.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062503","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":"Recruiting National Guard Members for Online Suicide Prevention Research: Engagement, Eligibility, and Ethical Considerations Across Mental Health and Fearlessness-About-Death Study Labels.","authors":"Daniel W Capron, Aleksandr T Karnick, Morgan Buerke, Brian W Bauer, Michael D Anestis","doi":"10.1093/milmed/usag435","DOIUrl":"https://doi.org/10.1093/milmed/usag435","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;National Guard suicide rates have been comparable to active-duty rates, yet Guard members may face geographic, stigma-related, and occupational barriers to mental health care. Recruiting National Guard members at elevated suicide risk into remotely delivered mental health and suicide prevention trials is difficult, particularly when direct suicide-related language may deter participation. This study examined whether a construct-targeted label intended to align with warrior-culture values (\"fearlessness about death\") was associated with greater engagement and study eligibility than a broad \"mental health\" label.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Twenty recruitment posts were placed in military-related Reddit communities between January 19, 2021, and April 18, 2022. Each post offered 2 otherwise identical study links labeled as either \"fearlessness about death\" or \"mental health\"; link position was counterbalanced, and respondents self-selected a link. A brief screener assessed current National Guard status, contact information and preferences, and the 7-item Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD). Eligibility for the parent online suicide prevention trial required current National Guard membership and an ACSS-FAD score greater than 17. Bot-generated, duplicate, incomplete, and non-National Guard responses were excluded. Group differences were examined using chi-square, independent-samples t, Fisher's exact, and risk-ratio analyses. All study procedures were approved by the institutions IRB before data were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The fearlessness-about-death link generated 797 raw responses, including 500 consecutive bot-generated responses, whereas the mental-health link generated 139. After exclusions, 124 valid and complete submissions remained. Valid submissions were more frequent through the mental-health label (99 vs. 25), contrary to the engagement hypothesis, χ² = 44.16, P &lt; .001, ϕ = 0.60. Respondents entering through the fearlessness-about-death label had higher ACSS-FAD scores (M = 18.64, SD = 4.65) than those entering through the mental-health label (M = 16.47, SD = 5.15), t = 2.03, P = .049, d = 0.43. Eligibility rates were 60.0% (15/25) and 38.4% (38/99), respectively (risk ratio = 1.56); however, despite the large effect, this difference did not reach conventional statistical significance, Fisher's exact P = .073. Most respondents preferred email to phone contact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A broad mental-health label was associated with substantially more valid responses and more eligible participants overall. The fearlessness-about-death label yielded fewer responses but may have concentrated respondents with greater suicide capability and thus study eligibility. Strengths include naturalistic recruitment of an understudied military population. Limitations include unequal group sizes. Suggestions for recruitment strategies ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039814","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}