Summary

Because the Defense Department (DOD) believes that military doctors are not prepared to provide trauma care to severely injured soldiers in wartime, Congress approved a demonstration project to train military doctors in public hospitals. Although GAO found that it is too soon to assess the effectiveness of the program--as of March 1998, only four surgeons had completed their training rotations--several questions need to be answered before the program is expanded. DOD needs to consider whether civilian trauma centers have the capacity to train large numbers of military personnel and whether military trainees can get enough experience, given that they will be competing with hospital personnel for training opportunities. In the long term, better information will be needed on wartime medical requirements, the personnel requiring trauma care training and their priority for such training, and the desired frequency of refresher training. The biggest challenge DOD may face is deciding how best to balance the need for wartime medical training with the substantial needs of its peacetime health care system.

GAO noted that: (1) it is too early to assess the effectiveness of DOD's demonstration program because it has only been in place since November 1997; (2) as of March 1, 1998, only four surgeons had completed their training rotations; (3) DOD has not finished the evaluation tool it is developing to assess the program's effectiveness; (4) due in part to the program's late start, DOD's actions to implement the program have not been fully consistent with the legislative provisions; (5) DOD missed the April 1996 implementation milestone and issued a report on its proposed demonstration program to Congress 5 months late; (6) DOD did not seek an agreement with the civilian center to provide health care to DOD beneficiaries that is at least equal in value to the services provided by the military trainees; (7) DOD officials believed that such an arrangement might have jeopardized the willingness of hospital officials to enter into the program; (8) GAO identified several other initiatives that might be used in assessing the feasibility of training military personnel in civilian trauma centers; (9) unlike the current demonstration program, these other initiatives have not limited their training to general surgeons; (10) the collective experiences of these programs, together with those of the demonstration program, could provide DOD valuable information in determining the feasibility and effectiveness of training military personnel in civilian trauma centers; (11) DOD will need to address several issues, none of which appear to be insurmountable, if it decides to expand its trauma care training program; (12) questions have arisen over physician licensure requirements; (13) two issues concern whether: (a) civilian trauma centers have the capacity to train large numbers of military personnel; and (b) military trainees can obtain sufficient experience, since they will compete for training opportunities with the centers' own personnel; (14) the first issue cannot be addressed because DOD has not yet estimated the number and type of medical personnel that might require trauma training; (15) DOD could deal with the second issue by selecting civilian centers that are understaffed because of their large caseloads; (16) in the longer term, better information will be needed on wartime medical requirements, the personnel requiring trauma care training and their priority for such training, and the desired frequency of refresher training; and (17) the biggest challenge DOD may face is determining how best to balance need for wartime medical training with the substantial needs of its peacetime health care system.