Well-being at a Military Medical School and Implications for Military Retention.

INTRODUCTION: Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student\u27s quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student\u27s likelihood to continue serving in the military and practicing medicine. METHODS: In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions. RESULTS: Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to reconsider their medical career choice compared to their pre-clerkship student counterparts. Medicine-oriented likelihood questions were associated with four unique MSWBI items, whereas military-oriented likelihood questions were associated with one unique MSWBI item. CONCLUSION: The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine

New approaches to selection system design in healthcare: The practical and theoretical relevance of a modular approach

This chapter presents a modular approach to healthcare selection system design. Contrary to the traditional holistic view on selection procedures, a modular approach highlights the components underlying selection procedures. Our framework identifies seven key design components of selection procedures (The stimulus format, contextualization, stimulus presentation consistency, the response format, response evaluation consistency, information source, and instructions) and reviews studies in the healthcare selection literature that compared the effect of these components on key selection outcomes. A modular approach allows (1) gaining insights into how the different components underlying selection procedures affect selection outcomes and (2) drawing conceptual similarities between components of different selection procedures. At a practical level, a modular approach permits developing a myriad of new selection procedures by "mixing and matching" different building blocks. We present two case studies and future research avenues to further illustrate these merits of a modular approach