A Decade of Progress - Contents
Education and Training
Instruction enlarges the powers of the mind.-HORACE.
The Surgeon General, acutely aware of theincreasing role of specialization and teamwork in medical science, stressedconsistently the need for creating an Army Medical Department team of highlytrained medical and paramedical specialists. Through training he hoped tointegrate concepts of teamwork and specialization into the entire spectrum ofArmy medical service, from the infantryman trained to give emergency first aidto his buddy on the nuclear battlefield, through the line commander responsiblefor the health of his troops, to the ultimate cooperation of surgical teamsworking over a soldier with multiple wounds.
From the beginning of General Heaton'stenure as The Surgeon General through the Army's combat test in Vietnam,training programs in the Medical Department were designed to harness the fullpower of modern medical specialization and teamwork to provide America'ssoldiers with the highest quality of medical care.
PROFESSIONAL TRAINING
The Army Residency Program
As a result of experience in World War II,when the small number of specialists in critical areas available from civilianpractice forced the Medical Department to institute crash programs to train thespecialists required for global war, the postwar Medical Department insti-
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tuted residency programs in an effort tocreate its own supply of specialists. The residency program in effect at thetime of General Heaton's appointment received his enthusiastic support. As herepeatedly told a variety of audiences, "I consider the residency trainingprogram the very heart of our recruitment program for the regular corps."During his tenure, the program continued to grow, expanding from a total of 330Army and 48 Air Force residents enrolled for training at Army teaching hospitalsin fiscal year 1958 to a total of 655 Army and 38 Air Force residents in fiscalyear 1968. About half of this expansion reflected increases in the size of theresidency program, and the remainder resulted from the expansion of Armyteaching facilities which allowed residents previously trained at civilianinstitutions to be absorbed into the military program. Between fiscal years 1958and 1968, the number of Army residents who had to be trained at nonmilitaryfacilities declined from 104 to 14. Most of those remaining in civilianresidencies were in specialties such as public health and children'sorthopedics, areas in which training was not available within the Army in broadenough scope to qualify residents for board certification.
Plans for the expansion of military trainingfacilities included a program for the affiliation of class I and class IIhospitals. During 1960, The Surgeon General prepared a pilot program calling foran affiliation between 10 class I and four class II hospitals in generalsurgery. Initially, the program was to begin in September 1960, but was laterdeferred until 1961 to allow general surgery residents assigned to class Ihospitals more time to become familiar with the procedures and methodology ofthese installations. During 1961, plans for a large-scale pilot program werediscontinued, but in the ensuing years an increasing number of class I hospitalsselectively entered programs of affiliation with class II hospitals. Theexpansion of facilities for residency was evidenced by the increase from 24residency training programs conducted at eight Army hospitals in 1959,
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to 28 programs at 17 hospitals, including seven class II and 10 class Iinstallations. Specialties either added or reinstated during the period includedcare and treatment of laboratory animals, forensic pathology, and physicalmedicine.
The Army Internship Program
Introduced into the Medical Department program of professional training atabout the same time as the Army residency program, the Army internship programcontinued throughout the decade to provide more and better professional trainingfor graduates of medical schools approved by the American Medical Association,who wished to serve in the Army Medical Department. Under this program, selectedgraduates were commissioned in the Medical Corps Reserve, and ordered to activeduty to complete a 12-month rotating internship. The program, designed to meetrequirements published by the Council on Medical Education and Hospitals of theAmerican Medical Association, included rotating training in internal medicine,surgery, obstetrics and gynecology, and pediatrics. A 2-month elective was alsoincluded in the program, and participants were not required to continue inmilitary medicine beyond their normal obligations.
General Heaton backed this program vigorously, and the years from 1959 to1969 were marked by continuous progress. The number of spaces available forinterns increased from 178 in fiscal year 1959 to 198 in fiscal year 1965, thelast year in which the number of spaces authorized increased. During 1964 and1965, internships at class I hospitals were discontinued, making training atlarge general hospitals available to all participating in the expanding program.Beginning in May 1968, the Medical Department was authorized to convert 32 ofits spaces into straight internships to allow participants to specialize earlyin their careers.
As a result of these developments, an increasing number of young physiciansentered Army residency programs and continued in military practice. Developments
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in the Army's program of dental internship were similarly progressive, andthe high level of interest evoked among dental students made it possible toselect students of the highest caliber.
The Army Fellowship Training Program
During the past decade, fellowship training was consistentlyavailable in the Medical Department for the purpose of providing officers withtraining in specialized fields. These fellowships could be used to broaden anindividual's general knowledge or to prepare him for an assignment as aninvestigator or teacher. The greatest number of fellowships were offered by theArmed Forces Institute of Pathology, which provided pathology training inseveral fields. A lesser number were offered by the Walter Reed Army Instituteof Research, which provided training in various aspects of hematology,biologics, and immunohematology. Fellowships were also available at the SurgicalResearch Unit, Brooke Army Medical Center, in surgery, internal medicine, andpathology. Still other fellowships were available for qualified officers atcertain foreign medical centers, and in other specialties, upon request. During1962, personnel policies were amended to require individuals in the fellowshipprogram, who had originally participated free of obligation, to pay back theirtraining by serving an additional year for each year on fellowship, thusensuring the Army Medical Department of their continuing service.
Military Postgraduate Courses
To supplement formal training provided by the residency,internship, and fellowship programs, the Army Medical Department provided acontinuously growing program of postgraduate education, consisting of long andshort courses ranging from 1 day to more than 2 years in length, at Armyhospitals, laboratories, and schools, as well as civilian institutions. Shortcourses (programs less than 20 weeks in length) were attended
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by officers on temporary duty status, while longer courses required apermanent change of station. As early as fiscal year 1960, more than 1,300officers of various Medical Department corps participated in one or more of 40different types of postgraduate professional short courses designed to keep themabreast of developments in their fields of specialization. By fiscal year 1966,this number had grown to a total of 1,776 Medical Department officers and 3,827others attending 87 short courses. In subsequent years, numbers decreasedslightly in response to personnel pressures resulting from South Vietnam. Manyof the courses conducted at Army medical facilities were of primary interest tophysicians, but a number of courses, such as Management of Mass Casualties, andPrinciples of Medical Operations in Nuclear Warfare, produced widespreadinterest in both the civilian community and the Military Establishment. Suchinterest was demonstrated by the growing number of "others"-a widerange of civilian and military personnel-who voluntarily attended MedicalDepartment short courses.
In addition to short courses offered by the Army Medical Department, anincreasing number of officers received valuable training through other Federalagencies. Between fiscal years, 1966 and 1968 alone, the number of officersattending courses offered by the Department of the Navy and the Air Force, theDepartment of Health, Education, and Welfare, the Civil Service Commission, theDefense Atomic Support Agency of the Department of Defense, and other agencies,increased 46 percent to a total of 430. Among the courses which resulted inincreased interest from the Army's specialized medicomilitary team were theDefense Atomic Support Agency's offerings in the medical aspects of nuclearwarfare, the Department of Defense Armed Forces Management Course, and theChemical, Biological, Radiological Weapons Orientation Course. As the threat ofbrush-fire wars continued to grow in the early l960's, increasing numbers ofMedical Department officers re-
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ceived counterinsurgency training. As early as fiscalyear 1962, 23 Medical Department officers were in training in this program atthe U.S. Army Civil Affairs School, Fort Gordon, Ga., and in 1964, anunscheduled seminar on the medical aspects of counterinsurgency was prepared forArmy Medical Department officers and medical personnel from other military andcivilian services. During fiscal year 1964, the number of Medical Corps officerswho completed airborne training increased from 24 to 45.
The complexity and interdependency of long- and short-coursetraining in building a team of specialized medical and paramedical militaryofficers was graphically illustrated by the growth of the Army's program inaviation-oriented medical service. The apex of this program was the ArmyAreospace Medicine Residency, a 3-year program in which the trainee pursued amaster of science degree in public health, or its equivalent, at a civilianinstitution, attended a 1-year advanced course at the U.S. Air Force School ofAviation Medicine at Randolph Air Force Base, Tex., and spent a final year at aU.S. Air Force installation in flight status, performing duties in aviationmedicine. The growth of this program reflected the Army Medical Department'sresponse to an increasing need for physicians qualified to handle the specialproblems of aviation and aerospace medicine. In addition to career-orientedMedical Corps officers trained through aerospace residency, the army required agrowing number of physicians trained as aviation medicine officers. Officersmeeting the physical standards for this training were selected from MedicalCorps officers on active duty, attended courses ranging from 9 to 22 weeks atthe Navy and Air Force schools of aviation medicine, and completed 2 weeks oftraining at the U.S. Army Aviation School at Fort Rucker, Ala. By fiscal year1966, the number attending the course had grown to 68 per year. During the sameyear, an aviation orientation course for senior Medical Department officers wasestablished at this school, emphasizing air mobility and the
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expanding utilization of Army aviation units to support ground forces. Atotal of 16 students attended during the first year of the course. Attendance atthe Aviation Crash Injury Course, a short course conducted by another Federalagency, also increased. Constantly growing numbers of paramedical militarypersonnel received training as helicopter pilots, and the number who receivedtraining as fixed-wing pilots declined throughout the period. Between fiscalyears 1962 and 1967 alone, the quota of Medical Department personnel to receivetraining as rotary-wing aviators increased from seven to 64. To round out theprogram of training for an aviation-oriented Army Medical Department, a newcourse, the 3-week Essential Medical Training for Aviators Course, was approvedin April 1965, to provide Medical Department pilots with a working knowledge ofthe problems encountered in aeromedical evacuation of the sick and wounded, andthe emergency techniques applicable to evacuation. Thus, a team was forged ofthe aerospace medical specialists, the pilot-surgeon's assistant, andspecialists in aviation medicine and support techniques, illustrating theinterdependency of specialists in modern Army medicine.
The decade was also marked by a significant increase in the number of seniorofficers who received advanced military training. In 1959, the number of ArmyMedical Department officers attending military staff colleges was small, butadequate for current requirements. Early in 1961, requests for additional quotaswere forwarded to the Department of Defense, because of the Medical Department'srecognition that, by 1965, the loss of officers qualified for staff positions byexperience in World War II would require an increased number of trained seniorofficers. By fiscal year 1964, the number of officers enrolled in Army and JointService Colleges had increased to four attending the Army War College, 20attending the regular course at the Command and General Staff College and 18 inthe shorter associate course, two attending the Industrial College of the ArmedForces, and
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four attending the Armed Forces Staff College.In many instances, this represented a doubling of previous enrollments. Becauseof demands placed on the Medical Department by the conflict in Vietnam,enrollments in senior service colleges declined slightly in subsequent years,but the total remained well above that reached in the previous decade.
Postgraduate Courses at Civilian Institutions
The National Defense Act of 1920, as amended, permitted theArmy Medical Department to send officers to civilian schools to receivespecialized training not available in the military school system. Courses ofless than 20 weeks were considered short courses and, until 1959, provided thebulk of professional training opportunities. In contrast, largely as a result ofGeneral Heaton's efforts, the decade was marked by an impressive expansion oflong courses and programs leading to academic degrees designed to advance hisconcept of specialization and teamwork.
In absolute numbers, the increased degree of MedicalDepartment participation in civilian education was impressive. From the fiscalyear 1959 total of 361 officers enrolled in civilian schools-212 inshort courses, 116 in long courses, and 33 in courses leading to an academicdegree-the total enrolled in all of these categories had increased to 1,384 byfiscal year 1967. Even more impressive, however, was the marked upgrading ofeducational requirements and opportunities within the Medical Department. Asearly as 1959, The Surgeon General emphasized the importance of qualifyingcareer officers for the master's degree, particularly in such fields asbusiness administration, hospital administration, public health, bacteriology,biochemistry, periodontics, institutional management, and physical therapy. Herecognized also the need for individuals with training through the doctorate insuch fields as entomology, microbiology, radiobiology, social welfare,bacteriology, biochemistry, and hospital administration.
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A salient example of the continuous upgrading of requirementsthat marked the past decade was the change in the advanced course inradiobiology, sponsored by the Defense Atomic Support Agency, and originallyheld at Reed College, Portland, Oreg. Originally 6 months in length,encompassing 24 weeks of applied work at Federal agencies, the course wasreorganized in 1960 to encompass 9 months of training leading to a master'sdegree. In the process of reorganization, it was transferred to the Universityof Rochester, Rochester, N.Y., which was authorized to award advanced degrees.In 1962, this course was supplemented by the establishment of a similar courseat the University of North Carolina, Chapel Hill, North Carolina.
In addition to advanced training for members of the MedicalCorps, educational opportunities were increasingly extended to the other corpsof the Medical Department. In fiscal year 1961, The Surgeon General receivedauthorization from the Department of the Army to increase the number of officersin the Degree Completion Program from 12 to 30, thereby allowing a larger numberof Medical Service Corps, Army Nurse Corps, and Army Medical Specialist Corpsofficers to obtain a college education. In fiscal year 1962, two members of theArmy Nurse Corps were working for the master's degree, and the following year,a Medical Service Corps officer seeking the doctorate in education was reportedas the first Army Medical Department officer in the Degree Completion Program atthis level. Other officers were increasingly reported as attendingnonprofessional long courses in such areas as institutional management,packaging, personnel management, business administration, hospitaladministration, and comptrollership
By 1965, The Surgeon General's concept of specialization andteamwork through training became increasingly recognized by the Department ofthe Army, a recognition that was reflected by the authorization of greaterdiscretionary power and approval of higher educational prerequisites for MedicalDepartment personnel.
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In April 1965, The Surgeon General assumedresponsibility for negotiating contracts for tuition and related fees withcivilian institutions for Medical Department military personnel, giving himgreater flexibility in meeting training requirements. The following year, theArmy Education Requirements Board approved the validation of an additional 720Medical Department positions, bringing the total number of validated positionsto 2,064. Subsequent actions by that Board in 1967 and 1968 brought the totalnumber of validated positions to 3,077, including 756 positions for MedicalDepartment officers requiring graduate education, 642 at the master's leveland 114 at the doctorate level.
On-The-Job Training
The last of the general categories ofprofessional training available to Medical Department officers was"on-the-job training," conducted within Army medical facilities anddesigned to train officers in specialized fields in which adequate knowledge ofa subject can be gained by working under close supervision. Predictably,training of this type declined as the educational requirements and opportunitiesincreased. In fiscal year 1959, Medical Corps officers were engaged in programsin otorhinolaryngology, radiology, and psychiatry, but only 36 physiciansparticipated as compared to 124 the previous year and 329 in fiscal year 1957.The same year, 42 graduates of the Medical Supply Officer Course were assignedto selected Army hospitals and medical depots for a 12-month period of training.Courses were also established for junior Army Nurse Corps officers to alleviateshortages of operating room, obstetric, and pediatric nurses. These new courseswere 22 weeks in length. The following year, fiscal year 1960, only 15 MedicalCorps officers were reported participating in on-the-job programs. A number ofjunior Medical Service Corps officers were assigned to hospitals in thecontinental United States for a year of training in personnel management and inthe duties of comptrollers and re-
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gistrars. After 1960, as the availability of formal trainingprograms grew, on-the-job programs ceased being discussed in The Surgeon General'sannual report. Subsequently, the only personnel reported trained by thesemethods were nurse anesthetists. Undoubtedly, on-the-job training continued tofill the needs of hospital and unit commanders in many lesser specialties, butits removal from the annual report as a significant category of trainingsignaled the growing reliance of the Medical Department on more formal methods.
SERVICE SCHOOL COURSES
Military Training
In applying the concept of specialized teamwork to thepractice of military medicine, the common bond between the Army MedicalDepartment's multitude of diverse specialties was provided by militarytraining. Traditionally, this union had been forged in courses provided by theMedical Field Service School (founded in 1920 at Carlisle Barracks, Pa., andmoved to Brooke Army Medical Center, Fort Sam Houston, Tex., in 1946) and theU.S. Army Medical Service Veterinary School Chicago, Ill., that grew out ofprograms in World War II. Programs at these facilitiesencompassed basic and advanced military training for elements of all corps andspecialties in the Medical Department. By regulation, supervision of themilitary training of all Medical Department officers is a direct responsibilityof The Surgeon General.
When General Heaton became The Surgeon General, the MedicalDepartment offered a comprehensive program of service school courses. In fiscalyear 1959, 15 special service school courses were conducted with spacesavailable not only to active-duty officers in the Army, but also to Navy, AirForce, Reserve, and National Guard officers, as well as to other Federalagencies, civilians,
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and foreign nationals. The total number ofMedical Department participants in these courses was 1,916.
One of General Heaton's first acts as chiefof the Medical Department was to protest the designation of the Medical FieldService School as the "Army Medical Service School." The name of theMedical Department's academic home had been changed as a result of a beliefthat the traditional designation was inaccurate because the school was notentirely restricted to field medical service. It was General Heaton's view,however, that the presence of a few purely professional and technical coursesdid not change the basic function of the school, and in a desire to stress theimportance of field medicine and the function of the school in developing andpromulgating doctrine on the principles and methods of field medical service, hepressed for a restoration of the traditional title. As a result of theseefforts, the traditional and historical designation of "Medical FieldService School" was restored in December 1960 (fig. 10).
A second significant achievement was TheSurgeon General's successful defense of his role as an independent trainingagency during the buildup years of 1965-66. On 23 June 1965, a board wasappointed by the Department of the Army to determine the adequacy and proprietyof the Army school system and the training of Army officers. This group, whichcame to be known as the Haines Board, after its president, Lieutenant GeneralRalph G. Haines, Jr., consisted of senior officers from the combat arms,technical services, and administrative services, and one civilian educator. Inits final recommendations, the Haines Board concluded that most Army schoolsbelonged under the command of the U.S. Continental Army Command, but that theMedical Field Service School should be continued under its traditionalcommander. After studying almost every facet of its operations, the Boardconcluded informally that the Medical Field Service School was one of thebest-run
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FIGURE10.-Medical Field Service School, Brooke Army Medical Center, Fort SamHouston, Tex. (Armed Forces Institute of Pathology photograph.)
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schools it had seen and expressed the opinionthat it should be left alone.
This opinion was reflected in the Board'sfinal recommendations, which stated that The Surgeon General should retaincommand of, and be completely responsible for, the Medical Field Service Schooland the Army Medical Department Veterinary School. They noted that "theAMEDS [Army Medical Service] School system and courses * * * are today beingoperated effectively and efficiently under [The Surgeon General]. The[Continental Army Command] span of control, already overextended, would bestretched even more if * * * AMEDS schools were added to it. The massive sizeand complexity of the AMEDS system commands its retention under existingarrangements." This finding was the most important recommendation of theHaines Board in respect to the Medical Department. Other recommendations whichaffected the Medical Field Service School included the use of programmedinstruction, television, teaching machines, and new methods in Army teaching.These recommendations brought many changes to the Medical Field Service Schoolin the following years.
During the decade, many changes were made inthe length and title of courses conducted by the Medical Department. Many ofthese changes were changes in name only, to renumber or alter titles to conformwith Department of Army directives and systems. A few, however, representhistorically significant innovations.
Among the significant trends in MedicalDepartment military education were an increasing emphasis on providing specialcourses to meet the needs of its components and an increasing emphasis onadvanced training for career officers. During General Heaton's first year inoffice, the general Army Medical Department Orientation Course was changed tothe Army Medical Department Officer Basic Course, and restricted to medical,dental, and veterinary officers, and new courses were provided for members ofother corps. The orientation
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course for Medical Service Corps officers waslengthened from 12 to 16 weeks and became the Medical Service Corps BasicCourse. New Army Nurse Corps officers were provided with a separate 9-week basiccourse, and new Army Medical Specialist Corps officers were allowed to attendthe first 4 weeks of that course. A 23-week course, Advanced Military Nursing,was established for career Army Nurse Corps officers, replacing an older coursein administration, and quotas for the Army Medical Department Officer AdvancedCourse, a career course designed to prepare officers for further schooling, wereexpanded to make more officers eligible for advanced education programs. Thispattern, in various guises, dominated the program of the Medical Field ServiceSchool throughout the decade. When the need arose, courses previously given asspecialties through the postgraduate short-course program were given functionalstatus and transferred to the service school program to provide large numbers ofofficers with special training. An example of this technique was theintroduction of an 8-week course, Introduction to Environmental Health, to thespecial service school program to provide recently commissioned engineers andentomologists in the Medical Service Corps with a working knowledge of militaryenvironmental health service to enhance their effectiveness in preventivemedicine, and the addition of a course in patient administration.
In addition to providing increasinglyspecialized military training, the Medical Field Service School was marked byrapidly increasing student loads. From a total number of 1,916 participants infiscal year 1959, the student load increased from 4,010 officers in the lastyear before the South Vietnam buildup to 6,544 officers in fiscal year 1968.Providing training for this number of officers resulted in severe strain on theschool's facilities, but basic training was provided for all new members ofthe Medical Department without a notable decline in the quality of itsgraduates.
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Training of Foreign Nationals
Among the responsibilities of the MedicalDepartment throughout the last decade was the training of foreign nationals.This program, designed to increase the efficiency of foreign programs andenhance the prestige of the Army Medical Department and the United Statedabroad, encompassed school and observer training in such specialties asmedicine, dentistry, nursing, and administration. Numbers involved in theprogram fluctuated heavily during the decade, ranging from as many as 400 to asfew as 150, with no apparent trend.
Training Aids
During the closing years of the 1960's, theArmy Medical Department made tremendous strides to keep itself abreast of moderndevelopments in educational techniques and theories. In response to therecommendations of the Haines Board, and subsequent objectives announced by theAssistant Secretary of Defense (Manpower), steps were taken to utilize tapedinstruction, television, computers, and other devices to present trainingmaterial to students at multiple locations. Early in 1967, plans were made andfunds were programmed for the installation of an extensive closed-circuitinstructional color television system at the Medical Field Service School. Thesystem was designed to overcome the problem of shortages of instructors byincreasing the number each instructor could reach through televised classes.Lectures were recorded for later use, and smaller systems were purchased forother Medical Department class II training activities, to provide a MedicalDepartment-wide closed-circuit instructional television network. In June 1968,The Surgeon General announced that all class II facilities except LettermanGeneral Hospital had been equipped with closed-circuit television, that a secondsystem had been established at the Medical Field Service School, and that avideo tape loan service with 52 programs had been established at the
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Armed Forces Institute of Pathology. A systemfor Letterman General Hospital was completed in June1969.
During 1967, contracts were also awarded forthe development of programmed instructional materials. A new and unconventionalteaching method, programmed instruction required less direct participation byinstructors, permitted precise definition of measurable learning objectives, andprovided for logical, progressive arrangement of the small steps of the learningprocess requiring frequent responses from the student and producing feedbackthat enhances learning. A 2-week workshop was held on programmed techniques forrepresentatives of Medical Department training facilities. In June 1968, TheSurgeon General reported that six programmed texts, including 20 hours ofinstruction in medical terminology, introductory microbiology, physiology, andrelated subjects, were being distributed to participants in the ClinicalSpecialist Course and that other programmed texts were being developed for use inapproximately 90 hours of instruction in resident courses at the Medical FieldService School.
In other developments, the Medical Departmentannounced the purchase of several cartridge-type 8-mm. film projectors for useby students for remedial studying, and an 8-mm. kinescope which converted videotape to film so that students could use taped lectures in the cartridgeprojectors. A plan for utilizing computer support for classroom instruction andwar games was also developed. Finally, the Medical Department joined inparticipating in Project Transition, which was designed to provide servicemenwith marketable skills to ease their change from military to civilian life.
Training Guidance
In addition to providing training for membersof the Medical Department, The Surgeon General continued to exercise hisresponsibility of providing training guidance in medical matters for the entireArmy. These duties
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encompassed not only the routine review oftraining films and literature, and their replacement or revision, but also theformulation of new doctrines on problems confronting military planners. Duringthe early 1960's, The Surgeon General placed increasing emphasis on Army-widetraining in emergency medical care for survival on the nuclear battlefield.Through training circulars and regulations, new policies were established fortraining the individual soldier for battlefield survival, and officers andenlisted personnel in the management of mass casualties.
In March 1960, the latest Army MedicalDepartment doctrines for response to nuclear disasters were tested at Fort SamHouston, in Operation SURVIVAL, before some of the Nation's leading civilianmedical educators and top-ranking members of the military services. One of thepurposes of Operation SURVIVAL was to underline the necessity of emergencymedical care training for Army troops to ensure their survival on the nuclearbattlefield. In demonstrating the techniques of emergency medical care and theirrelationship to various levels of division organization, three main problemswere highlighted: (1) In the field, as in garrison, the initial care tocasualties will frequently be self-aid or buddy-care, (2) the logistics burdenimposed by mass casualty situations represents a serious drain on a division'smanpower and equipment, and (3) a disparity exists between medical means andmedical requirements within the infantry battle group. Subsequent maneuversthroughout the decade continued to demonstrate the problems of medical supportto nonmedical military commanders.
ENLISTED TRAINING
At the beginning of the decade, responsibilityfor training all officer and enlisted personnel of the Medical Department wasvested in The Surgeon General. After the reorganization of the Department of theArmy in
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1962, however, command of all Army trainingcenters, including the Medical Training Center, was consolidated under the U.S.Continental Army Command, dividing the responsibility for enlisted trainingbetween The Surgeon General and a second Army Command. As a Special Staffofficer, and the director of a technical service, The Surgeon General retainedhis responsibilities for promulgating doctrine and controlling the technicalcontent of instruction. Responsibility for the control of doctrine for basicaidmen was discharged through the command channels of the U.S. Continental ArmyCommand, through the Fourth U.S. Army, to the U.S. Army Medical Training Center,Fort Sam Houston. Other duties included providing instruction in occupationalspecialties, advanced training in a number of specialties, and functional orrefresher training. During General Heaton's tenure, these responsibilitieswere discharged through the Medical Field Service School, the Army VeterinarySchool, and selected Army hospitals.
After the reorganization of the Department ofthe Army in 1962, advanced individual training for both male and Women's ArmyCorps enlisted personnel became a direct responsibility of the U.S. ContinentalArmy Command, with technical control exercised by The Surgeon General throughcommand channels. Students came to the Army Medical Training Center aftercompleting basic combat or Women's Army Corps basic enlisted training, wherethey participated in a 10-week Advanced Individual Training course (8 weeks forWacs), leading to Medical Aidman, MOS 91A10. A 6-week modified basic trainingcourse, excluding combat training, was also conducted for conscientiousobjectors, as well as several short courses in instructional techniques andduties not related to patient care. Further training in medical duties fellunder the direct control of The Surgeon General.
Training programs under the direct control ofThe Surgeon General spanned a broad range of courses and career patterns.Programs available to enlisted person-
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nel included special service schools andcivilian institutions in military occupational specialty qualifications rangingfrom operating room technician to food inspector. During the decade, courseofferings continuously changed to meet current and anticipated needs, as theMedical Department rose to the challenge of keeping abreast of changing medicaland military requirements. It was a mark of the high caliber of enlistedtraining that the Medical Department's greatest single problem during the 1960'swas in preventing the quantitative pressure of the South Vietnam buildup fromeroding the quality of training for enlisted personnel. During fiscal year 1966alone, the programmed enlisted training load of courses under the directauthority of The Surgeon General increased 34 percent, from 6,652 to 8,883, andthe following year this load increased to 10,302. This onslaught of trainees wasmet by adding courses, double-shifting courses on some occasions, and anincreasingly selective choice of instructor personnel. A part of this pressurewas also relieved by use of the educational innovations discussed earlier. By1968, with the peak of the buildup past, the Medical Department was able toreport that it had met the challenge of expansion without evident loss ofquality.
