Scripps Bolsters Military Medical Training
Scripps trains Navy physicians in trauma, emergency care and more
Scripps trains Navy physicians in trauma, emergency care and more
Physician training is inherently rigorous. After four years of medical school, new doctors embark on a demanding residency program lasting four to five years. Under the guidance of experienced attending physicians, they rotate through various hospital departments, gaining vital real-world experience in trauma, intensive care, cardiology, oncology and other specialties.
Military physicians follow a similar path, but with unique challenges. Military hospitals, such as Naval Medical Center San Diego (NMCSD), often lack the diverse cases required for comprehensive training. Military patients are often younger and healthier, and NMCSD does not have a trauma center. To bridge the gap between military and civilian medical training, Scripps Mercy Hospital (then Mercy Hospital) began integrating Navy residents into their programs in the early 1980s.
Many Scripps attending physicians have military backgrounds, which enriches this partnership. Richard Virgilio, MD, who ran Mercy’s trauma center and helped establish the NMCSD collaboration, was a Navy surgeon in Vietnam. His successor, Michael Sise, MD, trained at NMCSD and served as chief surgeon on USS Guam and USS Iwo Jima during Operations Desert Shield and Desert Storm.
“We are the main trauma training center for the Navy hospital,” says Vishal Bansal, MD, current director of trauma surgery at Scripps Mercy Hospital San Diego. “We train approximately 150 residents every year, and around 90% deploy after they finish. Later, fully trained graduates, who are now attendings, continue their trauma work with us.”
Training expansion
Through the years, the training program has expanded, with Navy physicians conducting rotations at Scripps Memorial Hospital La Jolla, Scripps Green Hospital and Scripps Memorial Hospital Encinitas.
“Military hospitals simply don’t have the volume of patients or the trauma center designation needed for comprehensive training,” says Walter Biffl, MD, trauma medical director at Scripps Memorial Hospital La Jolla, and a trauma surgeon at Scripps Clinic Anderson Medical Pavilion in La Jolla. “Centers like Scripps Mercy and Scripps La Jolla provide essential immersion experiences.”
Trauma care and other specialties
Like civilian residents, military residents begin their Scripps rotations immediately after medical school. Many will move in and out of Scripps hospitals during the next five years, which includes a year conducting research. Scripps Mercy Hospital San Diego and Scripps Memorial Hospital La Jolla rotations focus on trauma care. Scripps Green Hospital and Scripps Memorial Hospital Encinitas offer other specialties.
“They rotate in emergency medicine, internal medicine, gastroenterology/hepatology, general surgery, intensive care (ICU), gerontology, bone marrow transplant, OB-GYN, anesthesia and sleep medicine,” says Dawn Curtis, who manages Scripps Clinic/Scripps Green Hospital, Post Graduate Medical Education. “They’re in multiple specialties across our locations.”
During their trauma and emergency general surgery rotations, residents see cases that mimic potential military scenarios: gunshot wounds, motor vehicle accidents, traumatic brain injuries — complex cases with multiple urgent conditions vying for their attention. Many of these patients will be admitted to the ICU, a different rotation.
“They’re doing trauma evaluations, seeing emergency surgery patients in consultation, operating and working in the ICU,” says Dr. Biffl. “It’s a lot of information: the physiology in the ICU, the routine of working up a trauma patient. They run the same drill several times a day to master it.”
Training for military medical readiness
Lieutenants Laurinda Jackson, MD, and Cyril Harfouche, MD, are in their fourth years of residency (fifth, including their research) and will soon be deployed. After that, Lt. Jackson plans to continue in trauma and critical care, while Lt. Harfouche is focused on plastic and reconstructive surgery.
For these residents, the Scripps rotations provide invaluable experience in treating complex patient cases that require care across multiple specialties. The rotations also provide ample exposure to diverse attending physicians, who bring their own unique experiences and insights.
This is essential because Navy trainees must contextualize their experiences for two quite different scenarios: the surgical suites at Scripps Memorial Hospital La Jolla or Scripps Mercy Hospital San Diego and the hospital ship or frontline surgery unit. Scripps hospitals are well-resourced — outposts, less so. The attendings, many of them veterans, make sure trainees understand their choices.
“I might not always have the same resources when deployed. The attendings take the extra time to ask me: ‘If you didn’t have interventional radiology, if you didn’t have a full ICU, if you didn’t have all of these things, what would you do next?’” says Lt. Jackson.
The patient workflow is also different. Scripps surgeons understand these important distinctions between military and civilian practice and help guide their trainees accordingly.
“The attendings, nurses, everyone across all the Scripps hospitals are fully invested in our education,” says Lt. Harfouche. “They make sure we’re getting the best training, and appreciate the implications and importance of everything we’re learning.”
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.