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Back to the Future … Toward a Ready Army Reserve Medical Force

 

Col. Matthew D’Angelo, DNP, CRNA, AN, U.S. Army Reserve

 

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The success of military medicine over the past twenty years of war is unparalleled. It has produced the lowest mortality rate among combat casualties in modern history.¹ Despite advanced and innovative lethal weaponry used by our adversaries, U.S. combatants had a high probability of survival despite life-threatening wounds. To maintain this strategic advantage and mitigate “the Walker Dip,” service medical departments and Congress have prioritized military-civilian partnerships (MCP), an initiative to maintain critical wartime experiences.² While this practice has had some successes for the Active Component (AC), there has been little change in strategy for readiness training in the U.S. Army Reserve (USAR). Clinical currency is a relative assumption in the USAR. It is commonly believed that healthcare providers maintain clinical readiness within their civilian roles. This assumption, however, is flawed and a critical threat to the readiness of the USAR medical force. Therefore, USAR healthcare leaders must look beyond the constraints of the USAR “battle assembly” (monthly training) structure and reimagine how USAR healthcare teams prepare for war. The successes on the battlefield were not a result of the Active or the Reserve Component but the intracollaboration of these two components. Therefore, any thoughtful strategy should look for opportunities to increase the opportunity to provide USAR healthcare teams with critical experiences in a way where there is the capacity to incorporate AC healthcare teams. The only way to achieve such lofty goals is for the USAR to develop its own MCP networks. USAR has a rich history of very successful MCPs. As the United States transitions from active combat operations in Iraq and Afghanistan to regional stability operations, the USAR must look back to its history to prepare for the growing threat of large-scale combat operations of the future.³

The Current State of Military-Civilian Partnerships

MCPs are currently the focus of the AC. Centralized through the Defense Health Agency, the AC and individual service medical departments have spearheaded the current MCP initiative. Over the decades, there have been several examples of successful MCPs.⁴ The MCP programs target select AC personnel or teams and provide skill sustainment or just-in-time training before deployment.⁵ A small contingent of AC service members often staff these MCPs, integrating within the civilian healthcare team and guiding rotators in the clinical care settings for a period, usually two to four weeks in length. Although successful, these programs are limited by the capacity of the civilian partner to provide adequate experiences for the military rotators and equally by the capacity of military treatment facility (MTF) leaders to release personnel for training. Any large-scale movement of AC healthcare providers from an MTF to an MCP for training has the potential to limit services at the local MTF and the possibility to further promote leakage of care in the military healthcare system (MHS). The readiness of the AC healthcare team and beneficiary care require a delicate balancing act.

Unfortunately, the current MCP strategy does not include the USAR and primarily focuses on professional medical training for active-duty providers, with few training opportunities for enlisted medical skills. This is a critical point because the chain of survival begins with the medic. If medics are underprepared, we should expect increased combat mortality. The current MCP strategy provides a patchwork of skill sustainment opportunities but falls well short of meeting the requirements of the entire force. Capacity limitations and the potential geographic distances that service members must travel to participate make these less than ideal. Without a strategic policy change, there is little reason to believe that future MCPs will achieve their full potential—integrated military-civilian healthcare training platforms. To achieve greater capacity, military leadership must look to the USAR.

Military-Civilian Partnerships and the U.S. Army Reserve

MCPs are not a new phenomenon in the USAR. The USAR was founded in the early twentieth century based on the recommendations of the Dodge Commission that explored military failures during the Spanish-American War.⁶ The USAR began with the formation of the Reserve Medical Corps and expanded with the establishment of the Enlisted Reserve Corps. It is interesting to note the similarities between today’s world and those experienced more than a century ago. Then, the Army surgeon general quietly tried to prepare for war with a fixed force structure. Through a coordinated effort, the U.S. Army engaged the Red Cross and academic medical leaders to develop the Army medical reserve hospital system that could be mobilized for the Great War. History demonstrates that the medical reserve hospital system effectively provided quality care to the American expeditionary forces during World War I. The integration of Reserve-civilian medicine profoundly influenced American medicine, increasing knowledge sharing and increasing the innovation of civilian care for decades to come. Reserve general hospitals remained aligned with civilian academic medical centers through the Vietnam War, but they faded away due to the end of mandatory conscription and the changing perception of military service in the 1970s.

The challenges facing the military health system today are not so different from those faced by the leaders before World War I. Cost, staffing, and critical experiences are all in short supply today as they were over a century ago. Although the classic World War I-style Reserve hospital disappeared as the military grew during the Cold War, the cultural nature of MCPs remained until the early 1970s. The continuous flow of physicians from civilian to military and back to civilian practice allowed for the ongoing transfer of knowledge between these communities while maintaining a shared cultural experience.⁷ The fundamental ease with which MCPs existed in the early twentieth century no longer exists today and will require cultivation.

The challenges facing the “modern” MCPs can primarily be described from two perspectives. The first is legal and economic, and the second perspective is cultural. On the surface, MCPs appear as a logical means to integrate the expertise of two healthcare systems. However, as the American College of Surgeons has noted, the union of the military-civilian healthcare communities will not be without barriers. The Blue Book: Military-Civilian Partnerships for Trauma Training, Sustainment, and Readiness, published by the American College of Surgeons, identifies four significant challenges to MCPs.⁸ These challenges include the credentialing of military members in civilian centers, legal complexities of malpractice and the Feres doctrine, billing for services provided by military members, and privileging of military healthcare team members, with the most significant complexity for healthcare roles in the military that do not have equivalents in the civilian sector.

The Blue Book, however, only defines medical-legal barriers and may ignore some practical barriers to successful sustainability. Anecdotal experiences from existing MCPs suggest other obstacles to successful implementation, most notably diverging cultures. While a medical center’s chief executive officer may endorse an MCP, how is this communicated to the larger organization? Long after the VIP pictures are taken and the formal ceremony of the signing of the memorandum of understanding is complete, the members of each organization will be left to tackle a range of challenges that may span issues from how competition between military and civilian trainees affects culture to how call schedules will be managed between military and civilian practitioners. The cultures of the military and civilian communities are different.⁹ The cultural divide is only complicated by the nomadic nature of military assignments. As military partners move to new assignments, relationships and cultural connections can experience strain.

In addition to cultural challenges, what incentives are offered to the civilian staff to support their military colleagues? Although there is little data in the MCP domain, it has been this author’s experience that MCPs create burdens. While it is convenient to think that civilian clinicians’ support of MCPs will be done out of patriotism, this is not a realistic assumption. Overwork and professional burnout are the norms in today’s healthcare setting.¹⁰ Without proper execution, MCPs will become just another duty.¹¹ Therefore, future MCPs must be designed to sustain the military and its civilian partners. This will require stability to nurture the dueling roles of the MCP relationship. If MCPs become a critical component of the MHS’s ability to field competent and ready military healthcare teams, these challenges must be overcome.

The U.S. Army Reserve Medical Force

The USAR represents nearly one-third of the Army’s total medical force, maintaining 70 percent of the Army’s deployable medical force structure.¹² The USAR is a critical element to the Army’s successful execution of the national defense strategy.¹³ Unlike the AC, USAR medical assets are not aligned within the MHS. They do not directly affect military patient care during peacetime and do not draw bandwidth from the MHS to maintain partnerships. If developed correctly, USAR medical units would align to support the MHS and continue to provide ready medical assets to combatant commanders.

USAR medical assets are organized along three major medical commands. With over eight thousand soldiers and 119 units, the Army Reserve Medical Command provides a broad spectrum of care specialties nationwide.¹⁴ The 3rd Theater Medical Command commands and controls more than seven thousand soldiers from the East Coast of the United States to the Mississippi River. The 807th Theater Medical Command is the largest USAR medical command, with command and control of over ten thousand soldiers located west of the Mississippi River. The USAR can field ten hospital centers, including twenty-four field hospitals.¹⁵ These operational platforms must be prepared as the geopolitical landscape evolves and tensions among near-peer adversaries intensify.

The Reserve Military-Civilian Partnership Strategy

A successful Reserve military-civilian strategy would provide the USAR with healthcare skill sustainment while providing the civilian partner reciprocal gains. Unfortunately, the current mechanism for readying healthcare teams falls short. In most cases, USAR medical units perform their training isolated at reserve centers far from their future mission on the battlefield. If strategy shifted, USAR medical assets could align with the MHS. The Army Reserve Medical Command could maintain its geographic diversity and align units with current and future MTFs. This alignment would allow the AC to use USAR units to backfill during prolonged training and deployment while preparing reservists to function within the MTF. The 3rd and 807th Theater Medical Commands could remain expeditionary yet move their assets from reserve centers and establish several small partnerships in communities across the United States. While AC MCPs focus on large tertiary medical centers, Reserve MCPs (rMCPs) could prioritize hospitals not associated with the AC that can provide acuity and diversity for the Reserve medical assets, further integrating military-civilian medicine.

Through the USAR, rMCPs can be reimagined to provide a stable military partner that can integrate within the civilian organization and can provide capacity for the Reserve and Active Components to attend and participate in readiness training together. In the ideal setting, rMCPs would be integrated into the National Disaster Medical System (NDMS), furthering the National Academies of Sciences, Engineering, and Medicine’s vision for an integrated military and civilian trauma system to achieve zero preventable deaths after injury.¹⁶ There is little reason to believe that a sustainable rMCP program could not be achieved while simultaneously enhancing the readiness of the nation’s healthcare system through the NDMS. To achieve this reality, however, the design must be deliberate and focus on readiness.

A Ready Military Healthcare Force

Readiness for operational medicine is a complex matter that is more than skill sustainment. In war, the context and practice of healthcare often change due to the unique realities in the area of operation. For this reason, “readiness” must be incorporated into Reserve training. For this discussion, the readiness of the military healthcare force is the “professional, cognitive, environmental, and operational development that an individual requires to work within military healthcare teams to sustain competent performance in both complex and unpredictable military operational settings.”¹⁷ Grounded in this definition, a ready medical force requires training in four domains: (1) individual professional skills (medicine, nursing, medic), (2) specific skills for operational healthcare practice (i.e., outside of the MTF, familiarization with specialized field equipment), (3) military-based competencies (survival skills) to function in an operational environment successfully, and (4) individual and team-based cognitive readiness skills to perform optimally in complex battlefield environments. Reserve medical forces’ readiness will require an integrated approach like the AC. Hospital care should be balanced with medical field exercises (using expeditionary equipment) along with knowledge and skills assessments to ensure the healthcare team member can translate civilian healthcare into the operational environment.

The Army Reserve Field Hospital

This strategy proposes that the functional unit for a rMCP would be organized at the medical brigade level. A brigade houses a single Army hospital center (HC) composed of two field hospitals (FH) and a multifunctional medical battalion (MMB). At total capacity, the HC provides 240 beds, which includes 60 intensive care units (ICU) and 180 intermediate care beds. The size and scale of an HC is variable based on the modularization of the component units. The thirty-two-bed FH, however, represents the core element of a HC. Scalable assets are added or removed based on conditions around the operation. The HC, therefore, will be the nucleus. As a civilian partner’s capabilities to support rMCPs grows, so will the FH.

Most soldiers within the brigade and HC work “part-time.” They must serve fourteen days on active duty for annual training (extended combat training) and twenty-four days throughout the fiscal year at battle assemblies. Historically, USAR units perform duties over weekends and for two weeks in the summer. This schedule assumes that reservists practice their medical skills and maintain proficiency through their civilian clinical experience. This assumption, however, is a critical weakness in the current USAR strategy. For instance, a USAR critical care nurse who works in the civilian sector as a school nurse may not be clinically ready to function as a critical care nurse in the USAR. A general surgeon specializing in breast care may not be clinically prepared to function as a general surgeon in the USAR. Therefore, the USAR must have a method to assess healthcare providers’ civilian practice. Following this strategy, USAR healthcare providers would track their civilian clinical practice through the Medical Currency and Readiness Tracker (MCART) application. The MCART application was developed by the U.S. Air Force to be used on smartphones. The MCART app is programmed with specialty-specific readiness requirements, current procedural terminology codes, and International Classification of Diseases tenth edition (ICD-10 codes).¹⁸ Data entered by service members will be recorded and cross-matched with Army individual critical task lists (ICTL) or the knowledge-skills-attitudes (KSA) identified with the Defense Health Agency Clinical Readiness Program.¹⁹ With this information, leaders can assess a soldier’s readiness to perform in their military occupation and tailor battle-assembly training days to the individual needs of the soldier. This novel approach offers a degree of precision unique to the service member and the unit and not arbitrarily based on metrics.

Implementing the Army Reserve Field Hospital-Civilian Partnership

The ideal experience for a rMCP would be at an accredited Level 1 or Level 2 trauma center. This, however, may not be a realistic expectation due to competition with active-duty Medical Departments and civilian Graduate Medical Education Programs. Level 3-designated trauma centers, however, represent a reasonable setting for a reserve experience. These centers mirror the capabilities of a Role 2 and Role 3 deployed setting and are geographically dispersed in a pattern similar to current USAR medical assets.²⁰ Without a trauma center designation, the institution should have a larger beneficiary network with moderate-to-high-acuity patient care. rMCPs should use the same memoranda of understanding/agreement as others in the MHS to ensure consistency across the enterprise.

A presence within the organization will be critical for stability within an rMCP. A successful partnership requires joint ownership. Reservists cannot come and go. Success requires the regular engagement of Reserve healthcare team members working with civilian team members. A successful partnership must be grounded in a shared culture. Enculturation requires presence. Presence within the civilian institution with part-time service members will take creativity. The traditional “two days a month” will be inadequate to cultivate an rMCP. Therefore, using the definition of readiness previously discussed, annual training will remain for fourteen days and should be targeted to experiences in expeditionary healthcare in the operational setting. Military healthcare team members must be prepared to perform care in a contextually different environment from the brick-and-mortar facilities where they typically practice. Field training allows leaders to build team training and measure soldiers’ ability to perform in complex contextual environments to ensure soldier skills and patient care preparedness.

The remaining twenty-four duty days (192 hours) should primarily be dictated by soldier readiness and what is needed for their individual preparation. The readiness of healthcare providers is not unlike preparing combat fighter pilots. Experience has shown that flight time alone does not prepare combat pilots for the complexities of aerial warfare.²¹ In addition to flight time, pilots require weapon and targeting drills and other critical skills to retain lethality.²² Like pilots, patient care alone will not fully prepare a healthcare provider for the uniqueness of casualty care. Individual and healthcare team readiness will be achieved by integrating the core tenets of readiness, extending beyond individual skills and toward the requirements of expeditionary healthcare that will prepare healthcare team members for damage control resuscitation and surgery, prolonged field management, and evacuation to higher echelons of care.²³

Individualizing substantial portions of healthcare readiness allows for individualized training. Part-time clinicians below readiness metrics will likely require patient care time at the rMCPs. Soldiers whose civilian practice meets or exceeds ICTLs or KSAs should be given opportunities for additional training. For instance, a critical care physician meeting their readiness metrics could cross-train with anesthesiology. The critical element is that the training should be dictated by the soldiers’ needs, not a generic training schedule.

Training schedules within the rMCP will be unique, and they must be tailored to the organization and negotiated individually. rMCPs will differ based on the culture of the organization. Therefore, civilian organizations and brigade leadership should be able to develop innovative strategies to find shared areas of interest if the partnership meets minimal standards. Once developed, soldiers should be self-scheduled with their section leadership to fill training slots within the civilian partner’s organization. Self-scheduling allows soldiers the greatest flexibility to meet military requirements while balancing family and civilian employment requirements. This unique flexible scheduling will require a new form of leadership and organizational structure for USAR medical leaders.

The overall command and control of the HC will remain with the brigade commander; however, the HC and the MMB commanders will have direct relationships with the civilian partner leaders. The rMCP leadership group (HC, MMB commanders, and hospital chief executive officer or senior representative) will annually develop shared goals to guide the relationship. Planning will be conducted in partnership with the chief medical and nursing officers and other civilian stakeholders to support soldiers’ integration into the care teams. FH and medical detachment commanders will execute directives through a training schedule coordinated with departments throughout the civilian medical center. Soldiers will identify and self-schedule training days by specialty in appropriate discipline or sections. Oversight of the training schedule will be the responsibility of section leaders. Soldiers serving under flex scheduling may not be working with other service members. Therefore, select peer civilian leaders within the soldier’s discipline will provide written formative feedback and periodic peer review. Similarly, soldiers will be expected to provide an annual assessment of the rMCP training and their assessment of the partnership to guide future growth.

Healthcare practice and legalities remain a significant concern with MCPs. In the event of poor outcomes, there remains the question of liability. This becomes increasingly challenging with the enlisted medical specialties. Unlike their AC counterparts, enlisted soldiers may not practice their military skills in civilian employment. Medic training remains one of the most significant challenges. The role of the medic does not easily translate to the civilian medical community. Barriers to allowing medics to practice must be overcome. Patient survival on the battlefield begins with buddy aid and the combat medic. Creative strategies include partnering with local emergency medical services or in-house hospital paramedic transport. Either way, this critical component of the military healthcare system must be addressed.

The following demonstrates how soldiers may be rotated through a rMCP. Each area of concentration or military occupational specialty will have varying challenges to integrating within the rMCP. Army nurses were used for this example because of the number of nurses within HC organization. The table represents typical nurse staffing for an HC. A typical HC has personnel requirements for forty-one critical care nurses who must perform twenty-four duty days (192 hours) in addition to their annual training. This is a combined total of 7,872 hours (about eleven months) of required training.

The average hospital in the United States is 150 beds.²⁴ Of these, a hospital needs approximately 13.5 percent to be ICU beds.²⁵ Assuming 80 percent occupancy, one ICU bed requires seven thousand hours of around-the-clock care per year. If the training schedule allows the USAR to cover two ICU beds (fourteen thousand hours) throughout the year, soldiers will potentially have 1,168 twelve-hour shifts. This training schedule in one ICU and two beds would provide the appropriate number of training hours to support eighty critical care nurses, far exceeding the needs of a single HC. This additional bandwidth may be used for training by AC critical care nurses near the rMCP. rMCPs could be an asset for local MTFs struggling to maintain competency.

Based on this example, it is critical to note that the civilian partner should not reduce its staffing model based on the rMCPs. Instead, the civilian partner should reduce nursing hours to allow staff to attend continuing education or other training. This is an example of reciprocal gain, where the military gains experience and the organization and its staff benefit from the rMCP. This modeling could be transferred to other specialties and healthcare disciplines.

Recommendations

Revitalizing medical components in the USAR to align with the greater MHS strategy will be a monumental challenge but necessary to ensure that forces are prepared for future wars. As we saw from nearly two decades of war, the USAR was a critical component in the medical successes on the battlefield. Although not an exhaustive list, the following are key recommendations for rMCP success.

First, creativity will be required to make these changes in doctrine. Military leaders must look beyond what has been done to what must be done to modernize the force. The Reserve hospitals of the early twentieth century were a product of ingenuity and passion by civilian and military leaders created to save American lives on the battlefield.

In addition to creative leadership, the USAR medical brigade training must evolve. The days of “one weekend a month and two weeks each summer” must be rethought to allow flexibility within the system; it must allow soldiers to train in their area of expertise while not overwhelming the civilian market yet remain a continuous presence in the rMCP. USAR leadership must evolve to this new reality. Command and control of soldiers and Active-Guard-Reserve positions may need redeveloping to ensure congruence with this new training platform.

The long-term success of any partnership requires participation and mutual gain. Soldiers must be present and become part of the culture, and the rMCP community must mutually benefit. Reciprocal gains are critical for success. The USAR must be prepared to offer more than just personnel. Current successful partnerships are often grounded in shared simulation facilities and equipment. These and other solutions to common desires will help solidify the relationship.

Lastly, many regulatory changes must occur for success. Potential civilian partners often raise concerns about licensure of enlisted specialties, malpractice, and billing for services delivered by military providers in civilian centers. None of these issues are insurmountable, yet they require champions who can help drive deliberate changes to state and federal codes.

Conclusion

The USAR has a long history of successful rMCPs that were critical to the successful military healthcare system of World Wars I and II. As the historian and political scientist Walter Lippmann noted, “The lesson of history is that the lesson of history is never learned.”²⁶ The U.S. healthcare system offers opportunities to improve the readiness of Army Reserve healthcare assets. A rMCP offers the promise of improved training, while integrating the U.S. Army Reserve into the NDMS. To achieve these ends, we must separate ourselves from the dogmatic practices of current USAR training schedules and ways to demonstrate readiness. Through a new lens, the U.S. Army Reserve can again serve as the critical link between military and civilian medicine. To do so, however, leaders must look back to history to reimagine the future of military healthcare readiness.

 

The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Department of the Army, the U.S. Army Reserve, or the Department of Defense.

 

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Notes

1. David A. Blum and Nese F. DeBruyne, American War and Military Operations Casualties: Lists and Statistics (Congressional Research Service, 2020), 49.
2. Military and Civilian Partnership for Trauma Readiness Grant Program, Pub. L. No. 116-22, 133 Stat. 915 (2019), https://www.congress.gov/116/plaws/publ22/PLAW-116publ22.pdf; Guy Jensen et al., “Military Civilian Partnerships: International Proposals for Bridging the Walker Dip,” Journal of Trauma and Acute Care Surgery 89, no. 2S (August 2020): S4–S7, https://doi.org/10.1097/TA.0000000000002785. “The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict.”
3. Jensen et al., “Military Civilian Partnerships.”
4. Divyansh Agarwal et al., “Reciprocal Learning Between Military and Civilian Surgeons,” Annals of Surgery 274, no. 5 (November 2021): e460–64, https://doi.org/10.1097/SLA.0000000000003635; Daniel J. Stinner et al., “Building a Sustainable Mil-Civ Partnership to Ensure a Ready Medical Force: A Single Partnership Site’s Experience,” Journal of Trauma and Acute Care Surgery 93, no. 2S (August 2022): S174–S178, https://doi.org/10.1097/TA.0000000000003632.
5. Martin A. Schreiber et al., “Military Trauma Training Performed in a Civilian Trauma Center,” Journal of Surgical Research 104, no. 1 (1 May 2002): 8–14, https://doi.org/10.1006/jsre.2002.6391.
6. Agarwal et al., “Reciprocal Learning Between Military and Civilian Surgeons.”
7. Agarwal et al., “Reciprocal Learning Between Military and Civilian Surgeons.”
8. M. Margaret Knudson et al., The Blue Book: Military-Civilian Partnerships for Trauma Training, Sustainment, and Readiness (American College of Surgeons, 2020), 32, https://www.facs.org/media/ftgg2pyo/2020_mhssp_standards_blue_book.pdf.
9. Edward P. Manning, “A Veteran-Centric Model of Care: Crossing the Cultural Divide,” Annals of Internal Medicine 171, no. 11 (2019): 843–44, https://doi.org/10.7326/M19-1264.
10. Stefan De Hert, “Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies,” Local and Regional Anesthesia 13 (2020): 171–83, https://doi.org/10.2147/LRA.S240564.
11. Vivek H. Murthy, Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce (U.S. Public Health Service, 2022), https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout.
12. Department of Defense (DOD), Report to the Congressional Armed Services Committees: Section 719 of the National Defense Authorization Act for Fiscal Year 2020 (DOD, July 2021), https://health.mil/Reference-Center/Reports/2021/08/23/Limitation-on-the-Realignment-or-Reduction-of-Military-Medical-Manning-End-Strength.
13. DOD, Report to the Congressional Armed Services Committees.
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17. Matthew D’Angelo et al., “Decoding Readiness: Towards a Ready Military Healthcare Force,” Military Medicine 184, no. 5-6 (May-June 2019): 122–26, https://doi.org/10.1093/milmed/usy419.
18. “ICD-10-CM Codes Lookup,” Codify by AAPC, accessed 23 July 2025, https://www.aapc.com/codes/icd-10-codes-range?msockid=32e6e387e3aa6e362e68f5b5e2106f57.
19. Danielle B. Holt et al., “Clinical Readiness Program: Refocusing the Military Health System,” Military Medicine 186, no. S1 (January-February 2021): 32–39, https://doi.org/10.1093/milmed/usaa385.
20. “U.S. Trauma Centers,” Maptive, accessed 18 June 2025, https://www.maptive.com/ver3/traumacenters.
21. Richard K. Betts, Military Readiness (Brookings Institution Press, 1995), 77.
22. Betts, Military Readiness, 78.
23. Eric A. Elster, Mark W. Bowyer, and M. Margaret Knudson, “Assessing Clinical Readiness: A Paradigm Shift in Medical Education,” JAMA Surgery 156, no. 11 (2021): 999–1000, https://doi.org/10.1001/jamasurg.2021.3611; Danielle B Holt et al., “Clinical Readiness Program: Refocusing the Military Health System,” Military Medicine 186, no. S1 (January-February 2021): 32–39, https://doi.org/10.1093/milmed/usaa385.
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25. James Allen, “How Many ICU Beds Does a Hospital Need?,” What I’ve Learned as a Hospital Medical Director (blog), 10 October 2020, https://hospitalmedicaldirector.com/how-many-icu-beds-does-a-hospital-need/.
26. Michael E. DeBakey, “Military Surgery in World War II—A Backward Glance and a Forward Look,” New England Journal of Medicine 236, no. 10 (6 March 1947): 340–50, https://www.nejm.org/doi/full/10.1056/NEJM194703062361001.

 

 

 

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