Madigan Army Medical Center trains techs

JOINT BASE LEWIS-MCCHORD, Wash. -- Madigan Army Medical Center's 20-plus residency and variety of nurse training options are well known. Yet, there are 10 more training programs at Madigan that are standouts in Army Medicine.

Soldiers in medical technician training programs, the 68 series, complete advanced individual training in their chosen military occupational specialty with classroom work at the Army Medical Department Center and School at Fort Sam Houston in San Antonio, Texas. For most, classroom training is followed by a significant component at a large military treatment facility.

Lt. Col. Vincent Leto, chief of the Madigan Consolidated Education Division which oversees the practical nurse and operating room specialist AIT Phase II programs, described the format. The Army structures this training so it occurs in large medical centers to ensure a profound degree of patient care experience before graduates are stationed at any smaller military training facility or deployed. The pace and complexity that can be found at large care facilities advances skills more than most other training situations can.

Of the 22 medical technician specialties, only two programs that have students training outside of the AMEDDC&S do not have a presence here at Madigan. As a training facility, students are integral to all that Madigan does.

The 10 specialties at Madigan are orthopedic technician (68B), practical nurse (68C), operating room specialist (68D), physical therapy specialist (68F), medical laboratory technician (68K), occupational therapy specialist (68L), cardiovascular technologist (68N), radiology technologist (68P), ear, nose, and throat technologist (68U), and eye specialist (68Y). A keen look at three of these programs reveals their value to Madigan and its impact on students.

Practical Nursing

There are two types of AIT programs at Madigan -- the didactic/clinical and the full-time clinical. The largest of these programs, the practical nurse course, is 40 weeks of combined classroom training and clinical rotations. It produces an enlisted Soldier professional who is, as Kerry Castillo, practical nurse course deputy director, said, "a highly independent, trusted, and valued member of the medical team."

Non-commissioned officers and civilians are the backbone of this program. The NCOs serve as instructors and advisors, role models and mentors for the students; the civilians do the same for them and the program as a whole. Each NCO has 10 students they counsel who are often very young Soldiers just starting their independent lives in a situation that gives them a great deal of information and training in a short timeframe.

"Most successful Soldiers here literally live the performance triad. They eat, sleep, exercise, and find time for their mind. There is no extra -- very little time for other things," said Staff Sgt. Barbara Wandick, practical nurse instructor.

Wandick shepherds students through the first 20 weeks, called the junior section. Included are in-processing, a deep didactic dive into body systems and an introduction to clinical rotation starting at week eight at the Community Living Center of the American Lake Division of Veterans Affairs Puget Sound Health Care System. In these initial patient interactions the students work with people who are not like them. They learn patient care in the truest sense.

At the midpoint, Staff Sgt. Dayna Taylor carries these students through the senior section, which focuses on specialties. From pediatric to geriatric, the students get to experience it all.

Thankfully, the program is structured on a crawl, walk, run model. They get the concepts crammed into their brains in the classroom. They get to practice on mannequins and each other in the simulation lab. Then, it is on the floor for hands-on patient care.

The lab plays an important role. The program can include up to 50 percent simulation for the clinical time. The lab offers a valuable setting where you can, "press pause," as Wandick puts it. The student is able to be let loose to make mistakes, take their time, and be independent in their learning.

It is furnished with all the same equipment seen in the medical center. Castillo instills an appreciation for the tools and resources afforded to the students, especially the ones on which they learn how to handle and care for patients.

It has $90,000 worth of mannequins, many of which are high fidelity. The students can check their blood pressure, pulse and breathing and get a response. The students treat each one of them, and each other, just as they would any patient. Each time they approach a bedside, they perform proper hand hygiene, introduce themselves, and talk the patient through the entire encounter.

Care with compassion

"I know this looks kind of scary, but you'll be alright," said Pfc. Jacob Parker to a colleague playing his patient to practice using a lift to move her from the bed to a chair.

Patient interactions are significant to learning. "I'm not gonna lie," said Parker. "I was pretty uncomfortable with people. I'm a pretty awkward person. But, I've learned a lot about myself and grown. When you're dealing with a patient, it isn't about your comfort zone at that point. It's a matter of taking care of someone when they need help." It is this kind of attention to the human details that instills trust.

As the students progress through the blocks of classroom instruction, lab practice, and clinical rotation in the hospital, they appreciate the exposure to patient care they receive.

"It is surprising how much we have done in a short period of time," said Spc. Ashley Waters. "I know people who've gotten their BSN [Bachelor of Science in Nursing] and don't have as much clinical and patient experience as we do," she noted. Spc. Allysya Moore agreed. "I am surprised at how far we've come," she added.

Pfc. Jordan Lair likes the concentrated time on the floor. "You can see the progression of a patient from admission to possibly discharge," he said.

Some experiences have surprised them. "I helped deliver a baby; never done anything like that before. There is always so much to learn," Parker said.

As they approach their test date, students feel prepared for their first assignments. Lair has gotten orders for a combat support hospital while Parker is going to a labor and delivery unit. But, the proof, as they say, is in the pudding.

According to the National Council of State Boards of Nursing, National Clinical Licensure Examination pass rates for 2016 show an overall pass rate of 70.59 percent with a first time pass rate of 83.73 percent. The five AMEDD sites with PNC programs have a combined rate of 93 percent. Madigan's rate is 98 percent.

It is not just the AIT students who thrive and prove themselves through this program. The first four instructors to earn the basic instructor badge awarded at the AMEDDC&S, U.S. Health Readiness Center of Excellence were Madigan instructors. That group included Taylor and Wandick is set to get hers as well.

Impacting patient care

Obviously, Madigan is a good place to be in these programs. But, how do they benefit Madigan and patient care?

Madigan clinicians are training as they practice. They are consistently on top of their game because they are always modeling for the students. "See one, do one, teach one," as Leto puts it.

There are 200-plus students in the programs at any given time. They continually bring a fresh perspective and knowledge of the latest didactic training from the AMEDDC&S.

Leto pointed out that the Army overall benefits greatly by sinking knowledge and experience deeply into these students through the volume and complexity of patient and case exposure gained here at Madigan before they are placed in a smaller MTF or combat support hospital in a deployed situation.

The intensity of training at Madigan provides skills for the Soldier on the battlefield. So does the variety. The size, complexity of cases, and variety of care here affords students the opportunity to cross-train in specialty fields associated with their MOS.

This is true for students in the radiology technologist program. Staff Sgt. Cameron Kirby, instructor, said, "Because it's a large hospital, we have a lot of opportunities. Soldiers can cross-train in CT scan, interventional radiology, MRI, ultrasound, mammography, or fluoroscopy."

The long view

One thing heard a lot from AIT Phase II students is that this is a beginning. Many know they want to be in healthcare and work with patients. Being a tech is not their ending point, though.

Pfc. Nicole Shaffer, radiology technologist student, intends to earn a bachelor's and become a physician's assistant. "I'll use my experience that I gained here working with patients as kind of a bridge," she said. Some of what this program offers her is the ability to hone her instincts.

Spc. Staci Hernandez, operating room specialist student, agreed. Just a week away from testing and graduation she is feeling confident. "I am definitely understanding the process and how to do things, and anticipation, and it all comes over time," she said.

Hernandez has taken time out of her civilian life to train full-time in the program. As a reservist, she intends to not only use this training in the military, but in civilian life as well. Like Shaffer, she expects to continue into other fields in healthcare.

The second of the two programs that include classroom training, the OR specialist course packs 120 clinical cases into its mere 12 weeks. John Brown, primary clinical instructor, has patient safety and high standards in mind when he ensures they are well versed in every case they touch.

Prior to surgery, the student must do a full review and clearly explain the case to Brown. If they cannot prove they understand it, they are not ready to enter the operating room.

Hernandez explains the tech's role is 100 percent hands-on.

"I'm right there, passing instrumentations to the doctor, whatever the doctor needs to get the case done, that's my role -- to hand it off to the surgeon," she said. That means understanding the case itself and being able to anticipate the doctor's need before they make that next move in the procedure.

With the rigorous training and high pass rates, Madigan AIT students are confident and ready to assume their roles in the military medical mission at their first duty station.