The U.S. Army Medical Department Center and School, Health Readiness Center of Excellence, or AMEDDC&S HRCoE, developed a standard definition of "rigor". By establishing a common understanding of this concept in context of the CoE's training and education mission, the CoE can ensure the standards and intent of their new higher headquarters' command are met.

As a result of the 2017 and 2019 National Defense Authorization Acts, or NDAA, key Army Medicine assets were restructured and reassigned to improve Army readiness and increased lethality. On January 31, 2019, the AMEDDC&S HRCoE conducted a Transfer of Authority ceremony to publically recognize their realignment from the U.S. Army Medical Command to the U.S. Army Training and Doctrine Command, or TRADOC, with operational control under the Combined Arms Center as part of the restructure.

As outlined in NDAA 2019, the array of national security threats facing the United States is more complex and diverse than at any time since World War II. The strategic environment has not been this competitive since the Cold War; America no longer enjoys the competitive edge it once had over its adversaries.

As our future risk grows, U.S. Forces will need to be prepared to fight and win on an increasingly lethal and expanded battlefield, in complex terrain. This concept of Multi-Domain Operations, or MDO, represents the evolution and further refinement of the Multi-Domain Battle concept and describes how the U.S. Army, as part of the joint force, can counter and defeat a near-peer adversary capable of contesting the U.S. in all domains, in both competition and armed conflict.

TRADOC Pamphlet 525-3-1, The U.S. Army in Multi-Domain Operations 2028, dated December 6, 2018, characterizes soldier readiness as improving the resilience of leaders and soldiers through training, educating, equipping, and supporting them to execute MDO in all of its intensity, rigor, and complexity.

As part of the deliberate actions the HRCoE is taking to fully integrate into TRADOC, and accomplish both the TRADOC and HRCoE's priorities, the staff formed several working groups to examine the many nuances that should be assessed with such massive change. One working group was charged by Colonel Dan Bonnichsen, the HRCoE Chief of Staff with defining rigor and pinpointed areas where rigor could be increased or enhanced at the CoE.

Bonnichsen said, "One thing we noticed as a staff was that we needed to better define what 'rigor' should mean to our CoE to effectively meet the TRADOC Commander's and HRCoE's near term priority of improving the quality, rigor and resourcing of our training."

The AMEDDC&S, HRCoE was first accredited by the Army in 2010, however, as a direct reporting unit to the Medical Command, they were not a TRADOC school. On October 19, 2018 they became a direct reporting unit to TRADOC headquarters, and started the purposeful transition to achieve full compliance with all TRADOC regulations and policies by Fiscal Year 2020. This will include full adoption of the Decisive Action Training Environment, or DATE, MDO, and synchronization of Doctrine, Organization, Training, Materiel, Leader Development, Personnel, Facilities and Policies, or DOTMLPF-P, across the CoE.

In his FY 2019 Command Training Guidance, Major General Patrick D. Sargent, who has commanded the HRCoE since June 2018, directed commanders and staff to "increase the rigor of all Individual Military Training, Professional Medical Education, and functional training," to ensure alignment with TRADOC near term priorities.

Sargent said the guiding purpose was to change Army Medicine's culture from delivery of healthcare with a focus on limited contingency operations, to a focus on the professional knowledge, skills, and abilities "that will drive the right technical and tactical expertise to defeat peer threats in contested environments in DOTMLPF-P and multi-domain operations."

In his updated Commanding General's Priorities memo dated April 24, 2019, Sargent named 'increase rigor' as one of five near term priorities. The full list includes leveraging Simulations and the Synthetic Training Environment; ensuring Combat Fitness through the Army Combat Fitness Test, developing the capabilities of future of combat medics based on future battlefield requirements; increasing rigor; and horizontal integration and synchronization of DOTMLPF-P development into our doctrine and instruction.

The HRCoE's new definition of rigor is "Training that reinforces soldier and warrior acculturation, that is conducted in a DATE, under austere conditions, and allows for repetition to gain mastery of the required tasks while enduring physical and mental stress."

Bonnichsen continued, "I felt that only through a cooperative assessment of exactly what rigor would look like in our CoE could commanders and staff do an accurate judgement of required equipment, training, development, program of instruction, or POI, and organizational changes that needed to be made."

Bonnichsen asked HRCoE's Quality Assurance Office, or QAO, to lead the Rigor Working Group. The QAO has always served as the eyes and ears of the command with the mission to promote the Army's Quality Assurance program by evaluating training and training support processes to ensure compliance with Army accreditation standards.

As the CoE goes through this transformation and seeks to reform several programs and practices, Bonnichsen believes that ensuring there's no confusion regarding the expected increased rigor is crucial. "Not leaving this up to everyone's individual interpretation will help us operate efficiently as a staff and command and better use the valuable resources that are entrusted to us," he asserted.

While performing classroom observations and course evaluations over the years, the QAO has witnessed several instances of rigorous training. Bonnichsen explained, "It's not that HRCoE programs haven't been rigorous, but many times this rigor occurs by chance, rather than by design and is a consequence of a seasoned, innovative instructor instead of through course design and the courseware that should be guiding the instruction."

Arguably, HRCoE already has some of the most academically challenging courses in the Army. HRCoE graduate programs regularly make the top 10 list of Best Graduate Schools for Health according to U.S. News and World Report. Additionally the Texas Board of Nursing assesses HRCoE's pass rate on the National Council Licensure Examination for students in the 68C Licensed Practice Nurse course at 94.7 percent; well above the national average of 83.85 percent. Moreover, HRCoE 68W Combat Medics had a 94 percent cumulative pass rate for the National Registry of Emergency Medical Technicians in 2018, also well above the National average.

With rigor clearly defined and a renewed focus to ensure active measures are taken to add the principles of rigor to training, the CoE expects the cumulative effect on the quality of the graduates produced to be extremely positive in the long term.

The HRCoE working group identified several areas that could be enhanced to increase rigor in the cognitive, psychomotor and affective domains of learning. Recommendations for Advanced Individual Training, or AIT, Basic Officer Leadership Course, or BOLC, and the Captains Career Course, or CCC were to integrate field training, increase assessment of established learning objectives, and develop lesson plans that include scenarios using DATE to physically and mentally challenge trainees in an austere environment. The team also noted the need to have leaders involved in all aspect of training and to ensure instructors and training developers fully understood the shifting focus to MDO and large scale ground combat operations.

Many working group recommendations have already been put into course POIs. March graduates of the Army Medicine CCC became the first to take a doctrine exam on the first day of class, the first to have closed-book exams, the first to present individual concept of support briefs and the first class in over two decades to conduct a field training exercise as part of the course.

Additionally, BOLC has already implemented several quick wins by increasing practical exercises and adjusting curriculum in order to meet Combat Training Center and Operational Force competency gaps. The HRCoE is also aggressively revising the POIs for Advanced Individual Training courses to ensure compliance with the TRADOC commander's intent to increase the quality and rigor and build on soldier and warrior acculturation initiated in Basic Combat Training; each AIT POI will include a 72 hour Field Training Exercise conducted in an austere environment, using DATE driven scenarios.

The Army's Modernization Strategy has one focus: make soldiers and units more lethal to win our nations wars, then come home safely. Bonnichsen believes that enhancing Army Medicine training through increased rigor in AIT, BOLC, CCC and other professional military education courses at the HRCoE increases soldier preparedness.

Bonnichsen concluded, "We know that a soldier and leader who is better prepared to meet the challenges of an operational medicine assignment through the rigorous training received at the Health Readiness Center of Excellence, increases unit readiness and lethality across the Army."