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Governor's Newsletter, Spring 1998

Fall Meeting Follow Up

Fall Meeting Video Teleconferencing (VTC) Follow Up
Awards Presented at the Fall Meeting
Moser Award Winners
Army Chapter Laureates
Associate and Fellow Awards
Word from the Consultant
MEDDAC and Membership Column
Army ACP Senior Leader Column
Army ACP Associate's Column
Medical Student Activities

Army Chapter Activities
National ACP News

Greetings from the Governor

Greetings… The purpose of this newsletter is to provide information about our most recent chapter meeting, to update members on continuing activities at our local and national ACP, and to introduce award winners as well as new and upcoming features to the newsletter. Please note MAJ Wheeler's description of the role of video teleconferencing at our last chapter meeting. Also, MAJ Salerno, our MEDDAC representative, has started a column featuring input from senior Army Internist leaders; please read carefully COL Dunn's description of the potential role of Internal Medicine in the evolution of the Brigade Surgeon. This letter also has input from our OTSG consultant, as well as informatics, associate, and student reports.

Fall Meeting Follow Up

Once again, the Army Chapter, Present Concepts in Internal Medicine Meeting, at Reston Virginia this past November was a tremendous success. More than 300 members, associates and students were in attendance. There were new initiatives in video teleconference distance learning, medical student activities, and operational aspects of Army Internal Medicine Residency Curriculum Development. Plenary and breakout session speakers in general were excellent. Our ACP College representative, Regent and ABIM Vice­President Dr. Daniel Duffy, summarized the superb session as providing "high quality CME" and noted in particular the outstanding organization and planning. The smoothness of the sessions belies the excellent oversight and dedication by Program Chair COL Yancy Phillips. The day to day work by Ms. Daisy Word, consultants, and meeting planners was also excellent.

We congratulate COL Phillips on his recent promotion to Deputy Commander for Clinical Services at Walter Reed and are fortunate that he has agreed to continue to act as Program Chair for the 1998 meeting 18­21 November in Reston, and to help coordinate with BAMC for the 1999 Fall meeting in San Antonio.

Fall Meeting Video Teleconferencing (VTC) Follow Up

For the first time, portions of our Chapter Meeting (from this past Fall) were made available for interactive CME to other medical centers and hospitals by VTC. Mr. Tom Biggott, LTC Poropatitch, COL Phillips and others led the way on this project. A survey by MAJ Jeff Jackson from WRAMC was designed to assess efficacy and to find ways for improvement. MAJ Gary Wheeler served as the Project Officer ­ a summary of his AAR is provided below:

"VTC After Action Report"

Potential clinical points of contact (POC's) were identified at MAMC, WBAMC, BAMC, DDEAMC, WAMC, TAMC, LARMC, Ft. Jackson, Ft. Knox, and Ft. Campbell. POC's were identified after discussion with Department Chiefs, and technical POC's also identified to help coordinate the hardware and software aspects, as well as with rooms and scheduling.

Scheduled events included the morning plenary sessions on 13­14 November, 2 General Medicine breakout sessions, and the Plasma Therapy for Thrombotic Thrombocytopenic Purpura Workshop. The schedule and the survey developed by MAJ Jackson were transmitted to distant sites by cc:mail.

VTC execution was successful in broadcasting to MAMC, WBAMC, BAMC, DDEAMC, Ft. Knox and Ft. Campbell. The meeting was also made available to the WRAMC Dermatology service and Pentagon clinic.

Follow up and feedback showed that video quality was good and audio quality limited by room noise. Only a limited number of surveys were returned, some other contacts were made by telephone. There was support for future VTC projects, and the project was overall judged favorable; technically successful, but limited clinically with a reluctance to commit beforehand to unproven technology. It appeared that the success off­site was also limited by the fact that some POC's attended the meeting without local follow up.

It is recommended that the VTC project be continued for 1998, with greater lead time to assure physician availability, with greater marketing at the grass roots level, and with continued careful evaluation and follow up.

MAJ Wheeler and the others are to be commended for taking the initiative to start this project, and importantly, to study its impact, limitations, and future possibilities. It seems clear that this process is technically feasible, and will allow internists at remote sites to view portions of the meetings and obtain some CME credit. It is also clear that VTC is not yet technically optimal, and it does not replace the networking value of the meeting. VTC does not yet facilitate the important discussions with colleagues and speakers between plenary sessions, nor allow participation at the excellent breakout sessions. This is a technology that at present augments, rather than replaces the on site impact of the meeting. We should make every effort to continue to test and adapt this technology prospectively and proactively, to maximize the benefit that we bring back to our patients and colleagues.

Awards Presented at the Fall Meeting

Moser Award Winners

Col Mike Dunn chaired the COL Robert H. Moser Award subcommittee. The award recognizes an outstanding general internist in practice in a MEDDAC setting for two or more years. The criteria for the award include clinical competence, professionalism, humanistic values, compassion, and activity in CME, research, and military training. For the first time, there were two winners.

Major Gary Wheeler ­ a 1990 graduate of USUHS, he completed his Internal Medicine Residency at Walter Reed in 1993. He served 4 years as a General Internist at Moncrief ACH, Fort Jackson SC. At WRAMC in residency, MAJ Wheeler received the Malogne Award, and he earned the EFMB at MACH in addition to being the Chief of Internal Medicine. He was very active in teaching and CME. MAJ Wheeler is now a staff internist at WRAMC.

Captain Jennifer Thompson ­ a 1992 graduate of Harvard Medical School, she completed her Internal Medicine Residency at Walter Reed in 1995. She served 2 years as a general internist at the 121 Evacuation Hospital in Seoul Korea. At WRAMC CPT Thompson was voted the outstanding graduating resident, and in Korea was the Internal Medicine Clinic Chief. In Korea she served as the program director for the 38th Parallel Medical Society Health Education Conference. CPT Thompson is now an Infectious Disease Fellow at WRAMC.

Army Chapter Laureates

Laureates were chosen this year by a subcommittee headed by COL Nathan Erteschik. We were able to select 4 richly deserving Laureates.

COL (Ret) Kenneth Burman ­ a graduate of the University of Missouri Medical School in 1970, he completed an Internal Medicine Residency at Barnes Hospital in 1972, and then an Endocrinology Fellowship at Walter Reed in 1974. Dr. Burman continued a long tradition of Army excellence in endocrinology and retired in 1994. He served as Chief of Endocrinology at WRAMC, as the consultant in endocrinology to the Surgeon General, and Chair of Endocrinology and Professor of Medicine at USUHS. He is currently Chief, Endocrine Section, Washington Hospital Center, Washington DC.

COL (Ret) James Hanley III ­ a graduate of the University of Connecticut School of Medicine, he completed his Internal Medicine Residency at Madigan Army Medical Center and was Chief of Medical Residents until July of 1978. Dr. Hanley served at Army Community Hospitals and Medical Centers across the United States and in Europe, and was the Teacher of the Year at both Brooke and Fitzsimmons. He retired from the Army in 1996 as the Program Director at Fitzsimmons. He is currently the Program Director of the Internal Medicine Residency (and again Teacher of the Year) for the University of North Dakota School of Medicine.

COL (Ret) Michael T. McDermott ­ a graduate of Tulane School of Medicine, he completed his internship and residency, and then a fellowship in endocrinology at Fitszimmons Army Medical Center in 1982. He served as Chief of the North Base Clinic in the Sinai before returning to Fitzsimmons in 1983. At Fitzsimmons he was recognized as an outstanding clinical teacher, was Chief of the Endocrinology section, and served as the Consultant in endocrinology to the Army Surgeon General. He retired in 1997. He is currently a staff endocrinologist and Professor of Medicine at the University of Colorado School of Medicine.

COL (Ret) Jack Moore Jr. ­ a graduate of the University of Virginia School of Medicine, completed his internship and residency in 1978 and then a fellowship in Nephrology at Walter Reed. Dr. Moore was a Chief of Medical Residents at WRAMC, and on assignment there as a staff nephrologist was rapidly recognized as a superb clinician and clinical educator. He served as the Chief of Nephrology and was the Consultant in Nephrology to the Surgeon General. He retired from the Army in 1993. He is currently the Director of the Nephrology Section and Fellowship at the Washington Hospital Center.

Associate and Fellow Awards

The award for first place podium presentation by an associate at the meeting was given to CPT S. A. Harrison of Brooke Army Medical Center for his presentation: "Effects of a non­acetylated salicylate on bleeding time and platelet function in patients with osteoarthritis."

Among the many fellow presentations at break out sessions, information on awards is available from the Carl Temple Symposium. The Pulmonary Staff Award was received by CPT A. Shorr of WRAMC, and the Consultants Award was received by MAJ V. Grbach of BAMC.

Word from the Consultant

It has been a hectic, but rewarding first few months for me in my new role. I enjoyed meeting so many of you at our meeting in Reston, and I look forward to getting to know more of you in the Army Internal Medicine Community.

This year's GME conference was very successful ­ both as an example of increased tri­service cooperation, as well as for our specialty in particular. Nearly all residency and fellowship positions were filled, and filled with extremely qualified applicants. An overwhelming number of PGY­2 applicants were placed into their first­choice program. Additionally, all our residency programs remain viable and successful, both for the present and the future.

The time frame for placing folks in assignments takes place in the first few months of this year. Each facility has generated a requested number of staff Internists through its respective Chapter Medical Command, with these numbers being confirmed and adjusted at the January Distribution conference. Concurrent and subsequent to that meeting, COL Dunn's staff with input from myself finalizes assignments. I can assure you each request is handled in a personalized manner. Strong consideration is being given to increase staffing at locations with large active duty populations. Due to significant downsizing in Europe and relatively little turnover there next summer, only a few Internal Medicine positions will open in Germany for 1998.

I am also happy to report that during the JSGME meeting, I and all our residency program directors had the opportunity to participate one evening at USUHS in a meeting/presentation with medical students to promote Army Internal Medicine as a specialty. Thanks to Major Bill Gilliland for coordinating this, as well as 2 associate ACP resident members, Drs. Moran and Niven from WRAMC for making a significant and enthusiastic impact that evening. This was the first time Internal Medicine was involved with this annual event, and we plan to have continual involvement each year. I would like to encourage all of you to take every opportunity to do similar things, both formally and informally, with students, interns and residents at every chance you may have. Healthy competition among specialties is clearly alive and well.

Congratulations again to our Laureate and Moser award recipients from this past meeting ­ an extremely deserving group of individuals.

COL Nathan Erteschik, FACP
Chief, Department of Medicine
Womack Army Medical Center
Fort Bragg, NC

MEDDAC and Membership Column

The 1997 Army ACP meeting proved to be as successful as the 1996 meeting with about 300 participants. Although the number of internists from MEDDACs increased this year from 12% to 14%, there is still room for further growth. Funding for MEDDAC participants will remain a priority for me as we begin planning for our 1998 meeting this summer.

I am working on several new projects. First, you will note the addition in this newsletter of a new column where senior leaders such as Col Dunn provide insight on policy changes and other matters relevant to Army internists. With the implementation of the new brigade surgeon policy, we may soon find ourselves working with an internist colleague who as a brigade surgeon also sees patients in our medicine clinic part time. If you have ideas for a senior leader guest column or topic, please contact me.

I will also be conducting a review and update of our Army ACP chapter. If you or someone else you know does not get this newsletter, chances are that you are listed under the wrong chapter. I would appreciate it if internal medicine clinic chiefs and chief residents could ask their internists to contact me if they are not getting the newsletter.

Feel free to contact me at any time with ideas or comments at (706) 561­8787, 544­1251/1261, cc­mail or ssalerno@compuserve.com.

Stephen M. Salerno MD Major USA Medical Corps
Chief Internal Medicine, Martin Army Hospital
Army ACP Membership and MEDDAC Coordinator

Army ACP Senior Leader Column

"Internists, General Medical Officers, and Brigade Surgeons"

Over the next three years the Army will replace the General Medical Officers currently assigned as Brigade Surgeons of maneuver brigades with residency­trained specialists. It is worthwhile for Army internists to understand the background and implications of this significant change.

The responsibilities of a Brigade Surgeon are considerable in peacetime at home station. During deployments and combat, the Brigade Surgeon frequently makes a critical difference in the success or failure of a unit's mission. In a brigade of average size and complexity, the Brigade Surgeon is responsible for the health, fitness, and deployability, medical planning for the support of combat operations, and should it become necessary, combat casualty care for up to 5,000 soldiers. As a special staff officer, the Surgeon is responsible to the Brigade Commander, and exercises technical supervision over the training, readiness, and activities of about 100 enlisted medical specialists, 4 Physician Assistants, and when augmented for combat, 4 other physicians. The Brigade Surgeon in turn works under the professional supervision of a Division or Corps Surgeon, and plans for evacuation, medical logistics, and clinical support from divisional, corps, and other medical units. With the advent of TRICARE, the traditional dependence of the Brigade Commander on his or her Surgeon to solve access and quality issues for soldiers has intensified and come into sharp focus. In summary, the Brigade Surgeon tangibly represents and embodies Army medicine for a senior commander, a major staff, and the Brigade's soldiers and families.

It is not clear why Brigade Surgeons in recent years have normally been General Medical Officers who have completed PGY1 clinical training and the Officer Basic Course in terms of military training. From the foregoing information, it is clear that General Medical Officers who succeed as Brigade Surgeons do so by overcoming substantial deficits in clinical and military maturity that can severely limit their effectiveness. The importance of the position requires residency­trained and field­wise physicians.

Timing and executing the conversion requires attention to 3 interlocking considerations:

First, a Brigade­level special staff officer should be a senior Captain or junior Major, which equates to an Army physician on completion of residency or shortly thereafter. Since a key life goal of new residency graduates is solidifying competency and maturity in their clinical discipline, they need that opportunity in any clinical or operational assignment. The best way of ensuring this appears to be substantial investment of the clinically mature Brigade Surgeon in the primary care of the Brigade's soldiers and families. Rather than being viewed as a distractor from the Surgeon's combat planning activity, senior commanders rightly view hands­on clinical credibility as a major enhancer of the Surgeon's effectiveness in his or her operational functions. Focused correctly, the Surgeon's operational and clinical activities become mutually reinforcing. It will be easy to orchestrate such reinforcement for graduates of Family Practice, Internal Medicine, Pediatrics and Emergency Medicine programs because of the opportunity for practice in these specialties where maneuver brigades are stationed. While surgical or other specialties may with good reason desire a Brigade Surgeon assignment as a way to show their capacity for future senior leadership, it would be more difficult to structure their opportunities for simultaneous clinical development. Other specialties do have opportunities to serve in a number of appropriate operational positions, such as Division Psychiatrist, Forward Surgical Team Member, or Preventive Medicine Officer.

Second, clinical maturity does not ensure operational maturity. The majority of other Brigade Staff officers have completed the Officer Advanced Course and successful company command. Our clinical training constraints do not normally permit the same experiences for residency graduates. Should we delay two­year Brigade Surgeon assignments for a year or two beyond residency to allow OAC attendance and completion of the resident Brigade Surgeon's course at the AMEDD Center and School? For some officers who are not planning on subspecialty training and who can be pre­positioned a year or two early at the same location where they will join a brigade, the sequence would have merit. However, it would place at a disadvantage those officers who would be interested in subsequent fellowship training or development as academic leaders, a pool of physicians who should be attracted as prime Brigade Surgeon candidates if they are oriented to later leadership. For physicians who will become Brigade Surgeons upon residency graduation, we owe them the most thorough possible operational preparation consistent with their clinical training program requirements.

Third, the timing of the conversion requires attention. With ten Divisions each needing 4 Brigade Surgeons, and our independent Artillery and Aviation Brigades and Armored Cavalry Regiments, the total requirement is about 60 officers. Immediate reassignment of this number of residency graduates without their replacement in kind would compromise overall health care. This summer, with the support of the involved hospital commanders, we will assign residency­trained Brigade Surgeons to the 82nd Airborne Division at Fort Bragg, the 101st Airborne Division (Air Assault) at Fort Campbell, and the two brigades of the 2nd and 25th Infantry Divisions stationed at Fort Lewis. In each case, the hospital will absorb the General Medical Officers now assigned as Brigade Surgeons, and provide clinical access and specialty development opportunities for the new residency­trained Brigade Surgeons. Over the next three years, we will offer sufficient additional HPSP­deferred training primary care specialties to replace an equivalent number of General Medical Officers with residency­trained specialists until the conversion is completed.

To conclude, the Army's need for clinically mature, residency­trained physicians as Brigade Surgeons is compelling. Internists are prominent among those physicians best suited to succeed if the opportunity is structured to serve their needs for clinical, operational and leadership development. Army medicine is fully committed to promoting the interests and goals of officers who are willing to take up the challenge. I anticipate that in future years, the senior leaders in military medicine will include a substantial number of those who were successful Brigade Surgeons.

COL Mike Dunn, FACP
Chief, Medical Corps Branch, PERSCOM

Army ACP Associate's Column

Greetings from your associate's representative. I'd like to take this opportunity to tell you about the Air Force ACP Meeting I recently attended in San Antonio, TX with LTC Bolan and COL Erteschik. It was a pleasure interacting with such a professional and welcoming group. The Air Force meeting has some features that we may like at our Army Fall meeting. For instance, there is an associate jeopardy challenge between groups from the 4 Air Force Internal Medicine residencies. This was not only informative and entertaining, but competitive as well. In addition, there were staff challenge sessions and a series of unknown case presentations titled the "Thieves Market" where the audience participated by asking questions and guessing the diagnoses. I will be in touch with associate representatives from Army residency programs to see how we might bring some of this to our meeting.

At this time we are working with the Air Force to put together a shared meeting. As described elsewhere in this letter, the 1999 Army ACP meeting will be in San Antonio, hosted by Brooke Army Medical Center with input from the associated integrated fellowship and GME programs at Wilford Hall Air Force Medical Center. This will be a wonderful opportunity to initiate a shared, bi­service agenda, and learn more about the structure and philosophy of Air Force Internal Medicine and the San Antonio GME consortium. I'll be informing the associate's of any progress we make toward this goal.

I hope to have seen some of you in San Diego for the national ACP meeting.

CPT Kim Moran, MD
Army ACP Associate Coordinator
Walter Reed Army Medical Center
(202) 782­6205

Medical Student Activities

Recently, our chapter has been very active in encouraging students to consider Internal Medicine as a career, and we are establishing a Student Chapter Committee. As you might suspect, students at the Uniformed Services University of the Health Sciences have an interest in military medicine. So it is easy to find interested students through their "Club Med", the USUHS student run Internal Medicine interest group which has flourished under the tutelage of advisor COL Don Steinweg. The Army ACP chapter, along with the Navy and Air Force chapters, is moving to act as a sponsor for the group. It has been more difficult thus far to tap into smaller, more scattered groups of HPSP students, but a major goal of the Army ACP is to contact and encourage all medical students who may be interested in Army Internal Medicine. We are presently sending messages via electronic mail to HPSP students and working to coordinate the interest in students at USUHS with those throughout the country.

The initial Club Med meeting was attended by approximately 50­75 first and second year students at USUHS who met with LTC Bolan and myself. We have continued to sponsor speakers at USUHS. The Club Med chapter at USUHS includes all uniformed services and is led by two very capable and enthusiastic MS­2 students, 2LT Thomas Wertin and 2LT Eric Richter.

At the Army ACP Chapter Chapter meeting in Reston in November, approximately 60 students attended the meeting and were briefed on Army opportunities by COL Erteschik. All agreed it was an excellent introduction. Next year, we will plan some separate events for students. A possible example would be an explanation of the process of internship and residency selection, or a chance to meet with Program Directors at the Meeting.

This past December we joined with other specialties, such as Family Practice, who have been successful in attracting students to their specialty by arranging meetings with Program Directors who are in town during the Joint GME Selection Board. A jointly sponsored night filled the USUHS cafeteria with interested students, and was attended by representatives from all Army, as well as Navy and Air Force Internal Medicine Residencies. It was a wonderful, informal opportunity for students and program directors to get to know each other before the clinical years start. Special thanks to Col Erteschik for getting everyone to attend, as well as to 2LT Wertin and 2LT Richter for making the arrangements and creating interest at USUHS. We plan to continue this event next year, again, on a night at USUHS during the JSGMESB.

Other activities in the works include encouraging continued medical student membership in the ACP, establishing a medical student web page along with the Army ACP, participating in the AOA sponsored "Specialty Night" at USUHS in the Spring, and perhaps some outreach visits to some of the larger groups of HPSP students. I am open to any suggestions or advice about future activities, or how to improve either the Army ACP meeting or Student Night. I can be reached on cc:mail, or at (202) 782­5692/7056.

MAJ Bill Gilliland, FACP


I am honored and excited to be the first informatics member of the Army Chapter Council of the ACP. The ACP is a leader in exploring medical informatics to improve patient care, as well as patient and physician education. This technology also allows us to implement more robust performance improvement programs and optimize our costs, which are both critical under TRICARE. For those of you with web access, I encourage you to visit the excellent ACP site at http://www.acponline.org

The 14th Annual ACP/Army Chapter Meeting 12­15 November in Reston Virginia featured several firsts in information technology. The session was the first such conference connected by VTC link to several other sites, allowing interaction and possible category I CME credits thanks to the tremendous efforts of MAJ Gary Wheeler, Mr. Tom Biggot, LTC Ron Poropatich and others. While this did not substitute for being present at the meeting (see column by Maj Wheeler), it allowed for those who could not be present to see the presentations and even interact with the discussants. Technical glitches, though present, were few and we encourage local commanders to allow their personnel to participate in future events. We also hope to place presentations on our upcoming Army ACP Web page (see below).

The plenary session allowed us to demonstrate some examples of automation tools available to assist us in patient management and referral. Despite some problems with the communications link, I was able to show most of the available tools, and I greatly appreciate the plenary coordinators allowing me to "take risks" with this live demonstration. Briefly, I was able to give an overview on 1) the impact of automation in medicine, 2) the use of sample automation tools such as medline searching, spreadsheets, and online calculators to assist in patient management, 3) the use of tools in service performance improvement programs, 4) a customized self­paced, self instructional module to allow service chiefs to get all their staff up to speed in basic automation skills. In addition to the Army ACP Web page, this lecture is now online at the "selected nephrology lectures" section of the Walter Reed Nephrology home page http://www.wramc.amedd.mil/departments/medicine/nephro/NEPHROLOGY/.

The Army ACP Web page will feature an online version of the Chapter Newsletter, links to sections for Army ACP Associates, medical students, and materials for continuing medical education and research. We encourage suggestions for the best use of this tool.

Use of automation tools and the world wide web specifically will be emphasized more and more as we seek to ease referral from clinics and community hospitals to medical centers, and to provide better feedback to referring physicians. Distance learning is becoming a command priority as realize the need for continuing education army wide, and we hope this can become an available service for referring physicians. We have applied to offer free category I CME credit to military physicians for several online lecture series in the department of medicine and will announce this when complete. We are establishing a web page for the Army ACP chapter and will be providing details when this is complete as well. Work on a web based referral system is continuing feverishly, and is also a command priority.

We realize many members have tremendous skills in informatics and automation and I invite interested parties to email me through cc:mail (Abbott, MAJ Kevin) or kabbott@vs.wramc.amedd.army.mil. We also realize many members may not have had time to learn automation skills. As web access improves, we hope you can take advantage of our self paced instructional module and welcome any suggestions.

MAJ Kevin Abbott, MD
Staff Nephrologist, Informatics Officer
Department of Medicine

Army Chapter Activities

Fall 1999 Meeting ­ The chapter council voted, and the BAMC leadership agreed to host this meeting in San Antonio. A tentative date is 18­21 November. A major impetus for this move is to expose the Army Internal Medicine Community to the resources and expertise at Fort Sam Houston and BAMC. Due to the integrated fellowship programs at Wilford Hall, an added bonus of the meeting will be the participation of Air Force Internists and exposure to their system. This will not be a formal shared Army Air Force Meeting, as the Air Force ACP Meeting will be in San Antonio in the Spring of that academic year (2000) with participation from BAMC. Afterwards, we will look at the positive and negative aspects of possible future USAF sharing and timing .

The Fall 1998 meeting will be in Reston, again hosted by WRAMC and chaired by COL Yancy Phillips. Coordinating with BAMC personnel will be a priority, thus some subspecialty sessions, such as Hematology Oncology, will have meeting planners at BAMC with on site coordinators at WRAMC.

The Fall 2000 meeting will be shared with the NAVY ACP in the National Capitol Area, probably at Reston VA, co­sponsored by WRAMC and NNMC. Congratulations to US Navy CPT Angela Lazarus, Chief of Internal Medicine at Bethesda Naval Medical Center who has been appointed as the Navy ACP Governor and will start her term in 1999.

Dues ­ The Chapter council voted unanimously to set Chapter dues at $20 per year. Associate dues are tentatively set at $10 pending further input from the Associate's council. We join the Navy and Air Force in having chapter dues, although at a lower rate. Payment of chapter dues is not mandatory for national membership.

Awards and Recognition Chair ­ COL Les Reed, Chief of Medicine at Madigan has been elected to chair this new committee and has accepted the position. In this role he will help our chapter establish a process for selection of awards, as well as facilitating selection of chapter members for national ACP awards and recognition to include nomination of Masters.

Treasurer ­ MAJ Bill Gilliland was elected to fill this position. He has already started a reorganization and accounting of our present fund structure, this should allow establishment of endowment funds to support continued meeting activities, and support for increased associate and student initiatives.

New Chapter Council Member ­ The council voted unanimously to establish an at­large position and elected COL Mike Dunn as the first member.

New Awards ­ MAJ Gilliland has helped establish an award for the outstanding graduating medical student who has been selected for internship training in Internal Medicine, similar to an award given by the Navy ACP Chapter. The first Army award will be given this Spring at USUHS. Our chapter is also looking to establish awards for teaching, research (best publication), and operational internal medicine. Guidelines and proposals for these are being developed by council members for review by COL Les Reed's committee and subsequent presentation to the entire council. If you have suggestions, please contact your council representatives or COL Reed.

Guidelines for Senior Authors ­ Academic research, publication and peer review is the glue that holds together the tri­partite model of teaching, research and patient care. While each one of us may do more or less of each part of the model, it is imperative in our complex, rapidly changing practice environment that our medical system as a whole can do all parts. Because of this importance, authorship and publication are significant (although often vaguely defined) criteria for promotion in military and academic medicine, as well as for selection for GME training. Despite recent publications and revisions in the academic literature on guidelines for authorship, many younger authors in our system seem confused about such matters as determining the number and order of authors on a manuscript, and who is responsible for inclusion or exclusion of contributors to an evolving manuscript. Recently, I have started a collaboration with the Department of Clinical Investigation at Walter Reed Army Medical Center and with others to develop guidelines for senior authors to help lead their junior colleagues in developing the structure, responsibilities and format for changes during the construction of an academic publication. At a minimum, this will give guidance based on the professional standards and fairness expected of military officer leaders, as well as the required academic expertise. We have been refining this material for the WRAMC DCI Research course and will be bringing it to our chapter council for further review and comment. We welcome your input.

Chapter By­Laws ­ With the merger of the ACP­ASIM (see below) all chapters are required to submit revised by laws. Our chapter will complete this task before the next meeting. Our new by­laws will formalize the recent additions to the council in informatics, students, associate, chief resident, and at large council member positions and make provisions for election of members to standing committees. A goal of the new by­laws will be to strengthen the autonomy of the meeting planning process, and to increase capability for non­meeting related activities throughout the year that involve the entire Army Internal Medicine Community.

National ACP News

The biggest news is the upcoming merger with the American Society of Internal Medicine which was approved by the Board of Governors and Board of Regents at the Spring Scientific Session in San Diego. The new organization will go through at least a 3 year transition period with the name ACP­ASIM. While the ASIM does not have military chapters, the merger will affect our chapter in the sense that we will become part of a much larger organization that will speak with one voice for Internal Medicine, retaining the educational focus of the ACP and incorporating part of the advocacy for Internal Medicine seen with the ASIM. There is more detailed information about this merger in ACP publications such as the Annals.

The National ACP Meeting in San Diego this Spring was very successful, with a very visible presence from past, present and future Army Internists. We thank the Navy ACP chapter for organizing the Tri­Service Reception. More information next newsletter on all the contributions and successes of associates and others at this meeting.

Coming Features

Two new columns will debut next issue:

"Operational Internists" ­ This column will provide the stories of internists who have made outstanding contributions to patient care in operational settings. All of them provided superb medical care to their patients under difficult and dangerous military operations. All of them also continued to uphold the highest values of the American College of Physicians afterwards, whether they continued in the Army or in civilian life. The first will be Dr. Daniel S. Ellis, who started World War 2 as internist with the 6th General Hospital in North Africa and Italy, then served as a Battalion Surgeon with the Field Artillery and still later served with an evacuation hospital that was the first medical unit in Dachau concentration camp. Dr. Ellis returned to civilian medicine at the Massachusetts General Hospital, where he is Professor Emeritus of Medicine, a Master of the ACP and past Governor of the Massachusetts chapter. The themes of this section will be excellence and professionalism in the care of patients across wartime, operational and peacetime settings. I welcome suggestions or essays from readers of this newsletter for other internist physicians who fit this model.

"Clinical Corner" ­ This column will feature internists who share their expertise to answer questions or provide anecdotes to illustrate important clinical concepts, and will be sponsored by our Chief Resident Council Chapter representative. The requirement is for recognized expertise, and availability for our members who have questions. The "corner" will be kicked off next issue by Dr. Sandra Kweder, CDR USPHS, who spoke at our recent chapter meeting on the Internist and the Pregnant Patient. Dr. Kweder has completed fellowship training in this field, and she welcomes your suggestions or questions to be used next column. Please feel free to contact her at (301) 827­3221, or on e­mail at Kweder@CDER.FDA.GOV

The next newsletter will be shorter, and sooner ­ before the summer. It has been a tremendous privilege to serve as governor this past year. I look forward to your input and suggestions, and thank all the contributors to this newsletter and chapter activities.

LTC Charles Bolan, FACP
ACP Governor for Army


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