Military doctors: junior doctors’ experiences in the British armyBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5729 (Published 24 September 2014) Cite this as: BMJ 2014;349:g5729
- Gareth Huw Jones, core surgical trainee, retired British army medical officer 1,
- Matthew Wordsworth, core surgical trainee, British army medical officer2
Being a doctor in the British army is an exciting and challenging opportunity for UK medical graduates. Gareth Huw Jones and Matthew Wordsworth describe their experiences
Serving in the Royal Army Medical Corps allows doctors to combine clinical duties, including the treatment of wounded military personnel in intense combat situations, with the responsibility of organising and leading a medical unit as part of a coordinated military force. Medical officers, as doctors in the British army are known, are expected to handle the most demanding situations in a role that requires excellent clinical care, fitness, courage, leadership, initiative, and discipline.
Medical officers usually join the army during their first two years of medical school, after applying to the army officer selection board for consideration for a medical cadetship. This board tests physical fitness and mental acumen. Successful applicants achieve a short service commission of 10 years with the option to extend this if higher specialty training is sought within the army.
After completing medical school, a medical officer cadet is promoted to lieutenant and proceeds to foundation training, usually within a Ministry of Defence hospital unit, although foundation training is possible at any NHS hospital. The United Kingdom currently has four such units, based at Frimley Park, Portsmouth, Plymouth, and Northallerton. Foundation training can also be undertaken at the Royal Centre for Defence Medicine, which is based at Queen Elizabeth Hospital in Birmingham.
Until completion of foundation training, the career of a medical officer is identical to that of a civilian junior doctor.
Time at Sandhurst
However, when they have completed foundation training medical officers undertake three non-training years of general duties, which begin with the professionally qualified officer course at the Royal Military Academy Sandhurst. The course lasts 10 weeks and is designed to teach basic soldiering skills to enable professional individuals to integrate fully with the larger army.
After the professionally qualified officer course, medical officers attend a course focusing on the medical knowledge required for working as a general duties medical officer. This includes more advanced trauma training, emergency prehospital care, wilderness, and occupational medicine. On completion of this course, medical officers apply for a posting, similar to the way civilian trainees declare preferred hospital placements.
The posting has a military and a clinical component. The military component is responsible for administration and is usually in one of the fighting infantry and cavalry regiments of the army, known as teeth arm regiments, or in a specialised medical regiment. The army has six specialised medical regiments, which are made up of all the clinical personnel the army requires on operations. These units each have their own medical officer. Regiments can call on their medical officer for duties such as operational deployment or foreign and domestic military exercises.
The clinical component, which is a supernumerary position, is based at an army medical centre similar to a general practice. An assigned educational supervisor is responsible for maintaining a medical officer’s clinical skills, and annual appraisals are needed to meet the requirements of revalidation.
There is much more to life as a medical officer in the army than just work, with some great opportunities for sports and expeditions. Medical officers are able to offer medical support and are therefore enthusiastically recruited by expedition organisers. Social functions form an important part of army life, and medical officers quickly become part of the unit family. The cornerstone of social events among officers is the officers’ mess, which is similar to the doctors’ mess as it used to be, with young single officers living in. “Livers-in” dine together and can make use of reception rooms and the mess bar, an environment that is key to creating close relationships that can hold up under the stress of combat.
After medical officers have completed these three non-training years of general duties they usually apply via national selection for core training, which can be in general practice or a hospital based specialty. To maintain high standards, the army uses the national interview selection process to assess the suitability of its medical officers for their chosen specialty. In essence, for medical officers to secure a core training year 1 job they must achieve an interview score good enough to be offered the same specialty job in the NHS. Core training is usually undertaken at a Ministry of Defence hospital unit, but medical officers often find themselves working in NHS hospitals to achieve the necessary experience. Core training is identical for medical officers, who still need to achieve the desired competencies and pass their annual review of competence progression to be eligible to apply for higher specialty training.
Even though I now find myself several years behind my medical school colleagues on the training pathway, the years out have been hugely beneficial to my development. The experiences matured me; I feel more focused on my aim to become an ear, nose, and throat consultant; and, if I had my time again, I wouldn’t do anything differently. I would encourage anyone who is interested in an army career to attend a Sandhurst open day after filling in the application form. It’s never too late to inquire as the army is always looking for the right kind of medical students and doctors to recruit.
My experience: Gareth Huw Jones
My experience as an army medical officer was quite typical. I joined the army in my third year of medical school as a medical officer cadet and completed my foundation training in Birmingham. As my medical school colleagues went on to core training, I went to Sandhurst. The 10 week course at Sandhurst consisted of indoor and outdoor classes, navigation, marksmanship, fitness, and drill, with several week long exercises. It was a nice change from hospital life.
After submitting posting preferences I was allocated a position as a general duties medical officer at 3 Medical Regiment based in Catterick, North Yorkshire. The clinical posting was at the Army Foundation College in Harrogate, a military college for potential recruits, where our patient base was mainly 16 and 17 year olds and some permanent members of staff. The clinical position was supernumerary so that the medical regiment could deploy me when needed, and during my 30 months with the regiment I was deployed to Kenya, Canada, and Afghanistan.
The exercise in Kenya was essentially humanitarian. The medical regiment dispersed into the rural parts of Kenya and delivered primary healthcare to local people and education in schools. The Canadian exercise entailed providing medical cover for troops during a huge, multidisciplinary exercise designed to simulate a real battle involving tanks, artillery, and infantry. It was carefully controlled but inevitably injuries happened. I had my own helicopter on standby 24 hours a day, which would deliver me to the casualty for treatment and, if needed, evacuation to the local hospital. It was great experience and prepared me well for the tour of Afghanistan that was to follow.
Both Kenya and Canada were large generic exercises designed to give soldiers an opportunity to practise a whole spectrum of military skills. Before the tour of Afghanistan I completed a more specialised 12 month training programme, which every soldier deployed is expected to complete. It consisted of both soldiering and clinical skills specific to Afghanistan.
I deployed to Afghanistan for a six month tour of duty. Unlike the consultants, who are based at Bastion Hospital, the junior doctors were dispersed among the many small patrol bases throughout Helmand province to provide primary care and prehospital emergency care to frontline soldiers.
It was tough work being on call around the clock for six months in a harsh environment as a sole doctor without the amenities we take for granted in the UK, such as running water. As a medical leader, motivating those under my command under such conditions was among some of the challenges I faced. But it was an exciting time. I learnt important skills that were transferable back into the NHS, especially within the realms of management and clinical governance.
Midway through my tour of Afghanistan I returned home for the standard two weeks’ leave, which was arranged so that I could attend my core surgical training interviews. The army was unable to offer the ear, nose, and throat specialism that I wished to pursue, and, after finding out towards the end of my tour that I had successfully picked up a core surgical training place in the North West Deanery, I applied to leave the army. The army honoured my wish, and I was officially a civilian doctor when I started my core surgical training last year.
My experience: Matthew Wordsworth
I also joined the army while at medical school and experienced a medical elective in a Washington trauma centre, a general practice placement in Cyprus, and a skydiving trip. I served as a general duties medical officer at 4 Armoured Medical Regiment in Aldershot and worked with the Grenadier Guards on Operation Herrick 16 in Afghanistan. An operational tour was my main reason for joining the army, and it proved to be as challenging and exciting as expected. Having witnessed the skill set and professionalism of army consultant surgeons both in Afghanistan and in the UK, I have decided to stay in the army. I am currently an army core surgical trainee in London and will be applying for higher surgical training next year. If I am successful, I want to stay in the army and apply to extend my commission to serve as a consultant surgeon. Military life is not for everybody. The benefits and experiences gained have been considerable, but so too have the disruptions. If a career in the Defence Medical Services is of interest, then I would recommend exploring it further.
Competing interests: We have read and understood BMJ’s policy on declarations of interests and declare the following interests: None declared.