NEWS | May 22, 2018

Pacific Allies Observe U.S. Military Medicine

By Kirstin Grace-Simons Madigan Army Medical Center

JOINT BASE LEWIS-MCCHORD, WASH. -- At over 4,000 miles, Joint Base Lewis-McChord, Wash. is a ways to travel from Japan to have a look at something. For Japan Ground Self-Defense Force (JGSDF) medical officers Capt. (Dr.) Kento Sonoda and Capt. (Dr.) Shohei Inui, getting a close-up view of U.S. military medicine was worth the trek.

Each year, the JGSDF Staff Office selects two doctors to participate as international military students in the U.S. Army Medical Command Military Treatment Facility Observation Training program.

Sonoda, a family physician, and Inui, a radiologist, spent five weeks at Tripler Army Medical Center in Honolulu, Hawaii, and six weeks here at Madigan Army Medical Center.

"In Hawaii, we had a fundamental global health engagement course for a week, and went to the Veterans Affairs' clinic and Soldier-centered home clinic," said Sonoda.

At Tripler, their observation focused mostly on their respective clinical rotations. They have not been directly involved in patient care, but have attended examinations and engaged in follow up discussion. In addition to rotation observations, at Madigan, faculty development was a particular focus for Sonoda.

"It is a unique program even in the U.S. Army," said Sonoda. "Within the Japan Self-Defense Force medical facilities, there are no opportunities to have a fellowship of faculty development. So, it is one of the most impressive things during my stay in Tacoma."

Madigan offers the Faculty Development Fellowship through the Army Graduate Medical Education Office at the Office of the Surgeon General. With a mix of clinical rotation, research and precepting, the two-year fellowship is the only program of its kind in the Army that offers a unique blend of physician leader development, and an advanced master's degree, all while remaining clinically active in their specialty as adjunct faculty.

"It's focused on improving physician leadership and teaching skills, with the goal that many of us will go on to be leaders in military medical education," said Maj. (Dr.) Jeffrey Burket, one of the fellows. "We're from all specialties and branches of the service; currently most of us are family medicine physicians in the Army."

Given the differences in medicine between his country and the U.S., this fellowship is of interest to Sonoda.

In general, medical education in Japan puts emphasis on fostering specialists rather than family physicians or generalists, compared to the U.S.

"Family physicians need to see patients comprehensively, head-to-toe, not only from a physical perspective, but considering psychological and social concerns, sometimes involving issues of the family members," noted Sonoda. "I am very interested in this field. But, as I mention, we are facing a shortage of family physicians due to the specialists-oriented medical system in Japan. JGSDF has acknowledged the importance of family medicine and prioritized training medical officers with those skills."

Burket was keen on displaying the approach of the fellowship program to Sonoda during his stay.

"The whole point of our fellowship is to show that being intentional and dedicated to improving your teaching skills and your leadership skills within a medical training setting is important, that it takes time and effort and intentionality to do that well. This is part of how the U.S. military gets at that mission," he explained.

"Capt. Sonoda has also spent time with us in the preceptor room, like today when (Maj.) Dr. (Nick) Bennett and I are overseeing residents as they come in and discuss patient care; he's been observing and helping out with that. He can see, again, some of the things that we like to think about as far as educational theory and approaches to teaching the residents. What does that look like in a very real way in the clinic or in the hospital?" Burket said.

Sonoda and Burket agree that there is great value in this type of exchange.

"It's been nice having him around. And then he's got a lot of subject matter experience and perspective as well which is nice to add," said Burket.

Noting that deployed situations invariably involve working with multinational forces, Burket stressed that medical assets across partnering forces become integrated quickly in a tactical scenario. "So, the more we can know, understand and be able to work side-by-side easily, that's going to benefit all the Soldiers, Sailors, Marines, and Airmen down the road," he said.

Additionally, Sonoda gave a presentation to the Madigan Family Medicine Residency Program that described medical education in Japan, the basic organization of the JGSDF, and how medical personnel are integrated into the Japanese military. "For many of us, that was the first time we had had the opportunity to learn about Japanese military medicine. Every step towards more understanding and cooperation between our forces is important as we may end up working side-by-side together in the future," said Burket.

Sonoda nodded in agreement. He and Inui have visited a number of U.S. medical facilities, both military and civilian.

In addition to seeing Madigan assets, to include JBLM CARES, the Warrior Transition Battalion, Madigan Troop Battalion, the Puyallup Community Based Medical Home, the Andersen Simulation Center and attending a TeamSTEPPS training, the officers visited I Corps and 7th Infantry Division surgeon cells and spent time with the Soldiers and civilians of Public Health Command-Pacific and its veterinary health and food inspection units at Public Health Activity-Fort Lewis.

The officers will share their observations with their home units in the form of reports. "Some of the medical officers read it and learn it," said Sonoda. "If they get interested in my reports, they may contact me personally. Our society is very small, so it is easy to get access to others."