Leadership in the Army medical department 

October – December 2009 

Perspective 1

MG Russell J. Czerw 

Leadership and Healthcare Perfection 5 

COL Chuck Callahan 

Critical Leadership Attributes for Army Medical Department Officers 11

Jody R. Rogers, PhD 

An Exploratory Study of the Characteristics of an Admired Leader 14 

MAJ Samantha Hinchman; LTJG Jeff Magone (USN); CPT John Marshall; Benita Stoddard 

Leadership Wisdom 17 

COL Mark A. Melanson 

Leadership Math 21 

COL Chuck Callahan; 1st Lt Timothy Callahan (USAF) 

Personality Type and Leadership 24 

David K. Hagey, MS 

Dynamic Leadership: Essential for the 21st Century 27 

MAJ D. Scott McIlwain 

Resonance, Dissonance, and Leadership 32 

COL Chuck Callahan 

The Mentoring Spectrum 37 

COL Mark A. Melanson 

Seasons of Army Mentorship and the Mentoring Staircase 40 

COL Mark A. Melanson 

Qualities of the Ideal Protégé 44 

COL Mark A. Melanson 

The Personality, Passion, and Essence of a Leader 47 

MSG Reginald K. Hall 

Legal Counsel: A Leadership Tool 54 

MAJ Joseph B. Topinka 

360 Assessment, an Easier Pill to Swallow: Implementation of Peer Assessment 59 

for Captain’s Career Course Students and Staff 

LTC Eric Sones 

ALSO IN THIS ISSUE

Ultrasonography for Advanced Regional Anesthesia and 64 

Acute Pain Management in a Combat Environment 

COL (Ret) Randall J. Malchow

Cardiovascular Risk Factor Screening and Follow-up in a Military Population 67 

Aged 40 Years and Older

COL Diane Flynn; MAJ Jeremy D. Johnson; Cathy J. Bailey, RN; CPT Jason T. Perry; et al 
LTG Eric B. Schoomaker 

The Surgeon General 

Commander, US Army Medical Command 

MG Russell J. Czerw 

Commanding General 

US Army Medical Department Center and School 

October – December 2009 The Army Medical Department Center & School PB 8-09-10/11/12 

0932007 

GEORGE W. CASEY, JR 

General, United States Army 

Chief of Staff

DISTRIBUTION: Special 

Administrative Assistant to the 

Secretary of the Army 

By Order of the Secretary of the Army: 

Official: 

JOYCE E. MORROW 

Online issues of the AMEDD Journal are available at http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1 

A Professional Publication 

of the AMEDD Community 

The Army Medical Department Journal [ISSN 1524-0436] is published quarterly for 

The Surgeon General by the US Army Medical Department Center & School, ATTN 

MCCS-DT, 2419 Hood St STE C, Fort Sam Houston, TX 78234-7584. 

CORRESPONDENCE: Manuscripts, photographs, official unit requests to receive 

copies, and unit address changes or deletions should be sent to the Journal at the 

above address. Telephone: (210) 221-6301, DSN 471-6301 

DISCLAIMER: The Journal presents clinical and nonclinical professional information 

to expand knowledge of domestic & international military medical issues and 

technological advances; promote collaborative partnerships among Services, 

components, Corps, and specialties; convey clinical and health service support 

information; and provide a peer-reviewed, high quality, print medium to encourage 

dialogue concerning healthcare initiatives. 

Views expressed are those of the author(s) and do not necessarily reflect official US 

Army or US Army Medical Department positions, nor does the content change or 

supersede information in other Army Publications. The Journal reserves the right to edit 

all material submitted for publication (see inside back cover). 

CONTENT: Content of this publication is not copyright protected. Material may be 

reprinted if credit is given to the author(s). 

OFFICIAL DISTRIBUTION: This publication is targeted to US Army Medical 

Department units and organizations, and other members of the medical community 

worldwide. 
 October – December 2009 1

Leadership is a vital component to the success of any 

organizational enterprise. At the most basic levels, the 

practice of medicine is a team effort, with defined 

roles and responsibilities which, however, may overlap 

or merge somewhat in the turmoil of saving a life. At 

those moments, leaders must step in and direct the 

efforts toward the desired outcome. Otherwise, nondirected activity can be futile, and often deadly. This is 

especially true in the chaos of combat operations when 

medical resources can be overwhelmed in the crush of 

heavy casualties. Those leadership skills are 

developed, molded, and refined as military medical 

professionals move through their military careers, 

exercising ever-increasing levels of nonmedical 

responsibility and authority, all the while retaining, 

expanding, and practicing their medical skills. 

Military leadership skills have long been recognized 

for their value as military members leave active duty 

and move into civilian careers. Medicine is no 

different. Indeed, the many military medical professionals who are Reserve or National Guard naturally 

demonstrate their leadership skills and experience in 

positions of authority and influence in their civilian 

practices. This facet of professionalism sets them apart 

from their purely civilian contemporaries. The medical 

professional with military experience has long been 

considered to be a very desirable, extremely valuable 

asset by the medical community, not only for their 

incomparable medical skills and experience, but also 

for the irreplaceable leadership skills that are a product 

of that military environment. 

Two years ago, the Army Medical Department 

(AMEDD) Journal published an issue focused on the 

development of leadership among AMEDD officers. 

In that excellent issue, the emphasis was on the 

resources and structure in place to develop and refine 

the leadership skills and techniques of our officers 

throughout their military careers. Articles dealt with 

the formal training provided at the AMEDD Center 

and School, the continuing training and professional 

education provided to staff members at medical 

facilities, and various topics and elements which 

should be addressed in any leadership education. With 

this issue, I am pleased to present another collection of 

articles focused on leadership in the AMEDD. Most of 

these articles explore various aspects of the building 

blocks of leadership, the theories, the practice, and the 

application, along with the experiences and 

observations of some of our long-tenured military 

medical professionals who share a strong dedication to 

the development and practice of leadership skills. 

One of those who writes frequently on the subject is 

COL Chuck Callahan, who opens this issue with 

another of his thought-provoking articles. In this case, 

he addresses the relationship between leadership and 

the quest for perfection in the delivery of healthcare. 

We all understand that, in the literal sense, true 

perfection is unachievable in most human 

undertakings. COL Callahan develops the perception 

of healthcare perfection within an evolving, historical 

framework, and demonstrates that leadership skills and 

actions are woven throughout its progress, and will be 

more vital to its success in the future. Although the 

demographics of patient populations may be 

dramatically different, the principles presented in this 

article are relevant throughout the practice of 

medicine, whether military or civilian. 

Throughout history, leadership has been extensively 

studied as we have attempted to define the what and 

why of successful leaders. Dr Jody Rogers has 

contributed an article which looks at personal 

attributes which seem to be necessary for successful 

leadership. He discusses 5 specific attributes that he 

Perspective 

Major General Russell J. Czerw
2 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Perspective 

calls critical for effective leadership: character, 

competence, competitiveness, courage, and care. His 

approach is straightforward; an individual must 

prepare for positions of leadership by focusing on 

development of those 5 attributes, sooner rather than 

later. Dr Rogers develops each of the attributes from 

the perspectives of both the leader and those in his 

charge, making the case for each of them as a building 

block for effective, successful leadership. Military 

medicine depends on such leaders every single day to 

continue the high level medical care and services our 

Warriors deserve. 

MAJ Samantha Hinchman and her coauthors further 

explore personal attributes of successful leaders in 

their article describing a study among officer students 

attending the AMEDD Captain’s Career Course which 

examined their opinions of admired attributes of 

leaders. The survey used in the study was modeled on 

an extensive, worldwide study which involved over 

75,000 people. They compiled the results of the 

surveys administered to the students and compared the 

results to the earlier, larger study to see if the targeted 

military officer group had a different perspective on 

leadership than the other, much more diverse 

respondent population. Indeed, a statistically significant difference was revealed in 13 of 20 of the 

proposed attributes. It is understood that the military 

attracts a segment of the population with certain outlooks, opinions, and expectations, therefore, this type 

of study should be considered a first step in exploring 

their attitudes about leadership throughout their 

careers. This exploratory study suggests that academic 

and scientific research studies of specific or general 

population groups regarding leadership may not be 

directly applicable for the military environment. 

Additional data may indicate that our training and 

literature should be reviewed and adjusted to address 

the unique nature of both new and experienced leaders 

within AMEDD. 

Another of AMEDD’s more prolific contributors on 

various topics of leadership is COL Mark Melanson. I 

welcome him back to the pages of the AMEDD 

Journal with an article that effectively coalesces his 26 

years of leadership experience and advocacy into 10 

points that he calls tips for leaders at all stages of their 

careers. He explores each point from the perspective of 

his extensive research and experience, and presents 

them within the practical realities of real-world 

application. Such insight is invaluable for anyone 

involved in leadership, whether in practice or the 

development of training. Theories and academically 

developed methodologies obviously have their place in 

the molding of leaders. However, the most valuable of 

lessons are usually from those such as COL Melanson 

who have experienced what works and what does not 

as they themselves practice leadership on a daily basis. 

COL Chuck Callahan returns with a unique authorship 

collaboration, his son, 1st Lt Timothy Callahan, 

USAF, to contribute an article that frames leadership 

dynamics in a mathematical construct. The initial 

reaction to that description may be skepticism, but the 

approach reveals a practical, easily understood 

description of 10 elements of leadership theories and 

practice with direct mathematical corollaries. It is an 

easy and enjoyable read that brings the challenge of 

leadership into a truly user-friendly format. 

Leadership development is a challenging, complex 

undertaking, especially since it involves disparate 

individuals and provides virtually no metrics. Mr 

David Hagey’s article discusses what may be the most 

basic of parameters to consider in an individual’s 

development process, that person’s personality type. 

He presents one of the most widely used tools in 

personality evaluation and definition, the MyersBriggs Type Indicator, and applies its criteria to the 

various leadership styles that are common among 

individuals. Since leadership depends on effective 

personal interactions and positive perceptions among 

all involved, Mr Hagey posits that the successful 

leader understands his or her personality type and 

preferences, and then tailors their skills to optimize the 

associated natural leadership style. This is another 

easy, enjoyable read that invites the reader to think 

about important aspects of their own personality and 

preferences, and evaluate their personal leadership 

effectiveness from that perspective. 

Following consideration of perhaps the most basic 

element of leadership development and practice, the 

individual’s personality, MAJ Scott McIlwain presents 

us with a discussion of the largest factor, the 

demographics of the entire population from which the 

military draws its members. His article proposes that 

the changing character of that population will 

necessarily mandate adjustments in our approach to 

leadership at all levels. Such changes are required not 

only to guide those who are in the military, but also to 

adjust to those demographic shifts to continue 
 October – December 2009 3

THE ARMY MEDICAL DEPARTMENT JOURNAL

attracting the high quality individuals required by 

today’s military services. MAJ McIlwain explores the 

unrelenting changes in the racial makeup of the 

population, the changing character of ethnicities 

present in US society, the shifts in religious 

denominations and practices, and, finally, the everevolving generational shifts in attitudes and expectations. This article is a well-researched, absorbing 

presentation of the challenges that lay ahead for the 

military leadership of both today and tomorrow. 

After all of the elements examined in the articles 

discussed above have been addressed, a leader should 

be completely prepared to be successful and 

productive in application and practice; or perhaps not. 

COL Chuck Callahan’s last article in this issue 

discusses the situational and environmental factors 

which can either adversely or positively affect a 

leader’s effectiveness and the organization’s success. 

He presents the situational concepts of resonance and 

dissonance, and how these must be taken into account 

by leaders. While the concept may, on the surface, 

seem esoteric and perhaps academic, COL Callahan 

expertly develops them into real-world, everyday 

situations and scenarios that we all immediately 

recognize. Resonance and dissonance deal with the 

emotional environment within which we function. It 

can be reinforcing or destructive, and is the product of 

personalities and actions. Proper application of good 

leadership can correct a corrosive and destructive 

environment. Conversely, bad leadership can destroy a 

functioning, positive situation, sometimes beyond 

recovery. This is an important article, the premise of 

which should be carefully considered by those charged 

with leadership training and development. 

A longtime advocate of mentorship as a vehicle for 

professional development, COL Mark Melanson 

contributes 3 articles discussing different aspects of 

this very important tool. As in his first article, he 

draws upon his long experience in practicing the art of 

mentorship to develop these articles from an overview 

perspective. In the first article, he discusses the entire 

spectrum of the mentor’s roles in a long-term 

mentoring relationship. He charts the evolving nature 

of the mentor’s responsibility, starting as a role model, 

progressing through several other stages, until finally 

the mentor serves as the protégé’s counselor as he or 

she moves into positions of greater responsibility and 

influence. In the second article, he expands this approach, presenting a look at the pattern of growth that 

is experienced by successful Army mentors throughout 

their careers. He uses the analogy of the seasons of the 

year to describe the evolution, from the spring as a 

protégé, to the winter as a grand master mentor. He 

also charts the progression as a staircase coinciding 

with higher ranks and the incumbent increased 

responsibilities. These are illuminating and thoughtful 

articles that can be used as a barometer for all of us 

invested in the growth and success of those in our 

charge. 

In the third article, COL Melanson addresses the 

expectations a mentor should have in the protégé. 

Since a mentoring relationship is a reciprocal arrangement, the protégé’s attitude and commitment are 

important factors in success or failure. He describes 10 

qualities a mentor should expect from an ideal protégé, 

both initially and as the mentoring arrangement 

progresses. This article is an excellent, succinct 

presentation which could be used as a primer for a 

potential protégé to understand what is expected from 

him or her. 

The next article provides a valuable opportunity to 

present a thoughtful, articulate discussion of leadership 

from a completely different perspective, that of a 

senior, noncommissioned officer who has been 

exposed to leaders and leadership development 

training throughout his career as an enlisted Soldier. 

MSG Reginald Hall does not attempt to parse 

leadership into descriptive adjectives or quantify those 

elements that lead to success or failure. His approach 

is from a more “macro” level, those innate 

characteristics, talents, and qualities, especially a set of 

strong, personal values, that must be present before the 

more specific tools and techniques can be successfully 

applied. He challenges the comfortable (and easy) 

assumptions about leadership as a function of training, 

longevity, position title, and image. Rather, his article 

discusses many of the intangibles—those actions, 

nonactions, reactions, adherence to values, 

perceptions, and courage—that intelligent, competent 

people invariably look for in a leader. MSG Hall 

develops his presentation with obvious insight from 

experience, including that of being a leader himself, 

and education as he moved through his successful 

military career. As you read this article, you will 

recognize many things that you have seen or sensed in 

leaders (and followers), both in and out of the military 

environment. This is another article that should be 

carefully read and contemplated by everyone in 
4 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

leadership positions, and by those charged with 

preparing our Soldiers for those responsibilities. 

Obviously, leadership cannot be practiced in a 

vacuum. No one is omniscient and can address all of 

the facts and circumstances necessary for decisions 

and actions without informed advice. In our reality of 

statutes, regulations, directives, standards, and 

guidelines, no leader can improvise in areas that are so 

governed. MAJ Joseph Topinka’s article clearly and 

succinctly outlines a number of the many areas in 

which judge advocates are valuable resources for 

AMEDD leaders. From the routine decisions involving 

the obligation of funds, to the dynamic, reactive 

actions necessary in response to a declared public 

health emergency, the legal aspects and ramifications 

of many decisions must be understood, and addressed, 

always very early in the process. This article is a 

sobering synopsis of a few of the areas in the practice 

of military healthcare that are affected, either directly 

or peripherally, by important legal considerations. 

MAJ Topinka’s article is a timely reminder that 

military legal counsel is an invaluable, readily 

available tool in an AMEDD leader’s decision process. 

It is a source of very specialized assistance and 

guidance that we cannot afford to overlook. 

As mentioned earlier, leadership development is 

especially challenging in that it involves disparate 

individuals and offers virtually no metrics. Reduced to 

the most basic of parameters, the success or failure of 

leadership is dependent on the response from those 

who are led. Consequently, one of the ways to evaluate 

a person’s leadership potential is to ask those with 

whom that person interacts. Military schools and other 

training organizations often use peer evaluations to 

gauge each person’s perceived capabilities and 

potential. In his interesting, detailed article, LTC Eric 

Sones, Chief of the AMEDD Captain’s Career Course, 

describes the development of a peer assessment tool to 

assist the Small Group Leaders on the staff to improve 

their leadership skills. It is obvious that the successful 

implementation of the assessments was due to the 

extensive planning that was involved. The use of the 

surveys has now been expanded to the students at the 

Course, and the results have proven to be a valuable 

learning tool for students and staff alike. 

I am pleased that we have the opportunity to include 2 

additional articles in this issue dealing with delivery of 

healthcare. Each of these articles, albeit brief, contain 

information which is timely and important to the 

health and well-being of our Warriors. In the first, 

retired COL Randall Malchow describes his experience implementing the first use of ultrasound guided 

advanced regional anesthesia at a combat support 

hospital (CSH), in this case, the 47th CSH in Mosul, 

Iraq, in 2006-2007. This technique, using high 

frequency ultrasonography to identify individual nerve 

trunks for direct application of anesthesia, had been 

used in medical facilities for several years, but it had 

never been attempted in a deployed combat environment. In a 3-month period, 44 such procedures were 

successfully performed at the 47th CSH, not only validating this application, but stimulating the use of ultrasonography in other treatment applications as well. 

This article is another excellent example of the 

resourcefulness, energy, and dedication to the welfare 

of our Soldiers that is the standard of our military 

medical professionals. 

Concerned about information from the Armed Forces 

Institute of Pathology in 2008 that cardiovascular 

disease is the second leading cause of death in Soldiers 

aged 40 or older, COL Diane Flynn and her team 

conducted a study of that population group at Fort 

Lewis to determine 2 things; identification of 

unmanaged cardiac risk factors in those Soldiers, and 

the extent to which those so identified would comply 

with instructions to follow-up with their primary care 

provider. Their article reports their findings, which, in 

conjunction with earlier, similar studies, should be of 

concern to all of us involved in the delivery of 

healthcare. As pointed out in the article, voluntary 

participation may have skewed the results upwards, 

but it is still troubling that about a quarter of those 

examined had unmanaged cardiac risk factors. Even 

more disturbing, however, is that only a quarter of 

those with detected risk factors complied with 

instructions to follow-up to address those potential 

problems. As COL Flynn et al recommend, AMEDD 

should consider policies which ensure that Soldiers 

found to have cardiac risk factors do in fact report for 

follow-up evaluation and indicated interventions. 

Considering the statistical evidence of the potential 

seriousness of the conditions, and the indications in 

repeated studies of the presence of cardiac risk factors 

among our older Soldiers, the involvement of a 

Soldier’s command in follow-up examinations and 

care may be warranted. 

Perspective 
 October – December 2009 5

Hospitals are the sinks of human life in the Army. They 

have robbed the United States of more citizens than 

the sword. 

Dr Benjamin Rush1

Healthcare used to be simple. Three or four hundred 

years ago, people who were sick sought a provider to 

heal them of illnesses for which there was seldom any 

cure. If you needed a healthcare provider, the chances 

were that you were facing an inevitably fatal 

condition. The best “product” that the provider could 

offer was often palliative, and the best that the 

provider could hope for was to separate the patient’s 

presentation from his or her demise with enough time 

to avoid culpability. 

Healthcare was delivered in the home. Providers were 

summoned to the patient’s bedside. Diagnosis and 

treatment were rendered in the same room, and the 

family was responsible for continuing nursing care. All 

of the ownership of the processes to deliver 

“healthcare” belonged to the patient and his or her 

family. The provider often took away the “fee-forservice” on a leash or in a cage. 

Hospitals emerged for several reasons, including the 

need to cohort the sick to deliver more efficient care, 

or to quarantine them from society and minimize risk 

of contagion from poorly understood diseases. 

Hospitals also developed around the need to train more 

providers. In 1714, Herman Boerhaave incorporated 

clinical bedside teaching at Saint Cecaeilia’s Hospital 

in Leiden, modeled after that championed by Thomas 

Syndenham in England. Boerhaave’s system for 

training physicians became the model for Europe in 

the eighteenth and nineteenth centuries, and laid the 

foundation for American medical education. Medical 

students were trained to think of his system of training 

and practice as “perfect, complete and sufficient.”2

But what happened to healthcare? When patients were 

admitted to the hospital, they lost control of the 

healthcare processes they owned when their care was 

delivered at home. Providers also abdicated control of 

their patients who became cohorts in substandard 

facilities. They were turned over to a system that was 

poorly designed, and were surrendered to the care of 

attendants who had insufficient training and ill-defined 

duties and skill-sets. Medicine and healthcare delivery 

have not become any less complex since Boerhaave’s 

day. And yet there is no more consistent, clear ownership of the healthcare delivery personnel, processes 

and facilities today than there was 300 years ago. 

Today, healthcare is delivered in extraordinarily 

complex systems where routine activities are affected 

on high-risk patients and high-risk activities on routine 

patients. Hospitals are often places where 

insufficiently informed people are exposed to highly 

dangerous situations inflicted by well-trained, 

generally well-meaning but overworked professionals 

who are too often unaware of each other’s capabilities 

and limitations. Each owns an individual link in the 

healthcare delivery chain. But no one owns it entirely. 

There is no question that healthcare will eventually 

return to the home. As it is now, despite having a 

“hospital-centric” approach to healthcare in our 

country, a strikingly small percentage of a population 

ever come anywhere near a hospital. White et al 

introduced the concept of “healthcare ecology” in a 

1961 article.3

 White reviewed and validated the 

concepts several decades later while additional 

researchers demonstrated the principles in a range of 

populations.4-6 Healthcare ecology is a model that 

helps to describe the health concerns of a population as 

well as the sources of care for that population. For 

example, Green et al determined that, based on data 

from a series of national surveys, “Of 1,000 men, 

women, and children in the United States, we 

estimated that on average each month, 800 

experienced symptoms, 327 consider seeking medical 

care,....”5(p2023)

Further, the study by Green et al showed that 217 of 

those 1,000 hypothetical patients visit a physician’s 

office, 65 visit an alternative or complementary practitioner, 21 are seen in a hospital clinic, and 13 are 

seen in an emergency room. Of these numbers, only 8 

patients are hospitalized, of which one is admitted to 

Leadership and Healthcare Perfection 

COL Chuck Callahan, MC, USA 
6 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

an academic medical center.5(p2023) So, while 80% of 

the population has a medical question or concern for 

which they could use some information or insight, less 

than one third will seek help. Too often we use the 

term “access” to refer to a patient’s insurance coverage 

or the availability of patient appointments. Patients 

need answers to questions and concerns far more often 

than they require an intervention in the system. For the 

most part, these facets of care can be delivered at 

home. 

What kind of healthcare system will be robust enough 

to provide the depth of specialty and subspecialty care 

that is required for the most desperately ill in the 

population and will at the same time be agile, flexible 

and responsive enough to address patient’s healthcare 

concerns at home? 

Very simply put—a perfect one. 

We bristle at the term “perfection.” It could be because 

it was the standard to which we were held as children 

when we didn’t come home with “straight A s.” Or it 

could remind us of the excuse we used as kids when 

we failed to measure up: “Well, nobody’s perfect.” It 

may suggest a zero-defect, no-excuse, no-mistakestolerated climate where error or dissent is swept under 

the rug by smiling, well-dressed chief executive 

officers (CEO) or crisply starched commanding 

officers. But really, “perfect” is none of these things. 

The “absence of error” is only one definition for 

perfect. Perfect is better used as an adjective that 

means: “1. Lacking nothing essential to the whole; 

complete of its nature or kind. 2. Being without defect 

or blemish.... 3. Thoroughly skilled or talented in a 

certain field or area; proficient. 4. Completely suited 

for a particular purpose or situation.... 7. Pure....”7

The first definition, “...lacking nothing essential to the 

whole...” suggests that perfect is much more the 

presence of integrity than the absence of error. 

Integrity, especially as it relates to perfection, has 

become a popular word in recent years. Most leadership discussions start with the notion of integrity. It is 

much less frequently applied to systems of healthcare. 

Integrity was the Merriam-Webster “Word of the 

Year” in 2005.8

 While a more common, current 

definition of integrity implies “adherence to a code,” 

the traditional definition of integrity is very different. 

According to leadership guru Stratford Sherman, the 

principle definition of integrity in the original Oxford 

English Dictionary was, “The condition of having no 

part or element taken away or wanting; undivided or 

unbroken state; material wholeness, completeness, 

entirety.”9

 The definition stresses completeness or 

consistency. The concept of consistency and 

incorruptibility remained first listed among dictionary 

definitions through the 1950s when adherence to an 

external code became a more common definition. 

Integrity (or perfect) was a word used of people and of 

animals in the ancient Hebrew world. Both animals 

and people described as being perfect with the Hebrew 

word “tamiym” were without blemish, complete, 

perfect, blameless, having integrity. For an animal to 

be acceptable for its intended sacred purpose, it had to 

have tamiym. It had to be everything it was supposed 

to be (male, domestic animal, first born), nothing it 

was not supposed to be (imperfect, defective, 

blemished), consistent (without spot or blemish from 

head to tail), and complete (has all its features, is 

missing nothing).10

Perfection (or integrity) was a blend of what was 

expected as well as what was intrinsically consistent; a 

combination of an external standard, but more 

importantly an internal completeness. This is in 

contrast to the modern definition of integrity, 

demonstrated by the 2005 definition where the first 

definition is a “firm adherence to a code of especially 

moral or artistic values: incorruptibility."8

No matter how extensive and exhaustive they may be, 

perfect healthcare cannot be defined exclusively by 

complete compliance with the standards of The Joint 

Commission* or any other agency. A healthcare 

system can embrace external standards completely and 

still lack the soul that defines it as “perfect.” For a 

healthcare system to be perfect, and to be capable of 

responding perfectly to the looming changes in 

American healthcare, its leaders must focus on the 3 

pillars that define healthcare systems: people, 

processes, and the place where healthcare is delivered. 

PERFECT PEOPLE

A number of different populations experience our 

healthcare systems on a daily basis. Patients and 

family members walk in and out of our hospitals and 

*Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd, Oakbrook Terrace, Illinois 60181.

Leadership and Healthcare Perfection 
 October – December 2009 7

THE ARMY MEDICAL DEPARTMENT JOURNAL

clinics. They also attempt to reach their providers by 

phone, on the web, and by e-mail. They wonder at 

home or work about new or nagging health concerns, 

but do not attempt to reach out for information or 

insight because of the chaos of their lives—or of our 

healthcare systems. Our staff and other guests also 

move in and out of the system each day, each bringing 

their own attitude and affect to each encounter, 

inevitably shaping and changing others through 

interaction. The potential of possible interactions is 

practically infinite. Fortunately, the actual number of 

interactions is not. 

One day in the autumn of 2008 I counted the number 

of times I interacted with other human beings in the 

course of a day. As a hospital commander (or “CEO”), 

I had a number of meetings or interactions which 

might not be afforded to other members of staff. I 

counted every time I spoke to someone in person or on 

the phone, every hallway conversation, every person at 

a meeting I attended or class that I taught, every email 

I received, and every text message between 4 AM and 

10 PM. In 18 hours I had 283 interactions, one every 3 

minutes or so, with the highest number being emails 

and people I encountered in meetings. 

The point is that the number of interactions we 

experience on any given day is finite, even for 

someone whose business is leading and interacting 

with people. Since the number is finite, there is a finite 

number of times that we must choose to define the 

kind of interaction we will have and, to a very large 

degree, the kind of outcome we hope to achieve. 

Business models that focus on customer service are 

correctly applied to healthcare settings. They help 

define not only how our staff cares for patients and 

their family members, but perhaps even more 

importantly, how leadership cares for and about staff. 

We cannot expect our staff to treat patients any better 

than we treat them. Why should healthcare provide 

less service than Wal-Mart or Circuit City? As leaders 

we model the behavior we hope to see: provide what 

they need and exceed what they expect. It means that 

we will approach every human encounter the same 

way, but we will respond to every human encounter 

differently; based on the individual’s needs. 

In every case it is a choice to pay attention, to 

intentionally make a conscious decision to consider 

the patient’s best interest and then a choice to act on 

their behalf. Imperfection then, is not so much the 

presence of error as the absence of attention, inten‐

tion, decision, and action. Perfection in this realm of 

healthcare has certain consistencies. The interaction in 

general is enjoyable, entertaining, empowering, 

educating, and elucidating. Patients and our staff who 

are looking for this perfection ask us the following: 

“talk to me, sit with me, make eye contact, look me in 

the eyes, greet me by name, use my title, get to know 

me, ask me about me, touch me, shake my hand, and 

please do not read your autobiography to me.” 

The essence of healthcare is human interaction. 

Between 2002 and 2005 our pediatric research group 

in Hawaii spent more than a million and a half dollars 

looking at internet solutions for asthma care in the 

home. One of the most striking findings of our 

research was the importance of the relationship of the 

patient with the care manager regardless of the 

technology employed. In the face of systems of 

healthcare that are inconsistently consistent and 

consistently inconsistent, emphasis of the human or 

“people” aspect of the system will assure that the 

journey toward perfection will be characterized both 

by the absence of error wherever possible, but, more 

importantly, the presence of consistent effort. Patients 

recognize and appreciate effort. 

For 3 years in the late eighties, I worked as a pediatrician at the clinic at Fort Hood. Weekend and holiday 

clinics were conducted with one medic and 2 providers. One provider worked for 3 hours, and one for 6 

hours. Patients were scheduled at 5-minute intervals, 3 

every 15 minutes. On the 6-hour clinic shift we saw 72 

patients or more using 6 exam rooms over 6 hours. We 

were the only show in town, and so we hustled to provide the very best care we could in pretty constrained 

environment. I cannot speak for my 9 colleagues since 

I was only a captain, but I was not aware of a single 

patient complaint. People recognized effort and intention, and embraced an attitude similar to my teenage 

son’s comment to me several years ago, “Dad, you 

don’t always get it right but I know that you are 

always trying.” Perfection in the people aspect of 

healthcare is the consistent presence of attention and 

intention. 

PERFECT PROCESSES

Healthcare systems migrated from the home to the 

hospital primarily to protect the population from 
8 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

contagious diseases and to cohort patients for greater 

ease in medical education, in medieval Islam before 

medieval Europe. Patient preference, autonomy, and, 

unfortunately, patient safety were not the primary 

concerns. Once care migrated from the home to 

hospitals, those who were most invested in a favorable 

patient outcome were excluded from decision making, 

almost until the very present time. 

Leadership in perfect healthcare systems has embraced 

and promoted the Patient and Family Centered Care 

movement, which has gained momentum in the last 2 

decades. Patients and family members are now 

increasingly engaged not only in specific decisions 

regarding patient care, but also in the redesign of the 

very healthcare systems that care for them. Truly 

perfect processes will not be approached until patient 

care returns to the home or families, and patients 

become much more autonomous in decisions regarding 

hospital care. 

Perfect healthcare systems take the patient’s life and 

priorities into consideration. In these systems, the 

processes allow for patients empowered by medical 

information and insight to decide what they need 

themselves. Healthcare is convenient. Access is the 

window, wide open, between supply and demand. 

Access includes provider appointments, patient emails, 

text messages, nurse triage, and provider phone calls. 

Care is driven by demand, not supply. And demand 

goes both ways. 

Traditionally, access has been used to describe 

healthcare insurance or the availability of provider 

visits. Perfect systems use a different definition of 

access. Patients and their families are busy. Healthcare 

is just one of the priorities they juggle. They see 

healthcare access differently. Patients desire 

information (general health knowledge), insight (wise 

interpretation and application of specific healthcare 

knowledge), or intervention (a system encounter that 

leads to a diagnostic or therapeutic action). 

The system in return focuses on health promotion and 

disease prevention using the same model; “accessing” 

the population through the same windows. Patients 

need information (new recommendations for colon 

cancer or breast cancer screening), insight (interpretation of specific risk factors for cardiovascular 

disease), or intervention (pneumococcal vaccination 

for patients older than 65 years). The accessible, 

convenient healthcare system reaches back to them on 

email, telephone, or text messages, and invites them to 

consider their healthcare in the midst of the chaos and 

crises of life. 

Perfect healthcare systems and processes are also 

responsible. We have moved beyond the point where 

healthcare is a strictly personal issue. The healthcare 

covenant between patient and provider/system goes 

both ways. Each side of the covenant has obligations 

and responsibilities on the individual and the level of 

the greater public. Personal decisions (I choose to 

smoke, I choose to drink, I choose to engage in 

unhealthy sexual practices) have social implications as 

the public increasingly bears the impact of these decisions. Freedom and responsibility go hand-in-hand, so 

the choices to assume health risks should also imply 

accountability for the increased healthcare burden. 

These systems also recognize that there are business 

forces that contribute to negative public health implications, and the systems take them on. Our nation’s 

love affair with overeating calorie dense fast-food 

coupled with increasingly sedentary lifestyles has led 

to an obesity epidemic that is crushing our healthcare 

systems. It only makes sense that the leaders of 

healthcare systems should confront these challenges 

head-on, knowing that they may well be opposed by 

traditional corporate sponsors. For example, a general 

pediatrician in Korea worked with the on-post 

Department of Defense (DoD) schools to eliminate 

chips and fries from school lunches and soda machines 

from the cafeteria. Perfect systems will anticipate and 

address health care challenges at their roots. 

PERFECT PLACES

While hospitals evolved for the charitable care of the 

destitute ill in both Europe and the Middle East, and 

the nursing care was provided by dedicated religious 

orders, the wards were designed for the convenience of 

staff and the training of the providers who worked in 

them. Strong public health pressures also promoted the 

isolation and quarantine of the ill during eras of 

plagues. Patient and family considerations were not 

addressed in either the design or utilization of 

healthcare facilities. 

The trend in the construction of healthcare facilities 

centers on the evolving science of evidence-based 

Leadership and Healthcare Perfection 
 October – December 2009 9

THE ARMY MEDICAL DEPARTMENT JOURNAL

design. In newly designed facilities, patient rooms and 

clinical spaces are designed to improve patient 

outcomes. The new Fort Belvoir Community Hospital 

which will open in the spring of 2011 has been 

developed and is being built based on the principles of 

evidence-based design. In 2007, architects, builders, 

healthcare professionals, and facility designers met 

with patients, family members, and community leaders 

in a “visioning” session to develop the themes that 

should be prominent in the new community hospital. 

The group stressed 4 major points: the notion of 

“caring for our own,” the symbolism of the eagle for 

Fort Belvoir (where there are numerous nesting eagle 

pairs), the importance of history and military 

medicine, and the healing influence of nature. 

The hospital planning process took these factors into 

account while embracing evidence-based design, as 

well as Leadership in Energy and Environmental 

Design (LEED)11 construction guidelines. The result is 

a 120 bed, 1.3 million sq ft facility comprised of 5 

separate but linked buildings and 2 large parking 

garages, spread like fingers across a former golf course 

on Fort Belvoir. All the inpatient rooms are single and 

include patient, family, and staff spaces. There are 55 

outpatient clinics with 430 examination rooms. Every 

clinic waiting area as well as every inpatient room has 

abundant glass and natural light, and looks out on gardens, trees, and nature scenes. The building is oriented 

on a north-south axis so that the front rooms have 

morning sun and the back face westward toward the 

sunset. Staff lounges and offices also have windows. 

The facility’s inpatient tower has a green roof. The 

heat and air-conditioning units on the 4 ambulatory 

clinics are hidden beneath large, distinctive, swooping 

roofs so that inpatient rooms have pleasing views in 

every direction. The swooped roofs serve as prominent, aesthetic features, they collect rainwater into subterranean cisterns to water the landscape, and they give 

the facility the impression of an eagle rising in flight. 

The list of specific, cutting-edge features that will be 

incorporated into the facility is beyond the scope of 

this paper, but include patient lifts in each room, 

patient controlled temperature and lighting, “smartroom” technology that detects staff radio-frequency 

badges and identifies staff on plasma screens when 

they enter the room, subliminal color-based way 

finding, and design cues to promote hand washing. 

The curtains in examination rooms are designed so that 

providers can move in and out without touching them 

to cut down on the spread of infection. Clinic units are 

identical so that clinic function can be changed or 

modified in the future as medical missions change. 

The facility design is the prototype for future DoD 

hospitals and serves as the nation’s best “laboratory” 

to demonstrate and validate many principles of 

evidence-based design.12-14

Most importantly, it is a community hospital that is 

“the community’s hospital.” Military and civilian 

community leaders and laypeople have been involved 

in the design and are regularly briefed on its progress. 

When completed, the hospital will have 3,200 staff 

members, more than 3 times the staff of the current 

DeWitt Community Hospital on Fort Belvoir. With 

more than 100,000 enrolled patients as well as a robust 

“secondary” medical and surgical capability, it will be 

the hub for military healthcare for the 244,000 

beneficiaries living in the southern aspect of the Joint 

Operating Area of the National Capital Medicine Joint 

Task Force. 

Leaders building future healthcare facilities must insist 

on the very best patient and family centered care as a 

reflection of our commitment to the community, while 

stressing the application of LEED principles as a 

reflection of our commitment to society. For those of 

us working in aging facilities, we can still apply the 

principles of evidence-based design by making 

common areas light, open, airy, and inviting. Use of 

nature themes in interior design, attention to 

landscaping visible from patient windows or waiting 

areas, and efforts to decrease ambient noise all work 

toward the same goal. In one clinic of our 50-year old 

facility, the Muzak and overhead paging was so loud 

that providers had to raise their voices to be heard. 

There are many steps that can be taken to embrace 

these principles before our new facilities are ready. 

Dr Benjamin Rush’s criticism of the hospitals caring 

for soldiers during the Revolutionary War cost him his 

friendship with Washington. Writing about those 

Revolutionary War hospitals, he called them “sinks of 

human life.”1

 In the centuries following the war, the 

American hospital and the healthcare systems that ran 

them both played key roles in ushering in the era of 

modern medicine we now enjoy—almost complete 

freedom from the diseases that plagued Washington’s 
10 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Army and frustrated Dr Rush’s attempts to deliver 

healthcare. 

Today, there are new challenges for American’s health 

and the delivery of healthcare. There has been an 

emergence of a customer-focused culture that stresses 

the importance of service standards in these systems 

with an emphasis on the human, covenantal aspect of 

care delivery. Systems are being overhauled to make 

access seamless and to eliminate both systematic and 

random errors that have been tolerated in America’s 

healthcare system. Facilities are being designed to 

improve patient outcomes and to serve as models of 

energy and environmental efficiency. 

The military healthcare system is the model for a national integrated healthcare delivery system with international reach that is patient focused, efficient, and 

effective, while surpassing the very highest standards 

for quality and cost-effective care. Setting and exceeding the national standard will require leadership, 

decisiveness, and teamwork. Americans are awakening 

to the danger and the challenges in healthcare, and will 

not long tolerate nor endure the burdens of an 

inaccessible, inconvenient, inconsistent system. 

As inevitable changes come, will we be the leaders or 

the led? 

REFERENCES

1. Bayne-Jones S, ed. The Evolution of Preventive Medicine 

in the United States Army, 1607-1939. Washington, DC: 

Office of The Surgeon General, US Dept of the Army; 

1968:67. Available at: http://history.amedd.army.mil/books 

docs/misc/evprev/ch4.htm. Accessed April 11, 2009. 

2. Magner L. A History of Medicine. New York, NY: Marcel 

Dekker Publishers; 1992:226-227. 

3. White KL, Williams TF, Greenberg BG. The ecology of 

healthcare. N Engl J Med. 1961;265:885-892. 

4. White KL. The ecology of healthcare: origins and 

implications for population-based healthcare research. 

Health Serv Res. 1997;31:11-21. 

5. Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. The 

ecology of healthcare revisited. N Engl J Med. 2001; 

344:2021-2024. 

6. Dovey S, Weitzman M, Fryer G, Green L, Yawn B, Lanier 

D, Phillips R. The ecology of healthcare for children in the 

United States. Pediatrics. 2003;111:1024-1029. 

7. The American Heritage Dictionary of the English 

Language. 4th ed. Boston, MA: Houghton Mifflin 

Company; 2000. 

8. Merriam-Webster Online. Available at: http://www.mer 

riam-webster.com/info/pr/2005-words-of-year.htm. 

Accessed September 22, 2009. 

9. Sherman S. Rethinking integrity. Leader Leader. 2003;28: 

39-45. Available at: http://www.leadertoleader.org/

knowledgecenter/journal.aspx?ArticleID=132. Accessed 

March 3, 2009. 

10. Word search for tamiym (Strong's 8549). Blue Letter Bible 

web site. Available at: http://www.blueletterbible.org/lang/

lexicon/lexicon.cfm?Strongs=H8549&t=NASB>. Accessed

April 11, 2009. 

11. Intro – What LEED Is. US Green Building Council web 

site. Available at: http://www.usgbc.org/DisplayPage.aspx?

CMSPageID=1988. Accessed September 23, 2009. 

12. McCarty M. Healthy design. Lancet. 2004;364:405-406. 

13. Urich RS, Zimring CM, Zhu X, Dubose J, Seo H, Choi Y, 

et al. A review of the literature on evidence-based healthcare design. Health Environ Res Des J. 2008;1:61-125. 

14. Zimring CM, Malone E, Sadler BL. Implementing healthcare excellence. The vital role of the CEO in evidencebased design. Health Environ Res Des J. 2008;1:1-18. 

AUTHOR

COL Callahan is the Commander, Dewitt Army Hospital and Health Care Network, Fort Belvoir, Virginia. 

Leadership and Healthcare Perfection 
 October – December 2009 11

Critical Leadership Attributes for Army 

 Medical Department Officers 

Jody R. Rogers, PhD 

“If leadership is so simple, why is it so hard?” What a 

great question! This question was asked of me after I 

finished a presentation to 400 Reserve Captains Career 

Course officers. When speaking, I try diligently to 

demystify leadership as a way of motivating inexperienced and uncertain officers that they can enhance 

their leadership effectiveness by consistently applying 

relatively simple, common sense behaviors with their 

colleagues. It seems that too many people think 

leadership is the sole responsibility of a chosen few 

who are empowered by circumstance or position to do 

great things. In reality, leadership is everyone’s 

business and although only a few people may actually 

be assigned to formal leadership positions, it is 

everyone’s job to be a leader.1

 The Army Medical 

Department (AMEDD) can meet its mission only if 

everyone does their best to enhance their leadership 

effectiveness, regardless of position. If the AMEDD 

relied only on the leadership acumen of our senior 

executives to be successful, it would, in fact, not meet 

its organizational missions. This is not to denigrate the 

wonderfully effective senior leaders within the 

AMEDD today. God only knows how hard they are 

working to meet mission. They are doing the very best 

they can. My point is simple; in order to be successful, 

the AMEDD must have more leaders located 

throughout every level of the AMEDD. 

In reality, leadership is not that difficult. Leadership is 

nothing more than the consistent application of 

relatively common sense 

behaviors. There is no silver 

bullet, no quick fix to being 

seen as a more effective leader. 

The most effective leaders 

behave in a consistent manner 

that focuses on the development 

and well-being of their 

followers. Behaviors such as 

expressing a caring attitude, 

teaching/mentoring/coaching 

whenever possible with the 

focus on developing their 

followers, establishing and 

articulating a clear vision, establishing and maintaining challenging but achievable standards, and 

inspiring followers to meet/exceed organizational 

goals are but a few of the relatively simple things 

effective leaders do. 

Peter Luongo2

 writes about the need for effective 

leaders to hire good people. He lists several attributes 

that are mandatory in all his new hires. Two of the 

attributes are character and competitiveness. As I read 

his discussion, I came to the conclusion that many of 

the same attributes he looks for in his new hires are 

also critical for leadership effectiveness. The attributes 

critical for effective leadership are shown in the 

Figure. They include, in this order, character, competence, competitiveness, courage, and caring. It all 

starts with character and ends with a caring attitude. 

All are important with the attributes at the foundation 

of the pyramid being the most important. 

CHARACTER

Leadership effectiveness begins with character. A 

person of character is someone who has the values, 

integrity, morals, and ethics to earn the trust of 

colleagues. Character defines the “who” of the leader. 

The line, “It ain’t about who you are or what you are, 

it’s about what you do with what you’ve got” is 

inaccurate and sends a wrong message about 

organizational success.2(p31) What you accomplish as a 

leader is transitory if it is not accomplished in an 

ethical or moral manner. Great 

leaders know what they stand 

for, what they will tolerate, what 

they value, and how they want 

to be seen by their fellow 

employees. Leaders of character 

realize that who they truly are is 

more important than how they 

are perceived. Leaders of 

character know that the only 

person best able to judge their 

true character is the “person in 

the mirror.” That person can 

never be fooled. Any cracks in 

CHARACTER 

COMPETENCE 

COMPETITIVENESS

COURAGE 

CARE

Personal attributes essential to the exercise of 

effective leadership 
12 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

this foundational attribute will affect the stability and 

viability of every other attribute discussed below. 

What are some ways leaders can demonstrate their 

character? Once again, simplicity rules. Leaders can 

demonstrate character by always telling the truth regardless of how painful, by writing down their values 

and conducting a daily values review to ensure they 

are living their values in deed and word, by never humiliating or talking behind others’ backs, by ensuring 

they build and not destroy employee self-esteem, by 

being seen as optimistic realists, and by being respectful of everyone regardless of position or power.3

Character is nonnegotiable. As you strive to improve 

your leadership effectiveness, start by conducting a 

self-review of your character. Are your behaviors 

ethical and moral, and do you demonstrate integrity in 

all your actions? What are your values and have you 

shared them with your colleagues? Do you respect all 

with whom you work? Analyzing your character may 

seem simple, but it rarely is easy to do because once 

you start asking these questions of yourself, you risk 

not liking the answers. 

COMPETENCE

The very best leaders are also competent in their field. 

They may not be the smartest or most experienced 

person, but they are competent enough to be credible. 

Effective leaders also know they must continue to 

learn and refine their skills in order to maintain credibility with their employees. The concept of life-long 

learning is essential to effective leadership, simply 

because it is critical to establishing credibility. In his 

presentation to the AMEDD Executive Skills course 

students, Lieutenant General Weightman frequently 

talked about the fact that the leader may very well not 

be the oldest, most experienced, or most knowledgeable within a section; but he or she must demonstrate a baseline of knowledge and, more importantly, 

a strong desire to learn in order to enhance their skill 

level.4

 Effective leaders must also be sufficiently selfconfident to willingly acknowledge their lack of 

expertise or knowledge so as to not try to fool 

employees into thinking they are smarter or more 

competent then they really are. This issue falls back to 

the character issue. You cannot “fool the troops,” as 

they will quickly determine your true competence on 

their own. If you attempt to embellish your level of 

competence so as to not lose credibility, you will actually be compromising your character—that is always 

fatal as a leader. Always work hard to attain and maintain your competence. Your colleagues will appreciate 

your integrity if you willingly acknowledge your 

deficiencies but demonstrate your willingness to learn. 

COMPETITIVENESS

The first time I read about this attribute in Luongo’s 

book,2 I was somewhat taken aback. I initially 

considered competitiveness to be an attribute that 

could destroy teamwork and relationships in an 

organization if employees attempt to beat their 

colleagues by withholding information or not being a 

good team member to look good at a colleague’s 

expense. That is not what he meant by being 

competitive. I like to use the word ambitious as a way 

of explaining what I think competiveness means to me. 

Leaders should be ambitious. They should never be 

satisfied by the status quo and should always look for 

ways to improve the organization. They should set 

high standards and then lead the organization to 

accomplish them. The following profound insight is 

attributed to Michelangelo: 

The greater danger for most of us lies not in setting our 

aim too high and falling short, but in setting our aim too 

low, and achieving our mark.5 

I believe we have a tendency to set our goals too low 

and then wonder why our organizations do not change 

as much as we would like when we accomplish those 

goals. I am convinced our people like to be challenged 

as long as the challenges are reasonable. They would 

prefer to do meaningful work that is challenging rather 

than waste the day away doing less challenging work 

that is perceived as unimportant. A leader’s ambition 

or competitiveness should be outwardly focused with 

the goal of making the organization and its employees 

more successful. Ambition to make you better 

educated or more competitive for a promotion or 

greater responsibility should never come at the 

expense of others in the organization. Perceived 

selfishness is a quick way to destroy a leader’s 

integrity or character in the eyes of his or her 

followers. Remember, character is nonnegotiable. 

COURAGE 

What makes leadership difficult for most people is the 

realization that, in order to improve, leaders must do 

things that most people lack the courage to do. This is 

the primary reason why leadership is so hard for many 

people. It takes great courage to openly demonstrate a 

Critical Leadership Attributes for Army Medical Department Officers 
 October – December 2009 13

THE ARMY MEDICAL DEPARTMENT JOURNAL

caring attitude. It takes great courage to think long and 

hard about what your values are, what motivates you 

to greatness, who is important to you, what is 

important to you, and for what are you willing to 

suffer. It then takes even greater courage to share your 

thoughts, your professional desires/wants, your vision, 

and the answers to the previous questions with your 

colleagues. When was the last time you actually asked 

for feedback on how you are doing as a leader? Is it 

because you did not think that information would be 

important? Or, is it because you thought you may not 

like the answers you would receive. If you truly want 

to improve your leadership effectiveness, you must 

generate the courage to ask how you are doing and 

then to learn from the answers received. The best 

leaders tend to be very courageous and are comfortable 

in the answers they receive when they ask the tough 

questions. They are courageous enough to know it is 

not about them but about improving the organization. 

CARING

If I were to ask one of your employees, “Does (your 

name) care about you, I mean really care about you,” 

what do you think the answer would be? I believe all 

leaders think they care about their colleagues, but if 

you were to ask those colleagues, you may receive a 

different answer. The problem is demonstrating a 

caring attitude. Just showing up for work and handing 

out assignments is not enough. Openly demonstrating 

a caring attitude requires courage. As leaders, we often 

fear that being perceived as a caring individual is a 

sign of weakness. Nothing could be further from the 

truth. Someone who cares about their employees does 

not waste their time by giving them easy and/or 

meaningless work. Being a caring leader means giving 

your employees a clear, compelling vision of the 

future that is challenging and will require all their 

resources and knowledge to achieve. Being a caring 

leader means setting clear and ambitious standards of 

how the work is to be accomplished. There is nothing 

easy or soft about any of these things. Demonstrating a 

caring attitude also means treating people as human 

beings and not as functional employees, taking a 

personal interest in them so you can help them 

accomplish their professional and personal goals, and 

showing them that you are as committed as you want 

them to be. It is working hard to catch your employees 

doing great work and then recognizing/rewarding them 

for their efforts. One thing that is definitely required 

for most leaders to demonstrate they care is the 

courage to do so. Remember, everyone, regardless of 

rank, position, age, or experience wants to know someone cares about them and what they do. As a leader, 

you must have the courage to demonstrate you care 

about your people. It sounds simple, but is rarely easy. 

CONCLUSION

The very best leaders have character, are competent, 

are competitive, have courage, and are openly caring 

individuals. My “5 Cs” of leadership appear simple at 

first blush, but are rarely easy for most beginning 

leaders. They may not be easy but they are not 

impossible to the leader with the desire to improve 

their effectiveness. These attributes cannot be 

mastered overnight. Do not wait until you are 

promoted or assigned to a position requiring 

leadership. It is simply too late to start thinking about 

your leadership effectiveness at that time. You must 

start now to improve your leadership effectiveness. 

Work on enhancing your character, attain/maintain a 

high level of competency, always remain competitive 

with the focus on the improvement of your organization, develop the courage to take on the tough challenges facing leaders today, and never forget that your 

people want to know you care about them. I know it 

sounds simple, but for most of us it is hardly easy. 

REFERENCES

1. Kouzes JM, Posner BZ. The Leadership Challenge. 

4th ed. San Francisco, CA: Jossey-Bass; 2007. 

2. Luongo PA. 10 Truths About Leadership. Cincinnati, 

OH: Clerisy Press; 2007. 

3. Cockerell L. Creating leadership magic. Leader 

Leader, 2009;53:31-36. 

4. Weightman G. Presentation at: Army Medical 

Department Executive Skills Course; April 2007; 

Fort Sam Houston, TX. 

5. Michelangelo Quotes. Thinkexist.com web site. 

Available at: http://thinkexist.com/quotes/

michelangelo/. Accessed September 22, 2009. 

AUTHOR

Dr Rogers is a Visiting Professor in the Graduate Program 

in Healthcare Administration, Trinity University, San 

Antonio, Texas. He also works in the AMEDD Executive 

Skills Program, Leader Training Center, AMEDD Center 

and School, Fort Sam Houston, Texas. 
14 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

The Army Medical Department operates an Executive 

Skills Program within the Leader Training Center with 

the goal of developing leadership training programs 

for junior and senior officers. A survey was created by 

Dr Jody Rogers of the Center and administered to 

students in the Captain’s Career Courses from January 

to March 2008 to identify the 7 most admired 

leadership characteristics. The survey tool was based 

on the extensive research conducted by Kouzes and 

Posner. Their 2007 book, The Leadership Challenge,

1

is the source for all discussion of their studies and 

findings throughout this article. 

Kouzes and Posner cite additional research that 

identifies the characteristics an individual looks for in 

an admired leader. They further define admired leaders 

as individuals whom subordinates would be willing to 

follow. The qualitative exploratory research study 

identified 20 leadership characteristics. Respondents 

were asked to select 7 of 20 characteristics they most 

admired in a leader. The study was repeated over the 

course of 20 years in 6 continents. Their research 

revealed that the 4 characteristics most commonly 

selected were honest, forward-looking, inspiring, and 

competent. 

RESEARCH QUESTION

Our study was interested in answering the following 

question: Is there a statistically significant difference 

between the selected characteristics of an admired 

leader from the students in the surveyed Captains 

Career Course (CCC) and the data from Kouzes and 

Posner1

 of respondents from 6 continents? To 

investigate this research question, we obtained data 

from the Army Medical Department Executive Skills 

Center and compared it to their data. 

The Army Medical Department Executive Skills Center maintains a database with information from the 

students who have attended the CCC. Our research 

was an exploratory study of 272 surveys from this 

database (survey data collected January-March 2008). 

Of the 32 available data fields on each survey, only 20 

were included. Participation in this survey was voluntary and all survey results were anonymous. The 

survey was replicated from the Kouzes and Posner 

study that administered surveys to more than 75,000 

people around the world. The military students were 

asked to select 7 out of 20 characteristics that they 

found in an admired leader. Of the 272 surveys 

provided, 5 were excluded from the study due to 

missing data, leaving n = 267 for our study. The 5 

excluded surveys accounted for 1.8% of the total 

survey population. Another 11 surveys (less than 5% 

of the data collected) had some discrepancies as the 

subjects chose either more or less than 7 

characteristics. However, the data was compiled twice, 

once using those 7 surveys and once excluding them. 

Since there were no differences in the results, the 

surveys were included in our study. 

METHODOLOGY

The categorical variables in our study were the 

following 20 characteristics of an admired leader: 

ambitious, broad-minded, caring, competent, cooperative, courageous, dependable, determined, fairminded, forward-looking, honest, imaginative, independent, inspiring, intelligent, loyal, mature, selfcontrolled, straightforward, and supportive. The data 

was coded into 1 if selected and 0 if not selected. 

Since the variables from the CCC are categorical in 

nature, we did a general frequency analysis for the 20 

characteristics (Table 1). After obtaining the 

frequencies for each characteristic from the CCC data, 

we ran a hypothesis test to compare our results to the 

Kouzes and Posner1

 research results for the percentage 

of respondents selecting each criteria over 4 time 

periods (2007, 2002, 1995, and 1987). Our results 

were used as the hypothesized value for each of the 20 

An Exploratory Study of the Characteristics 

 of an Admired Leader 

MAJ Samantha Hinchman, MS, USA 

LTJG Jeff Magone, MSC, USN 

CPT John Marshall, MS, USA 

Benita Stoddard, LMSW 
 October – December 2009 15

characteristics of admired leaders to run a 

hypothesized test at the significance level 

(alpha) of 0.05 (Table 2). 

RESULTS AND FINDINGS

There were statistically significant 

differences between the hypothesized value 

(from the CCC survey) and the mean (from 

Kouzes and Posner) for the characteristics of 

ambitious, caring, competent, cooperative, 

dependable, fair-minded, forward-looking, 

honest, imaginative, inspiring, loyal, selfcontrolled, and straightforward. There were 

no statistically significant differences for the 

characteristics of broad-minded, courageous, 

determined, independent, intelligent, mature, 

and supportive. 

The following 4 characteristics led responses 

in the Kouzes and Posner surveys: honest 

(87%), forward-looking (69.75%), 

competent (66%), and inspiring (65%). 

However, the CCC results were led by 

honest (78.3%), competent (71.5%), 

inspiring (56.2%), and dependable (53.9%). 

Only 33.7% of CCC respondents selected 

forward-looking as compared to 69.7% from 

the Kouzes and Posner study. Conversely, 

only 33% of the Kouzes and Posner 

respondents selected the characteristic of 

dependable, whereas the CCC result was 

53.9%. 

Our CCC research showed statistically 

significant differences from the Kouzes and 

Posner data in 13 of the 20 surveyed 

characteristics of an admired leader. The 

most dramatic of these is the difference 

found in the characteristic of forwardlooking. Kouzes and Posner report that this 

is “what sets leaders apart from other 

credible individuals.”1(p37) The reason for the 

difference may be in the maturity and 

experience of the surveyed students in the 

CCC. Their view on leadership (at the rank 

of captain) is more limited to their 

experiences at the managerial level, rather 

than that of a more senior officer who has 

also had command and staff experience. 

Table 1. Captain’s Career Course categorical variable frequency table 

for survey responses. 

Characteristic Code* Frequency Percentage Valid 

Percentage 

Cumulative 

Percentage 

Ambitious 

0 205 76.8 76.8 76.8 

1 62 23.2 23.2 100 

Broadminded 

0 168 62.9 62.9 62.9 

1 99 37.1 37.1 100 

Caring 

0 148 55.4 55.4 55.4 

1 119 44.6 44.6 100 

Competent 

0 76 28.5 28.5 28.5 

1 191 71.5 71.5 100 

Cooperative 

0 213 79.8 79.8 79.8 

1 54 20.2 20.2 100 

Courageous 

0 203 76 76 76 

1 64 24 24 100 

Dependable 

0 123 46.1 46.1 46.1 

1 144 53.9 53.9 100 

Determined 

0 215 80.5 80.5 80.5 

1 52 19.5 19.5 100 

Fair-minded 

0 169 63.3 63.3 63.3 

1 98 36.7 36.7 100 

Forward-looking 

0 177 66.3 66.3 66.3 

1 90 33.7 33.7 100 

Honest 0 58 21.7 21.7 21.7 

1 209 78.3 78.3 100.0 

Imaginative 0 246 92.1 92.1 92.1 

1 21 7.9 7.9 100.0 

Independent 0 246 92.1 92.1 92.1 

1 21 7.9 7.9 100.0 

Inspiring 0 117 43.8 43.8 43.8 

1 150 56.2 56.2 100.0 

Intelligent 0 147 55.1 55.1 55.1 

1 120 44.9 44.9 100.0 

Loyal 0 172 64.4 64.4 64.4 

1 95 35.6 35.6 100.0 

Mature 0 212 79.4 79.4 79.4 

1 55 20.6 20.6 100.0 

Self-controlled 0 229 85.8 85.8 85.8 

1 38 14.2 14.2 100.0 

Straightforward 0 183 68.5 68.5 68.5 

1 84 31.5 31.5 100.0 

Supportive

0 168 62.9 62.9 62.9 

1 99 37.1 37.1 100.0 

*Code: 

0 Characteristic NOT selected 

1 Characteristic WAS selected 
16 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

LIMITATIONS AND FUTURE WORK

We recognize that this study is exploratory in nature 

from secondary data and, as a result, the data is 

limited. In the future, the survey instrument should be 

indexed by the CCC class number and dates of the 

class to ensure reliability and validity, as well as to 

increase the sample size for hypothesis tests. 

Additional research should also be conducted to 

include surveys from entry level leaders attending 

Officer Basic Course to senior leaders attending the 

Army War College, in order to further explore the 

characteristics of an admired leader at various stages 

of a Soldier's military career and maturity. 

CONCLUSION

Using a hypothesis test to compare our results to the 

results from the research by Kouzes and Posner, we 

found statistically significant differences in 13 

characteristics (ambitious, caring, competent, 

cooperative, dependable, fair-minded, forwardlooking, honest, imaginative, inspiring, loyal, selfcontrolled, and straightforward). After further review, 

one of the top 4 characteristics, forward-looking, 

which Kouzes and Posner identified as the discernable 

characteristic of an admired leader, was not selected 

by the CCC cohort. Based upon this, the CCC faculty 

should consider modifications to the leadership course 

in order to explore this characteristic and its 

importance with their students. 

REFERENCE

1. Kouzes J, Posner B. The Leadership Challenge. San 

Francisco: Jossey-Bass; 2007. 

AUTHORS

MAJ Hinchman, LTJG Magone, and CPT Marshall are 

resident students in the Army-Baylor University 

Graduate Program in Health and Business 

Administration at Fort Sam Houston, Texas. 

Ms Stoddard is also a student in the Army-Baylor 

University Graduate Program. She is a Health System 

Specialist with the Dept of Veterans Affairs Heart of 

Texas Health Care Network. 

An Exploratory Study of the Characteristics of an Admired Leader 

Characteristic Hypothesized 

Value 

Mean 

Data 

Std 

Dev 

Std 

Error n Z P value (alpha = 0.05) 

Ambitious 23.2 16.75 3.304 1.652 4 -3.90 *0.0001 

Broadminded 37.1 38 2.449 1.225 4 0.73 0.4624 

Caring 44.6 22.75 2.5 1.25 4 -17.48 *0 

Competent 71.5 66 2.16 1.08 4 5.09 *0.000000354 

Cooperative 20.2 26.5 1.732 0.866 4 7.27 *0.000000000000347 

Courageous 24 25.25 3.862 1.931 4 0.65 0.5174 

Dependable 53.9 33 0.816 0.408 4 -51.19 *0 

Determined 19.5 20.5 4.123 2.062 4 0.49 0.6276 

Fair-minded 36.7 42.5 4.509 2.255 4 2.57 *0.0101 

Forward-looking 33.7 69.75 5.5 2.75 4 13.11 *0 

Honest 78.3 87 2.708 1.354 4 6.43 *0.000000000132 

Imaginative 7.9 25.5 7.234 3.617 4 4.87 *0.00000114 

Independent 7.9 6.25 2.63 1.315 4 -1.25 0.2096 

Inspiring 56.2 65 4.967 2.483 4 3.54 *0.0004 

Intelligent 44.9 44.5 3.697 1.848 4 -0.22 0.8287 

Loyal 35.6 13.5 3.317 1.658 4 -13.33 *0 

Mature 20.6 18 4.761 2.38 4 -1.09 0.2747 

Self-controlled 14.2 9 3.367 1.683 4 -3.09 *0.002 

Straightforward 31.5 34.25 1.258 0.629 4 4.37 *0.0000124 

Supportive 37.1 35.75 3.775 1.887 4 -0.72 0.4745 

*Results are statistically significant, P < 0.05 

Table 2. Hypothesis test: mean vs hypothesized value 
 October – December 2009 17

The purpose of this article is to share some leadership 

insights that I have discovered during my career as an 

Army Medical Department (AMEDD) leader. While 

this is not an exhaustive treatise on the vast subject of 

leadership, it is a crisp list of 10 practical tidbits that I 

learned for myself through leadership research and 

practice, and from observing other skilled leaders. My 

hope is that leaders of all kinds, young and old, new 

and seasoned, will find these tips both practical and 

beneficial, and pass them on to others. 

START WITH LEADING YOURSELF

Although it may appear obvious, it is worth clearly 

stating that in order to effectively lead others, you 

must ultimately begin with properly leading yourself. 

The very first step in doing this is ensuring that you 

have a balanced, healthy degree of self-discipline; this 

includes your conduct both on and off duty. Any 

reckless behavior in your personal life will most 

certainly detract from your professionalism as a leader. 

In the end, if you cannot lead yourself, both in and out 

of uniform, you will be unable to effectively lead 

others. Next, you must develop and maintain a 

program of self-development. To me, selfdevelopment is one of the 4 essential pillars of Army 

leader development, along with professional schooling 

(both military and civilian), developmental 

assignments, and mentoring from others. For me, I 

have found it best to establish a set time to carve out 

some uninterrupted period for my personal selfdevelopment (I have been asked many times how I 

find the time to do this; I respond that I do not find the 

time to do this, I make the time to do this!). For some 

of my assignments, this occurred early in the morning 

before I began the day’s duties. For other jobs, I took 

time during the weekends to work on my own 

professional growth. Currently, I use the time that I 

commute by train to read and reflect on my own 

personal leadership development. Luckily, I am able to 

“tune out” the background noise of the multiple 

conversations around me and make the most use of 

this precious time for my personal and professional 

benefit. Another useful tip is to always carry along 

something of a professional nature to read (such as a 

book or an article) when you go to appointments. As it 

turns out, I spend considerable time each week waiting 

for appointments or meetings to begin. By bringing 

along professional development reading materials, I 

can readily capitalize on this otherwise “dead time” for 

brief, focused self-development. 

BE A GOOD FOLLOWER

After being able to lead yourself, the most important 

thing for a leader is to be a good follower. Each of us, 

whether we are a newly commissioned officer or a 

senior AMEDD leader, has a boss. Given that, it is 

incumbent upon all of us to always strive to be good 

subordinates. We can best do that by understanding 

our leaders one and 2 echelons above us, and do our 

utmost to make them successful. This includes using 

our time with our raters and senior raters to get a better 

sense of who these officers are and what are their 

leadership preferences. Therefore, the counseling 

which is the centerpiece of the officer evaluation 

system is also a two-way dialogue that lets us learn 

about those we follow and how we can best support 

them. Other ways to be a good follower is to keep our 

leaders informed about what we are doing, not going 

behind their backs to accomplish the mission, letting 

them know what is going right and what is going 

wrong, and never undermining their authority by 

criticizing or disparaging their orders or their 

leadership in public or in private. 

CHANGE CAN BE THE ILLUSION OF PROGRESS

The central premise of Darwin’s seminal work, The 

Origin of Species,

1

 is that the key to survival in 

biological evolution is the ability of a species to adapt. 

A species that does not adapt perishes, ultimately 

becoming extinct. The same can be said of the Army. 

When I first came in the Army, two and a half decades 

ago, I immediately struck by a tremendous cultural 

inertia that resisted critical change. Procedures were 

institutionalized and were out of step with the then 

current reality and external forces demanding that the 

Army evolve. Now, sadly I fear the opposite may have 

become true. With all of the dramatic and widespread 

change that I see all around me, I often wonder if 

perhaps the pendulum has shifted too far the other way 

Leadership Wisdom 

COL Mark A. Melanson, MS, USA 
18 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

and we have gone from change averse to change 

addicted. Now, I am not saying that we should never 

change things; however, we need to make sure we 

truly understand the status quo and determine if the 

situation has truly changed and warrants adaptation to 

ensure our continued effectiveness. That is why I make 

it a practice when I take on a new assignment or 

assume a new duty position, I hold off making any 

substantial changes for a set period of time (In my 

current assignment, I did not make any major changes 

for a period of 6 months). Instead, I focus on learning 

my new job and its current intricacies and nuances to 

be sure that I thoroughly understand it. Then, I 

discover my boss’s intent, and in what direction he or 

she intends to lead. Combining this with a realistic 

appraisal of the current situation and where I want to 

head, puts me in a much better position to properly 

design and effectively implement any needed, but 

measured change. 

DON’T DROP THE GLASS BALLS

An excellent metaphor for leadership is juggling. All 

of us have more on our plates than we can possibly 

hope to accomplish; that’s just the way it is. We 

cannot ever hope to do it all. Each day we start with a 

finite, known list of tasks that we strive to complete 

before we go home for the day. Unfortunately, 

throughout the day, we receive more and more tasks. I 

liken this situation to juggling balls. Some of the balls 

we juggle are what I designate as “tennis balls.” They 

are things that we or others want done but are not 

really critical. So, if you drop them (don’t do them or 

do them in time), they bounce on the floor and do not 

break (that is, there are no serious consequences). 

People may get angry or disappointed if we drop them, 

but it is not a disaster if we do so. Often, you can pick 

the tennis balls up later and resume juggling them with 

no serious penalty, personal or professional. 

Conversely, some balls I label as “glass balls;” these 

are things that are important and there will be real and 

serious consequences if we drop them; they will 

metaphorically “shatter” if dropped. Examples of glass 

balls include most tasks given to us by our superiors. 

Other examples of glass balls are compliance with 

Army regulations or command policies. Some not-soobvious glass balls include relaxing, spending quality 

time with our families, pursuing our treasured hobbies, 

and maintaining our own personal health, fitness, and 

well-being. 

Each of us has a certain limit in the number of balls we 

can actual juggle at any given time. This juggling limit 

also changes from day to day and can be affected by 

how well rested we are and whether or not we are sick. 

To further complicate things, some of the balls that we 

juggle may start out as either glass balls or tennis balls, 

and they may then unexpectedly change into to the 

other type of ball in midair. So, we need to be 

constantly evaluating all of the many balls we are 

currently juggling, determining whether or not they are 

made of glass or not, and assessing new balls that 

others throw to us to determine if we need to attempt 

to juggling them or let them fall to the floor (and 

hopefully they will bounce). Of course, one of the 

most effective ways to resolve this dilemma is to 

delegate the juggling of some of these balls to others 

so that they can begin handling them instead of us. 

However, we must be mindful and be sure not to give 

our subordinates too many balls to juggle, and we must 

always keep track of the glass balls to be sure that they 

remain in the air and are not lying behind us in 

shattered pieces on the floor. 

LEAD FROM THE FRONT

This advice has been a long time leadership maxim. 

Your Soldiers need to see you out and among them. 

They need to know that you are with them and out 

front leading the way. This is the military version of 

“Management by Walking Around” cited in the classic 

leadership book, In Search of Excellence.

2

 In a 

deployed setting, this means leaving your command 

post and going out to where the danger is. In the 

hospital setting, this means making the rounds to 

where the day-to-day activities are occurring, such as 

surgeries, procedures, appointments, etc. When a 

major problem or crisis arises, you should go directly 

to the scene, determine first-hand what is happening, 

and personally take charge. Once you have a handle on 

what is happening, you can then confidently step back 

and delegate others to implement your solutions. A 

leader who only leads from the rear is at best 

operationally blind with no real situational awareness, 

or at worst becomes loathed and resented by those 

whom he or she leads. 

NEVER LEAD ANGRILY

Each of us is human. When things go wrong or people 

do not do what we want them to, we can get angry. 

That being said, it is imperative that, as leaders, we do 

Leadership Wisdom 
 October – December 2009 19

THE ARMY MEDICAL DEPARTMENT JOURNAL

not lose our tempers. For me, when something happens 

that sets me off, I seek to immediately disengage from 

the situation so I can “blow my stack” quietly and in 

private. This can be accomplished by asking others to 

leave the room or by retreating into your office and 

closing the door (please note that yelling behind closed 

doors does not count). In my opinion, leaders that rant 

and rave in front of their subordinates are just bad 

leaders, plain and simple. I have no tolerance or 

respect whatsoever for these most toxic of leaders. The 

higher the rank, the more this is true. Senior leaders 

must master the vital skill of defusing their anger and 

maintaining their composure. Never make important 

decisions, give an order, counsel a subordinate, leave a 

voicemail message, or send a text or an email when 

you are angry. Once you do, you can never take it back 

and the results can be disastrous, even career ending. 

You need to experience your feelings, but not let them 

hijack your reason and distort your judgment. I know 

for me this is one of the most difficult things to do, and 

I am not always successful in doing so, even despite 

my best efforts. 

USE THE RIGHT TOOL FOR THE RIGHT JOB

My father is the ultimate “Mr. Fix-It,” and he taught 

me from a very young age to always use the right tool 

for the right job. This means knowing both your tools 

and the problem that you are trying to fix. Interestingly 

enough, effective leadership is like a toolbox. It is 

filled with many tools that a leader can use to motivate 

his or her followers to accomplish the mission: 

encouraging words, rewards, inspirational quotes or 

examples, recognition, shame, and the threat of 

punishment (if used both sparingly and gingerly), to 

name but a few. Unfortunately, there is not only one 

way to lead Soldiers, civilians, and contractors. Before 

you reach for a leadership tool, you need to know your 

subordinates and the proper leadership tool which is 

needed for that individual at that time. Some 

subordinates need to be clearly told what is expected 

of them and exactly how they should complete their 

duties. Others need to only be told to “take that hill” 

and they will make it happen. While everyone needs 

praise and encouragement, some individuals need 

more of it. Nonperformers need to be confronted early 

and in private when they are not performing properly, 

and continually held to task and to standard. In the 

end, all of this really boils down getting to genuinely 

know your people and how they each need to be lead. 

Hence, leadership is indeed very personal. 

CHECK WITH NAPOLEON’S CORPORAL

The French Emperor Napoleon Bonaparte had a 

corporal who shined his boots and helped maintain his 

uniforms. As the story goes, this corporal was always 

present when Napoleon met with his general staff. 

Before any major campaign decisions, the Emperor 

would turn to his corporal and ask what the man 

thought of the plan currently on the table. If the 

corporal understood the tactic and thought it made 

sense, Napoleon implemented the strategy; if he did 

not, Napoleon sent the staff back to the drawing board. 

Used properly and judiciously, I think this is 

invaluable leadership advice. While I do not vet all of 

my leadership decisions through my own Napoleon’s 

Corporal, I have used this method with large, complex, 

and very important matters. I have also seen one 

former Army Surgeon General use another version of 

this approach by asking the opinion of the most junior 

Soldier present in the room (someone other than the 

general’s aide) as a sanity check on a given course of 

action being proposed. 

BELIEVE IN YOUR SUBORDINATES

In my opinion, one the best kept secrets to being a 

highly successful leader is to truly and deeply believe 

in your subordinates. Regrettably, I have seen leaders 

who were wary or distrustful of their subordinates, and 

consequently became doomed to a career of 

micromanagement, or became overwhelmed and 

paralyzed by their inability to delegate. While holding 

too tightly to the leadership reins may work for a 

junior leader early on in his or her career, eventually it 

becomes impossible for one to succeed, except through 

one’s subordinates. Fortunately for us leaders, there is 

a wonderful phenomenon called the Pygmalion Effect. 

Pygmalion was a sculptor in ancient Greek Mythology 

who falls in love with a female statue that he carves 

out of ivory. His vision of her literally brings her to 

life from within the ivory block. In the Pygmalion 

Effect, people literally become what we expect them to 

be. In education, this is also referred to as the 

Rosenthal Effect, where student achievement is 

directly related to the teacher’s a priori expectation of 

how the students will perform. Luckily for those of us 

who lead, this phenomenon applies to those being led, 

they tend to rise or fall based upon our opinions of 

them, expressed or unexpressed. Soldiers who sense 

that their leadership has no confidence in them or does 

not trust them, will act accordingly. Conversely, 
20 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Soldiers who feel that their leadership believes in them 

and trusts them will often exceed the expectations of 

their leaders, and can move mountains. 

MINE THE DIAMONDS IN THE ROUGH

I end this essay on leadership with what I think is one 

of the most important bits of advice for leaders, 

passionately embrace mentorship. As leaders we have 

a sacred obligation to develop our subordinates and it 

is one of our greatest responsibilities as commanders, 

raters, and supervisors. We must make it our ongoing 

mission to assess the Soldiers we lead and discover 

those with the greatest potential, the diamonds in the 

rough. Once we identify them, we must make the time 

to mentor and groom these future senior leaders to 

assume the mantles of leadership years or decades 

down the road. As we all know, the Army grows its 

leaders from within. Hence, the future senior leaders of 

our Army Medical Department are our lieutenants and 

captains of today. Part of effective talent management 

is nurturing these rising stars so that we retain them 

and help them to grow into the future leaders that they 

are destined to become, and our Army will one day so 

desperately need. 

SUMMARY

Becoming a good leader starts with effectively leading 

yourself. Good leadership flows from good 

followership. While leaders need to be adaptive, they 

need to make sure that change is actually necessary 

and not merely the illusion of progress. Effective 

juggling of leadership responsibilities requires 

identifying the glass balls and making sure that they do 

not drop. 

Leaders need to be visible and be out front, especially 

when things get rough or when they are the most 

perilous. Anger should never be allowed to reign and 

cloud a leader’s judgment. Leadership is not “one size 

fits all,” those being led are unique and, consequently, 

different approaches will be necessary to properly 

motivate followers. When considering important 

leadership decisions, it is advisable to seek out your 

own Napoleon’s Corporal to be sure that your plan is 

sound and those who will implement it do in fact fully 

understand it. Genuine belief in your Soldiers is the 

most powerful and lasting thing that you can express 

as a leader. Lastly, mentoring is a solemn 

responsibility of leaders that must never be eclipsed by 

the many literal and figurative battles of the day. 

REFERENCES

1. Darwin C. The Origin of Species. Baltimore, MD: 

Penguin Books; 1968. 

2. Peters TJ, Waterman RH Jr. In Search of Excellence. 

New York, NY: Warner Books, Inc; 1984. 

AUTHOR

COL Melanson is Chief of the Health Physics Office, 

Walter Reed Army Medical Center, Washington, DC, 

and Radiological Hygiene Consultant to The Surgeon 

General. 

Leadership Wisdom 
 October – December 2009 21

Leadership is a lot like grade school. The basics are 

very similar. A good leader devotes him or herself to 

the 3 Rs, reading, writing, and arithmetic, plus one—

rhetoric. The first two are obvious. Leaders do not 

advance if they do not learn. And they do not learn if 

they do not read and communicate in writing. A leader 

must also be able to articulate his or her thoughts to 

others—the capacity for rhetoric. 

Leadership arithmetic is a little tougher to grasp at 

first. But, in many ways becoming the new leader to an 

organization is like encountering a complex mathematical equation. It conjures up memories of calculus 

as we attempt to influence the change of attitude, behavior and culture over change in time (da/dt). Or we 

grapple with trigonometry as we attempt to identify 

and solve for the group’s angles. There are some basic 

mathematical rules that can help us to be more 

effective leaders. 

1. Read the instructions first.

Know what you are trying to solve before you launch 

into the problem. There are a lot of variables for you to 

consider and you could work on any number of them. 

But you need to understand the keys to the equation 

and the desired results before you set to work on it. 

2. Consider the whole equation.

Take the time to look at both sides of the equation and 

all of the variables before you attempt to solve any 

aspect of it. The first weeks and months in any new 

organization should be devoted to understanding as 

much about it as possible. Only then can you begin to 

identify which aspects of the problem should be taken 

on first. 

3. Account for existing values and variables.

It is too tempting, especially early in a new leadership 

position, to jump into the equation without thinking 

through what has already been worked on and solved. 

Understanding the work of your predecessor is crucial 

to keep you from fruitlessly hammering at the same 

variables, or undoing something that has already been 

solved. 

4. Do not do addition without subtraction.

A new leader has lots of new ideas. They will be added 

to the equation early on in an effort to effect change 

and solve what appear to be the key variables. If you 

find yourself baffled as to why the things you are 

adding are not being factored into the equation, 

remember that you cannot really add without also 

subtracting. Time, energy, and focus are all finite 

factors for your subordinates. Anything you add must 

have an equal and opposite investment in time, energy, 

and focus subtracted from the equation. Balance must 

be maintained if there is to be any productive result at 

the end of the day. 

5. Do not miss the exponents.

The organizational chart should serve the needs of the 

organization and should change to match the mission 

and the individuals available to help meet the mission. 

There are talented individuals scattered across any 

organization whose attitudes and influence are 

exponential. They are the power factors in the 

equation. Remember that you cannot change the 

equation without taking their influence into 

consideration. Challenge them with meaningful 

opportunities for leadership. They will surprise you, 

and themselves. 

6. Factor out the negatives.

There are folks in any equation whose bent will be 

negative, no matter the subject under discussion. These 

are difficult individuals, regardless of your approach to 

the problem. You must engage them early, get them on 

your side, or remove them from the equation if you 

have any hope of solving it. It only takes a single 

negative individual to change a positive organization 

for the worse. 

7. Find the common denominators.

Solving conflict is often a matter of reducing a 

discussion to what both sides have in common. In 

practice, we remind ourselves what drew us into the 

equation in the first place, the care of Warriors and 

their Families, for example. It puts the differences into 

Leadership Math 

COL Chuck Callahan, MC, USA 

1st Lt Timothy Callahan, USAF 
22 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

context and provides a common framework to solve 

the problem. 

8. Simplify both sides of the equation.

Active listening allows the leader to identify and 

recount the key factors on both sides of a problem. 

When people on either side hear their leader identify 

and articulate the essence of their disagreement, they 

know that someone has listened to them. 

9. Do not forget to account for units.

Everyone in the organization brings their background 

and experience to the equation. It is too easy to lose 

visibility of these aspects of each variable when you 

are attempting to work through things. But, if you keep 

the units in mind, it will help you to understand the 

differences and you can use shared units and 

experiences to help solve problems. 

10. Check your work frequently.

Devoting regular time to step back from the problems 

and take stock of the progress is a key aspect of 

leadership. There is no one else in the organization 

who can be counted on to make sure that crucial 

aspects of the equation are being addressed. Stop at 

regular intervals, review the initiatives and projects, 

and make sure that they make sense in light of the 

organization’s overall strategy. 

Leaders are not born, they are made. They make 

themselves by attending to basics as leader-learners, 

just as they did in school: reading, writing, arithmetic 

and rhetoric. Retired General Tom Hill asked me at a 

cocktail party once what I was reading. It was in that 

conversation that he challenged me to read Manchester’s books on Winston Churchill1,2 and Ambrose’s 

book on Lewis and Clark, Undaunted Courage.

3

 He 

told me that sometimes he asked young officers what 

they were reading, and he got the answer “Sir, I can’t 

afford the time to read.” He would bellow, “Son, you 

can’t afford the time not to read.” Reading is a 

leadership fundamental. 

So much of fundamental communication is writing – 

modern leaders and commanders must use writing to 

communicate their message to their troops. There are 

simply too many of them to depend on one-on-one 

conversation. The battlefield is so fluid that a 

conversation held last week is out of date and devoid 

of importance a week later. I have developed the habit 

of re-reading emails before I send them out, and 

having my public affairs officer check every email I 

intend to send out to “all users” before I punch “send.” 

I also keep a file of written “missives” and other 

articles on the shared drive which includes my 

leadership philosophy, philosophy on OER rating, and 

others. Effective leaders have to be effective 

communicators. And in the 21st century of electronic 

mail, “Facebook,” and blogging, we must be able to 

write things that others will want to read. 

I am constantly amazed at how often I am called on as 

a leader to speak in public, whether at morning report 

as a department chief, to residents as a program director, medical staff as deputy command of clinical services, or any number of forums as commander. 

Recently, as I was standing outside the hospital’s conference room, my Sergeant Major asked me to come in 

and address his meeting of 60 or so Soldiers who were 

up for reenlistment. Before I had time to protest (or 

think) he called the room to attention and I was on the 

stage. It happens frequently. Public speaking is something that can be learned through practice and coaching. Rhetoric (the use of language to persuade) is a 

skill taught to preachers and salesmen. It is something 

that a leader can always sharpen. Record (video and 

audio) your next speech and have someone whose 

public speaking skills you respect watch it with you. 

Like arithmetic, leadership is a skill set that can be 

learned. I am embarrassed to admit that my approach 

to algebra one in 8th grade was to copy Jane’s 

homework each morning, and then wonder why my 

performance was so poor on the tests. Leadership can 

be imitated, but not copied. Like math, it takes 

practice, patience, and persistence. Patience may be 

the most difficult part of the puzzle, because it means 

that results of your labor may not become apparent in 

the commander’s or leader’s brief tenure. 

I recently received an email from a civilian employee 

in my organization which included: “I believe that you 

will be able to plant the seed for change. The change 

will not happen today or tomorrow and may not 

happen in the next two years, but it will change...” 

That kind of command “delayed gratification” will 

require patience and will provide lots of opportunity 

for practice. What is true in math is true in leadership. 

Remember the 3 Rs plus one—keys to being and 

becoming an effective leader. 

Leadership Math 
 October – December 2009 23

THE ARMY MEDICAL DEPARTMENT JOURNAL

REFERENCES

1. Manchester W. The Last Lion: Winston Spencer Churchill: Visions of Glory, 1874-1932. Boston, MA: Little, Brown, 

and Company; 1983. 

2. Manchester W. The Last Lion: Winston Spencer Churchill: Alone, 1932-1940. Boston, MA: Little, Brown, and 

Company; 1988. 

3. Ambrose SE. Undaunted Courage. New York, NY: Simon & Schuster, Inc; 1977. 

AUTHORS

COL Callahan is the Commander, Dewitt Army Hospital and Health Care Network, Fort Belvoir, Virginia. 

1st Lt Callahan is a Project Engineer with the 355th Civil Engineer Squadron, Davis-Monthan Air Force Base, 

Tucson, Arizona. 
24 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Leadership is expected from everyone in the Army 

regardless of designated authority or recognized 

position of responsibility.1

 

We are all leaders, even though we might not have a 

designated leadership position on an authorization 

document. As leaders, we need to understand those we 

work with and ourselves. 

In our work relationships, we find that people have 

different interests, varied skills, occasional difficulties 

communicating what they mean, and they choose to 

live life in their own way. 

So how do we appreciate and reconcile the differences 

in people in order to build and develop strong, 

successful teams? 

One of the tools available to us is the Myers-Briggs 

Type Indicator (MBTI) (CPP Inc, Mountain View, 

CA). Developed by Katherine Briggs and Isabel 

Briggs Myers2,3 based on the work of Carl Jung,4

 this 

highly regarded and widely used tool can assist us in 

identifying what Jung called “preferences.” 

The MBTI does not attempt to stereotype or 

compartmentalize anyone. It tries to help us better 

understand ourselves, make us aware of what 

motivates us, allow us to recognize our natural 

strengths, and permit us to realize our potential for 

growth. Our personalities are a culmination of many 

things like genetics, family life, life circumstances 

outside the family, society's expectations and 

requirements, and many learned traits. Psychological 

or personality type is just one aspect of personality. 

The MBTI attempts to identify self-reported patterns 

to help us look at others and ourselves. 

The MBTI uses 2 opposing behavioral divisions on 4 

scales to produce a “personality type” or preference. 

First, how do we prefer to direct our attention or our 

energy? Second, how do we prefer to take in information? Third, how do we prefer to make decisions? 

Fourth, how do we orient ourselves to the outer world 

or the kind of lifestyle that we have adopted? 

Our results from the MBTI instrument may change 

depending on our frame of reference and/or our 

environment when taking the MBTI instrument. 

Remember, the MBTI results identify valuable 

differences between normal people. No bad types exist 

within the MBTI results, only differences in people. 

To clarify what preference means, try a quick 

experiment. Take a moment and sign your name on a 

piece of paper. That would indicate your preference 

for signing your name. Now, switch the writing 

instrument to the other hand and sign your name again. 

Most of us are able to do this, although it may require 

increased effort and concentration to do it with the 

nondominant hand; we may find it uncomfortable. 

This exercise shows that, given a particular 

circumstance or situation, we can operate through the 

full spectrum of an MBTI scale, but we generally find 

a particular section on the scale more comfortable than 

the rest. This result is our preference. 

THE 4 SCALES AND 8 PREFERENCES OF THE MBTI 

Extraverts and Introverts 

If you get energy from being around people and 

process information externally, then you are classified 

as an extravert. When “Es” have a problem to solve, 

they typically pick up the phone and call someone, go 

and visit family or friends, or find some other way to 

connect with people. Es find small group work and 

open forums very helpful as it allows them to talk out 

loud (externally processing) and use the energy from 

others to recharge and solve their problems (leadership 

style: interactive). 

If you get energy by being alone and process 

information internally, then you are classified as an 

introvert. When “Is” have a problem, they need to be 

alone so that they can think about the situation and 

come up with a solution through introspection. 

Personality Type and Leadership 

David K. Hagey, MS 
 October – December 2009 25

Introverts find support through self-help books, 

movies, and other resources that allow them the time 

to process the information (leadership style: 

reflective). 

Example from work: 

Your boss is an I and you are an E. You both come 

into work early. 

As an E, you are there to socialize and talk with 

others. The boss is there to focus on the work at 

hand. You see him walk into the office area and 

greet him with a big “Hey!” He goes into his office 

without responding. What do you do? 

Introverts and Extraverts working together must respect their differences and find ways to accommodate 

the needs of both personality types. 

Sensors and Intuitives 

A Sensor (“S”) is someone who is very detail oriented. 

Sensors see minor flaws as major flaws. Sensors notice 

the fine details when asked to describe something. 

Sensors prefer practical solutions to theories and call 

themselves realists. Sensors live in the present. If 

Sensors are looking for solutions to problems, they 

will put more value in experience over a hunch. 

Sensors excel when asked to use tried and true 

methods that draws on their existing skill set 

(leadership style: administrative). 

Intuitives (“N s”) are big picture thinkers. Intuitives 

look to the future and can see all the possibilities. 

Intuitives dream big. N s are the idea people and admire others who are creative thinkers. Intuitives notice 

what is new and different and comment on the overall 

feel and look of things. Ns are the inventors—they see 

how problems can be solved with a new invention or 

process. Intuitives consider the future when they process information. They sometimes make “random 

leaps of thought” during this process. Ns trust their 

gut. Intuitives like to spend time analyzing and considering the possibilities (leadership style: visionary). 

Example from work: 

The colonel ( N ) needs to know where the 

department could hold a conference. He calls in one 

of the captains (S ) and asks him to develop a list of 

hotels in the local area where they could hold a 

conference. The captain comes back later and 

hands the colonel a list of hotels. The colonel eyes 

the list and asks, “But where are the telephone 

numbers for points of contact, and how many 

people will the rooms hold, what about 

refreshments and maps that show distance from our 

facility?” The captain replies, “But sir, all you 

asked for was a list of hotels.” 

Sensors and Intuitives must understand the differences 

in the ways they process information to work together 

in harmony. 

Thinkers and Feelers 

If you are a “T” (a Thinker), you will base your 

decision-making around practical, objective criteria. 

Thinkers appear cold and reserved often seen as 

antisocial at a conference or meeting, as Thinkers are 

more interested in finding practical solutions to 

problems—that is why they came in the first place. 

Thinkers like to be thought of as realists (leadership 

style: logical). 

As a Feeler (“F”), you base your decision-making 

around your values and emotional clues. Feelers trust 

their gut and care about how actions make them feel or 

others feel. F s exercise compassion and empathy, and 

look for harmony. Feelers are easy to spot due to their 

warm and friendly nature; they are often labeled as 

people persons (leadership style: harmonious). 

Example from work: 

The Company Commander ( T ) and the First 

Sergeant ( F ) find out two of their personnel have 

been arrested for shoplifting in the Post Exchange. 

As they discuss the issue, the Commander is ready 

to impose maximum punishment under the 

Uniform Code of Military Justice.* The First 

Sergeant mentions that one of the Soldiers is 

married and lives off-post with his family, while 

the other Soldier is single and lives in the barracks. 

He states that it is not fair to punish them with the 

same penalties. 

Feelers like to work in harmony where feelings and 

personal values are regarded as important. Thinkers 

*The Uniform Code of Military Justice, a federal law,5 is the 

judicial code which pertains to members of the United States 

military.
26 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

focus on practicality and impersonal, analytical problem solving. 

Judgers and Perceivers 

Judgers require a very structured, ordered, and 

predictable environment to be happy. If “J s” are 

working in an unorganized environment, they will 

either try to organize it or they will constantly 

complain that things are a mess, nothing is in its place, 

or that the disorganized workplace environment affects 

their productivity. Judgers thrive in highly regulated 

environments. J s work first and play later (leadership 

style: planful). 

Perceivers like a more laid-back approach. “P s” focus 

on the experience and they prefer things to unfold as 

they will. Perceivers do not like to limit options, and 

thrive in dynamic, ever-changing workplace 

environments. P s can work in a mess, in fact, they 

prefer to work in chaos as it stimulates creative 

thinking when predictability is removed. Perceivers 

seek employers that offer flexible working 

arrangements. P s love to play. If work is lighthearted 

and not terribly regimented, they are content 

(leadership style: flexible). 

Example from work: 

As a J, do you keep a to-do list? When you 

accomplish something on the list, do you mark it 

off? As a J, when you do something not on the list, 

do you add it to the list and then mark it off to show 

it was completed? Have you ever turned-in a 

project by the due date, even when you needed 

more time to research? As a P, do you keep a to-do 

list? How often do you write things down and how 

often do things on the list change? Have you 

occasionally called to extend a deadline in order to 

develop more/better data? 

The Judger prefers a highly structured work 

environment, whereas the Perceiver enjoys a more 

relaxed climate for work. 

Some of us may think that the MBTI is a “touchyfeely” tool. If used correctly and ethically by a 

qualified practitioner, the Myers-Briggs Type Indicator 

increases self-understanding and appreciation of 

personal differences in order to improve one-on-one 

interactions and team success. 

Information about the MBTI is available from a 

myriad of sources, including the following websites: 

www.mbticomplete.com (MBTI Complete (CPP)) 

www.aptinternational.org (Association for Psychological Type International) 

www.keirsey.com (Keirsey Temperament Sorter) 

REFERENCES

1. Field Manual 6-22: Army Leadership; Competent, 

Confident, and Agile. Washington, DC: US Dept of 

the Army; October 12, 2006: p3-11. 

2. Saunders FW. Katherine and Isabel: Mother’s Light, 

Daughter’s Journey. Palo Alto, CA: Consulting Psychologists Press; 1996. 

3. Myers IB. Gifts Differing: Understanding Personality 

Type. 2nd ed. Palo Alto, CA: Consulting Psychologists Press, Inc; 1995. 

4. Jung CG. Psychological types. In: Hull RFC, transed. The Collected Works of C. G. Jung. Vol 6. Princeton, NJ: Princeton University Press; 1976. 

5. Uniform Code of Military Justice, 64 Stat. 109, 10 

USC, ch 47. 

AUTHOR

Mr Hagey is a Training Instructor, Oral and Written 

Communications, at the Leader Training Center, Army 

Medical Department Center and School, Fort Sam 

Houston, Texas. Mr Hagey is certified as an MBTI 

practitioner by the Association for Psychological Type 

International (http://www.aptinternational.org). 

Personality Type and Leadership 
 October – December 2009 27

CROSSROADS

Convergence 

Sigmund Freud’s Convergence Theory holds that 

crowd behavior is not a product of the crowd itself, but 

is brought to the crowd by particular individuals. Thus, 

crowds amount to a convergence of like-minded individuals. Therefore, people who wish to act in a certain 

way come together to form crowds. For instance, 

Soldiers with common job skills, badges, patches, or 

even a favorite football team may band together within 

the Army with overt intentions. Convergence theory 

also asserts that crowd behavior itself is not irrational, 

but rather, people in crowds express existing beliefs 

and values so that the group reaction is the product of 

widespread popular feeling. Properly directed, this 

feeling can be esprit de corps. In some instances, this 

leads to parochialism and pontification within an 

organization. However, the chain of command in the 

Army is, by design, the common denominator for all 

Soldiers and employees and therefore responsible for 

controlling the many degrees of freedom within the 

units. Since leadership is situational, a single article 

can not address the different levels of leadership, much 

less different types of leadership requirements of 

different types of units (eg, sniper platoon vs 

preventive medicine detachment). However, 

discussing social reality within the context of the 

Army in contemporary America may be the key to the 

recruitment and retention of high quality Soldiers. 

A Young Democracy 

In the 1923 case of United States v Bhagat Singh 

Thind,

1

 a naturalized citizen, the US Supreme Court 

ruled Asian-born persons could not become citizens. 

Bhagat was stripped of his citizenship based on a 1790 

statute that declared Indians to be Asians and Asians to 

be “not white,” and therefore ineligible for US 

citizenship. By 1924, the Johnson-Reed Act2

 set strict 

quotas on immigration by origin. However, the scope 

of the exclusion expanded over the years to include 

Japanese, Koreans, and other “Asiatics.” 

Paradoxically, Jesus would not have been allowed 

citizenship and the majority religion of the country 

was Christianity. Fortunately, the Civil Rights Act3

was passed in 1964 and paved the way for the 1965 

Immigration and Nationality Act.4

 For the first time 

since 1924, people from all over the world could come 

to America and become citizens. Figure 1 shows how 

the trend of foreign-born US citizens was affected by 

legislation, with a distinct drop in foreign-born 

population after the Johnson Reed Act followed by a 

recovery increase after the Immigration and 

Naturalization Act. Certainly there were global 

circumstances that instilled fear among many 

Americans and caused such legislative knee-jerk 

reactions, but one must remember that policy is meant 

to be created, changed, and/or abolished to suite 

contemporary circumstances. 

Dynamic Leadership: 

 Essential for the 21st Century 

MAJ D. Scott McIlwain, MS, USA 

Uniform \'yü-nə-fôrm\ consistent in conduct or opinion, from Latin uniformis (one form). 

Ethnic \'eth-nik\ of or relating to large groups of people classed according to common racial, national, 

tribal, religious, linguistic, or cultural origin or background, from Latin ethnicus (nation, people). 

Religion \ri-'li-jən\ a personal set or institutionalized system of attitudes, beliefs, and practices, from Latin 

religio (constraint). 

Generation \je-nə-'rā-shən\ a body of living beings constituting a single step in the line of descent from 

an ancestor. 

Source: Merriam-Webster Online Dictionary. Available at: http://www.merriam-webster.com/. 
28 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Change 

There are 192 member states in the United 

Nations.7

 Each one is represented in the US 

Census. The United States is the most diverse 

nation on earth. This growth is a result of our 

nation’s birthrate rising faster than the 

mortality rate. When these 2 factors combine 

with immigration and mixed ethnicity 

marriages, a faster growth of minority 

ethnicities is created. Even the US Census 

Bureau has changed its data collection 

methods to more accurately reflect the 

diversity of the United States. In 1977, the 

Office of Management and Budget (OMB) 

issued Statistical Policy Directive Number 

15.8

 In this new government policy, only 4 

races were options. A review of the Directive 

by an interagency committee in the mid-1990s 

resulted in recommendations for change, the most 

notable of which was the ability for respondents to 

select one or more race on surveys.8

 For example, the 

selections “White” and “Asian” can be simultaneously 

selected by a respondent with biracial parents. Tiger 

Woods even light-heartedly comments that he is 

“Cablinasian” when asked about his ethnicity, which 

represents his mix of Caucasian, Black, Indian, and 

Asian heritage. In October 1997, the OMB announced 

that these revised standards for federal data on race 

and ethnicity would be utilized by all governmental 

agencies beginning in January 2003.9

THE NEW FACE OF AMERICA

Ethnicity 

Different cultures came with our nation’s immigrants . 

Although the cultures were present, they were not 

readily visible because expression of uniqueness was 

not the norm in American culture until recent decades. 

For instance, study groups for a particular religion 

would not openly advertise or meet in public venues. 

Over the years, as the minority populations have 

grown, their cultures make their way out of the 

basements of houses and into mainstream America.10

The national paradigm is rapidly shifting from a 

“melting pot” to a “mixed salad.” Rather than the 

dissolution of immigrant cultures into our society, 

unique cultures now stand out as individual parts. 

Today, the fastest growing groups in the United States 

are Hispanics and Asians. Each is nearly as large as 

the black population. By 2050, Caucasians are 

predicted to no longer be the majority in the United 

States.11

Many immigrants are maintaining ties with their 

homeland with telecommunication and the internet. 

The local newspaper can easily be accessed in most 

cases allowing immigrants to keep abreast of 

community events. Globalization of communication is 

allowing immigrants to be a part of their homeland on 

a continuous basis rather than shedding their past to 

conform to a new society. 

Religion 

The founding fathers of our nation wrote a religionfree constitution. Therefore, no religious belief would 

be considered privileged in the public eye. Even so, 

Christianity was still the dominant religion of our 

fledgling country. This led to spirited competition 

among congregations since they had no support from 

government. This free market of religion became a 

unique characteristic of America that exists today. 

In the past 3 decades, the majority religions in the 

United States were Catholic, Protestant, and Jewish. 

Now, the fastest growing religion in the United States 

is the Muslim faith. In the United States, there are 

more Muslims than Episcopalians or Presbyterians and 

approximately the same number of Jews. This trend is 

followed closely by Mormonism, Hinduism, 

Buddhism, and Sikhism. In 1997, there were over 

Dynamic Leadership: Essential for the 21st Century 

Figure 1. Foreign-born percentage of total US population for each year, 

1850 through 2000. 

Sources: 

Gibson and Lennon5

; Census Brief 2000 6

Hart‐Celler

Immigration

Act

Expansion of

Racial Quotas

and

Exclusions

Chinese

Exclusion

Act

Percentage 
 October – December 2009 29

THE ARMY MEDICAL DEPARTMENT JOURNAL

1,000 Muslim mosques in the United States. In 1960, 

there were none.10

The religions of the world share one important feature. 

They all aspire toward a spiritual goal, whether it is the 

union with a supreme being or the realization of a 

higher spiritual state. Although there are many faith 

traditions in the world, similarities in their moral code 

are striking. Believers are inspired to pursue their 

faith's moral code as closely as possible. Aside from 

teaching religious ceremony and ritual, religions teach 

people to respect each other and help others in need. 

Moral codes have inspired nonprofit organizations 

such as the Muslim Red Crescent, Christian Red 

Cross, and nondenominational Habitat for Humanity. 

It is apparent in public politics that multiculturalism is 

recognized, but religion is foreshadowed. Religions 

shape every aspect of our daily life, from laws 

regarding marriage and divorce to the details of food 

preparation. Both nations and individuals describe 

themselves in religious terms. Religion provides 

people with hope for the future and comforts them in 

times of anguish. Therefore, it cannot be ignored by 

leaders. 

Generation Disconnect 

The term “generation gap” refers to a 15-year period 

(1965 – 1980) where birth rates sharply declined after 

the post World War II “baby boom.”12,13 Once the 

children of the baby boomers began having families of 

their own, the birth rate once again started to 

rise. However, children born in this dip, or gap, 

are referred to as generation X. The title is representative of the disproportionately small growth 

of this age group that was “lost in the gap.” The 

growth following the gap is the grandchildren of 

the baby boomers known as generation Y, or 

millennials. The rise in the birth rate is 

noticeable in this group, but not as pronounced 

as the baby boom. After generation Y, is another 

marked “echo” gap resulting from the smaller 

generation X starting families (Figure 2). 

The attitudes and behaviors of each generation 

are studied by sociologists because of the impact 

their interactions have on society, and moreover 

the workplace. There is no magic age that makes 

you one generation or the next, nor does being 

labeled a particular generation make you 

predisposed to certain characteristics. What 

makes these generational groups have different mind 

sets are their experiences. Figure 3 identifies the 

percentage each generation contributes to the Army’s 

population and a few identifiable characteristics. 

With approximately 80 million peers and having 

parents from the “greatest generation,” baby boomers 

tend to be highly competitive and will readily work 

long hours and sacrifice to remain competitive. 

Unfortunately, this also correlates with a high divorce 

rate and clashes with other generations in the work 

place. This group is credited with shaping today’s 

corporate culture that has made the United States a 

dominant figure in agriculture, medicine, business, and 

manufacturing. 

The high divorce rates from the baby boom generation 

and the recession of the 1980s shapes the mindset of 

generation X. Watching sacrificial hard work be 

rewarded with layoffs and personal hardship, 

generation X is particularly untrusting when it comes 

to employers. Between divorce and dual career 

parents, this generation is often referred to as the 

“latchkey” generation. This is a reference to children 

who would go home after school to an empty house 

because their parent(s) were still at work. This created 

a sense of independence among this group that carries 

over into the work place. This group does not believe 

in the career ladder and will change jobs without a 

second thought. 

Gen Y

1977‐1998

75 million

Gen Z

2002 to

Present

Baby

Boom

1946‐1964

76 million

Gen X

1965‐1976

51 million

Birth Rate 

Figure 2. The US birth rate (live births per 1,000 population) for the 

years 1940 through 2005. 

Sources: 

Vital Statistics of the United States, 1994 14; Hamilton, Martin, and Ventura15
30 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Generation Y is just beginning to show up in the 

work force. Growing up in a thriving economy, this 

generation is the most optimistic of all generations in 

the work place. They are accustomed to being 

involved in decision making, are technologically 

savvy, and have high expectations from their 

employers.12 This generation constitutes the bulk of 

the Army and our future. 

CONCLUSION

Convergence of religion, ethnicity, and generations 

are shaping our future and mandates the 

development of dynamic leaders. Keeping abreast of 

these issues through education will allow leadership 

to maintain a proactive stance on change and the 

diversity within the United States. Acknowledging 

that differences exist, even in an organization that is 

driven by uniformity, can facilitate a collegial 

atmosphere and ultimately a more productive 

organization. 

REFERENCES

1. United States v Bhagat Singh Thind, 261 US 204 

(1923). 

2. Immigration Act of 1924, 43 Stat. 153; 8 USC 201 

(1924). 

3. Civil Rights Act of 1964, Pub L 88-352, 78 Stat. 241 

(1964). 

4. Immigration and Nationality Act of 1965, Pub L 89-

236, 79 Stat. 911. 

5. Gibson CJ, Lennon E. Historical Census Statistics on 

the Foreign-born Population of the United States: 

1850-1990. Washington, DC: US Bureau of the 

Census; February 1999. Population Division Working 

Paper No. 29. Available at: http://www.census.gov/

population/www/documentation/twps0029/

twps0029.html. Accessed October 5, 2009. 

6. US Bureau of the Census. Census Brief 2000. 

Washington DC: US Bureau of the Census; August 

2000. Available at: http://www.census.gov/

prod/2000pubs/cenbr002.pdf. Accessed October 5, 

2009. 

7. Press Release ORG/1469: United Nations Member 

States. United Nations Website. July 3, 2006. Available at: http://www.un.org/News/Press/docs/2006/

org1469.doc.htm. Accessed March 31, 2008. 

8. Directive No. 15: Race and Ethnic Standards for 

Federal Statistics and Administrative Reporting. 

Washington, DC: Office of Management and Budget; 

May 12, 1977. Available at: http://

www.whitehouse.gov/omb/fedreg_directive_15/. 

Accessed September 24, 2009. 

9. Race Data. US Census Bureau Website. Available at: 

http://www.census.gov/population/www/socdemo/

race/racefactcb.html. Accessed March 18, 2008. 

10. Eck DL. A New Religious America. San Francisco, 

CA: Harper Collins; 2001. 

11. Bernstein R, Edwards T. An older and more diverse 

nation by midcentury [press release]. Washington 

DC: US Census Bureau; August 14, 2008. Available 

at: http://www.census.gov/Press-Release/www/releas 

es/archives/population/012496.html. Accessed October 5, 2009. 

12. Cheung E. Baby Boomers, Generation X, and Social 

Cycles. Vol 1. Toronto, Canada: Long Wave Press; 

2007. 

13. Bennis WG, Thomas RJ. Geeks and Geezers: How 

Era, Values and Defining Moments Shape Leaders. 

Boston, MA: Harvard Business Publishing; 2002. 

14. National Center for Health Statistics. Vital Statistics 

of the United States, 1994, Volume 1, Natality. 

Atlanta, GA: US Centers for Disease Control and 

Prevention; 1994: Table 1-7. Available at: http://

w w w . c d c . g o v / n c h s / d a t a / s t a t a b / n a t f i n a l 

1995annvol1_07%20.pdf. Accessed October 5, 2009. 

15. Hamilton BE, Martin JA, Ventura SJ. Births: 

preliminary data for 2007. National Vital Statistics 

Reports, Vol 57 No 12. Atlanta GA: US Centers for 

Disease Control and Prevention, National Center for 

Health Statistics; March 18, 2009. 

Dynamic Leadership: Essential for the 21st Century 

4% of the Army

 Work defines life

 High divorce rate

 “Breadwinners”

12% of the Army

 Works to live

 Very untrusting

 Dual career family

83% of the Army

 “Connected”

 High expectations

 Telecommuting

Figure 3. The proportion of the “generations” across the US Army 

Soldier population. 

Sources: 

Cheung12; Bennis and Thomas13; Maxfield16; Wong17
 October – December 2009 31

THE ARMY MEDICAL DEPARTMENT JOURNAL

16. Maxfield BD. Army Profile 2005. Washington, DC: 

Office of Army Demographics, US Dept of the 

Army; September 30, 2005. Available at: http://

www.armyg1.army.mil/HR/docs/demographics/

FY05%20Army%20Profile.pdf. Accessed October 5, 

2009. 

17. Wong L. Generations Apart. Xers and Boomers in 

the Officer Corps. Carlisle, PA: Strategic Studies 

Institute, US Army War College; October 1, 2000. 

Available at: http://www.strategicstudiesinstitute 

.army.mil/pubs/display.cfm?pubID=281. Accessed 

October 5, 2009. 

AUTHOR

MAJ McIlwain is the Director, Otolaryngology 

Technologist Program, Academy of Health Sciences, 

US Army Medical Department Center & School, Fort 

Sam Houston, Texas. 

No matter the generational niche, throughout history members of the US military have 

unfailingly displayed courage and dedication in defense of freedom and our way of life. Moreover, 

in so doing they also have reflected the inherent decency and generosity of the people of the 

United States, whenever and wherever they serve. 
32 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

When I was 11 years old, my friend Mike and I formed 

the Lafayette Escadrille (LE). It was a club based on 

riding around on bikes looking for noble deeds to 

accomplish. As I remember, there were precious few 

noble deeds to occupy preadolescent boys in the New 

Jersey suburbs of the sixties. But we had an elaborate 

system of ranks, emblems, laws, maps and notebooks 

along, with about a half-dozen kids who were, to a 

one, far less enthusiastic about the LE than we were. I 

was, as I recall, the leader. 

Leadership has been a lifelong study for me. I believe 

that leaders (those who end up in positions of responsibility and authority) should be students of leadership 

(the ability to motivate a group of people toward a 

common goal). To be a lifelong student means that one 

has never quite arrived at the level of leadership 

expert. There are always more lessons to learn. 

I am also convinced that leadership is life. The lessons 

that one learns as a leader and in the practice of 

leadership forge principles which are also essential for 

success in marriage, parenthood, business partnerships, 

friendships and all scope and manner of human 

relationship. The opposite is also often true, although 

we seldom make the observation. For example, if I can 

figure out how to successfully parent a child through 2 

decades of development, I can also learn to adapt my 

leadership style to different situations and individuals 

within an organization. 

Leadership in an individual is a product of nature, 

nurture, and “knocks.” Clearly there are certain 

personality types that are more common in leaders. For 

example, in a study of 270 senior officers at the Army 

War College, Herbert Barber determined that 71.1% of 

the students indicated preferences that fit into one of 

the 4 Myers-Briggs Personality Types* that include 

thinking and judging: 

 ISTJ - Introverted Sensing Thinking Judging 

 ESTJ - Extroverted Sensing Thinking Judging 

 INTJ - Introverted Intuitive Thinking Judging 

 ENTJ - Extroverted Sensing Thinking Judging 

These traits suggest a distinction in how leaders make 

decisions; thinking (whether one values impersonal 

logic) vs feeling (using personal feelings in processing 

information or making decisions). They suggest a 

distinction in the way a person encounters the world; 

judging (one analyzes and judges the external 

environment) vs perceiving (reacting to it with 

flexibility and spontaneity).2

Strong nurturing environments also promote the 

development of leadership. There are numerous 

examples of leaders whose childhood was supporting 

and nurturing. Someone puts the idea in a child’s head 

that he or she can be more, do more, accomplish more 

than imagined. World renowned neurosurgeon Ben 

Carson points to the influence of his mother and 

family,3

 as does President Obama. General Douglass 

MacArthur’s mother “Pinky” followed him to West 

Point and lived in the hotel off post while he was a 

cadet.4

But leadership is also a matter or responding to 

knocks—the knocks of opportunity or the knocks of 

life. British Prime Minister Benjamin Disraeli said 

“The secret of success in life is for a man to be ready 

for his time when it comes.”5

 When an opportunity to 

lead presents itself, leaders step up. Similarly, when 

trials or difficulties come—the knocks of life—the true 

leader separates himself or herself from the pack by 

demonstrating courage, perseverance, and purpose. 

The practice of leadership is based on a leader’s 

principles. Principles define the “who” of a person; 

what they stand for, how they are defined. Integrity, 

humility, honor, and faith are examples of principles 

that define who we are. Values describe “how” we 

live. They are the way we work out principles in the 

practice of our lives. Justice, mercy, loyalty, veracity, 

service, courage, and wisdom all represent values we 

*The Myers-Briggs Type Indicator (CPP Inc, Mountain View, CA) is a personality questionnaire designed to identify certain 

psychological differences according to the typological theories of Carl Gustav Jung as published in his book Psychological Types.

1

See related article on page 24.

Resonance, Dissonance, and Leadership 

COL Chuck Callahan, MC, USA 
 October – December 2009 33

use to negotiate life. The last of these, wisdom, may in 

some ways be the most important. Wisdom knows the 

right thing to do or say in the right circumstance. It is 

based on intuition, which in itself is a combination of 

instinct (feelings or emotions) and intellect (cognition 

and knowledge). 

Crucial then for wisdom is an understanding of one’s 

feelings and emotions as well as the feelings and 

emotions of others. Emotional intelligence describes a 

person’s ability to be aware of and responsible for the 

management of his own feelings, as well as being able 

to be sensitive and respond appropriately to the 

feelings of others. In his 2002 book,6

 Daniel Goleman 

summed up his research on emotional intelligence in 

the workplace. He described 6 types of leadership 

styles (visionary, coaching, affiliative, democratic, 

pacesetting, and commanding), 4 domains of emotional intelligence (self-awareness, self-management, 

social awareness, and relationship management), and 

the steps leaders could take to learn these leadership 

skills. The result of successfully considering emotional 

intelligence in any setting was what he called 

“resonance.”6(p55)

The notion of resonance and resonant leadership is 

based on a principle of physics that describes the 

generation of sound of musical instruments. Instruments all have natural frequencies at which they are 

capable of vibrating if they are struck, strummed, or 

blown at the appropriate frequency (think about the 

appropriate “buzzing” of the lips for those who play 

brass instruments or reed vibration for woodwind 

players). When one object vibrating at the same natural frequency of a second sets the second into vibrational motion, you have resonance. And you get music. 

The sound of the sea you hear when you listen to a 

seashell is also due to resonance. Even an apparently 

quiet room is filled with sound waves with a range of 

frequencies. These sounds are mostly not heard 

because of their low intensity. This background noise 

fills the seashell, causing vibrations within the 

seashell. The seashell has a set of natural frequencies 

at which it will vibrate. If one of the frequencies in the 

room forces air within the seashell to vibrate at the 

shell’s natural frequency, a resonance situation is 

created and the “sound of the ocean” is loud enough to 

be heard. 

Emotional resonance is similar. When, through paying 

attention and being intentional, I allow my emotional 

state to reflect yours, or when I am able to influence 

your emotional state in a positive way, I create resonance. Humor and laughter (that is not at the expense 

or hurt of another) are good examples of emotional 

resonance. They can be amplified as they are shared 

and can create resonance. All of us can recall a tense 

or uncomfortable situation that was instantly 

transformed by a shared laugh or smile. The best 

indicator of the morale or “timbre” of an 

organization—its resonance—is the presence of 

laughter. 

Dissonance is the opposite. It is the creation of 

negative emotions through my inability or 

unwillingness to appreciate your emotional state. Or is 

it a negative influence that I generate through my own 

ill-humor, or ill-treatment of others. Goleman and his 

associates recognized that certain leadership styles 

were more likely to create resonance in the workplace 

(visionary, coaching, affiliative, democratic) and 

others were more likely to create dissonance (pacesetting and commanding).6(pp71-80)

This is not really sophisticated stuff. I think that most 

of us understand intuitively the difference between 

resonance and dissonance. You meet someone at a 

party and strike up a conversation. You find that you 

share similar interests and some similar experiences. 

You share a brief anecdote about a serious or 

challenging aspect of your life. You laugh together. 

When you walk away from the encounter, you say to 

yourself, “What a great guy! We have to get together 

again.” When you share the same ideas or concepts, 

you have cognitive resonance. When you find yourself 

sharing the same feelings, you have established 

emotional resonance. 

You also probably know what dissonance looks like. 

Or you know someone like this at work or in the 

family. Whenever he is around, things are tense. He 

seems to be unable to appreciate (or care!) when you 

are stressed or struggling with your job or personal 

issues. His attempts at humor are unappreciated or, 

even worse, mean-spirited. People shake their heads 

when he walks away and find themselves saying things 

about him such as: “He is so out of touch,” “He just 

doesn’t get it,” “He doesn’t listen,” or “He is not on 

the same sheet of music with us.” 

This is also the guy who seems to always be thinking 

of what he is going to say while you are still talking, 
34 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

and doesn’t let you finish your sentences. He will cut 

off the conversation before you are sure he 

understands your concerns, or he will change the 

subject (often using a personal anecdote) and force the 

conversation in another direction. This person creates 

cognitive dissonance by centering on discussion 

(where he attempts to “help” you see the error of your 

ways) instead of dialogue (where both parties are 

willing to confer and concede on specific points). 

Emotional dissonance is also created by his unwillingness to consider how you feel. 

We find that cognitive and emotional dissonance play 

themselves out in 3 different settings that can be 

broadly grouped as “love” (our close, personal 

relationships), “life” (our professional relationships), 

and “leadership” (the way we relate to groups of 

individuals). In each case, there are unique risks and 

benefits to working toward resonance and away from 

dissonance. 

LOVE

My wife and I lost our first baby. Her pregnancy after 

a year of marriage had been the answer to our dreams. 

She had a miscarriage at about 12 weeks in July 1981, 

and we felt as though our lives were shattered. People 

close to us said things like “You’re still young,” or 

“You’ll have another.” I know that they meant well, 

but we didn’t want another baby. We had already 

bonded with this child. We had already named him. I 

remember thinking through my tears, “We would have 

played ball together....” In the next decades, we were 

blessed with 7 children and a number of foster 

children, and I have played ball with and been soundly 

beaten by more than one of them. But I remember how 

distant I felt from friends and family—emotional 

dissonance. 

More importantly, my wife and I grieved at a different 

pace. I was “over” it well before she was, and dove 

into my second year of medical school studies to 

distract me from the loss. My wife wrestled with the 

loss of the baby longer than I did, and she struggled 

with questions the whole experience raised about God 

and faith. We learned that for us to experience what I 

now know to be emotional resonance, we had to learn 

to listen to each other, to appreciate where we were in 

the emotional recovery process, and to give each other 

space where it was needed. We were blessed to bring 

home our oldest son a year later. 

There are scores of examples of the same kinds of 

emotional dissonance and resonance in raising children 

and staying married for nearly 3 decades. I believe that 

the longer you work at being married and parenting, 

the more time you spend working toward both 

cognitive and emotional resonance. A key that I 

learned from Steven Covey is one of his “Seven 

Habits”: listen first to understand, then to be 

understood.7

 Active listening is the key to establishing 

emotional resonance with those whom we love. 

LIFE

A wise family practitioner once told me, “Whenever 

you are with a patient and you feel anything, ask 

yourself what’s happening.” He used it as an 

opportunity to teach his young medical students about 

situations that ranged from patients evoking anger in 

us by frustrating conversations, to picking up on 

patients making sexual advances toward us. 

His insight was invaluable in my first job as a 

pediatrician. Our acute or same-day appointments 

were scheduled at 5 minute intervals, 36 appointments 

per half day, 72 in a 6-hour weekend clinic. In a 5-

minute appointment, there is not a lot of time to 

explore the subtle nuances of emotion and cognitive 

resonance. I found very quickly that if I sat down (I 

used the trash can in the exam room), leaned forward, 

made eye contact, and disciplined myself to try to 

mirror the patient’s level of concern with my own 

facial features, we were often able to establish 

emotional resonance. I heard many times, “Dr Callahan really listens to me.” I wish I was always as confident that I was listening. But what the parent was 

usually trying to say was that we were able to establish 

emotional resonance, even within a 5-minute visit. 

Patients and our peers more often than not merely 

want to be understood. They want to know that someone is willing to consider what they are feeling, and is 

willing to try to understand their perspective. An 

unwillingness to feel and to understand leads to dissonance. The discipline requires that we approach 

every encounter in life with attention (what are the 

needs of the person with whom I am speaking?), 

intention (what can I do to connect and to understand?), decision (will I choose to take the initiative to 

establish or deepen this relationship?), and action (will 

I take the necessary steps to make this connection?). 

Resonance, Dissonance, and Leadership 
 October – December 2009 35

THE ARMY MEDICAL DEPARTMENT JOURNAL

LEADERSHIP

Sometimes I am accused of trying to reduce life to a 

series of 2  2 tables. It may be true, but, especially in 

leadership, I think sometimes that simple observations 

can be made. Interactions between a leader and his or 

her subordinates can either create resonance or 

dissonance. (Interactions can also be neutral, in which 

case the relationship remains unchanged, shaped by 

previous resonance or dissonance.) Leaders create 

resonance or dissonance either on purpose (resolute) or 

by accident (dissolute). 

Some leaders, whether through their innate leadership 

style or their personality, create resonance on purpose: 

resolute resonance. These are leaders who talk about 

the importance of their people, and then demonstrate it 

with their actions. In the 1954 movie White Christmas

(Paramount Pictures, Hollywood, CA), starring Bing 

Crosby, Danny Kaye, and Rosemary Clooney, the men 

describe their old World War II general (MG Thomas 

Waverly played by Dean Jagger) by saying, “we ate 

then he ate, we slept then he slept...” and sang “We’ll 

follow the old man wherever he wants to go....” By 

his intentional and “attentional” actions on behalf of 

his men, the fictional MG Waverly demonstrated resolute resonance. (There are certainly scores of examples 

of nonfictional leaders who have demonstrated the 

same ability to create resolute resonance.) 

Sometimes you have to shake things up. It is common 

when taking over an organization that needs a 

turnaround starting at the very top. Michael Watkins’ 

book, The First 90 Days,8

 is a must read for every new 

commander and leader. He makes the point that new 

leaders in struggling organizations may need an outsider to come in and “break some eggs,” shattering pat 

solutions and shaking up an established, but unsuccessful corporate culture.8(pp61-62) Such a leader can be 

considered to be practicing resolute dissonance; creating organizational dissonance for a specific reason. 

In the book, Band of Brothers,

9

 Steven Ambrose 

describes the soldiers of Easy Company of the 506th 

Infantry Regiment, 101st Division, as being united in 

their hatred of their first company commander, CPT 

Herbert Sobel, whose leadership style could at best be 

considered narcissistic. He did not take the unit into 

combat, but as his soldiers shared a common hatred of 

him, they united as a team.9(p25) Thus, CPT Sobel’s 

leadership created resonance he did not intend, 

dissolute resonance. 

Finally, there are leaders whose style is simply 

degrading and discouraging for those with whom they 

work. One Army commander is given to angry tirades, 

demeaning his staff in front of others. Another 

commander works every night until midnight and 

expects all his staff members to do the same. A 

hospital department chief sows dissent by talking to 

staff members about other members of the staff behind 

their backs. The actions of these leaders result in 

dissolute dissonance. The workplace climate they 

create is one of dissonance, but they have no idea that 

they are doing it, nor would they necessarily care. 

What disciplined practices will help us to be aware of 

the principles of emotional intelligence and to practice 

an awareness of our emotions and the emotions of 

others as we move through the chaos and crisis of day 

to day living and leading? 

GET UP ON THE BALCONY

Getting above what is happening or what we are 

feeling must become a continual process for leaders. 

Every time we get angry, annoyed, or perplexed—

something is happening. Every time we feel happy, 

satisfied, or fulfilled—something is also happening. 

Understanding what led to these feelings and taking 

the opportunity to respond rather than react depends on 

our ability to pause and look down on what is 

occurring. We need a regular seat on the balcony. 

LISTEN TO LANGUAGE

From this balcony view we can also be aware of the 

feelings and reactions of others. When we say 

something that makes someone else annoyed or 

impatient, we can often tell by their body language and 

posturing. Their “natural language” communicates 

without them saying a word. 

ALWAYS ASK WHY? 

Understanding what is going on with those whom we 

lead is crucial. There may be little we can do to 

mitigate others’ emotional responses to what we say or 

do, but we need to understand them. People follow 

managers with their heads. They follow leaders with 
36 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

their hearts and emotions. It is crucial that we be 

sensitive, then, to the very things that will motivate 

them to either follow, or not. 

SHOOT AN AZIMUTH

Compare the way you are feeling or the feelings you 

observe in others with your overarching goals. Weigh 

actions carefully—will this accomplish what I am 

really after? If I react angrily or speak sharply, will 

that make my people more likely to accomplish what I 

think are our shared objectives and goals? Will it 

accomplish my own, personal, professional, or 

leadership goals? Having a good sense of our 

“azimuth” will keep us out of trouble. 

CHOOSE ACTIONS

This follows naturally. Feelings are amoral, they are 

neither good nor bad. What we do with them most 

certainly can be. What separates humans from other 

animals is, in part, our ability to choose how we 

respond to our feelings or the feelings of others rather 

than just reacting. Many adults and, in fact, many 

leaders never quite reach this level of evolution. 

Life is complex. There is a messy unpredictability to 

it. Philosopher G.K. Chesterton captured this notion in 

a 1924 work, 

The real trouble with this world of ours is not that it is 

an unreasonable world, nor even that it is a reasonable 

one. The commonest kind of trouble is that it is nearly 

reasonable, but not quite. Life is not an illogicality; yet 

it is a trap for logicians. It looks just a little more 

mathematical and regular than it is; its exactitude is 

obvious, but its inexactitude is hidden; its wildness lies 

in wait.10

We are in the business of navigating that very wildness, between the logic of reason and the inexactitude 

of emotion. It is an unpredictable and somewhat 

dangerous course. 

– But that is what leadership is for – 

REFERENCES

1. Jung CG. Psychological types. In: Hull RFC, transed. The Collected Works of C. G. Jung. Vol 6. 

Princeton, NJ: Princeton University Press; 1976. 

2. Barber HF. Some personality characteristics of senior 

military officers. In: Clark KE, Clark MB, eds. 

Measures of Leadership. West Orange, NJ: 

Leadership Library of America, Inc; 1990:441-448. 

3. Clarrissimeaux A. Never give up – how to live a 

meaningful life. Success. October 2008. Available at: 

http://www.thefreelibrary.com/Never+give+up: 

+Dr.+Ben+Carson%27s+only+childhood+advantage: 

+his...-a0206255463. Accessed 23 September, 2009. 

4. Perret G. Old Soldiers Never Die: The Life of 

Douglas MacArthur. Holbrook MA: Adams Media 

Corporation; 1996:29. 

5. Maxwell JC. The 360-Degree Leader: Developing 

Your Influence From Anywhere in the World. 

Nashville, TN: Thomas Nelson, Inc; 2005:128. 

6. Goleman D, Boyatzis R, McKee A. Primal 

Leadership. Realizing the Power of Emotional 

Intelligence. Boston, MA: Harvard Business School 

Press; 2002. 

7. Covey S. The Seven Habits of Highly Effective 

People. New York, NY: Simon and Schuster; 

1989:239-241. 

8. Watkins M. The First 90 Days. Boston MA: Harvard 

Business School Press; 2003. 

9. Ambrose S. Band of Brothers. New York, NY: 

Simon and Schuster; 1992. 

10. Chesterton GK, Dooley D. G.K. Chesterton Collected 

Works, Volume 1: Heretics Orthodoxy The Blatchford Controversies. San Francisco CA: Ignatius 

Press; 1986:285. 

AUTHOR

COL Callahan is the Commander, Dewitt Army Hospital and Health Care Network, Fort Belvoir, Virginia. 

Resonance, Dissonance, and Leadership 
 October – December 2009 37

INTRODUCTION

In a traditional mentoring relationship, the mentor 

guides the protégé and shares wisdom gained from his 

or her career. Each mentoring relationship is unique, a 

direct result of the individual personalities of the two 

participants. While some mentoring relationships are 

very brief, perhaps only the duration of a project (or 

deployment), others can last an entire career, or even 

longer. The purpose of this paper is to present a model, 

the Mentoring Spectrum, to describe the broad range 

of mentoring relationships that can exist between a 

mentor and a protégé. It starts with the simplest 

relationship, the Role Model, and continues with 

deeper and more complex relationships until it reaches 

the epitome of mentorship, the Counselor. The goal of 

this article is to present the continuum of mentoring 

relationships so that mentors and protégés can better 

understand the various options for mentoring 

partnerships that are available to them. 

ROLE MODEL

The Role Model is the first type of mentoring 

relationship in the Mentoring Spectrum and is the 

simplest. In this relationship, the senior officer serves 

as an example for the junior officer to follow. By 

observing the mentor, the protégé learns what is proper 

personal and professional behavior. While this form of 

mentoring relationship is more passive than the others 

that will be described, it is still an active form of 

mentoring. In some cases, the mentor may not even 

know that a particular subordinate is watching and 

modeling the superior officer’s pattern of behavior. 

Regardless, the seasoned leader knows that he or she is 

being watched and could be serving as a role model for 

junior officers to follow. So, senior officers need to 

remember that they are always “on stage” and are 

potentially mentoring through their daily 

“performances.” 

PRECEPTOR

Unlike the Role Model, the Preceptor is a much more 

active and engaged form of mentoring. The term 

preceptor is borrowed from examples in medicine, 

where a new physician is paired with a more 

experienced clinician who serves as a teacher and is 

expected to instruct the neophyte on what he or she 

needs to know clinically. Therefore, this type of 

mentoring relationship usually occurs in the early 

phases of a junior officer’s career. In the case of the 

Preceptor, both the mentor and the protégé are aware 

of each other and their relationship. The mentoring 

focus is strictly technical, on the development of 

specific skills. Typically, the relationship only lasts 

until the protégé has mastered the requisite skills and 

has therefore completed the preceptorship. However, 

in some cases, a bond may be formed that can blossom 

into a deeper mentoring relationship. I know this was 

true for me; my longtime mentor started out by 

teaching me how to perform physics testing of medical 

x-ray systems when I was a brand new second 

lieutenant. But his genuine interest in my technical 

development and the rapport that developed between 

us set the stage for the growth of a much deeper 

mentoring relationship that continues to this day. 

COACH

The next role in the Mentoring Spectrum is the Coach. 

Unlike the Preceptor, the Coach is focused on the 

overall job performance of the protégé, not just the 

mastering of an individual task or skill. So, the Coach 

is concerned with mission accomplishment and how 

the protégé functions within the unit or organization. 

Supervisors typically mentor their subordinates by 

being Coaches. Because the mentoring focus is on job 

performance (and the Coach may also be personally 

accountable for the success or failure of the protégé), 

there may be some limitations to the depth of this 

relationship. For example, the protégé may be 

reluctant to share doubts or weaknesses with the 

mentor for fear of receiving a bad rating. Also, if the 

senior leader supervises more than one junior officer, 

the cautious mentor might be concerned about the 

appearance of favoritism by providing more mentoring 

to one subordinate over another. As a result, the level 

of trust between mentor and protégé may be limited 

when the mentoring relationship is one of coaching. 

The Mentoring Spectrum 

COL Mark A. Melanson, MS, USA 
38 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

ADVISOR

While an Advisor is also concerned with protégé job 

performance, this mentor is also focused on the junior 

officer’s career and professional development. Hence, 

the Advisor often becomes involved in issues such as 

future duty assignments and pursuing advanced 

civilian and military schooling. Career or specialty 

consultants usually have an Advisor-like mentoring 

relationship with the junior officers in their Area of 

Concentration (AOC). Hence, these mentors also delve 

into more personal matters, such as family issues 

pertaining to a proposed permanent change of station 

(having a child in his or her senior year of high school) 

or a deployment (having a brand new baby on the 

way). However, since the consultant literally holds the 

protégé’s career in the palm of his or her hand, the 

wary protégé may be reluctant to share everything with 

the Advisor (such as doubts about continuing an Army 

career or thoughts about transferring to another AOC). 

CONFIDANT

After sufficient trust has developed between the 

mentor and protégé, then the mentoring relationship 

can deepen with the mentor becoming a Confidant. 

The Confidant is more trusted and fully capable of 

dealing with personal issues that the protégé may have 

(for example, marital problems, uncertainty about 

continuing an Army career, or the decision about 

whether or not to retire). Since the protégé deeply 

trusts the mentor, he or she is not reluctant to discuss 

sensitive topics such as personality conflicts with other 

senior officers or dissatisfaction with AOC leadership. 

For the protégé, the Confidant serves as a sounding 

board for ideas and helps to brainstorm solutions to 

problems of both a personal and professional nature. 

COUNSELOR

The Counselor is the pinnacle of the mentoring 

spectrum and is the fullest and deepest expression of 

the mentoring relationship. He or she is an avatar of 

the personae Mentor, in Homer’s Odyssey. With a 

Counselor, a protégé can discuss any topic and will 

seek guidance from the mentor in either personal or 

professional matters. As a result, the Counselor 

remains an enduring influence on the protégé and the 

relationship can last for decades. It is important to note 

that it normally takes a long time to reach this depth of 

mentoring. In my case, it took approximately 10 years 

before my mentoring relationship deepened to the 

level where my mentor became my Counselor. 

THE MENTORING SPECTRUM

The previous discussion outlined the 6 different 

mentoring relationships that can exist between mentors 

and protégés. The Figure shows these relationships as 

a part of the Mentoring Spectrum. In the Figure, the xaxis is labeled as “Trust” (referring to the protégé’s 

trust) and the y-axis is labeled as “Influence” (or the 

mentor’s influence). As the graph depicts, as a protégé’s trust increases, so does the mentor’s influence. 

So, a Counselor has more trust and more influence 

than a Confidant, who has more trust and more influence than an Advisor, etc. Within the graph there is a 

dividing line near the center. To left of this dividing 

line is a region labeled as “Professional Trust” and to 

the right of this dividing line is a region labeled as 

“Personal Trust.” This line of demarcation reflects the 

transition from a protégé only sharing work or career 

related issues (demonstrating professional trust) to 

ultimately opening up and including personal matters 

(demonstrating personal trust). In most cases, this transition tends to occur at the point when a mentor becomes an Advisor, although the actual transition point 

will vary for each individual mentor–protégé pairing. 

SUMMARY

The purpose of this paper is to discuss the Mentoring 

Spectrum, a model which helps to explain the various 

mentoring relationships that can occur between a 

mentor and a protégé. First, a senior leader can be a 

Role Model, setting the example for known and 

The Mentoring Spectrum 

Professional 

Trust 

Personal 

Trust 

Role Model

Preceptor

Coach

Confidant

Counselor

Advisor

TRUST 

INFLUENCE 

Graphical depiction of the Mentoring Spectrum. 
 October – December 2009 39

THE ARMY MEDICAL DEPARTMENT JOURNAL

unknown protégés alike. Next, a superior officer can 

become a Preceptor and teach the protégé a specific 

skill or task. When mentors are Coaches, they are 

focused on improving the overall quality of duty 

performance and may also have a personal stake in the 

protégé’s success. As an Advisor, a mentor has a 

longer perspective in mind and guides the protégé 

towards career development and professional growth. 

After personal trust is earned, a mentor can become a 

Confidant and be a sounding board for more sensitive 

and personal matters. Finally, a mentor can reach the 

summit of mentoring and become a Counselor, 

providing the entire range of guidance typically 

associated with the mentor archetype. As the 

Mentoring Spectrum illustrates, when the mentor gains 

more and more trust, he or she has more and more 

influence over the protégé, to include ultimately 

matters of a highly personal nature. It is hoped that by 

understanding these different mentoring relationships, 

mentors and protégé can select the type of partnership 

that is the best fit for them. 

AUTHOR

COL Melanson is the Chief of Health Physics at Walter 

Reed Army Medical Center, Washington, DC, and the 

Radiological Hygiene Consultant to The Army Surgeon 

General. 
40 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

INTRODUCTION

Although mentoring is an inherent responsibility of all 

Army leaders, not all mentors will have the same 

degree of success or experience the same depth of 

mentor development. While some officers will thrive 

and grow as mentors, others will never quite get the 

hang of it. Despite this natural disparity in individual 

mentoring potential and ability, I have come to believe 

that there is a clear pattern of growth unfolding 

throughout the careers of effective Army mentors. The 

purpose of this paper is to share the seasonal-like 

aspects of mentoring I have witnessed in my own 

career and the discovery of a model, the Mentoring 

Staircase, which accurately reflects and charts my own 

personal growth, as a protégé and mentor, over the 

past 26 years, and into the future. 

Throughout this paper, I will use as an example the 

mentoring development of a due course officer 

(commissioned as a second lieutenant with no 

constructive credit, peaking at the rank of colonel, and 

retiring after 30 years), the situation with which I am 

most familiar. However, I think sufficient parallels 

exist for those who are commissioned at higher ranks 

and receive constructive credit, the timelines need 

merely be adjusted accordingly. Despite this small 

degree of timeline variability, I hope that all students 

of Army mentoring will find this discussion relevant 

and will benefit from this critical, introspective 

analysis. 

SEASONS OF ARMY MENTORSHIP

While the metaphor of life being a series of 4 

consecutive seasons is not a new concept, I am not 

aware of it being used to describe Army mentoring. 

However, the seasonal analogy does make perfect 

sense. A newly commissioned officer is “planted” in 

the fertile soil of the Army and then he or she is 

(hopefully) nurtured and helped to grow. Having 

grown, the mid-career officer takes his or her place as 

an Army leader and, in turn, helps others to learn and 

grow. As eligibility for retirement approaches, the 

officer begins to think about the remaining time that is 

left and what will be his or her legacy. Finally, the 

senior officer enters the last stage of his or her career, 

tying up loose ends, and ultimately retiring. So are the 

seasons of Army mentorship, from spring to winter, 

from beginning to end. 

SPRING: BEING MENTORED

Spring is the first season in Army mentorship and is a 

time of profound personal and professional growth. 

The primary goal during this initial period is for our 

new officer to become fully competent in his or her 

career field. Typically, this early season encompasses 

the company grade ranks of second lieutenant through 

captain. The fact that this initial developmental 

interval lasts roughly 10 years is not arbitrary. 

According to researchers who study experts and 

expertise, it normally takes about 10 years for one to 

truly master one’s craft and become an expert. This 

decade of mastery is often referred to in the 

professional literature on expertise as the “Ten Year 

Rule.”1

 It consistently applies across all domains of 

human expertise: chess, athletics, music, and, in my 

opinion, mentoring. 

During this initial phase, our newly minted officer is 

focused on learning his or her various duties and what 

it means to be a commissioned Army officer. 

Hopefully, competent senior officers are actively 

mentoring the young officer. Additionally, the 

company grade officer is also growing through selfstudy and self-reflection. Given these facts, our junior 

officer is identified as a Protégé. Now, that is not to 

say that the young officer is not in some limited way 

mentoring others. For example, he or she may be 

guiding enlisted personnel or conducting peer 

mentoring, like showing a fellow junior officer how to 

perform a specific task. But, the Protégé has not fully 

matured and is not yet prepared to mentor other 

officers in full scope and depth of mentorship, such as 

career development, maintaining competitiveness for 

Seasons of Army Mentorship and the 

 Mentoring Staircase 

COL Mark A. Melanson, MS, USA 
 October – December 2009 41

promotion, balancing career and family, etc. Simply 

put, one cannot expect to fully and properly mentor 

what one has not yet personally experienced and 

consequently mastered. 

SUMMER: BECOMING A MENTOR

After the completion of his or her first 10 years, our 

young field grade officer has reached many important 

milestones. First, he or she has been promoted 3 times, 

thereby demonstrating both past success and future 

potential. Additionally, this officer has successfully 

tackled 3 or 4 different assignments and acquired a 

modicum of experience. In some cases, the officer has 

earned a graduate degree and achieved specialty board 

certification. With regards to making the Army a 

career, this officer has passed the critical halfway point 

to 20 years, and has usually committed to the Army for 

at least another decade. All of these factors combine to 

make the young major ripe and ready to don the role of 

a Mentor, one who guides and develops company 

grade officers. 

On top of his or her game in terms of technical 

expertise and having a burning desire to share what he 

or she knows, our young Mentor makes the first 

serious attempts to deeply mentor junior officers. If the 

new Mentor has been properly groomed by others, he 

or she will seek to learn from and emulate the 

mentoring behavior of those personal mentors 

(sometimes successfully, sometimes unsuccessfully). 

Officers who were not mentored strive to give others 

the important guidance and direction that they were 

denied and had to learn for themselves, often the hard 

way. In both cases, the fledgling Mentors will have to 

learn by trial and error. Hence, this aspiring Mentor 

will again follow the Ten Year Rule and spend the 

next decade perfecting his or her mentoring skills and 

developing a unique, individual style of mentorship. 

At the end of this important decade of mentoring 

growth, our striving Mentor will emerge as a fully 

competent mentor of young protégés. 

AUTUMN: BECOMING A MASTER MENTOR

Another major milestone in any Army career is hitting 

the highly coveted 20-year mark. For some, it is the 

time to retire and open the next chapter of life. For 

others, they are still climbing the ladder of Army 

success with “stars in their eyes” and no apparent end 

in sight. However, for a select few, it is a time of great 

introspection with thoughts shifting towards what they 

want to accomplish before retirement, whenever that 

will inevitably occur. Regardless of their situation, 

these fully vested senior officers have ideally perfected 

their skills as mentors, developing many junior officers 

and teaching them how to be competent junior Army 

leaders. Many of the younger officers that they have 

mentored over the years are now entering the 

“summer” of their own careers and are starting to take 

on protégés of their own. Hence, the mentoring focus 

for our senior field grade officer shifts to teaching their 

long-time protégés, as well as others, how to mentor. 

In order to denote this important passage into a new, 

deeper level of mentoring, I choose to designate this 

senior field grade officer as a Master Mentor, or 

mentor of mentors. 

Hopefully, this Master Mentor has had the benefit of 

quality mentoring during his or her early protégé years 

and has spent another decade learning how to mentor 

young protégés. In this later season of Autumn, our 

Master Mentor is now sharing with the mentor-intraining the essential skills for mentoring another 

officer. As in the previous two seasons, this 

development period can last as long as 10 years. 

Although, for some Master Mentors it may be shorter, 

depending upon when they retire or whether or not 

they reach the next and final plateau of mentoring 

(discussed below). Instinctively, this senior officer 

seeks guidance from his or her own mentors, most, if 

not all of whom have retired. In addition to reflecting 

upon personal experiences, Master Mentors often 

conduct independent research into the field of 

mentoring in order to further grasp its fullest 

dimensions. He or she also actively seeks out other 

master mentors to share experiences and learn from 

these sagacious peers. For some, such as me, 

mentoring becomes a deep passion and one of the 

primary reasons that these dedicated officers remain 

on active duty and defer their retirement, often despite 

the “Sirens’ song” of lucrative career opportunities 

beyond the Army. 

WINTER: THE LEGACY OF THE GRAND MASTER

MENTOR

As in nature, the final season of Army mentoring is 

Winter. The Winter of Army mentoring is marked by 

both the impending finality of retirement and the deep 

compelling desire to leave some lasting legacy. For 

those very few officers that reach this highest plane of 

mentoring, this season is marked by a rare ability to 

rise above their role as a Master Mentor and reflect 
42 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

about how to mentor other master 

mentors. In essence, the Grand 

Master Mentor is a mentor of 

mentors of mentors. The epitome 

of the Grand Master Mentor is the 

wise and humble character of 

Yoda, in the Star Wars movie saga. 

Like Yoda, our Grand Master 

Mentor fully understands the entire 

mentoring process and how all of 

the seasons fit together into an 

overall lifecycle of mentoring. 

Within the Army Medical 

Department, many consultants, 

assistant corps chiefs, and corps 

chiefs are able to successfully 

ascend to the role of Grand Master 

Mentor. For some, their ultimate 

goal is to establish a culture of selfperpetuating mentoring for all of their officers and 

maximize the overall effectiveness of each season of 

the Army mentoring lifecycle. Given that, our Grand 

Master Mentor has the unique opportunity to make 

profound and lasting changes in his or her Area of 

Concentration (AOC) and, perhaps, even beyond. 

THE MENTORING STAIRCASE

In addition to viewing the growth of a mentor in terms 

of successive seasons, it is also useful to look at 

mentoring development as ascending steps, each 

building upon the previous ones, like a staircase. 

Figure 1 depicts the Mentoring Staircase, a model 

which shows how each mentoring step builds upon 

what is learned in the previous stages. In the first 

phase, the Protégé step, the officer is engaged in selfdevelopment while receiving guidance from a Mentor. 

As previously discussed, this time period lasts about 

10 years until promotion to major for due course 

officers. Eventually, the newly promoted field grade 

takes the next step, placing a junior company grade 

officer under his or her wing and proceeding to show 

the young protégé the ropes. During this second 

decade, the Mentor further develops and hones skills 

in mentoring company grade officers. (Also, the 

Mentor continues to self-develop while receiving 

mentoring from a Master Mentor). After the 20-year 

mark is passed, presuming the officer does not retire, 

there is an opportunity for a deepening of the 

mentoring role with this Mentor stepping up to 

becoming a Master Mentor and developing midcareer 

protégés in the fine art of becoming Mentors 

themselves. (Ideally, there is a senior officer 

mentoring him or her in addition to this officer 

engaged in self-development). Lastly, our “crusty, old” 

mentor takes the final step up the Mentoring Staircase 

and becomes a Grand Master Mentor, guiding Master 

Mentors on how to effect lasting change and growth. 

COMBINING THE MODELS: 

A PERSONAL EXPERIENCE — THE EAGLE IN WINTER

Finally, it is possible to combine both models, the 

Seasons of Army Mentorship with the Mentoring 

Staircase. Figure 2 illustrates this superimposition of 

models with regard to my own Army career. The 

journey began with my commissioning in 1983 and 

will ultimately end with my mandatory retirement date 

in 2013. During the Spring, the first decade of my 

career, I was at the Protégé step, blessed to have an 

outstanding Mentor who really taught me what it 

meant to be an Army officer. I spent this first season 

relentlessly pursuing personal development and 

excellence. With promotion to major, I entered the 

Summer of my career, becoming a Mentor and guiding 

several company grade officers by sharing what I had 

learned over the previous decade. In 2003, I hit my 20-

year mark and the Autumn of my career, becoming a 

Master Mentor and beginning to share with wider 

audiences, in lectures and in writings, what I had 

learned about mentoring.2-4 On the occasion of my 

quarter century in the Army, I was nominated and 

appointed by the Army Surgeon General as the AOC 

Seasons of Army Mentorship and the Mentoring Staircase 

Figure 1. The Mentoring Staircase. 

30 Years

25 Years

20 Years

10 Years

Master 

Mentor 

Mentor 

Protégé 

Grand 

Master 

Mentor 

mentors

mentors

mentors

self

development

General Officers 
 October – December 2009 43

THE ARMY MEDICAL DEPARTMENT JOURNAL

Consultant for my career field, taking the 

final step to become a Grand Master Mentor 

and guiding others on how to set up 

mentoring programs and develop mentors.5

In fact, this very article is but another 

affirmation of my own passage from Master 

Mentor to Grand Master Mentor and 

entrance into the Winter of my career. 

SUMMARY

The purpose of this paper is to share 2 

complimentary models for the growth and 

development of Army mentors, the Seasons 

of Army Mentorship model and the 

Mentoring Staircase model. During the first 

phase of development, Spring, a young 

officer starts out on the first step as a 

Protégé, receives mentoring, and learns selfmastery. After a decade of learning and 

promotion to field grade, the more experienced officer 

enters the Summer of his or her career and steps up to 

become a Mentor, mentoring protégés. With the arrival 

of retirement eligibility, those Autumnal officers who 

do not retire can take an additional step and evolve 

into Master Mentors who teach others how to 

effectively mentor. Lastly, in the twilight years of 

Winter, those who reach the highest level of Army 

mentoring can take the final step and become Grand 

Master Mentors, establishing a long lasting culture of 

mentoring that will be a fitting legacy to their 

leadership and example. To close, I sincerely hope that 

those reading this article are inspired by this discourse 

and strive to make the most out of their own mentor 

journey and reach their greatest mentoring potential, 

whatever that may be. I know for me personally, it has 

become the most satisfying accomplishment of my 

Army career. 

REFERENCES

1. Simonton, DK, Historiometric Methods, The Cambridge Handbook of Expertise and Expert Performance. 

New York, NY: Cambridge University Press; 2006:327. 

2. Melanson, MA, Winstead AD. Officer professional development: a case study in officer mentorship. Army Med 

Dept J. January–March 2003:7-10. 

3. Melanson, MA. Mentor and protégés: simple rules for success. Army Med Dept J. July–September 2006:50-58. 

4. Melanson, MA. Evolving Roles of highly successful mentors. Army Med Dept J. October–December 2007:37-39. 

5. Melanson, MA. Mentoring in the Army Medical Department: Advice for Senior Leaders. Army Med Dept J. 

October–December 2007:26-28. 

AUTHOR

COL Melanson is the Chief of Health Physics at Walter Reed Army Medical Center, Washington, DC, and the 

Radiological Hygiene Consultant to The Army Surgeon General. 

1983

Master 

Mentor 

Mentor 

Protégé 

Grand 

Master 

Mentor 

1993

2003

2008

2013

Winter 

(5 years) 

Autumn 

(5 years) 

Summer 

(10 years) 

Spring 

(10 years) 

Figure 2. Seasons of an Army Career and the Mentoring Staircase. 
44 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

INTRODUCTION

A vital responsibility of senior leaders is to mentor 

junior officers so that they can one day step forward 

and lead the Army Medical Department. One of the 

key things that a good mentor looks for when selecting 

a protégé is whether or not a particular junior officer 

has potential. Then, there is the natural question: what 

exactly is potential? Ultimately, potential manifests 

itself as the ability to one day, through growth, study, 

and practice, become a fully developed and highly 

competent Army officer. So, what does potential 

actually look like? For me, there are certain unique 

traits that I look for as evidence of true potential in a 

prospective protégé. This short list of qualities is based 

upon nearly a decade of research on the subject of 

mentoring, observing the junior officers that I have 

mentored over the years (both successfully and unsuccessfully), and an assessment of my own strengths and 

weaknesses as a protégé. It is hoped that by identifying 

and developing these qualities, junior officers who 

have mentors or are seeking mentorship will experience the deepest and fullest benefits of mentoring. 

LOVE OF LEARNING

The first important quality of an ideal protégé is to be 

a true lover of learning. This is not surprising since the 

entire mentoring relationship revolves around the 

conveyance of knowledge and wisdom from mentor to 

protégé. (Coincidently, the quality of being a 

consummate student is also a key trait in highly 

successful mentors.1

) Therefore, in order for this 

partnership to work, the protégé must truly want to 

learn. For the ideal protégé, the mentoring experience 

is a journey towards deep personal and professional 

growth. By finding a revered and trusted mentor, the 

junior officer is fully engaged in the process of 

growing and learning under the tutelage of that 

seasoned senior officer. This special relationship can 

be very short or last an entire career, or even longer. 

SELF-STARTER

For me, an ideal protégé is a true self-starter. This protégé knows that he or she is the one primarily responsible for his or her career being successful. Therefore, 

this young leader does not sit around waiting to be told 

what to do and takes charge of his or her own 

development. By being proactive, the ideal protégé is 

constantly assessing his or her strengths and 

weaknesses and how to improve and grow. Likewise, 

when the chance to learn presents itself, this junior 

officer is the first one to stand up and seize the 

opportunity. While remaining a full mentoring partner 

with his or her mentor, the junior officer is also doing 

a lot of self-development work on his or her own. 

When it is all said and done, the self-starting protégé 

actually leads the mentoring experience, with the 

mentor coming along for the ride and providing 

needed help and guidance. 

CONFIDENCE

In order to be successful as a protégé (and an Army 

leader for that matter), one must be confident. I know 

personally that this can be particularly hard, especially 

when one is first commissioned and does not yet know 

very much about being an Army officer. But, with 

time, experience, and patience, a junior officer will 

learn and acquire the skills necessary to succeed. It is 

important to note that this confidence is measured; it is 

not arrogance or cockiness. That being said, an officer 

always knows his or her own limitations. So, if you are 

getting into a situation where you are in over your 

head, you must quickly recognize this and promptly 

seek assistance from your mentor. Failure to do this 

has often been the root cause for ending many an 

officer’s career, regardless of rank. 

RISK TAKER

Despite the real perils mentioned in the previous 

paragraph, the ability to take risks is a very important 

trait of the ideal protégé. Today’s Army desperately 

needs officers at all levels who are willing and able to 

take risks and do what needs to be done to accomplish 

the mission, often in the absence of guidance. Now, I 

am not advocating irresponsible or careless risk taking. 

Rather, I am referring to the ability to assess a 

situation, understand the mission, and then develop 

and implement new and innovative courses of actions. 

Qualities of the Ideal Protégé 

COL Mark A. Melanson, MS, USA 
 October – December 2009 45

It all boils down to the ability to overcome the fear of 

doing something new or untested and squarely face the 

threat of failure. Unfortunately, there is no other way 

to grow; without taking risks you cannot reach your 

fullest potential. 

RESILIENCY

If a protégé is going to take risks, then sometimes the 

outcome will be unsuccessful. Hence, mistakes will be 

made and failures will occur. No one likes to fail, 

especially hard-charging junior officers (and crusty old 

colonels like me!). But, the ideal protégé accepts 

complete responsibility for all mistakes or failures and 

seeks to fully understand what went wrong and why. 

This officer does not engage in a blame game or make 

excuses. Rather, the ideal protégé is reflective and 

studies personal defeats in order to learn from them, 

often referred to as failing forward.2

 Then, the junior 

officer gets up, dusts his or herself off, and tries again. 

The key to resiliency is to truly accept that no one is 

perfect, to believe that we can learn from our mistakes, 

and to realize that it is often from our setbacks and 

failures that we learn our greatest lessons in life. 

Therefore, in order to stay the course, a protégé must 

be resilient. 

ENTHUSIASM

For a mentor, one of the most refreshing traits of a 

desirable protégé is genuine enthusiasm. It is this clear 

and palpable excitement for the mentoring partnership 

that continually stokes the fire of this important 

relationship. As for me personally, it is one of the 

primary reasons that I enjoy being a mentor. A 

protégé’s enthusiasm is contagious and can jump-start 

and revitalize the mentoring experience. It also helps 

the protégé find the energy and maintain the focus 

required to do the hard work that so often accompanies 

personal and professional growth. So, be excited about 

being a protégé and embarking on the unique journey 

of self-discovery that is mentoring. 

OPEN-MINDED

Being open minded to a mentor’s advice is not 

difficult when one is a new junior officer and knows 

very little about Army officership. However, as one 

grows in knowledge and experience, it can become 

easy for a protégé to assume that he or she has all of 

the answers and needs no help. The ideal protégé 

remembers that the mentor has vastly more experience 

and precious wisdom to share. Hence, the protégé 

listens to advice given and carefully considers it, rather 

than disregarding it out of hand. This includes 

constructive feedback that may seem negative and may 

be difficult to hear. By being open-minded to new and 

different ways of looking at situations and approaching 

problem solving, the ideal protégé is more able to 

experience the full spectrum of mentoring. 

COMMITMENT

Commitment is the glue that keeps the mentoring 

relationship together. Without it, the mentorship will 

inevitably die a quiet death. To avoid this, the ideal 

protégé is deeply committed to being mentored. This 

means that the protégé faithfully attends mentoring 

sessions, completes assigned homework, and keeps 

promises that are made. While the Protégé’ s commitment is first and foremost to the mentor, it is also a 

commitment to one’s self and to reaping the fullest 

benefits of the mentoring experience. From my 

observations over the years, the most committed 

protégés usually end up as the most successful. 

LOYALTY

Without trust, there is no mentoring relationship. It is 

within this safe environment that the mentor and 

protégé can be open and honest. For the protégé, it is 

the chance to ask potentially embarrassing questions. 

Likewise, the mentor can also share past blunders and 

failures that have important lessons to teach the 

protégé. In order for this candid dialogue to occur and 

continue, both members must maintain confidences. 

All of this simply comes down to loyalty. The protégé 

must be loyal to the mentor and not divulge anything 

confidential without the mentor’s blessing. Always 

remember, trust is hard to earn and can be lost so very 

easily. 

GRATITUDE

The final quality of the ideal protégé is gratitude and it 

is the most important. The ideal protégé is always 

grateful to his or her mentor. The mentor is taking time 

out of the busy duty day (and often during off-duty 

time) solely for the purpose of helping the protégé 

develop and grow. As mentioned above, the mentor is 

also sharing personal mistakes and setbacks so that the 

protégé can learn from them. Given that, the protégé 

must be appreciative of this gift of mentoring. In my 

opinion, the best way to sincerely show gratitude is for 

you to take what you have learned and share it with 

others. In order to do this, you must be willing to “pay 
46 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

it forward” and ultimately become a mentor yourself. 

This is how I have chosen to repay the superb officers 

that have mentored me and are mentoring me still. 

Indeed, the astute reader will quickly recognize that 

this very article is but another example of my humbly 

paying it forward. 

SUMMARY

The purpose of this paper is to share what I view as 10 

important qualities of an ideal protégé. First, protégés 

must have a deep-seated love of learning that drives 

them to make the most out of the mentoring 

partnership. Next, protégés must be self-starters who 

take personal charge of their mentoring. Confidence is 

vital so that the junior officer can face the many 

challenges that lay ahead in any Army career. Careful 

risk taking is necessary so that the protégé can reach 

his or her greatest potential. Bouncing back from 

mistakes and failures is crucial for protégés, so they 

must be resilient. Ongoing enthusiasm is the fuel that 

sustains the mentoring relationship over time. By 

being open-minded, a protégé carefully considers all 

advice, including constructive criticism, that the 

mentor shares along the uphill path to wisdom. 

Remember that commitment is the very glue holding 

the mentoring relationship together. Also, protégés 

remain loyal to their mentors by always maintaining 

confidences. Most important, an ideal protégé is truly 

grateful for all the things that the mentor has done and 

repays that debt by also becoming a mentor. In 

closing, it is hoped that by developing these qualities, 

present and future protégés will get the most out of 

their mentoring partnerships and keep the age-old 

spirit of mentorship alive. 

REFERENCE

1. Melanson MA. Evolving roles of highly successful 

mentors. Army Med Dept J. October–December 

2007: 37-39. 

2. Maxwell JC. Failing Forward. Corning, CA: Nelson 

Books; 2000:191-192. 

AUTHOR 

COL Melanson is the Chief of Health Physics at Walter 

Reed Army Medical Center, Washington, DC, and the 

Radiological Hygiene Consultant to The Army Surgeon 

General.

Qualities of the Ideal Protégé 
 October – December 2009 47

INTRODUCTION

In military environments and cultures of urbanized 

societies, the word “leader” is as common as the word 

“I.” Such a comparison might have never been 

considered, but take time and seriously consider it. 

Conceptualize how often the word I is used in a world 

that statistically grows more egocentric each day. “I 

don’t like that; I refuse to sit there; I wish I had 

something like that; I need one of those; or I got mine, 

so that’s all that matters.” Reflection might reveal that 

I is an almost completely worn-out word. Now 

examine the effectiveness of the word leader in an 

environment where it is used frequently and 

injudiciously—almost as much as the word I. How 

often at a military school, briefing, formation, or 

professional forum does the facilitator begin by saying 

“good morning leaders,” or “welcome leaders”? Does 

anyone not believe that most military personnel are 

automatically considered and addressed as leaders 

based solely on their rank? Should everyone in the 

military beyond the grade of E-4* be recognized as a 

leader? Does this not weaken the word’s value and 

wrongfully associate those who are leaders with the 

likes of those who are not? Is wearing a rank or 

holding a managerial position enough to be validated 

as a leader? These inaccuracies should be carefully 

considered. The arbitrary and unmerited practice of 

addressing large groups as leaders vastly diminishes 

the culture of leadership. Unless individuals 

demonstrate the personality, passion, essence, and 

other key traits (enthusiasm, confidence, mental 

toughness, compassion, emotional stability, etc) that 

undoubtedly distinguish them in an objectively 

positive manner, they should not be deemed a leader. 

With so many ways that personalities can be analyzed, 

described, and categorized, it is interesting to consider 

whether there is a personality type that can be truly 

identified among the world’s greatest leaders. If so, 

imagine reading descriptions of personality types and, 

by description alone, selecting an individual who 

matches a personality type that will lead you in life, 

relationships, business, finances, religion, politics, 

values, peace, and even war from that day forward. 

Does personality have anything to do with being a 

leader, leading, and displaying leadership? Is 

leadership a byproduct of certain personality types? 

Think, conclude, and share. 

Passion is a very strong word, so strong that there’s 

even passion in the word passion, so strong that it is 

extremely difficult to say the word passion without 

somewhat changing your tone or demeanor to 

demonstrate some degree of its definition, and yet so 

strong that the thought of passion is almost always 

inspiring. Are leaders inspiring? Do leaders make 

people change their tone and demeanor? Do leaders 

have passion; do all leaders have passion; and is 

passion a prerequisite for being a leader or by concept, 

leading? Maybe it is; maybe it is not. If passion is a 

trait that a leader must possess, embrace, and 

demonstrate, then at what level should a leader’s 

passion be? Ruminate, decide, and internalize your 

thoughts. 

Essence is the quality with which something is 

identified, the most important feature or idealized form 

of something. What is the essence of a leader? What is 

a leader’s most important feature? Are leaders 

idealized? If yes, then why? Is it their essence? What 

makes one person willing to idealize, admire, or model 

another? Admiration sometimes comes very easy—

simply by having a single trait or skill that another 

person does not. Are you one of those leaders whom 

others idealize and look to as a role model? If not, then 

why, and if you know why, are you willing to become 

what others need and hope to look up to? 

Without a doubt, you can be one of the world’s 

greatest leaders, but maybe you have never reached 

inside your soul, made a strong base of your values, 

and built upon the appropriate traits and features. 

Would you believe that there are millions of people 

The Personality, Passion, and Essence 

of a Leader 

MSG Reginald K. Hall, USA 

*Army and Marine corporal; Navy petty officer 3rd class; 

Air Force sergeant
48 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

wandering through life having renounced the hope of 

finding someone to look up to? Perhaps there are also 

millions of people so bemused by life that they are 

clueless of their own desire to have someone to look 

up to, until they find that “magnetic” force to which 

they quickly attach. Often, that attraction is leadership. 

Consider the power of leadership and decide if the 

following statements support reality. 

Animals often look for masters who will lead 

them. 

Children build and embrace relationships more 

quickly with adults who will lead them. 

Some of the world’s strongest female leaders 

hope passionately for husbands who will lead 

them and their households. 

Men will normally only submit to someone who 

has proven capable of leading them. 

Nations select politicians who they feel will lead 

them. 

Church members elect pastors who they trust 

will lead them. 

There are infinite propositions such as those, so 

leadership is inevitably important. It separates men and 

women from the majority, and it supports the 

fundamentals of life. 

FORMING A LEADER

Some people tend to think that leaders are born with 

some kind of remarkable trait that makes them stand 

out in a crowd, exude confidence, or take charge of 

situations as opposed to allowing themselves to be 

bystanders of situations gone wrong. Who knows? 

These theories may be correct, but, if so, why do so 

many organizations spend large amounts of money and 

invest substantial amounts of time trying to develop 

and grow leaders? In the abstract, if leaders are born as 

such, would not it be more practical to find those 

people who are seemingly born as natural leaders and 

pay them to multiply, rather than risk wasting money 

and training on people who will never prove to be 

great leaders? There might be a need for a new 

investment strategy, or perhaps the need for a 

completely new outlook on leadership. 

The majority of people who attend leadership courses 

are not really premier candidates. Are the investments 

that organizations make for leadership training 

practical and cost-effective strategies for the vast 

majority of people who attend? How often has 

someone attended a leadership course and recognized 

an individual who is absolutely not an obvious leader, 

example, or role model, as far as can be seen to their 

left and right? This happens often. Perhaps if such a 

situation is not noticed, it is a sign of one’s own 

blurred judgment. Is the idea of only placing specific 

qualifying personnel in specific types of schools or 

training a wrongful approach? Some people would say 

“send those who are not good leaders to leadership 

training to make them good leaders.” Any logical 

person might laugh at that statement or that kind of 

thinking because it has been proven historically and 

repetitively that opportunity does not always lead to 

success. More realistically, it rarely leads to success. It 

is more logical to understand that the more 

opportunities that one is given to find success, there’s 

higher likelihood that they will be unsuccessful. 

Therefore, wasting opportunities wastes time and 

resources; wasting time and resources is an obvious 

and significant waste of money. 

Simply said, leaders are formed around personal 

values, hopes, and commitment. Standing out in a 

crowd does not make someone a leader; it more 

logically means that a person has a unique quality that 

most likely has little to do with leadership. The critical 

thinker knows that anyone who witnesses another 

person presenting a stronger demeanor than their own 

could falsely (as is commonly done) classify the other 

as a leader. Think about this. How many of the people 

who are said to be leaders have justifiably proven 

themselves as such? Also, exuding confidence does 

not make someone a leader, though this is undoubtedly 

a quality that a good leader should have. Exuding 

confidence could simply mean that a person hides their 

flaws well, is a great actor, or has a very poor sense of 

self-evaluation which falsely allows him to feel 

confident. There are droves of people who appear 

confident, but have no clue of the ignorance of things 

they say, or the possible harm they could cause. 

Maybe they are unaware of the inappropriateness or 

ineffectiveness of things they do. Even taking charge 

is not an absolute sign of leadership. Action without a 

good plan is just action. Taking charge could simply 

be a sign of impatience or intolerance. Being the first 

person to say “let’s go” or “let’s do this” does not 

indicate that the initiator is a leader by any sense of the 

The Personality, Passion, and Essence of a Leader 
 October – December 2009 49

THE ARMY MEDICAL DEPARTMENT JOURNAL

word. So many leaders “by virtue of school” and “by 

virtue of position” carelessly and hastily make these 

claims. Again, leaders are formed from personal 

values, hopes, and commitment.

Just like great performers, athletes, or strategists, 

leaders are very similar. They are who they are 

because they commit to being who they are; they value 

what they represent, and often aspire to be better or 

improve upon the person that they have become. This 

is a very simple concept, so why are so many people 

falsely glorified as leaders. What are a leader’s values? 

Why do leaders hope and work to be leaders? Why do 

leaders commit themselves to such stringent actions, 

habits of thinking, and results? Why? Those who are 

leaders know these answers, plus answers to any other 

questions concerning their commitment and why they 

consider themselves to be leaders. Those who are not 

true leaders (thus not convincingly committed by 

personal values, hopes, and actions) will think and 

ponder over these simple questions, showing evidence 

that they have not thought and rethought these questions with every value they demonstrated, task they 

performed, and encounter they shared. Great performers can always articulate why they do what they do, 

why they commit so determinedly, and why they value 

what they do. Athletes and strategists can do the same. 

Why would leaders be any different? They are not. 

THE HIERARCHY OF DISCIPLINE

Of all the traits and elements of a leader, discipline 

reigns supreme. Previous Army leadership doctrine 

defined discipline as “prompt obedience to orders.” 

This is a powerful definition. The same doctrine also 

defined discipline as “doing what’s right even when no 

one is looking,” and more current editions include 

“doing what’s right regardless of who’s looking.” 

These are value-driven definitions. The first definition 

illustrates a person’s (more so, a leader’s) commitment 

and actions. To execute any action promptly upon 

orders demonstrates the commitment and discipline to 

do so. To demonstrate obedience in any regard proves 

the commitment of values and selflessness which 

overpower rebellion and hesitation and creates 

consistency. To be a true leader, one must demonstrate 

values, function selflessly, deter rebellion, eliminate 

hesitation, and be consistent in all things. Again, 

discipline is prompt obedience to orders. Disciplined 

people and leaders (those having discipline and so 

much more) “do what’s right even when no one is 

looking” because the eyes that control and shame them 

are the eyes within their souls. These same individuals 

“do what’s right regardless of who is looking” because 

their objective is not to satisfy anyone, but to prove to 

themselves and others the value of living with honor 

and being committed to those things that reflect 

values. Discipline reigns supreme. 

Which is more important, discipline or one’s 

conscience? Which is more powerful? Which is a 

greater contributor to leadership? Without a doubt, 

discipline reigns supreme. Discipline is more 

important, more powerful, and contributes more to the 

ideals of leadership. Having a conscience is simply 

having enough character to be concerned about 

something that is a violation of a personal value. 

Discipline is having the commitment to always support 

one’s values, regardless of external pressures. Having 

a conscience is powerful because very often when 

something wrongful or unsubstantial is internalized, 

the underlying value will cause a change in action or 

behavior and create a positive or satisfying result. 

Discipline is far more powerful because it is much 

simpler. With discipline, if something is right, it is 

supported consistently in behaviors and actions. When 

something is wrongful or unsubstantial, it is not 

supported and is often corrected. Consistency and 

discipline tie firmly together. There is never one without the other. A person cannot be considered disciplined if he* occasionally abandons his personal 

values and standards. A person might sometimes be 

considered to have discipline, but is not disciplined. If 

a person does anything the same way all the time 

(consistency), he demonstrates discipline, and is 

justifiably considered to be disciplined in that regard. 

If a person has no consistency in what he does or what 

he says, the root cause can be easily traced to a lack of 

discipline. In the same regard, a person is not a strong 

leader if he is not consistent, and he is not a leader if 

he is not disciplined. Discipline reigns supreme. 

In so many situations that life presents, leaders must 

always show discipline. There are infinite ways to take 

shortcuts. There are also infinite ways to achieve 

marginal or satisfactory results. Having discipline 

means having the willingness to duplicate what is 

valued on a consistent basis to ensure a consistent 

result. In all things that a leader does, discipline must 

always reign supreme. 

*Throughout this article, the use of “he” is a nongender-specific 

convention for simplification and readability. 
50 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

ACCEPTING AND ENDURING SACRIFICE

Being a leader takes great sacrifice, moving beyond 

the comfort zone and giving more than what is natural, 

all for the greater benefit of others. Sacrifice is sometimes easy, but often, not so easy. For those who sacrifice little or seldom, what is given might seem as no 

big deal or appear to have almost no adverse impact on 

life. Being committed to personal sacrifice, and sacrificing repeatedly is a much different circumstance. 

Because a leader always has many things to do, 

recognizes more that needs to be done, and has more 

people asking for assistance (as they trust his judgment, perspective, work, and counsel), time is always 

very critical. Time is the one element of life that cannot be reproduced or regained, at least not in the physical sense. Ironically, more time is also the one luxury 

on almost everyone's wish list. Imagine sacrificing 

your time (just your time) any and every time that 

someone asks. Calls for assistance, obvious signs of 

confusion, desperate cries for attention, on-the-spot 

interruptions to vent or chat, and many other similar 

circumstances really take a toll on a leader’s time. 

Because a leader recognizes that everyone needs or 

will need something at one time or another as an 

antidote to make it through the day and get back on 

track with life, sacrifices are made and time is given. 

There is a huge reward for what is given; a feeling of 

personal satisfaction gained by enabling someone to 

move beyond an issue or roadblock and continue life 

with a less stress, more focus, and a lot more empowerment. Leaders make great sacrifices. 

Often, the need for phenomenal patience comes with 

sacrifice. Many people are egocentric (all about 

themselves) and somewhat inconsiderate as to what 

they ask for and how often they ask. They might ask 

things of a leader that they would not ask of a close 

relative, and also repetitively ask for time and 

attention. People today are often very egocentric in 

balancing their requests with a leader’s sacrifice. For 

example, someone with a serious need might deem it 

more important (really more self-satisfying) to risk 

arriving late to be helped and have the leader wait, 

rather than opting to be early and feeling inconvenienced by waiting. A leader might also find it very 

common to have others be unacceptably disorganized 

when articulating needs or presenting problems, thus 

vastly wasting the precious commodity of time. It can 

be very frustrating to refrain from making tempered 

comments when it is obvious that sacrifices and time 

are taken for granted, or when understanding that the 

pace of the average person is rarely comparable to 

your own (the leader). In these situations, a leader 

sacrifices many things: time, patience, a measure of 

sanity, and adherence to personal values. 

There are some occasions when such sacrifice is not 

wise. These are the times when a specific sacrifice 

does not support the most good for the most people, 

does not support personal growth of those capable of 

sustaining on their own, or when personal strength will 

be diminished, causing the leader to be a broken 

source for the numerous individuals he miraculously 

supports. A leader who neglectfully allows personal 

matters to become chaotic and unmanaged is of little 

use in helping others manage their issues and 

concerns. 

With age comes wisdom. As leaders mature, they 

realize that not everyone can be helped simultaneously, or continuously. When necessary and feasible, these are times when leaders offer short, clear, and 

specific guidance as a first course of action until more 

time is available. Sometimes leaders must simply 

employ other capable but less experienced individuals 

who can assist, while also benefiting from the 

increased opportunities to mentor. Visionary leaders 

always look ahead and can often preview an issue 

before it becomes an issue. This is when “pearls of 

wisdom” might be offered to prevent unwanted results 

and exhaust the need for more serious attention in the 

future. Most commonly, leaders rarely say “no,” but 

learn that saying “yes” does not always have to be a 

self-crippling effort. Leaders grow and share wisdom. 

Because of the compassion in a leader’s heart, he gives 

eagerly and often. Sacrificing as a leader means that 

there will be numerous occasions when the burden of 

sustaining one’s own professional and personal 

responsibilities will seem monotonous because of the 

time spent investing in others. Sacrifice hardly ever 

comes easily or conveniently, however, it often comes 

with great reward, but only when managed wisely. 

FALSE HYPOTHESES OF LEADERSHIP 

More than anything, individuals must embrace the 

concept of leadership and ask themselves what it 

means to be a leader, what is the value of being a 

leader, and what it takes to become a leader? These are 

The Personality, Passion, and Essence of a Leader 
 October – December 2009 51

THE ARMY MEDICAL DEPARTMENT JOURNAL

very serious questions that are rarely acknowledged by 

many who think they are leaders or by others that 

people often mistake as leaders. 

Being in a leadership position does not make an 

individual a leader. A leadership position should 

inspire an individual to commit to becoming a good 

leader and demonstrate strong leadership attributes 

(enthusiasm, confidence, mental toughness, 

compassion, emotional stability, etc) to live up to the 

expectations of such a key position. Ironically, 

leadership positions often hinder growth because an 

individual sometimes selfishly and unconsciously 

becomes crippled by the fact that he has the right to 

give orders. The common response is personal 

gratification and the thrill of empowerment which 

normally drive individuals to become self-serving. A 

more responsible and appropriate response would be 

the cautious and meticulous execution of tasks and 

decisions to consistently ensure a logical, productive, 

and honorable example. Being in a leadership position 

should inspire leaders to lead. 

Wearing a leader’s rank or being assigned to a leader’s 

office does not make someone a leader. In the military 

(depending upon specific branches of service), 

corporals through generals wear leaders’ ranks, but can 

you honestly say that all or even most of them embrace 

the responsibility of leadership? Many careless 

thinkers might automatically believe and say that 

senior noncommissioned and commissioned officers 

have to be leaders. Critical thinkers would probably 

say that every noncommissioned or commissioned 

officer should be a leader or be made to embrace and 

demonstrate leadership and the principles thereof. 

Other careless thinkers might say noncommissioned 

and commissioned officers are forced to be leaders. 

Critical thinkers would more appropriately say only 

that these individuals are forced to be in leadership 

positions. However, the few individuals truly 

committed to being leaders would articulate their 

opinions even more discriminately. It is distressing to 

acknowledge that many people, by virtue of their 

careless nature, often tend to become lazier and less 

attentive to leadership responsibilities as they achieve 

higher ranks and offices. Though many senior level 

individuals often perform the technical responsibilities 

of their positions well, a significant proportion seldom 

embrace those critical leadership attributes that are 

more common among young, energetic populations. 

This leads to the next simple truth, but remember, rank 

does not justify leadership. 

A stellar job performance or demonstration of competence does not make an individual a leader. A person 

might do a great job or consistently perform many 

tasks without visible flaws, but there might be no 

leadership shown in the way that the tasks are 

performed, or in the attention given to teach others to 

perform them. Some of the smartest people will admit 

that they are not good leaders. This can be 

demonstrated by assembling a group of stellar 

performers and asking them to work together to 

complete moderately simple tasks to the highest 

standard possible. Often those who are not good 

leaders will much rather work through problems and 

situations on their own because they find it much 

easier. It might be a psychologically painful 

experience for some independent thinkers and doers to 

have to work in groups, deal with alternative opinions, 

have personal suggestions critiqued, execute a plan 

with which they disagree, and be submissive to the 

direction of others appointed to be in charge. When 

faced with similar situations, regardless of personal 

preference, strong leaders humble themselves, 

appropriately invest time to allow everyone to express 

opinions as to how things should be done, form a plan 

based on the best ideas from every individual, and 

normally complete what is required with better results 

than they have previously experienced. It takes a 

humbled and disciplined thinker to become such a doer 

who will discover the fruition of humbled and 

disciplined efforts. Neither competence nor job 

performance is the same as strong leadership. 

The presence of people who are willing to follow one’s 

actions or thinking does not make an individual a 

leader. Having followers means only one thing, there 

are people willing to follow. Often, regardless of 

person, actions, ideas, cause, or objectives, there will 

always be someone willing to follow someone else. It 

is an observable truism that many people wander 

through life simply looking for someone or something 

to whom or which they can attach. Many others simply 

look for an opportunity to be considered a part of 

something, but not necessarily a part of something 

greater than themselves. Emerging from a sense of 

desperation, being a part of something brings peace to 

the lonely. There are also populations of people who 

look for opportunities to be in the spotlight and, 
52 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

tragically, being in the spotlight or being seen by 

others brings more satisfaction than the purpose for 

which they are spotlighted. These few of many similar 

truths demonstrate that having followers often has 

little or nothing to do with being a leader. Logically, 

there is credibility shared for what resembles 

leadership. Perhaps appropriate descriptors of a person 

with followers would be “that person is influential,” 

“that person has gained a group of followers,” and/or 

“that person has given someone a purpose for which to 

unite.” Likewise, what is commonly verbalized by 

noncritical thinkers and allegers (without a measured 

criterion) is inappropriate. They tend to automatically 

say “that person is a leader” or worse, “that person is a 

good leader” or “...strong leader.” Even when liberally 

(but logically) granting credit, having followers might 

mean people have enough trust in another to follow 

that individual, but it does not measure up to the 

wholeness of leadership. With hundreds of distinct 

reasons why one person might follow another, we 

must absolutely break the trend of falsely honoring 

people as leaders simply because they have followers. 

This is equally but more distinctly true when 

considering self. True leaders lead consistently, 

consciously, and cautiously because they know that 

everything that is done, can and will be duplicated, 

but, trustingly, not to the detriment of others. Having 

followers only means that others are following you, 

not necessarily for good or positive reasons. 

Copying a leader’s actions makes no one a leader. 

Some people feel that they will be good leaders if they 

copy what was done by someone whom they 

considered to be a good leader. In a narrow scope of 

thinking, such justifications might suffice, but actually 

such thoughts are misleading when it comes to 

leadership. Following anyone while doing anything 

makes one a follower. Though anyone is capable of 

learning from the past, great leaders know that actions, 

behaviors, and decisions are pertinent to specific 

times, locations, circumstances, groups, personalities, 

and more. What may have been a great plan in 2003 

could be a terrible plan in 2037, based on the exact 

conditions but with different people. The personalities, 

experiences, attitudes, motivations, and values could 

not only make the plan from 2003 not fitting for 

current strategy, but might make the plan a bad fit for 

the future, thus becoming a terrible plan in its entirety. 

It must be understood that people respond differently 

depending on their values, perspectives, morale, 

discipline, attitudes, and more. It must also be 

understood that people respond differently from person 

to person based on all the aforementioned factors, plus 

others such as appearance, demeanor, tone, and style. 

It is more logical to say that great plans from leaders 

of the past can always be considered, but modified to 

complement the personnel, circumstances, mission and 

goals at hand. With so many logical justifications, it 

should be clear that following good leaders does not 

make someone a good leader and duplicating good 

plans does not make a current plan a good one. 

Additionally, great leaders (normally passionate in 

their values and actions) rarely want the same result as 

other leaders. That sense of “settling” is not what 

leaders desire. It is very reasonable to want better 

results given the kick start of a plan that once proved 

positive. Consider that anyone who begins planning 

with the feeling that there is not much to think about or 

consider because the plan is already in place is 

destined to fail or reap marginal results. If plans and 

actions are not results of critical thinking, doers have 

failed to consider human factors, risks, conditions, and 

potential outcomes that could lead to detrimental 

results. These are reasons why strong leaders never 

“cookie-cut” their leadership styles and actions. Going 

beyond what is historical or traditional, leaders 

approach planning calmly, logically, and critically, 

anticipating distractions and chaos but implementing 

checks and balances to ensure optimal results. Finding 

good in others and their actions, extracting ideas or 

methodologies from the past and our own experiences, 

and then modernizing all to benefit current situations is 

a far more logical approach than copying past leaders 

in hopes of being a good leader today. 

Being the senior person involved does not make an 

individual a leader. Some people feel that they have the 

“right to lead” by virtue of seniority. Do you agree? 

What gives a person the right to lead? Does anything? 

Experiences, résumé, positions, and other such factors, 

help people earn the right to serve in leadership 

positions. There is no true right to lead when the 

complexity of human interaction is considered. From a 

values perspective, there are mutual competing 

satisfactions in a person desiring to lead as there are 

with followers “choosing to be led.” There are a large 

number of humans who, by virtue of their own 

intellect, arrogance, and cautions, will not allow just 

anyone to lead them. Humans desire the personal 

The Personality, Passion, and Essence of a Leader 
 October – December 2009 53

THE ARMY MEDICAL DEPARTMENT JOURNAL

satisfaction of feeling comfortable with those who lead 

them, those they allow to lead them, and those they 

choose to follow. Therefore, seniority does not convey 

the right to be a leader. The right to lead is earned 

through a person’s proven willingness, commitment, 

and humbleness to lead cautiously. 

There are many invalid perceptions and false idols of 

leadership. Regardless of the situation, circumstance, 

position, role, level of authority, or any other factor, 

identification of leaders should not be falsely 

hypothesized. The best and most accurate way to 

identify a leader is to sacrifice, commit, and become a 

leader. 

THE POWER OF LEADERSHIP

One of the greatest and most powerful gifts that one 

person can give another, tertiary to life and love, is 

leadership. In the midst of discouragement, hard times, 

mental distress, and many other negative influences, 

strong leaders radiate a sense of hope. In the presence 

of strong leaders, people tend to know that resolution 

will appear, and, in regards to their personal matters, 

leaders will take the time needed to offer meaningful 

guidance or direction that will somehow make things 

better. Even without personal conversations, the hope 

that stems from a leader opens the mind and allows 

flowering buds of discovery to bloom with new ideas, 

clearer thinking, and foreseeable resolutions. Within 

days or even hours of being around strong leaders, the 

once foreseeable forecast of hope floods the mind with 

inspiration until faith settles the dust of pessimism. 

Strong leaders might be seen as the dawn of a new 

day. Leadership is very powerful. 

Association with strong leaders is one of the most 

comforting experiences that a person can witness. 

Despite only knowing a strong leader for a very short 

time, a person might immediately feel a calming 

sensation and reassurance that things will be okay, 

even in a crisis. People love feeling comforted. For 

most people, there is a remarkable satisfaction that 

comes with knowing that there is someone who will 

figure things out, develop a plan, look out for 

everyone’s best interest, take nothing for granted, and 

always work diligently for the best result possible. 

Perhaps these are the factors that bring quiet in the 

midst of a storm, and compel others to gravitate 

toward strong leaders. Leadership is comforting. 

Even those who feel threatened by strong leaders often 

end up appreciating the aura of positivity that 

somehow evolves from their presence. Have you ever 

witnessed how people respond in the presence of such 

leaders? Some automatically sense that they must step 

up their game, stand a little taller, sharpen their 

attitudes, and enhance their performance. Often 

without words, these things happen. Why is that? It is 

the power of strong leadership. 

Being around strong leaders might cause those 

individuals identified as “weak links” in the chain to 

feel anxious in one breath and reassured in the next. 

They tend to somehow sense that adjustments will be 

uncompromised, know that adaptation will force them 

beyond their comfort zones, but also understand that 

their bad or relaxed habits should be changed. 

Ultimately they trust that through it all and regardless 

of the conditions, they will be treated fairly without 

being wrongfully singled out so that they will 

eventually blend in with all others. How can so many 

emotions be stirred simply by someone’s presence? 

How can so many truths be interpreted strictly by 

witnessing a person’s demeanor? How can so much 

understanding occur without even asking one 

question? It is the power of strong leadership. 

CLOSING THOUGHT

The most powerful person on earth is not the one who 

has the most money. The most powerful person in the 

world is not the one who brings the most fear. The 

most powerful people, alive or dead, are perhaps those 

who have demonstrated the willingness, commitment, 

and humility to lead cautiously, with the ultimate, 

sincere goal of taking care of people while producing 

outstanding results. That within itself is powerful. A 

true leader has the right personality, passion, and 

essence. Do you? 

AUTHOR

MSG Hall is the provisional Sergeant Major for the 

Center for Health Education and Training, Academy of 

Health Sciences, Army Medical Department Center and 

School, Fort Sam Houston, Texas. 
54 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

BACKGROUND

As the Army Medical Department (AMEDD) 

undergoes significant transformation and faces 

numerous challenges in fulfilling its mission to 

provide world-class healthcare to Soldiers, their 

Families, retirees, and other beneficiaries, AMEDD 

leaders should be aware that they are not alone in their 

decision-making, especially in terms of legal support. 

There are numerous judge advocates, civilian 

attorneys, military paralegals, and civilian paralegals 

providing legal support throughout the AMEDD at the 

8 medical centers and numerous hospitals, clinics, and 

facilities throughout the Army. They provide valueadded advice and support, possess a unique macro and 

micro perspective, and have access to legal channels 

which can be beneficial to the leader and his or her 

organization. 

A critical leadership skill for AMEDD leaders is the 

ability and willingness to make prudent decisions even 

without having full information. Leaders quickly 

realize they can never get all the pertinent information 

to make fully informed decisions. They develop 

confidence in knowing they have enough information 

to make the best decision in a timely manner. Leaders 

also realize that the best way to gain well-timed 

information is to create a team of subject matter 

experts capable of providing prompt, accurate 

information. One of the key members of this team 

should be the legal counsel in the organization. 

AMEDD leaders should utilize their legal counsel in 

traditional and innovative ways and include them as a 

member of the team as they deal with issues that span 

a spectrum of subjects. The following is an array of 

subjects for which legal counsel are currently 

providing support to leaders throughout the AMEDD. 

MILITARY SUPPORT TO DECLARED PUBLIC HEALTH

EMERGENCIES

The AMEDD provides support to declared public 

health emergencies arising from disease, such as 

pandemic influenza. Following such a declaration, the 

President may direct any federal agency to use its 

authorities and resources in support of state and local 

assistance efforts. The Department of Defense (DoD) 

and the Department of the Army have developed 

response plans, in coordination with the Department of 

Health and Human Services and the Centers for 

Disease Control and Prevention, in the event of such 

an outbreak of disease. Current strategy for an avian 

flu pandemic may involve isolation and quarantine. 

Isolation refers to the separation and the restriction of 

movement of people who have a specific infectious 

illness from healthy people in order to stop the spread 

of that illness. Quarantine refers to the separation and 

restriction of movement of people who are not yet ill, 

but who have been exposed to an infectious agent and 

are therefore potentially infectious. Legal counsel are 

critical advisors to the public health emergency 

officers and their staff who are planning when, where, 

and to what extent the military role will be in such an 

event. 

HUMAN SUBJECT RESEARCH

The Surgeon General of the Army oversees all human 

subject research within the Army. Legal counsel 

advise local Institutional Review Boards which 

oversee research projects at the regional medical 

commands and medical centers. Legal counsel are ever 

vigilant of the rights of patient subjects, consent forms 

that are difficult to understand for participants, and 

protocols which violate bioethical standards. 

STANDARDS OF ETHICAL CONDUCT

Ethics counselors in the Army are required to be 

attorneys. In the AMEDD, legal counsel help leaders 

to avoid violating Titles 5a

, 18b, and 31c of the United 

States Code (USC) and the Joint Ethics Regulation.

1

Within the AMEDD, frequent ethics issues facing 

personnel are gifts, postgovernment employment, offduty employment, relationships with contractors, and 

travel payments under 13 31 USC §1353.2

Legal Counsel: A Leadership Tool 

MAJ Joseph B. Topinka, USA 

a

Government Organization and Employees, 5 USC 

b

Crimes and Criminal Procedure, 18 USC c

Money and Finance, 31 USC 
 October – December 2009 55

PERSONAL HEALTH INFORMATION

Legal counsel advise AMEDD leaders on the rules for 

protecting patient confidentiality under the Health 

Insurance Portability and Accountability Act of 1996 

(HIPAA).3

 HIPAA requires everyone in the Military 

Health System to safeguard and keep confidential the 

health information of patients (personal health 

information (PHI)). A patient’s healthcare information 

is confidential and will be not released to anyone 

without an authorization from the patient or an 

exception to HIPAA. While commanders and their 

designees have a specific exception to receive health 

information that others do not, it is limited and they do 

not have unrestricted access to a Soldier’s PHI. This 

can sometimes cause misunderstanding and a phone 

call to the supporting attorney may be in order. 

QUALITY ASSURANCE

Documents and information produced by or pertaining 

to activities carried out by the DoD as part of a 

medical quality assurance (QA) program are 

confidential and privileged.4,5 A QA program is any 

activity by or for the DoD to assess the quality of 

medical care. This includes activities such as 

privileging, infection control, patient care assessment, 

medical records review, health resources management 

review, and identification and prevention of medical or 

dental incidents and risks (risk management, patient 

safety, and incident reports). Only The Surgeon 

General may authorize release of QA documents or 

information outside of DoD. Legal counsel are critical 

in providing advice to leaders and staff on QA 

activities and appropriate handling of QA documents 

and information, especially with regard to procedures 

involving health provider misconduct and malpractice 

that affect the privileges of physicians, dentists, nurses, 

and other healthcare practitioners. 

PHYSICAL DISABILITY EVALUATION SYSTEM

The US Army Physical Disability Agency, under the 

operational control of the Commander, Human 

Resources Command, operates the Physical Disability 

Evaluation System (PDES) and executes Secretary of 

the Army decision-making authority as directed by 

Congress.6-11 The Physical Disability Evaluation 

Boards (PEBs) meet at 3 locations: Walter Reed, 

Washington, DC; Fort Sam Houston, TX; and Fort 

Lewis, WA. In light of the increase in personnel 

processing through the PDES, the Army, through the 

Army Medical Command (MEDCOM), mobilized 18 

Judge Advocates and paralegals in 2007 and has 

continued a cycle of mobilizations of legal personnel 

to assist Warriors in Transition Soldiers as Soldiers 

Counsel (Office of Soldiers’ Counsel (OSC)) before 

the PEBs at the 3 PEB sites, plus locations at Fort 

Carson, CO; Tripler Army Medical Center, HI; and 

Landstuhl Army Medical Center in Germany. These 

attorneys provide the advocacy for Soldiers facing 

disability determinations that will impact the rest of 

their lives. 

MEDICAL EVALUATION BOARDS

In 2008, the Army, through the MEDCOM, hired 

Medical Evaluation Board (MEB) outreach attorneys 

and paralegals for 19 Warrior Transition Unit 

battalions to handle regional MEB outreach needs. The 

posts that have the MEB outreach teams include: 

 Walter Reed Army Medical Center, 

 Washington, DC 

 Fort Polk, Louisiana 

 Tripler Army Medical Center, Hawaii 

 Fort Gordon, Georgia 

 Fort Benning, Georgia 

 Fort Stewart, Georgia 

 Fort Riley, Kansas 

 Fort Campbell, Kentucky 

 Fort Knox, Kentucky 

 Fort Drum, New York 

 Fort Bragg, North Carolina 

 Fort Sam Houston, Texas 

 Fort Hood, Texas 

 Fort Bliss, Texas 

 Fort Lewis, Washington 

 Fort Richardson, Alaska 

 Heidelberg, Germany 

These positions were established to ensure that 

Soldiers obtain the legal counseling they need to make 

the appropriate decisions early in the review process. 

They supplement the specially trained OSC physical 

disability attorneys at a local level. They also provide 

Soldiers in the MEB process with general legal 

assistance to help resolve personal legal matters, other 

than criminal actions. 
56 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

RESOURCE SHARING

Since federal agencies have had the ability to costshare for years under the Economy Act, the sharing of 

resources between DoD and the Department of 

Veterans Affairs (DVA) is not a new concept. 

However, since 1982 when Congress passed the 

Veterans Administration and Department of Defense 

Health Resources and Emergency Operations Act,12

the Secretary of the DVA and the secretaries of the 

military departments may enter into healthcare 

resource sharing agreements pursuant to guidelines 

established jointly by the Secretary of the DVA and 

the Secretary of Defense. Under these guidelines, 

heads of individual medical facilities can enter into 

local agreements and such agreements require the 

finesse and review by counsel who have an 

understanding of the applicable law.* 

TRAINING AGREEMENTS

Military treatment facilities (MTFs) operate 

professional education programs to train military 

healthcare professionals in various areas of expertise.14

The MTFs often enter into gratuitous training and 

affiliation agreements with civilian healthcare 

institutions under the authority of 10 USC §4301.15

The primary legal issue for these training agreements 

is liability coverage for the healthcare provider. The 

Department of Justice (DoJ) requires MTFs to use 

language in the training agreement that would either 

require the civilian training institutions to provide 

liability coverage for the DoD provider, or include 

language that would imply the provider is a barrowed 

servant of the institution. More recently, civilian 

training institutions are rejecting the DoJ language and 

insisting that DoD carry liability for their providers. 

Legal counsel must see these agreements and often 

have to coordinate with the DoJ to ensure that the 

signed agreement will ensure that AMEDD providers 

are appropriately covered for liability. 

INTERAGENCY AGREEMENTS

Interagency agreements come in a number of forms 

ranging from recordings of mutual understandings to 

multiple year, multiple million dollar acquisitions of 

goods and services. An agreement involving 

acquisition of goods and services from other federal 

agencies is generally prohibited absent a statute 

specifically authorizing it. While there are several 

statutes that provide such exceptions, each has 

different requirements and is applicable in different 

circumstances. Within the DoD, various statutory 

authorities authorize agreements in specific 

circumstances. Similarly, a variety of regulatory and 

policy directives prescribe procedures that differ, for 

example, in acquisitions (a) from DoD agencies rather 

than other federal agencies; (b) involving contract 

support from other agencies rather than noncontract 

support; (c) involving DoD contracting activities rather 

than non-DoD contracting activities; and (d) involving 

one-time requirements versus recurring support. 

Advice from legal counsel on the specific 

circumstances can assist AMEDD commanders to 

identify the correct authority and form of agreement 

most supportive of their mission requirements. 

OBLIGATION AND EXPENDITURE OF APPROPRIATED

FUNDS

Activities across the AMEDD run the gamut from the 

most regular and mundane, to the most unusual and 

arcane. One thing most of these activities have in 

common is that they involve the obligation and 

expenditure of funds appropriated by Congress and 

allocated for AMEDD use. The funds come in various 

“colors” and various periods of “availability” for new 

obligations. Depending on the activity the commander 

wants to undertake, the funds required to do so may 

vary depending on the nature and structure of the 

activity, the authority for the activity, the magnitude of 

the activity, the timing of the activity, and the actions 

previously taken by others with regard to the activity. 

Only one color can be correct. Some funding actions 

raise little or no issue, while color, timing, and 

availability of funds may make others problematic. 

Legal counsel can help the commander sort through 

these issues by identifying the fiscal rules applicable to 

the activity and the funding the commander proposes. 

UNAUTHORIZED COMMITMENTS

As AMEDD becomes increasingly more dependent on 

contracts to provide services, the need for a better 

understanding of contracts is ever more critical. This is 

especially the case when changes are required in the 

contract and leaders or management personnel decide 

Legal Counsel: A Leadership Tool 

*Only those VA/DoD Resource Sharing Agreements between DoD and the VA entered into pursuant to Public Law 97-17412 and 

38 USC §8111 13 can be accurately termed as “Resource Sharing Agreements.” All other sharing agreements are more 

accurately termed “Interagency Agreements.”
 October – December 2009 57

THE ARMY MEDICAL DEPARTMENT JOURNAL

to make those changes without the advice of legal 

counsel or without contacting the contract officer or 

the contracting officer representative. These changes 

can result in unauthorized commitments. Such 

commitments must be investigated and ultimately 

approved for ratification. If they are not ratified, 

individual liability may result. Ratification is not 

automatic and the advice of legal counsel is often 

required when a decision on ratification is being made. 

DISCIPLINE

AMEDD commanders have options available for the 

resolution of disciplinary problems for military 

personnel. In summary, they can determine that no 

action is necessary; initiate administrative action, 

dispose of the offense with nonjudicial punishment, or 

dispose of the offenses by court-martial. Whatever the 

decision, advice of legal counsel is key. Recently, a 

great deal of attention has been paid by the media to 

nonjudicial punishment so some additional details 

about that option are important to note. Nonjudical 

punishment under Article 15 of the Uniform Code of 

Military Justice* is a means of handling minor 

offenses requiring immediate, corrective action. 

Nonjudicial punishment hearings are nonadversarial. 

They are not a “mini-trial” with questioning by 

opposing sides. The commander conducts the hearing. 

A Soldier may request an open or closed hearing, 

speak with a defense attorney about his or her case, 

have a spokesperson, and present witnesses. The 

commander conducting the hearing must be convinced 

that the Soldier committed the offense in order to 

impose punishment. A Soldier has a right to appeal 

nonjudicial punishment to the next-higher commander. 

AMEDD commanders and leaders also have options 

available for the resolution of disciplinary problems 

with civilian personnel. Options include counseling, 

reprimands, suspensions, and termination. Advice by 

legal counsel who serve as labor attorneys in 

conjunction with the local civilian personnel offices is 

a must, especially as the rules and laws in terms of 

civilian personnel discipline are complex and often can 

involve local labor unions. 

CONCLUSION

While the aforementioned subjects are not meant to 

represent a comprehensive list, they provide a sense of 

the spectrum of legal issues facing leaders in the 

AMEDD for which legal counsel are there to support 

and advise. It is a team effort and the legal counsel of 

the AMEDD team are important players whose 

training and experience can be invaluable to the 

solutions of both legal and nonlegal problems. Most of 

all, legal counsel can help the leader focus on the big 

picture and its interaction with the law.17

ACKNOWLEDGEMENT

I thank Charles Orck, Maurice Deaver, and Rosalind 

Gagliano for their assistance in the preparation and 

review of this article. 

REFERENCES

1. Department of Defense 5500.7-R: Joint Ethics 

Regulation. Washington, DC: US Dept of Defense; 

August 1993 [ch 6 March 23, 2006]. 

2. Acceptance of Travel and Related Expenses from 

Non-Federal Sources, 31 USC §1353 (2003). 

3. Public Law 104-191 Health Insurance Portability 

And Accountability Act Of 1996. August 21, 1996. 

4. Department of Defense 6025.18-R: DoD Health 

Information Privacy Regulation. Washington, DC: 

US Dept of Defense; January 24, 2003. 

5. 10 USC §1102 (2004). 

6. Retirement or Separation for Physical Disability, 10 

USC §61 (2008). 

7. Department of Defense Directive 1332.18: 

Separation or Retirement for Physical Disability.

Washington, DC: US Dept of Defense; November 4, 

1996. 

8. Department of Defense Instruction 1332.38, Physical 

Disability Evaluation. Washington, DC: US Dept of 

Defense; November 14, 1996 [ch 1 July 10,2006]. 

9. Department of Defense Instruction 1332.39: 

Application of the Veterans Administration Schedule 

for Rating Disabilities. Washington, DC: US Dept of 

Defense; November 14, 1996. 

10. Army Regulation 40-501: Standards of Medical 

Fitness. Washington, DC; US Dept of the Army; 

December 14, 2007 [revised September 10, 2008]. 

*The Uniform Code of Military Justice (UCMJ), a federal law,16 is 

the judicial code which pertains to members of the United 

States military. Under the UCMJ, military personnel can be 

charged, tried, and convicted of a range of crimes, including 

both common-law crimes (eg, arson) and military-specific 

crimes (eg, desertion). 
58 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

11. Army Regulation 635-40: Physical Evaluation for 

Retention, Retirement, or Separation. Washington, 

DC: US Dept of the Army; February 8, 2006. 

12. The Veterans Administration and Department of 

Defense Health Resources and Emergency 

Operations Act, Public L No. 97-174. 

13. Sharing of Department of Veterans Affairs and 

Department of Defense Health Care Resources, 38 

USC §8111. 

14. Army Regulation 351-3: Professional Education and 

Training Programs of the Army Medical Department.

Washington, DC: US Dept of Army; October 15, 

2007. 

15. Members of Army: detail as students, observers, and 

investigators at educational institutions, industrial 

plants, and hospitals, 10 USC §4301. 

16. Uniform Code of Military Justice, 64 Stat. 109, 10 

USC, ch 47. 

17. Chanen, JS. The Strategic Lawyer, ABA Journal

[serial online]. July 2005. Available at: http://www. 

abajournal.com/magazine/the_strategic_lawyer1/. 

Accessed August 4, 2009. 

AUTHOR

MAJ Topinka is Deputy Staff Judge Advocate, Office 

of the Staff Judge Advocate, US Army Medical 

Command, Fort Sam Houston, Texas. 

Legal Counsel: A Leadership Tool 
 October – December 2009 59

Would you be a better leader today if, while you were 

a junior leader, there had been a formal pathway to 

receive constructive feedback from peers, 

subordinates, and supervisors? The 360 feedback 

assessment is an appraisal tool with which individuals 

(self-assessment), subordinates, peers, and supervisors 

within an organization provide constructive feedback 

to each other, with the goal of improving the 

leadership development process. 

As Chief of the Captain’s Career Course (CCC) 

Branch at the Army Medical Department (AMEDD) 

Center and School, my mission is delineated in 

Department of the Army Pamphlet 600-4: 

...to train officers to lead company or equivalent-sized 

organizations and serve successfully in U.S. Army staff 

positions. Graduates of the AMEDD CCC are prepared 

for subsequent assignments by learning the leader, 

tactical, and technical tasks, including the supporting 

knowledge and skills necessary to support the Joint 

Team across the full spectrum of military medical 

operations.1

In taking this mission and defining leadership 

development, I continually come back to the fact that 

good leaders are self-aware. This is a key tenant in 

leadership development. 

Understanding yourself (self-awareness) through selfdevelopment is essential to effective leadership. 

According to Kouzes and Posner, 

Leadership development is self-development....The 

quest for leadership is first an inner quest to discover 

who you are. Through self-development comes the 

confidence needed to lead. Self-confidence is really 

awareness of faith in your own powers. These powers 

become clear and strong as you work to identify and 

develop them.2 

Receiving honest and constructive feedback from your 

peers, subordinates, and supervisors can be a helpful 

exercise in building confidence, as well as self-development. Senior Army leadership will acknowledge 

that leadership is an ongoing process. I can definitely 

attest to this. After 18 years of service, I am still learning and developing my leadership style. With this in 

mind, together with the help of my Small Group 

Leaders (SGLs), we developed a process of using the 

360 assessment tool for assisting us in molding our 

leadership development. Although familiar with the 

Army’s internet (Army Knowledge Online) based 360-

degree assessment (Multi-Source Assessment and 

Feedback Program) and Kouzes and Posner’s Leadership Practices Inventory,3

 we chose to develop an assessment tool which would directly address the leader 

development process in an academic environment, 

specifically, the Captain’s Career Course. 

BACKGROUND

Although I thought I understood the gravity of Army 

values, during a recent assignment I saw first-hand the 

devastation that follows when a junior officer in both 

personal and professional conduct disregards the Army 

values of integrity and honor. After this incident, I 

considered for the first time whether peer assessments 

could be used with junior officers to develop or 

enhance Army core values to prevent incidents such as 

this from ever happening again. 

In 1992, during Ranger School as a second lieutenant, 

I was exposed to my first peer evaluation. At the end 

of each of the 4 phases of Ranger School, the platoon 

conducted peer evaluations. This evaluation was very 

effective in the field environment because it gave each 

of us (Ranger students) a voice on who was pulling 

their weight during missions. In addition, it provided 

the Ranger Instructors a clearer assessment of the 

students in the platoon. The peer evaluation process 

surfaced “Spotlight Rangers” who would only shine 

when the instructors were watching. Each student 

would rank order every platoon member (ie, 1 to 30, 

360 Assessment, an Easier Pill to Swallow: 

 Implementation of Peer Assessment for 

 Captain’s Career Course Students and Staff 

LTC Eric Sones, MS, USA 
60 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

30 being the worst), and, as a result, the bottom quarter 

of the class automatically recycled to the beginning of 

that particular phase. This type of ranking system is 

what some may consider as the “hard pill to swallow.” 

Being labeled at the bottom of your peer group by your 

peers, without an explanation of why or how to 

improve, could potentially cause a loss of interest in 

leader development by some individuals who might 

have benefited otherwise. This factor led to the 

development of the CCC 360 assessment tool that 

seeks to improve all who participate, rather than 

exclude those who are not seen as stellar performers 

by their peers, subordinates, or supervisors. 

THE PROCESS

My initial intent was to use our specifically designed 

self/peer instructor-based assessment concept with the 

CCC’s 14 SGLs. Refining this new assessment process 

would be a challenge in an educational environment, 

but would ultimately be beneficial to all who 

participated. With initial consultation and input from 

COL Jeffery Haun, Director of AMEDD Leader Training Center; Dr Jody Rogers, Director of the AMEDD 

Executive Skills Program; and Dr Robert Leeds, CCC 

Future Operations, the Leadership Survey was created 

and administered to the SGLs on July 31, 2008. 

Each SGL had to complete an initial self-survey, 

shown as Figure 1. The self-survey listed 12 different 

categories, focusing on specific leadership attributes 

that pertained to each individual’s responsibilities as 

an instructor. Each category has a point value from 

Strongly Disagree (1) to Strongly Agree (6). Each 

SGL checks the point value to match each category 

based on a self-assessment. The lowest category 

marked for improvement requires the SGL to enter at 

least one comment focused on improvement. The highest marked category on success requires the SGL to 

enter at least one “sustain” comment. In addition to addressing the highest and lowest category, each SGL 

then listed the top 3 personal values that they see in 

themselves, further building on the success comment. 

After completing the self-survey, the SGLs moved to 

the peer survey. The same process as the self-survey 

was followed, as each SGL completed a peer survey 

on each of their colleagues. As Course Chief, I 

completed a supervisor survey on each SGL, and, in 

turn, each of them completed a subordinate’s survey 

on me. 

Finally, the CCC students completed a student survey 

on their SGL. Except for the omission of categories 11 

and 12, the student survey was identical in structure to 

the self-survey, as shown in Figure 2. 

All surveys were collected in a self-sealing folder, 

signed on the back by each party, collected by a 

disinterested person, and then delivered to the 

AMEDD Executive Skills Program office for analysis. 

The results of the analysis for each SGL were then 

incorporated into an individual graph, illustrated in 

Figure 3, which was a consolidation of self, peer, 

student, and supervisor evaluations. Each graph had 

different data points matching the weighted criteria for 

each question answered. In addition to the graph, a 

sustain/improve comment sheet was provided. The 

comment sheets filled in the gaps that the graph was 

unable to explain. 

Each SGL’s graph and comment sheet were placed in 

a sealed folder which was signed by the Executive 

Skills Program office representative and delivered to 

the SGL. Next, each SGL was required to meet with 

360 Assessment, An Easier Pill to Swallow: 

Implementation of Peer Assessment For Captain’s Career Course Students and Staff 

Figure 1. The initial self-survey administered to the Small Group 

Leaders of the Captain’s Career Course. 

Category 1(SD) 2 3(D) 4(A) 5 6(SA) 

1 I always display honesty, integrity, and 

trustworthiness. 

2 I make decisions...and do not shy away 

from the tough ones. 

3 I communicate often and clearly...with 

everyone. 

4 

I mentor, empower, and develop my 

subordinates...a consummate team 

player. 

5 I hold everyone accountable, including 

myself. 

6 I have strong control over my emotions. 

7 I excel in pressure situations. 

8 I have the compassion to listen to 

others. 

9 

I know the material that I teach/

instruct and can lead any discussion in 

my small group. 

10 I have a positive attitude and 

am passionate about what I do. 

11 I am a team player. 

12 I am a catalyst for and manager of 

change 

Provide one Sustain and one Improve comment 

Sustain Overall Score_________ 

 1) 

Improve 

 1) 

Top three values you see in yourself 

 1) __________________ 2) ____________________ 3) _____________________ 

Leadership (Self) Survey
 October – December 2009 61

THE ARMY MEDICAL DEPARTMENT JOURNAL

Dr Rogers, who provided some professional trend 

analysis on the graph and comment sheets as part of 

their initial assessment. 

RISK AND MITIGATION

As I planned to introduce this new concept/process to 

my SGLs, I knew that with potential benefits came 

some potential risks. Below are some potential risks 

with this process and the subsequent mitigation I found 

useful. 

Risk: Unconstructive Feedback. Using the 360-degree 

approach may give some SGLs an opportunity to share 

feedback that is unconstructive and hurtful, thereby 

disrupting the teamwork and cohesiveness of our 

group. 

Mitigation. Set grounds rules early. Emphasize that 

comments (sustain/improve) should be centered on 

categories, based on constructive thoughts, not be 

emotionally based, and should focus on ideas and 

behavior, rather than individuals. Show an example of 

a constructive thought in the survey process. Try not to 

assume that everyone has the same vision you may 

have. It is important to have a source trusted by all to 

review the comment sheets, ensuring all comments are 

constructive. If the trusted source finds some 

comments offensive, he/she can approach the 

recommender to refine the comment in terms that are 

more diplomatic and still allow for feedback. 

Risk: Old Dog, New Tricks. Sometimes participants 

tend to voice lack of interest in the process due to their 

habitual comfort in their style and approach. This lack 

of enthusiasm could potentially spread to other 

participants. 

Mitigation. Lack of enthusiasm is hard to mitigate. The 

process should be emphasized as a tool that may be 

useful to some and maybe not others. This instantly 

allows the skeptics to place themselves in whichever 

category is suitable. Deemphasizing it as a “silver 

bullet” to leader development will take away the 

skeptic’s negative response to the process. Once the 

initial assessment is complete, skeptics at least have 

information on which they can choose to take action or 

ignore. The majority of my SGLs knew some of their 

own strengths and weaknesses, however, having others 

(peers) recognize these challenges may entice each 

SGL to make a change in leadership behavior. This 

Leadership (Student) Survey

Category 1(SD) 2 3(D) 4(A) 5 6(SA) 

1 This person always displays honesty, 

integrity, and trustworthiness. 

2 This person makes decisions...and does 

not shy away from the tough ones. 

3 This person communicates often and 

clearly...with everyone. 

4 

This person mentors, empowers, and 

develops subordinates...a consummate 

team player. 

5 This person holds everyone accountable, 

including himself/herself. 

6 This person has strong control over his/

her emotions. 

7 This person appears to excel in pressure 

situations. 

8 This person has the compassion to listen 

to others. 

9 This person knows the material they 

instruct and can lead any discussion. 

10 

This person exudes a positive attitude 

and is passionate about what he/she 

does. 

Provide one Sustain and one Improve comment 

Sustain Overall Score_________ 

 1) 

Improve 

 1) 

Top three values you see in the Instructor 

 1) __________________ 2) ____________________ 3) _____________________ 

Figure 2. The survey used by students at the end of the 

Captain’s Career Course to evaluate each student’s Small 

Group Leader. 

0

1

2

3

4

5

6

7

Q1

Q2

Q3

Q4

Q5

Q6

Q7

Q8

Q9

Q10

Q11

Q12

Weighted Criteria 

Student

Self

Peer

Supervisor

Survey Question 

Figure 3. An example of the plot of the consolidated, weighted 

scores from the 4 surveys that is prepared for each Small 

Group Leader as part of his or her individual assessment for 

each Captain’s Career Course class. 
62 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

360-degree process challenged some of the negative 

group dynamics, broke down mental barriers, and 

focused on the fact that this assessment was an 

opportunity to learn and grow. 

Initially, my SGLs did not want to participate in the 

evaluations. Little trust existed in the process, in my 

ability and willingness to use the information 

constructively, and in the ability of their fellow 

officers to evaluate each other in a compassionate and 

helpful way. As a result, I acted first in evaluating 

myself and in asking my SGLS to evaluate me. I then 

used their input to demonstrate what I was looking for, 

and the importance of their evaluations of me. I 

believe giving them the opportunity to evaluate me 

was very helpful in allaying some of the concerns they 

had of this evaluation. They saw firsthand how I 

planned to use the information to improve my 

leadership abilities. Once they saw the process unfold, 

they were more willing to participate in the evaluation. 

Risk: Evaluation Influence. The 360-degree assessment 

could indirectly influence evaluation criteria on each 

SGL’s Officer Efficiency Report. 

Mitigation. In consultation with immediate leadership, 

the consensus was the outcome would prove more 

effective for the SGLs if the supervisor was not 

involved in the survey collection. Therefore, a disinterested party, in this case the Executive Skills Office, 

became part of the collection and analysis process. 

Taking the supervisor out of the collection and analysis of the survey assessments helped the SGLs grow 

personally and professionally which was the primary 

intent behind the 360-degree assessment process. 

Risk: Leading by Example for Group Buy-In. Sharing 

your comments in an open forum is helpful, but 

caution must be exercised. Some comments were 

hurtful to some of the officers. My SGLs learned that 

giving constructive feedback is just as important as 

receiving constructive feedback. Feedback seen as 

cruel and vindictive is not beneficial to helping a 

fellow officer grow. Learning how to give constructive 

feedback in a nonthreatening manner is a critical 

leadership mentoring/coaching tool that my officers 

learned through this process. Going first in this process 

proved very instructive to me. I was learning as my 

SGLs were observing the process that they would soon 

be undertaking. 

After receiving my survey feedback during the 

meeting, an open discussion followed concerning each 

point. In an effort to lead by example, this forum 

allowed me to emphasize how important this new tool 

was to our organization and how I would address the 

constructive feedback shared in their assessment of my 

leadership at CCC. 

Mitigation. As the leader, you must be willing to go 

through the process yourself and show how the comments will lead you down a path to self-improvement. 

However, reemphasizing the constructive format, and 

having a disinterested party participate in “filtering” 

these comments is essential, especially when the 

results were discussed openly with the group. 

ADDITIONAL LESSONS LEARNED

1. All sustain and improve comments need 

elaboration. A one-word comment, like 

“communication” in the improve column does not 

provide adequate detail for the process to begin. 

This comment leaves it up to the rated individual 

to decipher how he or she should improve on 

communication. For example, is the rated individual talking too much or too little, difficult to read, 

or do nonverbal cues need to be improved, etc? 

2. Sharing one or 2 overarching theme(s) for sustain 

and improve areas in an open forum can be 

effective. Sharing in front of others shows an 

outward commitment to their peers that they will 

work on specific sustains and improvements. Start 

with the crawl phase in the process and make 

realistic goals. Make periodic status checks each 

quarter to verify personal progress. 

3. Give individuals completing surveys adequate 

time to do so. If possible, provide a few days to 

allow each participant to consider the individual 

they are assessing. It is obvious that the more 

thought and consideration given to each individual 

survey will make it more valuable in the 

assessment process. 

4. Use an outside, unbiased source to consolidate 

comments, mentor, and share thoughts with each 

individual’s assessment. If one is not available, at 

the very least provide guidance through an officer 

professional development session on how to read 

the graphs. 

360 Assessment, An Easier Pill to Swallow: 

Implementation of Peer Assessment For Captain’s Career Course Students and Staff 
 October – December 2009 63

THE ARMY MEDICAL DEPARTMENT JOURNAL

5. Administer the self, peer, and 

supervisor 360-degree assessment 

to newly assigned SGLs around 

their 6-month anniversary of 

arrival so others can properly 

assess and answer each category 

comfortably. 

FUTURE STEPS/SUMMARY

Would you be a better leader today, if, 

when a junior leader, there had been a 

formal pathway for you to receive 

constructive feedback from peers, 

subordinates, and supervisors? I know 

for me, the answer is, without a doubt, 

yes. Whether it is returning a lost 

wallet or obeying a commander’s 

policy completely, as Army leaders 

each one of us is tested each day. 

These daily tests refine our values as 

leaders. Rather than simply relying on 

these daily challenges to develop our 

officers, it is our hope at CCC that the 

360-degree tool will make leadership 

development deliberate and intentional 

in an educational setting. 

The CCC-designed SGL self, peer, and 

supervisor assessment surveys are now 

conducted twice a year, and the student 

surveys completed at the end of each 

graduating class (4 times per year). The current survey 

forms were refined to adopt the 10 rating criteria from 

Kouzes and Posner’s Leadership Practices Inventory.3

The new SGL self-survey is shown in Figure 4. Each 

time the survey is conducted, data is compiled so 

individual SGLs can see the trend analysis over time. 

Since benefits of the 360-degree process were 

indisputably evident, we have implemented the 360-

degree assessment within our CCC student population 

as well, in an effort to create a mentorship experience 

for our entire student body. 

Overall, the 360-degree assessment process has been 

an eye-opening experience for our team. The 360-

degree effort, while labor-intensive at times, has 

created an environment for leadership development 

that is unparalleled in its effectiveness and has opened 

new doors for self-development within our 

organization. 

REFERENCES

1. Department of the Army Pamphlet 600-4: Army 

Medical Department Officer Development and 

Career Management. Washington, DC: US Dept of 

the Army; June 27, 2007: 13. 

2. Kouzes JM, Posner BZ. The Leadership Challenge. 

4th ed. San Francisco, CA: Jossey-Bass; 2007:344. 

3. Kouzes JM, Posner BZ. The Leadership Challenge 

Workbook. 3rd ed. San Francisco, CA: Jossey-Bass; 

2006:14. 

AUTHOR

LTC Sones is Chief of the Captain’s Career Course, 

AMEDD Center and School, Fort Sam Houston, Texas. 

Figure 4. The current SGL self-survey form used by the CCC. The 10 rating criteria 

(detailed below), were adopted from Kouzes and Posner’s Leadership Practices 

Inventory3 and are also used in the current student survey. 

Leadership (SGL Self) Survey

Category 1(AN) 2(R) 3(S) 4(OW) 5(O) 6(ST) 7(FO) 8(U) 9(VF) 10(AA) 

1 I always display honesty, 

integrity, and trustworthiness. 

2 I make decisions...and do not 

shy away from the tough ones. 

3 I communicate often and 

clearly...with everyone. 

4 

I mentor, empower, and develop 

my subordinates...a 

consummate team player. 

5 I hold everyone accountable, 

including myself. 

6 I have strong control over my 

emotions. 

7 I excel in pressure situations. 

8 I have the compassion to listen 

to others. 

9 

I know the material that I teach/

instruct and can lead any 

discussion in my small group. 

10 I have a positive attitude and 

am passionate about what I do. 

11 I am a team player. 

12 I am a catalyst for and manager 

of change 

Provide one Sustain and one Improve comment 

Sustain Overall Score_________ 

1) 

Improve 

1) 

Top three values you see in yourself 

 1) ________________ 2) __________________ 3) ___________________ 

Key to Criteria:

(AN) Almost never

(R) Rarely

(S) Seldom

(OW) Once in a while

(O) Occasionally

(ST) Sometimes

(FO) Fairly often

(U) Usually

(VF) Very frequently

(AA) Almost always
64 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

Ultrasonography for Advanced Regional 

 Anesthesia and Acute Pain Management in 

 a Combat Environment 

COL (Ret) Randall J. Malchow, MC, USA 

*The Military Advanced Regional Anesthesia and Analgesia Initiative was established in 2005 to develop consensus recommendations from the 

Army, Air Force, and Navy anesthesia services for the implementation of improvements in medical practice and technology that will promote 

regional anesthesia and analgesia in the care of military beneficiaries. It also serves as an advisory board to the individual service anesthesia 

consultants to the surgeons general. 

INTRODUCTION

Ultrasonography has revolutionized modern medicine 

empowering physicians to offer an increasing number 

of diagnostic and therapeutic procedures using 

ultrasound guidance. These advances have expanded 

their use on the battlefield in Operation Enduring 

Freedom and Operation Iraqi Freedom by radiologists, 

general surgeons, urologists, emergency medicine 

physicians, and gynecologists.1,2 Anesthesiologists 

have also utilized ultrasonography as early as 1978 

when ultrasound was used to aid in the identification 

of vascular structures for the supraclavicular brachial 

plexus block,3

 while more recent higher frequency 

probes have allowed anesthesiologists to identify 

individual nerve trunks and thus provide peripheral 

nerve blockage under direct visualization. Military 

anesthesiologists have also advanced acute pain control of Soldiers with extremity injury beyond the exclusive use of opioids. The placement 

of the first continuous peripheral nerve 

block (CPNB) in a wounded Soldier in 

Iraq on October 3, 2003, opened the 

door to pain control never experienced 

previously in a combat environment.4 

Since that time, numerous Soldiers 

have benefited from the growing use of 

CPNB catheters that can accompany 

them through the echelons of military 

trauma care until they arrive at medical 

facilities in the United States. This case 

series reports the first use of ultrasound 

in a military deployed environment for 

the specific use of providing advanced 

regional anesthesia and acute pain 

management. 

OBSERVATION

Upon notification of my pending deployment to Iraq in 

early 2006, I contacted the Military Advanced Regional Anesthesia and Analgesia Initiative* to explore the 

concept of applying ultrasonography to advanced 

regional anesthesia in a combat environment. In support of our efforts, GE Healthcare Systems (Waukesha, Wisconsin) offered to provide one of their high 

resolution systems, and shipped a new GE Voluson i

ultrasound system (with all accessories) to the 47th 

Combat Support Hospital (CSH) in Mosul, Iraq. 

Most anesthetics at the 47th CSH were conducted with 

a balanced general anesthesia with morphine as needed 

for postoperative pain on the surgical ward. With the 

arrival of the GE Voluson i ultrasound system with 2 

ultrasound probes (a 12L (12 MHz linear) probe and a 

4C (4 MHz curved) probe), a plan was implemented to 

use ultrasound guided advanced 

regional anesthesia techniques as part 

of the perioperative anesthesia and 

analgesia plan for wounded, 

polytrauma patients. 

RESULTS

Forty-four ultrasound-guided regional 

anesthetics were performed by the 

same anesthesiologist experienced in 

regional anesthesia for a variety of 

upper and lower extremity trauma over 

a 3-month period, as outlined in the 

Table. The 12L probe was used in the 

short axis view for most blocks with 

excellent resolution, while the 4C 

probe was used for the deep 

Distribution of upper and lower 

extremity nerve blocks using 

ultrasound. 

CPNB Single 

Shot 

Total 

Interscalene 4 1 5 

Supraclavicular 5 4 9 

Infraclavicular 0 2 2 

Axillary 5 0 5 

Subtotal 14 7 21 

Lower Extremity 

Femoral 6 5 11 

Sciatic 2 4 6 

Popliteal 5 0 5 

Other 1 0 1 

Subtotal 14 9 23 

Total Regional Anesthetics: 44 

Upper Extremity 
 October – December 2009 65

penetration often required for infraclavicular and 

sciatic blocks, for example. Color flow doppler was 

particularly useful in confirming the location and 

orientation of vascular structures. Proximal nerves (eg, 

interscalene, supraclavicular, sciatic, and popliteal) 

were clearly seen as hypoechoic structures surrounded 

by hyperechoic border (classically described as a 

“honeycomb appearance”), consistent with previous 

reports,5

 compared to distal peripheral nerves which 

were smaller hyper-echoic structures such as in the 

axillary region. Using the combined use of nerve 

stimulation, the needle was frequently repositioned 

after an initial injection of 5 ml of local anesthesia 

solution to optimize the spread of local anesthesia 

around neural targets. Incorporating ultrasound in 

advanced regional techniques resulted in a success rate 

of 95%, a 100% patient satisfaction rate, and no 

known complications. 

DISCUSSION

The potential benefits of ultrasound-guided regional 

anesthesia are numerous. Nerve stimulation techniques 

for single injection blocks or placement of CPNB 

catheters can be extremely challenging in Soldiers 

with complex combat-related extremity injuries due to 

pain, amputation, or difficult patient communication 

due to other injuries. The use of ultrasound technology 

in regional anesthesia has unique application in these 

devastating extremity injuries.6

 Higher success rates 

and decreased onset times have been previously 

demonstrated, as the anesthesiologist can optimize 

needle placement during injection to ensure appropriate spread.7-12 Because vascular, neural, as well as 

other structures such as pleura can be well-visualized, 

fewer complications from needle penetration or 

vascular injection should result. In the case of trauma, 

the sole use of ultrasound technique should also 

decrease pain compared to nerve stimulation technique 

causing extremity movement. The risks of the application of ultrasound are minimal; however, indirect 

challenges do exist such as maintaining a sterile field 

with extra equipment, increased cost, and the 

additional time for training required for ultrasound 

guided blocks. Finally, as the portable ultrasound’s 

distinct advantage of higher resolution compared to the 

smaller, hand-held ultrasound devices became apparent, other hospital specialists also began employing 

this highly capable ultrasound machine as a diagnostic 

tool in the emergency department, the intensive care 

unit, as well as in radiology, which expanded its utility 

within the 47th Combat Support Hospital. 

CONCLUSION

Advanced regional anesthesia and aggressive acute 

pain management employing high-resolution ultrasound technology results in high success rates, low 

complication rates, high patient satisfaction, and great 

applicability in extremity trauma patients in a combat 

environment. As military anesthesiologists become 

more facile with ultrasound techniques, they will continue to be on the leading edge of acute pain management for the benefit of the wounded warrior. Medical 

logisticians should strongly consider the availability of 

at least one portable, high-resolution, ultrasound 

machine for each deployed combat support hospital, 

significantly advancing medical care across specialties. 

ACKNOWLEDGEMENT

The GE Voluson i ultrasound system used in the 

procedures described in this article was provided by 

GE Healthcare Systems, Waukesha, Wisconsin. 

REFERENCES

1. Harcke HT, Statler JD, Montilla J. Radiology in a 

hostile environment: experience in Afghanistan. Mil 

Med. 2006;171:194-199. 

2. Rozanski TA, Edmondson JM, Jones SB. Ultrasound 

in a forward-deployed military hospital. Mil Med. 

2005;170:99-102. 

3. La Grange P, Foster PA, Pretorius LK. Doppler ultrasound blood flow detector in supraclavicular brachial 

plexus block. Br J Anaesth. 1978;50:965-967. 

4. Buckenmaier CC, McKnight GM, Winkley JV, et al. 

Continuous peripheral nerve block for battlefield 

anesthesia and evacuation. Reg Anesth Pain Med. 

2005;30:202-205. 

5. Marhofer P, Schrögendorfer K, Koinig H, Kapral S, 

Weinstabl C, Mayer N. Ultrasonographic guidance 

improves sensory block and onset time of 3-in-1 

blocks. Anesth Analg. 1997;85:854-857. 

6. Plunkett AR, Brown DS, Rogers JM, Buckenmaier 

CC III. Supraclavicular continuous peripheral nerve 

block in a wounded soldier: when ultrasound is the 

only option. Br J Anaesth. 2006;97:715-717. 

7. Perlas A, Chan VW, Simons M. Brachial plexus 

examination of localization using ultrasound and 

electrical nerve stimulation: a volunteer study. 

Anesthesiology. 2003;99:429-435. 
66 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

8. Silvestri E, Martinoli C, Derchi LE, Bertolotto M, 

Chiaramondia M, Rosenberg I. Echotexture of 

peripheral nerves: a correlation between ultrasound 

and histologic findings and criteria to differentiate 

tendons. Radiology. 1995;197:291-296. 

9. Chan VW, Perlas A, Rawson R, Odukoya O. 

Ultrasound-guided supraclavicular brachial plexus 

block. Anesth Analg. 2003;97:1514-1517. 

10. Williams SR, Chouinard P, Arcand G, Harris P, Ruel 

M, Boudreault D, Girard F. Ultrasound guidance 

speeds execution and improves the quality of 

supraclavicular block. Anesth Analg. 2003;97:1518-

1523. 

11. Soeding PE, Sha S, Royse CE, Marks P, Hoy G, 

Royse AG. A randomized trial of ultrasound-guided 

brachial plexus anaesthesia in upper limb surgery. 

Anaesth Intensive Care. 2005;33:719–725. 

12. Sites BD, Beach ML, Spence BC, Wiley CW, 

Shiffrin J, Hartman GS, Gallagher JD. Ultrasound 

guidance improves the success rate of a perivascular 

axillary plexus block. Acta Anaesthesiol Scand. 

2006;50:678-684. 

AUTHOR

COL (Ret) Malchow is an Associate Professor of 

Clinical Anesthesiology at the Vanderbilt University 

Medical Center, Nashville, Tennessee. When this article 

was written, he was Staff Anesthesiologist at the 47th 

Combat Support Hospital, Mosul, Iraq. Subsequently, 

COL (Ret) Malchow was Chief, Regional Anesthesia 

and Acute Pain Management, Brooke Army Medical 

Center, Fort Sam Houston, Texas. 

Ultrasonography for Advanced Regional Anesthesia and 

Acute Pain Management in a Combat Environment 

The GE Volusion i ultrasound system in use at the 

47th Combat Support Hospital in Mosul, Iraq. 

The GE Volusion i ultrasound system. 

Image courtesy of GE Healthcare Systems, 

Waukesha, Wisconsin. 
 October – December 2009 67

INTRODUCTION

According to CDR L. Pearse* (conversation, March 5, 

2008), cardiovascular disease is the second leading 

cause of death, after neoplasm, in US Army service 

members aged 40 and older and accounts for 40-50 

deaths per year among Active duty, Reserve, and 

National Guard Soldiers. The prevalence of heart 

disease among Army personnel of all ages is 3%, and 

increases to 9% in the population aged 40 to 65.1

Diagnosed hypertension is present in 2% of all service 

members and in 7% of those aged 40 to 65.1

Diagnosed hyperlipidemia is present in less than 1% of 

service members under aged 40 and in 3% of those 

aged 40 to 65.1

 Obesity (BMI >30) is present in 5% of 

all Army personnel, and increases to nearly 9% among 

personnel aged 40 to 65.1

 Smoking prevalence 

decreases with age among Army personnel and is 27% 

overall, but 17% among personnel aged 40 to 65.1 

In 2004, a worksite-based cardiovascular risk 

assessment was performed on a self-selected sample of 

59 Soldiers aged 40 and older assigned to I Corps, Fort 

Lewis, Washington. In that voluntary program, 46% of 

participants had multiple cardiac risk factors and 18% 

showed a >10% Framingham 10-year cardiac risk.2

METHODS

In the current analysis, the Fort Lewis worksite-based 

program was again offered to I Corps. In addition to 

identifying Soldiers with unmanaged cardiac risk, this 

analysis sought to determine whether or not Soldiers 

identified as having unmanaged cardiac risk factors 

would comply with instructions to follow-up with a 

primary care provider. Participation was voluntary, 

and was offered to all service members aged 40 and 

older. One week prior to the event a mobile 

phlebotomy team drew fasting lipids and glucose onsite at the unit headquarters. At that time, participants 

were asked to consent to be in the study. On the day of 

Cardiovascular Risk Factor Screening and 

 Follow-up in a Military Population Aged 40 

 Years and Older 

COL Diane Flynn, MC USA 

MAJ Jeremy D. Johnson, MC USA 

Cathy J. Bailey, RN 

CPT Jason T. Perry, MC USA 

Charles A. Andersen, MD 

John G. Meyer, MD 

Nancy A. Cox, RN 

ABSTRACT

Objective. This study analyzed a worksite-based cardiovascular risk assessment offered to Soldiers aged 40 and older to 

identify unrecognized cardiovascular risk and evaluate compliance with instructions to follow up for further evaluation. 

Methods. Participants had fasting blood tests, waist circumference and blood pressure measurement and a carotid artery 

duplex scan performed at their worksite. A healthcare professional discussed the participants’ results with them and, if 

indicated, recommended follow up within the following one month. 

Results. Seventy-six (46%) of the 163 eligible Soldiers agreed to participate. Twenty-nine (38%) of the 76 participants 

were instructed to follow up for elevated blood pressure, glucose, or lipids. Only 7 of 29 (24%) complied with follow-up 

instructions. 

Conclusion. Voluntary worksite-based interventions can effectively identify Soldiers with unmanaged cardiovascular risk 

factors, but a more aggressive follow-up strategy should be used to ensure these Soldiers receive indicated medical 

intervention. 

*CDR Pearse was Chief, Mortality Surveillance Division, Armed 

Forces Institute of Pathology, Washington, DC, in March 2008. 
68 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

the outreach event, each participant was 

assessed for the following cardiac risk 

factors: elevated blood pressure, lipids, 

glucose, waist circumference, current 

smoking status and family history of 

premature cardiovascular disease. If 

systolic blood pressure was >130 and/or 

diastolic was >80, it was repeated in the 

opposite arm and the average of the two 

readings was recorded. In addition, each 

participant had an ECG rhythm strip and 

carotid artery duplex scan performed. 

After risk factor assessment was 

completed, a provider or nurse met with 

each participant individually and 

reviewed his or her risk of cardiac 

disease. If historical, physical, or lab 

findings revealed unmanaged cardiac 

risk, the individual was instructed to 

follow-up in his/her primary care clinic 

within the next 30 days. Each participant 

was provided with a written summary of 

his/her risk assessment and instructions for follow-up, 

if indicated. Smokers were also given information on 

resources for smoking cessation. 

Six months after the intervention, medical records of 

all participants were reviewed to determine if 

participants complied with follow-up instructions, as 

well as to compare any post-intervention blood 

pressure and laboratory values with baseline values. 

The student’s paired t test was used to compare 

baseline and follow-up Framingham 

cardiac risk among participants who 

complied with instructions to follow-up. 

RESULTS

Of 163 members aged 40 and older 

assigned to I Corps, and therefore eligible 

for participation, 76 (47%) agreed to 

participate. The age range was 40 to 57 

years with a mean age of 45 years. Men 

comprised 85% of the sample. Also, 53% 

of the sample were enlisted personnel. 

Twenty-eight (37%) participants had an 

average systolic blood pressure >140 and/

or diastolic blood pressure >90 on the day 

of the outreach program (Figure 1). 

Although a diagnosis of hypertension cannot be made 

based on the readings measured in a single day, this 

represents a substantial population at risk for 

uncontrolled hypertension. All but one participant had 

fasting lipids and glucose drawn within one month 

prior to the outreach program. Twelve participants 

(16%) had an low density lipoprotein (LDL) above 

their National Cholesterol Education Program goal.3

Five participants (7%) had a triglyceride >200 mg/dL, 

and five (7%) had a fasting glucose >110. Eight 

Cardiovascular Risk Factor Screening and Follow-up in a Military Population Age 40 years and Older 

Figure 1. Prevalence of cardiac risk factors among participants. 

Key to risk factors: 

1. Elevated blood pressure 

2. Elevated low density lipoproteins 

3. Elevated triglycerides 

4. Elevated fasting blood sugar 

5. Metabolic syndrome 

6. Smokers 

7. Carotid stenosis 

0%

5%

10%

15%

20%

25%

30%

35%

40%

1234567

Percentage of Participants 

Figure 2. Distribution of the Framingham Risk Categories 

among participants. 

0%

10%

20%

30%

40%

50%

60%

70%

0%-5% 6%-10% >10%

Framingham 10 year coronary heart disease risk 

Percentage of Participants 
 October – December 2009 69

THE ARMY MEDICAL DEPARTMENT JOURNAL

participants (11%) were current 

smokers. Questions pertaining to past 

medical history revealed that eleven 

(14%) had a known history of 

hypertension, three (4%) had 

diabetes and one (1%) had a history 

of coronary artery disease. Eleven 

(14%) had a family history of 

premature heart disease. 

Seven participants (9%) met criteria 

for metabolic syndrome and one 

participant (1%) was found to have 

carotid stenosis of 30% to 50% on 

carotid doppler screen. Most participants were found to be at low risk 

of an adverse cardiac event with 68% 

having a Framingham 10-year risk of 

0% to 5 %. However, 25% were 

found to have a Framingham 10-yr 

risk of 6% to 10%, and 7% had a 

Framingham 10-year risk greater 

than 10% (Figure 2). 

Of the 29 participants who were instructed to followup for elevated blood pressure, glucose and/or lipids, 

records review covering the 6 months following the 

worksite-based screening revealed that only seven 

(24%) had a documented follow-up visit for the 

specific reason of addressing cardiovascular risk. The 

seven who followed-up had a total of 10 cardiac risk 

factors. Among them, two with elevated blood 

pressure had normal blood pressure at follow-up and 

one with elevated glucose had normal glucose at 

follow-up. Of the remaining, two were started on 

medication for elevated lipids and two were started on 

medication for hypertension. No significant change in 

Framingham cardiac risk was observed among the 

seven who complied with follow-up instructions 

compared to their baseline (P = 0.46). 

Eight of the 27 participants (30%) who did not comply 

with instructions for follow-up of elevated blood 

pressure were noted to have normal blood pressure at 

subsequent visits for unrelated reasons. Likewise, 2 of 

12 participants who did not comply with instructions 

to follow-up for elevated LDL and 2 of 5 participants 

who did not comply with instructions to follow-up for 

elevated fasting glucose had normal laboratory studies 

at follow-up for unrelated reasons (Figure 3). 

DISCUSSION

The value of screening for cardiovascular risk in 

Soldiers has been evaluated in several recent analyses. 

In a study of more than 15,000 US Army personnel 

undergoing routine annual health risk assessment at 

Fort Lewis, WA, during 2004, the prevalence of blood 

pressure (BP) > 140/90 was 11.1% among Soldiers 

aged 17 to 39 and 27.2% among Soldiers aged 40 and 

older, suggesting that prevalence of hypertension in 

this group may be higher than previously known.4

The Longitudinal Health Risk Assessment Program 

(LHRAP) was a 3-year pilot program of 1,609 active 

duty Army Soldiers over the age of 35 years assigned 

to Fort Meade, Maryland, to identify Soldiers with 

chronic health risks, including hypertension, 

hyperlipidemia, obesity, and smoking at the time of 

periodic physical examination, and to encourage 

follow-up of these conditions.5

 In this voluntary 

program, the prevalence of elevated blood pressure 

and smoking was similar to the overall Army 

population aged 40 and older, with BP>140/90 found 

in 9% of male participants and 4% of female 

participants, and smoking found in 17% of all 

participants. However, the prevalence of elevated 

cholesterol and overweight or obesity was higher than 

the population of all Army personnel aged 40 and 

older, with total cholesterol > 200 observed in 50% of 

0%

5%

10%

15%

20%

25%

30%

35%

Elev BP Elev LDL Elev glucose Elev TGs

Elevated BPa Elevated LDLb Elevated

Glucose

Elevated TGsc

Percentage of Participants 

Figure 3. Percentage of Participants with selected Risk Factors who 

complied with instructions to follow-up within six months or who had 

assessment of cardiac risk at visits for unrelated reasons. 

a. Blood pressure 

b. Low density lipoproteins 

c. Triglycerides 

No Follow‐up

Normal Value at visit for unrelated reason

Followed‐up as  instructed
70 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

male participants and 42% of female participants, and 

body mass index (BMI) > 30 found in 85% of male 

participants and 58% of female participants. Based on 

each participant’s risk category, a case manager 

contacted participants and recommended appropriate 

follow-up consults and referrals. Approximately half 

of the participants with a >20% Framingham 10-year 

cardiac risk followed-up with the case manager. 

Approximately one-third of those with a 10% to 20% 

Framingham risk followed-up. Among those who 

followed-up, one-third had improvement in their 

cardiovascular risk category (M. Bell and M. Birk, 

unpublished report,* July 5, 2007). 

Worksite-based health promotion has been shown to 

enhance productivity of American workers by 

decreasing medical costs and absenteeism.6

 Several 

critical reviews of the literature support the clinical 

effectiveness and cost-effectiveness of health 

promotion interventions at the worksite, with each 

dollar invested yielding between $3 and $6 of return 

on investment.7

 Individual counseling and follow-up 

were among the most important components of 

successful programs.8

 A follow-up physician visit, 

however, has not been shown to add substantially to 

the value of worksite cholesterol screening in changing 

diet, BMI, exercise levels, or smoking status.9

In this self-selected sample of active duty Soldiers 

aged 40 and older, about one-half of those who were 

offered cardiovascular risk assessment at the jobsite 

agreed to participate. About one-quarter of participants 

were found to have unmanaged cardiac risk factors 

that were substantiated on subsequent measurement. 

The prevalence of cardiovascular risk factors was 

higher in participants than the overall population of 

Soldiers aged 40 and older. This increased prevalence 

may be due to adverse self-selection, which has been 

observed in other voluntary worksite health promotion 

programs, and suggests that relatively unhealthy individuals tend to be more likely to participate in voluntary wellness programs than healthier coworkers.10

Despite individual counseling of this at-risk group, 

only about one-quarter of participants with unmanaged 

cardiac risk complied with advice to follow-up. 

SUMMARY

Voluntary worksite-based interventions appear to be 

an effective in identifying Soldiers with unmanaged 

cardiovascular risk. However, individual risk identification and counseling alone do not appear to be 

effective in motivating most Soldiers to seek follow-up 

care to modify their risk. The integration of Framingham risk calculation into the recently implemented 

annual Periodic Health Assessment of Soldiers aged 

40 and older presents a valuable opportunity to identify unmanaged cardiac risk. This study suggests that 

once cardiovascular risk factors are identified, followup recommendations should be carefully monitored, 

perhaps involving telephone, mail, or email contact, to 

ensure that Soldiers found to have unmanaged cardiac 

risk factors receive indicated interventions. 

REFERENCES

1. McDonald M, Hertz RP. The Health Status of the 

United States Army: Findings from the Total Army 

Injury and Health Outcomes Database. Pfizer Facts. 

Pfizer, Inc; 2003. Available at: http://

www.usariem.army.mil/download/usarmystatus.pdf. 

2. Bingham M. Presentation to the 18th Annual Pacific 

Nursing Research Conference. Honolulu, Hawaii; 

March 2005. 

3. Third Report of the National Cholesterol Education 

Program (NCEP) Expert Panel on Detection, 

Evaluation, and Treatment of High Blood Cholesterol 

in Adults (Adult Treatment Panel III) final report. 

Circulation. 2002;106(25):3143-3421. 

4. Smoley B. Presentation to the Uniformed Services 

Academy of Family Physicians Annual Meeting. 

Hilton Head, North Carolina; March 11-16, 2007. 

5. Bell M, Birk M, Allen J, Jones C. Longitudinal 

Health Risk Assessment Program. Army Med Dept J. 

January-March 2004:15-20. 

6. Chapman LS. Meta-evaluation of worksite health 

promotion economic return studies: 2005 update. Am 

J Health Promot. 2005;19(6):1-11. 

7. Matson Koffman DM, Goetzel RZ, Anwuri VV, 

Shore KK, Orenstein D, LaPier T. Heart healthy and 

stroke free: successful business strategies to prevent 

cardiovascular disease. Am J Prev Med. 2005;29(5 

Suppl 1):113-121. 

8. Pelletier KR. A review and analysis of the clinicaland cost-effectiveness studies of comprehensive 

health promotion and disease management programs 

at the worksite: 1998-2000 update. Am J Health 

Promot. 2001;16(2):107-116. 

Cardiovascular Risk Factor Screening and Follow-up in a Military Population Age 40 years and Older 

*Final written project report, US Army Center for Health 

Promotion and Preventive Medicine Health Promotion 

and Prevention Initiatives Program, July 5, 2007. 
 October – December 2009 71

THE ARMY MEDICAL DEPARTMENT JOURNAL

9. Wang JS, Carson EC, Lapane KL, Eaton CB, Gans 

KM, Lasater TM. The effect of physician office visits 

on CHD risk factor modification as part of a worksite 

cholesterol screening program. Prev Med. 1999;28

(3):221-228. 

10. Haynes G, Dunnagan T, Smith V. Do employees 

participating in voluntary health promotion programs 

incur lower health care costs? Health Promot Int. 

1999;14(1):43-51. 

AUTHORS

COL Flynn is Chief, Dept of Family Medicine, 

Madigan Army Medical Center, Tacoma, Washington. 

MAJ Johnson is the Associate Program Director of the 

Family Medicine Residency, Tripler Army Medical 

Center, Honolulu, Hawaii. 

Ms Bailey, a Certified Chronic Care Professional, is a 

Nurse Case Manager in the Health Outcomes 

Management Division, Madigan Army Medical Center, 

Tacoma, Washington. 

CPT Perry is a Resident in the Dept of Surgery, 

Madigan Army Medical Center, Tacoma, Washington. 

Dr Andersen is Chief of Vascular Surgery, Dept of 

Surgery, Madigan Army Medical Center, Tacoma, 

Washington. 

Dr Meyer is the Director, Health Outcomes 

Management Division, Madigan Army Medical Center, 

Tacoma, Washington. 

Ms Cox is the A Company Nurse Case Manager, 

Warrior Transition Battalion, Madigan Army Medical 

Center, Tacoma, Washington. 
72 http://www.cs.amedd.army.mil/dasqaDocuments.aspx?type=1

THE US ARMY MEDICAL DEPARTMENT

REGIMENT

The US Army Medical Department was formed on July 27, 1775, when the Continental Congress 

authorized a Medical Service for an army of 20,000 men. It created the Hospital Department and named 

Dr Benjamin Church of Boston as Director General and Chief Physician. On April 14, 1818, the Congress 

passed an Act which reorganized the staff departments of the Army. The Act provided for a Medical 

Department to be headed by a Surgeon General. Dr Joseph Lovell, appointed Surgeon General of the 

United States Army in April 1818, was the first to hold this position in the new organization. The passage 

of this law marks the beginning of the modern Medical Department of the United States Army. 

Throughout its early history, the size and mission of the US Army Medical Department would wax and 

wane in response to military events around the world. There was, however, no formal regimental 

organization until World War I. Then, in the late 1950s, the brigade replaced the regiment as a tactical unit. 

In the reorganization that followed, some Army units lost their identity, their lineage, their history. This 

loss did not go unnoticed. The US Army Regimental System was created in 1981 to provide soldiers with 

continuous identification with a single regiment. Department of the Army Regulation 600-82, The US 

Army Regimental System, states the mission of the regiment is to enhance combat effectiveness through a 

framework that provides the opportunity for affiliation, develops loyalty and commitment, fosters a sense 

of belonging, improves unit esprit, and institutionalizes the war-fighting ethos. 

The US Army Medical Department Regiment was activated on July 28, 1986, during ceremonies at Fort 

Sam Houston in San Antonio, Texas, the “Home of Army Medicine.” Lieutenant General Quinn H. 

Becker, the US Army Surgeon General and AMEDD Regimental Commander, was the reviewing officer. 

He was joined by general officers of the US Army Reserves and the Army National Guard, representing 

the significant contributions and manpower of the reserve forces in the Total Army concept. 

The Regimental web site (http://ameddregiment.amedd.army.mil/default.asp) is designed to provide you 

with useful information about the US Army Medical Department (AMEDD) Regiment. Through the web 

site, you can learn the history of the AMEDD Regiment, the symbolism behind our heraldic items, how to 

wear the Regimental Distinctive insignia, and various programs available to you and your unit. 

The Office of the AMEDD Regiment is located in Aabel Hall, Building 2840, on Fort Sam Houston, 

Texas. The Regimental staff can provide further information pertaining to the history of the Army Medical 

Department and the AMEDD Regiment, and assist with any of the services described in the web page. 

For additional information please contact the Army Medical Department Regimental Office at the 

following address: 

Commander 

US Army Medical Department Regiment 

ATTN: MCCS-GAR 

2250 Stanley Road 

Fort Sam Houston, Texas 78234-6100 

The telephone number is (210) 221-8455 or DSN 471-8455, fax 8697. 

Internet: http://ameddregiment.amedd.army.mil/ 

Email: amedd.regiment@amedd.army.mil 
SUBMISSION OF MANUSCRIPTS TO THE ARMY MEDICAL DEPARTMENT JOURNAL

The United States Army Medical Department Journal is published quarterly to expand knowledge of domestic and international

military medical issues and technological advances; promote collaborative partnerships among the Services, components, Corps,

and specialties; convey clinical and health service support information; and provide a professional, high quality, peer reviewed

print medium to encourage dialogue concerning health care issues and initiatives.

REVIEW POLICY

All manuscripts will be reviewed by the AMEDD Journal’s Editorial Review Board and, if required, forwarded to the appropriate

subject matter expert for further review and assessment.

IDENTIFICATION OF POTENTIAL CONFLICTS OF INTEREST

1. Related to individual authors’ commitments: Each author is responsible for the full disclosure of all financial and personal

relationships that might bias the work or information presented in the manuscript. To prevent ambiguity, authors must state

explicitly whether potential conflicts do or do not exist. Authors should do so in the manuscript on a conflict-of-interest

notification section on the title page, providing additional detail, if necessary, in a cover letter that accompanies the

manuscript.

2. Assistance: Authors should identify Individuals who provide writing or other assistance and disclose the funding source for this

assistance, if any.

3. Investigators: Potential conflicts must be disclosed to study participants. Authors must clearly state whether they have done

so in the manuscript.

4. Related to project support: Authors should describe the role of the study sponsor, if any, in study design; collection, analysis,

and interpretation of data; writing the report; and the decision to submit the report for publication. If the supporting source

had no such involvement, the authors should so state.

PROTECTION OF HUMAN SUBJECTS AND ANIMALS IN RESEARCH

When reporting experiments on human subjects, authors must indicate whether the procedures followed were in accordance with

the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki

Declaration of 1975, as revised in 2000. If doubt exists whether the research was conducted in accordance with the Helsinki

Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body

explicitly approved the doubtful aspects of the study. When reporting experiments on animals, authors should indicate whether the

institutional and national guide for the care and use of laboratory animals was followed.

GUIDELINES FOR MANUSCRIPT SUBMISSIONS

1. Articles should be submitted in digital format, preferably an MS Word document, either as an email attachment (with

illustrations, etc), or by mail on CD or floppy disk accompanied by one printed copy of the manuscript. Ideally, a manuscript

should be no longer than 24 double-spaced pages. However, exceptions will always be considered on a case-by-case basis. In

general, 4 double-spaced MS Word pages produce a single page of 2 column text in the AMEDD Journal production format.

2. The American Medical Association Manual of Style governs formatting in the preparation of text and references. All articles

should conform to those guidelines as closely as possible. Abbreviations/acronyms should be limited as much as possible.

Inclusion of a list of article acronyms and abbreviations can be very helpful in the review process and is strongly encouraged.

3. A complete list of references cited in the article must be provided with the manuscript. The following is a synopsis of the

American Medical Association reference format:

 Reference citations of published articles must include the authors’ surnames and initials, article title, publication title,

year of publication, volume, and page numbers.

 Reference citations of books must include the authors’ surnames and initials, book title, volume and/or edition if

appropriate, place of publication, publisher, year of copyright, and specific page numbers if cited.

 Reference citations for presentations, unpublished papers, conferences, symposia, etc, must include as much identifying

information as possible (location, dates, presenters, sponsors, titles).

4. Either color or black and white photographs may be submitted with the manuscript. Color produces the best print reproduction

quality, but please avoid excessive use of multiple colors and shading. Digital graphic formats (JPG, GIF, BMP) and MS Word

photo files are preferred. Prints of photographs are acceptable. Please do not send photos embedded in PowerPoint. Images

submitted on slides, negatives, or copies of X-ray film will not be published. For clarity, please mark the top of each

photographic print on the back. Tape captions to the back of photos or submit them on a separate sheet. Ensure captions and

photos are indexed to each other. Clearly indicate the desired position of each photo within the manuscript.

5. The authors’ names, ranks or academic/certification credentials, titles or positions, current unit of assignment, and contact

information must be included on the title page of the manuscript.

6. Submit manuscripts to:

EDITOR, AMEDD JOURNAL

ATTN MCCS DT

2419 HOOD ST STE C

FORT SAM HOUSTON, TX 78234-7584

DSN 471-6301

Comm 210-221-6301

Email: amedd.journal@amedd.army.mil