July – September 2013 

Perspective 1

COL Randall G. Anderson; COL Mustapha Debboun; Richard Burton

The US Army Medical Corps Leadership 4

Development Program 

The US Army Leadership Development Program Working Group 

Know Yourself, In Order to Lead Others 30

MG David A. Rubenstein, US Army Retired 

Trust: the DNA of Leadership 33

COL Eric Sones 

Inculcating Core Values Through Application 36 

of the Patient CaringTouch System 

COL Daniel W. McKay 

Characteristics of Most-Admired 41

Army Medical Department Leaders 

Jody R. Rogers, PhD; A. David Mangelsdorff, PhD 

Qualities of the Ideal Mentor 47

COL Mark A. Melanson 

Leader Development Within the Army Medical Department 52

Jody R. Rogers, PhD; Emil F. Meis, MBA; Jeffrey D. Haun, MS 

Leading in the Joint Medical Environment 56

COL William P. LaChance 

Moving from a Medical Anachronism: A New Approach 60

to Military Medical Treatment Facility Organization in 

the National Capital Area 

COL Charles W. Callahan 

Army Medical Department Leaders and the Law 65

MAJ Joseph B. Topinka; et al

Leadership in the Army Medical Department 
July – September 2013 The Army Medical Department Center & School PB 8-13-7/8/9 

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RAYMOND T. ODIERNO 

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LTG Patricia D. Horoho 

The Surgeon General 

Commander, US Army Medical Command 

COL Randall G. Anderson 

Acting Commander 

US Army Medical Department Center & School 
July – September 2013	 1

Perspectives

Acting Commander’s Introduction

COL Randall G. Anderson

Is leadership an innate talent? Is it an instinctive capability? Is it a learned skill? Is it an amalgam of all of those? 

Indeed, throughout the history of structured human societies, the question “are leaders born or made” has been 

discussed and debated. Leadership remains perhaps one 

of the most extensively pondered and analyzed aspects 

of the human condition, as both scholars and the simply 

curious attempt to define, dissect, and quantify it.

The intensity and persistence of interest in the essence 

of leadership is not simply the product of academic curiosity. The absolute necessity of effective leadership in 

the success and survival of societies and even civilizations has been recognized and understood for several 

millennia. History is replete with civilizations that rose 

and prospered under a series of successful leaders, only 

to wither and die as ineffectiveness and incompetence 

became the norm. Not surprisingly, such cycles are still 

obvious in nations of today’s world. No organizational 

enterprise, be it societal, political, commercial, or especially military, can afford to wait for capable leadership 

to simply appear and lead it to success. Therefore, entities with clear historical perspective and understanding will commit significant effort and resources to the 

identification, development, and nurturing of skills and 

characteristics attributed to successful leadership.

To that end, leadership training has long been a fact of 

life for members of the US military services. Since most 

Soldiers find themselves in positions of responsibility 

for others early in their military experience, their formal training requirements always contain elements of 

leadership, which increase in sophistication in keeping 

with their broadening responsibilities over time. This is 

an important component in the mission of the AMEDD 

Center and School (AMEDDC&S), which is responsible 

for the creation and delivery of leadership training to 

Army medical professionals at various stages in their 

military careers. This issue of the AMEDD Journal is 

the result of efforts of the AMEDDC&S Leader Training Center to present the most current initiatives, internal research, and thinking in optimizing the effectiveness of leadership training within AMEDD. Although 

the Leader Training Center is chartered to develop and 

deliver leadership training to Army medical officers, 

the concepts, techniques, and tools discussed in this issue have universal applicability to professional military 

medical leadership development at all levels. Further, 

such training has even broader implications. It is widely 

acknowledged that successful leadership skills developed in the military carry over far beyond the military 

experience, reflected in countless success stories and 

major achievements by former military medical professionals in advancing medical science.

The US military is experiencing yet another tumultuous 

period in meeting its current evolving missions, attempting to project and define the future threats and requirements to meet them, and determining how to address 

the transition from one to another. It is absolutely vital 

that the Army Medical Department meets those same 

challenges in real time with the rest of the defense establishment of the United States. Indeed, there are societal, 

political, and financial obstacles to progress, but such 

has always been the case. Strong, effective leadership at 

all levels across the AMEDD is as important now as it 

has ever been. Current and future AMEDD leaders will 

ensure the rich, historical legacy of service, support, and 

extraordinary medical achievements of Army medicine 

will continue unabated..

Editor’s Perspective

In today’s world of seemingly continuous action and reaction in which everything apparently is required yesterday, there never seems to be enough time to examine 

and evaluate existing institutional structure and processes. After all, everything has been working for years—at 

least on the surface. Fortunately, within AMEDD an internal examination of “business as usual” is an integral 

element of each Corps transformation planning process, 

and leadership development is an essential area of interest. As a result of the Army Nurse Corps top-to-bottom 

mission analysis in 2008-2009, structural changes were 

implemented and significant leadership development resources were committed to ensure that effective leaders 

were always in place at all levels of Army nursing. In 

2011, the Chief of the Army Medical Corps directed the 

creation of a working group to specifically address leadership development for all Army physicians throughout their careers. The result of the collaboration of 40 
2	 http://www.cs.amedd.army.mil/amedd_journal.aspx

Medical Corps officers is a candid examination of the 

status quo, and a carefully constructed, detailed proposal to ensure that every Army physician receives appropriate leadership development training and support 

throughout his or her career. The complete report and 

plan, entitled All Physicians Lead, will soon be available 

from the Medical Corps. The AMEDD Journal is happy 

to present an advance look at this important work, with 

a collection of extracts from throughout the document.

The AMEDD Journal welcomes former AMEDDC&S 

commander MG (Ret) David Rubenstein back to these 

pages with his thoughts concerning a baseline for any 

individual faced with leadership responsibilities. His insightful article points out that a clear understanding of 

ourselves as leaders will simplify our task in facing the 

challenges of successfully leading others. It may sound 

simple in concept, but the reality of practice is something else entirely.

In the military, trust is elemental and essential for survival and success. Whether it is the deadly chaos of a firefight, the desperate activity of the trauma team around 

a critically wounded Soldier, or the directions of a unit 

commander to his staff, everyone must be confident that 

the others “have my back.” This is especially true for 

leaders. As COL Eric Sones succinctly and clearly outlines in his article, a leader must first earn and hold the 

trust of those in his or her organization, otherwise they 

will quickly look elsewhere for guidance and inspiration. The absence of direction will eventually become 

obvious, ultimately reflected in mediocrity or failure in 

accomplishing the mission. In a medical unit, such deterioration can have serious ramifications for those whose 

lives may depend on the professionalism and capability 

of the organization.

As mentioned earlier, since 2009 the Army Nurse Corps 

has implemented proactive measures to ensure that 

leadership skills among Army nurses develop as their 

careers progress. In his article, COL Daniel McKay 

describes how the Nurse Corps approach to leadership 

development incorporates a values-based foundation for 

decisions made in both patient care situations and those 

choices required in leadership roles. The important aspect of this approach is the emphasis on understanding 

that the ability to recall a list of words (organizational 

values) is worthless unless those values become part of 

an individual’s personal values. Only then will a leader 

truly base his or her approach to both work and leadership on the set of standards expected of all within the 

organization. As with trust, hypocrisy on the part of a 

leader with respect to personal values is usually obvious, and the organization invariably suffers as a result.

Researchers have long sought to identify and define the 

essence of effective leadership. The most logical approach to obtaining such information is to ask those who 

respect and admire a leader to quantify why they have 

that opinion. As data collection and statistical analysis have become increasingly more sophisticated over 

the last half century, lists of statistically relevant key 

characteristics and attributes found in successful leaders across a spectrum of organizations have been compiled. Dr Jody Rogers and Dr David Mangelsdorff of the 

AMEDDC&S Leader Training Center have contributed 

an article describing a 3-year effort to identify leadership characteristics observed in respected AMEDD 

leaders, and compare the results with those obtained 

from nonmilitary survey populations. Such data allows 

those responsible for the design and implementation of 

leadership training to address those aspects identified 

specifically as contributing to success and effectiveness. 

This article is an excellent example of the dedication, 

expertise, and professionalism of those charged with 

forming AMEDD’s leaders of tomorrow.

Mentoring may be the longest-practiced approach to 

leadership development. It has probably existed in some 

form or another since human family groups evolved into 

tribes, and eventually into societies where it has become 

a recognized, formalized process. Its effectiveness is beyond dispute, else it would have long faded into history. 

The concept is deceptively simple, but there is much 

more to it than one might think. COL Mark Melanson 

has been a dedicated advocate and practitioner of professional mentoring throughout his military career, and 

has published many articles and papers on the subject, 

a number of which have appeared in the AMEDD Journal. He has contributed an article to this issue in which 

he calls on his many years of experience and extensive 

knowledge of the professional literature to derive 10 

essential qualities of the ideal mentor. Although these 

qualities are undoubtedly applicable to mentors across 

the board, COL Melanson has tailored his article to 

specifically address mentoring within AMEDD, within 

which he has contributed to the development of a number of successful leaders over his 30-year career.

As discussed earlier, the Leader Training Center of the 

AMEDDC&S has the responsibility to develop and deliver leadership training to Army medical officers. To 

that end, the Center is always abreast of the latest research, thinking, and tools available in professional leadership development. Dr Jody Rogers and his coauthors 

have contributed an article describing the use of one such 

widely-used program, The Leadership Challenge, by the 

Leader Training Center to develop and enhance the leadership skills of AMEDD officers. This interesting article 

Perspectives
July – September 2013	 3

The Army Medical Department Journal

details the philosophy and approach of the various elements of the program, and explains how it is implemented within the environment of military medicine.

One of the important changes in the ongoing transformation in the Department of Defense is the consolidation of certain elements of military healthcare into 

multiservice, aka joint, operations. The reality of this 

approach can be seen at Fort Sam Houston, where virtually all triservice medical training is now conducted 

at the Medical Education and Training Campus. COL 

William LaChance addresses the effect and differences that military medical professionals must consider 

in exercising leadership in this changing environment. 

In his article, he recognizes the potential institutional 

and philosophical impediments to personally accepting 

and embracing this new situation, especially among the 

more experienced military medical professionals. This 

is a superb, thought-provoking treatment of the new reality that should be a must-read for all military medical 

professionals, because the “culture shock” is definitely 

not limited to the Army.

COL Charles Callahan continues the discussion of the 

joint military medical environment with his article detailing the successful transition in what was perhaps 

“ground zero” of the consolidation of military medical 

care. Prior to 2010, each of the 3 military services had a 

major medical treatment facility in the national capital 

area, as well as an Army hospital at Fort Belvoir. Among 

other things, the Base Realignment and Closure Act of 

1995 directed the consolidation of military healthcare 

in the nation’s capital, which initiated a 5-year effort by 

a joint task force to create and implement a new organizational model for joint operation of a regional military healthcare structure. The 3 major medical centers 

were merged in Bethesda, Maryland, and the Fort Belvoir hospital was replaced by a larger facility by the 

end of 2012. COL Callahan’s article clearly describes 

the differences in organization and staff structure philosophy among the services that had to be understood 

and addressed. This is a very informative article which 

provides excellent insight into an extremely complex 

process that resulted in successful, cooperative joint operation of military healthcare delivery on a wide scale.

An important caveat to any investigation into successful 

leadership is the environment in which it was experienced. The reigns of many legendary successful leaders 

throughout history were absolute, their decrees and orders established law, no matter how brutal or seemingly 

incoherent. Ultimately, their successes were eventually 

followed by decline and anarchy. Over the centuries, a 

number of human societies (not many by any measure) 

have struggled to establish the rule of law rather than the 

decree of man. Such structured societies must continue 

to produce leaders to guide and nurture them to prosperity and success, but always remain on guard against 

sliding back into the darkness of rule by decree. The 

United States is the current world history success story 

in living within the rule of law. All leaders in our nation 

must conform to a structure defined by law, and the US 

military is no different. MAJ Joseph Topinka returns to 

the AMEDD Journal with a team of professional military legal professionals to contribute a compendium of 

legal considerations that must be understood as a baseline by all US military leaders. A US military leader, 

including those in the AMEDD, will face many decisions throughout his or her career, and the knowledge 

of the boundaries and options imposed by law will be 

extremely important in formulating the choices. In the 

US Army, the Army Ethic is foremost in the foundation 

of leadership, and that ethic is immutably locked into the 

laws of our nation. The article by MAJ Topinka et al is 

a consolidation of the legal topics taught as part of the 

Leader Training Center’s courses. It touches many areas, some immediately relevant to most AMEDD leaders, some that will come into play in special situations. 

In the tumult of today’s world, a military professional 

never knows when he or she will become involved in 

such a circumstance or situation. This article is a valuable resource for both new AMEDD leaders and those 

with many years of experience who may benefit from a 

review of the legal basics of military leadership.
4	 http://www.cs.amedd.army.mil/amedd_journal.aspx

This work is about culture change. At its foundation is a 

program of leadership development that is broader and 

more powerful than we in the Army Medical Corps currently consider. It is a program that has great relevance 

to every Army physician, not just those aspiring to senior clinical or executive leadership positions within 

Army Medicine.

Physicians implicitly must do 2 things: teach and lead. 

One form of the Latin root word of doctor, docere, means 

“to teach.” For a modern doctor, passing knowledge 

to patients and trainees is a mandate. Leading is also 

a critical professional skill. Leading healthcare teams, 

leading patients, and leading trainees are all required. 

Leadership has been defined as the art of convincing 

someone to do something they do not want to do. Often 

this is the very essence of the physician-patient relationship—stop smoking; lose weight; take your medications.

We have noted throughout our careers that there is almost 

no formal education regarding teaching or leading. We 

have created a leadership development program to address the latter deficiency. With implementation, we will 

change the current paradigm of “accidental leadership 

training” into a structured program that is inclusive for 

all Army physicians in order to improve patient care delivery, improve the functioning of our healthcare teams, 

and enlarge and strengthen our candidate pool for senior 

leader positions in the Army Medical Department.

That is our task.

Currently, too few Medical Corps officers are interested 

in pursuing leadership positions outside of the clinical 

setting. Additionally, Medical Corps officers who attain 

clinical or command leadership positions are often unfamiliar with the principles of leadership practice and 

theory. The extent to which they may be prepared is usually the result of random events, focal mentorship experiences, and/or great personal effort and study rather 

than any leadership development program.

The standard approach to leader succession addresses 

only the challenges faced by those at or near the top of 

the leader pyramid and ignores the majority of those at 

the base. By failing to provide leadership education and 

experience from the beginning of every Medical Corps 

officer’s career, we significantly decrease the available pool from which to select senior level leaders, and 

worse, we fail to prepare every physician to optimally 

care for patients in today’s team-oriented, patient-centered environment.

Structural impediments to the acquisition of leadership 

training can be overcome with a well-designed, carefully implemented educational program. Unfortunately, 

the cultural challenge we face is significantly greater, 

and is based on a strong perception on the part of physicians that leadership applies only to those Army Medical Corps officers who are striving to become department chairs, commanders, or general officers.

In the summer of 2011, the Chief of the Army Medical 

Corps approved the creation of a working group to establish a leadership development program for all Army 

physicians. The initial problem statement focused on 

leader succession planning in the Army Medical Corps. 

The product of the working group’s efforts is the US 

Army Medical Corps Leadership Development Program, 

presented in All Physicians Lead, which will soon be 

available from the Army Medical Corps. This article is 

a condensed presentation of the information contained 

in that publication, providing an introduction to the program and an overview of our approach to institutionalizing structured leader development as an integral part 

of a military physician’s career from its beginning. Each 

of the following sections is derived from a chapter of the 

same name in All Physicians Lead. Each section ends 

with related observations and insights from experienced, 

current leaders within the Army Medical Corps.

The fundamental premise of the Army Medical Corps 

Leadership Development Program is that the most basic 

Introduction

COL Leon E. Moores, MC, USA

The US Army Medical Corps

 Leadership Development Program

The US Army Medical Corps Leadership

Development Program Working Group
July – September 2013	 5

definition of leadership, the ability of one individual 

to influence the behavior of other individuals, applies 

broadly to every physician in every aspect of professional life. A program requiring every physician to study the 

theory and practice of leadership will have far-reaching 

positive effects on the ability of those physicians to lead 

healthcare teams, to care for patients and their families 

in the daily practice of medicine, to teach the next generation of medical students and residents, and to influence 

population health through scientific research. Broadly 

applied across the entire Army Medical Department 

(AMEDD), this initiative could have a greater impact on 

the improvement of patient care over the next decades 

than any program in recent history.

Although the program was sponsored and developed 

by the Army Medical Corps, we are hopeful that other 

Corps within the AMEDD and our sister military services will find it appropriate to take advantage of this 

program and future products as they become available. 

Additionally, we hope that other federal and civilian institutions involved in training medical professionals at 

all levels will find this program helpful in their efforts 

to create medical leadership programs for their students 

and faculty.

Leadership in the broadest sense of influencing others in 

order to achieve desired outcomes is a core competency 

for all physicians. Ironically, the majority of physicians 

in this country receive minimal education in the theory 

and practice of leadership. We can and will do better, 

and we see the Army Medical Corps Leadership Development Program as a first step in that direction.

Every Physician Leads:

Rationale, Structure, and Proponency

COL Leon E. Moores, MC, USA

Every system is perfectly designed to get the results 

it gets. Paul Batalden1

While he was CEO of General Electric, Jack Welch 

spent 50% of his time developing people with special 

emphasis on developing future leaders.2

 How committed to leader development are we?

A working group was established in October 2011 to 

evaluate the current state of Army Medical Corps leadership development and build a comprehensive program. 

It quickly became clear that 2 fundamental premises 

would frame the working group’s effort:

3⁄4 Leadership is a core competency for all physicians. 

3⁄4 We can do better at leadership development within 

the Army Medical Corps.

Core Competency

Leading is a critical professional skill for all physicians, 

but it is almost unrecognized as such. Whether you are 

in single practice or a department chair at a major academic medical center, you are required to lead a healthcare team and your patients. Leadership is often defined 

as the art of convincing someone to want to do something they initially do not wish to do. Although every 

physician must do this almost every day, “leadership” 

literature as it applies to physicians uniformly addresses 

senior executive positions and ignores the requirement 

for leadership knowledge, skills, and attitudes at lower 

levels, including the medical student and resident levels.

Because of the misperception that only senior physicians 

aspiring to run hospital systems need leadership training, there is little to no foundational education in the 

theory and practice of leading. Physicians are typically 

left to learn this critical skill using the age-old apprenticeship model, “see one, do one, teach one.” Good and 

bad examples of leadership are placed before the student or resident and the trainee is required to choose and 

develop a style based upon individual (and untrained) 

assessment of what seems effective. Physicians at all 

levels could lead much more effectively if fundamental 

aspects of leadership were taught beginning at the medical student level and continued throughout the medical 

career. This work outlines a program for full-spectrum, 

total career leadership development.

The Accreditation Council for Graduate Medical Education has taken some steps in the direction of leader 

development. A specific core competency addresses 

professionalism, and many medical schools are now engaged in teaching professionalism. However, professionalism can exist in a vacuum and can ignore the dynamic 

interaction between the individual who is attempting to 

be “professional” and others in the vicinity influenced 

by that behavior. That complex interaction is better encapsulated under the rubric of leadership. You can practice professionalism in a room all by yourself, but you 

cannot lead without engaging others.

Another important leadership requirement exists beyond 

the complex leader-to-led dynamic. Physicians do not 
6	 http://www.cs.amedd.army.mil/amedd_journal.aspx

lead in a vacuum. They lead within complex medical 

systems with internal business and administrative components, as well as external forces that shape the behavior and direction of the enterprise. Leadership is less effective if the leader does not possess an awareness of all 

of these levels. The depth and breadth of this awareness 

must increase as the leader takes on more senior leadership roles. An effective leadership program must build 

knowledge and experience in both the “hard” or technical skills of financial management, labor-management 

relations, and organizational structure; and the “soft” 

skills, such as interpersonal communication, conflict 

resolution, and decision making. 

Finally, it is important for all Army physicians to acknowledge that leadership performance and potential 

are essential parts of the military evaluation system and 

the merit-based promotion system. We do a disservice 

to our younger physician colleagues if we do not give 

them the tools to excel within the organizational and operational parameters of the Army in which we all serve.

We Can Do Better

Army officers are required to attend schools and courses 

that address professionalism and leader development 

throughout their careers. It is often difficult for Army 

physicians to access many of these excellent programs 

because of time constraints and the numerous external 

accreditation requirements of medical school, residency, 

fellowship, and board certification. A key to the successful execution of these programs would be the development of curricula and content delivery methods which 

take into consideration trainee work hour restrictions 

and the requirements of medical training. At the same 

time, the programs must provide high-quality leadership 

development lessons and practical tools that trainees see 

as useful in their current education and future practice.

Leadership training in the traditional military is heavily 

focused on field duty or command. While these areas 

do indeed represent an important subset of requirements 

for Army physicians at some points in their careers, it 

does not fully encompass all of the physician’s multifaceted leadership requirements. For example, better 

understanding of how a brigade combat team operates 

in a deployed environment will certainly help a brigade 

surgeon communicate with the commander and staff. 

However that understanding may not prove beneficial to 

a pediatric neurosurgeon attempting to manage a challenging patient-parent-physician relationship. Basic and 

advanced leadership skills (as opposed to position-specific leader skills) apply broadly to all facets of physician interactions. These skills should be taught to every 

physician at an early level as a foundation upon which to 

build advanced or position-specific leader skills during 

later years. The ability to lead depends on both learning the craft of leadership and gaining the experience of 

serving in positions as the leader.

The Leadership Development Program working group 

could merely have created a classic succession-planning 

program. Such a program would be designed to develop 

interest at an early stage of a medical officer’s career, 

identify promising young officers, provide structured 

experience and education, and offer ongoing mentorship. 

Such a program’s objective would be to create consistently high quality, well prepared colonels to become commanders and general officers from the Army Medical 

Corps. Developing a robust leader succession program is 

a critically important endeavor outlined later in the section Building the Bench (page 21). However, in order to 

enhance patient care and healthcare team effectiveness, 

we have substantially expanded the approach to include 

leadership development for all physicians at all career 

stages by providing foundational and ongoing training 

in the theory and practice of leadership. The enormous 

secondary benefit of this broad-based education is that 

it creates a much more robust pool of talent from which 

to select midlevel and senior-level clinical and executive 

leadership positions (service chief, department chief, 

program director, deputy commander for clinical services, commander, command surgeon, etc).

Ultimately, this program should become “the way we 

do business.”

There are both organizational and cultural impediments to physician leadership development in Army 

medicine. Not surprisingly, many are not significantly 

different from impediments encountered in the civilian sector. Extraordinary time commitments during 

medical school, residency, and fellowship; work hour 

restrictions limiting curricular additions; and funding 

constraints within training programs make it very difficult to add focused leadership education and training. 

Additional years following medical school and residency 

training required to achieve board certification, build a 

practice, and develop skills in one’s specialty mean that 

many physicians are senior majors or lieutenant colonels 

before they are fully clinically competent. Understandably, preparation to lead a department or hospital is not 

a consideration for physicians before this career point. 

If we expand the definition of leadership to include 

the entire range of clinical interactions (interactions of 

medical students with technicians in the emergency department, residents with the operating room team, and 

The US Army Medical corps leadership development program
July – September 2013	 7

The Army Medical Department Journal

junior attendings with the staff on the inpatient ward), 

we then have a rationale to implement an education program that is relevant and practical. 

From a cultural standpoint, military physicians often 

avoid leadership opportunities and training because of 

the perception that it will detract from their clinical practice by taking them out of the clinic or operating room 

for a portion of each week. Antagonism between clinicians and healthcare executives (even executives who are 

former clinicians) may cause young physicians to avoid 

leadership roles in order to avoid being perceived as 

“lesser” clinicians. Combined with a lack of formal training in leadership theory, these barriers create significant 

problems when physicians assume clinical or executive 

leadership roles. Without training, the physician may 

also avoid taking a risk to seek a leader role outside his or 

her comfort zone. When physicians are forced to assume 

a leadership position, they may experience stress, dissatisfaction, or outright failure. This stress is compounded 

by physicians’ natural desire to perform at a high level. It 

is worth considering that stresses caused by being forced 

to lead without adequate preparation may also contribute 

to disruptive physician behavior.

We began by exploring several lines of effort (LOEs). 

Each LOE (early exposure/develop interest; provide 

leadership education; mentorship and coaching; and 

develop future senior leaders) was developed and studied by a senior physician team focusing on current state, 

ideal end state, gap analysis, and goals intended to close 

the identified gaps. Outside organizations, such as our 

line counterparts the Veterans Health Administration, 

industry, civilian healthcare systems, and professional 

associations, were studied for comparison. Teams were 

not constrained by resources or history. Divergent thinking was encouraged, and everything was on the table.

As we developed the program goals, we recognized that 

successful implementation must minimize any additional administrative and resource burdens at all levels. 

Many of the defined goals could substitute for currently 

existing training so that the programs are standardized 

across the Army Medical Command while meeting external accreditation requirements. The Accreditation 

Council for Graduate Medical Education Competencies, 

AMEDD military unique curriculum, residency review 

committee professionalism training, and maintenance of 

certification requirements can be met with elements of 

the proposed curriculum.

The envisioned result is a widely embraced program 

that teaches leadership to all physicians, while also 

identifying individuals to be developed for senior physician leader positions. 

Proposed Structure

Establish a Medical Corps Leadership Consultant

The AMEDD recognizes nonclinical specialty consultants to The Surgeon General, Medical Corps history, 

ethics, and Medical Evaluation Board consultants, for 

example. We will establish a Medical Corps Leadership 

Consultant who will oversee implementation of the program. Ideally, this consultant will be based at Fort Sam 

Houston with the Corps Specific Branch Proponency 

Officer and will report directly to the Medical Corps 

Chief. The Leadership Consultant will be a senior colonel who has served the AMEDD in significant leadership 

roles (commander, deputy commander for clinical services, consultant to The Surgeon General, department 

chief, etc) and has demonstrated an interest in leadership development. The Consultant will be responsible 

for the implementation and maintenance of the Medical 

Corps Leadership Program, including the provision of 

guidance and oversight for the Leadership Development 

Committee and subcommittees. He or she will be supported by a Medical Corps lieutenant colonel as deputy 

consultant and a civilian assistant. Regional leadership 

consultants, combined with local leadership coordinators at facilities and installations with large Medical 

Corps populations, will assist with implementation and 

provide feedback for continuous program improvement.

Establish a Leadership Development Committee

The Medical Corps will create a Leadership Development Committee (LDC), the membership of which will 

be comprised of top-level senior executives such as 

commanders of medical treatment facilities, commanders, command surgeons, Medical Corps consultants, 

directors of medical education, Medical Corps staff officers in the Office of The Surgeon General, and other 

leaders as appropriate. The group will meet formally 

twice annually. The LDC will create an executive committee, chaired by the Medical Corps Leadership Consultant, consisting of 10 members with decision-making 

authority. The committee will meet monthly and will 

provide ongoing guidance and support for execution of 

the leadership program, including creating and directing subcommittees as described below.

Subcommittees will be created to take responsibility 

for development and execution of all major program 

components: develop interest, education, mentorship/

coaching, leader development, strategic communication/knowledge management/website maintenance. The 
8	 http://www.cs.amedd.army.mil/amedd_journal.aspx

subcommittees will report to the Chair of the LDC Executive Committee (Medical Corps Leadership Consultant). The LDC will develop metrics to evaluate the effectiveness of the leadership program and to drive continuous program improvement.

Summary

Leadership is a core competency for all physicians, but 

the theory and practice of leadership are taught inconsistently. The Army Medical Corps will develop a comprehensive Leadership Development Program that will ultimately improve patient care, enhance the performance 

of healthcare teams and thereby improving safety and 

quality of care. The program will significantly enhance 

physicians’ preparedness to assume clinical and executive leadership roles at all levels.

A Question and a Leader’s Answer

Rushing out of your department on the way to the 

hospital pharmacy and therapeutics committee 

meeting, you overhear a conversation between one 

of the junior residents and a more senior member of 

your department.

“Son, don’t waste your time reading any of that 

leadership bull#%&! You become the best doc you 

can be and you will find that the nurses and the 

bean-counters will be listening to you because you 

actually touch patients. They better! Otherwise they 

are as stupid as the so-called experts who write 

those leadership books but don’t know anything 

about real medicine.”

You run into the same resident at the coffee shop 

on your way back from the committee meeting. You 

were the one who recommended the leadership 

books to him in the first place. What do you say to 

him now?

Inquiring about how his reading on the leadership material I recommended is going (but reluctant to admit 

that I eavesdropped on his earlier discussion with the 

senior staff member), I would offer that there are many 

whom he will encounter who do not have a lofty opinion of such literature for a variety of reasons. I admit 

frankly in these situations that I am among those who 

read leadership books and articles—especially those in 

the business community—with a healthy dose of skepticism. Too often I have seen writers who fail to recognize 

the distinction between leadership competencies and 

managerial skills, two overlapping but different sets of 

learned and innate skills. In fact, I have said before that 

many in business and academic communities appear to 

think that leadership is “management on steroids.” I believe the application of too many formulaic models of 

leadership by consumers of these materials may have 

led to bad leadership examples and spawned some of 

the resistance of these leaders’ subordinates to step into 

important positions themselves when good leaders are 

needed.

But this does not explain all of the inherent resistance 

to seeking these opportunities or taking these important 

assignments. All of us share to a variable degree a fear 

of change and of placing ourselves into roles in which 

we might feel only marginally competent and, even if 

qualified, we lack the degree of self-confidence which is 

born of proven success which characterizes our professional and technical roles as physicians and caregivers. 

While being “the best doc you can be” has always been 

the foundation of the best physician-leaders, it does not 

provide all of the qualities and qualifications needed to 

be a great leader. It also does not complete the education 

and training necessary to develop each of us into the 

kind of leader our organizations require for the dynamic 

world in which we live and work. Being a great physician means being an effective and inspiring small unit 

leader. Physicians work with the most compelling and 

intimate aspirations of our patients, guiding them during even life-threatening moments, assisting them while 

in harm’s way to their ultimate objective of safety and 

well-being.

In our best moments, we provide vision and courage, and 

remove obstacles in the way of our patients’ achievement of health and optimal function. No image better 

describes a successful military, business, government, 

nonsecular, or community leader. But to venture further 

into leadership of more complex organizations, even 

to the highest operational and strategic levels, requires 

risk-taking; a knowledge of self, ethics, interpersonal 

skills; a knowledge of organizations and the people 

who populate them; strategic planning; and other areas 

which cannot be gained by remaining focused solely 

upon the medical literature, our practices, and our roles 

as doctors. Ultimately, we can assure this young physician that practical leadership experience and learning 

from errors trumps everything learned from books.

LTG (Ret) Eric B. Schoomaker

The Surgeon General of the Army, 2007-2011

The US Army Medical corps leadership development program
July – September 2013	 9

The Army Medical Department Journal

Leaders are made, they are not born. They are made 

by hard effort, which is the price which all of us must 

pay to achieve any goal that is worthwhile.

Vince Lombardi3

A critical but underappreciated skill necessary for effective physician practice is leadership. Physicians lead 

patients to comply with treatment regimens; they lead a 

surgical team through an operation; they lead complex 

therapeutic interventions. Unfortunately, many physicians do not possess the skills necessary to become innovative, forward thinking, team leaders, often because 

of a lack of exposure to leadership principles and opportunities early in their careers.

The Army has made a total commitment to the development of future leaders by providing them opportunities 

to develop the skills, knowledge, and attributes required 

to meet the challenges through a deliberate, continuous, 

sequential, progressive process.4,5 This leadership development is executed through 3 domains: institutional 

training, operational assignments, and self-development. 

Institutional or “schoolhouse” training requires the officer to progress through the sequential military education levels starting with the Basic Officer Leader Course 

(BOLC) and subsequent courses such as the Captains 

Career Course (CCC) and intermediate level education.

Medical Corps officers often experience a significant 

gap between attendance at BOLC and CCC in order to 

complete medical school and graduate medical education programs. During this period, there is a great opportunity to improve junior officer leadership exposure, 

interest, and development. Recently graduated residents 

serving in positions such as clinic officer-in-charge, section chief, or an operational assignment frequently note 

the lack of leadership skills needed to excel in their new 

position. Many junior medical officers find themselves 

in new leadership positions unprepared and uncomfortable. A negative experience may eventually dissuade 

them from seeking future assignments requiring advanced leadership responsibilities and may even influence their decision to remain in the military past their 

initial active duty service obligation. A poorly performing Medical Corps officer also hinders the success of the 

organization and may result in erosion of confidence and 

trust in the Medical Corps to provide capable leaders.

Junior medical officers should be taught that basic physician and military-unique leadership skills are not just 

essential for the select few that follow an administrative 

track towards command or operational positions. These 

fundamental officership and leadership skills can be 

just as important for the clinician and researcher as they 

are for the future commander. The skills and training 

should be provided in small increments over an entire 

career, rather than in large segments followed by periods where the skills are not exercised. This does not 

negate the importance of a comprehensive leader succession program to identify and groom physicians for 

specific senior leader roles (developed in the section 

Building the Bench (page 21)), but stresses that the craft 

of leadership applies to all physicians.

Current Successes and Gaps

The Ideal State

All junior Medical Corps officers will receive programmatic, ongoing leadership education throughout medical 

school, residency, and early in their careers, with practical opportunities to observe and actively participate in 

activities designed to foster leadership development.

Successes

Available institutional training both at the AMEDD 

and within the Army provides a foundation in leadership training as articulated by Army Doctrine Reference 

COL Kristie J Lowry

COL Neil E. Page

COL Bertram C. Providence

COL Erin P. Edgar

COL George Appenzeller

COL Daniel S. Berliner

MAJ Patrick Birchfield

COL Thomas R. Burklow

COL E.Darrin Cox

COL James R. Ficke

LTC Melissa G. Givens

LTC(P) Stephen A Harrison

COL David K Hayes

LTC Mary M. Klote

LTC Brian A Krakover

COL Joseph F. McKeon

COL Randolph E. Modlin

LTC(P) Clinton Murray

COL Michael R. Nelson

COL Joseph S Pina

COL Ronald D. Prauner

COL Stephen Salerno

COL Douglas Soderdahl

COL Martin E Weisse

COL Charles W. Callahan

COL Leon E. Moores

Develop Interest:

Early Exposure to Leadership Theory

The following US Army Medical Corps officers collaborated in the development and writing of Chapter 2 of 

All Physicians Lead from which this section is adapted:
10 http://www.cs.amedd.army.mil/amedd_journal.aspx

Publication 6-224 and joint professional military education. Courses such as BOLC and CCC make officership 

and leadership skill training available and integrate operational and deployment education training into physician development. The Medical Corps has outstanding 

graduate medical education (GME) programs which 

produce well-educated, competent military physicians. 

These programs focus on several core competencies that 

dovetail with leadership development, such as interpersonal and communication skills, professionalism, and 

systems-based practice.

Military graduate medical education programs are required to incorporate military unique curriculum into 

their standard curriculum. Many of these have successfully exposed junior medical officers to fundamental 

military leadership skills and engaged them in innovative curriculum activities and practical exercises.

The Joint Medical Executive Skills Institute provides 

military healthcare professionals with executive management and administrative skills through educational 

programs, products, and services. This training is accomplished primarily through distance learning and 

covers many of the 35 leadership competencies required 

by senior healthcare managers.

Gaps

There is no “off-the-shelf” formal curriculum available that incorporates physician and military leadership 

skills which can be used by the wide variety of existing Accreditation Council for Graduate Medical Education (ACGME) programs. Without a standardized curriculum template, each program is left to develop their 

own at great time and expense, and the AMEDD is not 

consistently producing physicians with developed leadership skills by the end of residency training.

There is no requirement for junior physicians to gain any 

structured leadership experience other than occasional 

intraresidency positions such as chief resident.

There is no easily accessible, centralized repository 

for practical information regarding career progression, 

leadership opportunities/development, and guidance for 

junior medical officers.

There is no proponency who clearly has the task to ensure junior officers receive excellent leadership training, 

especially during medical school and residency/fellowship training.

Courses offered by the AMEDD do not always match 

medical professional requirements such as those 

prescribed by the American College of Physician Executives, ACGME, and other organizations.

There is no existing centralized, formal mentoring program within which more experienced officers can help 

shape the interests and careers of junior Medical Corps 

officers.

Closing the Gaps

Short Term (6-12 month) Goals

Update the Medical Corps website to provide specific information on leadership development, career progression, 

and career milestones. This website should be the portal 

by which all Medical Corps officers access leadership 

material and information. The website will be tailored to 

specific users and be modeled after university websites 

that have different areas for prospective students, undergraduates, postgraduate students, and faculty in addition 

to general information applicable to all. The Army Medical Corps website will have areas for medical students,* 

GME participants, junior staff, senior staff, etc. The site 

will have links to the core leadership curriculum, other 

web-based leadership modules, and leadership websites 

and blogsites, such as “Henry V.4.3” (http://henryv43.

wordpress.com/). The site would also include a recommended reading list that is specific for different phases 

of the physician’s career and provide information on 

nonmedical training programs such as those offered by 

the RAND Corporation, White House Fellowships, and 

Army-Baylor University programs. The website would 

proide dissemination of information about positions for 

midrange and senior physician leaders

Develop an Army Medical Corps leadership presence 

on social media sites. Current senior leadership is just 

becoming comfortable with email, texting, and social 

media, however, the next generation is fully conversant 

with web based portals of information exchange. This 

will not be limited to sites proprietary to the military 

(Army Knowledge Online, MilSuite.mil, etc), but to the 

most commonly used sites such as Facebook, and Twitter. This social media presence needs to emphasize leadership development and opportunities.

Ensure that Medical Corps officers start residency training with a sponsor/mentor. The sponsor will be selected 

by the resident (not assigned) from a pool of eligible faculty. Time spent with the sponsor will include modeling 

of leadership activities such as participating in hospitalwide committees, administrative meetings, and counseling sessions. The resident will also be involved with 

*Those students in the Armed Forces Health Professions 

Scholarship Program or the Uniformed Services University of 

the Health Sciences.

The US Army Medical corps leadership development program
July – September 2013	 11

The Army Medical Department Journal

military administrative activities such as writing Army 

Officer Evaluation Reports, Noncommissioned Officer 

Evaluation Reports, and awards; dealing with disciplinary actions; civilian labor disputes; property accountability; and other practical topics. Residents will maintain a meeting log similar to a procedure log in which 

they document hospital board, committee, or business 

meeting attendance each month. Residents will be given 

the opportunity to shadow senior leaders during some 

unique leadership opportunities, such as local community speaking engagements or attending a meeting with 

a senior mission commander and staff. This is designed 

to be experiential, similar to medical school rotations 

that expose students to various specialties to develop 

their interest.

Expand membership of various hospital committees 

to house staff members. This exposes junior officers 

in a project-oriented manner to processes and change 

management strategies used by organizational leaders 

within the institution. Allowing house staff members 

to attend these meetings should be a stated priority of 

training programs, with justification as meeting the systems-based practice competency.

Intermediate Term (1-2 year) Goals

Establish a Medical Corps “speakers bureau” to provide 

local, “just in time” leadership training. Topics could 

include case-based accounts related to particular leadership challenges such as resolving conflict, disruptive 

behavior, dealing with “toxic” leadership, and leading 

change. These sessions would also provide practical education on topics such as officer efficiency reports and 

award writing for physicians. Instructors—who should 

have AMEDD leadership experience—will demonstrate 

competence in leadership theory, organizational behavior, and facilitation of small group discussions. Regular 

interviews with physician-leadership at each site will 

also highlight the diverse talents of Medical Corps leaders. A suggested topic list could be maintained on the 

Medical Corps website so the local speaker’s bureau 

will have guidelines for this training.

Strictly enforce BOLC attendance during medical school. 

There should be mandatory attendance after internship 

prior to starting any other residency training or other assignment for the infrequent outliers. It is important that 

this foundational training is completed on time to ensure 

a common fund of training for junior medical officers.

Appoint a medical treatment facility Medical Corps 

leadership coordinator at each hospital, who will also 

serve as director of military unique training within the 

facility. The coordinator will have time dedicated for 

program development and execution. The coordinator 

will monitor the implementation of the leadership program and will meet separately with each year group periodically throughout the year to review the schedule for 

the year, topics to be discussed, and available opportunities based upon year group.

Create an annual leadership day for all house staff based 

on residency year. Morning didactic sessions will review 

basic leadership skills from a variety of perspectives 

(military unique, physician, research, etc) and the afternoon will contain panel discussions involving senior 

leaders with various backgrounds to discuss leadership 

scenarios likely to be encountered by military physicians. 

Leadership day topics could also emphasize individual 

topics or subjects in the core leadership curriculum.

Provide ongoing leadership training for midlevel officers. These officers will assist with the leadership development of their subordinates and will therefore require development and sustainment of their leadership 

instruction skills. This can be accomplished in venues 

such as faculty development seminars or external events 

sponsored by military or civilian entities. Establish a 

supportive network of individuals that meet regularly, 

weekly to monthly. This would be targeted at officers 

that have already finished training. The establishment of 

regional associations (like the Silver Caduceus Society 

of Medical Service Corps officers) to promote Medical 

Corps history and develop leadership will allow for informal small-group discussions/education and will improve fellowship among Medical Corps officers. These 

meetings could also be developed across the different AMEDD disciplines: Medical Corps, Nurse Corps, 

Medical Service Corps, Dental Corps, Veterinary Corps, 

Enlisted Corps, and the Civilian Corps. Group members 

will have required readings and discussions, and would 

attend specific workshops and leadership symposia, as 

well as collaborate online. The core leadership curriculum, with its programmed reviews and changes of content, can always serve as the juncture for ongoing leadership training of these midlevel officers.

The Medical Corps will annually fund 3 company grade 

Medical Corps officers per region to attend leadership 

symposia, events, or workshops through an online application process.

Establish a physician leadership elective for all AMEDD 

GME programs in cooperation with GME program directors that allows residents a block of time to work 

alongside hospital or operational Medical Corps leaders 

for exposure to the unique professional challenges and 

opportunities of these leader positions.
12 http://www.cs.amedd.army.mil/amedd_journal.aspx

Standardize residency “transition to practice” seminars 

at all the main GME platforms. Residents have time 

available between graduation and change of station that 

could be leveraged more effectively to provide a standardized core of “just-in-time” training that could be 

tailored to expected job assignments. Capitalize on the 

current best practices in the AMEDD and make a core 

curriculum available across the enterprise.

Long Term (3-5 year) Goals

Develop a tool for tracking leadership development 

throughout a medical officer’s career. This would be 

modeled on the portfolio model that was described by 

the RAND Corporation.6

 The officer develops the leadership portfolio over time and it links to established 

leader development checklists which are used to monitor 

education and experience.

Allow the Health Professions Scholarship Program to 

cover dual-degree programs and have access to graduate business degrees throughout the Medical Corps officer’s career. While a Master of Business Administration 

or Master of Healthcare Administration does not guarantee the creation of first-class leaders, those curricula 

provide valuable additional skills for medical executive 

leaders.

Summary

Developing interest requires early exposure to leadership materials and opportunities. Key to this will be 

establishing a highly interactive and effective internet 

presence where material could be accessed by officers 

early in career development, including medical school 

and residency. Engaging internet materials will be followed with regularly scheduled activities within the 

GME curriculum as described throughout this section.

A Question and a Leader’s Answer

For three years you have told your residents that 

their first priority when they graduate should be to 

pass their board examinations. The junior staff has 

proposed that you start a leadership breakfast or 

lunch session weekly. You already have challenges 

getting the residents and medical students to attend 

the didactic sessions for the training program. 

Starting a leadership session would take another 

hour out of the week for a subject that will definitely 

not be on the board. What’s more, the Department 

Chief wants to know your rationale if you decide to 

change the curriculum. What will you do and what 

will you tell him?

The junior staff members are right. The military unique 

curriculum that was accepted by our Residency Review 

Committee is lacking. While our knowledge of Army 

Regulation 40-5017

 is sufficient, our ability to provide 

leadership knowledge is lacking. Learning to lead and 

developing that competency is perhaps more important 

than the clinical skills the residents already possess. 

Starting a twice-monthly leadership discussion at lunch 

and encouraging participation of residents (particularly 

during their outpatient months) is an easy first step toward leader development. One morning report or even 

an afternoon conference slot could also be used. We 

will get acceptance from the junior staff and residents 

by showing physician leadership has direct relevance to 

medical practice, not just health care administration.

Junior staff will be invited to lead the sessions. I will assume some risk by buying the lunches to show my commitment to the vision and my understanding of the residents’ pressing time constraints. Beginning each session 

with leadership scenarios* will help the residents gain 

perspective, flexibility, and the mental stamina which 

will help them prepare for success on their board examinations. Modifying the curriculum will not only meet 

the needs of the junior staff and residents while serving in the military, it will also prepare them for leadership roles in the civilian world, which needs leadership 

presence more than ever. Ultimately we must ask the 

question: what are we preparing them for, their future 

leadership challenges or the boards?

COL Neil E. Page

Deputy Commander for Clinical Services

Montcrief Army Community Services

Fort Jackson, South Carolina

*Complete curriculum is included in All Physicians Lead.

The US Army Medical corps leadership development program
July – September 2013	 13

The Army Medical Department Journal

The one quality that can be developed by studious 

reflection and practice is the leadership of men.

General of the Army Dwight David Eisenhower8

A sound leadership education program is the foundation 

upon which all other components of the Medical Corps 

leadership development are built. This program will adhere to several key principles:

 It must provide a broad leadership educational curriculum that is suited to contemporary working 

environments.

 It must provide programs focused on early exposure, 

ensuring all officers recognize that they are leaders.

 It must be longitudinal, and relevant throughout the 

continuum of the Medical Corps officer’s career, 

and must be closely synchronized to match both 

grade and potential positions.

The principles of the leadership education program will 

include development of a core leadership curriculum, 

executive skills training, an introduction to strategic 

thinking for midgrade officers, tailored developmental programs for senior officers, and establishment of a 

Medical Corps Leadership Consultant and Leadership 

Development Committee to manage these programs and 

identify additional opportunities.

Development of a core leadership curriculum is essential. 

This curriculum, while primarily designed for current or 

future Medical Corps officers early in their career, can 

be used throughout the officer’s career to either refresh 

or review knowledge of key leadership theory and discussion. It will be centralized and virtual, accessible to 

officers stationed around the globe. It will be modulebased so that it can be delivered in its component parts 

or its entirety. Trained instructors will facilitate it, so 

that a standardized product will be delivered. Finally, 

a curriculum committee will periodically review the 

product to ensure it is relevant and addresses key core 

leadership principles important to Medical Corps officers throughout their careers.

Midgrade officers need both practical executive 

skills training specific to Army Medical Department 

(AMEDD) managerial and business practices, as well as 

strategic level training to prepare them to assume senior 

leader positions. The AMEDD and Military Health System both offer several, albeit limited, opportunities for 

development of practical executive skills.

Senior officers need continued development of their 

leadership skills through individualized leadership development programs. Coaching/mentoring and executive skills continuing medical education (CME) opportunities (through groups like the American College of 

Physician Executives) will be targeted at key senior leader positions. It is essential that AMEDD senior leaders 

complete the mentorship curriculum to ensure they have 

the skills necessary to serve as mentors for upcoming 

Medical Corps leaders. All Medical Corps officers must 

possess the skills and desire to coach fellow officers.

The leadership curriculum will incorporate preexisting educational venues and opportunities when possible. The core curriculum can be taught in its component parts beginning in medical school and throughout 

postgraduate training. Finally, a proponency office will 

be developed to manage these physician leadership programs. This office will be crucial in performing the continuous review and modification of this program over 

time to meet the evolving demands facing all Medical 

Corps leaders.

Current Successes and Gaps

The Ideal State

A core leadership curriculum exists for all Medical 

Corps officers.

Existing courses for professional development of Medical Executives are well known to all Medical Corps 

officers.

Mentoring and executive coaching are commonly practiced throughout the Medical Corps.

COL Mark W. Thompson

COL Frank L. Christopher

COL Bret T. Ackermann

MAJ Robert J Cornfeld

COL Telita Crosland

COL Thomas K Curry

LTC Christian Meko

COL Kelly A. Murray

COL Mary Nace

COL Peter E Nielsen

LTC Aaron C. Pitney

MAJ Timothy Switaj

COL Charles W. Callahan

COL Leon E. Moores

The Foundation:

Provide Leadership education

The following US Army Medical Corps officers collaborated in the development and writing of Chapter 3 of 

All Physicians Lead from which this section is adapted:
14 http://www.cs.amedd.army.mil/amedd_journal.aspx

An internet-based leadership forum is available for officers throughout the Medical Corps to facilitate communication and sharing of ideas.

Successes

Several pieces of this leadership education program are 

already in place. A core curriculum has been in development and in use at multiple locations throughout the 

Army Medical Command. The basic lessons that comprise this curriculum can be found in All Physicians 

Lead.

The AMEDD-specific executive skills curriculum provides multiple opportunities for Medical Corps officers 

to participate both online and at specific executive skills 

sessions tied directly to position-specific training courses (for example, the Brigade/Division Surgeon’s Course). 

Information is available at the AMEDD Joint Medical 

Executive Skills Institute (https://executiveskills.amedd.

army.mil/welcome.asp).

The US military has well-designed Master of Business 

Administration (MBA) programs at Baylor University 

and the Uniformed Services University of the Health 

Sciences (USUHS). However, the 2-year, full-time curriculum presents a challenge for Medical Corps officers. 

Many universities offer executive level MBA programs 

which can be performed via distance learning, thus allowing Medical Corps officers to continue to practice 

medicine while also pursuing their degree.

For officers who are preparing to assume senior leader 

positions, the Pre-Command Course provides opportunity for operational level executive skills development. 

The Pre-Command Course also offers the Leadership 

Challenge Workshop, a valuable exercise for leaders 

at all levels to recognize their leadership strengths and 

weaknesses. Senior service college opportunities allow 

senior officers to develop strategic insight into the profession of arms. Much of this curriculum is transferable to 

AMEDD positions and is critical to the continued interaction of the Medical Corps with combat arms branches.

Gaps

The leadership development curriculum is not standardized and most Medical Corps officers are not aware that 

it exists. Because the curriculum contains clips from 

movies, magazine articles, and book chapters, copyright 

permissions may be necessary.

While the AMEDD-specific executive skills curriculum 

program provides standardized tactical-level AMEDD 

specific executive skills ideal for midcareer officers, it 

does not provide “strategic-level” executive skills as 

currently taught in civilian executive masters programs.

No formal executive coaching program exists for Medical Corps officers in, or selected for, senior leadership 

positions. Similarly, mentorship training is lacking 

throughout the medical profession. Although mentorship programs have been well described throughout the 

medical profession, a curriculum to train mentors does 

not currently exist in the Medical Corps. A formal mentor training program must be developed.

No internet-based social media products exist for the 

Medical Corps, and the Medical Corps website is not 

optimally utilized.

Closing the Gaps

Short Term (6-12 month) Goals

Standardize and advertise the core leadership curriculum. Standardize the content, reading material, and video clips of the core curriculum. Obtain permissions for 

access to leadership reading materials in order to allow 

unlimited usage. Similarly, obtain permissions for the 

use of copyrighted video clips for education.

Advertise the executive skills course curriculum presented through Joint Medical Executive Skills Institute 

(http://www.cs.amedd.army.mil/jmesi.aspx). Selection 

boards should be instructed to consider executive skills 

courses as a positive discriminator in selection for promotion and command.

Develop a social media strategic communications plan 

and a centralized online Medical Corps leadership forum that provides access for all Medical Corps officers 

to the curriculum, as well as a range of leadership blogs 

and websites with recommended readings.

Under the leadership of the Medical Leadership Consultant, a core group of educators would be identified 

and certified to be the developers and initial teachers of 

the curriculum. Appropriate portions of the curriculum 

would be incorporated into the USUHS and the Armed 

Services Health Professions Scholarship Program undergraduate requirements. Ensure that all students rotating at military treatment facilities participate in intern 

leadership development opportunities.

Consider offering a 2-week or 4-week leadership elective during medical school sponsored by entities such 

as AMEDD Center and School, the Army Medical 

Command Headquarters, or the Office of The Surgeon 

General.

The US Army Medical corps leadership development program
July – September 2013	 15

The Army Medical Department Journal

Create a leadership program within existing GME programs with a curriculum specific to the level of the individual and the flexibility to be tailored by different 

medical specialties to address unique skills and requirements. This curriculum would contain a mix of onsite 

activities with in-person teaching/coaching/mentoring 

in addition to web-based educational activities. Centralized training through structured distance learning cannot completely replace hands-on, personal interaction 

with senior leaders through spontaneous contact.

This training will meet the Accreditation Council for 

Graduate Medical Education program requirements for 

program or institutional level training, which should 

help in garnering acceptance from program directors 

and leaders within GME.

These issues could be addressed in relatively short order to allow rapid dissemination and execution of curriculum and teaching in multiple venues throughout the 

Medical Corps.

Intermediate Term (1-2 year) Goals

The 2 primary intermediate objectives are the establishment of a midgrade executive skills MBA-type program 

and executive opportunities for those senior Medical 

Corps officers identified for key executive positions.

Midgrade Executive Skills

Midgrade leaders will be offered opportunities to develop their executive skills, including leadership, as 

they prepare to enter positions of greater influence and 

responsibility. Physician executive MBA/MPH/MHA 

educational opportunities should be offered to selected 

Medical Corps officers. This will be done either through 

the current Baylor University program, or through various civilian long-term health education program opportunities. Multiple civilian institutions offer these 

programs with combination on-line and on-campus 

curricula (an example of such programs: http://www.

physiciansmoneydigest.com/lifestyle/top-10-businessgraduate-schools-for-physicians). A program, as well 

as a funding source, will require development for select midgrade officers for these opportunities. Medical 

Corps officers will be selected through a formal board 

process. The Captains Career Course will be prerequisite, and these opportunities will be available prior to or 

in concert with intermediate level education. Selected 

officers would be highly competitive for medical center 

department chief, deputy commander for clinical services, and division or command surgeon positions. These 

key Medical Corps officers will possess the foundational leadership knowledge to fill senior leadership positions and to train/mentor junior Medical Corps officers. 

Shorten the Captains Career Course to a length appropriate for the career development of physicians in their 

early years on active duty and provide content appropriate for the leadership opportunities they will face as 

junior and ultimately senior staff members.

Senior Level Executive Continuing Medical Education 

One of the hallmarks of a successful industry senior 

leadership development program is targeted executive 

skill development opportunities. A number of civilian 

educational institutions offer a wide variety of opportunities spanning multiple subjects pertinent to senior 

executives, including leadership development. Specific 

opportunities to receive leadership continuing medical 

education would be offered to officers in specific projected senior leadership positions.

Long Term (3-5 year) Goals

Develop a thorough, system-wide, understanding of all 

Medical Corps job and training opportunities so that 

mentors can provide all protégés a complete picture of 

the opportunities available to them.

Develop training opportunities to allow mentors to adequately function in that role this training would include:

• Training on “critical conversations” in order to establish the ability within a mentor’s repertoire to 

have those difficult yet “critical” discussions with 

protégés as they examine strategic career decision 

points.

• Training on how to review key personality type inventories, like Myers-Briggs, so that mentors can 

provide key feedback to protégés when they take 

such inventories.

• Training on reviewing current or future 360-degree 

evaluation schemes to be able to provide this critical feedback to the protégé.

Summary

The Medical Corps Leadership Curriculum plan is the 

foundation upon which many of the other aspects of the 

Medical Corps Leadership Development Program are 

built. Defining and standardizing the primary aspects of 

the core curriculum is the key short-term (6-12 month) 

goal to accomplish in enacting this plan.

The complete development of a Medical Corps Leadership Curriculum will require further time and effort. Intrinsic and extrinsic opportunities must be leveraged to 

create a curriculum that addresses the longitudinal leadership needs of Medical Corps officers and mitigates 
16 http://www.cs.amedd.army.mil/amedd_journal.aspx

inconsistencies over an extended career spanning a 

wide variety of positions.

A Question and Leaders’ Answers

You agree that some of the most important teaching 

that you can pass on to your residents and medical 

students involves their development as leaders. You 

have been meeting with a small but dedicated group 

each Tuesday at 0630 for breakfast. One of your 

students asks you what she should be reading for 

leadership and asked you the single most important 

lesson you ever learned about being a leader. What 

would you tell her?

The book I recommend is Primal Leadership: Realizing 

the Power of Emotional Intelligence.

9

 In my opinion it 

is the best leadership “textbook” in existence. It gets to 

the heart of the key leadership skills that define success, 

those being encompassed by emotional intelligence, and 

also provides strategies to improve your individual performance in key aspects of emotional intelligence if you 

see yourself lacking in certain areas. While it is not an 

engaging narrative relating the actions (or inactions) of 

well-known leaders from the past, it does give a very 

solid and easily understood review of what personality characteristics are essential for success, and how to 

manifest those in your day-to-day work.

The single most important leadership lesson I learned 

was on rounds in the neonatal intensive care unit 

(NICU). That lesson is that your leadership of your 

small team creates the conditions for success. Your life 

as a leader is filled with a series of small team leadership 

experiences where success is defined for your organization by how well you lead that small team. In the NICU, 

how well you lead your small team of nurses, therapists, 

residents, and parents set the conditions for how well 

the babies healed. How well you encouraged free exchange of information, responsible disagreement, and 

group consensus set up the conditions for success. The 

same scenario has repeated itself time and again in new 

leadership experiences. The size and complexity of the 

overall organization being led increased, but there was 

always that small group of core individuals with which 

you interacted. If you successfully led that group, the 

overall organization, no matter what the size, responded 

in a positive manner. No matter what position you hold, 

there will always be that small team around you. If you 

lead that team well, the organization will perform well.

COL Mark W. Thompson

Commander, US Army Medical Activity

Fort Drum, New York

When GEN (Ret) Hugh Shelton was Chairman of the 

Joint Chiefs, he required the other Chiefs of Staff to read 

McMaster’s Dereliction of Duty: Lyndon Johnson, Robert McNamara, the Joint Chiefs of Staff, and the Lies 

that Led to Vietnam.

10 The book describes how President 

Johnson’s decisions affected the execution of the war 

in Vietnam. Most significantly from a military senior 

leadership perspective, McMaster shows how the Joint 

Chiefs of Staff contributed to the failed strategies and 

polices by failing to provide the president with their best 

professional military advice. Service chiefs looked out 

for their own services’ interests over the interests of a 

united recommendation to the Commander-in-Chief regarding military strategy for the deepening involvement 

in Vietnam. One can draw parallels to young midlevel 

physician leaders who must learn to address hospitalwide issues while balancing their department’s interests. Recognizing a successful hospital or health system 

strategy requires looking through other lenses beside 

one’s own department or professional perspective.

The late COL Brian Allgood taught me my single most 

important leadership lesson. We served together in the 

US Special Operations command back in the mid-1990s. 

One evening on a deployment, while I was a senior captain on my first staff physician assignment out of residency and he was a lieutenant colonel in the rare officer/

physician role as medical battalion commander, I asked 

him, how can I be like you? Brian told me that no one 

could be like him. And just before I became annoyed at 

what initially sounded like a flippant comment, he elaborated by saying that his genes, his rearing, and his life 

experiences all molded him to be a unique individual 

with his unique strengths and weaknesses. No two people are the same. So he made the point—don’t try to be 

like anyone else. Rather, be the best person who I could 

be. Know your strengths and weaknesses, improve them, 

and always remember the people and families we serve. 

That conversation remains with me to this day.

COL Bret T. Ackermann

Emergency Medicine Physician

Tripler Army Medical Center, Honolulu, Hawaii

Formerly Commander, 121st Combat Support Hospital/

Brian Allgood Army Community Hospital

Seoul, Republic of Korea

There’s one book that is a must-read for any military officer and leader, and almost universally appears on a chief 

of staff’s or commandant’s required reading list for new 

officers, Anton Myrer’s Once an Eagle.

11 The novel is 

over 40 years old, yet simply and elegantly demonstrates 

the differences between a leader (the protagonist Sam 

The US Army Medical corps leadership development program
July – September 2013	 17

The Army Medical Department Journal

Damon) who provides a continual focus on his mission 

and his men and another senior officer (the antagonist 

Courteney Massengale) who focuses his entire career 

on himself and his own ambition, regardless of human 

cost or morale. The novel follows their fictional parallel 

careers from World War I to Vietnam. Myrer humanizes 

Sam Damon. He shows him as fallible, yet humble and 

professional, and demonstrates that large organizations 

cannot survive with a zero-defect mentality. The lessons 

learned throughout this book are easily generalized to 

any organization, medical, military, or otherwise.

The most important lesson that I have learned throughout my career is that your success as a leader is best 

measured by the success of your subordinates and the 

accomplishment of your mission. These two metrics are 

inseparable. Both our Army and AMEDD are full of intellectual capital and vast talent. Set the conditions for 

your subordinates to plan and execute, and allow them 

to do so without micromanagement. When the organization is a success, publicly praise, award, and recognize those who have done the hard work. When the organization inevitably falls short of expectations, you as 

the leader are responsible and take the blame. This will 

engender your subordinates with trust and confidence 

in you, and will inspire them to give you their absolute 

best. As you see sergeants become lieutenants, privates 

become warrant officers, and combat medics become 

board-certified physicians and commanders, you will 

also feel the pride of your efforts coming to the forefront.

A secondary corollary is a simple maxim: never ask (or 

direct) a subordinate to do something you will not do, 

cannot do, or would not be willing to learn how to do 

yourself. You may have never performed a complex surgical procedure yourself, but as a combat support hospital deputy commander for clinical services, you should 

spend time in the operating room, scrubbed in. You may 

not know how to perform daily preventive maintenance 

checks and services on a military vehicle, but as a field 

surgeon attached to a battalion, you should ask the vehicle operators to show you how. Small measures like 

these will instill Soldiers’ pride in their work and establish you as a caring, concerned leader.

COL Frank L. Christopher

Deputy Commander for Clinical Services

Womack Army Medical Center

Fort Bragg, North Carolina

Mentorship is the voluntary developmental relationship 

that exists between a person of greater experience and a 

person of lesser experience. This relationship is characterized by mutual trust and respect; it develops out of a 

selfless bond of trust that allows for open-ended protégé 

guidance over a prolonged period of time. Executive 

coaching is about individual performance improvement 

or individual skills development with a specific agenda 

or goal in mind. It is prescriptive and intended to provide 

immediate results.

Medicine has always been a guild with an apprenticebased system of training. Historically, physicians and 

surgeons trained under more senior clinicians until the 

senior clinicians felt that they were ready to work independently. Even within the last century, medical students, interns, and residents learned most of their craft 

from more senior residents, fellows, and junior staff 

who served both as role models and clinical instructors. 

A similar model exists for junior clinical investigators 

whose success has relied on their ability to join a more 

senior scientist to learn the craft of medical research.

In addition to teaching the art and science of medicine 

to younger trainees, these experienced clinicians and 

scientists also provided insight into potential career opportunities which became available and professional 

and personal advice, both solicited and unsolicited. In 

this model, there have been opportunities for instruction 

and direction in the day-to-day practice of medicine and 

research (coaching), as well as in the pursuit of longer 

term ambitions and opportunities (mentoring).

A large volume of material in the business and leadership literature compares and contrasts coaching and 

mentoring. Executive coaching in business initially 

COL Erin P. Edgar

COL Mark W. Thompson

COL Bret T. Ackermann

COL George Appenzeller

MAJ Robert J Cornfeld

COL James R. Ficke

COL David R. Hayes

COL Joseph F. McKeon

LTC Christian Meko

COL Mary Nace

COL Michael R. Nelson

LTC Aaron C. Pitney

MAJ Timothy Switaj

COL Charles W. Callahan

COL Leon E. Moores

APPRENTICESHIP rEFINED:

mENTORSHIP AND COACHING

The following US Army Medical Corps officers collaborated in the development and writing of Chapter 4 of 

All Physicians Lead from which this section is adapted:
18 http://www.cs.amedd.army.mil/amedd_journal.aspx

developed as a means for correcting the poor behavior of 

executives. It has since evolved into a program to develop the capabilities of high-potential performers. James 

Hunt describes coaching as effective for executives who 

say “I want to get over there, but I’m not sure how to 

do it.” 12 A study in 2004 found that 86% of companies 

surveyed used coaches to sharpen the skills of individuals selected as future organizational leaders. In fact in 

2004, IBM had 60 coaches on staff.

Executive coaching is commonplace in business, but is 

a rare formal practice in medicine. Very little has been 

published on executive coaching in the field of medicine. 

In one review, 5 new departmental executive officers in 

the University of Iowa Carver College of Medicine were 

offered executive coaching at the start of their new positions.13 The executives desired assistance in improving their skills in facilitating institutional change. After 

the program, the executives believed that the value of 

the coaching received was in their improved ability to 

receive external advice about specific issues, assistance 

with implementation of organizational change, focused 

career guidance, and improved time management.

The practice of medicine requires physicians to employ 

many clinical leadership skills on a regular basis, but it 

is not safe to assume these skills will translate well to 

organizational leadership. Physicians who leap unprepared into organizational leadership roles often experience tremendous frustration, and generate frustration in 

their subordinates and their superiors. Mentoring plays 

a valuable role in leadership development across the entire physician career spectrum. Executive coaching may 

play a valuable role in the transition to specific senior 

leadership roles. Effective application of both will lead 

to improved organizational performance.

Current Successes and Gaps

Ideal State

A formal leadership training program is incorporated 

into residency training programs. In addition, all Medical Corps officers are afforded the opportunity for formal mentorship via a regionally administered program 

by a mentor who has received formal education in the art 

of mentoring. Identified senior leaders (deputy chief of 

clinical services, medical treatment facility (MTF) and 

TOE unit* commanders, etc.) receive executive coaching via a centrally administered program.

While complementary in nature, these programs are 

distinct programs with different focuses. The mentoring 

program will focus on the strategic development of all 

Medical Corps officers, while the coaching program 

will focus on the individual development of Medical 

Corps officers in key leadership positions.

Current State

Many informal mentor-protégé relationships already 

exist across the AMEDD. In addition, the sporadic use 

of executive coaches exists in some MTFs where contract or civil servant organizational development practitioners are used to assist in strategic planning and executive development. The current practice of physician 

development is a fertile model for the application of both 

coaching and mentoring in physician leadership.

Gaps

Most Medical Corps officers currently serving as mentors have not received formal instruction in the art of 

mentoring. The availability of mentoring for junior 

Medical Corps officers is typically dependent on informal programs and the availability of interested senior 

personnel willing to serve as mentors. Time and resources are typically not allocated to facilitate mentoring relationships. There is no centralized structure to 

identify mentors. Executive coaching opportunities are 

rare and not centrally funded.

Closing the Gaps

Short Term (6-12 Months) Goal: Establish a Formal 

Mentorship Program for the Medical Corps.

Each regional medical command will appoint, as an additional duty, a senior Medical Corps regional leadership consultant (senior colonel.) Each MTF and large 

installation will appoint a leadership champion (colonel 

or lieutenant colonel.) Ideally, the leadership champions 

will be volunteers with a passion for developing junior 

officers, and they will possess the ability to coordinate 

a formalized program for the MTF. Formal training opportunities will be afforded the leadership champions. 

Larger medical centers might consider delegating below 

that facility level where feasible.

The regional leadership consultant will be a senior physician well-respected by peers and well-connected within the Medical Corps in both the clinical and deployed/

operational environments. Experience serving in multiple areas in previous assignments equips the leadership consultant with a wide span of knowledge to share.

Create a pool of available mentors and a method to 

link them to developing leaders. Understanding that it 

is unlikely a mentor could support multiple protégés 

simultaneously due to other commitments, the pool of *A unit with structure and equipment defined by a Table of Organization and Equipment (TOE).

The US Army Medical corps leadership development program
July – September 2013	 19

The Army Medical Department Journal

available, trained mentors must be expanded. The mentor will identify goals focused upon particular tasks or 

objectives (consider the Individual Development Action 

Plan from the Army Mentorship Handbook 14). Individual mentoring will occur in a manner suitable for both 

mentor and protégé. Mentoring typically is long term, 

and the relationship enduring. Both the mentor and the 

protégé will participate in a review process and the protégé’s developmental plan will be modified based on 

feedback from leaders.

Intermediate Term (1-2 year) Goal: Establish Mentor 

Training Opportunities

Mentors will be prepared to teach protégés in both general and specific terms (that is, from the potential career opportunities and nuances of leadership to the finer 

points and details of officer record briefs and officer 

evaluation reports). They will be prepared to speak to 

the importance and timing of the Officer Education System including the Basic Officer Leader Course (if not 

already completed), the Captains Career Course, intermediate level education, and senior service school.

Mentors will expose junior Medical Corps officers to 

career opportunities that are available after training (for 

example, joint medical augmentation unit, fellowships, 

and forward surgical team command opportunities). 

The basics of the promotion system will be covered with 

the importance of the official photo, the officer record 

brief, and the officer evaluation report. As both deployment and operational medicine experience are essential 

for developing AMEDD leaders, mentors will attempt 

to expose protégés to operational units during residency.

Junior Medical Corps officers need to familiarize themselves with the organization of the Department of Defense, the AMEDD, the Navy Bureau of Medicine and 

Surgery, and the Air Force Medical Service. It will be 

rare to find mentors who are well-versed in all of the 

topics, so mentors must be able to harness subject matter experts from other fields and other services who can 

share this knowledge. Finally, mentors will link protégé 

with senior informal mentors where potential common 

bonds exist.

Mentors will be provided maximum exposure to conferences and courses that will enhance their ability to 

develop protégés. The following list is a start and will 

be expanded as necessary: Association of Military Surgeons of the United States Medical Strategic Leader 

Program, Association of the United States Army (both 

Army-wide and AMEDD programs) Joint Inter-Agency 

Medical Executive Course, AMEDD Capstone, Military 

Health System conference, Human Capital Distribution 

Conference, and, perhaps, an off-the-shelf course that 

trains leaders to be mentors.

A formal mentorship training curriculum will be established. Whether embedded within other training opportunities or as a standalone course, identified mentors 

will receive training that covers some of the key mentorship essentials.

Long Term (3-5 year) Goal: Establish a Corporate 

AMEDD Executive Coaching Program

Executive coaching is a different skill than informal or 

formal mentorship which can be performed in-house as 

focused on the military specific topics. Executive coaching will require either significant investment to develop 

coaches from within the ranks of the AMEDD or, more 

likely, the hiring of experts from the organizational development or executive coaching community. Specific 

outcomes will be documented with the coaching investment and will be an expectation as an essential part of 

coaching—agreeing to reflect how practice has changed 

as a result of coaching and if not, why not.

If an in-house program is developed, those identified 

Medical Corps officers discussed in the section Building the Bench (page 21) will serve not only as potential 

recipients of an executive coaching program, but also as 

future coaches themselves for key leadership positions 

they have already held. The time frame for this goal 

will be accelerated if coaching experts from outside the 

AMEDD are hired to serve this function.

Every Medical Corps officer entering into senior MTF 

or regional leadership positions will have executive 

coaching available at the onset and throughout the first 

year in the position. Additional access to this expertise 

will be available as the need or requirement arises, such 

as, for example, the development of significant difficulties in performance or organizational challenges during 

the course of a leadership tour.

Summary

The Medical Corps needs a formal leadership development program to enhance the development of physician 

leaders throughout the scope of their careers, beginning 

with initial training. Mentorship and executive coaching are 2 key leadership development programs that 

will greatly expand the effectiveness of Medical Corps 

officers as leaders. Mentorship will be available for all 

Medical Corps officers, while executive coaching will 

be available for senior Medical Corps officers in key 

leadership positions. The balance between coaching and 

mentoring will allow for the tactical, operational, and 

strategic development of senior leaders.
20 http://www.cs.amedd.army.mil/amedd_journal.aspx

A Question and Leaders’ Answers

The new commander of one of the regional Army 

hospitals is an inexperienced former department 

chief. You met him for the first time at the regional 

command conference. He admits that he does not 

feel particularly well-prepared for his new job, especially the subject of medical boards. He approaches you and asks for advice because he knows you 

were a deputy commander for clinical services and 

a department chief. He needs a mentor. Could it be 

you? What would you do next?

The first step is to look at the relationship you have with 

this officer, your compatibility and if having a mentor 

relationship is feasible. If it is not, then the best thing to 

do is to refer them to someone who can appropriately 

guide them, while also giving some initial advice. If 

this is someone you can mentor then the advice will not 

change, but there is more involved.

In both cases, my first recommendation is to read the 

appropriate Army regulations. For this officer, the list 

would include Army Regulation (AR) 40-501: Standards 

of Medical Fitness,

7 AR 600-60: Physical Performance 

Evaluation System,

15 parts of AR 40-400: Patient Administration,

16 and AR 635-40: Physical Evaluation for 

Retention, Retirement, or Separation.

17 Additionally, I 

would point the officer to the latest medical command 

orders related to the Integrated Disability Evaluation 

System. The commander must assure that the system is 

functioning fairly and efficiently with a focus on Soldiers, must know the individual roles and responsibilities within the process, and must be familiar with every 

step of the process. A close alliance with the local subject matter expert and an on-the-ground walkthrough of 

the system at the new command is essential.

There are few more pressing issues for a commander 

today than this one, and it underscores the importance 

of the mentor in helping the protégé to identify crucial 

areas of focus and encouraging him or her to develop 

expertise in these areas. It also reinforces the fact that 

there are many areas of overlap between the roles of 

mentor (guidance, motivation, emotional support, and 

career role modeling) and coach (self-discovery of key 

practices that result in improvements in the business as 

well as in the personal life of the leader). Leaders, particularly those in new roles, need both.

Finally, as a fellow officer, mentor, or friend, you must 

ask the hard question: “what are you really concerned 

about?” In this case, there is likely more to the story 

than simply concerns over an unfamiliar process or procedure. Our job is to look past the obvious and get to the 

root of the issue. The officer commented that he does 

not feel particularly well-prepared for the job. We should 

find out why; address the concerns; and provide ongoing 

support, advice, and an unbiased ear when needed. That 

is the purpose of a mentor and coach.

COL George Appenzeller

Commander, US Army Medical Activity-Alaska

I cannot imagine myself refusing to be a mentor to someone, unless I knew that we viewed the world through incompatible lenses. If that were the case, I would direct 

him to someone else. I would still try to help, but perhaps 

not as a mentor. Whether or not we “clicked” as mentor/

protégé, I would reassure him not to worry about his lack 

of experience in medical boards. So much of his job will 

have nothing to do with that one aspect, and the Army 

and the AMEDD had the confidence to choose him. I 

would tell him that we are all unsure of ourselves initially. I submit that an Army career is a series of jobs for 

which one feels ill-prepared, often for the first 20 years.

As far as the medical board issue, I would try to put him 

at ease. First, the landscape is different, and much has 

changed with how things are done under the Physical 

Disability Evaluation System. In addition, Army Regulation 40-5017

 is under rewrite, so more will probably 

change. I would share my secret of success: 5 minutes 

lead time and an internet connection. It is amazing how 

smart one can seem to be given those two resources. So, 

given a few minutes preparation, he can gain familiarity with the issues to be discussed. I would share that 

another of my “secrets” is to admit that I am not an expert, and to sit down with subject matter experts and get 

candid opinions on process improvement.

It is also critical to know where to go for expert opinion. 

Often we go to the policy makers or the schoolhouse 

subject matter experts, when really those Soldiers in the 

field best understand the process. As a young doctor, I 

almost always tried to figure it out on my own. Not only 

is that approach time-consuming, but one often does 

not get the complete or even correct answer. We as senior folks have often learned where to go for answers, 

whether a local expert or the specialty leader. Asking 

the specialty consultant carries the weight of that person’s expertise through a career in the discipline, as is 

the case with our consultant pool. The local clinician 

understands what works best at that location, so both 

approaches have merit.

My colleague should be reassured that his concern is 

very reasonable. I would be more concerned about a 

The US Army Medical corps leadership development program
July – September 2013	 21

The Army Medical Department Journal

commander who faked expertise and stumbled through 

command without asking the questions necessary to 

ensure he grasped the issues, and that his command 

was functioning as it should. The lives of Soldiers are 

greatly impacted by all that we do in medicine. Sometimes we need to make quick decisions with partial information, and, while it is important to have confidence 

despite ambiguity, it is always best not to be cavalier. 

As commander, he will set the tone in his unit. I would 

encourage him to savor the experience, command is the 

greatest privilege a Soldier can have.

COL Joseph F. McKeon

Commander, US Army Aeromedical Activity

Consultant to The Surgeon General

in Aerospace Medicine 

Leadership, like swimming, cannot be learned by 

reading about it.

Harry Mintzberg18

Army Medicine requires the Medical Corps successfully identify, recruit, and select top officers for future 

executive positions. In order to do this, we must begin to 

provide ongoing leadership training to all.

Early identification of physician leaders who have the potential to serve as future commanders and senior leaders 

can be based on (senior mentor) observation of character, 

presence, and intellect. These traits, from Army Doctrine 

Publication 6-22: Army Leadership,4

 are key characteristics of successful leaders. Creating the next generation 

of successful leaders will require a deliberative process.

The professional interest of the physician-leader in operational, clinical, academic, and hospital administration 

will drive the formal training courses and leadership 

possibilities for the midlevel physician-leader. However, 

the formal training and the skills required for successful 

senior leadership is broad. Opportunities for experience 

in several areas should be provided and encouraged to 

prepare a well-rounded, future senior leader.

Current State and Gaps

The Ideal State

The Medical Corps maintains a robust leader succession program which identifies future leaders that can 

successfully assume key developmental positions 5 to 7 

years (or 1 to 2 promotions in grade) from initial identification. These officers are groomed for success with 

appropriate educational opportunities, assignments, 

mentoring, and executive coaching.

In the ideal state, all Army Medical officers will have 

embarked on a lifelong journey of leadership development. From that body, officers can be recruited to 

lead in executive positions within the Army Medical 

Department.

Successes

Many structured leadership programs (Basic Officer 

Leader Course, Captains Career Course, intermediate 

level education, joint professional military education, 

Joint Medical Executive Skills Program courses, and civilian training opportunities) are already well developed 

and have mature plans of instruction in place.

COL Bertram C. Providence

COL Frank L. Christopher

COL Kristie J. Lowry

COL Neil E. Page

COL Erin P. Edgar

COL Daniel S. Berliner

MAJ Patrick Birchfield

COL Thomas R. Burklow

COL E. Darrin Cox

COL Telita Crosland

LTC Melissa G. Givens

LTC(P) Stephen A. Harrison

LTC Mary M. Klote

LTC Brian A. Krakover

COL Randolph E. Modlin

LTC(P) Clinton Murray

COL Kelly A. Murray

COL Peter E. Neilson

COL Michael R. Nelson

COL Joseph S. Pina

COL Ronald D. Prauner

COL Stephen Salerno

LTC Elizabeth Sawyer

COL Douglas Soderdahl

COL Martin E. Weisse

COL Lisa L. Zacher

COL Charles W. Callahan

COL Leon E. Moores

Building the Bench:

Identify, Recruit, Build Experience

The following US Army Medical Corps officers collaborated in the development and writing of Chapter 5 of 

All Physicians Lead from which this section is adapted:
22 http://www.cs.amedd.army.mil/amedd_journal.aspx

Military GME programs are among the best in the world 

as measured by board certification pass rates. In addition, GME programs teach military-unique curricula. 

Officers who complete these courses are clinically wellprepared to practice within their specialties.

Informal mentoring, and in some cases formal mentoring, is common in medical centers with GME programs.

Gaps

While there are many excellent physician leaders in 

Army Medicine, the identification of leaders is often an 

accidental phenomenon. An “executive leader” is chosen at the last moment when a need is identified, and 

those closest to the available position anoint someone to 

take that job—a proximity choice.

Medical Corps officers often cannot take advantage of 

formalized schoolhouse training opportunities because 

the timing is not synchronized with the AMEDD timelines due to other training realities (residency, fellowship, board certification).

The targeted experiences necessary to qualify for specific leader roles are unclear. Other Army competitive 

category corps have positions considered to be branchqualifying jobs. In the AMEDD, there is no defined 

equivalent, and therefore no requirement to successfully 

complete branch qualifying jobs. Such positions exist, 

but incumbents are not required to progress professionally and earn promotions. Chief resident, brigade/

division surgeon, service/department chief, and deputy 

chief of clinical services assignments are all pathways 

to prepare Medical Corps officers for senior executive 

positions.

There are currently no organized short courses scheduled around large meetings such as the Association of the 

US Army, Medical Health System, and GME selection 

boards to provide a convenient opportunity to work with 

a large number of physician leaders as a group. Physicians who have been identified as potential leaders based 

on aptitude and ability should be steered toward appropriate leadership positions by their mentors in a deliberative fashion by the Leadership Development Committee.

There are no incentives to identify promising future 

leaders and invest the time (and lose the clinical workload) to enroll them in a formal leadership development 

program.

There is no centralized support (space, funding, informatics, people) to manage a leader succession program.

Closing the Gaps

Short Term (6-12 month) Goal: Identify Candidates 

for Future Senior Level Leader Positions.

Successful future leaders are usually individuals who 

succeeded in previous and varied leadership roles. These 

include not only leadership roles in the organization 

such as functional management team leaders and hospital committee chairs, but extracurricular leadership 

roles such as officers in parent-teacher student organizations, civic organizations, and professional societies. 

Documentation to support these experiences can be a 

CV, letters of endorsement, personal leadership philosophies, official transcripts, and service records.

When possible, identification will occur at the earliest 

point in the officer’s career where supervisors, peers, 

civilians, and even patients recognize them as having 

the potential for service as a successful leader. In some 

cases this could even be done at the interview phase for 

the Uniformed Services University of the Health Sciences or Health Professions Scholarship Program (HPSP) 

students. Candidates will be formally notified that they 

are recognized as a potential future leader and opportunities for leadership education and experiences can be 

tailored to student schedules and individual enthusiasm 

for the program.

Leader candidates from the HPSP will be identified at 

the earliest point in their medical education. Typical proponents for this portion include program director, service chiefs and medical treatment facility commanders. 

The treatment facility GME office will provide leadership development programs with appropriate guidance 

on nominative guidelines.

Officers who have served as prior enlisted Soldiers, 

who have served in other services, have served in the 

Reserve Officer Training Corps programs, or who have 

attended a service academy will have additional skills 

and experiences that improve both their receptiveness to 

leader development and the expression of leader skills.

The annual Joint Service Graduate Medical Education 

Selection Board is an opportunity for program directors to identify residents, and for department chiefs to 

identify junior staff who have potential for long-term 

AMEDD leadership for the Leadership Consultant 

group to manage more closely.

All nominee names will be forwarded to the Leader Identification Program committee. A letter of endorsement 

from the first colonel or captain (US Navy) in the chain 

The US Army Medical corps leadership development program
July – September 2013	 23

The Army Medical Department Journal

of command as well as any supporting documents could 

be required. The nominee will also submit a personal 

leadership philosophy statement. The committee will 

be comprised of a combination of 15 senior AMEDD 

and non-AMEDD officers selected by the Commanding 

General, US Army Medical Command/Army Surgeon 

General with recommendations from the Consultants to 

the Office of The Surgeon General (OTSG), GME directors, commanders, and the Medical Corps Chief.

Physicians who have demonstrated interest in visiting 

medical schools and premedical programs to recruit for 

AMEDD programs have self-selected and should be recognized for their incentive with the opportunity to wear 

the recruiting badge.

Intermediate Term (1-3 year) Goals

The mentorship subcommittee will create and manage a 

database that delineates and captures individual Medical Corps officer competencies, key skills, and leadership qualifications, as well as successful assignments in 

key leadership development positions (clinic chief, forward surgical team commander, battalion/brigade surgeon, service or department chief, etc). This database 

will be regularly updated in conjunction with input by 

program directors, Consultants to the OTSG, promotion 

and command boards (below the zone promotions, command select list selections, etc). The goal of the database is to allow the mentorship subcommittee to identify 

high potential officers early in their careers and to work 

closely with the Army Human Resources Command 

GME program directors, and OTSG consultants to provide the career path development required to be successful senior leaders in the AMEDD.

A progressive curriculum should be developed which 

identifies junior officers with leadership potential, and 

then provides the necessary formal and informal leadership skills development and opportunities for them to 

develop into midlevel leaders and subsequently into successful senior leaders. Due to the differences between 

training requirements and the duration of training for 

the specialties of the Medical Corps, the delineation 

between a junior officer and a midlevel officer may be 

more accurately reflected by the physician’s duties than 

by rank or time in grade. It is envisioned that this effort 

will identify and actively manage the careers of approximately 25% of Medical Corps captains, 20% of majors, 

15% of lieutenant colonels, and 10% of colonels.

The Brigade/Division Surgeon Course will significantly 

enhance the operational capability of the physician. The 

AMEDD Executive Skills Course and opportunities 

to pursue Long Term Health Education and Training 

through the Army-Baylor University program or in other 

Army-sponsored programs should be made accessible to 

midlevel officers who have been identified as potential 

senior leaders. During this time, formal mentoring remains a critical aspect of individual development.

A centralized or regional database will be developed for 

tracking and monitoring officers enrolled or interested 

in this program. The candidates can be categorized by 

area of interest (operational, clinical, command, academic, etc). Data will be derived from the individual’s 

personal statement, notes from the mentoring program, 

completion of the education curriculum, command input, and input from a candidate’s sponsor.

Once individuals are identified, they will be provided 

targeted experiences to allow them to grow into the next 

generation of successful leaders. These experiences can 

be defined for many levels of junior leaders. Leadership experiences must be catalogued and translated into 

qualitative metrics in order that junior physician leaders 

who are clinically oriented can somehow be compared 

to other AMEDD or line officers who have been platoon 

leaders and company commanders. Once the physician 

leaders have established technical competence within 

their specialty, such experiences allow them to broaden 

their perspective and develop a better appreciation for 

what other AMEDD and Army professionals are contributing to the fight. This group is mentored and managed closely. Their careers are followed closely by senior 

Medical Corps leadership and they are given opportunities such as resident intermediate level education, early 

deputy commander for clinical services positions, opportunities to attend a Army-Baylor program, etc.

Identified leaders will be provided the opportunity to attend leadership training courses, such as Training with 

Industry, or advanced schooling such as Master of Business Administration in Health Care, Master of Hospital 

Administration, or Master of Medical Management. In 

addition, the opportunity to participate in non-AMEDD 

courses will allow interactions with nonphysician leaders who may identify a potential leader who may not be 

apparent in GME settings.

Courses that target specific jobs such as department 

chief will be developed. In this example, course content 

would include information necessary to run a service or 

department in a medical activity or medical center and 

would include such topics as managing the table of distribution and allowances, human capital distribution and 

labor relations, basics of Lean Six Sigma, the interaction 

between the medical center and TriCare, clinical operational metrics, and clinical quality measures.
24 http://www.cs.amedd.army.mil/amedd_journal.aspx

The Medical Corps website will list educational opportunities linked to career maps, highlighting self-taught, 

local, centrally-funded and civilian opportunities for advanced training in leadership and management. A list of 

minimum prerequisites and expected skill sets will be developed for senior leadership positions, with an interactive “report card” demonstrating to the individual his or 

her progress toward self-development and requirements 

for senior positions in which he or she may be interested. 

Funding would be obtained to increase availability of 

Training With Industry type programs instead of senior 

service college for additional years of commitment or for 

agreement to accept a key leadership position.

A matrix cross-linking career paths (administrative, 

clinical, academic, research, operational) with specific 

required education and recommended experience will 

be developed for each individual and regularly updated. 

Officers will be able to clearly see where they are on the 

development timeline by printing a report summarizing 

their leadership development, short-term and long-term 

goals, and suggested leadership roles for their level of 

training and experience.

Long Term (3-5 year) Goals

As the Leadership Development Committee and the 

Leadership Development Program mature, the infrastructure required to support the program will increase. 

Planning should begin for space and equipment, a program manager, data managers, webmaster, etc, to allow 

ongoing success of the program. Some of these jobs can 

be additional responsibilities for some individuals, especially the various committee members, but the program 

will require professional management.

The implementation of an executive skill designator 

would allow formal recognition. An additional skill 

identifier similar to the “9” series (in residency, fully 

trained, board certified, OTSG recognition) will be 

developed, with various letters following the number 

identifying the progress toward leadership training. For 

example, if the leadership identifier is 7, 7D would designate initial leadership coursework completed (such 

as the Basic Officer Leader Course, Captains Career 

Course, and Joint Medical Executive Skills Institute); 

7C would designate additional training and experience, 

including board certification, clinic leadership, intermediate level education, etc; 7B would designate further 

training and experience to include brigade surgeon, 

forward surgical team command, departmental leadership, residency program director, etc. Similar to the 9A 

designator, 7A would designate a fully trained, successful senior leader, award of which would be approved by 

OTSG based on recommendation by the Medical Corps 

Chief. Requirements for this designation would include 

completion of a successful leadership tour. The requirements for these designators will necessarily be broad so 

that officers on various career tracks (administrative, 

clinical, research, operational) can achieve recognition 

and designation. However, there will be enough commonality in course content and similarity in leadership 

experience to allow leaders in one career track to move 

into another area during his or her career. Key positions 

will require a specific level of skill identifier.

Summary

Our nation’s best and brightest have chosen to simultaneously serve 2 professions which embody both service 

and leadership: medicine and the profession of arms. 

Selections to medical schools, internships, residencies, 

and fellowships have well-defined, transparent requirements that are essentially uniform across the allopathic 

and osteopathic programs. Our Medical Corps has an 

opportunity now to develop a similar model to identify, 

nominate, and recruit the right officer physicians to successfully lead the health care profession in our Army.

A Question and Leaders’ Answers

She is clearly the best resident you have ever known. 

She quickly mastered the skills of her medical discipline and now has been engaged at the department 

and hospital levels working with a team on performance improvement initiatives. Her interpersonal 

skills are as extraordinary as her clinical skills, and 

you know that with her Reserve Officer Training 

Corps college scholarship and her attendance at the 

Uniformed Services University of the Health Sciences, she has a long active duty commitment. She 

will clearly be a leader in the Medical Corps and the 

AMEDD. How would you recommend that her career be managed? By whom and how?

High performers often run for the exhilaration of the 

run, not the finish line. This resident is a high performer 

who will run selflessly, but perhaps to her own detriment. Occasionally, undirected energy benefits no one, 

not her, her patients, or the military that could eventually benefit from her leadership. The coach or teacher 

knows when to hold the high performers back, when to 

redirect, and when to release them. This is what is required of the senior leader mentoring and managing the 

career of a highly talented, future physician leader.

First and foremost, she must be told that we have seen 

her skills and understand her potential, and would like 

to know what she sees in herself. We cannot assume 

that she has the same future vision as we have, but this 

first step will allow the occurrence of “resonance” as 

described by Goleman et al,9

 and thereby an unfolding 

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July – September 2013	 25

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of a magnified vision for her future success. Once a synchronous relationship is established, she can be allowed 

to participate in a few structured experiences (such as 

action officer for a new program) with very specific outcome measures and regular feedback sessions. These 

experiences should be tailored to core competencies of 

both clinical leadership and military leadership (culled 

from the residency review committee and Joint Medical 

Executive Skills Program).

Her resident advisor should manage her, but, as she progresses in skill, the program director, department chief, 

deputy commander for clinical services, and hospital 

commander will all have a requirement to manage her 

skill development drawing from their own experiences 

to expose her to progressively more complex learning 

experiences. The program director will necessarily 

have to ensure that her military education (Basic Officer Leader Course, Captains Career Course) have been 

mapped out and her subsequent supervisor will have to 

ensure intermediate level education (a strong transfer 

from the losing command) and further development are 

arranged.

COL Neil E. Page

Deputy Commander for Clinical Services

Montcrief Army Community Services

Fort Jackson, South Carolina

This is the kind of officer that we want to be the backbone of the AMEDD moving forward. It is critical that 

she is mentored and coached by a senior leader(s) with a 

clear understanding of the opportunities that exist within the AMEDD and who can articulate the pathways to 

help facilitate her continued progress. Depending on 

her specialty and location, it would seem that her program director or division/department chief would be the 

initial officer to coach her in career development. This 

may be as simple as arranging a meeting or series of 

meetings with the young officer to convey the fact that 

she has been identified as someone with a significant 

amount of potential, not just as a future leader in her 

chosen field, but also as a potential future leader within 

the AMEDD. Subsequently, her name would be submitted to the Leader Identification Program Committee 

with a letter of endorsement from the first colonel or 

captain [USN] in her chain of command and a personal 

statement from the junior officer outlining her personal 

leadership philosophy.

Within the construct of these early meetings, it would 

be imperative for the mentor to outline what options are 

available outside of her specific area of concentration, 

including administrative and operational assignments. 

In addition, the military education that is required to 

continue to progress in these specific tracts should be 

clearly delineated. These would include the Captains 

Career Course and intermediate level education. Furthermore, this would also be the time for counseling on 

how to write a curriculum vitae, to review her officer 

record brief (ORB), and instruction as to how to manage 

the ORB throughout her career.

Her mentor(s) and the Leader Identification Program 

committee will work closely with this young officer to 

ensure that she achieves the milestones needed to continue her career progression in the field that she has chosen. 

We must ensure that this junior officer is afforded every 

opportunity to become an outstanding, future AMEDD 

leader while mitigating potential pitfalls along the way.

LTC(P) Stephen A. Harrison

Chief, Hepatology/Gastroenterology Service;

Program Director, Gastroenterology Fellowship

Program, San Antonio Military Medical Center;

Consultant to The Surgeon General for

Gastroenterological Diseases

Hospitals are the sinks of human life in an army. 

They robbed the United States of more citizens than 

the sword.

Dr Benjamin Rush19

Medicine used to be simple. 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 the nursing care. The ownership of the healthcare delivery processes belonged to the patient and family. The most the 

doctor could offer was often palliative. The best the doctor could hope for was to separate the patient’s presentation from his or her demise with enough time to avoid 

culpability. He often left with his fee-for-service on a 

leash or in a bushel.

Physicians must Lead:

the elusive “Sweet-spot” of healthcare delivery

COL Charles W. Callahan, MC, USA
26 http://www.cs.amedd.army.mil/amedd_journal.aspx

After a several century hiatus, healthcare is returning 

to the home, back to the control of the patient and the 

family where both the authority and the responsibility 

to direct health and well-being must ultimately lie. The 

transformation will run across the grain of our delivery systems, our education platforms, and our medical 

business models. The changes will require professionals 

with the willingness and skill to lead in the face of powerful resistance.

In the history of healthcare, hospitals emerged for several reasons: to cohort the sick, to deliver more efficient 

care to the poor, and to quarantine the contagious from 

society. Hospitals also developed around the need to 

train more providers. In 1714, Herman Boerhaave incorporated clinical bedside teaching at St. Cecaeilia’s Hospital in Leiden. His hospital-centric system for training 

physicians became the model for Europe 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.” 20 Today’s medical student and resident education depend on 

the same system.

What happened to healthcare when it moved from the 

home to the hospital? Hospitals of the 17th and 18th centuries were regarded with dread. The sick were usually 

better off at home.21(p72) In the hospital, the family relinquished control of the healthcare processes they owned 

when their loved one was at home. Providers also abdicated partnership with patient’s families to the staff 

of large wards who before the formalization of nursing 

care had insufficient training and ill-defined duties.

Medicine and healthcare delivery have not become any 

less complex since the 18th century. And yet, 300 years 

later ownership and leadership of the system is no clearer. 

Hospitals are often places where insufficiently informed 

patients are exposed to highly dangerous situations inflicted by well-trained, 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. This is to say nothing of the near complete lack 

of continuity between inpatient and ambulatory patient 

care in nearly every setting. As of yet, no profession has 

emerged in this system of “disintegrated,” desynchronized care to lead from chaos to patient safety.

The growth of cities in the United States between the 

17th and 18th centuries also helped to drive medical care 

from the home to the hospital and to paid professionals 

selling their services in a competitive market. According 

to sociologist Paul Starr, this transition of care from the 

home to the market place and the evolution of medical 

care into as “a commodity” is one of the most significant 

transformations in American medicine.21

The delivery of healthcare today is still driven by a commodity business model that rewards office based intervention, pays a premium for technologically dependent 

procedures, and preferentially reimburses for inpatient 

stays. It undervalues prevention and low cost management of chronic disease using telecommunication or the 

internet, the very methods patients would prefer to use 

to manage their healthcare.

The military health system has also embraced the civilian business model. We use the same measures of effectiveness and productivity. Thus military and civilian 

medicine are trapped together in a commercial system 

of healthcare delivery. No profession has emerged in the 

context of this flawed business model to lead medical 

practice in the direction that patients really need and 

want: health rather than just the absence of disease.

While the commercial model is built around the office, 

the clinic, and the hospital; and patient safety efforts 

rightly target the dangers of inpatient care, today most 

healthcare happens at home. Despite a hospital-centric 

approach to healthcare and provider education, only a 

relatively small number of people enter the healthcare 

system at any given time.

Healthcare ecology is a model that helps to describe the 

health concerns of a population and the sources of care. 

For example, based on national surveys for a population 

of 1,000 people over the course of a month, 800 have 

medical symptoms and 327 consider seeking care. Only 

217 of the 1,000 hypothetical patients will visit a physician’s office, and only one is hospitalized in an academic 

teaching hospital.22-24 The others ignore their symptoms, 

seek alternative sources of care, or seek care at home 

from other sources just as they did in centuries past.

In the future, our healthcare system must take the patient’s life and priorities into consideration. Processes 

will allow for patients empowered by medical information, insight, and access to their records to decide what 

they themselves need. Healthcare will be convenient. 

Telemedicine and telehealth practices will abound. Access to care will be the window, wide open, between 

healthcare supply and demand. Access will include provider appointments, patient emails, text messages, nurse 

triage, and provider phone calls. Care will be driven by 

demand, not supply.

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Traditionally, access has been used to describe populations with healthcare insurance or the availability of a 

provider visit. Future systems will redefine access. Patients and their families are busy. Healthcare is just one 

of the priorities they juggle. They see healthcare access 

differently than those who provide it. 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.) Only a small 

percentage of the patient’s need and desire for access 

requires a traditional healthcare visit. They would rather 

be at home.

Healthcare leaders must be prepared and poised to shepherd the disruptive changes that loom for the American 

medical system. These leaders must be experienced 

members of the healthcare team who are familiar enough 

with the direct provision and practice of healthcare both 

within and outside of the hospital to be able to discern 

the needed changes from the background of commercial 

chaff. They must be sufficiently steeped in the study of 

leadership to have the range of skills necessary to lead 

the medical team, the community, medical education 

institutions, and our political systems through the most 

profound season of change in US healthcare history. 

They must be able to inspire and to teach the need for 

change to the remainder of the healthcare team and the 

American population. 

An American healthcare reformation is coming. The 

transition will span the next generations. Physicians 

have the experience and technical skills to lead the 

change in both military and civilian medicine. The time 

for deliberate physician leadership training has arrived.

Will we be the leaders—or the led?

A Question and Leaders’ Answers

Postretirement you find yourself consulting for an 

organization working with a large civilian healthcare system. Your expertise is being leveraged as 

you help them transition to the new, required, accountable healthcare organization guidelines. What 

lessons from healthcare leadership will you draw 

from, and how will you apply them as you become a 

consultant to your civilian brethren? What tools will 

you use to assess your strengths and weaknesses 

in this new leadership environment? Whom within 

your organization will you seek for guidance and 

mentorship, whom from outside your organization, 

and whom will you choose to mentor? How will you 

assess your performance as you move forward?

There are as many roles in consultancy postretirement 

as there are major aspects to health improvement and 

healthcare delivery. Consultants provide optimal prevention strategies, quality improvement methodologies, 

guidance in selecting and training the best employees 

for an effective and efficient healthcare organization, 

and insight into the optimal use of emerging technologies in providing patient-centered guidance on tailored 

health advice, medical diagnostics, and therapeutics. All 

are familiar to military medical leaders who have had 

to grapple with very similar issues over the past two to 

three decades, and especially during the decade of conflict through which we have navigated.

Healthcare outcome and financial accountability, improvements in population health, achieving and sustaining or restoring optimal health and function, and rapid 

adoption of evidence-based administrative and clinical 

practices have all been cornerstones of military medicine. Few large, fully integrated systems of health and 

healthcare have such a long record of striving to maintain optimal health, and of advancing cutting edge diagnostics and therapeutics as the US Military Health 

System.

Whom I shall seek for mentorship (among former coworkers and superiors or newly acquired colleagues), for 

improvement in my consulting skills, and in closing gaps 

in specific knowledge will rest entirely upon the context 

of the work I will seek and the clientele I will serve. Remaining open to learning; agile in thinking; receptive 

to constructive criticism; circumspect about my impact; 

and deeply values-based standards regarding honesty, 

integrity, trustworthiness, and the demonstration of 

personal courage in matters where these are challenged 

seem to me to be the keys to success. All of these are the 

attributes of the best military medical leaders as well.

LTG (Ret) Eric B. Schoomaker

The Surgeon General of the Army, 2007-2011

The successful transition of a senior medical leader following retirement from the military is an appropriate 

capstone thought exercise for this work. It encapsulates 

all we have discussed about institutional learning, selfstudy, and experience, and it highlights the need for lifelong learning well into the most senior level leadership 

positions.

The first step in answering all of the questions is to perform a needs assessment relative to your new organization and your role within. As a consultant, you are expected to bring knowledge gained from prior experience 
28 http://www.cs.amedd.army.mil/amedd_journal.aspx

and study, but each situation is unique. Depending upon 

the urgency of the situation and the timeframe required 

to produce appropriate consulting results, this needs assessment may take several days to several weeks.

It is important to determine if your energy is required at 

the strategic or operational level, keeping in mind that 

exploration of the tactical level will also be an important 

part of the needs assessment.

Once this analysis is complete, you will be able to determine which of your consulting requirements are personal strengths and which will require self-study or outreach to subject matter experts. You will not have time 

to become knowledgeable in every aspect of this organization’s transition—you must focus your study.

At this point in your career, you have made connections 

with other senior leaders who may have gone through 

similar transitions with their organizations. Learn from 

their experience. Furthermore, ask them who they contacted for advice when they were going through their 

organizational transition. If appropriate within your organization, consider bringing some of these individuals 

onto your team as subject matter experts.

Many private organizations such as the American College of Healthcare Executives and the American College 

of Physician Executives possess a wealth of written resources and human contacts also able to assist you in everything from needs assessment through execution and 

performance measurement. Additionally, government 

organizations at the federal and state level directing this 

accountable care transition will have resources and consultants available. Take advantage of these, as success or 

failure will be measured based upon adherence to specific guidelines.

Yours will not be the first organization these government entities have shepherded through the process, and 

your status as a military retiree may allow you valuable 

access to senior civil servants with a wealth of knowledge. If there is sufficient time, focused coursework at 

one of the nation’s business schools may complement the 

work you are doing. There is nothing like didactic study 

in the midst of hands-on work to cement knowledge 

into place. This is what we all accomplished during our 

residency programs. Finally, numerous books and periodicals are available and can be accessed based upon 

knowledge gaps you find initially or during subsequent 

feedback sessions.

Obtaining feedback on your performance in such a rapidly changing environment can be difficult, but it is essential that you continuously check with the leadership 

of the organization, individuals who work most closely 

with you, and as many external contacts as possible who 

have visibility of your work. While you will almost certainly be measured by objective metrics, it is also important that you consistently ask for feedback and accept 

that feedback with positivity and grace. Your sincerity 

and appreciation will ensure that you will continue to receive this essential feedback, allowing you to constantly 

adjust and provide the service the healthcare system 

needs.

COL Leon E. Moores,

Leadership Consultant, US Army Medical Corps

Special Assistant to the President, Uniformed Services

University of the Health Sciences

References

1. McInnis D. What system?. Dartmouth Medicine. 

2006;30(4):32. Available at: http://dartmed.dartmouth.edu/summer06/pdf/what_system.pdf.xxxxx

Accessed April 1, 2013.

2. Hymowitz C, Murray M. General Electric’s Welch 

discusses his ideal on motivating employees. Wall 

Street Journal. June 21, 1999. Available online at: 

http://www.wright.edu/~tdung/welch.htm.xxxxxx

Accessed April 1, 2013.

3. Famous Quotes by Vince Lombardi. VinceLombardi.com website. Family of Vince Lombardi c/o 

Luminary Group LLC. Available at http://www.

vincelombardi.com/quotes.html.xxxxxxxxxxxx

Accessed April 1, 2013.

4. Army Doctrine Reference Publication 6-22: Leadership. Washington DC: US Dept of the Army; 

September 10, 2012. Available at: http://armypubs.

army.mil/doctrine/DR_pubs/dr_a/pdf/adrp6_22_

new.pdf. Accessed April 1, 2013.

5. 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.

6. Kirby SN, Marsh JA, McCombs JS, Thie HJ, Xia 

N, Sollinger JM. Developing Military Health Care 

Leaders. Santa Monica, CA: RAND Corporation; 2011. Available at: http://www.rand.org/pubs/

monographs/MG967.html. Accessed April 1, 2013.

7. Army Regulation 40-501: Standards of Medical Fitness. Washington, DC: US Dept of the Army; 2011.

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8. Letter from Dwight Eisenhower to John Eisenhower, June 19, 1943. Abilene, Kansas: Eisenhower 

Library. Cited by: Ambrose SE. Eisenhower’s generalship. Parameters. June 1990;XX:2.

9. Goleman D, Boyatzis R, McKee A. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston, MA: Harvard Business School 

Press; 2002.

10. McMaster HR. Dereliction of Duty: Lyndon Johnson, Robert McNamara, the Joint Chiefs of Staff, 

and the Lies that Led to Vietnam. New York, NY: 

HarperCollins Publishers; 1997.

11. Myrer A. Once An Eagle. New York, NY: Harper 

Collins Publishing; 2002 [original ©1968].

12. Michelman P. What an executive coach can do for 

you. Harvard Business School Working Knowledge. June 13, 2005. Available at: http://hbswk.hbs.

edu/archive/4853.html. Accessed April 2, 2013.

13. Geist LJ, Cohen MB. Mentoring the mentor: executive coaching for clinical departmental executive 

officers. Acad Med. 2010; 85(1):23-25.

14. Army Mentorship Handbook. Rosslyn, VA: DCS 

G-1 Headquarters, Dept of the Army; January 

2005. Available at: http://www.armycounselingon

line.com/download/Mentorship%20Handbook.

pdf. Accessed April 2, 2013.

15. Army Regulation 600-60: Physical Performance 

Evaluation System. Washington, DC: US Dept of 

the Army; 2008.

16. Army Regulation 40-400: Patient Administration. 

Washington, DC: US Dept of the Army; 2010.

17. Army Regulation 635-40: Physical Evaluation for 

Retention, Retirment, or Separation. Washington, 

DC: US Dept of the Army; 2006.

18. Mintzberg H. The Nature of Managerial Work. 

New York, NY: Harper & Row; 1973:190.

19. Rush B. The result of observations made upon the 

diseases which occurred in the military hospitals 

of the United States, during the Revolutionary 

War Between Great Britain and the United States. 

In: Rush B. Medical Inquiries and Observations. 

Vol. 1. 2nd ed. Philadelphia, PA: J Conrad & Co; 

1805:276. Available at: http://archive.org/stream/

medicalinquiries01rush#page/n5/mode/2up.xxx

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20. Magner LN. A History of Medicine. Boca Raton, 

FL: Taylor & Francis Group; 2005:346.

21. Starr P. The Social Transformation of American Medicine. New York, NY: Perseus Books 

Group;1982.

22. White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;265:885-892.

23. Green LA, Fryer GE, Yawn BP, Lanier D. Dovey 

SM. The ecology of medical care revisited. N Engl 

J Med. 2001;344(26):2021-2025.

24. Dovey S, Weitzman M. Fryer G, Green L, Yawn 

B, Lanier D, Phillips R. The ecology of medical 

care for children in the United States. Pediatrics. 

2003;111:1024-1029.
30 http://www.cs.amedd.army.mil/amedd_journal.aspx

With over 35 years of healthcare leadership under my 

belt, and an uncountable number of paid and complimentary presentations on the subject, you would think 

I should have no problem penning some thoughts about 

leading fellow healthcare professionals. The truth is, 

there may be nothing more daunting than trying to 

stand out among the throngs of authors already writing 

about leadership.

In December 2012, Amazon books had over 96,000 hits 

for the keyword leadership, while the Harvard Business 

School listed 370 articles on the topic (http://hbswk.hbs.

edu/topics/). Within our own healthcare profession, the 

wide range of options can be just as unwieldy. Amazon 

books listed 1,258 hits for healthcare leadership, while 

the American College of Healthcare Executives’ own 

Health Administration Press listed 50 titles (http://www.

ache.org/hap.cfm). On a narrower front, the American 

Organization of Nurse Executives, in conjunction with 

the American Hospital Association, offered 70 titles on 

its webpage (http://ams.aha.org/eweb), and the American College of Physician Executives offered a dozen 

(http://www.acpe.org/publications). The topics run the 

gamut of models as authors try to teach us the way to 

succeed based on the leadership traits of Attila the Hun 

to those of Bob Hope, based on skills learned on the golf 

course to those learned on the battlefield, and based on 

secrets from Star Trek and from Santa Claus.

In my opinion, most of the authors of leadership books, 

articles, and checklists assume that their readers have a 

well-formed concept of themselves as a leader. But, in the 

rush to lead others, it appears that many early-, middle-, 

and late-career leaders have yet to develop that sense of 

who they are relative to being a leader. Too many of us 

try to emulate Attila the Hun or Santa Clause before we 

know who we are and what we are about. Would it not 

be wonderful if more of us, me included, had a much 

more accurate understanding of ourselves as leaders so 

that we could better excel at the responsibility of leading 

others?

How do we proceed to know what we are about? The 

foundation for knowing about ourselves as a leader is 

being able, in a private conversation before a mirror, to 

describe what we strive for as our own personal leadership mission, vision, and values.

Mission

Private Dwayne Turner was a combat medic in the 101st 

Airborne Division. In 2003, he and his unit were violently attacked by insurgents south of Baghdad, Iraq. At 

the onset of the attack, Turner was wounded when hit by 

hand grenade fragments. He saw a wounded Soldier and 

“checked him out, and tried to get him into a building.” 

He then left the relative safety of the building to continue “assessing the situation, seeing who was hurt, giving 

them first aid and pulling them into safety.” In the process, Turner, already wounded with grenade fragments, 

received additional fragment wounds and was further 

hit with gunshots that injured his left leg and broke his 

right arm. He remembered someone telling him he was 

wounded and, when seeing the blood, thinking “oh hell, 

if I’m not dead yet, I guess I’m not dying.” Despite the 

realization that “it would have been really easy to just 

stay in that corner.... I realized I could let them continue to get hurt—and possibly die—and not come 

home to their families, or I could do something about 

it.” He chose the latter and continued to leave the relative safety of the building to bring in the wounded until 

his injuries forced him out of action. Despite receiving 

multiple serious wounds himself, Private Turner repeatedly moved openly around the battlefield to care for 16 

fellow Soldiers. He was credited with saving at least 2 

lives. When he received the Army’s Silver Star his reply 

was to profess that “other people may see me as a hero; I 

see myself as doing my job.”1

Turner’s job as a combat medic—his mission—was to 

keep his fellow Soldiers healthy and to care for them 

when they became ill, injured, or wounded. He well understood his mission and did not allow external influences to dissuade him from accomplishing it. What is 

instructive is that Turner’s mission, though nested within his unit’s mission, was unique to him. It helped accomplish the organizational mission, but was not a mirror of it. Private Turner serves as a springboard for each 

of us. He had the benefit of having platoon sergeants 

and instructors repeatedly drill into him his mission as 

a medic. Most of us do not have the benefit of that direct, 

in-your-face instruction. Instead, we have to develop 

our leadership mission through study, observation, and 

practice. Our goal should be the ability to look within 

ourselves and state our personal mission as a healthcare 

leader. What is your personal leadership mission?

Know Yourself, in Order to Lead Others

MG David A. Rubenstein, US Army Retired
July – September 2013	 31

Vision

Private First Class Monica Brown was awarded the 

Silver Star for her actions in 2007 while assigned as a 

combat medic to the 82nd Airborne Division’s 4th Brigade and attached to 2nd Platoon, Charlie Troop, 4th 

Squadron, 73rd Cavalry Regiment. Brown was the only 

medic in a 5-vehicle convoy returning to the unit’s forward operating base from a mission at a nearby village 

in Paktika Province, Afghanistan. One of the trail vehicles triggered a roadside bomb which was followed by 

an insurgent attack with mortar and machine gun fire. 

“They stopped the convoy. My platoon sergeant got out 

of the truck and said, Doc, let’s go,” Brown recalled. After running 300 meters with her aid bag, Brown went 

into immediate action to care for the 5 Soldiers injured 

in the attack while the battle raged around her and ammunition started exploding in the vehicle that hit the 

bomb. She first assessed the situation, and then rendered 

immediate care to the most severely injured. While she 

was treating the most compelling injuries, the enemy attacked with mortar rounds that endangered Brown and 

the casualty she was treating, so she “dove over him. [I 

made] sure he didn’t get any shrapnel or anything from 

it,” she recalls. With the casualties triaged and immediately treated, Brown and her fellow Soldiers loaded 

them into vehicles and moved out of harm’s way to continue treating them and to meet a medical evacuation 

helicopter. After the wounded were flown away, Brown 

stopped to consider what had just happened. Then, she 

has admitted, “I threw up.” Brown has also said of her 

actions “I wasn’t scared for my life. I was scared because I was afraid I wasn’t gonna be competent and able 

to do my job.”2

Brown’s vision of the future of her role was that of a 

focused, competent, and able combat medic. Her actions in the face of this combat operation certainly allow 

her to look back at what she did and compare it very 

favorably to the vision she had of herself as a combat 

medic. We each have a vision of what we want to see 

about ourselves when we look back on our career. As 

leaders, we work in organizations where leaders, both 

us and those above us, have identified a vision for the 

organization. From a personal perspective, though, our 

vision as a leader is something different. Our personal 

vision is one that describes what we want to have accomplished when we look back on our career or on a 

segment of that career—an assignment, a project, or a 

specific effort. What is your personal vision of yourself 

as a leader?

Values

Private First Class Stephen Tschiderer received no 

medal. He just did his job. PFC Tschiderer is a combat 

medic who, in 2005, was attached for duty to 3rd Battalion, 156th Infantry Regiment, 256th Brigade Combat 

Team, 3rd Infantry Division. He was with his unit on a 

convoy in the western part of Baghdad, Iraq, looking for 

someone shooting at Americans. At a stop, Tschiderer 

dismounted and walked around his vehicle. While engaged with his duties, an enemy sniper team in a van 

across the street and not more than 75 meters away, took 

careful aim on Tschiderer. Their aim was excellent, as 

a bullet from a Dragunova sniper rifle tore a hole in his 

jacket and embedded in his body armor directly over his 

heart. After being knocked to the ground by the force of 

the bullet, Tschiderer bounced up and ran for cover. In 

his words “It’s not a big deal that I got shot, I’m a Soldier, 

and Soldiers get shot every day.” He then directed his 

platoon’s attention toward the sniper’s location. During 

the ensuing vehicle chase, the sniper received wounds 

that hobbled him, but that did not prevent him from running off. Tschiderer then pursued on foot and was part 

of the team that caught up with the insurgent and captured him. After capturing and handcuffing the sniper, 

the same person who had just shot him in the chest, Tschiderer started treating his wounds. “He was hurt and I 

had to do my job,” he said. “I’m a medic. It’s my job. It 

doesn’t matter, friend or foe, soon as he’s put down his 

weapons, I’ve got to treat him.”3,4

Stephen Tschiderer is a Soldier. As such, he’s constantly 

bombarded with reminders about the values a Soldier is 

held responsible for keeping. The same is true for millions of men and women over the years who have served 

the Army as Soldiers or Army Civilians. Each has been 

held responsible for adhering to the Army Values during 

the conduct of their professional lives and responsibilities. 

But, sadly, there is a gulf between knowing one’s organizational values and living them. We as leaders need to 

know more than the values of the organization to which 

we belong. We need to know what our personal values 

are, and we need to live those values in our dealings with 

others. What are your personal values as a leader?

Internal Expectations, External Realities

I am often asked if all the introspection is really necessary. Do we as leaders really need to know what we hold 

as important? Can we just wing it? My answer is yes, we 

need to know who we are, and no, we cannot just wing 

it. There are a host of reasons for my answers, most of 

which you could easily recite. Here is the most obvious 

one, though we may not think about it too often. Being able to describe to ourselves what we strive for as 

our mission, vision, and values are important because 

of what those around us see—our internal expectations 

are seen and judged as external realities. What we strive 

for is internal. What we actually do is external. And, as 
32 http://www.cs.amedd.army.mil/amedd_journal.aspx

we should realize, our people, those around us whom we 

are leading and affecting every day, know our mission, 

vision, and values very well. They make this assessment 

based on how we act, how we behave, how we make 

decisions, and how we lead.

If we know what we want to be as a leader—our mission, our vision, and our values—we will be better 

able to provide that leadership to our people and our 

organizations.

References

1. American Forces Press Service. 101st Airborne 

Division Soldier receives Silver Star. February 11, 

2004. Available at: http://www.defense.gov/News/

NewsArticle.aspx?ID=27336. 

Accessed April 18, 2013.

2. CBS News. Pvt. Monica Brown and the Silver Star. 

February 11, 2009. Available at: http://www.cbs

news.com/8301-18560_162-4635035.html. 

Accessed April 18, 2013.

3. American Forces Network Iraq. Medic survives 

sniper attack package. Defense Video & Imagery 

Distribution System. July 27, 2005. Accessible at: 

http://www.dvidshub.net/video/11411/medic-sur

vives-sniper-attack-package#.UOMorG-1XYY. 

Accessed April 18, 2013.

4. Robicheaux E. 256th Brigade Soldier recalls sniper 

attack. Defense Video & Imagery Distribution System. August 30, 2005 Retrieved from http://www.

dvidshub.net/news/2863/256th-brigade-soldierrecalls-sniper-attack#.UOM8-m-1XYY. 

Accessed April 18, 2013.

Author

MG Rubenstein retired from the Army after a 35-year 

career culminating as Commanding General of the 

Army Medical Department Center and School and 16th 

Chief of the Army Medical Service Corps. He is a Fellow, 

American College of Healthcare Executives, Clinical 

Associate Professor of Health Administration at Texas 

State University, and a public speaker on the topics of 

leadership, mentoring, and ethics.

Know Yourself, In Order to Lead Others

Articles published in the Army Medical Department Journal are indexed in 

MEDLINE, the National Library of Medicine’s (NLM’s) bibliographic database 

of life sciences and biomedical information. Inclusion in the MEDLINE 

database ensures that citations to AMEDD Journal content will be identified 

to researchers during searches for relevant information using any of several 

bibliographic search tools, including the NLM’s PubMed service.
July – September 2013	 33

Trust: this small, 5-letter word can move an organization forward or stop it completely. Its powerful ability to 

make or break a unit has made it a top priority of Army 

leadership in recent years. 

In a recent interview with Army Times,

1

 Army Chief of 

Staff GEN Ray Odierno said “Whether you’re a lieutenant, whether you’re a captain, whether you’re a 4-star 

general, you have to constantly earn [Soldiers’] trust, 

and they don’t ask for a whole lot. What they want you 

to do is be true to your word. They want to know you’ll 

fight for them when necessary. They want to know you’ll 

make the hard, tough decisions when necessary, whether 

it be in combat or not. That’s what they expect from you.”

Trust is leading. A dictionary definition of trust is the 

“assured reliance on the character, ability, strength, or 

truth of someone or something.”2

Successful leadership cannot exist without trust. Building it must be intentional, and requires diligence and 

perseverance. The respect of those you lead is earned 

and does not exist outside of a climate of trust. The core 

Army values of loyalty, duty, respect, selfless service, 

honor, integrity and personal courage are fostered by the 

presence of trust. Clearly, trust in an organization can 

empower a unit; the lack of trust can destroy it. If your 

unit has lost trust in you, you have lost the ability to lead.

While understanding the importance of trust appears 

straightforward, earning trust in an organization may 

seem like a daunting task. Depending on the command 

climate established by the leadership, achieving trust 

may either come quickly or take a substantial amount of 

time. In their research, Mishra and Mishra3

 noted that 

trust in a leader develops over time as “it is based on repeated experiences that have been validated in a variety 

of situations.”3(p8)

During my recent command experience, I determined 

that 4 key elements are critical to building trust in any 

organization: confidence, reliability, empowerment, and 

care of others.

Confidence in the Command

Building trust requires confidence in the command. 

Members of an organization must be able to place 

confidence in their leadership no matter the situation. 

When confidence is broken, the ability to trust is paralyzed. Trustworthy leaders can be “depended upon 

when things go well and when they do not.”3(p8)

The team must have confidence in the leadership to ultimately make the right decision for the benefit of the 

organization rather than their self interests, especially in 

the tough times. Effective leaders understand the organization and its mission are far bigger than themselves. 

The leader builds confident teams who will loyally follow them and fight for the success of the mission.

Commanders also instill confidence in others when 

they demonstrate confidence in their own ability to lead. 

Confident leaders are not afraid to make decisions, and 

build trust when they tackle the tough issues by making 

the right decision rather than the easy one. Instead, toxic 

leaders erode trust in the organization.

As GEN Odierno explains, “A toxic leader might abuse 

his subordinates, or is unable to empower his subordinates. It also could be a leader who is unwilling to make 

decisions or makes decisions for his own benefit and not 

the benefit of the organization.”1

Reliability

People don’t listen to you speak; they watch your feet.

Anonymous4(p128)

Trust comes when leaders are true to their word. Actions speak louder than words. When a team sees their 

leader putting his or her talk into action by consistently 

doing the right thing for the team, trust is built. Leaders 

establish high expectations for themselves and others by 

being true to their word and keeping their promises.

Breaking your word destroys trust. You have to follow 

through on what you are going to say you are going to 

do. If you fail at this task you start to whittle away at the 

trust within the unit.

CPT Charles Wyatt, company commander, 

232nd Medical Battalion, April 23, 2013

Trust is not just handed to you; it is earned through hard 

work. You earn it by being honest and truthful and not by 

twisting the truth around. People watch you closely and 

really see if you are being straight up with them.

1SG Gilberto Colon, 232nd Medical Battalion, April 24, 2013

Trust: the DNA of Leadership

COL Eric Sones, MS, USA
34 http://www.cs.amedd.army.mil/amedd_journal.aspx

You can say a lot of things, but unless you actually do 

them, your words will not build trust; in fact, they will 

destroy it. Stephen Covey4(p128)

Effective leaders also build trust through consistency. If 

you say you are going to do something, do it. It’s difficult to ask the team to be reliable, when you are unwilling to do the same. 

Trust is also developed when a leader has the courage to 

take responsibility for his/her mistakes. Contrary to popular belief, apologizing is not necessarily a sign of weakness. Owning up to your mistakes illustrates honesty 

and transparency, and builds an environment of trust.

Mishra and Mishra point out that “We...have found that 

apologizing is often a necessary and even first step in 

fostering open and honest communication when trust 

has been broken.” Further, “...the reality is that while 

trust can be robust, it quickly becomes fragile when 

mistakes or wrongdoing occurs without ready acknowledgment and making amends.”3(p167)

Empowering Others

The people when rightly and fully trusted will return the 

trust. Abraham Lincoln

Micromanagement stifles trust because it sends the message that the command does not trust them to do their job 

effectively. Team members are unable to thrive in an environment of micromanagement. Tunnel vision replaces 

great ideas because subordinates no longer take risks.

Leaders build trust by giving their subordinates the flexibility to do their job, take risks, and, if necessary, learn 

from their mistakes.

I appreciate the trust the leadership put in me by allowing 

me the freedom to command and learn from my mistakes.

CPT William Pitt, company commander, 

232nd Medical Battalion, March 25, 2013

If I make a mistake, the positive environment created 

by the command team lets us learn from a mistake. We 

become better leaders when we can trust our command.

SFC Philip Baldwin, platoon sergeant, 

232nd Medical battalion April 25, 2013

Trust goes both ways. Leadership must first establish a 

climate of trust in the organization by trusting their subordinates. Leaders, who see the best in their employees 

and demonstrate total faith in their abilities, empower 

them to do their job and complete the mission. They 

trust their subordinates unless there is a solid and founded reason not to trust them.

I have found that by trusting people, until they prove 

themselves unworthy of that trust, a lot more happens.

Jim Burke, former chairman and CEO of Johnson & Johnson4(p316)

Care of Others

Caring for your people opens the door to trust, builds 

morale, and creates a positive command environment.

Commanders build trust by meeting the needs of those 

they lead. A selfless leader is willing to risk his or her 

fortune in order to do what is right for the Soldier. Selfserving, forceful leadership destroys trust while a caring, selfless leader builds it.

Effective leaders build trust through transparent and authentic relationships with their staff. Active listening is 

a critical component to building a team. Soliciting and 

valuing the opinion of every individual creates this climate of teamwork and trust.

Good commanders have the ability to understand and 

listen to subordinate leaders. It gives us the confidence 

that our commander really trusts what we say and do.

CPT Nickolas Baranello, company commander, 

232nd Medical Battalion, April 6, 2013

Conclusion – Creating A Climate of Trust

How do you know when you have trust in the organization? According to Jack Welch, former CEO of General 

Electric, “You know it when you feel it.”4(p5)

The best leaders treat all personnel within the organization with respect, as one team, by putting others before 

themselves. These actions create a positive climate of 

trust. Trust has strong roots in an organization. When 

trust is present, it has the power to allow team members 

to do exceptional things. However, once trust has been 

lost, it is difficult to restore.

It’s clear that the ultimate success of any organization 

can be traced to the ability of its leadership to foster a 

team environment through a solid atmosphere of trust.

At some point in time, either in the military or in the private sector, we have all been part of a great team. What 

made that team so exceptional? It was trust. 

The DNA in your leadership is made up of your values 

and these values make up your character. Ultimately, 

the answer of trust lies in your character.

Trust: The DNA of Leadership
July – September 2013	 35

The Army Medical Department Journal

References

1. Tan M. Odierno to top leaders: expect tougher evals. Army Times. April 8, 2013:12.

2. Merriam-Webster online dictionary. Merriam-Webster website. Available at: http://www.merriam-webster.com/. 

Accessed May 30, 2013.

3. Mishra AK, Mishra KE. Trust is Everything: Become the Leader Others Will Follow. Self-published; 2008:8.

4. Covey SMR. The Speed of Trust. New York, NY: Free Press; 2006.

Author

COL Sones is the Assistant Chief of Staff, Operations/G-3, Europe Regional Medical Command, Heidelberg, Germany. 

Previously he was the Commander, 232nd Medical Battalion, 32nd Medical Brigade, AMEDD Center and School, JBSA 

Fort Sam Houston, Texas.
36 http://www.cs.amedd.army.mil/amedd_journal.aspx

Ask any Soldier or Department of the Army civilian and 

he or she will recite the Army values,* but, as evident 

in each publication of the Army Times, recital is different from living up to these values. Where is the gap between knowledge and action? The gap may begin during 

the accession process, not as much because of what is 

taught but more in how it is taught. The Army Learning 

Concept 20152

 calls for more relevant, tailored, and engaging learning experiences for our students. Based on 

gaps identified by a Corps Chief working group, in 2011 

the Army Nurse Corps restructured their Basic Officer 

Leader Course Nurse Track to include a block of instruction on values in an effort to ignite a grass-roots movement to better inculcate values-based decision-making. 

This article describes the methodology behind the effort 

to provide entry-level officers self-awareness of deeper 

personal values and understanding of how personal and 

institutional values lead to values-based decisions in 

support of the Patient CaringTouch system of care.

Perspective

In 2010, as part of the Army Nurse Corps (ANC) Campaign Plan,3

 the Department of Nursing Science at the 

Army Medical Department Center and School conducted a massive, bottom-up review and retooling of courses 

offered through the recently established Army Nursing Leader Academy (ANLA). The ANLA is a suite of 

courses designed to promote lifelong learning across the 

career span of ANC members. The Academy’s purpose 

is to develop adaptive, decisive action nurse leaders 

through the tenets introduced by COL (Ret) Kathleen 

Dunemn into the Army Nursing Collaborative Learning 

Framework: formal schooling, professional experience, 

functional/technical expertise, self-development, and 

coaching.4

 The ANLA is grounded in the Patient CaringTouch system, guided by nursing competencies and 

gauged by the Nursing Leader Capabilities Map.4(p21)

Values are one of the 10 Patient CaringTouch system 

components.

We all know the Army values acronym LDRSHIP,* but 

living the meanings/actions represented by that acronym is truly the test of individual and organizational 

character. Values define what individuals, organizations, 

institutions, and even nations consider important. In the 

context of this discussion, values are how we aspire to 

conduct ourselves, our business, our organization, or 

our country through thoughts and deeds. Values serve 

as guides to actions. The Army Values clearly define 

expected behaviors of Soldiers, NCOs, officers, and DA 

civilians from a corporate vantage point. However, the 

level of commitment to organizational values is less dependent upon knowing the corporate language and more 

dependent upon understanding and self-actualizing personal values.5

Kouzes and Posner5 present over 30 years of research 

which answer the question:

How much of a difference does it make in commitment 

to the organization for members to have a high 

understanding of organizational vs personal values?

Their findings revealed that people who lacked clarity 

of personal values but possessed high clarity of organizational values generally demonstrated a 69% commitment level to the organization. Conversely, individuals 

who acknowledged a high understanding of their personal values but little understanding of the corporate 

values demonstrated an 87% commitment to the organization. They live up to their personal values. Interestingly, when individuals are able to possess high clarity 

of both personal and organizational values, they demonstrated a 90% commitment to the organization.5

 It is this 

pivotal, incontrovertible evidence that forms the basis of 

the ANC Core Values instruction.

The Class

The main purpose of the Core Values class is to connect 

personal values to behaviors. In the Patient CaringTouch 

system, Core Values place our patients at the center of 

care and guide our daily nursing practice, as well as 

our interactions with patients, families, and colleagues. 

In keeping with the Army Learning Concept 2015, the 

course transitions from lecture to blended presentation 

and discussion in which PowerPoint slides serve to keep 

the group focused. Small group discussions, return presentation, and open large group discussion in a nonattributional forum serve as a framework for learning.2

Inculcating Core Values Through Application

 of the Patient CaringTouch System

COL Daniel W. McKay, AN, USA

*Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, Personal Courage (LDRSHIP)1
July – September 2013	 37

During the initial part of the class, participants identify the connection between the Patient CaringTouch 

system and Army Values. The new Nurse Corps officers identify values, their origins, and how they know 

the organizational values. This interactive, large-group 

discussion is followed by a review of the Army Values 

building blocks, starting with the LDRSHIP acronym. 

Since these officers were introduced to the LDRSHIP 

concepts in the general Basic Officer Leader Course, the 

discussion focuses on rank ordering the Army Values. 

Collins6

 and Lee7 supply the theoretical justification for 

a hierarchal ranking of value importance. Ranking the 

Army Values allows officers to make sound decisions 

when faced with conflicting adherence to various corporate values. If officers hold that all values are “most 

important,” then none are important.6

 Of course there is 

no right answer, but integrity, honor, and duty seem to 

rise to the top in class after class.

Next, officers examine other Army Values supporting 

documents such as the “The Soldiers Creed” (page 39)

where instructors make a specific point of reminding 

them that they are Soldiers first, officers second and 

Nursing is what they bring to the fight. Following the 

Soldiers Creed, officers are introduced to The Army 

Nursing Team Creed (page 39) and demonstrate the 

connection to this creed and the Patient CaringTouch 

system. Going further with the nursing-themed documents, the nurses briefly review the American Nurses 

Association Standards of Practice and Professional 

Performance8

 and Code of Ethics.

9

 All these documents 

combine to guide our corporate and professional nursing values. This is where most Army Values classes 

stop. However, the evidence in mainstream media and 

research by Kouzes and Posner5

 have pushed the ANC 

to take another step.

After a brief interactive discussion of Kouzes and Posner’s evidence (again linked to the Patient CaringTouch 

system as evidence-based), the participants are asked to 

conduct a practical exercise with the goal of affirming 

their personal values and comparing personal values to 

the corporate values. They are provided a list of 56 values as shown in the Figure. First they are asked to work 

independently by responding to the statement, “these 

are my values.” They must limit their choices to 10 values. Then they are asked to engage in critical, introspective thinking by narrowing their first list to no more than 

3 values by responding to the statement, “these are my 

values to which I am 100% committed and will not betray.” This part of the exercise engages the learner from 

multiple cognitive avenues while solidifying learning, 

commitment, and self-actualization.

To help solidify the learning, the participants break into 

small groups (6 to 8 per group) and discuss their values, 

identify commonality, and compare the commonalties 

to the corporate values. After the small group discussions, each group reports their findings and, as a class, 

discovers the commonalties and diversity. This promotes camaraderie, cohesiveness, understanding, and 

trust. To round out this segment of the class, participants 

are asked to rate on the 1 to 10 scale their level of commitment to common values and how committed they are 

to demonstrating these values in the workplace. Participants use their hands to show their level of commitment 

(usually from 5 to 9). Those demonstrating a level less 

than 8 are asked: “what would it take to improve your 

level of commitment?”

The next practical exercise is designed to help participants envision the benefits of living their identified core 

values with patients and nursing staff by simply asking 

them to discuss 2 questions:

1. What is the benefit(s) to our patients in your living 

your core values?

2. What is the benefit(s) to the nursing staff in your 

living our core values?

Officers discuss these questions first in their small 

groups, then report to the large group. After receiving 

and consolidating the replies representing the group’s 

values, we compare those replies to the Army Values. To 

date the two sets of values have been strikingly similar.

The final exercise is presented to the students as an option because by this time we have been working for about 

2 hours. To date, every class has decided to conduct the 

exercise. The purpose of the final exercise is to actualize their personal values in their individual nursing 

experiences through storytelling. Stories are the richest source of identity for groups. Through our stories, 

we share learning, joy, sadness, mistakes, and triumphs. 

We see our values in action.10 The participants are asked 

to share in their small groups a lived experience that 

demonstrated their values. Afterwards, we reassemble 

as a large group and ask volunteers to share a story (not 

their own) which demonstrated expression of uniquely 

nursing values-based connections with our patients. The 

stories are always remarkable and humbling.

To close the class we show a brief video11 concerning how 

and why people and organizations drift away from their 

values. The best outcomes measure from this course will 

be 4 to 6 years in the future when these officers become 

eligible for separation from the ANC and choose to stay 
38 http://www.cs.amedd.army.mil/amedd_journal.aspx

Challenge Simplicity Health Growth Beauty Autonomy Happiness

Trust Productivity Empathy Respect Faith/

Spirituality Risk-Taking Dependability

Independence Innovation Competition Variety Power Freedom Decisiveness

Curiosity Friendship Honesty/Integrity Security Harmony Humor Achievement/

Success

Communication Respect Open-mindedness Love/

Affection Diversity Service Recognition

Honor Creativity Competence Hope Duty Teamwork Loyalty

Patience Strength Family Effectiveness Truth Quality Equality

Wisdom Prosperity/

Wealth Flexibility Dependability Courage Intelligence Discipline

From the above list, select 10 values that you consider to be your personal values.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

From the above 10 values, select 3 which fit the characterization, “these are my values to which I am 100% committed and will 

not betray.”

1.

2.

3.

Value 1: ______________ is most important to me because ___________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Value 2: ______________ is most important to me because ___________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Value 3: _______________ is most important to me because __________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Compare and contrast your personal values with Army Values. 

Loyalty 

Duty 

Respect 

Selfless Service 

Honor 

Integrity 

Personal Courage

The Clarification of Personal Values worksheet.

Inculcating Core Values Through Application of the Patient CaringTouch System
July – September 2013	 39

The Army Medical Department Journal

The Army Nursing Team Creed

Authored by LTC Leigh McGraw

I am a member of the Army Nursing Team

My patients depend on me and trust me to provide compassionate and proficient care always. I nurture the most helpless and 

vulnerable and offer courage and hope to those in despair. I protect the dignity of every individual put in my charge. 

I tend to the physical and psychological wounds of our Warriors and support the health, safety, and welfare of every retired 

Veteran. I am an advocate for family members who support and sustain their Soldier during times of War. It is a privilege to 

care for each of these individuals and I will always strive to be attentive and respectful of their needs and honor their uniquely 

divine human spirit.

We are the Army Nursing Team

We honor our professional practice standards and live the Soldier values. We believe strength and resiliency in difficult 

times is the cornerstone of Army Nursing. We embrace the diversity of our team and implicitly understand that we must 

maintain a unified, authentically positive culture and support each other’s physical, social, and environmental well-being. 

We have a collective responsibility to mentor and foster the professional growth of our newest Team members so they 

may mentor those who follow.

We remember those nursing professionals who came before us and honor their legacy, determination, and sacrifice. We 

are fundamentally committed to provide exceptional care to past, present, and future generations who bravely defend and 

protect our Nation.

Th e A r m y N u r s i n g Te a m : C o u ra g e to C a re , C o u ra g e to C o n n e ct , C o u ra g e to C h a n g e 

Embrace the Past, Engage the Present, Envision the Future

Soldier’s Creed

I am an American Soldier.

I am a warrior and a member of a team.

I serve the people of the United States, and live the Army Values.

I will always place the mission first.

I will never accept defeat.

I will never quit.

I will never leave a fallen comrade.

I am disciplined, physically and mentally tough, trained and proficient in my warrior tasks 

and drills.

I always maintain my arms, my equipment and myself.

I am an expert and I am a professional.

I stand ready to deploy, engage, and destroy the enemies of the United States of America in 

close combat.

I am a guardian of freedom and the American way of life.

I am an American Soldier
40 http://www.cs.amedd.army.mil/amedd_journal.aspx

because they are connected to an organization aligned 

with their personal values. Our only current measures 

are the course evaluations from participants. We have an 

overwhelming positive response, consistently showing a 

greater than 80% value-added response rate.

Conclusion

In November 2012, a modified version of the Basic Officer Leader Course Patient CaringTouch Core Values 

class was presented to most of the Army Nurse Corps 

executive leadership during the ANC Campaign Planning Conference I. These senior nurses were asked to 

complete the same personal values exercise and came 

to consensus as a group on their shared values: integrity, 

loyalty, respect, and family. The challenging road ahead 

for the ANC is now to live up to the standards set forth 

by those simple, eloquent, but powerful words. Let our 

integrity be uncompromising, let our loyalty to the sons 

and daughters serving this great nation be unquestionable, let our respect be present in every interaction, and 

let our sense of family extend beyond bloodlines to encompass our fellow service men and women. If, from our 

generals to our basic privates, Army Medicine can live 

these values, the Army Medical Department would reach 

the vision and mission set forth by The Surgeon General. 

It all hinges on commitment to our shared values!

References

1. Field Manual 6-22: Army Leadership. Washington, 

DC: US Dept of the Army; October 2006:2-2.

2. TRADOC Pamphlet 525-8-2. The U.S. Army Learning Concept for 2015. Fort Monroe, VA: US Army 

Training and Doctrine Command; January 20, 2011. 

Available at: http://www.tradoc.army.mil/tpubs/

pams/tp525-8-2.pdf. Accessed April 23, 2013.

3. Clark S, Brewer R. Building the Army nursing 

campaign plan. US Army Med Dept J. OctoberDecember 2011:10-17.

4. Dunemn K, Hopkins-Chadwick DL. Designing 

and implementing the Army Nursing Leader Academy. US Army Med Dept J. October-December 

2011:18-23.

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

5th ed. San Francisco, CA: Jossey-Bass; 2012.

6. Collins J. Good to Great. New York, NY: HarperCollins Publishers, Inc; 2001.

7. Lee F. If Disney Ran Your Hospital: 91⁄2 Things You 

Would Do Differently. Bozeman, MT: Second River 

Healthcare Press; 2004.

8. Nursing: Scope and Standards of Practice. Silver 

Spring, MD: American Nurses Association; 2010.

9. Code of Ethics for Nurses With Interpretive Statements. Silver Spring, MD: American Nurses Association; 2011.

10. Perry B. Core nursing values brought to life 

through stories. Nurs Stand. 2005;20(7):41-48.

11. Blumberg JB. Good to the core, building value with 

values. Simple Truths LLC Website. Available at: 

http://www.goodtothecoremovie.com/. 

Accessed April 23, 2013.

Author

COL McKay is Chief, Army Nurse Corps Branch, Center 

for Professional Education and Training, AMEDD 

Center and School, Fort Sam Houston, Texas.

Inculcating Core Values Through Application of the Patient CaringTouch System
July – September 2013	 41

Leadership is in the eyes of other people; it is they 

who proclaim you as their leader.

Carrie Gilstrap1

What do people look for in their leaders they admire 

most? What characteristics or attributes can be ascribed 

to those we admire more than other leaders? Studies to 

identify key characteristics or attributes found in leaders 

admired most have recently been conducted.2-6 Kouzes 

and Posner6

 addressed this question for the past 30 years 

by surveying thousands of business and governmental 

executives. Many attributes were identified and, through 

further analysis to include content analysis by independent judges followed by additional empirical studies, the 

list was narrowed to 20 characteristics or attributes. Although this study falls more in line with trait theory of 

leadership, identification of important attributes or traits 

found in those we admire most could serve as a precursor 

to identifying the behaviors found in leaders we admire 

most. Studying traits alone as the sole way of becoming a better leader has been shown to be inadequate at 

best. Nonetheless, Ledlow and Coppola7

 indicated that 

identification of key traits or characteristics is an important first step in understanding what leaders in a specific 

business or industry do to be successful.

Respondents were asked to list the characteristics they 

found most common in leaders they would “willingly” 

follow. It is important to emphasize willingness to follow as people often must follow leaders unwillingly because their jobs or positions depend upon their ability 

to follow someone. These leaders may be in leadership 

positions but have not earned the right to be followed 

willingly by their colleagues.6

Despite broadening the surveyed population to include 

leaders from around the world, the characteristics found 

to be common in leaders admired most have remained 

very consistent. The top 4 characteristics have always 

included honest, forward-looking, competent, and inspiring. In fact, these are the only ones which routinely 

received more than 50% of all votes. All characteristics 

received votes, meaning all the characteristics are important; but the only ones receiving greater than 50% of 

all votes are those four.6

 Do these same characteristics 

apply to Army Medical Department (AMEDD) leaders? 

Although Kouzes and Posner did include government 

executives, they did not include military personnel in 

their surveys. Researchers from the Leader Training 

Center and the US Army-Baylor University Graduate 

Program in Business and Health Administration at the 

AMEDD Center and School asked this same research 

question to a survey population of military personnel.

Methodology

Surveys were conducted with the intent of identifying 

which of 20 skills AMEDD personnel deemed most important in the person they identified as their most admired 

leader. The survey tool chosen was based on research 

conducted by Kouzes and Posner.6

 The proposal for the 

study design and survey was examined by the Brooke 

Army Medical Center Institutional Review Board and 

considered exempt research. The research question was 

to determine if there was a statistically significant difference between the selected characteristics of an admired 

leader as chosen by AMEDD personnel and respondents 

from data collected by Kouzes and Posner.

Data was collected from 2009 thru 2012 from 2,530 

AMEDD students attending 32 officer training courses 

at the AMEDD Center and School (Basic Officer Leader, Captains Career, Head Nurse, Brigade Surgeon, and 

AMEDD Executive Skills courses). Respondents were 

asked to rate each of 20 leadership attributes used by 

Kouzes and Posner in terms of importance in regards to 

the person they identified as their most admired leader 

using a 7-point Likert scale (1=least to 7=most important), reproduced in Figure 1. Secondary research questions included determining whether there were statistically significant differences in attributes based on age, 

gender, rank (company grade vs field grade*), corps 

(Medical, Nurse, Medical Service, Specialist, Dental, 

and Veterinarian), and environmental factors such as 

time spent in hospitals (fixed facility experience) and 

time spent in the field (operational unit experience). The 

data portion of the questionnaire is presented in Figure 

2. Statistical analyses included descriptive and inferential analyses; Wilcoxon Signed Ranks test; reliability 

Characteristics of Most-Admired Army

Medical Department Leaders

Jody R. Rogers, PhD

A. David Mangelsdorff, PhD, MPH

*Company grade officers – 2nd lieutenant, 1st lieutenant, captain. Field grade officers – major, lieutenant colonel, colonel.
42 http://www.cs.amedd.army.mil/amedd_journal.aspx

analysis (Cronbach’s alpha); analysis of variance (ANOVA) for age, gender, rank (company grade vs field grade), 

and environmental factors (fixed facility and operational unit experience) by corps.

Results

Summary descriptive statistics (mean and standard deviation) are shown in Table 1. Comparisons were made to 

the attribute rankings of Kouzes and Posner.6

 Wilcoxon 

Signed Ranks tests (Table 2) between the Kouzes and 

Posner rankings vs comparison groups (officers aged 

40 years or more, field grade officers, and all AMEDD 

Corps) showed no significant differences in rankings. 

The leader attribute “honest” was ranked first in Kouzes 

and Posner and for all comparison groups. “Competent” 

and “inspiring” were consistently ranked highly. There 

was general agreement for the attribute rankings. The 

Cronbach α was calculated for the 20 items (0.907; 

P<.001); the items were significantly reliable (the ratings 

were consistent). There were significant differences in the 

summary demographic statistics between the AMEDD 

medical officer corps (Table 3) and in the ANOVA of 

the leader characteristics between officer corps (Table 4).

The results of the AMEDD study closely correlates with 

The Leadership Challenge (TLC) study with a few important distinctions. Although there were no overall differences in the rank ordering of these attributes between 

Characteristics of Most-Admired Army Medical Department Leaders

Attributes of an Admired Leader

We look for special attributes in our leaders. Research indicates that the attributes listed below are the ones we admire 

most in our leaders. From this list of 20 attributes, please indicate your opinion of each attribute in terms of importance to 

effective leadership using the Likert scale from 1 to 7:

Least Important 1 2 3 4 5 6 7 Most Important

Ambitious 1 2 3 4 5 6 7

(aspiring, hard-working, striving)

Honest 1 2 3 4 5 6 7

(truthful, has integrity, trustworthy, has character)

Broad-minded 1 2 3 4 5 6 7

(open-minded, flexible, receptive tolerant)

Imaginative 1 2 3 4 5 6 7

(creative, innovative, curious)

Caring 1 2 3 4 5 6 7

(appreciative, compassionate, concerned, loving, 

nurturing)

Independent 1 2 3 4 5 6 7

(self-reliant, self-sufficient, self-confident)

Competent 1 2 3 4 5 6 7

(capable, proficient, effective efficient, professional)

Inspiring 1 2 3 4 5 6 7

(uplifting, enthusiastic, energetic, humorous, positive, 

cheerful)

Cooperative 1 2 3 4 5 6 7

(collaborative, team player, responsive)

Intelligent 1 2 3 4 5 6 7

(bright, thoughtful, intellectual, reflective, logical)

Courageous 1 2 3 4 5 6 7

(bold, daring, fearless, gutsy)

Loyal 1 2 3 4 5 6 7

(faithful, dutiful, unswerving in allegiance, devoted)

Dependable 1 2 3 4 5 6 7

(reliable, conscientious, responsible)

Mature 1 2 3 4 5 6 7

(experienced, wise, has depth)

Determined 1 2 3 4 5 6 7

(dedicated, resolute, persistent, purposeful)

Self-controlled 1 2 3 4 5 6 7

(restrained, self-disciplined)

Fair-minded 1 2 3 4 5 6 7

(just, unprejudiced, objective, forgiving, willing to 

pardon others)

Straightforward	 1 2 3 4 5 6 7

(direct, candid, forthright),

Forward-looking	 1 2 3 4 5 6 7

(visionary, foresighted, concerned)

Supportive 1 2 3 4 5 6 7

(helpful, offers assistance, comforting)

Figure 1. The Likert scale rating questionnaire used to collect data regarding the study participants’ opinions of the importance of each of the 20 leadership attributes used in the research by Kouzes and Postner.5
July – September 2013	 43

The Army Medical Department Journal

the two studies, upon closer examination, noteworthy 

differences do occur. For example, the top 4 attributes 

were slightly different. Honesty remained the most important attribute in both studies, but differences started 

to emerge following this attribute. In the TLC study, forward-looking was the second most commonly chosen 

attribute, followed in order by inspiring and competent. 

As mentioned earlier, these 4 attributes were found to 

be most important in every survey conducted over the 

past 25 years, even when international leaders were included in the study. Honesty was always found to be the 

most important attribute, whereas the scores of the next 

3 attributes were relatively close, with competent and 

loyal often switching places in terms of importance.6

The consistency of results despite the expansion of their 

study to include international leaders is quite interesting. Regardless of where leaders are, the attributes most 

important to them remain consistent.

The attributes most important to leaders AMEDD personnel would willingly follow are slightly different. Honesty remained the most important attribute regardless of 

Demographic Questionnaire

for Study Participants

1. Age:_______

2. Gender (circle one):

Male

Female

3. Military pay grade (circle one):

O1

O2

O3

O4

O5

O6

O7 and above

4. AMEDD Corps or affiliation (circle one):

Medical Corps

Army Nurse Corps

Medical Service Corps

Specialty Corps

Dental Corps

Veterinary Corps

Civil Service

Foreign officer

5. Ethnicity or Race (circle one):

African American

Asian/Pacific Islander

White

Hispanic

Native American

Other: _________________

6. Years of experience serving in:

Operational units _______

Fixed facilities ______

Figure 2. Reproduction of the demographic 

data questionnaire completed by each study 

participant.

Table 1. Summary Descriptive Statistics

Leadership Trait n Mean SD

1 Ambitious 2510 5.54 1.24

2 Broad-minded 2518 5.82 1.05

3 Caring 2514 5.71 1.16

4 Competent 2520 6.48 0.86

5 Cooperative 2522 5.80 1.06

6 Courageous 2525 5.41 1.28

7 Dependable 2520 6.49 0.84

8 Determined 2503 5.87 1.09

9 Fair-minded 2521 6.04 1.05

10 Forward-looking 2512 5.88 1.06

11 Honest 2524 6.73 0.74

12 Imaginative 2517 5.13 1.24

13 Independent 2515 5.23 1.33

14 Inspiring 2517 5.98 1.08

15 Intelligent 2525 5.79 1.08

16 Loyal 2521 6.21 1.03

17 Mature 2522 5.79 1.16

18 Self-controlled 2515 5.89 1.09

19 Straightforward 2521 5.74 1.14

20 Supportive 2521 5.83 1.13

Demographic

Age (years) 2491 36.91 8.15

Fixed facility*

experience (years) 2411 5.80 5.91

Operational unit†

experience (years) 2413 4.21 5.29

n %n

Age>40 years 2530 35%

Field grade rank 2288 35%

Male 2516 61%

n=Number of study sample population who selected 

the characteristic or responded to the demographic 

category. Total study sample (N)=2,530.

Mean and SD are that of the cumulative Likert scale 

rankings (1=least to 7=most) of the characteristic 

by the respondents.

*Fixed facility indicates an established medical 

healthcare facility, such as a clinic, community hospital, or medical center.

†Operational unit indicates a deployable unit configured to provide medical services in the field in a deployed/combat environment.
44 http://www.cs.amedd.army.mil/amedd_journal.aspx

rank, age, or Corps affiliation. The importance of honesty to effective leadership cannot be understated. Honesty is as absolutely critical to leader effectiveness in 

the AMEDD as it is in nonmilitary settings. The second 

most important leader attribute for AMEDD officers 

was dependable, followed by competent and loyal. given 

our specific population, these results are understandable. 

Sixty-five percent of all respondents were company 

grade officers. It seems quite logical that while honesty is the most important attribute to leader effectiveness, company grade officers are looking for leaders 

who are dependable, competent, and loyal. Inspiring 

and forward-looking were important attributes, ranking 6th and 8th respectively. They were not as important as dependability and loyalty, at least for company 

grade respondents.

Attributes most important to field grade officers differed slightly. Again, honesty was most important, followed by competent, dependable, and loyal. The same 

4 attributes as identified by company grade officers 

but in a slightly different order. The fifth most important attribute was inspiring followed by fair-minded 

(ranked 8th by company grade officers).

The consistency of attributes important in the most admired leaders among field grade and company grade officers was somewhat surprising. For example, it is easy 

to imagine that field grade officers would place greater 

importance on being forward-looking and inspirational. 

Senior officers are expected to take a big picture approach to their units and then sell their vision of the 

future to those they lead. Yet, dependability and loyalty 

remained more important even to field grade officers.

Leadership attributes among the different Corps proved quite interesting 

as well. The top 4 leadership attributes 

most important to Medical Service, 

Army Nurse, and Dental Corps officers were the same: honest, dependable, competent, and loyal. For Medical 

Corps officers, the top 4 attributes were 

honest, competent, dependable, and a 

tie with inspiring and loyal. Specialty 

Corps Officers identified honest, competent, dependable, and loyal as their 

most admired attributes.

Comment

The most noteworthy finding from this 

study was the striking similarity in the 

top 4 most important attributes identified by AMEDD officers—regardless 

of rank, experience, age, and Corps affiliation—in leaders they admired most is honesty, dependability, competence, and loyalty. Military service places unique 

requirements on those who choose to serve. The inherent dangers associated with military service affects the 

choices of attributes most admired in military leaders. The importance of being honest is as extremely 

Characteristics of Most-Admired Army Medical Department Leaders

Table 2: Comparison of rankings between Kouzes and Posner5

and other Categories

Kouzes and

Posner

(n>1.5 million)

AMEDD

Personnel

(all)

(n=2530)

Age>40

Years

(n=898)

Field

Grade

Rank

(n=800)

Leadership Trait

Ambitious 17 17 18 18

Broad-minded 8 11 16 12

Caring 14 16 10 9

Competent 4 3 2 2

Cooperative 11 12 15 15

Courageous 12 18 17 17

Dependable 10 2 3 3

Determined 13 9 12 11

Fair-minded 6 5 5 6

Forward-looking 2 8 7 7

Honest 1 1 1 1

Imaginative 15 20 19 19

Independent 20 19 20 20

Inspiring 3 6 6 5

Intelligent 5 13 14 14

Loyal 18 4 4 4

Mature 16 14 11 10

Self-controlled 19 7 8 8

Straightforward 7 15 13 15

Supportive 9 10 9 13

Table 3: Demographics of study participants who were members of an AMEDD

military officer corps.

MS

n=739

MC

n=471

NC

n=660

DC

n=236

VC

n=69

SP

n=177

Overall

N=2352

Demographic

Age>40 years 29% 30% 38% 39% 26% 38% 34%

Male 71% 76% 37% 71% 42% 68% 61%

Field grade rank 23% 71% 21% 62% 18% 18% 34%

Fixed facility*

experience (yrs) 4.14 6.48 6.09 8.60 4.34 5.39 5.67

Operational unit†

experience (yrs) 5.68 2.51 3.09 3.05 1.66 6.13 4.00

Acronyms:

MS - Medical Service Corps NC - Nurse Corps VC - Veterinary Corps

MC - Medical Corps DC - Dental Corps SP - Specialist Corps

*Fixed facility indicates an established medical healthcare facility, such as a clinic, community 

hospital, or medical center.

†Operational unit indicates a deployable unit configured to provide medical services in the field 

in a deployed/combat environment.
July – September 2013	 45

The Army Medical Department Journal

important as in the TLC study. The consistency between 

studies for honesty strongly indicates its importance, regardless of employment. Any successful leader must 

be honest. This finding is no different in the military. 

Leader development programs must emphasize the importance of honesty. The programs must ensure all leaders understand the meaning of this term and use case 

studies or discussion time to reinforce how one demonstrates this attribute as a leader. The use of case studies 

and open discussion can help everyone understand how 

difficult it can be to be honest at all times. The telling of 

little “white lies,” for whatever the reason, can be perceived as compromising one’s honesty. We tell little lies 

because we do not want to appear confrontational, or 

Table 4. Variables across the specific AMEDD military officer corps. All values in the officer corps columns are 

the means of the cumulative Likert scale rankings (1=least to 7=most) of the characteristic by the respondents. 

The ANOVA examined differences between the officer corps means.

AMEDD Military Officer Corps

MS MC NC DC VC SP ANOVA

Characteristic df F P

a01 Ambitious 5.67 5.22 5.70 5.52 5.00 5.39 5,2326 13.426 <.001

a02 Broad-minded 5.86 5.67 5.90 5.71 5.86 5.77 5,2335 3.487 .004

a03 Caring 5.75 5.57 5.82 5.70 5.26 5.51 5,2330 5.751 <.001

a04 Competent 6.49 6.45 6.57 6.46 6.23 6.40 5,2336 3.157 .008

a05 Cooperative 5.88 5.59 5.95 5.71 5.65 5.69 5,2339 8.413 <.001

a06 Courageous 5.47 5.25 5.56 5.20 4.97 5.26 5,2341 6.920 <.001

a07 Dependable 6.50 6.38 6.59 6.49 6.48 6.35 5,2336 4.426 .001

a08 Determined 6.01 5.66 5.96 5.73 5.51 5.80 5,2321 9.360 <.001

a09 Fair-minded 6.04 5.85 6.19 6.00 5.99 5.92 5,2338 6.135 <.001

a10 Forward-looking 5.98 5.82 5.89 5.72 5.59 5.86 5,2331 3.584 .003

a11 Honest 6.72 6.63 6.81 6.73 6.54 6.75 5,2340 4.276 .001

a12 Imaginative 5.26 5.02 5.13 5.01 4.59 5.12 5,2334 5.482 <.001

a13 Independent 5.31 4.87 5.50 5.06 4.77 5.12 5,2333 16.115 <.001

a14 Inspiring 6.04 5.90 6.05 6.02 5.58 5.89 5,2334 3.711 .002

a15 Intelligent 5.81 5.67 5.92 5.80 5.36 5.64 5,2341 6.051 <.001

a16 Loyal 6.30 5.91 6.31 6.31 5.97 6.08 5,2337 11.849 <.001

a17 Mature 5.84 5.60 5.90 5.89 5.65 5.61 5,2338 5.664 <.001

a18 Self-controlled 5.98 5.67 6.00 5.96 5.86 5.67 5,2331 7.896 <.001

a19 Straightforward 5.80 5.51 5.85 5.80 5.45 5.57 5,2337 7.435 <.001

a20 Supportive 5.81 5.55 6.10 5.83 5.68 5.58 5,2337 15.504 <.001

Demographic

Age 34.78 37.65 37.11 38.76 34.76 36.71 5,2312 14.177 <.001

Fixed facility* experience 

(years) 4.15 6.48 6.09 8.60 4.34 5.39 5,2261 25.086 <.001

Operational unit†

experience (years) 5.68 2.51 3.09 3.05 1.66 6.13 5,2263 42.228 <.001

%n

n=739 n=471 n=660 n=236 n=69 n=177

Age>40 years 29% 30% 38% 39% 26% 38% 5,2346 4.414 .001

Male 71% 76% 37% 71% 42% 68% 5,2338 56.526 <.001

Field grade rank 23% 71% 21% 62% 18% 18% 5,2239 112.675 <.001

Acronyms:

MS - Medical Service Corps NC - Nurse Corps VC - Veterinary Corps

MC - Medical Corps DC - Dental Corps SP - Specialist Corps

*Fixed facility indicates an established medical healthcare facility, such as a clinic, community hospital, or medical center.

†Operational unit indicates a deployable unit configured to provide medical services in the field in a deployed/combat environment.

n=Number of study sample respondents who specified the AMEDD officer corps designation displayed in the column heading.
46 http://www.cs.amedd.army.mil/amedd_journal.aspx

because we do not want to hurt people’s feelings. When 

we do this, we must realize we may be compromising 

the trust others place in us to always be honest and tell 

the truth. Honesty is something everyone wants to demonstrate, but which can be very difficult to always do.

Dependability is critically important in the military. If 

military personnel cannot depend on others to accomplish their missions, unit effectiveness can be severally 

compromised. Teamwork is highly emphasized in military training. Military personnel are taught to always 

sacrifice for the team and to ensure they are capable of 

performing their tasks in support of the team. As such, 

the team is strongest when everyone is staunchly reliable and are capable of performing their duties as well 

a possible. It is not surprising that dependability was 

selected as the second most frequent attribute found in 

admired leaders within the AMEDD.

Competence is closely associated with dependability. 

In order to be dependable, leaders must also be competent. Leaders in AMEDD must demonstrate a level of 

competency which shows their colleagues they have the 

expertise necessary to help accomplish the mission. An 

AMEDD officer deemed incompetent will quickly lose 

the respect of those they are leading. It is important to 

clarify what competence means to an AMEDD leader. 

AMEDD leaders must not only be competent in their 

chosen fields, but also in basic soldiering skills. Being 

a competent Soldier is what separates the military professionals from their civilian counterparts. Competent 

AMEDD leaders must not only be technically competent; they must also be competent as Soldiers.

Loyalty is an extremely important attribute to AMEDD 

leaders. Serving in the military is extremely challenging. Serving as a valuable team member is critical to 

organizational success. In addition to dependability and 

competence, the most effective team members are loyal 

to each other and to the mission. AMEDD leaders are 

expected to demonstrate their loyalty to organization 

and to always place the needs of the organization and its 

people above their own needs. They are expected to assist their colleagues during times of great need or stress. 

This loyalty is essential to unit cohesion. Without loyalty, the unit’s ability to efficiently accomplish its mission 

may be compromised. Most importantly, without loyalty, trust will be compromised. Lack of trust definitely 

compromises unit effectiveness.

Conclusion

The attributes of the most admired leaders identified 

in this study of AMEDD officers did not differ in the 

aggregate when compared to the studies conducted by 

Kouzes and Posner.6 There are slight differences in the 

top attributes of the most admired leaders. Whereas 

Kouzes and Posner identified honesty, forward-looking, 

competence, and inspiring as the most frequently chosen attributes in their studies, AMEDD officers identified honesty, dependability, competence, and loyalty as 

the top 4 attributes in their most admired leaders. The 

consistency of both studies concerning the importance 

of being honest cannot be overstated. Although dependability and loyalty were found to be significant attributes 

to AMEDD leaders, this difference with the Kouzes and 

Posner study is not surprising due to the critical nature 

of military service and the importance of these 2 attributes to organizational success. Leader development 

programs for AMEDD officers must emphasize the importance of these attributes to leadership effectiveness. 

All small group classes should include discussions exploring the definitions of these attributes and how they 

can be practiced in the work setting.

References

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

4th ed. San Francisco, CA: Jossey-Bass; 2007:27.

2. Kirkpatrick SA, Locke EA. Leadership: do traits 

matter?. Acad Manag Exec. 1991;5(2):48-60. Available at: http://sbuweb.tcu.edu/jmathis/Org_Mgmt_

Materials/Leadership%20-%20Do%20Traits%20

Matgter.pdf. Accessed April 18, 2013.

3. Coach4Growth.com. The characteristics of a leader: demonstrating good leadership skills. October 

28, 2010. Available at: http://coach4growth.com/

leadership-skills/the-characteristics-of-a-leaderdemonstrating-good-leadership-skills. 

Accessed October 8, 2012.

4. Giovannelli D, Yamamoto MM. The Sergeants Major of the Army: On Leadership and the Profession 

of Arms. Arlington, VA: Institute of Land Warfare, 

The Association of the United States Army; 2009.

5. Sugarman K. Leadership characteristics. 1999. 

Available at: http://www.psychwww.com/sports/

leader.htm. Accessed April 18, 2013.

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

5th ed. San Francisco, CA: Jossey-Bass; 2012.

7. Ledlow G, Coppla N. Leadership for Health Professionals. Sudbury, MA: Jones and Bartlett Learning; 2011.

Authors

Dr Rogers is Program Manager, AMEDD Executive Skills 

Program at the Leader Training Center, AMEDD Center 

and School, Fort Sam Houston, Texas. He is also a visiting 

professor at Trinity University, San Antonio, Texas.

Dr Mangelsdorff is a professor at the Army-Baylor 

University Graduate School, AMEDD Center and School, 

Fort Sam Houston, Texas.

Characteristics of Most-Admired Army Medical Department Leaders
July – September 2013	 47

Mentoring has always been and remains one of the key, 

strategic responsibilities of all Army Medical Department (AMEDD) leaders, ensuring that future generations of Soldiers and civilians are properly groomed to 

one day step forward and assume the mantle of senior 

leadership.1-5 Given the vital importance of leader mentorship, it is both curious and alarming to note that little 

to no attention has been paid to the actual qualities or 

attributes of successful mentors.6,7 While it is true that 

each mentor will have his or her own personal style, I 

have come to believe that there is a core set of developable traits that make a mentor most successful. This 

short list of 10 qualities is based upon over a decade 

of scholarly research into the subject of mentoring, my 

career long observations of successful and unsuccessful mentors (both personal mentors, military and civilian, as well as those that I have watched mentoring 

others), and a critical assessment of my own strengths 

and weaknesses as a mentor of both military and civilian protégés. It is hoped that by outlining and presenting 

the attainable qualities of the ideal mentor, this article 

will help both aspiring and well established mentors to 

assess their own mentoring attributes and develop them 

to their fullest. Additionally, potential protégés should 

be on the lookout for these recognizable qualities when 

carefully seeking individuals to serve as their own mentors. Lastly, the AMEDD senior leadership may want to 

include training about these mentoring attributes as a 

part of leadership development programs.8-10

APPROACHABLE

The first quality of an ideal mentor is being approachable; it is one of the most important. This is because if a 

“would be” mentor is not approachable, then regardless 

of how much wisdom he or she has to share, it is highly 

unlikely that this person will be considered for mentoring. Obviously, negative traits such as arrogance and 

hubris do not enhance mentor approachability; instead 

they serve to either deter prospective protégés or eclipse 

a potential mentor’s other positive qualities, thereby 

limiting his or her ability to groom others.11 I was witness to such a situation with an Army colleague of mine 

who was one of the preeminent scientists in his field. 

His inflated ego and bravado repelled potential protégés. 

About a decade ago, during a workshop on mentoring 

that I led which was attended by both senior and junior 

officers, he actually said to the group, “If you want me 

to mentor you, you must first pass my test, and, if I deem 

you are worthy, then I will share my knowledge with 

you.” Needless to say, no one ever took him up on his 

offer. Instead, he retired a few years ago feeling empty, 

frustrated, and disappointed that he was unable to pass 

on any of his wisdom. Unfortunately, he still remains 

blind to his central role in this mentoring failure and 

instead chooses to blame it on others (they were all undeserving, unappreciative (of his wisdom), or ungrateful). Fortunately for us, however, we can all learn from 

his failings as a frustrated, aspiring mentor. What my 

colleague failed to realize is that mentor approachability 

is a complex quality that is a balanced blend of affability, 

confidence, and humility. Some of the keys to affability are being open, upbeat, and friendly. Add the right 

mixture of confidence and humility, and the mentor now 

becomes approachable for potential protégés.

EMPATHETIC

After “approachable,” the next important quality of the 

ideal mentor is empathy. The ideal mentor is able to 

relate to and appreciate the feelings of the protégé.12,13

These feelings normally cover a wide spectrum, encompassing goals and aspirations, as well as doubts and 

fears.14 Sometimes these emotions are familiar, ones that 

the mentor has also experienced or perhaps still feels. 

However, the best mentors are able to empathize with 

feelings that they have not personally felt. The recognition and acceptance of these protégé feelings without 

any judgment is one of the most powerful qualities of 

the ideal mentor.15-19 It is important to note that empathy is also crucial to facilitating diversity mentoring, the 

guiding of individuals who are different from the mentor—diverse in race, gender, or ethnic background.20,21

Diversity mentoring should be deliberately pursued 

with much vigor by all AMEDD leaders, especially 

those who seek to forge and cement an enduring legacy 

as masters of leader mentoring.22-25

REFLECTIVE

One of the key things that protégés seek from those that 

mentor them is any useful insight that mentors have 

gleaned from their own careers.26,27 Therefore, the ideal 

mentor constantly reflects upon his or her own mentoring voyage, diving deep into past experiences in order to 

Qualities of the Ideal Mentor

COL Mark A. Melanson, MS, USA
48 http://www.cs.amedd.army.mil/amedd_journal.aspx

harvest any pearls of wisdom that might benefit the protégé.28 This keen introspection includes both successes 

and failures, for the wise mentor knows that it is often 

from our failures or setbacks that we learn our greatest 

lessons in life. Hence, self-awareness and self-reflection 

are critical if one is to become an effective mentor. Given that fact, an ideal mentor might even dare to quote 

the ancient Greek philosopher Socrates, also one of the 

world’s most renowned historical mentors, and boldly 

reaffirm, “The unexamined life is not worth living.”29

PATIENT

The next important quality of the ideal mentor is patience. While a good mentor may be able to assist a 

protégé to visualize his or her desired mentoring end 

state, the ideal mentor is able to remain patient during 

the mentee’s often long, uphill journey towards self-discovery.30 But this is not to say that mentor should have 

infinite patience.31 Rather, the mentor should help the 

protégé set realistic goals and timelines and should also 

strive to help hold the mentee accountable to them.32 In 

some extreme cases, the mentor may even have to encourage the protégé forward, step by step. Conversely, 

it may be necessary for the mentor to help the protégé 

realize and acknowledge that a certain goal is not realistic or is best deferred to a later time. I have personally 

done this by actually mentoring a few protégés out of 

the Army (which I do not say glibly). When asked if I 

consider these mentoring efforts as unproductive or a 

waste of my time, I strongly disagree. In my mind, mentoring is always focused on helping the protégé reach 

his or her greatest potential and, if this does not align 

with an Army career, then the mentee should leave and 

pursue career options outside the Army. When this happens, I still believe that this is a mentoring success story 

(recalling that the focus on mentoring should always be 

upon the protégé33-36). It is important to note that such an 

outcome also serves the Army well since these individuals did not, in my opinion, have the potential to become 

effective AMEDD leaders.

LOYAL

A mentor is always loyal to both the protégé and the realization of his or her potential.37 This means being protective of the one being mentored (in fact, in French the 

word protégé literally means “the protected one”) and 

safeguarding any shared secrets or weaknesses. Hence, 

the mentor must establish a safe and secure environment 

where the protégé can feel comfortable to learn and 

grow.38 A loyal mentor also rises to the defense of his 

or her protégé and stands up for the mentee whenever 

necessary (such as in response to unfair criticism or directly confronting bullying by a senior officer, therefore 

making mentoring a strong and effective antidote for the 

poisonous venom of “toxic leadership”39,40). However, 

sometimes being loyal to the protégé also includes providing candid, critical feedback concerning any failure 

of the mentee to live up to his or her potential.

HONEST

One of the essential qualities of the ideal mentor which 

can at times be the most difficult is honesty.41,42 Being 

honest means giving the protégé truthful, unvarnished 

feedback that may include things that the mentee may 

not want to hear.43,44 Given that, a mentor may be reluctant to give such feedback, fearing that it may sour 

or even ruin the mentoring relationship.45 However, the 

ideal mentor always remembers that effective mentoring 

often includes such needed criticism, along with plenty 

of encouragement. Usually a protégé cannot grow without first hearing and then accepting such potentially distasteful albeit important advice. Hopefully, as long as 

it is given in a caring manner, the message should be 

received in the nurturing spirit with which it was given 

and become profoundly appreciated by the mentee as 

the mentoring bond deepens with trust.46,47

AUTHENTIC

The ideal mentor is authentic.48,49 There are no airs of 

pretense or futile efforts by the mentor to try to be someone that he or she is not. Real authenticity comes with 

maturity, self awareness, and a true acceptance of one’s 

self, to include all of one’s faults (not easily done, I must 

admit). Without it, a striving mentor is doomed to being 

either a hypocrite or a phony.50 With it, the ideal mentor 

can comfortably share personal mistakes and setbacks 

without a fear of embarrassment. Interestingly enough, 

it is often this hard won authenticity which ultimately 

secures the mentor’s place as an enduring and pursued 

counselor of protégés. As I reflect back upon my favorite 

leader mentors, all of them clearly share this common, 

even defining trait of genuine authenticity.

LOVER OF LEARNING

Ideal mentors are passionate lovers of learning.51,52 They 

enjoy learning, mastering skills, and developing expertise. First and foremost, they love learning about themselves and how to improve.28 However, this learning 

also extends to the noble quest of discovering potential 

in others and helping them realize it (or in other words, 

mentoring). I believe that this attribute is essential for 

mentors who seek to guide others who are different from 

themselves. This natural or acquired intellectual curiosity, coupled with sincere empathy, is what helps to make 

diversity mentoring most successful. I have learned the 

most about myself through diverse mentoring relationships which helped to challenge my assumptions about 

what it means to be an effective senior leader.

Qualities of the Ideal Mentor
July – September 2013	 49

The Army Medical Department Journal

COMMITMENT

Commitment to the mentoring partnership is the very 

glue that holds the relationship together.53 The mentor is 

committed to the protégé and makes sure that he or she 

is upholding his or her end of the mentoring pact.54 This 

means always honoring promises and keeping appointments. If the mentor promises to review the protégé’s 

officer evaluation report support form, then he or she 

does so and does it promptly. When the mentoring pair 

agrees to routine meetings, the mentor is always early 

(demonstrating enthusiasm) and fully prepared to do his 

or her part. Broken promises and missed appointments 

will ultimately lead to the quiet, shameful death of the 

mentoring relationship. Even more tragic, such a negative mentoring experience may ultimately turn off an 

outstanding protégé to any future mentoring opportunities just to avoid any further hurt or disappointment.55

In extreme cases, this can directly result in the loss of a 

promising mentee who would have one day blossomed 

into a stellar senior AMEDD leader, if only someone 

had seriously committed to his or her mentorship. This 

is why leaders must not pursue mentoring lightly, and, 

should they decide to engage in mentoring (which I sincerely hope they do), they absolutely must make it a top 

priority in their busy schedules.33 Otherwise, they are 

doing more harm than good.56

POTENTIAvOyANCE

I have never been one to casually create words (at least 

not since I was a very young child, so I am told). However, 

I have not found a single term that properly captures the 

essence of the most important quality of an ideal mentor. 

Metaphorically, it is the golden ability to envision with 

the mind’s eye the mighty oak, cloaked and quiescent inside the tiny acorn (page 51). Or, simply put, it is a sort of 

clairvoyance for protégé potential. Hence, I boldly coin 

the term “potentiavoyance,” or the ability to fully see 

another’s latent potential and help that person attain it. 

First, a potentiavoyant mentor has the honed ability to 

quickly and accurately assess a protégé’s strengths and 

weaknesses. Next, this gifted mentor has a special knack 

for recognizing clues of the hidden, dormant potential 

within an individual, even when others are either unable 

or unwilling to see it.57,58 Further, the ideal mentor can 

envision the required path that ultimately leads to realizing this underlying potential. Finally, the most important 

ingredient of potentiavoyance is the talent of inspiring or 

coaxing the unseeing protégé to recognize and embrace 

this new vision of his or her future self (otherwise, the 

above discussions of the other 9 qualities are truly for 

naught). The rare, but achievable combination of all of 

these attributes is what I call potentiavoyance, the almost 

mystical spirit of mentoring. During my almost 30-year 

career, I have personally experienced potentiavoyance 

regarding my own protégés—it was a powerful, moving 

experience each and every time it happened. I am also 

proud of the fact that of those protégés not deemed worthy of mentoring by fellow senior officers whom I have 

chosen to mentor, all but one are now rising stars in their 

own right, thanks in part to the awesome, transforming 

power of potentiavoyance.

SUMMARY

An ideal mentor is first and foremost approachable so 

that potential protégés will become attracted and seek 

them for mentoring. Next, this mentor has true empathy 

so that he or she can feel, understand, and appreciate the 

fears and desires of the protégé. By living an examined 

life, the reflective mentor is able to extract and refine 

the meaningful lessons of his or her own career, sharing 

the needed wisdom. Measured patience is required to 

allow the protégé to find and pursue their individualized path to self discovery. Loyalty to the protégé and 

his or her mentoring quest helps the mentee to stay the 

course. The ideal mentor candidly tells the protégé what 

he or she most needs to hear. Authenticity is a must if a 

mentor is to attract and retain the protégé in the mentoring partnership. By being a lover of learning, the mentor 

maintains both personal and protégé awareness, thereby 

ensuring the successful conveyance of wisdom. Mentor 

commitment is the very glue holding the mentoring relationship together. By attaining potentiavoyance, the ideal mentor is able to visualize the diamond in the rough, 

nurture its own self-discovery, and guide in the mining, 

sculpting, and polishing of the precious gem. I sincerely 

hope that all AMEDD leaders will seek to identify and 

develop all of these achievable mentoring qualities in 

themselves, and that those seeking mentorship will look 

for them in potential mentors. Also, the senior AMEDD 

leadership should include teaching these attributes during all stages of leader development training..

References

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development: a case study in officer mentorship. 

Army Med Dept J. January-March 2003:7-10.

2. Hunsinger N. Mentorship: growing company grade 

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3. Melanson MA. Leadership wisdom. Army Med 

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4. Johnson WB, Andersen GR. Formal mentoring 

in the U.S. military: research evidence, lingering 

questions, and recommendations. Naval War College Review. 2010;63(2):113-126.

5. Lackey J, Kamena GC. Mentoring: finding our way 

to the future. Fires. May-June 2010:22-25. 
50 http://www.cs.amedd.army.mil/amedd_journal.aspx

6. Wicks RJ. Sharing Wisdom: The Practical Art of 

Giving and Receiving Mentoring. New York, NY: 

Crossroads Publishing; 2000.

7. Delacort CJ. Mentoring: Establishing a legacy, 

shaping the future. Mil Rev. November-December 

2002:35-39.

8. Melanson MA. Mentoring in the Army Medical 

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Dept J. October-December 2007:26-28.

9. Stone F. The Mentoring Advantage: Creating the 

Next Generation of Leaders. Chicago, IL: Dearborn Trade Publishing; 2004.

10. Shenkman MH. Leader Mentoring: Find, Inspire, 

and Cultivate Great Leaders. Franklin Lakes, NJ: 

Career Press; 2008.

11. Shea GF. Mentoring: How to Develop Successful 

Mentoring Schemes. Boston, MA: Thompson Publishing; 2002.

12. Merlvede PE, Bridox DC. Mastering Mentoring 

and Coaching with Emotional Intelligence. Norwalk, CT: Crown House Publishing; 2003.

13. Cottrel D. Monday Morning Mentoring: Ten Lessons to Guide You Up the Ladder. New York, NY: 

Harper Collins; 2006.

14. Cherniss C. The Role of Emotional Intelligence in 

the Mentoring Proces. The Handbook of Mentoring 

at Work: Theory, Research, and Practice. Thousand Oaks, CA: Sage Publications; 2007.

15. Murray M. Beyond the Myths and Magic of Mentoring. San Francisco, CA: Jossey-Bass; 2001.

16. Law H, Ireland S, Hussain Z. The Psychology of 

Coaching, Mentoring, and Learning. West Sussex, 

UK: John Wiley and Sons Publishing; 2007.

17. Peddy S. The Art of Mentoring: Lead, Follow, and 

Get Out of the Way. Houston, TX: Bullion Books; 

1998.

18. Meggins D, et al. Mentoring in Action. London, 

UK: Kogan Page Publishing; 2006.

19. Luecke R. Coaching and Mentoring: How to Develop Top Talent and Achieve Stronger Performance. Boston, MA: Harvard Business School 

Publishing; 2004.

20. Clutterbuck D, Ragins BR. Mentoring Diversity: 

An International Perspective. Oxford, UK: Butterworth-Heinemen Publishing; 2002.

21. Johnson, HM, Xian X, Allen TD. Reflections on 

diversity and mentoring. In: Allen TD, Eby LT, eds. 

The Blackwell Handbook of Mentoring. West Sussex, UK: John Wiley & Sons, Ltd; 2010:301-304.

22. Kopser GJ. Mentoring in the military: not everyone 

gets it. Mil Rev. November-December 2002:40-44.

23. Adams DE. Mentoring Women and Minority Officers in the U.S. Military. Thesis, Air Command 

and Staff College; 1997.

24. Kem JD. Mentoring: building a legacy. Mil Rev. 

May-June 2003:62-64.

25. Melanson MA. Seasons of Army mentorship and 

the mentoring staircase, Army Med Dept J. October-December 2009:40-43.

26. Young PG, et al. Mentoring Principles: Frameworks, Agendas, Tips, and Case Stories. Thousand 

Oaks, CA: Corwin Press; 2005.

27. Phillips JJ, Stormei LK. Creating Mentoring & 

Coaching Programs in Action. Alexandria, VA: 

ASTD Press; 2001.

28. Melanson MA. Evolving roles of highly successful mentors. Army Med Dept J. October-December 

2007:37-39.

29. Neville DF, trans. Plato. The Apology of Socrates. 

London, England: F. E. Robinson & Co; 1901:77.

30. Stoddard DA, Tamasy RJ. The Heart of Mentoring: Ten Proven Principles for Developing People 

to Their Fullest Potential. Colorado Springs, CO: 

NavPress: 2003.

31. Pegg M. The Art of Mentoring. Gloucestire, UK: 

Forge House; 1999.

32. Maxwell JC, Developing the Leaders Around You: 

How to Help Others Reach Their Potential. Nashville, TN: Nelson Business; 1995.

33. Melanson MA. Mentors and protégés: simple rules 

for success. Army Med Dept J. July-September 

2006:50-58.

34. Allen TD, et al. Designing Workplace Mentoring 

Programs: An Evidence Based Approach. West 

Sussex, UK: Wiley-Blackwell Publishing; 2009.

35. Kram KE. Mentoring at Work: Developmental Relationships in Organizational Life. Lanham, MD: 

University Press of America; 1988.

36. Dungy T. The Mentor Leader: Secrets to Building People and Teams that Win Consistently. Carol 

Stream, IL: Tyndale House Publishers; 2010.

37. Bell CR. Managers as Mentors: Building Partnerships for Learning. San Francisco, CA: Berret-Koehler Publishing; 2002.

38. Ibara H. Coaching and Mentoring: How to Develop Top Talent and Achieve Strong Performance. 

Boston, MA: Harvard Business Press; 2004.

39. Reed GE. Toxic leadership. Mil Rev. July-August 

2004:67-71.

Qualities of the Ideal Mentor
July – September 2013	 51

The Army Medical Department Journal

40. Reed GE, Olsen RA. Toxic leadership: part deux. 

Mil Rev. November-December 2010:58-64.

41. Nigro N. The Everything Coaching and Mentoring 

Book. Avon, MA: Adams Media Group; 2003.

42. Shea GF. The Mentoring Organization. Menton 

Park, CA: Crisp Publications; 2003.

43. Trautman S. Teach What You Know. Upper Saddle 

River, NJ: Prentice Hall Publishing; 2007.

44. Cohen N. The Manager’s Pocket Guide to Effective 

Mentoring. Amherst, MA: HRD Press; 1999.

45. Maxwell JC. Mentoring 101: What Every Leader 

Needs to Know. Nashville, TN: Thomas Nelson 

Publishing; 2008.

46. Melanson MA. The mentoring spectrum. Army 

Med Dept J. October-December 2009:37-39.

47. Darling LAW. Discovering Your Mentoring Mosaic: A Guide to Enhanced Mentoring. Breiningsville, 

PA: Booklocker Publishing; 2006.

48. Hendricks H, Hendricks W. As Iron Sharpens Iron: 

Building Character in a Mentoring Relationship. 

Chicago, IL: Moody Press; 1995.

49. Megginson D, Clutterbuck D. Techniques for 

Coaching and Mentoring. Oxford, UK: Butterworth-Heinemann; 2007.

50. Johnson WB, Ridley CR. The Elements of Mentoring. New York, NY: Pagrave-MacMillian Publishing; 2004.

51. Zachary LJ. The Mentor’s Guide: Facilitating Effective Mentoring Relationships. San Francisco, 

CA: Jossey-Bass; 2000.

52. Ensher F, Murphy S. Power Mentoring: How to 

Successful Mentors and Protégés Get the Most Out 

of Their Relationships. San Francisco, CA: JosseyBass; 2005.

53. Brounstein M. Coaching & Mentoring for Dummies. New York, NY: Wiley Publishing; 2000.

54. Rowley JB. Becoming a High Performance Mentor. 

Thousand Oaks, CA: Corwin Press; 2006.

55. Cohen NH. A Step by Step Guide to Starting an Effective Mentoring Program. Amherst, MA: HRD 

Press; 2000.

56. Wooden J. A Game Plan for Life: The Power of 

Mentoring. New York, NY: Bloomsbury; 2009.

57. Melanson MA. Qualities of the ideal protégé. Army 

Med Dept J. October-December 2009:44-46.

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How to Help Others Achieve Their Goals. Oxford, 

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Author

COL Melanson is Director, Armed Services Radiobiology 

Research Institute, Bethesda, Maryland. He is also a 

member of the board of directors of the International 

Mentoring Association.

“POTENTIAvOyANCE”
52 http://www.cs.amedd.army.mil/amedd_journal.aspx

Leader development is a critical responsibility of the 

Army Medical Department (AMEDD). The current 

and previous Surgeons General of the Army identified leadership as a critical skill necessary to transform 

the AMEDD to better serve the changing mission and 

focus of the Army. Most organizations are challenged 

in the development of capable leaders who will have 

positive institutional effect. The Leader Training Center, 

AMEDD Center and School, adopted The Leadership 

Challenge® to help meet its mission of developing and 

enhancing the leadership skills of AMEDD officers.

Based on the work of Kouzes and Posner,1

 The Leadership Challenge is an industry leading, evidence-based 

training program designed to enhance the personal leadership skills of those attending a highly interactive, facilitator-led 2 or 3 day workshop. Kouzes and Posner use 

over 30 years of research and data from over 3 million 

leaders to identify 5 practices exemplary leaders use on 

a routine basis:

Model the way.

Inspire a shared vision.

Challenge the process.

Enable others to act.

Encourage the heart.

Kouzes and Posner then identified 6 specific behaviors, 

associated with each practice, for a total of 30. For example, one of the behaviors associated with “model the 

way” that highly effective leaders frequently display is 

“I follow through on the promises and commitments that 

I make.”2

 The authors then created the Leadership Practices Inventory,3

 a 360 degree evaluation* of a leader’s 

effectiveness based on how frequently a leader displays 

all 30 behaviors in the workplace.

This article discusses how the concepts, techniques, 

and practices of The Leadership Challenge have been 

incorporated into leadership training within AMEDD. 

Examples of a workshop are presented and future plans 

for this training are discussed.

Background

Faculty members of the Leader Training Center were 

first introduced to The Leadership Challenge in 2005. 

Selected faculty members attended 2-day workshops designed to teach the 5 practices of exemplary leadership 

discussed above, followed by a 2-day workshop learning how to facilitate this training. Courses are taught by 

certified facilitators, usually under the supervision of a 

certified master facilitator. Certification as a facilitator 

is granted upon completion of the 4-day training course 

and facilitation of a workshop while under evaluation by 

a master facilitator. Master facilitator certification requires years of training, including the conduct of workshops, publishing, and observing training conducted by 

master facilitators. The theory behind achieving master 

facilitator certification is the requirement to complete at 

least 10,000 hours required to become an expert in a chosen field.5

 Currently, the Leader Training Center has 12 

certified facilitators and one master facilitator on its staff.

Leader Development Using The Leadership

Challenge

The Leadership Challenge workshops are currently conducted during the AMEDD pre command courses, entry 

level executive nurse courses, a one semester leadership 

course in the US Army-Baylor University Graduate Program in Business and Health Administration, Warrior 

Transition Command/Para-Olympian programs, and 

the Civilian Life-Long Learning Program. In addition, 

workshops are scheduled for multiple organizations 

throughout the AMEDD. Feedback from all courses has 

been very positive with attendees often telling us they 

wish a course was longer. Attendees experience the following benefits when attending a workshop:

3⁄4 Build trust.

3⁄4 Identify their leadership strengths and weaknesses.

3⁄4 Identify their values and priorities as a person and 

as a leader.

3⁄4 Build collaboration and teamwork skills.

Leader Development Within

 the Army Medical Department

Jody R. Rogers, PhD

Emil F. Meis, MBA

Jeffrey D. Haun, MS

*360-degree evaluation is also known as 360-degree feedback 

(among other names). In most applications, it will include direct feedback from an employee’s subordinates, peers, and 

supervisor(s), as well as a self-evaluation. However, in some 

cases it can also include feedback from external sources, such 

as customers, suppliers, or other interested stakeholders.4
July – September 2013	 53

3⁄4 Apply lessons learned to organizational challenges.

3⁄4 Learn the power of encouragement/affirmation 

with their associates.

3⁄4 Seek new ways to challenge/solve current problems.

3⁄4 Create a vision for their section which supports unit 

vision.

3⁄4 Identify ways to inspire others to accomplish their 

vision.

3⁄4 Solve unit specific problems through enhanced 

teamwork and collaboration.

The power in The Leadership Challenge is that it just 

makes sense from a leadership standpoint. The 5 practices of exemplary leadership are not just the ideas of Kouzes and Posner, but are based on over 30 years of research 

and data collection. As such, it is an evidence-based 

model of leadership. Healthcare professionals relate well 

to this training because of the recent emphasis on the use 

of evidence-based medical practices and procedures by 

healthcare providers in the care of their patients.

There is a fundamental truth about leadership that also 

makes The Leadership Challenge a powerful training 

tool: leadership is everyone’s responsibility. Everyone 

in the organization can and should enhance their leadership skills in order to help the organization accomplish 

its mission. The principle leadership problem within 

the AMEDD is not that there are no effective leaders, 

but that there are not enough good leaders. We simply 

believe that strong leadership at all levels in an organization is necessary for an organization to be truly outstanding. World-class organizations require world-class 

leaders, and many of them.

Workshops are designed for individuals wanting to enhance their leadership effectiveness. They are appropriate for any leader, regardless of rank, experience, age, 

etc, who wishes to become a better leader. We find that 

colonels learn as much about their leadership effectiveness and how to enhance their leadership ability as do 

captains and majors with far less experience. The Leadership Challenge focuses on the following core concepts:

 Leadership is everyone’s business.

 Leadership is a relationship.

 The best leaders are the best learners.

 It takes deliberate practice to become a better leader.

 Leadership is an aspiration and a choice.

 Leaders make a positive difference.

Workshop attendees quickly realize that embracing 

these concepts can help them become better leaders, as 

well as help them mentor the next generation of AMEDD 

leaders.

Typical AMEDD Workshop

While we teach leadership, the workshops are primarily 

designed to facilitate learning. The ideal size of a workshop is 20 to 25 attendees, but we have conducted workshops for as many as 75 and as few as 15. Small group 

work as called for by the Army Learning Concept 20156

is emphasized so all attendees sit at round tables with 6 

to 8 other attendees. Collaboratively sourcing knowledge 

from attendees is as important as providing knowledge 

to them. When it comes to leadership, especially more 

experienced leaders, they “...need to be reminded more 

often than they need to be instructed.”* Therefore, our 

overarching goal is for attendees to learn as much, if not 

more, from each other than they do from the facilitators.

Workshops normally consist of 2 days of training involving 7 modules:

1. Introduction to importance of leadership and return of attendee’s Leadership Practice Inventories (detailed in the following section).

2. Practice 1: Model the Way

3. Practice 2: Inspire a Shared Vision

4. Practice 3: Challenge the Process

5. Practice 4: Enable Others to Act

6. Practice 5: Encouraging the Heart

7. Committing

All workshops include use of movie videos, tabletop 

exercises, and individual activities designed to enhance 

discussion and foster exchange of information. As a 

result of these activities and the time allowed for discussions within and among tables, attendees frequently 

comment they wanted more time to enhance their learning, particularly among their small groups.

Attendees are asked to complete some short preworkshop exercises designed to encourage discussion and new 

learning. The first exercise is to write and be prepared 

to discuss their personal best leadership experience. The 

questions asked about their personal best leadership experience are intended to encourage attendees to share 

their leadership experiences with their tablemates. Attendees learn from what went well and what went poorly 

during those experiences. This exercise also enables attendees to realize that they have already enjoyed some 

successes as a leader, and that their development so far 

*Attributed to Samuel Johnson (1709-1784), English author, 

critic, and lexicographer.7
54 http://www.cs.amedd.army.mil/amedd_journal.aspx

has been fruitful. Three basic questions must be answered by each attendee:

1. What was the context of your personal best leadership experience? Describe the situation, who 

else was involved, and the primary challenge 

you faced.

2. What happened? Be specific. What actions did 

you take and what were your initial impressions 

of your successes (or failures)? 

3. How did you feel after the experience concluded? 

What lessons did you learn?

Depending on the needs of attendees, other exercises 

may be used to help solve problems, develop greater collaboration and teamwork, and to build trust.

A crucial component of The Leadership Challenge is the 

Leadership Practices Inventory (LPI). The LPI provides 

a snapshot in time of observed behaviors proven to be 

critical in the most successful leaders across the world. 

Observations are gathered from the people (direct-report peers and superiors) chosen by the attendee. The 

central workshop focus centers on the LPI results, so 

it is imperative that attendees complete the evaluation 

before attending the workshop.

Leadership Practice Inventory

Although it is important to know and understand the 5 

practices of exemplary leadership discussed earlier, it 

is even more important to understand the 30 behaviors 

associated with those practices. Leadership is in the eye 

of the beholder, therefore, leaders must demonstrate 

certain behaviors to enhance their leadership effectiveness. Leadership is a behavior, not a title or a position. 

You must do something to be a leader. The LPI focuses 

on those behaviors that exemplary leaders demonstrate 

on a frequent basis. Kouzes and Posner1

 demonstrate 

empirically that those leaders who consistently demonstrate the 30 behaviors

• have a higher degree of personal credibility,

• are more effective in meeting job-related demands,

• are able to increase motivation levels,

• are more successful representing their group to upper management,

• have a higher performing team,

• foster greater loyalty and commitment, and

• experienced reduced absenteeism and turnover and 

reduced stress levels.

Approximately a month prior to a course, attendees are 

registered into the LPI. They receive an email with instructions directing them to the LPI website. They must 

complete their self-evaluation using the Likert scale 

across the 30 behavior statements. They are asked to 

rate themselves on how frequently they demonstrate 

the 30 behaviors. After completing their self-evaluation, 

leaders enter the names and email addresses of observers who will evaluate them on how frequently they see 

the leader demonstrate the same 30 behaviors. Observers also have the opportunity to respond to 4 narrative 

questions. Ideally, at least 2 supervisors, 2 colleagues, 

and 2 direct-report peers should be selected to complete 

the evaluation. A minimum of 3 and no more than 12 

observers are needed for an accurate report. It is critical 

that observers have seen the individual in action and are 

willing to honestly evaluate how frequently they see him 

or her demonstrating those behaviors. Failure to properly select the appropriate observers will significantly bias 

the results and greatly minimize the value of the information in the survey. Attendees receive their LPI early 

during the workshop and are given sufficient time to 

analyze the results. The LPI is also used throughout the 

workshop so attendees can focus on those behaviors they 

deem important to them to becoming a better leader.

It is critical that attendees do not view the LPI results 

as “good or bad,” rather that they gain an appreciation 

for those behaviors which are characterized as observed 

or not, and to what degree. Based upon this, an attendee 

can begin to visualize where improvements can be made 

in exhibiting more positive leadership behaviors and the 

frequency in order to improve as a leader. The areas for 

improvement can then form the basis for the attendee’s 

“committing” phase at the end of the workshop.

Feedback from Workshops

Feedback from attendees has been very positive. They 

enjoy getting honest feedback concerning their leadership effectiveness and learning how to demonstrate certain behaviors in the workplace so they can be seen as 

an even better and more authentic leader in a very short 

time. Attendees are also given plenty of time to develop 

their own specific leadership development plan so they 

can continue their “leadership journey” well beyond the 

workshop.

Future Plans for The Leadership Challenge

Our experience from workshops conducted during the 

past 3 years clearly demonstrates that attendees are learning how to enhance their leadership abilities and that they 

have found the workshops to be stimulating and thoughtprovoking. The Leader Training Center has developed a 

sufficient number of certified facilitators with the goal of 

taking this training to regional locations and to military 

treatment facilities. AMEDD commands and organizations wanting facilitators to conduct onsite training can 

Leader Development Within the Army Medical Department
July – September 2013	 55

The Army Medical Department Journal

contact the AMEDD Center and School Leader Training 

Center at 210.221.8530 or 210.221.7480 for information.

Conclusion

The Leadership Challenge has proven to be a highly 

effective training tool in the development of AMEDD 

leaders. Its emphasis on the use of proven leadership 

tools and practices makes it a model of leadership that 

is definitely evidence-based. Power comes from the fact 

that it is highly intuitive, empirically based, and learnable. The opportunity for aspiring leaders to be given the 

time to focus on their leadership abilities is of particular 

value for all who attend. The Leadership Challenge experience adds to the ideal that leadership is truly lifelong 

learning and anyone can improve their leadership skills.

References

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

5th ed. San Francisco, CA: Jossey-Bass; 2012.

2. Kouzes JM, Posner BZ. The Leadership Challenge 

Workshop. San Francisco, CA: Pfeiffer; 2012.

3. Kouzes JM, Posner BZ. LPI: Leadership Practices 

Inventory 360. Pfeiffer Assessments website; 2013. 

Available at: http://www.pfeiffer.com/WileyCDA/

Section/id-811878.html. Accessed May 15, 2013.

4. 360-Degree Assessment: An Overview. Washington, DC: US Office of Personnel Management; September 1997. Available at: http://www.

opm.gov/policy-data-oversight/performancemanagement/performance-management-cycle/

rating/360assessment.pdf. Accessed May 15, 2013.

5. Gladwell M. Outliers: The Story of Success. New 

York, NY: Hachett Book Group; 2011.

6. TRADOC Pamphlet 525-8-2. The U.S. Army Learning Concept for 2015. Fort Monroe, VA: US Army 

Training and Doctrine Command; January 20, 

2011:19,50. Available at: http://www.tradoc.army.

mil/tpubs/pams/tp525-8-2.pdf. 

Accessed April 23, 2013.

7. Michael Moncur’s (Cynical) Quotations. The Quotations Page website. Accessed at: http://www.quo

tationspage.com/quote/38442.html. 

Accessed May 15, 2013.

Authors

Dr Rogers is Program Manager, AMEDD Executive 

Skills Program, Leader Training Center, AMEDDC&S, 

Fort Sam Houston, Texas. He is also a visiting professor 

at Trinity University, San Antonio, Texas.

Mr Meis is Deputy Chief, Leader Training Center, 

AMEDDC&S, Fort Sam Houston, Texas.

Mr Haun is Instructor, The Leadership Challenge, Leader 

Training Center, AMEDDC&S, Fort Sam Houston, Texas.
56 http://www.cs.amedd.army.mil/amedd_journal.aspx

Driven primarily by economic necessity, the military 

health system has embarked upon a historic transformation of organization, business, and culture that will forever change Army Medicine and the delivery of healthcare across the Department of Defense. Decades-old 

plans and concepts for the consolidation of the service 

medical departments are no longer the topic of idle discussion, they are the new rapidly evolving reality. Evidence of this transformation can be found at every level 

of the service medical departments.

The 2005 Base Realignment and Closure Commission 

(BRAC) set the stage for the consolidation of service 

medical departments by collocating the once geographically separate service medical headquarters into one location now known as the Defense Health Headquarters. 

The 2005 BRAC Report1

 further directed the consolidation of service medical training at Fort Sam Houston, Texas. This consolidation resulted in the establishment of the Medical Education and Training Campus, a 

triservice training and educational institution providing 

enlisted medical skill training to meet the operational 

needs of all services. The National Defense Authorization Act of 2012 (Pub L No 112-81, December 31, 2011)) 

followed to set into motion plans for the formation of 

a Defense Health Agency. Local consolidations, such 

as the Joint Task Force National Capital Medicne in 

the Washingtom, DC area,* the San Antonio Military 

Medical Center in San Antonio, and the formation of 

joint bases are the prototypes for service medical consolidations. If there are any doubts, one need only walk 

the halls of the Walter Reed National Military Medical 

Center, San Antonio Military Medical Center, Tripler 

Army Medical Center, or the Landstuhl Regional Medical Center among staff members wearing all services’ 

uniforms to understand the reality of a joint medical 

environment is fast approaching. As the environment 

changes, so must leader skills and attributes. This article is not intended to enumerate in detail a list of technical and leadership talents. Rather, it serves to open the 

discussion on the challenges this new environment will 

present and offer insight on transforming institutional 

education and training and leader development of junior 

leaders. This article presents the case that leaders who 

employ the right combination of attitude, skill, courage, 

and vision will find the greatest success in the new reality of a joint medical environment.

It may sound simplistic, but the most important attribute 

required to lead in the joint medical environment is the 

right attitude. It is often said that attitude is everything. 

The joint medical environment will be no different. Success will be attained by those who believe, understand, 

and embrace the joint environment to look beyond the 

parochial and understand the tactical, operational, and 

strategic values of the services working in concert. In 

other words, leaders must have the capacity to envision “what could be” versus “the way it should be.” The 

power of the right attitude opens the mind to different 

ideas and methodologies that may originate within another service, or perhaps leverages the best of all concepts to generate a completely new approach that is better than any. The joint environment must not be viewed 

as a threat, rather an opportunity to rethink, redesign, 

and renew approaches and methodologies to provide the 

best healthcare across all services, both deployed and at 

home. As powerful as this opportunity is, it will never 

be realized unless leaders at all levels across all services 

engage with the right attitude. Those who cannot escape 

service parochialism will not simply be ineffective, they 

will become irrelevant. Admittedly, there will a certain 

level of service parochialism that will, especially in the 

early years, impede progress. The reluctance to commit 

and to self-preserve are conditioned responses resulting from competition and rivalry between the services 

that bring with it an underlying sense of distrust. Understanding the historical nature of the service relationships underscores the importance the right attitude will 

play in joint environment. A positive attitude, rooted in 

the sincere desire to attain the greater good, helps break 

down barriers in communication and helps shape the attitudes of our service partners. Leaders who are positive 

and sincere in word and deed will build relationships 

of trust across service lines and, in the process, shape 

the attitudes and actions of those critical to success. It 

is often said that a positive attitude is a force multiplier—infectious and able to change other’s attitudes and 

Leading in the Joint Medical Environment

COL William P. LaChance, MS, USA

*See related article on page 60.
July – September 2013	 57

environments. While a positive attitude and the relationship of trust that results will be of critical importance 

across services lines, it will be equally important to the 

success of leadership within Army Medicine. Change 

is never easy and not readily accepted by established 

organizations. Leaders must garner the trust of their organization to gain the internal commitment necessary 

to lead in the give and take nature of an evolving joint 

environment. It will take positive, well respected leaders at all levels to communicate the goodness of change, 

build the trust and confidence within the organization, 

and then move boldly towards change.

Another aspect of attitude that is critical to joint success 

is respect, or, in the case of the joint environment, mutual respect. Leaders must understand the simple fact that 

every member of other military services is deservedly 

proud of their culture, lineage, traditions, and history of 

their service. This concept is simple enough to understand but all too often ignored, not out of malice, but for 

lack of understanding of how simple actions, or inactions, send the wrong message. To that end, leaders must 

not only understand the culture, lineage, traditions, and 

honor of other services, but respect them as well. This 

means doing the little things right, such as ensuring that 

the appropriate service flags are at ceremonies when 

multiple services participate. As simple as this example 

may be, it can have a profound impact on the attitude of 

the neglected service. If a mistake is made, as occasionally happens, do not ignore it, instead correct it and be 

the first one to apologize personally and publicly as necessary. Attitude shapes a leader’s words and actions and 

will ultimately shape success. The right attitude opens 

the mind to new possibilities beyond simple tradition, 

and helps building the foundation of trust essential to 

short- and long-term success.

Credibility is another key to leader success in the 

emerging joint environment as it will serve as the 

leader’s source of influence. Senior leaders, especially 

in the tri-service environment, often have little or even 

no direct authority to unilaterally implement profound 

organizational and cultural change. Absent a command 

and control authority, leaders in these complex environments must adapt to an approach to leadership emphasizing coordination and collaboration. This places great 

demands upon the leader’s ability to assess problems, 

evaluate internal and external environments, develop 

winning strategies, communicate effectively, and negotiate to attain consensus. While the idea of attaining 

consensus may be a foreign and even uncomfortable 

concept to those accustomed to the normal military authority and decision making, it is the reality of multiservice environments where a wide range of influences 

and interests must be taken into consideration. While 

leaders in a joint environment must possess the requisite 

analytical, organizational, communications, and negotiation skills, they will offer little sway if the leader espousing such talents lacks credibility. In the 1980s, the 

investment firm E. F. Hutton ran a series of commercials 

depicting 2 young urban professionals, better known at 

the time as “yuppies,” talking about their investments at 

a noisy social event. As the scene played out, one yuppie leans into the other as if to pass along a secret and 

says “my advisor is E. F. Hutton and E. F. Hutton says....” 

Instantly, the noisy social scene around them becomes 

completely quiet, while all the partygoers lean in trying 

to hear the advice of E. F. Hutton as the narrator says 

the tag line “when E. F. Hutton talks, people listen.” The 

commercial is clearly over-dramatized but it does make 

the point that credibility is a source of power and influence. If E. F. Hutton was a person, no one would care 

what he had to say unless they first believed that he or 

she was credible, not just in having the right technical skills sets, but credible in that there was a proven 

track record of outstanding performance. The same is 

true when leading in a joint environment. The ability 

of a leader to influence and command attention for their 

ideas will be a direct result of the perception of that 

leader’s credibility. While rank and or position will, by 

their very nature, convey some degree of credibility, one 

should expect to lead in peer environments where rank 

offers little influence. Like E. F. Hutton, credibility in the 

joint environment is more than technical skill sets, it’s 

having the leader-development experiences appropriate to the assignment and a proven record of outstanding performance. Becoming the E. F. Hutton of the joint 

environment requires one to become a service expert, 

or in the case of Soldiers, an Army expert. This means 

understanding and being bound to the Army’s lineage, 

tradition, history, organization, values, culture, and role 

within the profession of arms. Army leaders in the joint 

environment cannot truly represent the interests of Soldiers if they are not first a Soldier themselves. Service 

expertise continues with a detailed understanding of the 

Army Medical Department (AMEDD), its organization, 

and the depth and breadth of its complex mission set. 

This knowledge is supported by key and progressive 

leadership and staff experiences that solidify mastery 

of leadership and technical capacities, as well as an understanding of organizational roles and missions. All of 

which must be supported by institutional training and 

education, military and civilian, to attain and develop 

the appropriate leadership and technical skills. One aspect of credibility that warrants special attention is emotional intelligence. Understanding your own emotions, 

the emotions of others, and the environment, while having the ability to self-regulate and influence others is one 
58 http://www.cs.amedd.army.mil/amedd_journal.aspx

aspect of credibility that cannot be overlooked. The joint 

environment will present many personal, professional, 

and organizational challenges and frustrations. Emotional outbursts, justified or not—especially at senior 

levels—will deal a serious blow to a leader’s credibility 

in the assessment of service peers. A calm, professional, 

and consistent approach, supported by appropriate talents and experiences, will maximize credibility and the 

ability to build consensus and influence decisions.

While leading in the joint environment requires the right 

attitude and credibility, it also requires the courage to 

act. For all the attributes and skills discussed thus far, 

this may be the most difficult or perhaps unnerving for 

junior leaders to master. As has already been discussed, 

change is difficult and not always welcomed by established organizations. The Army Medical Command 

(MEDCOM) is comprised of many well-established 

organizations with proud histories of service to the 

Army and the United States. It is to be expected that 

these proud organizations will be somewhat resistant to 

change, especially if it means the loss of missions, facilities, and/or people. One of the great promises of the 

joint medical environment is the opportunity to become 

more efficient by eliminating duplication through consolidation. This will necessitate a give and take between 

the services that is certain to present very difficult 

choices. At the strategic level, it could mean that some 

MEDCOM organizations realign command authority, 

undergo significant restructuring, or even cease operations. At the operational and tactical levels, it could offer 

changes in missions and services. No matter the level, 

the decisions will be emotionally charged as, unfortunately, decisions are often assessed in terms of winners 

and losers. Leaders in this environment must possess 

the courage to lead, decide, and act for the greater good, 

even if it means ceding missions and capabilities to another service. Commanders and leaders who adopt a 

“not on my watch” approach may believe they are acting in the best interest of their organization, which may 

be true in the short-term. In the long-term, however, a 

parochial approach may prove detrimental as those who 

resist change decline in influence, while those who embrace change fill the gap to affect the final outcome. This 

is not to say that commanders and leaders should cede 

to the wishes of other services without analysis or challenge. Ideas should undergo rigorous scrutiny and be opposed when they do not serve the greater good. Those 

ideas that do serve the greater good, regardless of origin, 

should not be summarily dismissed or opposed simply 

to protect the proverbial “rice bowl.” The leadership described here requires courage—the courage to make decisions that may have unfavorable and/or uncomfortable 

effects on proud organizations and people. Leaders 

who are entrusted to make such decisions will find that 

leadership is lonely and their decisions will be repeatedly questioned. Leaders facing these difficult decisions 

must have the courage to make tough decisions for the 

right reasons and follow them to completion.

The leader attributes and skill sets discussed thus far 

are of critical importance, but in many ways they lay 

the foundation for what maybe the most important talent of joint leadership: the ability to articulate a joint 

vision that is inclusive of all services. The consolidation 

of the service’s medical departments into a single joint 

institution will be a historic first for the Department of 

Defense. The scope, complexity, and sheer magnitude 

such a change is likely to create a sense of uncertainty 

and confusion within organizations and personnel not 

accustomed to such turmoil. Clausewitz, the highly-regarded Prussian Soldier and military theorist, characterized the chaos of battle as “the fog of war.”2

 Clausewitz 

understood that the ever-changing dynamic of battle 

produced a changing reality on the ground that clouded 

the view, the judgment, and ultimately the confidence of 

leadership. Absent confidence, leaders tend to hesitate 

in making decisions; in so doing, they create a reactionary decision-making environment that stresses the organization. The evolution of the joint medical environment will create similar uncertainty or, as Clausewitz 

might characterize it, “the fog of change.” Penetrating 

that fog will require the ability to formulate and articulate a service-inclusive vision that serves as a clearly 

defined end-state.* A clearly articulated end-state will 

empower subordinate leaders to make decisions to realign efforts and resources beginning at the lowest levels that will ultimately lead to the attainment of operational and strategic end-states. Defining the end state is 

arguably the most important and most difficult leader 

task as it guides and informs every decision and every 

action that the organization undertakes. Leaders should 

understand that in defining the end state, they must be 

cognizant of the level of leadership at which they serve 

to avoid micromanaging the very leaders they must empower. At strategic levels, leaders should form a mental image of the end state while avoiding directive-level 

detail. Leaders at operational and tactical levels must 

also consider the degree of detail necessary to ensure 

that the right leaders possessing the right information 

are empowered to make the right decisions for the betterment of the organization. Developing the capacity for 

vision involves a level of understanding and perspective 

that can only come through extensive experience and 

*End state is defined as “The set of required conditions that 

defines achievement of the commander’s objectives.”3

Leading in the Joint Medical Environment
July – September 2013	 59

The Army Medical Department Journal

serious contemplation. Leaders seeking to progress in 

the joint medical environment must actively cultivate 

their capacity for building and articulating a serviceinclusive vision.

The military health system has embarked upon a historic transformation of organization, business, and culture 

that will have profound effects upon the future of Army 

and military medicine and will place unprecedented demands upon leadership at all levels across all services. 

While the core leadership and technical competencies 

and talents will remain, the complexities and dynamics 

of the interservice environment will present challenges 

foreign to those developed within traditional, servicefocused leader development models. The institutional, 

operational, and self-domains of leader development 

must be reassessed to ensure they support the unique demands of an evolving joint medical environment. How 

will leaders gain the cultural awareness, understanding, 

and respect of missions and capabilities of the other services? How will the AMEDD build leaders comfortable 

with the joint environment who are credible and have 

the courage to make tough decisions and follow them to 

conclusion for the attainment of the greater good? The 

concepts noted here are easily said but difficult to inculcate and develop in leaders. For the AMEDD and the 

other services, it means a cultural shift that breaks down 

historical barriers and builds mutual respect and, above 

all, mutual trust. Command and healthcare functions 

and enlisted training efforts are, at varying degrees, already moving toward cooperation and integration. On 

the other hand, officer education lags well behind as it 

remains a service-specific function with few opportunities for integration. Programs such as the AMEDD Executive Skills and the Medical Strategic Leadership programs offer opportunities for joint education, but they 

are focused almost exclusively on strategic level leadership. These programs offer great benefits, but in many 

cases come too late in the officer’s career to build the 

skills and the long-term relationships required for joint 

success. Integration of all officer education and training programs should be the next step in building joint 

medical capacity. Army leadership education at lieutenant, captain, and major levels could meet both servicespecific and joint requirements by offering a common 

core curriculum supported by service-specific tracks. 

The curriculum should focus on building both hospital 

and operational understanding to improve interoperability in both garrison and the deployed environment. The 

AMEDD Center and School (AMEDDC&S) or its jointnamed successor would be the ideal location for a joint 

officer training school. The AMEDDC&S is a wellestablished training institution that offers the technical 

talents and capacities to assume this important mission. 

A joint officer training school collocated with the Medical Education and Training Campus will offer limitless 

potential for the continued growth and development 

of joint enlisted and officer leadership capacities. This 

type of change will require an approach to leader development that breaks the historical segregation of service 

training efforts and combines them to both acknowledge service-unique requirements while preparing officers for the reality of the joint medical environment.

For all the change the future may present, much will remain constant. Organizations, alignments, and missions 

may change, but what will not change is Army Medicine’s commitment to provide the highest quality healthcare. The joint medical environment is not to be feared 

and resisted. It is an opportunity to work in concert 

with the other armed services to improve the business 

and provision of healthcare—not just for the Army, but 

for the nation. This historic change will require leaders 

who embrace the joint concept, possess the credibility to 

lead, and have the courage to make the tough decisions 

that lie ahead.

Are you ready?

References

1. Final Report to the President. Crystal City, VA: Defense Base Closure and Realignment Commission; 

September 8, 2005. Available at: http://www.brac.

gov/finalreport.html. Accessed May 10, 2013.

2. Clausewitz CV. On War. Graham JJ, trans. London, 

England: N. Trübner; 1873.

3. Joint Publication 1-02: Department of Defense 

Dictionary of Military and Associated Terms. 

Washington, DC: US Dept of Defense; November 8, 

2010 [amended April 15, 2013]. Available at: http://

www.dtic.mil/doctrine/new_pubs/jp1_02.pdf. 

Accessed May 10, 2013.

Author

COL LaChance is Chief, Leader Training Center, 

AMEDD Center & School, JBSA Fort Sam Houston, TX.
60 http://www.cs.amedd.army.mil/amedd_journal.aspx

An anachronism is something that belongs to another 

time period. The current organizational structure of the 

Army medical treatment facility (MTF) is an anachronism that reflects medical care delivery characteristic of 

the last century. The current structure is too narrow and 

too vertical to allow a reasonable span of control for today’s complex military hospital. And it does not provide 

for enough organizational level leader experiences for 

the Army Medical Department’s (AMEDD) developing 

leaders.

Subordinate to the MTF Commander, there is generally only one deputy commander position for each major AMEDD corps. Limited opportunities necessitate 

short tours. Professionals who represent smaller subsets of the corps (ie, pharmacists, physical therapists, or 

optometrists) are usually ineligible for these roles. The 

few deputies in the current system may find themselves 

overwhelmed with the demands of “tactical” hospital 

operations and unable to devote time and energy to their 

strategic organizational roles. Of greatest concern, because of the jobs’ professional demands the most seasoned and senior leaders in the MTF are often unavailable to coach and mentor junior, developing leaders.

Fortunately, an alternative organizational structure exists and has operated successfully for the past several 

years at the Department of Defense’s (DoD’s) 2 joint 

facilities in the National Capital Area: Walter Reed 

National Military Medical Center and the Fort Belvoir 

Community Hospital. As the nation’s current conflicts 

end, the period of transition may be the ideal opportunity to review the organization of Army MTFs and to 

consider if it is time for change.

Background

At the outbreak of World War I, Walter Reed General 

Hospital was led by a commanding officer, an executive 

officer, “charged, under the direction of the commanding officer, with the coordination of all departments 

of the hospital,” and an adjutant who was “in charge 

of all incoming and outgoing correspondence, orders, 

and circulars, and had general control of all hospital 

records.”1

 There were departments of administration, 

service and supply, professional services, reconstruction and education, physiotherapy, and nursing. Under 

professional services, the medical and surgical services 

were led by service chiefs. The nursing department of 

the hospital was administered by the principal chief 

nurse and the assistant principal chief nurse, the day 

supervisor of graduate nurses, the night supervisor of 

graduate nurses, and the superintendent of the Army 

School of Nursing.1

 It was presumably the typical organizational structure for Army garrison hospitals during 

the first decades of the 20th century.2

This structure, with a commander and executive officer typical of Army units at the company, battalion, and 

brigade levels, continued through World War II and the 

Korean conflict.3

 The hospital commander was always a 

physician, but, beginning with the Korean conflict, the 

role of the hospital executive officer, “the chief of administration and the principal adviser on management 

to the commander” (the chief operating officer), who 

had traditionally been a physician, could now also be a 

medical service corps officer.4

A chief of professional services (CPS) and chief administrative services were added to the hospital structure in 

the early 1970s. Technical Manual No. 8-230,

5 published 

in 1970 and now obsolete, described the positions of 

commander (a senior medical corps officer), executive 

officer (a medical corps or medical service corps officer), 

chief of professional services (medical corps), and chief 

administrative officer (medical service corps) equal 

in position to the chief of professional services (CPS). 

Under the CPS were departments of medicine, surgery, 

psychiatric services, and clinics. In addition, radiology, 

pathology, nursing, social work, and pharmacy services 

were positioned under the CPS.5(pp9-1–9-4)

“Building Two,” a thousand bed patient care complex 

named the Heaton Pavilion in honor of Army Surgeon 

General MG Leonard Heaton (1959-1969), was opened 

Moving From a Medical Anachronism:

 A New Approach to Military Medical

 Treatment Facility Organization in the

 National Capital Area

COL Charles W. Callahan, MC, USA
July – September 2013	 61

at the Walter Reed Army Medical Center (WRAMC) in 

1977. There were 3 large offices in the command suite 

for the commander, the chief of professional services 

and the chief of administrative services. The role of 

deputy commander for nursing (DCN), equal in position to the clinical services and administrative deputies, 

was not suggested until 1989. Throughout the 1990s and 

into the next decade, the transition to organizations with 

the DCN and the DCN’s role in hospital governance 

gradually occurred across the AMEDD.6

 For example, 

the chief of the department of nursing at WRAMC was 

located in another section of the hospital until the deputy 

commander for nursing moved to the command suite in 

the summer of 2006.*

This system of hospital organization persisted throughout 

the 1970s, while many of the functions of the executive 

officer and chief of administrative service were gradually combined into a single position. For example, there 

was a commander, executive officer, chief of professional 

services, and adjutant running Ireland Army Hospital at 

Fort Knox, KY, in 1980.7

 Increasingly complex clinical 

issues required a senior deputy equal in position to the 

executive officer with direct access to the commander. 

Thus the chief of professional services became the deputy commander for clinical services (DCCS).

In 1979, there was a DCCS at Brooke Army Medical 

Center, TX (LTG (Ret) R. Blanck, oral communication, 

March 19, 2013) and a DCCS at both Fort Benning, GA, 

and Fort Sill, OK, in 1984.8

 MG James Rumbaugh was 

the DCCS, WRAMC in 1986,7

 and LTG James Peake, 

The Surgeon General from 2000 to 2004, was DCCS, 

Tripler Army Medical Center, Hawaii, in 1987.9

In 1998, MTF commander positions were opened to other than Medical Corps officers for the first time.† This 

was in part a result of the experience of deploying medical units to the first Gulf War (1990-1991) commanded 

by Medical Service Corps officers who were replaced 

after arrival in the combat zone by physicians who may 

not always have been as qualified for command. The 

general model of MTF organization, with 3 deputy commanders (including the deputy commander for nursing) 

and a command sergeant major as senior enlisted advisor, persists with minor variation in most Army MTFs 

today.

The Base Realignment and Closure Act of 2005 led to 

development of new form of MTF organization in the 

National Capital Area. A joint task force was established 

to merge the Walter Reed Army Medical Center with 

the National Naval Medical Center in Bethesda, MD, 

and teams of leaders from Army and Navy medicine began to develop a new organizational model in the winter 

of 2006. The first draft was circulated in the summer 

of 2006, and fully 9 different versions were staffed and 

reviewed before the final version, shown in the Figure, 

was adopted in 2010, just 18 months before the merger 

of the hospitals.

Challenges in the development of the

new joint hospital organization

Army and Navy MTFs have significantly different organizational structures. These differences had to be identified, considered, and modified in the process of creating 

the joint organizational structure. For example, the older, 

traditional command structure of most Army hospitals 

resembles that of an Army division—the commander 

fills the equivalent role of the division commander, the 

deputy commander for clinical services fills the role of 

assistant division commander for maneuver (or operations), and the deputy commander for administration is 

the equivalent of the assistant division commander for 

support. With the addition of the senior enlisted advisor and later the deputy for nursing, the structure has 

been the basis for Army hospital leadership for the last 

several decades.

Typical of all Navy medical facilities, the National Naval Medical Center’s command structure was organized 

more like that found on a ship. In Navy MTFs, the senior 

leadership team includes the commanding officer, an executive officer or deputy, the command master chief (senior enlisted), and the heads of the hospital sections or 

directorates (directors). The hospital commander can be 

from any of the corps (including the Dental Corps) and, 

other than at the medical centers, the deputy is generally 

chosen from a different corps.

Like a ship’s executive officer (XO), the hospital deputy 

functions as the “chief operating officer” for the MTF. 

In the Navy culture, the commander has the responsibility for the mission and the crew, but is also specifically tasked to mentor and train the deputy to become a 

commander. Both of the new joint hospitals, the Walter 

Reed National Military Medical Center (WRNMMC) 

and the Fort Belvoir Community Hospital (FBCH), include this “second in command” leadership position, 

designated as the “chief of staff.” While this position 

was found historically in Army hospitals and remains 

typical of maneuver Army battalions and brigades today, 

*The author was a resident at WRAMC 1984-1987, and was the Deputy Command for Clinical Services, WRAMC from 2005 to 2008.

†The Surgeon General of the Army Action Memo of January 17, 1997; Subject: Command of Medical Units. Internal military document not 

readily accessible by the general public.
62 http://www.cs.amedd.army.mil/amedd_journal.aspx

The organizational model for the Walter 

Reed 

National 

Military 

Medical 

Center, a joint military medical treatment facility created from the merger of the 

National 

Naval 

Medical 

Center and the Walter 

Reed 

Army 

Medical 

Center in 2012.

Glossary:

ACOS - assistant chief of staff

 Med/Surg/Peds/ICU - medical/surgical/pediatrics/intensive care unit

ECONS - executive committee of the nursing staff Mgmnt - management

ECOMS - executive committee of the medical staff OB GYN - obstetrics and gynecology

IM/IT - information management/information technology

Operations &

Emergency Mgmnt

Logistics

ACOS ECONS ACOS ECO

MS ACOS Public Health

Deputy

Commander

Surgery

Deputy Commander

Nursing

Deputy

C

D

ommander

entistry

Deputy 

Commander

Behavioral Health

Deputy Commander

Education, Training,

and Research

Commander

Deputy Commander

R

O

eadiness and 

perations

Deputy Commander

Health Operations &

Strategic Planning

Deputy Commander Clinical Support

Deputy Commander

Administration

Deputy C

Medicine

ommander

Chief of Staff

Senior Enlisted

Leader

ACOS Special

Assistants

Managed

Care

Strategic

Communications

Clinical

Support

Liaison

Military

Security

Quality

Management

IM/IT

Nutrition

Services

Safety

Facilities

Patient

Administration

Human

Resources

Comptroller

Staff & Faculty

Development

Research

Programs

Health Profession

Education

D

Graduate Med &

ental Education

Hospital

Dentistry

Oral Maxillofacial

Surgery

Adult Behavioral

Health

Child/Adolescent

Behavioral Health

Med/Surg/Peds/

ICU Nursing

Maternal-Child &

Psychiatric Nursing

Traumatic

Brain Injury

Nursing

Administration Primary Care

Dentistry

Perioperative

Nursing

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Medical

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Moving from a Medical Anachronism: A New Approach to Military

Medical Treatment Facility Organization in the National Capital Area
July – September 2013	 63

The Army Medical Department Journal

contemporary Army hospitals have no equivalent of the 

XO in their organizational structures.

In a Navy facility, the clinical and administrative functions of the hospital are arrayed like ship’s departments 

(administration, deck, engineering, navigation, supply, weapons, etc). The new joint hospitals embraced 

the Army concept of deputy commanders as “executive vice presidents,” and the Navy system of directorates or departments in its final organizational structure. 

Thus, there are 10 directorates, each led by a deputy 

commander: nursing, dentistry, surgery, medicine, behavioral health, clinical support services, administration, health care operations, training/education/research, 

and readiness/operations. There is the assistant chief of 

staff (ACOS) for public health, the elected president of 

the medical staff, and the ACOS for “special assistants” 

(chaplain, staff judge advocate, executive services). 

There is a fourth ACOS at FBCH, the ACOS for nursing, who serves as the assistant deputy commander for 

nursing as well as the chair of the executive committee 

of the nursing staff.

The organizational chart shown in the Figure does not 

necessarily dictate the hospital’s system of governance. 

The composition of the hospital’s executive committee, 

or “board of deputies,” varies between the 2 facilities, as 

do some of the relationships and composition of the hospitals’ major committees. For example, the comptroller 

is a voting member of the hospital’s governing board at 

WRNMMC but is represented by the deputy commander for administration at FBCH. Prominent in both governance systems is the role of the assistant deputy commander for each of the major directorates. These more 

junior officers (majors/lieutenant commanders, lieutenant colonels/commanders) assist their directorate deputy 

commanders and serve important roles in hospital quality, manpower, space committees, and the awards boards. 

In serving as “assistant deputy commanders,” they have 

the opportunity to gain both perspective and experience 

in the business of hospital operations beyond the limits 

of their own “tactical” or direct leadership roles.

Advantages of the new joint organizational

structure

In the standard Army MTF structure, there are a maximum of 2 senior strategic leadership positions per MTF 

that can be held by an officer from any one corps: the 

commander and a service specific deputy commander 

(ie, DCCS, DCA, DCN). In the new joint structure, the 

number of leadership positions is increased to include 

the position of chief of staff. Five different Army and 

Navy officers have held this position in the 2 National 

Capital Area hospitals since 2009: one Medical Service 

Corps, one Nurse Corps, and 3 Medical Corps. The 

chief of staff position is unlike any in the current Army 

model; he or she is responsible for all hospital operations and functions as the commander’s right hand.

There are 10 deputy commanders in the joint MTF organization. The members generally serve 2-year terms, 

although the terms can be extended with consent of the 

Commander of the Joint Task Force (which itself will 

soon be transformed into the National Capital Region 

Directorate of the Defense Health Agency). Civilians 

currently serve as deputy commanders at both hospitals, 

representing the critical contribution of civilians to our 

MTF team and offering an opportunity for senior civilian leadership in the MTF organization. As of this writing 2 years since the merger, in addition to the 2 civilians, a total of 21 Medical Corps officers, 5 Nurse Corps 

officers, 15 Medical Service Corps officers (including 

pharmacist, psychologist, social worker, optometrist, 

and administrator specialties), and 2 Dental Corps officers have served as either chief of staff, assistant chief of 

staff, or deputy commander at FBCH and WRNMMC.

By one account, 70% of a leader’s development comes 

as a result of serving in jobs that provide opportunities 

for growth.10 Junior leaders consistently rank challenging leadership opportunities as the most important part 

of their own leader development.11 Thus, in addition to 

the narrower and more focused span of control, a significant advantage of this joint system of hospital governance is an increased number of senior positions, and 

thus opportunities for leadership development.

There are a number of additional advantages of the joint 

MTF organizational structure. With this model, strategic leadership opportunities become available for some 

specialists who might not have the opportunity in the 

current structure, including, for example, pharmacists, 

social workers, psychologists, and optometrists. Thus, 

the enterprise benefits from the leadership skills of an 

increased pool of officers without diluting the experience and opportunity for the larger corps. Each position has a narrower span of control, allowing for more 

focused mastery of a specific area of hospital operations. 

A narrower span of control allows the clinical leader to 

continue to practice in his or her corps specialty, thus 

maintaining crucial clinical credibility while adding to 

MTF productivity and access. Finally, there is also a 

greater opportunity for mentoring and coaching subordinates in each directorate, as the narrower span of control provides the leader more time and energy to focus 

on the subtle but equally important aspects of leadership, 

including subordinate development, strategic communication, and executive rounding.
64 http://www.cs.amedd.army.mil/amedd_journal.aspx

The major criticism of this flatter, more horizontal organization is that there is too great a diffusion of responsibility. However, that situation has not manifested in 

practice. The commander has a single point of contact 

for all aspects of hospital operations in the chief of staff. 

The chief of staff is also responsible with the commander for helping to build the executive teams and for developing the senior hospital leaders. In situations where 

the chief of staff is not a physician, the commander may 

lean more heavily on the specific clinical deputy commanders or for matters pertaining to credentialing and 

privileging, the president of the medical staff who also 

serves as the chair of credentials and the chair of the 

executive committee of the medical staff.

Summary

Leaders develop by doing hard things—being coached 

and mentored while they operate in challenging 

positions. They also grow by observing credible leaders with whom they can relate and identify. Finally, 

those same credible leaders are the best source of formal leader development programs and mentoring for 

their subordinates. The traditional Army MTF organizational structure makes provision of these 3 means of 

leader development (direct mentoring, coaching, leader 

instruction) extremely difficult. There are too few developmental organizational-level MTF positions, and those 

who serve in the positions are often too taxed to provide 

the kind of leader development support that subordinates should have. The new joint MTF organizational 

structure operating at WRNMMC and FBCH allows for 

all of these leader development practices. It could also 

offer better opportunity for the future development of 

AMEDD leaders in the MTF, whose vocation must always be to lead, to teach, and to serve.

References

1. Weed FW. The general hospital (permanent). Walter Reed General Hospital, Washington, D.C., pre-war period. 

In: Lynch C, Weed FW, McAfee L, eds. The Medical Department of the United States Army in the World War. Vol 

5. Washington DC: US Army Medical Dept Office of Medical History; 1923:271-322. Available at: http://history.

amedd.army.mil/booksdocs/wwi/WRAMCWWI/WRGHWWI.html. Accessed February 7, 2013.

2. Weed FW. Personnel. In: Lynch C, Weed FW, McAfee L, eds. The Medical Department of the United States Army in 

the World War. Vol 5. Washington DC: US Army Medical Dept Office of Medical History; 1923:121-144. Available at: 

http://history.amedd.army.mil/booksdocs/wwi/MilitaryHospitalsintheUS/chapter7.htm. Accessed February 7, 2013.

3. 77th Station Hospital/231st Station Hospital unit history. WW2 US Medical Research Center Website. Available at: 

http://www.med-dept.com/unit_histories/77_sta_hosp.php. Accessed February 7, 2013.

4. Van Ness Ginn R. History of the U.S. Army Medical Corps. 1983. Available at: http://history.amedd.army.mil/

booksdocs/HistoryofUSArmyMSC/chapter8.html. Accessed February 7, 2013.

5. Technical Manual No. 8-230: Army Medical Department Handbook of Basic Nursing [obsolete]. Washington, DC: 

US Dept of the Army; November 1970. Available at: http://archive.org/details/Tm8-230. Accessed February 7, 2013.

6. Sarnecky MT. A Contemporary History of the Army Nurse Corps. Fort Sam Houston, Texas: The Borden Institute. 2010:202. Available at: http://www.cs.amedd.army.mil/borden/Portlet.aspx?ID=099df372-1e64-4a5f-99a6-

c814bd87fe6c. Accessed April 26, 2013.

7. Threet HR. A Study of the Committee Structure of Ireland Army Hospital. August 1980. Available at: http://www.

dtic.mil/dtic/tr/fulltext/u2/a202853.pdf. Accessed February 7, 2013.

8. Mosesman L. A Study to Determine the Best Organizational Structure, Both Administrative and Professional, Between Reynolds Army Community Hospital, Ft. Sill, Oklahoma, and Its Troop Medical Clinics. August 1984. Available at: http://www.dtic.mil/dtic/tr/fulltext/u2/a209733.pdf. Accessed February 7, 2013.

9. Biography of Lieutenant General James Peake. Available at: http://history.amedd.army.mil/surgeongenerals/J_

Peake.html. Accessed February 7, 2013.

10. Center for Army Leadership Technical Report 2007: Commander’s Handbook for Unit Leader Development. Available at: http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA492849. Accessed March 6, 2013.

11. Schirmer P, Crowley JC, Blacker NE, Brennan RR, Leonard HA, et al. Leader Development in Army Units. Views 

From the Field. Santa Monica, CA: RAND Arroyo Center; 2008. Available at: http://www.rand.org/content/dam/

rand/pubs/monographs/2008/RAND_MG648.pdf. Accessed May 21, 2013.

Author

COL Callahan is Commander, Fort Belvoir Community Hospital, Fort Belvoir, Virginia. He also was Deputy Commander 

for Clinical Services, Walter Reed Army Medical Center; Commander, DeWitt Health Care Network (AMEDD); and 

Chief of Staff, Walter Reed National Military Medical Center (Joint Task Force National Capital Medicine).

Moving from a Medical Anachronism: A New Approach to Military

Medical Treatment Facility Organization in the National Capital Area
July – September 2013	 65

As of this writing, the final draft of Army Doctrine Reference Publication 1 is not yet approved doctrine and as 

such cannot be used for reference or citation. However, 

the developing draft construct1

 is a very useful tool for 

all of us who are part of the Army. It provides insight 

for Army Medical Department (AMEDD) leaders about 

the significance of understanding key legal subjects 

throughout their careers in the US Army.

Officers attending the Basic Officer Leader Course or 

the Captains Career Course at the AMEDD Center and 

School (AMEDDC&S) are exposed to specific legal topics designed to empower them throughout their careers. 

The courses are intended to help them develop an understanding of the framework of the Army Ethic.1

 The 

subjects taught within each course cannot be learned in 

just a few hours. This article is written to focus on those 

topics and should be of assistance to young, AMEDD 

leaders who are developing a true understanding of the 

importance of legal matters for success in their careers, 

whether military or civilian. It is also an excellent review for midlevel and senior leaders who understand 

that such elements must be practiced, understood, and 

applied along with the use of effective and knowledgeable legal counsel.

This article is organized into 4 sections:

Standards of Conduct

Military Justice

Law of Armed Conflict

Medical Negligence in the Military Setting

Army Medical Department

 Leaders and the Law

MAJ Joseph B. Topinka, JAG, USA

...[T]he Army Ethic is rich and varied in its sources and its content. Parts of the Army Ethic originate 

from codified, legal documents, such as the Constitution and the Uniform Code of Military Justice....Army 

professionals conduct their individual duties according to the legal part of the Army Ethic.1

The Framework of the Army Ethic

Legal Foundations Moral Foundations

Army

as a Profession

Laws/values/norms for performance of collective institution

Legal-institutional

US Constitution

Titles 5, 10, 32 US Code

Treaties to which the United States is party

Status of Forces Agreements

Laws of Armed Conflict

Moral-institutional

US Declaration of Independence

Just war tradition

Trust relationships of the profession

Individual

as Professional

Laws/values/norms for performance of individual professionals

Legal-individual

Oath of:

Enlistment

Commission

Office

US Code–Standards of Exemplary Conduct

Uniform Code of Military Justice

Rules of engagement

Soldier’s rules

Moral-individual

Universal norms:

Basic rights

Golden Rule

Values, creeds, and mottos:

Duty, Honor, Country

7 Army Values

Soldier’s Creed, Warrior Ethos

MAJ Topinka is an Assistant Professor, US Army-Baylor University Graduate Program in Health and Business 

Administration, and is the Legal Instructor at the Army Medical Department Center and School Leader Training Center, 

Fort Sam Houston, Texas.
66 http://www.cs.amedd.army.mil/amedd_journal.aspx

Army Medical Department Leaders and the Law

Public service is a public trust, requiring military and 

civilian government employees to place loyalty to the 

Constitution, the laws, and ethical principles above private gain. In general, the most significant matters that 

challenge both leaders and followers are the basics of 

the proper treatment of gifts, conflicts of interest and 

how to prevent them, and the proper use of government 

resources.

Gifts

The general rule is that Department of Defense (DoD) 

employees shall not, directly or indirectly, solicit or accept a gift from a prohibited source or a gift given because of the employee’s official position. A prohibited 

source is a very specific term of art and often gets confused. It specifically refers to anyone

 seeking official action from your agency;

 doing or seeking business with your agency;

 regulated by your agency; or,

 having an interest affected by the performance or 

nonperformance of your official duties.

Gifts include gratuities, favors, discounts, entertainment, 

hospitality, loan forbearance, items of monetary value, 

services, training, transportation, local travel, lodging 

and meals, purchase of tickets, and advance payments. 

They do not include non-meal foods such as coffee and 

donuts, greeting cards, plaques, trophies, discounts available to the general public or to all Soldiers, or anything 

for which fair market value is paid by the employee.

If something is a gift, however, there are some exceptions to the general rule which are good for all federal 

employees to know. The first is unsolicited gifts of $20 

or less per occasion, not to exceed a total value of $50 

from a single source in one calendar year. It is a very 

straightforward restriction, but one often violated by 

people who think they can accept more than $20 at one 

occasion and never remember the source for successive 

events. It should be noted that the Secretary of Defense 

recently waived this $20 gift limit for military personnel in the pay grades of E-6 and below when the gift 

is offered by charitable or veterans service tax-exempt 

organizations, is not in the form of cash, and does not 

conflict with other applicable ethics rules and regulations. The second exception involves gifts received because of personal relationship. A personal relationship 

is one that usually has lasted more than a few minutes. 

I cannot tell you how many times previous clients have 

referred to their good, vendor friends that they have only 

known for about an hour. One hour is not sufficient time 

to establish such a friendship. In general, there are some 

basic limitations on the exceptions to rules that federal employees should consider when dealing with gifts 

from outside sources:

• Never accept a gift for influence of an official act.

• Never solicit or coerce the offering of a gift.

• Do not accept so frequently that anyone could believe you are using your public office for private gain.

• Do not accept in violation of any statute.

• Do not accept vendor promotional training contrary 

to applicable regulations.

Normally, employees may not give a gift or solicit a 

contribution for a superior; and they may not accept a 

gift from an employee receiving less pay. Like all rules, 

there are exceptions such as gifts on an occasional basis, special infrequent occasions, minor contributions 

of food that will be consumed at the office, and hospitality in the home. Gifts on an occasional basis include 

things like office functions where a gift is traditional. 

Gifts must be limited to $10 or less in value. Gifts on 

an occasional basis also include things like food and refreshments to be shared at the office like the very common office “potluck,” as well as items customarily given 

in connection with personal hospitality in a residence. 

Special, infrequent occasions are infrequently occurring 

occasions of personal significance or involving termination of the official relationship. Examples are transfer, 

marriage, birth of a child, illness, or retirement. Good 

solid rules for employees to follow on those special, infrequent occasions are:

• All donations must be voluntary.

• No donor may be asked to contribute more than $10. 

A donor may contribute more than $10, but he or she 

cannot be asked to contribute more than $10.

• No contribution more than $300 per donating group.

• If a donor is a member of more than one donating 

group, those groups will aggregate and be subject 

to a single $300 limit. Sometimes members of one 

donating group give in another without realizing it, 

so be careful.

Gifts of Official Travel

Federal employees can be very mobile and official travel 

brings its own set of ethical challenges. First, remember that all promotional benefits, such as frequent flier 

Standards of Conduct

MAJ Joseph B. Topinka, JAG, USA Ryan D. Chandlee, JD
July – September 2013	 67

The Army Medical Department Journal

miles, obtained as a result of official travel belong to the 

individual traveler, provided the benefit is available to 

the general public under the same terms and at no additional cost to the government. Second, there are specific 

rules to airline “bumping”: If you are on official temporary duty (TDY) travel orders and you are involuntarily 

bumped, any benefits belong to the government, but you 

may remain on TDY at government expense. If you voluntarily “bump” yourself, any benefits belong to you the 

traveler, but you cannot charge the government for any 

costs associated with this on your TDY voucher. Third, 

never accept upgrades or benefits from bumping when 

based on rank or wearing your uniform. An airline operational consideration is one thing, an upgrade based on 

your rank or official position is another. It must be understood that as long as upgrades are not offered because 

of your official position, you can accept them. However, 

the government traveler must always understand that the 

more senior you are, the more likely your official position may be a consideration in the airline’s decision. Finally, never voluntarily give up seating if doing so will 

interfere with mission accomplishment. That is not to 

say that you cannot exchange seats with a family that is 

separated by a row or two, but that is different than doing something that will not permit you to arrive on time 

at a designated location pursuant to official orders.

Gifts of Honoraria

There are many myths about honoraria, and I hope this 

article will dispel them. First, a federal employee should 

never accept compensation from a nonfederal source 

for teaching, speaking, or writing that relates to official

duties. Second, a federal employee should ever wonder 

about official status versus personal status, he or she 

should answer the following questions:

` Undertaken as part of official duties?

` Invitation based on official position rather than subject matter expertise?

` Invitation extended by entity with interest in the 

performance of official duties?

` Draws on nonpublic information?

` Deals with ongoing operation of the agency, or any 

matter to which assigned in the past year?

If the answer to any of the questions is yes, then something is likely related to official duties and the employee 

should refuse the honorarium.

Conflicts of Interest

As a federal employee, do not, in your official capacity, 

participate personally and substantially in any matter in 

which you have a personal financial interest. This includes interests held by your spouse and minor children. 

This is to avoid even the appearance of impropriety. 

There are some general remedies for financial conflicts 

of interest such as disqualification, waiver, and divestiture of the assets which are causing the conflicts. Other 

remedies include reassignment, transfer, or resignation 

from an outside position.

Outside Employment

Outside employment is a significant issue within the 

AMEDD, and the good common sense approach is for 

employees not to engage in outside employment that 

interferes or is incompatible with official duties, brings 

discredit upon the employee or the Army, or creates an 

actual or apparent conflict of interest. The US Army 

Medical Command has specific rules for outside employment in its off-duty employment regulation.2 To 

ensure availability of healthcare personnel, providers 

must obtain command approval before obtaining outside healthcare employment, give monthly status declarations of their outside employment, and give monthly 

reports of the hours worked. Officer trainees may NOT

hold off-duty employment. Army Medical Department 

personnel, however, can get compensation for teaching 

or speaking about their profession in general. For example, a family physician could be paid for speaking about 

general preventive health practices.

In addition, employees cannot represent another party 

before the federal government (“representing back”), 

which is what someone is usually doing when working 

off-duty in a government facility. You should be careful about conflicts of interests that result from being involved in a nonfederal entity (NFE) and representing that 

NFE back to the government, acting on matters in your 

official capacity involving the NFE in which you may 

be an officer, and organizing various “teambuilding” activities centered around doing charitable work with that 

NFE when it may also involve your official duties.

There are also some bans about which you should be 

aware after your departure from federal employment. 

First, there is a lifetime ban from working on particular matters in which you participated “personally and 

substantially” as a government employee. There is also 

a 2-year ban from working on particular matters “pending under your official responsibility” within 2 years of 

leaving government service. “Particular matters” is defined as something involving deliberation, decision, or 

action, and that is focused on the interests of specific 

persons, or a discrete and identifiable class of persons.

Use of Resources

Government resources include equipment, time, communications, Internet access, transportation, personnel, 
68 http://www.cs.amedd.army.mil/amedd_journal.aspx

Army Medical Department Leaders and the Law

Table 1. Political activities in which Soldiers MAY participate.

Register, vote, and express a personal opinion, but not as a representative of the Army.

Promote and encourage other military members to exercise their voting franchise, if such promotion does not constitute an attempt to influence or interfere with the outcome of an election.

Serve as an election official, if such service is not as a representative of a partisan political party, does not interfere 

with military duties, is performed while out of uniform, and has the prior approval of the Secretary of the Army or 

his designee.

Join a political club and attend its meetings when not in uniform.

Sign a petition for a specific legislative action or a petition to place a candidate’s name on an official election ballot, 

if the signing does not obligate the Soldier to engage in partisan political activity, and is done as a private citizen 

and not as a representative of the Army.

Write a letter to the editor of a newspaper expressing the Soldier’s personal views on public issues or political candidates, if such action is not part of an organized letter-writing campaign or a concerted solicitation of votes for or 

against a political party or candidate.

Contribute up to the statutory contribute limit to a political organization, party, or committee favoring a particular 

party or candidate.

Attend partisan and nonpartisan political meetings or rallies as a spectator when not in uniform.

Display a political bumper sticker on a personal vehicle.

and official positions. The general rule is that government resources, including personnel, equipment, and 

property, shall be used by federal employees for official 

purposes only. However, use may be authorized when 

it does not adversely affect official duties, is of reasonable duration, serves a legitimate public interest, does 

not reflect adversely on DoD, is at no significant cost 

to the government, and official time is dedicated to the 

conscientious performance of duties. Union and professional development activities may be authorized.

Equipment

Any official or personal use of communications equipment may be monitored by the government, including telephone conversations, email notes, and Internet searches. Certain communications are prohibited. 

These include commercial or personal business; chain 

letters, dirty jokes or ethnic slurs; viewing or downloading pornography; and security violations. Brief personal 

messages, web browsing on personal time, and professional web searches may be authorized by the appropriate supervisor.

Official Position

Employees should never reference title, position or organization to endorse a nonfederal entity. This suggests 

official endorsement or preferential treatment. Employees should not target subordinates or prohibited sources 

with personal endorsements of nonfederal entities. Official endorsements of a nonfederal entity, event, product, 

service, or enterprise may neither be stated nor implied 

except for the few authorized organizations. Federal 

employees shall not endorse membership drives of fundraisers except for the following:

` Combined Federal Campaign

` Army Emergency Relief (or the similar funds of the 

other military services)

` Organizations composed primarily of DoD employees or their dependents when fundraising among 

themselves.

Use of Government Vehicles

Government vehicles are for official use only. They are 

not to be used for transport to private social events or personal errands or transport of dependents/visitors without 

an escort. Transportation to after-hours official functions 

(which must begin and end at the duty station) is permissible when authorized. Government-owned vehicles may 

be used while on temporary duty assignment to go to and 

from lodging, restaurants, physical training, barbershop, 

religious services—but NOT for entertainment.

POLITICAL ACTIVITY

Federal employees must be careful about the political 

activities in which they may become involved.

The political activities in which Soldiers may participate are listed in Table 1. Those activities from which 

Soldiers are prohibited from participating are listed in 

Table 2. The political activities in which DoD civilian 

employees may and may not participate are listed in 

Tables 3 and 4 respectively.
July – September 2013	 69

The Army Medical Department Journal

Table 3. Political activities in which civilian DoD employees MAY participate.

Vote as you choose.

Register as a member of a political party.

Join and be an active member of a political party or club.

Express opinions about candidates and issues.

Attend and be active at political rallies, conventions, and meetings.

Contribute money to political candidates and organizations.

Attend political fund raising functions.

Give a speech at a fund raiser so long as the speech does not include an appeal for political contributions.

Hold office in political clubs or parties so long as the duties do not involve personal solicitation, acceptance, or receipt 

of political contributions.

Campaign for or against candidates in partisan elections.

Campaign for or against referendum questions, ballot initiatives, constitutional amendments, and municipal ordinances.

Sign nominating petitions, make nominations, or place a name in a nomination at a nominating caucus.

Assist in voter registration drives, including serving in a polling place.

Serve as a delegate, alternate, or proxy to a state or national party convention.

Distribute campaign literature in partisan elections.

Run as a candidate for public office in nonpartisan elections.

Run as an independent candidate in a partisan election in certain jurisdictions which are specified by the Office of 

Personnel Management (OPM).

Manage or otherwise work on a partisan political campaign of a candidate for public office, except for activities involving the direct solicitation, acceptance, or receipt of funds.

Serve as poll watcher, election judge, clerk, or similar official.

Drive voters to polling places for a partisan political candidate.

Table 2. Political activities in which Soldiers may NOT participate.

Use official authority to influence or interfere with an election, solicit votes for a particular candidate or issue, or solicit 

political contributions.

Be a candidate for a civil office.

Participate in partisan political management or campaigns, or make public speeches in the course thereof.

Allow or cause to be published partisan political articles signed or written that solicit votes for or against a partisan 

political party or candidate.

Participate in any television, radio, or other program or group discussion as an advocate of a partisan political party 

or candidate.

Use contemptuous words toward the President, Vice President, etc.

March or ride in partisan parades.

Participate in organized efforts to transport voters to polls.

Promote political dinners or fundraising events.

Sponsor or serve in an official capacity of a partisan political party or club.

Attend partisan events as official representatives of the armed forces.

Display large signs/banners/posters on private vehicles.

Display banners/signs in yards of post/base housing or federal offices or buildings.

Conduct a political opinion survey.
70 http://www.cs.amedd.army.mil/amedd_journal.aspx

The military has a unique judicial process that depends 

heavily upon the independent judgments of commanders. The commander is engaged at every step of the system. For this reason, it is essential that Army leaders understand the military justice system and the implications 

of their actions. This section is intended to be a primer 

for understanding the system and the commander’s role.

Uniform Code of Military Justice

The Uniform Code of Military Justice (UCMJ) (10 USC, 

chp 47) defines the crimes for which service members 

can be prosecuted at courts-martial. It contains both civilian-type offenses, such as rape, murder, and larceny, 

as well as strictly military offenses, such as desertion, 

disobedience, and disrespect. It also includes protections for service members, including the right against 

self-incrimination and various procedures the command 

must follow before disciplining a Soldier.

Jurisdiction

In order for a person to be subject to the military justice 

system, the commander or court involved must have jurisdiction. Jurisdiction is the authority of a commander 

or court to try a case and render a valid judgment. The 

UCMJ sets forth 2 conditions for jurisdiction: (a) jurisdiction over the person, and (b) jurisdiction over the offense. The UCMJ defines persons subject to its jurisdiction as “members of a regular component of the armed 

forces...and other persons lawfully called or ordered 

into, or to duty in or for training in, the armed forces, 

from the dates when they are required by the terms of 

the call or order to obey it” (10 USC, Article 2(a)). One 

consequence of this rule is that an Active Duty commander must be aware of the status of National Guard 

and Reserve Soldiers since they can only be prosecuted 

for misconduct committed while in Title 10 status.* If 

the Soldier is not on Title 10 status at the time of the 

offense, an Active Duty commander must consider alternative methods of disposing of the offense. The Supreme Court has limited the powers of courts-martial 

to those offenses that are “service connected.” This requirement, however, is not as limiting as it may appear 

on its face. Generally, it is met by the offenses Congress 

has approved under the UCMJ. It is important to note 

that there is no geographic limitation for jurisdiction. So 

long as jurisdiction over the person and the offense exist, 

Army Medical Department Leaders and the Law

Table 4. Political activities in which civilian DoD employees may NOT participate.

Engage in political activity while on duty.

Engage in political activity while wearing an official government uniform.

Engage in political activity while using a government vehicle.

Engage in political activity in any government office.

Engage in political activity while using government property, including computers, printers, copiers, fax machines, and 

telephones.

Wear political buttons while on duty.

Display items (such as posters, signs, stickers) at work that indicate support of or opposition to a political party or a 

candidate in a partisan election

Run as a candidate for public office in any partisan election, except in jurisdictions specified by OPM.

Solicit, accept, or receive political contributions (except in limited circumstances involving certain federal labor or 

employee organizations).

Solicit, accept, or receive political contributions from a subordinate employee.

Allow your official title to be used in connection with fund raising activities.

Host a fund-raising function at your home.

Use your official authority or influence to interfere with an election.

Knowingly solicit or discourage the political activity of any person who has business before DoD.

Military Justice

MAJ Joseph B. Topinka, JAG, USA

CPT Kristine Knodel, JAG, USA CPT Christopher Crall, JAG, USA

CPT Melissa Anderson, JAG, USA CPT Calandra Woolam, JAG, USA

*US military Reserve and National Guard personnel on active military service and paid under direct control of the US government 

are serving in Title 10 status.
July – September 2013	 71

The Army Medical Department Journal

a Soldier may be tried for misconduct that occurred in 

Nairobi, Kabul, or even outer space.

Handling Discipline at the Lowest Level

Commanders have a litany of available methods to respond to Soldier misconduct from simply closing the 

case without further action to referring the case to a 

General Court-Martial. The UCMJ requires that matters be disposed of at the lowest appropriate level. When 

considering the appropriate response, commanders 

should consider the

• nature and circumstances of the offense and the extent of the harm caused, including effect on morale, 

health, safety, welfare, and discipline;

• character and military service of the accused;

• appropriateness of the authorized punishment to 

the particular accused or offense;

• reluctance of the victim or others to testify;

• availability and admissibility of evidence;

• possible improper motives of the accuser; and

• cooperation of the accused in the apprehension and 

conviction of others.

The 3 most common command responses when faced 

with misconduct are nonjudicial punishment, administrative separation, and courts-martial. Administrative 

separations and some punishments are not technically 

military justice actions since they are based on regulation and not the UCMJ. This means that certain rights 

and procedures will differ as prescribed by regulation.

Reprimands

Any commander may issue a written reprimand so long 

as that commander believes by a preponderance of the 

evidence that the Soldier committed the alleged misconduct. The real question is how the reprimand will 

be filed—either in the Soldier’s “local” file or in the 

Official Military Personnel File (OMPF). Under Army 

Regulation 600-37,

3

 only a general officer or the Soldier’s General Court-Martial Convening Authority (GCMCA) may file a reprimand in the OMPF. Therefore, if 

a battalion commander issues a written reprimand and 

wishes to file it in the Soldier’s OMPF, the reprimand 

must be forwarded up the chain-of-command until the 

proper authority can make that decision. The usual practice for issuing reprimands is that the commander will 

sign a reprimand and have it served upon the Soldier. 

The reprimand will include a recitation of the Soldier’s 

misconduct, as well as notice that it may be filed in the 

OMPF and that it is not punishment under Article 15 of 

the UCMJ. The Soldier will sign a form acknowledging receipt and then take the reprimand, along with all 

supporting documentation, to a defense attorney. The 

reprimand will include a date by which the Soldier must 

provide any rebuttal matters. The issuing authority will 

review whatever matters are provided and then make a 

filing decision. If the reprimand is filed in the local file, 

it will remain there for 3 years or until the Soldier is 

transferred to a different GCMCA. If it is filed in the 

Soldier’s OMPF, it will go in the “performance section.” 

There is no option to file a reprimand in the “restricted 

section” of the OMPF.

Nonjudicial Punishment

Nonjudicial punishment is outlined in Article 15 of the 

UCMJ, and the legal process involving nonjudicial punishment is commonly referred to as simply “Article 15.” 

Chapter 3 of Army Regulation 27-10 4

 provides further 

guidance. The general rule is that Article 15s should be 

given for minor offenses under the UCMJ’s punitive articles. An offense is considered “minor” if the maximum 

punishment under the UCMJ does not include a dishonorable discharge or confinement for more than one 

year. This is only a guideline, though, and commanders 

should also consider the factors discussed earlier. For 

example, the UCMJ authorizes 2 years confinement for 

failing to obey a general order. Still, not all misconduct 

that constitutes failure to obey a general order warrants 

such punishment; depending on the circumstances, it 

can still be considered a minor offense.

There are 2 types of Article 15 actions: summarized 

and formal. Summarized proceedings may be used if 

the Soldier is an enlisted member, and it is determined 

that, should punishment be appropriate, it should not exceed extra duty for 14 days, restriction for 14 days, oral 

reprimand or admonition, or any combination thereof. 

Formal proceedings will be used if the Soldier alleged 

to have committed the offense is an officer, or if the appropriate punishment might exceed extra duties for 14 

days, restriction for 14 days, oral reprimand or admonition, or any combination thereof. The actual authorized 

punishments vary depending on the imposing officer’s 

rank (company-grade, field-grade, or general officer). 

Since punishment under Article 15 is governed by the 

UCMJ, the standard of proof is the same as for courtsmartial: beyond a reasonable doubt. This is higher than 

the preponderance of the evidence standard in place for 

written reprimands.

When administering an Article 15, a commander must 

provide notice to the Soldier of his or her intention to 

impose an Article 15. The notice will include the alleged misconduct and the maximum punishment that 

may result, should the Soldier be found guilty of the 

offense(s). The Soldier should be provided with a copy 

of Department of the Army (DA) Form 2627 (Record of 
72 http://www.cs.amedd.army.mil/amedd_journal.aspx

Proceedings Under Article 15, UCMJ) and the supporting documents and statements for use during the proceedings. The commander may designate an officer or 

noncommissioned officer (NCO) (grade E-7 or above) to 

deliver the DA Form 2627 and inform the Soldier of his 

or her rights. The NCO should ordinarily be the unit first 

sergeant or the senior NCO of the command concerned.

During Article 15 proceedings, a Soldier has the following rights: to remain silent; to counsel (formal proceedings only); to present evidence; to request an open 

hearing (formal proceedings only); to request a spokesperson (formal proceedings only); to appeal; and to demand court-martial. A commander is not limited to the 

Article 15 charges if the Soldier demands court-martial; 

additional charges may be added to the charge sheet for 

consideration by the court.

The Soldier may request a reasonable time to decide 

whether to demand a court-martial and to gather matters 

in defense, extenuation, and/or mitigation. The decision 

period will not begin until the Soldier has received actual notice and explanation of rights under Article 15. 

Normally, formal proceedings require at least a 48-hour 

decision period. Summarized proceedings normally 

require a 24-hour decision period. If a Soldier wishes 

to call witnesses on his or her behalf, those witnesses 

will be at no expense to the government. If the witness 

is located at the installation or nearby, that witness is 

considered available if his or her attendance would not 

unnecessarily delay the proceedings.

At the hearing, the commander will consider all evidence presented, including evidence of extenuating and/

or mitigating factors. Such evidence is relevant to determine the appropriate punishment, if any. The formal 

rules of evidence do not apply, except those pertaining 

to privileges (attorney-client privilege, doctor-patient 

privilege, etc.). Therefore, the commander may consider 

any matter, including unsworn statements, that is reasonably relevant to the offense. Again, the commander 

must find that the Soldier committed the misconduct 

beyond a reasonable doubt in order to find him or her 

guilty of the charges.

As noted earlier, one of the rights available to a Soldier 

is the right to an appeal. An appeal not made within a 

reasonable period of time may be rejected by the appellate authority. An appeal made within 5 days after 

imposition of the punishment is considered timely. The 

commander may extend that time for good cause. The 

appellate authority may deny the appeal or alter the punishment in any way that is more lenient to the Soldier, 

including discarding the Article 15 altogether.

In addition to any reduction in rank, extra duty, forfeitures, or reprimands imposed as punishment under Article 15, a commander determines where the Article 15 

will be filed. If the Soldier is E-4 or below, it is automatically filed in the Soldier’s local file. If the Soldier 

is above the rank of E-4, the commander must decide 

whether to file it in the performance section or restricted 

section of the OMPF. There is no option to file an Article 15 in the local file if the Soldier is above the rank of 

E-4. The restricted section is “that portion of the OMPF 

that contains information not normally viewed by career 

managers or selection boards....”4(p4)

The commander’s discretion to impose an Article 15 is 

personal and must not be hampered by any superior’s 

guidelines or policies. Although a superior commander 

may not tell a subordinate when to impose an Article 15 

or what punishment to assess, the superior commander 

may withhold authority to impose the Article 15 at his or 

her level of command. This may be done through a partial withholding of certain categories of offenses (for example, all drug offenses), certain categories of personnel (such as all officers or all noncommissioned officers), 

or in individual cases. The commander may also totally 

withhold all Article 15 authority to his or her level.

Administrative Separations

Commanders will often initiate administrative separation subsequent to a written reprimand or Article 15. 

However, an administrative separation may be initiated 

as a separate action; there is no requirement that the 

commander formally punish a Soldier before initiating 

separation. Guidelines for separating enlisted Soldiers 

are found in Army Regulation 635-200,5

 while the guidelines for officers are in Army Regulation 600-8-24.

6

Enlisted separations are generally initiated by the company commander and will include a recommendation 

as to the characterization of service, either Honorable, 

General (Under Honorable Conditions), or Other Than 

Honorable (OTH) conditions. The available characterizations vary depending on which chapter of Army 

Regulation 635-200 5

 is the authority to separate the Soldier. For example, if the Soldier is being separated under 

Chapter 18 (failure to meet weight control standards), 

only an Honorable characterization is authorized. If the 

Soldier is being separated under Chapter 14-12c (commission of a serious offense), an OTH characterization 

may be appropriate.

Once the commander initiates separation, the Soldier 

will take a copy of the memorandum and supporting 

documentation to a defense counsel. The Soldier has 7 

days to respond to the allegations. Whatever material 

Army Medical Department Leaders and the Law
July – September 2013	 73

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the Soldier presents will be forwarded along the chainof-command until it reaches the final approval authority, 

with each intermediate commander making a recommendation as to separation/retention and characterization of service.

If the command recommends an OTH characterization, 

or if the Soldier has over 6 years time-in-service, the 

Soldier is entitled to have an Administrative Separation 

Board consider the matter. The Board will hold a hearing 

that is basically an informal trial where it will consider 

evidence from both the Government and Defense. The 

Board will then make a determination as to (1) whether 

the Soldier committed the misconduct; (2) whether the 

misconduct warrants separation; and (3) the appropriate 

characterization of service. The GCMCA will consider 

the Board’s findings and recommendations before making any final decision. If the Board recommends retaining the Soldier in the Army, the GCMCA is bound by 

that recommendation.

Officer eliminations must be initiated by a General Officer Show Cause Authority (GOSCA). Basically, this is 

any General Officer that has a legal advisor. The GOSCA 

will sign a memorandum informing the officer of the reasons for elimination. The officer has 30 days to respond. 

The officer may elect to retire (if eligible), resign, or have 

the matter heard by a Field Board of Inquiry (if eligible). 

Officers are eligible for a Board of Inquiry if the GOSCA 

is recommending an OTH characterization or the officer 

has over 5 years time-in-service as an officer. The approval authority for officer eliminations is the Army Human Resources Command (HRC). Once the officer has 

responded and provided the command with any rebuttal 

matters, the GOSCA will forward the elimination packet, 

including chain of command recommendations, supporting documentation, and the Board findings and recommendations (if applicable) to HRC. The Commanding 

General, HRC will make the final decision on retention/

separation and characterization of service. This process 

generally takes anywhere from 2 to 5 months.

In addition, an officer who commits misconduct may 

have his or her file sent to the Army Grade Determination Review Board. That Board will determine the rank 

at which the officer last served honorably and has the authority to reduce the officer to that rank for retirement/

resignation purposes.

Courts-Martial

If a Soldier’s misconduct is of such a nature that some 

lower level of punishment is not an adequate remedy, the 

commander may elect to initiate court-martial proceedings. Typically, the company commander will inform 

the servicing trial counsel that he or she wants to proceed with a court-martial, and the trial counsel will review the case file and draft a charge sheet. Keep in mind 

that this is a very lengthy and serious process and must 

be given the consideration it is due. The charges will 

then be “preferred” against the accused. “Preferral of 

charges” is the term of art for an accuser swearing to the 

charges. Generally, the company commander will prefer 

charges, but anyone may do so. As will be discussed 

later, nobody may be ordered to prefer charges.

In cooperation with the trial counsel, the command will 

also determine the appropriate level of court-martial. 

There are 3 levels: summary, special, and general.

Summary Court-Martial

A summary court-martial provides for the disposition 

of minor offenses under simplified procedures and is 

generally convened by the battalion commander. This 

type of court can only try enlisted personnel. In addition, instead of a military judge, the presiding official 

is a commissioned officer, usually field-grade, who may 

be a lawyer, but that is not a requirement. Further, the 

accused is not entitled to a military defense lawyer to 

represent him at the summary court but is allowed to 

consult one before trial for legal advice. A Soldier may 

always hire a civilian defense lawyer to represent him or 

her, but he or she would have to pay for such representation. Finally, similar to an Article 15, a Soldier must consent to disciplinary action under summary court-martial. 

However, if a Soldier does object, the case can then be 

sent to a higher level court-martial. The maximum punishment available at a summary court-martial depends 

on the rank of the accused.

Special Court-Martial

There are 2 types of special courts-martial; one empowered to adjudge a bad-conduct discharge (BCD), known 

as Special-BCD, and one that is not so empowered (typically referred to as a “straight special”). A brigade commander is typically empowered to convene a straight 

special. The ability to convene a Special-BCD is withheld to the GCMCA. Given that the difficulty and expense of holding a straight special is the same as that for 

a Special-BCD, and the fact that a straight special cannot discharge a Soldier, it is becoming increasingly rare 

for a command to convene a straight special. A special 

court-martial can take one of 2 forms. It may consist of 

a military judge and not less than 3 panel members, or a 

military judge sitting alone. If the accused requests the 

latter, the military judge will decide guilt or innocence 

and, if found guilty, an appropriate punishment. If an 

enlisted accused requests trial before members, he or 

she can request at least 1⁄3 of the members be enlisted, 
74 http://www.cs.amedd.army.mil/amedd_journal.aspx

although none would be junior in rank to him. Both a 

trial counsel and defense counsel are detailed to represent the respective interests of the government and the 

accused. Just like a summary court, the accused can 

hire a civilian lawyer and pay for such representation using his or her resources. The maximum punishment at a 

Special-BCD is a bad-conduct discharge, one year confinement, reduction to E-1, hard labor without confinement for 90 days, and/or forfeiture of 2⁄3 pay per month 

for one year. Officers may not be discharged or reduced 

at a SPCM. While a summary court-martial may be 

more informal, a special court-martial is conducted just 

like any trial in the civilian world. The rules of evidence 

apply, as do numerous procedural rules.

General Court-Martial

A general court-martial is the highest military trial court 

and is usually convened by a general officer, typically 

the commanding general of a division or senior commander at an installation. It requires more formal detailed administrative procedures than either a summary 

or special court-martial. These procedures include conducting a pretrial investigation into the allegations, commonly referred to as an Article 32 investigation. In addition, the staff judge advocate must issue written advice 

to the GCMCA concerning: (1) whether there is jurisdiction to try the accused, (2) whether each specification alleges an offense under the UCMJ, and (3) whether each 

specification is warranted by the evidence. The general 

court-martial consists of a military judge and at least 

5 court members, or a military judge alone. The maximum punishment available at a general court-martial is 

the maximum punishment listed for each offense in the 

Manual for Courts-Martial.7

 A general court-martial is 

the only court-martial able to adjudge a dishonorable 

discharge. It is also the only court-martial that can dismiss an officer.

The military justice system does have a system of appeals courts. Following disposition at the trial court, an 

accused may appeal the findings and/or sentence to a 

higher court. Some cases are automatically heard on appeal, such as those that adjudge a bad-conduct discharge. 

Ultimately, the US Supreme Court may hear military 

justice cases.

The UCMJ lists 5 different sentencing principles in the 

determination of an appropriate sentence for misconduct. 

Judges and panel members use these principles at courtmartial, but they can also be used by commanders as 

they make decisions concerning the appropriate disposition of matters or as they impose punishment under 

Article 15. The sentencing principles include:

 rehabilitation of the wrongdoer,

 punishment of the wrongdoer,

 protection of society,

 preservation of good order and discipline in the 

military, and

 deterrence of the wrongdoer and those who know 

of his crimes.

Personnel entrusted with the responsibility of implementing the military justice system should balance these 

principles in consideration of an appropriate punishment.

Unlawful Command Influence

Unlawful command influence (UCI) has been called “the 

mortal enemy of military justice,” and it is certainly the 

scourge of a system that requires commander involvement at all levels and in every disciplinary action that 

can be taken against a Soldier. It is defined as the unlawful assertion of authority that interferes with the fair and 

just administration of military justice under Article 37, 

UCMJ, which was written to ensure that commanders 

do not unlawfully influence the disposition of charges 

or otherwise poison the justice process. It acknowledges 

that commanders have a wide range of authority in the 

military justice sytem but requires that they act with 

discretion and independence when enforcing good order 

and discipline. Most of all, commanders must remember that they are judicial authorities and that some of the 

judgments and practices on which they rely in the operational setting are inappropriate or counterproductive to 

the fair administration of justice under the UCMJ.

There are 3 populations that commanders should keep 

in mind when considering whether their conduct has the 

potential to unlawfully influence the judicial process: 

subordinate commanders, court-martial panel members, 

and potential witnesses. When it comes to subordinate 

commanders, such commanders are required to make 

independent recommendations regarding the disposition of cases or to make the decisions to dispose of them 

at their levels, as the MCM requires that all cases be 

disposed of at the lowest appropriate level.

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The Army Medical Department Journal

While traveling through what is now Italy in 1859, Swiss 

businessman Jean-Henry Dunant stumbled upon one 

selfless idea: that we should help to relieve the suffering 

of Soldiers and civilians during a time of war. A pure 

concept, although perhaps not very novel in and of itself, his idea changed the world. After he witnessed the 

aftermath of the battle of Solferino, he recorded his experiences in the book A Memory of Solferino8

 in which 

he described the terrible battle and its bloody aftermath, 

at first from the sidelines and then as a volunteer and 

organizer of relief efforts. He recalled in great detail the 

horrors, suffering, and deaths of the Soldiers for whom 

he cared, spoke with, and consoled before they died. He 

also described the efforts of doctors and civilians along 

with the military medical personnel that cared for masses of casualties, the dead, the dying, the amputees, the 

disfigured, and the deaf and blind from each side of the 

conflict. Most notably, Dunant put forward ideas and 

proposals for the future, aimed at preventing a repetition of the suffering that he had witnessed at Solferino.

In 1863, only a year after he published his book, Dunant 

(with some help) organized a conference in Geneva, to 

which 16 countries sent their representatives. Since then 

there have been 3 additional major conventions in Geneva, and 3 protocols added to the original charter, the 

last in 2006. The “Geneva Conventions,” as we refer to 

them, are really a series of treaties on the treatment of 

civilians, prisoners of war, and Soldiers who are otherwise rendered hors de combat, or incapable of fighting. 

The first convention was initiated by the International 

Committee for Relief to the Wounded, which became 

the International Committee for the Red Cross (ICRC). 

This convention produced a treaty designed to protect 

wounded and sick Soldiers during wartime. The Swiss 

Government agreed to hold the conventions in Geneva, 

and a few years later, a similar agreement to protect shipwrecked personnel was produced. Following World War 

II, 2 new conventions were added to the original two in 

1949, and all 4 have since been ratified by 194 countries.

Concept

The laws governing actions or conduct of armies, Soldiers, and combatants during hostilities although codified through the 4 conventions in Geneva, are not actually laws as we recognize the concept of a legislatively enacted law. The Geneva Conventions are a set 

of internationally recognized principles sanctioned by 

a convention. They are principles, customs, rules, and 

doctrine with which all nations and combatants can 

and should accept, recognize, and follow. However, the 

force of law, the ability to punish offenders who breach 

the principles and articles established by the conventions, and the very thing that gives them life lies within 

the individual signatory nation states, not Switzerland 

or the ICRC in Geneva. Under the Geneva Conventions 

and Additional Protocol I of 1977, states must prosecute 

people accused of war crimes before their own national 

courts or extradite them for trial elsewhere. It is a nation’s national legislation; their military’s regulations, 

customs, and ideology; and their government, judiciary, 

and military’s will and readiness to police its own, that 

gives the law of war muscle.

Which course of action a combatant will take treating 

the enemy, civilians, and property during hostilities will 

be determined by the national character, the ideology, 

and the military strategy of each nation. The principles 

contained in the Geneva Conventions are enforced by 

the individual nation states through their respective 

judicial systems, ad hoc courts set up by the warring 

parties (usually the victors), or through the International 

Criminal Court (ICC). However, not all states recognize 

the jurisdiction of the ICC or have ratified the Treaty of 

Rome which established the court. Currently the United 

States is not a member of the ICC and is not legally obligated to comply with the court.

The United States conducts its military operations in 

accordance with the principles set forth in the Geneva 

Conventions, customary international law, and treaties, 

and recognizes the 3 additional protocols following the 

1949 convention, although the US has not ratified the 

protocols. The Law of Armed Conflict, Law of War, or 

International Humanitarian Law are the terms commonly used to refer to the laws applicable to the conduct of warfare on land/sea and to relationships between 

belligerents and neutral states. Customary international 

law can best be understood as the “unwritten” rules that 

bind all members of the community of nations. Customary international law is the result of the general and consistent practice of states followed from a sense of legal 

obligation, either by treaty, regular practice over time, or 

excepted principles of conduct. Customary international law is binding on all nations, not just signatories of 

treaties. Conventional international law refers to codified rules binding on nations based on express consent, 

through treaty, convention, protocol, or membership 

within certain international organizations incurring legal obligations.

Law of Armed Conflict

MAJ Joseph B. Topinka, JAG, USA CPT Adam Jonasz, JAG, USA
76 http://www.cs.amedd.army.mil/amedd_journal.aspx

In reality, the Law of Armed Conflict is a set of laws 

through which individual nation states and/or belligerents regulate the conduct of their own armies, combatants, and civilians during times of hostility. Remember, 

under the Geneva Conventions and the Additional Protocol I of 1977, states must prosecute people accused of 

war crimes before their own national courts or extradite 

them for trial elsewhere. In effect, national legislation 

which attempts to prevent, limit, restrain, or control the 

conduct of its own armies, Soldiers, civilians, and government in a time of hostilities or war are the only true 

Laws of Armed Conflict for which a government, army, 

or Soldier is responsible. In the United States, for example, The War Crimes Act of 1996 (18 USC, §2441, 

amended 1997) authorizes the prosecution of individuals in federal court if the victim or the perpetrator is a 

US national (as defined in the Immigration and Nationality Act (Public Law 82-414, 66 stat 163 June 27, 1952)) 

or a member of the US armed forces, whether inside or 

outside the United States. Jurisdiction attaches if the accused commits any of the following:

3⁄4 A grave breach of the 1949 Geneva Conventions

3⁄4 Violations of certain listed articles of the Hague 

Conventions

3⁄4 Violations of Common Article 3 of the Geneva 

Conventions, and of Protocol I or Protocol II of the 

Geneva Conventions when and if the United States 

becomes a party to either of the Protocols

3⁄4 Violations of Protocol II to the Amended Conventional Weapons Treaty

3⁄4 Violations of US national legislation (federal law/

UCMJ)

Core Principles

Under the Geneva Conventions, there are 5 core principles governing what conduct is internationally acceptable in armed conflict. Violations of these principles 

constitute “grave breaches” and thus can be considered 

war crimes. These principles are: civilian immunity, 

(the prohibition against intentionally targeting civilians 

or otherwise treating them as combatants); distinction

(the imperative to distinguish between civilians and 

combatants in military operations, and for combatants 

to distinguish themselves as such through identifiable 

dress and insignia and by carrying arms openly); proportionality (the requirement to use force in a manner 

that is proportionate to the military value of the target); 

necessity (the obligation to restrict targets or tactics to 

those necessary to achieve legitimate military goals); 

and humane treatment (the prohibition of torture, inhumane and degrading treatment of prisoners, and the 

imperative to guard the rights and interests of “protected persons,” the legal term for civilians and medical/

religious service members on the battlefield).

The lawful conduct of war—the bounds of lawful use of 

force—is defined by the concepts of military necessity, 

avoidance of unnecessary suffering, and proportionality. 

The Law of Armed Conflict allows combatants to take 

actions with respect to targeting and engagement that 

are not specifically prohibited by international law (convention law) and that are necessary and directly related 

to the prompt submission of the enemy. The concept of 

military necessity never allows for a waiver of the Law 

of Armed Conflict. Arms, projectiles, and material calculated to cause unnecessary suffering and/or destruction of property are prohibited. Otherwise lawful arms 

cannot be used to cause unnecessary suffering (for example, use of unguided munitions with the intent to extend collateral damage to surrounding civilian property 

or persons would be unlawful). There must be discrimination in that attacks must be directed against a specific, 

military target. The loss of life and damage to property 

incidental to an attack must not be excessive in relation 

to the concrete and direct military advantage gained.

Lawful and Unlawful Targets

Combatants are defined as those engaging in hostilities 

in an armed conflict on behalf of a party to the conflict. 

Combatants are lawful targets unless “out of combat.” 

The Geneva Convention definition of “combatant” is 

someone under responsible command, wears distinctive 

signs recognizable at a distance, carries arms openly, 

and abides by the laws of war. Military objectives are 

defined as combatants, defended places, and those objects which by their nature, location, purpose, or use 

make an effective contribution to military action.

Incidental injury and collateral damage is unavoidable 

as unplanned damage to civilian personnel and property incurred while attacking a military objective. Incidental (collateral) damage is not a violation of international law. While no Law of Armed Conflict treaty 

defines this concept, its inherent lawfulness is implicit 

in treaties referencing the concept. An attack on noncombatants or protected property is illegal.

Weapon Systems

Article 23e of Convention IV of the Hague Treaties 

states “In addition to the prohibitions provided by special Conventions, it is especially forbidden...(e) To employ arms, projectiles, or material calculated to cause 

unnecessary suffering;...”9

 This concept also extends 

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July – September 2013	 77

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to unnecessary destruction of property. Arms cannot 

be used that are calculated to cause unnecessary suffering. Otherwise lawful arms cannot be used in a manner that causes unnecessary suffering. Weapons may be 

illegal per se in that they are calculated to cause unnecessary suffering determined by the “usage of states.” 

Examples include lances with barbed heads, dumdum 

rounds, irregularly-shaped bullets, projectiles filled 

with glass.10(p18) They can be illegal by improper use 

such as using an otherwise legal weapon in a manner 

to cause unnecessary suffering. For example, a conventional air strike against a military objective where civilians are nearby versus use of a more precise targeting 

method that is equally available, if the choice is made 

with the intent to cause unnecessary suffering. They 

can be illegal by agreement or prohibited by specific 

treaties. For example, certain landmines, booby traps, 

and laser weapons are prohibited under the Protocols 

to the 1980 Conventional Weapons Treaty. Note that all 

weapons issued for use by the US armed forces have 

been tested for compliance with the Law of Armed 

Conflict and have been found to be lawful when used 

for their intended purpose.

The Law of War Protects Certain Targets

Under the Law of Armed Conflict, certain persons are 

protected as “noncombatants.” Civilians and civilian 

property may not be the subject or sole object of a military attack. Civilians are persons who are not members 

of the enemy’s armed forces; and who do not take part in 

the hostilities.11 Those Soldiers who have fallen by reason of sickness or wounds and who cease to fight are to 

be respected and protected. Civilians are included in the 

definition of wounded and sick (who, because of trauma, 

disease,...are in need of medical assistance and care and 

who refrain from any act of hostility).11 Shipwrecked 

members of the armed forces at sea will be respected and 

protected.12 Shipwrecked includes downed passengers/

crews on aircraft, ships in peril, and castaways. Medical 

personnel are considered out of combat if they exclusively engaged in medical duties.10(p89),12 Prisoners of war may 

surrender by any means that communicates the intent. 

There is no clear-cut rule as to what constitutes surrender. 

However, most agree surrender constitutes a cessation of 

resistance and placement of one’s self at the discretion 

of the captor. The onus is on the person or force surrendering to communicate intent to surrender. Captors must 

respect (not attack) and protect (care for) those who surrender—no reprisals.9,13 Surrender may be made by parachutists from disabled aircraft.10(p17) Parachutists who are 

crewmen of a disabled aircraft are presumed to be out 

of combat and may not be targeted unless it is apparent 

they are engaged on a hostile mission. Paratroopers are 

presumed to be on a military mission and therefore may 

be targeted. Chaplains are protected persons. Journalists 

are given protection as “civilians,” provided they take no 

action adversely affecting their status as civilians.11

Protected Property

Under the Law of Armed Conflict, there is a prohibition 

against attacking civilians or civilian property.10(p98),11 A 

presumption of civilian property attaches to objects traditionally associated with civilian use (dwellings, school, 

etc).11 There is also a prohibition against attacking cultural property. The 1954 Cultural Property Convention 

elaborates, but does not expand, the protections accorded cultural property found in other treaties.9,10(p21) The 

convention has not been ratified by the United States. 

Cultural property includes buildings dedicated to religion, art, science, charitable purposes, historic monuments, hospitals, and places where the sick and wounded are collected. Misuse will subject them to attack. The 

enemy has the duty to indicate presence of such buildings with visible and distinctive signs. Protected cultural 

property is identified through use of protective emblems.

A shield, consisting of a royal blue square, one of the 

angles of which forms the point of the shield and of a 

royal blue triangle above the square, the space on either 

side being taken up by a white triangle.14

In addition, transports of the wounded and sick or of 

medical equipment shall not be attacked.12 Medical 

transports may include ambulances, medical ships, and 

medical aircraft. Fixed or mobile medical units shall be 

respected and protected. They shall not be intentionally 

attacked. Protection shall not cease, unless they are used 

to commit “acts harmful to the enemy.”10(pp102,103) Medical supplies may not be intentionally destroyed.12 Under 

the Geneva Conventions of 1949, medical aircraft must 

have an agreement as to their route, altitude, and time 

of flight in order to be protected. Objects and personnel 

displaying emblems are presumed to be protected under the Conventions.12 Medical emblems include the red 

cross, red crescent, and lion and sun. Protocol III signed 

in 2005 adopted the red crystal as another protected emblem. The ICRC adopted the red crystal as a compromise 

to countries that refused to use the red cross or red crescent because of the religious connotations those symbols 

hold. The red crystal is the ICRC attempt to create a nonreligious symbol that all nations can agree to use.

Medical personnel may be armed for their own defense 

against marauders and those violating the law of war 

by attacking a medical unit. Medical personnel thus 

may carry small arms such as rifles or pistols for this 

purpose. In contrast, placing machine guns, mines, etc, 

around a medical unit would cause a loss of protection.15
78 http://www.cs.amedd.army.mil/amedd_journal.aspx

Normally, medical units are guarded by their own personnel. It will not lose its protection, however, if a military guard, attached to a medical unit, guards it. These 

personnel may be regular members of the armed force, 

but they may only use force in the same circumstances. If possible, medical facilities should not be placed 

near military objectives in order to minimize collateral 

damage to the medical facility in the event the military 

objective is attacked. Medical units/establishments lose 

protection if committing “acts harmful to the enemy.” 

Examples or acts harmful to the enemy are using a 

hospital as a shelter for combatants, as an ammunition 

dump, or as an observation post. Protection ceases only 

after a warning has been given and it remains unheeded 

after a reasonable time to comply. A reasonable time 

varies on the circumstances. For example, no time limit 

is required if fire is being taken from the hospital. Additionally, no warning would be necessary if a unit is 

taking fire from a hospital.11,15

Improper Use of Symbols

The enemy can certainly be tricked by setting ambushes, 

sending false radio traffic, using enemy passwords, etc. 

These are not unlawful. Combatants may wear enemy 

uniforms (for example, to infiltrate) but cannot fight in 

them. Military personnel not wearing their uniform lose 

their prisoner of war status if captured and risk being 

treated as spies.16,17 Treachery or perfidy are different 

matters altogether; they involve injuring the enemy by 

its adherence to the Law of Armed Conflict (actions are 

in bad faith). Perfidy degrades the protections and mutual restraints developed in the mutual interest of all parties, combatants, and civilians. In practice, combatants 

find it difficult to respect protected persons and objects 

if experience causes them to believe or suspect that the 

adversaries are abusing their claim to protection under 

the Law of Armed Conflict to gain a military advantage. 

Thus, the prohibition is directly related to the protection of war victims. The practice of perfidy also inhibits restoration of peace. The use of medical symbols is 

restricted to facilities or transport exclusively engaged 

in medical duties. The 1949 Geneva Convention (II) 12

requires that wounded and sick, hospitals, medical vehicles, and, in some cases, medical aircraft be respected and protected. Protection is lost if committing acts 

harmful to enemy. Feigning surrender or the intent to 

negotiate under a flag of truce is unlawful. A white flag 

is an indication of a desire to negotiate only and its holder has the burden to come forward.11 Feigning protected 

status by using United Nations (UN), neutral, or nations 

not party to the conflict’s signs, emblems, or uniforms 

is also perfidy.11 Note, however, that this prohibition only 

applies if the UN force is not an actual combatant force. 

In fact, UN forces have been actual combatants on only 

one occasion in its history, the Korean War. Feigning 

incapacitation by wounds/sickness is also perfidy, as is 

feigning civilian, noncombatant status.11,16

Rights of Prisoners of War

Prisoners of war (POWs) have the right to receive the basic necessities to stay in good health to include reasonable accommodation of food habits. For example, one 

should not provide a person of the Muslim faith with 

pork. Shelter and clothing should be consistent with the 

climate in the area. Prisoners of war (POWs) have a right 

to retain items such as pictures of a significant other, a 

religious medallion, badges, and basic clothing items. 

Weapons or military equipment they would not need for 

health, protection, or shelter reasons can be taken away. 

What a prisoner needs depends on where he or she is on 

the battlefield. If money is found during a search of a 

POW, an officer must be notified as only an officer can 

seize money from a prisoner. The officer must issue a 

receipt to the POW stating the amount seized and the 

name, rank, and unit of the officer seizing the money. 

Once a POW reaches a camp, a copy of the Geneva Convention on POWs must be available to him or her. The 

ICRC will normally have copies available.

Prisoners of war have the right to make requests regarding the conditions of captivity to the camp commandant. 

This is normally done through the prisoner’s representative, either the POW’s senior ranking officer or a POW 

elected by the body of POWs. Complaints will be directed to the camp authorities through the senior ranking US official, be that officer or enlisted, present in the 

camp. All POWs have the right to practice their religion. 

Premises to conduct worship of their religion shall be 

provided. The Geneva Conventions do place certain 

obligations on POWs. The only information POWs 

must disclose to their captors is name, rank, identification number, and date of birth.13 They must obey lawful camp rules and regulations. If a POW violates such 

rules and regulations, he or she can be punished, either 

by a court-martial or an administrative proceeding. A 

capturing power may use the labor of POWs who are 

physically fit. The labor may not be unhealthy or dangerous or directly contribute to the enemy’s war effort.13

Rank has its privileges among POWs. Retained persons 

may only be used in medical activities.

Retained personnel, detainees, and POWs should be provided both medical and dental care. Civilian internees 

must be provided medical care, but if hospitalization is 

required, they will, if possible, be moved to a civilian 

hospital where treatment must be as good as that provided to the general population. The occupying power must 

ensure that civilians have access to adequate medical 

Army Medical Department Leaders and the Law
July – September 2013	 79

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care, although that care does not have to be provided by 

the occupying power.

As a minimum, retained medical personnel shall receive 

the benefits and protection given to a POW and shall 

also be granted all facilities necessary to provide for the 

medical care of POW. They shall continue to exercise 

their medical functions for the benefit of POWs within 

the scope of the military laws and regulations of the US 

Armed forces. They shall be provided with necessary 

transport and allowed to periodically visit POWs situated in working detachments or in hospitals outside the 

POW camp. Verifications of retained status and medical proficiency will be recorded on the DA Form 4237-R 

(Detainee Personnel Record) of the person concerned.

Responsibilities of Prisoners of War

All POWs, American or otherwise, must provide their 

name, rank, service number, and date of birth. This is 

a requirement of the Code of Conduct for US personnel, 

and is a requirement of the Geneva Convention. Other 

armies allow their POWs to provide more information, 

but the US Code of Conduct limits Americans to providing only the 4 items listed above. Prisoners of war have 

an obligation to obey all rules established by their captor. This does not mean that they cannot try or attempt 

to escape. However, there are consequences associated 

with attempting to escape. It is like a contract. The captors agree not to kill or harm the POW, and in exchange, 

the POW promises not to commit an act harmful to its 

Soldiers or its cause. If the POW violates the terms of 

this contract, the captors can punish the POW. Because 

POWs are a burden on the capturing nation, that country 

can compel POWs to do certain work. A POW can be required to do any act within the camp that is of benefit to 

the entire camp. Examples would be cooking the POWs’ 

food, digging latrines, and building their shelters. POWs 

can also be compelled to do work outside the camp, such 

as working on farms, in commercial businesses, and 

transporting and handling of goods which are not military in character or purpose.

Investigating Violations of the Law of Armed 

Conflict

The Geneva Conventions divides traditional war crimes 

into “grave breaches” and “simple breaches.” DoD Directive 2311.01E18 requires the prompt reporting and 

investigation of alleged war crimes, as well as appropriate disposition of resulting cases under the UCMJ. Most 

violations of the Law of Armed Conflict committed by 

persons subject to the UCMJ will constitute violations 

of the UCMJ. Violations that are not subject to the punitive articles of the UCMJ usually constitute violations 

of federal laws. Chairman of the Joint Chiefs of Staff 

Instruction 5810.0119 establishes joint policy and guidance for the implementation of the Law of Armed Conflict. It provides that it is the policy of DoD to ensure that 

the Law of Armed Conflict is observed and enforced by 

US armed forces. It requires violations, whether committed by or against US or enemy personnel, to be promptly 

reported, thoroughly investigated and, where appropriate, remedied. Law of Armed Conflict violations alleged 

to have been committed by or against allied military or 

civilian personnel, will be reported through appropriate 

command channels for transmission to appropriate agencies or allied governments. Commanders of combatant 

commands are responsible for the overall execution of 

the DoD Law of War Program. Therefore, it is up to 

them to create appropriate plans, policies, and directives 

for reporting any violations through command channels, 

as well as to conduct appropriate investigations to determine if US military personnel were involved, and to 

ensure future enforcement of the Law of War.

Command Liability for

Law of War Violations

Commanders and other superiors are responsible for 

their own conduct, and can, in some cases, be responsible for the conduct of those serving under them. If a 

commander or superior knows or should have known 

of a violation of the Law of Armed Conflict either before, during, or after the violation and failed to act, the 

commander is responsible for his or her failure to command or lead. For example, after World War II, Japanese 

General Tomoyuki Yamashita was sentenced to death 

by a military commission for offenses committed by 

those under his command in the Philippines. Although 

the commission made no direct findings that General 

Yamashita ordered all of the murders and rapes of civilians and prisoners of war, it was concluded that the 

crimes were so widespread that General Yamashita 

must have known about their commission.

Reporting Law of Armed Conflict Violations

Any information about the event (persons involved, location, date, time, names of witnesses, description of 

events, etc) as well as any existing evidence, physical or 

otherwise, should be communnicated to the commander, 

and then by the commander to others. The commander 

will make the effort to secure all documentation and evidence relating to the report, and higher command will 

appoint an investigating officer, should that be necessary.

In spite of the stated process to be used in reporting 

war crimes, violations have been reported to chaplains, 

judge advocates, inspectors general, provost marshals, 

military police, and the criminal investigation division.
80 http://www.cs.amedd.army.mil/amedd_journal.aspx

Why Follow the Law of Armed Conflict?

Service members follow the Law of Armed Conflict for 

many reasons. Ultimately, US laws, regulations, and 

military custom require it. A member of the US armed 

forces remains responsible for his or her personal actions at all times. This is even expressed and made clear 

in our Code of Conduct.20 Its 6 articles deal with chief 

concerns of an American in combat. Although the Code 

was first expressed in written form in 1955, it is based 

on time-honored concepts and traditions that date to 

the days of the American Revolution. The Code clearly 

states that US service members will obey only “lawful 

orders,” even as a POW. The Code also states “...I will 

obey the lawful orders of those appointed over me and 

will back them up in every way. I will never forget that 

I am an American, fighting for freedom, responsible for 

my actions, and dedicated to the principles which made 

my country free.”

Army Medical Department Leaders and the Law

As a result of “sovereign immunity,” people cannot 

sue most governments unless they actually allow you 

to do it. In the United States, the vehicle for recovery 

of a tortuous injury is the Federal Tort Claims Act (28 

USC §2679 (1946)). The Act represents the opportunity 

for an injured party to seek compensation and be made 

whole for the negligent acts of a government employee 

unless the injured individual is on military active duty 

at the time of injury. Active duty military do not have 

this right of recovery. There is a separate discussion concerning a case called Feres v United States (340 US 135 

(1950)) and what it means to be “Feres Barred.” Retirees, 

spouses, family members, and civilians being treated for 

emergent matters are covered by the Federal Tort Claims 

Act (FTCA). However, for AMEDD healthcare providers, 

the FTCA and the Army Tort Claims process in general 

can be a scary labyrinth of blame and licensure implications that may consume several years.

Tort

A tort is a wrongful act, damage or injury done to someone else.21 It can be intentional (for example, an assault). 

It can also be a negligent act, such as failing to take 

proper care in performing a task that results in injury 

to another person. The tort at issue in medical malpractice claims is usually deemed to be failing to provide 

the care that a “reasonably prudent practitioner” would 

have provided. It can be a failure to act (nonfeasance) or 

acting carelessly without regard for the safety of others 

(malfeasance). In either case, if the tort causes damages, the individual patient is allowed recovery under the 

FTCA for the acts of providers acting within the scope 

of their federal duties.

Scope

Scope is an important concept that generally is not sufficiently analyzed when medical providers are learning 

about the FTCA Process. As scope determines FTCA application, the scope analysis is critical. While the Army 

has the opportunity to make recommendations, the 

authority to certify that federal employees were acting 

within scope of their duty lies with the Department of 

Justice. This scope certification must be made prior to removal of a lawsuit and the substitution of the US government as the party being sued (28 USC §2679(d)(1), (d)(2)).

Federal employees providing medical care are covered 

only if their conduct is within the scope of their duties 

(Gonzales Act, 10 USC §1089 (1988)). Thus, a federal 

employee in off-duty employment status would not be 

covered under the FTCA for any acts performed as part 

of that off-duty employment. Military health providers 

should be aware of what their scope of practice actually 

is for their duty. They should know the limitations of 

their individual licensure and the policies of their clinic or ward. If they are in a resident status, they should 

know the scope of their clinical duties as outlined by 

the program director and the department for each year 

of the residency. If they are staff members, the biggest 

issue is to maintain supervision over the residents or 

subordinate paraprofessionals, and to make sure that 

as subordinates, they know to inform their superiors 

of complications or changes in a patient’s status. Also, 

they should be able to recognize when to consult another subspecialty of care and document those actions in 

the medical record. If they order a consult or additional 

medical tests, they should follow-up on those results, because that is the standard of care.

Standard of Care vs Standard of Proof

The very definition of standard of care is, in fact, a 

standard. This implies that health providers are acting within the big bell curve that is the standard of their 

profession. The legal definition is often stated as “what 

a reasonably prudent provider would do in the same or 

similar circumstances.” Health providers should make 

sure they are practicing to professional standards cited 

by their clinic or hospital policies, professional organizations, Army regulations, or state licensure authorities. Standard of care is a wide gray zone. The trick to 

Medical Negligence in the Military Setting

MAJ Joseph B. Topinka, JAG, USA Melissa W. Hartley, JD
July – September 2013	 81

The Army Medical Department Journal

proving that a provider is practicing within standard of 

care is documenting the thoughts and circumstances at 

the time in question. Ultimately, detailed documentation 

is necessary because of the legal standard of proof for 

medical malpractice cases. The legal standard of proof 

in a medical negligence case is preponderance of the 

evidence22 and not beyond a reasonable doubt as in a 

criminal case. This generally means that when all of the 

evidence is heard and placed on the figurative “scales of 

justice,” which way do the scales tip? Are they “for” or 

“against” the government? In FTCA cases that are not 

disposed of in the claims process, a federal judge is the 

decider of fact. There are no juries. The judge will look 

at the evidence and determine “on a more probable than 

not basis” if negligence occurred. Fifty-one percent is 

more probable than not. In reality, the government must 

prove on a “more probable than not basis” that the medical provider did not commit negligence.

Proving a negative is a challenging concept, so it helps to 

look at it from the plaintiff’s perspective. While the government is trying to prove it did not commit malpractice, 

the plaintiff must actually try to prove 3 separate things. 

The plaintiff must first prove that the medical provider 

owed the plaintiff a duty of care. This is simple. If the 

plaintiff was the patient, the medical provider generally 

had a duty to care for him or her. Next, the plaintiff must 

show how the medical provider breached that duty. Even 

if the medical provider somehow failed to meet the standard of care, the plaintiff must still prove how that breach 

actually caused the damages the plaintiff is claiming, 

the third element of malpractice. Sometimes the causation of damages can be pretty simple. For example, if a 

medical provider failed to administer antibiotics and the 

patient suffered an infection that left him or her with an 

ugly scar, the damages are obvious. Likewise, it is easy 

to identify with the loss of a limb and imagine the effect on a person’s daily activities. However, sometimes 

damages are less obvious. A delay in a diagnosis of cancer could have a loss of chance for recovery. Sometimes 

the percentage of chance of cure is so highly technical 

and speculative that even the hospital tumor board may 

have difficulty deciding on what chance of survival the 

patient had based on the date of diagnosis, or whether 

that percentage would have changed based on the delay. 

Birth injury cases that cause a developmental delay may 

be speculative as well. It is hard to argue how any child 

would have matured absent an injury.

Reporting Databases

Medical providers normally believe that the government will cover them as long as they are within their 

scope of practice, but they should still be concerned 

about a claim. Any tort claim filed against the federal 

government for medical malpractice must be reviewed 

through the Army’s Quality Assurance process, typically by the hospital Risk Management Committee.23 Even 

if a claim is denied later, an initial review through the 

quality assurance process will occur. Any actual payment made “for the benefit of a health practitioner” in a 

medical malpractice case is reportable by the Office of 

the Surgeon General to the National Practitioner Databank (NPDB). The NPDB, set up under the Health Care 

Quality Improvement Act of 1986 (Title IV, Pub L No. 

99-660 (1986)), is the central repository for information 

on individually credentialed medical providers. There 

is another lesser-known reporting databank, the Health 

Integrity and protection Databank (HIPDB), a national 

collection data program where civil judgments, convictions for healthcare fraud, and adjudicated decisions on 

other professions are reported. While the HIPDB and 

NPDB are not searchable by the general public, the information is available to all state boards of licensure for 

the various health professions. Medical providers who 

hold more than one state license may receive multiple 

letters about the incident from their states. Every state 

will likely become aware of the NPDB report and may 

open individual investigations. They have the authority 

to request records and their state licensure board may 

make their own independent standard of care determination. This information must also be reported to every 

prospective employer, as well as to insurance providers 

when the medical provider applies for any type of professional practice liability insurance.

Prevention

There is no magic in avoiding medical negligence cases—accidents do happen. However, documentation has 

been proven to be effective in medical malpractice cases 

across the country. Good documentation can provide 

safer communication, better informed patients, smoother transfers of care to colleagues, and improved patient 

outcomes. Good documentation also stands the test of 

time. The FTCA process is a lengthy one. The claimant 

has up to 2 years from the date of injury to file a claim. 

The supporting legal office has an additional 6 months 

to investigate the claim pursuant to Army Regulation 27-

20.

24 Some claims take even longer to investigate, based 

on the course of treatment for a complicated injury, or 

the lack of reliable test data for an infant. The statute 

of limitation is tolled as long as the claimant files the 

claim before the 2-year mark of the date that they “discover” the injury (Landreth v United States, 850 F2d 

532,533 (9th Cir 1988) citing United States v Kubrick, 

444 US 111 (1979)). From the point the claim is denied or 

if settlement is offered and rejected, the claimant has the 

right to file suit in federal court. Once in federal court, it 

can take anywhere from 18 months to 3 years to actually 
82 http://www.cs.amedd.army.mil/amedd_journal.aspx

get a case to trial. A well written medical record holds 

enormous weight to the court since it was written at the 

time of the event. It was not something created by a paid 

expert or drafted under the guidance of an attorney. It 

was written immediately so it is obviously an accurate 

reflection of the events that had just occurred. The court 

will be looking to see if the records reflect that the medical provider met the standard of care and did “what a 

reasonably prudent provider would have done in the 

same or similar circumstances.” Did they show that the 

medical provider was reasonably prudent by paying attention to detail? Do they explain the circumstances and 

what he or she were thinking at the time? Did the patient 

have numerous confusing symptoms that caused the 

medical provider to have to rule out a number of differential diagnoses? If so, there may be a valid defense regarding why a particular referral was not a delay in care 

that equated to malpractice. Did the medical provider 

consult the appropriate specialty care or senior provider 

for advice? If so, whom did the provider call and what 

did he or she said? Did the provider order appropriate 

tests? Were some tests not necessary in an atypical case? 

If so, why not? Did the provider discuss all options of 

care with the patient (Howard v University of Medicine 

and Dentistry of New Jersey, 172 NJ537 (2002))? Did 

the provider discuss risks and benefits of both having 

a procedure versus not having a procedure? If the patient spoke limited language, how did the provider, as a 

reasonably prudent provider, ensure that the patient understood what the provider was explaining/discussing? 

Did the provider use a language line? Did the provider 

rely on a family member to interpret? Did the provider 

ask the patient to verbalize the follow-up plan so the 

provider could be assured that he or she knew when to 

schedule the next appointment or test? If the provider 

ordered tests, did he or she check for results? If the provider communicated results to the patient, is there a note 

explaining when and how this occurred?

Reality of Medical Negligence Cases

The reality is a balancing act. A medical provider does 

not have enough time in the day to write every detail on 

every patient. But what is the perspective of a federal 

judge reading the medical provider’s notes? Will he or 

she think that the provider was a conscientious provider who had a plan of action and addressed the patient’s 

concerns? Or are there a number of identical notes using 

the copy/paste function in the medical records system 

with only the drop-down template boxes checked? Sometimes, even with the best documentation, claims cannot 

(nor should) be defended. Sometimes patients are injured 

and it is the fault of either the healthcare system or one 

particular provider. In those cases, the legal office’s responsibility is to assess damages and make a fair settlement to compensate the injured party.25 Sometimes the 

healthcare system should apologize to the patient or the 

family and restore trust in the system. Compensating an 

injured party when the government is truly responsible 

for damages is the right thing to do.26 It is also the whole 

reason the federal government waived sovereign immunity in the first place. Army Regulation 27-2024 specifies 

that the role of the claims investigator is to fully and fairly 

investigate the claim and adjudicate it in a way that is fair 

to both the injured party and the government. Ultimately, 

accurate records and candor with supporting legal counsel can benefit the medical provider when settling a case. 

First, it can help in settling the case so it does not extend 

it with horrible consequences to the patient, including 

unemployment, further damages, and lingering injuries. 

Second, a medical provider could find it easier to explain 

a payout for $50,000 for a medical error rather than a 

$500,000 payout for the exact same error at a later stage 

of the process. Third, clear and complete medical records 

after the injury play a large role in helping government 

counsel prove exactly what damages (and therefore settlement amount) can actually be substantiated.

Army Medical Department Leaders and the Law

The partnership of law and medicine is truly a noble team, but like any team, it is as only as good as the sum of its 

parts. In many ways, leaders in AMEDD must understand legal basics almost as well as AMEDD legal counsel 

must know the law within the context and culture of Army medicine where they advise and work. Together, an 

incredible synergy results. Together, they support the framework of the Amy Ethic. Together, they contribute to 

superb patient care.

Acknowledgments

Mr Chandlee is Chief, Administrative Law and the ethics counselor at Office of the Staff Judge Advocate (OSJA), 

AMEDDC&S. CPT Crall, CPT Anderson, CPT Knodel, and CPT Woolam are the military prosecutorial team at the 

OSJA, AMEDDC&S. CPT Jonasz, former Administrative Law Attorney, OSJA, US Army Medical Command, is one 

of a group of JAG Corps officers who have deployed multiple times and have real-world experience with the laws of 

international armed conflict.

Conclusion

MAJ Joseph B. Topinka, JAG, USA
July – September 2013	 83

The Army Medical Department Journal

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11. Protocol Additional to the Geneva Conventions 12 August 1949, and Relating to the Protection of Vicims of International Armed Conflicts (Protocol I). Geneva, Switzerland; June 8, 1977.

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Army; October 7, 2011:4-10.

16. NWP 1-14M: The Commander’s Handbook on the Law of Naval Operations. Washington, DC: US Dept of the Navy; 

October 1995:12-2.

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US Dept of the Air Force; 1976:8-6.

18. Department of Defense Directive 2311.01E: DoD Law of War Program. Washington, DC: US Dept of Defense; May 

9, 2006 [current as of February 22, 2011].

19. Chairman of the Joint Chiefs of Staff Instruction 5810.01D: Implementation of the DoD Law of War Program. Washington, DC: US Dept of Defense; April 30, 2010.

20. Department of Defense Directive 1300-7: Training and Education to Support the Code of Conduct (CoC). Washington, DC: US Dept of Defense; December 8, 2000 [current as of November 21, 2003].

21. Restatement of the Law Second, Torts. Vol 1. Philadelphia, PA: The American Law Institute; 1965.

22. Garner BA, ed-in-chief. Black’s Law Dictionary. 8th ed. St Paul, MN: West Publishing Co; 2008.

23. Army Regulation 40-68: Clinical Quality Management. Washington, DC: US Dept of the Army; February 26, 2004.

24. Army Regulation 27-20: Claims. Washington, DC: US Dept of the Army; February 8, 2008.

25. Army Regulation 27-40: Litigation. Washington, DC: US Dept of the Army; September 19, 1994.

26. American Medical Association Code of Medical Ethics: Opinion 8.12 – Patient Information; 1981. Available at: 

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Accessed May 24, 2013.

Acknowledgments (Continued)

I thank Ms Hartley, Deputy Center Judge Advocate, Madigan Army Medical Center, for mentoring and training me 

and many other military lawyers who have served the Army Medical Department. Since the Army JAG Corps has no 

formalized training program in health law for attorneys, we rely on experienced civilian attorneys such as Ms Hartley, to 

lead us through our experiences in military health law.
84 http://www.cs.amedd.army.mil/amedd_journal.aspx

©George Lamson and Studio E, printed with permission. The above image is a reproduction of a 

graphite drawing by the artist George E. Lamson in collaboration with MAJ Joseph B. Topinka, 

JAG, US Army. Mr Lamson’s artwork illustrates the synergy of the US Army Judge Advocate 

General’s Corps and the US Army Medical Department in support of Soldiers, family members, 

and retirees. 

Army Medical Department Leaders and the Law
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. 

INFORMED CONSENT

Identifying information, including names, initials, or hospital numbers, should not be published in written descriptions, 

photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives 

written informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown the 

manuscript to be published. Authors should disclose to these patients whether any potential identifiable material might be 

available via the Internet as well as in print after publication. Patient consent should be written and archived, either with the 

Journal, the authors, or both, as dictated by local regulations or laws. 

GUIDELINES FOR MANUSCRIPT SUBMISSIONS

1. Manuscripts may be submitted either via email (preferred) or by regular mail. Mail submissions should be in digital format 

(preferably an MS Word document on CD/DVD) with 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. 

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, with the following required data: 

 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 imagery 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, TIFF, GIF) are preferred.

Editable versions with data sets of any Excel charts and graphs must be included. Charts/graphs embedded in MS Word cannot 

be used. Prints of photographs are acceptable. If at all possible, please do not send photos embedded in PowerPoint or MS 

Word. 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. Submit manuscripts to: 

EDITOR, AMEDD JOURNAL

AHS CDD BLDG 4011 

2377 GREELEY RD STE T 

FORT SAM HOUSTON, TX 78234-7584 

DSN 471-6301 

Comm 210-221-6301 

Email: amedd.journal@amedd.army.mil