The Official USU Newsletter

Learning to Care for Those in Harm’s Way

Volume 11, Issue 4 n March 28, 2016

www.usuhs.edu
2 the pulse March 28, 2016

On the cover

Sharon Holland

Deputy Vice President for External Affairs and Managing Editor

Eric Ritter

Writer and Editor

MC3 Laura Bailey

Writer and Photographer

Tom Balfour

Photographer

 

Production

Editorial content is edited, prepared and 

provided by the USU Office of External 

Affairs unless otherwise indicated. The 

Pulse staff may include or exclude articles based upon news value, impact on 

the university and space availability.

Submissions

The Pulse is published biweekly on 

Mondays. The deadline for submissions 

is at 4 p.m. Tuesday prior to the publication date. Submissions can be sent to 

eric.ritter2@usuhs.edu or by calling 301-

295-3791.

By Sharon Holland

USPHS Lt. Andrew Hickey, Ph.D., M.P.H., 

a 2010 USU graduate secures a quarantined 

area of a mobile treatment facility in the 

country of Liberia during last year's Ebola 

outbreak in that country. Hickey has been 

selected to lead a team of HIV researchers in 

Indonesia. See story on page 5. (photo courtesy of Lt. Andrew Hickey) 

USU Faculty, Student, Alumn 

Recognized for Life-saving Care

The grateful words of a father led to an awards presentation for 

three members of the USU community on Feb. 11, 2016.

Army 2nd Lt. Anant Shukla, a fourth-year medical student and Dr. 

Edward Mitre, an associate professor in the Department of Microbiology 

and Immunology, at the Uniformed Services University of the Health Sciences, along with USU class of 1981 alumna, Dr. Wendy Bernstein, a hematologist in the Department of Research Programs at Walter Reed National Military Medical Center (WRNMMC), were recognized by Army Maj. 

Gen. (Dr.) Jeffrey B. Clark, former Director of WRNMMC and then-Director of the National Capital Regional Medical Directorate, for outstanding 

efforts that contributed to saving the life of a young woman at the hospital 

last year.

According to a letter sent by the father to Clark in December, the 

patient was taken to the emergency room at WRNMMC where she was 

diagnosed with accelerated hypertension and acute renal failure. She was 

transferred to the medical intensive care unit, where she was evaluated by a 

number of specialty teams. 

Mitre was not officially assigned to the girl’s case, but was called 

in as a consultant. “His diligent review of the literature led to recognition 

of a novel diagnostic test for [atypical hemolytic uremic syndrome] aHUS 

called the modified HAM test, developed by Johns Hopkins Hospital; the 

new test was literally published in the journal Blood the same month,” the 

father recounted in his letter to Clark, which was read during the awards 

ceremony. “His independent communication with Johns Hopkins’ hematologists resulted in information sharing with Drs. [Dustin] Little [her 

primary case physician and nephrologist] and Bernstein, delivery of my 

daughter’s blood to Johns Hopkins, confirmation of the diagnosis of aHUS 

(a feat not achievable the prior month), and initiation of kidney and, likely 

lifesaving, eculizumab treatment.”

Bernstein thoroughly researched and coordinated the blood workup and eventual treatment with the complement inhibitor, eculizumab, and 

provided emotional support to the patient throughout the hospital stay. 

Shukla was on a nephrology rotation at WRNMMC and, as part of 

the health care team, was lauded for providing simplified explanations of 

complex medical issues and showing a compassionate bedside manner. 

“His warm, caring demeanor were notably instrumental in my 

daughter’s care,” the father continued in his appreciation letter. Most notably, Shukla drove to Johns Hopkins in Baltimore to deliver blood for the 

modified HAM test and stayed there until the test was completed to ensure 

results would be conveyed quickly. “His commitment, diligence, and intelligence led to the Chief of Hematology at Johns Hopkins jokingly asking 

me if 2nd Lt. Shukla could be transferred from USUHS to Johns Hopkins 

Medical School.” 

Mitre, Shukla and Bernstein’s efforts, along with the primary attending physician, Dr. Dustin Little, and the WRNMMC team of providers, led 

to the young woman’s clinical stabilization and initiation of lifesaving hemodialysis and state-of-the-art anti-complement therapy for presumptive 

diagnoses of two exceedingly rare diseases -- aHUS and scleroderma renal 

crisis SRC.
3 the pulse March 28

By Sharon Holland

Manzanares Named 2015 OSD Senior Enlisted 

Member of the Year

Army Staff Sgt. (promotable) David Manzanares, a health 

physics specialist at the Armed 

Forces Radiobiology Research Institute of the Uniformed Services University of the Health Sciences, was 

named 2015 OSD Senior Enlisted 

Service Member of the Year. Michael Rhodes, Director of Administration, Office of the Deputy Chief 

Management Officer, Department 

of Defense, made the announcement March 15. 

Manzanares, who has been 

selected for promotion to Sgt. 1st 

Class, was chosen from a candidate 

slate of service members in grades 

E-7 through E-9 representing the 

Office of the Secretary of Defense, 

the Office of the Chairman of the 

Joint Chiefs of Staff, Washington 

Headquarters Services, a variety of 

Defense Agencies and DoD Field 

Activities. Nominees are assessed 

on the basis of performance of duty, 

military bearing, self-expression, 

general military knowledge, leadership qualities and potential, and 

must have been assigned to their 

command for at least one year prior 

to their nomination. 

Manzanares was born in Managua, Nicaragua, but was raised in 

Miami. He joined the Army in 2003 

and served as a preventive medicine technician and health physics 

NCO for four years before leaving 

the service for a year during which 

he served as a health inspector for 

the State of Florida. In 2008, Manzanares returned to the Army as the 

preventive medicine team leader 

for the 227th Preventive Medicine 

Detachment at Fort Lewis, Washington. The following 

year, he was assigned as 

a health physics NCO at 

Walter Reed Army Medical Center in Washington, DC, and later at 

Fort Belvoir Community Hospital in Virginia. 

In January 2013, Manzanares reported for 

duty at AFRRI. 

In addition to 

his excellent work performance, Manzanares 

has also excelled academically. He earned 

an Associate of Science 

degree from Drury University in Springfield, 

Missouri, and will graduate in June 2016 with 

a Bachelor of Arts degree in Natural Science and Mathematics from 

Thomas Edison State University in 

Trenton, New Jersey. 

“I’m truly humbled by my 

selection for the Office of the Secretary of Defense Service Member of 

the Year. I know that all of the nominees were the best service members 

from their respective organizations. 

I am proud to have been able to represent and win for the Armed Forces Radiobiology Research Institute 

and the Uniformed Services University of the Health Sciences,” said 

Manzanares.

“We are extremely pleased 

that Staff Sgt. (promotable) Manzanares was selected for this honor. 

He is a truly outstanding Soldier 

and leader who sets the example for 

all NCOs,” said USU Brigade Commander Army Col. (Dr.) Jerome 

Buller. “His exemplary performance 

is reflective of the quality of the 

NCOs here at USU and throughout 

the Military Health System.”

Manzanares is USU’s second 

enlisted member to earn the OSD 

honor. Navy Hospital Corpsman 

1st Class Daryl Mercado, was selected for the Secretary of Defense’s 

2012 Junior Enlisted Member of the 

Year award. Mercado, a laboratory 

technician, served as the leading 

petty officer and enlisted advisor 

for the Graduate Education Office 

at USU. Mercado, who is a now a 

Chief Hospital Corpsman, was recently selected for a Navy in-service 

commissioning program to become 

a Health Care Administration officer. 

The award, which includes a 

Joint Service Commendation Medal, will be presented to Manzanares 

during a formal Pentagon ceremony 

April 15.

Staff Sgt. (promotable) David Manzanares (Photo 

by Tom Balfour)
4 the pulse March 28, 2016

Proper Nutrition Helps Fuel a Proper Lifestyle By Eric D. Ritter

See nutrition page 5

Nutrition is relatively new to 

the medical field. It wasn’t until the 

early 1900s when vitamins such as 

Vitamin A was deemed critical to 

health. The study of nutrition is also 

becoming more important because 

obesity and other weight-related 

health problems such diabetes and 

heart disease are affecting more and 

more Americans.

To help spread the message 

of healthy eating, March has been set 

aside as National Nutrition Month. 

According to Uniformed 

Services University (USU) Senior 

Nutritionist, Sheryl C. Hoehner, 

MS, RDN, LDN, National Nutrition 

Month began in 1973, but at that 

point it was just a week. However, 

by 1980, it became so popular with 

dietitians that it become a monthlong observation.

“The purpose of the observation is to increase the public 

awareness of the importance of good 

nutrition and to help the public become aware of the dieticians as the 

nutrition experts,” Hoehner said. 

“We know there is a crisis 

of overeating in this country that is 

leading to weight gain and obesity, 

and I think people give up trying to 

eat properly too easily.”

Hoehner’s Nutrition branch 

falls under USU’s Consortium for 

Health and Military Performance 

(CHAMP) which aims to be DoD’s 

best resource for evidence-based information on human performance 

optimization (HPO) to improve the 

performance and resilience of service members and their families. 

Hoehner said she has more 

than 30 years of nutrition knowledge from the grocery store perspective as well as being a retired 

army dietitian, so meal planning is 

very important to her.

“When I work in grocery 

stores, I love helping people find 

what they need and make needed 

dietary changes,” she said. “Sometime these changes can be revolutionary for them in terms of health 

and wellness.”

Nutrition is important, especially for military members, she 

said, because it helps servicemembers “go the distance in the field, 

so that they work more efficiently, 

think more clearly and do what they 

need to do."

Proper nutrition is also important because improperly managed meals can lead to weight gain, 

and that can affect someone’s military career. 

The availability of poor food 

choices is far greater now, too.

“When I was younger, and 

we would stop at a gas station, it 

was for gas,” she said. “Now, you can 

get hotdogs, candy and giant sodas 

while you’re getting gas. We are inundated everywhere we go with 

poor food choices, and that makes 

it difficult for many people to stick 

with healthier choices.” 

“Proper meal planning is 

also healthy for the social aspect of 

families,” she said. “Families tend to 

interact more during proper meal 

preparation. Too many people want 

to do things quickly, like a drivethrough, and that can be very unhealthy. “It’s in our nature to want 

something that’s fast and available. 

We don’t always want to do the hard 

work of preparing meals, but proper 

nutrition often will require some of 

that hard work.” 

She continued that there are 

many healthy options that are quick 

such as cooking chicken in a crock 

pot and then using that chicken for 

sandwiches, casseroles and soups all 

week long. Also, having on-the-go 

snacks available like raisins, dried 

prunes, and peanut butter which 

can stay fresh indefinitely in a desk 

or back pack, so you have nutritious 

choices available.

Hoehner said the Nutrition 

branch at CHAMP also provides 

nutrition information for service 

members' family members by updating tips on their website and social media on topics such as meal 

planning and how to properly fuel 

their child for athletic activities.

“We try to make our pieces 

very practical and relevant to the 

service members and their families, 

and we can measure what’s relevant 

by the feedback on our social media 

sites.”

Hoehner said she and fellow CHAMP nutritionists mentor a group of USU students called 

STING (STudents Interested in Nutrition Group) to help them learn 

more about nutrition and how it relates to medicine and health.

One of the biggest challenges 

she sees with nutrition is that there’s 

so much information out there, and 

sometimes the media will run with 

one study. 

“With the proliferation of 

technology we have today, bad information can be spread quickly," 

she explained. “Trying to correct 

those misconceptions is one of the 

biggest challenges we have as dietitians.”

She pointed out another 

misconception she sees often is the 

cost of healthy eating.

“It’s very much a misconception that eating healthy costs a 

lot of money,” she said. “There are 

many foods in grocery stores that 

are healthy and do not cost much 

such as dried beans and peas, pota-
5 the pulse March 28

Nutrition, from Page 4

toes, apples and frozen vegetables, 

plus produce in season. Restaurant 

meals, which is where many folks 

use their food dollars, are usually 

many times higher in price and not 

as healthy." 

Eating well is easy to achieve 

with simple planning, and to help 

guide service members and their 

families, CHAMP has information 

available.

Don’t forget the importance 

of breakfast, Hoehner also said.

“Breakfast is key. It fuels you 

through the day. If you skip breakfast, you may find yourself starving 

later and may eat much more than 

you would if you ate properly earlier 

in the day.”

Hoehner said she is excited 

for the future of nutrition.

“It is still such a young science, and we are learning new things 

about how our bodies perform better all the time.”

A 2010 alum of the Uniformed Services University of the 

Health Sciences (USU) Emerging 

Infectious Disease Program will begin a six-year assignment with the 

Centers for Disease Control Prevention (CDC), Thailand, leading 

a Human Immunodeficiency Virus 

(HIV) Research Laboratory team. 

U.S. Public Health Service 

Lt. Andrew Hickey, Ph.D., M.P.H., 

said he feels prepared for his new 

assignment in Thailand, due in part 

to lessons learned from previous 

assignments. During the last three 

years, Hickey has been on detail to 

Department of Homeland Security where he served as the subject 

matter expert for more than ten biological events, including the Ebola 

epidemic in West Africa for which 

Hickey has been deployed to Liberia 

twice. He served as the safety and 

infection control officer at a U.S.-led 

Ebola Treatment Unit in Monrovia, 

Liberia, during the early stages of 

the Ebola epidemic until Feb. 2015. 

In Sept. 2015, he returned to Liberia 

to serve as the team lead for Ebola 

Rapid Diagnostic Testing (RDT) 

and laboratory advisor for the CDC, 

where he developed a national strategy for introducing an Ebola RDT in 

Liberia and began pilots at two sites 

to initiate phased implementation of 

the Liberia national strategy to provide presumptive Ebola diagnostic 

testing for approximately 5,000 patients and dead bodies in the most 

densely populated regions of Liberia. He will begin his Thailand 

assignment in April. 

The CDC Thailand works 

closely with the Thailand Ministry of Public Health (MoPH) to 

develop model approaches and 

expand prevention, surveillance, 

care and treatment of Human 

Immunodeficiency Virus (HIV) 

and other sexually transmitted 

diseases (STD). 

As the new chief of the 

HIV and STD lab section, Hickey will be leading a group of 15 to 

20 assignees to conduct studies 

of HIV and STD incidence and 

risk behaviors, and evaluate current clinical trials for efficacy and 

safety with the people of Thailand. If the efficacy trial in Thailand proves effective, participants in 

that trial and their community will 

be the first to benefit. All trial participants will receive treatment for at 

least one year after efficacy is proven 

while the CDC works with the Thai 

Food and Drug Administration for 

approval of use by the Thai health 

care system. 

“To say that I’m excited 

would be an understatement,” said 

Hickey. “It’s really exciting to be able 

to participate in something that will 

eventually go into clinical practice 

around the world. As a virologist, 

you want to see that what you’re 

doing will have an effect. That’s the 

gratifying part for me.” 

The CDC Thailand provides 

support to neighboring countries, 

including Laos, as the Asia Regional 

Office. Their support efforts provide 

technical assistance and often includes Thai government partners in 

the collaborations. The CDC, along 

with their partners, work to improve 

HIV programs by building country capacities needed to mount and 

sustain an effective national HIV 

response. These activities support 

a data-driven, evidence-based approach that is tailored to the unique 

characteristics of the local epidemic 

for maximum health impact and the 

most efficient use of resources. 

Hickey to Lead HIV Research Team in Thailand

By MC3 Laura Bailey 

USPHS Lt. Andrew Hickey, USU 2010 

PhD graduate, to lead HIV research team 

in Thailand. (Courtesy Photo)
6 the pulse March 28, 2016

By MC3 Laura Bailey

SOM Students, Faculty Receive 2017 Academic Awards

See Awards Page 7

Arthur L. Kellermann, MD, MPH (center), Dean of the F. Edward Hébert 

School of Medicine (SOM) at USU presents the Awards for Outstanding Academic Performance to 2nd Lt. Aimee Moores (right) and 2nd Lt. Michael 

Larkin during the 2017 Academic Awards' ceremony at USU, March 4. (Photo 

by Tom Balfour)

Students and faculty at the F. 

Edward Hebért School of Medicine 

(SOM) at the Uniformed Services 

University of the Health Sciences 

(USU) received awards during the 

Class of 2017 Academic Awards 

Ceremony at USU, March 4. 

For more than 25 years, the 

SOM has been sponsoring a student 

awards program recognizing the academic excellence of USU medical 

students. The ceremony recognizes 

students in the Class of 2017 who 

have completed the year-long clerkship phase of the curriculum which 

consists of six major core clerkships. 

The awards program identifies those 

students who achieved significant 

academic success by receiving the 

grade of ‘Honors’ in at least four of 

those clerkships. In total, 26 students were recognized. 

There are three tiers of 

awards: The Outstanding Academic Performance Award is present 

to students who have four grades 

of ‘Honors’; the Distinguished Academic Performance Award is presented to students who received five 

grades of ‘Honors’; and the Dean’s 

Award for Academic Excellence is 

the highest award and is given to 

those students who maintained a 

broad general excellence by receiving ‘Honors’ in all six clerkships. 

In addition to student 

awards, the leadership of the Class 

of 2017 presented several awards 

recognizing accomplishment of faculty, staff and departments. 

“With our Class of 2017 

Clerkship Awards, we knew we 

wanted to recognize the work of our 

outstanding clerkship directors and 

particularly good teaching hospitals, 

and we had precedence for those 

awards,” said 2nd Lt. Aimee Moores, 

a third-year medical student at the 

SOM at USU and the vice president 

of the Class of 2017. “However, as 

a class, we also had the desire to 

recognize specific attending physicians who played an integral role 

in our development over the clerkship year. In order to facilitate this, 

the class officers created a portion 

of the awards survey that allowed 

our classmates to nominate up to 

three attendings – each who they 

felt should be commended for their 

outstanding teaching. For a class of 

over 150 students rotating in all core 

specialties in more than 20 military 

training facilities, we saw striking 

consistency in the names put forth. 

Typically, when asked to provide 

reasons for nominating a particular 

staff physician, the students would 

describe characteristics of enthusiasm for teaching, respect for all 

team members to include medical 

students, and consistent demonstration of qualities we hope to emulate in our practice of medicine. 

The class officers ultimately agreed 

on a list of ten of these faculty – the 

ten who received the most nominations, to be formally recognized and 

awarded at our ceremony.”

This was the first time the 

awards had been extended to recognize faculty from teaching hospitals 

outside the USU campus. The ceremony was originally just for recognizing students, but over the years, 

it has evolved, said William Wittman, Ph.D., the associate dean for 

the Office of Student Affairs (OSA) 

at the SOM, USU. 

The awards are as follows: 

Faculty Awards

Best Clerkship Director: Lt. Col. 

Matthew Eberly; Col. William Kelly 

(Tie)

Best Teaching Site (Large): Walter 

Reed National Military Medical 

Center (WRNMMC); (Small): Eglin 

Air Force Base 

Best Support Staff: Mrs. Rachel Darling, Naval Hospital Portsmouth, 

Va. 

Exceptional Attending: Cmdr. Todd 

Gleeson (Infectious Diseases, Wash-
7 the pulse March 28

Awards from Page 6

The Uniformed Services 

University of the Health Sciences 

(USU) is headquarters for a newly-established ‘think tank’ to study 

issues of concern to the Military 

Health System (MHS).

The Defense Health Horizons (DHH) was created at the direction of Assistant Secretary of Defense for Health Affairs (ASD HA), 

Dr. Jonathan Woodson, to provide 

critical insights into key MHS issues, develop proposed courses of 

action, and outline potential policy 

implications to MHS leadership – in 

90 days or less.

Comprised of a diverse 

cross-section of relevant USU, MHS, 

and external scholars and leaders, 

the DHH provides access to both civilian and military healthcare expertise on issues the MHS leadership 

views as being potentially important 

and challenging in the foreseeable 

future.

The group recently finalized 

its first effort, which was to outline 

the potential effects of new CMS 

(Centers for Medicare and Medicaid Services) coding rules on Graduate Medical Education (GME). 

At the ASD HA’s direction, they 

recently began an analysis of GME 

in the MHS as their next challenge. 

Among future approved topics are 

a review of pain management and 

opioid use in the MHS; examining 

policy implications for women’s 

health benefits in comparison with 

those of the Affordable Care Act; 

and a study on potential productivity measures to succeed the current 

RVU (relative value unit) approach.

Dr. Linda Degutis, former 

director of the Center for Disease 

Control and Prevention’s National 

Center for Injury Prevention and 

Control, serves as the DHH executive director, and Ms. Racine Harris 

is the group’s program manager.

Other members of the DHH 

include Dr. Carolyn Clancy, chief 

medical officer, Department of Veterans Affairs; Navy Lt. Cmdr. Eric 

Dietrich, director, Master of Health 

Administration and Policy degree 

program, USU; Navy Capt. (Dr.) 

Stephen Ferrara, interventional radiologist, Walter Reed National 

Military Medical Center; ret. Navy 

Rear Adm. (Dr.) Christine Hunter, chief medical officer, U.S. Office 

of Personnel Management; Navy 

Cmdr. Kevin Jackson, chief of staff, 

School of medicine, USU; Dr. Brent 

James, quality officer and executive 

director, Intermountain Institute 

for Health Care Delivery Research; 

Dr. Arthur Kellermann, dean, F. 

Edward Hébert School of Medicine, USU; ret. Navy Capt. Patricia 

Kenney, assistant dean, Daniel K. 

Inouye Graduate School of Nursing, 

USU; Dr. Tracey Koehlmoos, division director, Health Services Administration, USU; ret. Army Col. 

Thom Kurmel, president, TDK Consulting, LLC; Dr. Jeffrey Longacre, 

vice president for External Affairs, 

USU; ret. Navy Rear Adm. Thomas McGinnis, former chief, Pharmaceutical Operations Directorate, 

Department of Defense; Mr. Allen 

Middleton, special assistant to the 

President, USU; Dr. Charles L. Rice, 

president, USU; Dr. Carol Romano, 

dean, Graduate School of Nursing, 

USU; ret. Army Lt. Gen. (Dr.) Eric 

Schoomaker, professor and vice 

chair for Leadership, Centers, and 

Programs, Department of Military 

and Emergency Medicine, USU; 

ret. Army Maj. Gen. Patrick Sculley, 

senior vice president for University 

Programs (Southern Region), USU; 

ret. Army Col. Robert Thompson, 

chief of staff, Office of the President, 

USU; Mr. William Thresher, senior 

advisor to the TRICARE Health 

Plan, Defense Health Agency; Dr. 

Gail Wilensky, economist and senior Fellow, Project HOPE; and Dr. 

Jonathan Woodson.

MHS ‘Think Tank’ Based at USU

By Sharon Holland

ington DC VA Medical Center); 

Capt. Gregory Gorman (Pediatric Nephrology, WRNMMC); Col. 

Brent Lechner (Pediatric Nephrology, WRNMMC); Lt. Col.(P) Todd 

Villines (Cardiology, WRNMMC); 

Maj. Jennifer Hepps (Pediatrics, 

WRNMMC); Col. Dwight Kellicut (Surgery, Tripler Army Medical 

Center) (TAMC); Dr. Robert Martin (Surgery, San Antonio Military 

Medical Center); Lt. Cmdr. Shellie 

Kendall (Pediatrics, Naval Medical 

Center San Diego); Capt. Bill Shimeall (Internal Medicine, WRNMMC); Maj. Lauren Greer (Surgery, 

TAMC)

Student Awards 

Outstanding Academic Performance: 2nd Lt. Max Barnes, 2nd 

Lt. Jeremy Brenneman, 2nd Lt. 

Donald (Trey) Colantonio, 2nd Lt. 

John Curtin, 2nd Lt. Ryan Mann, 

2nd Lt. Chloe Shea, 2nd Lt. Shannon 

Thompson, 2nd Lt. Nathan Bastien, 

2nd Lt. Logan Clemons, 2nd Lt. 

Theodore Crisostomo-Wynne, 2nd 

Lt. Kelley Flesher, 2nd Lt. Douglas 

Morte, 2nd Lt. Matthew Smith, Ensign Daniel Zink 

Distinguished Academic Performance: 2nd Lt. Bryan Adams, 

2nd Lt. Andrew Branting, 2nd Lt. 

Timothy Gregory, 2nd Lt. Elizabeth 

Okonek, Ensign Elise Sienicki, 2nd 

Lt. Subodh Arora, 2nd Lt. Jakob 

Fischer, 2nd Lt. Brian Merrigan, Ensign Elizabeth Schroff, Ensign Adrienne Wendling

Dean’s Award for Academic 

Excellence: 2nd Lt. Michael Larkin, 

2nd Lt. Aimee Moores, 2nd Lt. Carolina Stark 
8 the pulse March 28, 2016

Final Frame

Third-year medical students at the F. Edward Hébert School of Medicine (SOM) at the Uniformed Services 

University of the Health Sciences (USU) participate in the third annual "Gunpowder Challenge" adventure 

race, March 24, 2016.This race is the capstone event for the Medical Field Practicum (MFP) 201 "Operation 

Gunpowder." MFP201 is a two-day exercise that focuses on small-team leadership, group dynamics, crisis 

communication and how stress affects performance. (photo by MC3 Laura Bailey)