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Academic Medicine:
doi: 10.1097/ACM.0b013e3181f59316
Response to 2010 Question of the Year

The F. Edward Hébert School of Medicine Model: Tuition-Free Medical School in Exchange for Public Service

Waechter, Donna M. PhD; Gilliland, William R. MD; Laughlin, Larry W. MD, PhD

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Dr. Waechter is associate dean for medical education, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Gilliland is assistant dean for curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Laughlin is dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Correspondence should be addressed to Dr. Gilliland, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Office of Medical Education (MEE), 4301 Jones Bridge Road, Bethesda, MD 20814-5199; e-mail: wgilliland@usuhs.mil.

The Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine (FEHSOM) is tuition-free and avoids the tuition-related debt that Dr. Kanter1 mentioned first on his list of the benefits of an education–service exchange. FEHSOM students earn the pay of an ensign or second lieutenant (more than $55,000 per year) and receive comprehensive health benefits for themselves and their family members throughout medical school. In exchange for their tuition-free education, graduates serve at least seven years in the uniformed services—either the Army, Navy, Air Force, or Public Health Service (PHS). Our PHS alumni fulfill important service needs in rural and underserved regions, while our Army, Navy, and Air Force alumni provide medical care for our men and women in uniform, their family members, and those retired from military service. Our alumni also provide medical care during humanitarian missions in the United States and abroad. The unique aspects of the FEHSOM may be a useful model for consideration as the country addresses issues such as increasing coverage of the uninsured, health care disparities, and financial barriers for economically disadvantaged medical school applicants.

Graduates of the FEHSOM matriculate to graduate medical education (GME) programs throughout the Department of Defense (DoD) and civilian institutions. The FEHSOM curriculum provides a strong foundation in primary care and preventive service, but students are prepared to pursue any form of traditional GME training as well as career options unique to military medicine. In addition to content that maintains institutional accreditation, the FEHSOM curriculum places additional emphasis in areas critical to the uniformed physician: trauma and emergency medicine, infectious disease and global health, humanities and behavioral sciences, and principles of leadership and teamwork.

The FEHSOM was established to provide a comprehensive medical education to men and women who demonstrate potential for and commitment to long-term careers as medical corps officers in the uniformed services. The medical school admitted its charter class of 32 students in 1976. Today, class size has grown to 171, and the medical school has graduated more than 4,300 physicians. Measures of the success of our program include the percentage of alumni who remain on active duty until retirement (76%), select a career in family medicine (16%),2 or serve in leadership positions (75% have been chief of a service/clinic and 51% have deployed in medical support of combat missions).3 We attribute our success in recruitment and retention to our admissions process' focus on the applicant's commitment to public service, our curriculum content, and the sense of community from our faculty's shared belief in the school's mission and their own dedication to public service.

Major constraints at the FEHSOM that have precluded broader application (i.e., increasing class size) are tied to funding—for more faculty, buildings/space, and federal authorization for more training slots.

Also, expansion of our clinician–researcher (MD/PhD) program as an alternate path to graduation would likely attract more applicants and supply the nation with clinical researchers focused on areas that, while important to underserved populations, are not financially profitable to pursue and, thus, are largely neglected by private-sector research (e.g., malaria, leishmaniasis).

Another useful model, the Health Professions Scholarship Program (HPSP), is intended to bring a large number of medical professionals into the armed services for shorter periods of obligated service and so provides an alternate means for students to have their medical education funded in exchange for service as a DoD physician (the scholarship is not available to the PHS). Given the FEHSOM curriculum's emphasis on long-term service and medical leadership, it is not considered to be in competition with the goals of the HPSP.

In terms of the value the FEHSOM has accrued to individuals and society, our alumni provide military- and public-health-relevant education, research, service, and consultation to the United States and the world, actively collaborating with other nations, research institutes, and public and private organizations. There are increasing opportunities for the school to partner with others in new initiatives in areas such as international health, disaster medicine, humanitarian efforts, and psychological resilience and care. Other areas of opportunity for the school, our students, and our alumni include information technology, biotechnology, prosthetics research, biodefense, and medical ethics. Our 30 years of successfully attracting and retaining talented men and women to careers in caring for the underserved and those in harm's way persuade us to offer the FEHSOM as one viable model for national service.

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References

1 Kanter S. 2010 question of the year. Acad Med. 2010;85:1–2.

2 Pugno PA, McGaha AL, Schmiyyling GT, DeVilbiss AD, Ostergaard DJ. Results of the 2009 National Resident Matching Program: Family medicine. Fam Med. 2009;41:567–577.

3 Cohen D, Durning SJ, Cruess D, MacDonald RM. Long-term career outcome study (LtCOS) of Uniformed Services University of the Health Sciences medical school graduates; Class of 1980–1989. Mil Med. 2008;173:422–428.

© 2010 Association of American Medical Colleges

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