Readiness, Teamwork, and Navy Medicine

An interview with RADM Bruce Gillingham, MD
Navy orthopaedic surgeon Rear Admiral Bruce Gillingham, MD, served as commander of Navy Medicine West until his promotion to deputy chief, readiness and health directorate, US Navy Bureau of Medicine and Surgery. I recently sat down with him to discuss the Navy and its need for orthopaedic surgeons.

Dr. Edwards: Thank you for taking time out for questions. You must be very busy, learning your new command.

RADM Gillingham: Yes, the readiness and health directorate at the Navy's medical headquarters encompasses all current operations, both in military treatment facilities and in units deployed in support of the Navy and Marine Corps. It's truly a global operation and the learning curve is steep. Fortunately, I work with an incredible group of professionals who are bringing me up to speed quickly.

Dr. Edwards: What do you see as the Navy's need for orthopaedic surgeons and musculoskeletal medicine?

RADM Gillingham: In terms of staffing, we are pretty well staffed, but when I think of our needs broadly, the relationships we have with civilian professional societies are critically important. Certainly there has been a lot of bidirectional learning from our experiences in Iraq and Afghanistan, such as with the combat extremity trauma meetings. This year, subject matter experts came together to discuss and develop research protocols based on lessons learned from recent wartime conflicts and how to adapt them to homeland defense situations like the Boston Marathon bombing.

Dr. Edwards: Talk a bit about the hospital ships, the Comfort, which I saw after the Haiti earthquake, and the Mercy. You were once assigned to the Mercy?

RADM Gillingham: There I was, literally, in a tent in Iraq in December 2004, when my wife sent me an email saying that the Mercy was going to Indonesia to provide disaster relief following the devastating tsunami. That mission was really a renaissance of the hospital ship.

There is now a regular schedule of planned humanitarian missions. Both Mercy on the West Coast and Comfort on the East Coast participate in those missions, and they are generally planned with four or five countries in a particular region. That all happened after my time on Mercy, so I didn't have the chance to deploy personally, but I'm thrilled to cheer from the sidelines and to see our staff participate in missions that are truly life-changing—for both themselves and the patients they care for.

Dr. Edwards: What are the characteristics of orthopaedic surgeons that make them successful in military medicine, the Navy in particular?

RADM Gillingham: Orthopaedic surgeons who succeed in military medicine are team players. I think all of us go into surgery because we like the team aspects of what we are doing, but in military medicine, in particular, everyone needs to understand his or her role on the team and the fact that it might change on short notice and might be in a very austere location. Some of my best memories are of the team that I served with in Iraq, just because of the teamwork and problem solving. You know, probably the reason that a lot of us join the military is to do something in service to an idea that is greater than yourself and to do it as a team.

Dr. Edwards: Is there a big difference in case load, depending on where someone is deployed?

RADM Gillingham: Although we saw casualties every day in Taqaddum (Iraq), other surgical units in Anbar Province didn't see the same number of patients. Often, a surgeon is sent as a contingency, and may not operate for some time. We've done some internal rotation to limit the time surgeons are away from full-time practice. It's important to understand that the Navy is sensitive to the maintenance of current competence. If deployed surgeons haven't been doing many surgeries during an assignment, we arrange for them to do supervised refresher training when they return.

Dr. Edwards: The airlines tend to pair an experienced pilot with a less experienced pilot. Does the Navy do that with surgeons?

RADM Gillingham: We try to do that, too, particularly for remote assignments and overseas facilities. Our colleagues in the Naval Reserve frequently fill some of these gaps and bring a tremendous wealth of experience and enthusiasm to the task.

Dr. Edwards: What would you like to convey to members of the Academy as far as how they can help the Navy or what you would like to see?

RADM Gillingham: Military surgeons—and I include my Air Force and Army colleagues, of course, and those who work in the VA [Veterans Affairs]—have unique requirements. We appreciate the continued willingness to accept military surgeons into fellowships. We have found that those who complete a fellowship—and the places they go are top-notch—­return and become teachers in our medical centers. Those are the surgeons who make military medicine a career.

We also appreciate the continued support within professional societies. When I was a young staff orthopaedist, going to specialized forums in my particular specialty was an incredible opportunity for sharing and professional development. The support of fellowship training and the academic support that specialty societies provide go a long way. For example, if you are a board examiner, understand that the case collection of a military surgeon may be quite limited, based on where the surgeon was stationed or the fact that he or she was deployed.

Dr. Edwards: It's really heartening to hear that we have well-trained people, including fellowship-trained surgeons, doing a great job for our service men and women, who have done so much for us. Thank you for serving.

RADM Gillingham: You're welcome. It's a privilege. Daniel J. Edwards, MD, is in private practice in Indiana and intends to apply to the Navy Reserves.

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