October is Operation Bushmaster (www.usuhs.edu/about/operationbushmaster) season for Uniformed Services University (USU) medical and nursing students. This exercise is the culmination of years of military medicine training where the students practice Role 1 field medicine in a simulated combat environment. Bushmaster days are long, extremely stressful, and jampacked with medical disaster. Nobody ever wins Bushmaster; you survive it. I have spoken of this activity multiple times in this column, because I believe it is the defining endeavor that embodies everything that is different and special about USU graduates, setting the institution apart from its peer medical education facilities in this country.
As an alumnus of USU (Class of ’92), I had my own Operation Bushmaster experience and, although the activity back then pales in comparison to the current exercise provided by USU, the lessons I took away from Bushmaster are still with me today. The dean, USU School of Medicine, Arthur Kellermann MD, recently related that he was told by a former USU student that he had forgotten much of the of the medical physiology he had learned in medical school, but he recalled every minute of his Bushmaster experience. Operation Bushmaster defines the USU graduate as something unique and special in American medicine.
For years now, I have served as a platoon team leader, responsible for coordinating the Bushmaster faculty observer/controller evaluators and guiding the student platoon during the weeklong exercise. The OCs are there to observe and evaluate performance only; the student platoon leads itself with students rotating through various graded positions to include platoon leader and assistant platoon leader, surgeon, ambulance team leader and medic, preventive medicine and combat stress control. During a typical Bushmaster day, the student platoons will experience four scenario days of compressed activity in a 24-hour cycle, with student leadership roles changing with each scenario day. The Bushmaster scenarios are ripped directly from the last 18 years of armed conflict, depicting the challenges of care under fire, interactions with host nation patients and leaders, global health engagement, preventative medicine, military bureaucracy, medical ethics, and so much more against a constant background of beautifully moulaged polytrauma casualties arriving at the battalion aid station entrance. There is always too much to do, and utter chaos often reigns, for the platoon aid station is only a student’s poor decision or miscommunication away at any given moment from things going very wrong.
As a team leader OC, I have tremendous power to mess with the students as they lead themselves through each scenario. During the mortar attack scenario, for example, I randomly and wantonly destroy their platoon aid station, and I usually (notionally) kill off a few students for good measure and effect. I admit that I take an unhealthy pleasure in this activity—it is my favorite scenario— but it does provide a means of simulated stress in a safe environment where the students can exercise leadership, and the consequences of their decisions do not impact on life, limb or eyesight. In short, the stress is very real, but the danger is not, and most Bushmaster graduates will admit that the experience results in some level of personal growth and introspection.
Regardless of prior military experience, life experience or personal toughness, it is hard to go through Bushmaster and not come out changed. As I have already noted, there is no way to “win” or “beat” Bushmaster; it is the “Kobayashi Maru” of medical exercises (shoutout to “Star Trek” fans). Even with perfect plans and communication (which never happens) the OCs will ensure things go terribly wrong (which always happens).
This exercise is not about how successful the students are at overcoming any particular scenario; it is about how effective they are at building teams and systems to manage the scenario and how resilient their systems are to the inevitable chaos that is literally just 15 minutes away. This is a leadership exercise dealing with how to accomplish big tasks as both a team leader and team member within the context of the larger overall task force mission.
Despite having been involved with Bushmaster for years, I never lose fascination with the often novel and brilliant solutions (sometimes not so much) each unique student platoon develops for their Bushmaster iteration. I always learn something from them that is useful to include and, occasionally, how absolutely not to approach a particular scenario. I have observed through the Bushmaster exercise that the most-successful platoons are not necessarily the ones with the most experienced prior service students, or the platoons containing the most class leaders or even the best students. The most successful platoons are the ones that can generally efficiently and quickly form teams internally and communicate effectively between these teams and externally to the task force command—a team of teams, if you will. All Bushmaster platoons (eventually) come to understand from the Bushmaster exercise that the OC-enforced chaos cannot be overcome; it can only be efficiently managed through teamwork and effective communication. Leadership is about creating the conditions for the team to develop and function within this chaotic and difficult environment. This is what represents success at Bushmaster.
I have taken the time in this editorial to describe the Bushmaster exercise because I believe it is emblematic of the functions essential to the execution of good medicine within the federal system. As the author John Maxwell tells us, “Nothing of significance was ever achieved by an individual acting alone. Look below the surface and you will find that all seemingly solo acts are really team efforts.” Like all Bushmaster graduates, I have internalized this lesson. If you have anything to do with federal medicine, it is a lesson worth learning.
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