~Anonymous

Editor-In-Chief,
Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

This past October, I served as a staff platoon team leader for the annual Uniformed Services University (USU) Bushmaster exercise, which I have discussed in previous editorials.1 The training exercise is for senior nursing and medical school students and serves as the field practicum final exam for military healthcare professionals. The two weeks at Fort Indiantown Gap working with new inductees to the field of military medicine recharges my batteries, restores my faith in our military institutions and reminds me why I continue to beat my head against the bureaucratic wall of federal medicine. I have been staffing this event for many years now, and I have developed a list of 10 suggestions to the students for successful completion of this stressful event that I read at the beginning of each week to my platoon. While this list is worded specifically for the Bushmaster exercise, I feel the suggestions are apropos to working in federal medicine generally. With the reader’s indulgence, I thought I would share “Buckenmaier’s List for Bushmaster Success.”

  1. Common sense is king! In the volatile, uncertain, complex and ambiguous world of the modern battlefield or local federal bureaucracy, remembering this simple rule can make all the difference in mission completion.
  2. We are not playing stump the chump. Use everything and anything available to you. For years, these students have been consuming information and regurgitating it back on exams. Bushmaster is not about the right answer as much as finding some answer when surrounded by chaos. I appreciate and applaud the students who seek information to solve a problem from the team, especially when they are smart enough to consult with the noncommissioned officers.
  3. I don’t care how your “unit” did it. We are preparing for the next war, not the last war. Historically it seems we always arrive at the next conflict with the expectation that old solutions from the last conflict will always work. It is perhaps a strength of the American military that we tend to overcome this falsehood faster than many other modern armies.
  4. To be a good leader you must understand how to be a good follower. I am a firm believer that leaders are developed, not born with some intrinsic leadership ability. Leaders are forged from the ranks of other good leaders, and it is the good followers who receive the message.
  5. Even when you are not in a “rated” position, you are in a rated position. It is easy to perform when you know the evaluator is watching, but the true star performer is always giving their all, regardless of the task. If you happen to be tapped as the litter bearer (no offense to the litter bearer), be the best litter bearer you can. Every job on the team is vital and important to overall success.
  6. PITO—Personal, Interpersonal, Team, Organization in the framework of individual character, competence, context, and communication. PITO is a leadership framework taught at USU to develop leadership skills in the university’s graduates. This model stresses personal awareness and responsibility beyond immediate tasks, stressing the importance of understanding how local leadership decisions impact on the greater organization. In this era of instant communication, globally-aware leaders are required at all levels, since consultation with more senior leadership is rarely an option today.
  7. Mission first, soldiers always. For every task, begin with, “Why am I here?” This simple motto has a corollary in all the services. Mission is paramount, but mission success depends on the team (i.e., people). It can be easy to become wrapped up in the “stuff” of federal medicine and forget the primary mission: Our reason for being is patient care. Good patient care only happens when medical leaders are taking care of their people. Sadly, this is perhaps one of the most ignored lessons in my experience.
  8. Assumption—the first three letters. This is self-explanatory or, to quote Ronald Reagan, “Trust but verify.”
  9. If you insist on going it alone, you will fail alone. At its core, the military is a team of teams, which is the only way something as complex as war can be prosecuted. Medicine is no less complex and no different in its successful application.
  10. Common sense is king! A concept that is so important when chaos reigns that it bears repeating.

With each iteration of Bushmaster, I find myself pulling this list out and tweaking it. Personally, I find this list of guiding principles valid in all aspects of my federal medicine career. I am sure you, the reader, can come up with improvements to these bits of advice.

At the end of each week, as I congratulate the students for successfully completing the challenging Bushmaster exercise and welcome them as colleagues to federal medicine, I remind them of the mission to which we have pledged ourselves: the care of soldiers (airman, sailors, Marines and coastguardsmen) and their families. I reinforce the idea with my students that the Bushmaster exercise is about them, as I point to our enlisted support soldiers, not us. Bushmaster refreshes that mission in my mind and prepares me for another federal medicine year. If my list has helped remind you of our vital mission to care for those who protect our democracy, then perhaps this has been one of my most successful editorials as we greet the new year. Mission first, soldiers always!

1https://www.youtube.com/watch?v=IWNJ6kdQpqY. Accessed November 6, 2017.