DHA Total Learning Architecture (TLA)

Anita L. Fligge, Brig Gen, USAF, NC

Deputy Assistant Director, Education & Training

Paul R. Cordts, MD, MSS

Deputy Assistant Director, Medical Affairs

Disclosures

• Brig Gen Anita Fligge and Dr. Paul Cordts have no relevant financial or non-financial interests to disclose.

• Disclosure will be made when a product is discussed for an unapproved use.

• This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

• Commercial Support was not received for this activity.

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Learning Outcomes

At the conclusion of this activity, participants will be able to:

1. Define the Military Health System (MHS) high level requirements that for an infrastructure that can enable lifelong blended, data driven training tailored to the individual and the educational and operational goals of the services and the MHS as a whole.

– Are there existing systems/efforts that can be leveraged?

– What needs to be acquired?

2. Define the Science and Technology gaps that must be addressed for this infrastructure to be successful.

3. Define the roles of Defense Health Agency (DHA) and the infrastructure requirements to support MHS Graduate Medical Education (GME).

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• Lack of ability to capture complete and integrated readiness data

• Lack of ability to identify education/training needs and provide offerings to medical force in a timely manner

1. Lack of Complete, Enterprise level Readiness Data for MHS or

Services

• Content is primarily outdated (e.g. PowerPoint) and needs to be modernized

• Training courses are taught differently across locations and need standardization

2. Training Content is not Optimized or Standardized

• Many learning experiences are not recorded or data is in disparate data repositories

• Learning experiences are often marked as completion only and discrete performance data is not captured

3. Learning Data is Isolated throughout the MHS Continuum

and Lacks Granularity

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MHS TLA Initiation and Background

Army Synthetic

Training

Environment

Air Force Learning

Services Ecosystem

Ready Relevant

Learning;

LVC Efforts

ADL Total Learning

Architecture

Navy Air Force Army

Advanced Distributed Learning Initiative

Defense Health Agency

DHA Total Learning Architecture

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Throughout the DOD, many organizations are working on their own version of a “Learning Architecture or Ecosystem”

Proposed Solutions

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01

Completed initial research to identify:

• Best practices, standards, technology, and complementary efforts that can be leveraged

• Lessons learned and best practices from learning science perspective

• Systems engineering lessons learned / infrastructure / interoperability that can be leveraged from past/current efforts

Completed a draft roadmap which consists of gaps to be resolved by DHA or S&T efforts

• Need for more granular performance data

03Completed TLA Requirements Document

• Version 1 of the High Level TLA Functional Requirements Document

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TLA Progress to Date

Total Learning Architecture: A modern, modular, interoperable ecosystem

that can support the full continuum of interconnected learning opportunities

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MHS Total Learning Architecture Concept

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Inconsistencies and inefficiencies in performance measurement/ talent management

• The MHS needs to employ standardized performance metrics and thresholds along with a strategic approach to data driven training and education

Incomplete Enterprise Infrastructure and Analytics• The MHS processes and systems that are currently in place have no ability to

report enterprise-wide education, training, and human performance metrics• Data is isolated across disparate, stove-piped systems that do not have sufficient

connectivity to provide data and information exchange and analytics• Data is not granular enough for performance measurement

Fragmented linkages between education, training, and operational goals:• Mission-> Education/Training Goals-> Measurement Strategy-> Data Strategy->

Analytics

Results: MHS Training & Education Gaps

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Limited Readiness

“Check the box”

Now

Future

Near

Term

Required Completions

Annual Requirements for Credential / Certification Tracking

Role Based Readiness

Sub-Course CompletionsLeverage Existing Efforts

(KSA project, ICTLS)

Course Completions

Standardized Metrics/Thresholds

Clinical & Readiness Critical Tasks/Experiences

SME Provided / Organization Approved

• Role based proficiency calculations

• Targeted training per role type• Data driven training and

education:• Media selection (e.g.

80% Sim, 20% Live)• Assessment selection• AAR selection

Individualized Readiness

Sub-Course Completions

Course Completions

KSAs

SME Provided / Organization Approved

Clinical & Readiness Critical Tasks/Experiences

KSAs

KSA Standardized Metrics/Thresholds

Capability Data CapturedFoundation for Performance

MeasurementResults

Stepwise Approach to Data-Driven Training and Education

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Scope of Warfighter Journey

Previous Training/ Education

Basic Training

Home Station

On the Job Deployed

Performance Metrics/Thresholds

Key Performance

AreasKSAs

Competency Models

Assessment Strategy

Data StrategyTraining

Effectiveness Models

xAPI Selection

xAPI ProfilesxAPI

Metadata

Training Delivery/Deployment

Technologies for

Deployment

Training Content

Optimal Spacing/ Timing

Performance Data

Collection

Enterprise Data Aggregation/Storage

Data Aggregation

Strategy

Data Exchange

Library

Data Analysis & Visualization

Data Visualization

Training Effectiveness

Evaluation

Human Factors Analysis

TLA Path Forward

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Graduate Medical Education (GME)

• DHA transformation

• Progress

• Challenges

• Future

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DHA Transformation

• GME is the primary force generator for the Services’ Medical Corps.

• DHA provides oversight of MHS GME programs.

• GME programs may be reshaped based on operational needs of the Services, as well as other tenets of NDAA17, Section 749.

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NDAA17 Sections 702 & 749

• Sec 702– DHA via DAD-MA is responsible for policy, procedures and direction of GME.

• Sec 749

– Develop oversight process to ensure:• Programs focus on operational medical force requirements and are

conducted jointly to the extent practicable,

• Minimize [unwarranted] duplicative programs among the MILDEPs

• Coordination of assignment of faculty, support staff, and students

• Optimization of resources by appropriately using MTFs as training platforms

• Reviewing and restructuring/realigning programs if/when necessary

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DHA GME Responsibilities

• Provide oversight of DoD GME programs

• Administration of GME Advisory Boards

• Execution of all aspects of JSGMESB, except Service Selection Boards

• Policy development for DoD GME

• Analyze DoD GME data to develop initiatives and policies

• Tracking of all accreditation decisions and other metrics

• Preparation of all requests for information re: DoD GME

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Service Responsibilities

• Title 10: recruit, train, equip, and organize

• Services will:– Recruit new Medical Corps officers

– Decide how many and what type of specialties to train

– Support GME with military faculty and support staff

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Progress

• Oversight infrastructure

– Oversight Advisory Council (OAC)

• DHA Deputy Assistant Director - Medical Affairs

• Service Medical Corps Chiefs

– Integration Advisory Board (IAB)

• DHA GME Director

• Service GME Directors

• OAC primary duties

– Focus on Medical Force Readiness

– Review Service-specific training plans

– Evaluate recommendations for policy, procedures, and direction of GME

• IAB primary duties

– Draft recommendations for policy, procedures, and direction of GME

– Develop Joint Training Plan by coordinating Service Training Plans

– Review training plans and make proposals for restructuring/realigning programs if/when necessary

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Evaluation of the Number & Size of GME Programs

• Each specialty is reviewed at least every other year– Operational training requirement = total number of new starts/year for the

three Services combined

– Total training capacity = total number of training positions/year available across all the programs in that specialty across the MHS

• Too little capacity in MHS for that specialty?– Expand existing partnerships, open programs, establish new partnerships

• Too much capacity in the MHS for that specialty?– Evaluate programs to determine if programs could be restructured or

realigned

• Operational, academic, and market criteria

• Includes consideration of required program interdependencies 17

Challenges

• Volume of patients treated in the MTFs with the needed acuity and complexity

• Staffing of medical personnel and funding at MTFs to support GME programs

• DHA is actively working with Services, Veterans Affairs (VA) and civilian partners to address these challenges and others.

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Future

• Strengthen VA and civilian partnerships

• Reform business practices in MHS to sustain GME

• Reduce unwarranted duplication of GME programs

• Increased integration with professional military education

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Madigan AMC:• Emergency Medicine• Family Medicine• General Surgery• Internal Medicine• Neurology• OB/GYN• Ophthalmology• Orthopaedics• Otolaryngology• Pathology• Pediatrics• Preventive Medicine• Radiology• Transitional Year• Urology

Tripler AMC:• Family Medicine• General Surgery• Internal Medicine• OB/GYN• Orthopaedics• Otolaryngology• Pediatrics• Psychiatry• Radiology• Transitional Year• Urology

Darnall AMC:• Emergency

Medicine• Family Medicine

Martin ACH- Ft Benning:

• Family Medicine

Eisenhower AMC:• Family Medicine• General Surgery• Internal

Medicine• Orthopaedics• Transitional

Year

Wright Patterson AFB:• Emergency Medicine• General Surgery• Internal Medicine• OB/GYN• Pediatrics• Psychiatry

USAF-SAM:• Aerospace Medicine

Travis AFB:• Emergency

Medicine• Family Medicine• General Surgery• Internal Medicine• Orthopaedics• Radiology• Transitional Year• Vascular Surgery

Offutt AFB:• Family

Medicine

Scott AFB:• Family

Medicine

Nellis AFB:• Emergency Medicine• Family Medicine• General Surgery• Obstetrics-

Gynecology

Eglin AFB:• Family

Medicine

National Capital Consortium:• Anesthesiology• Dermatology• Family Medicine• General Surgery• Internal Medicine/Psychiatry• Internal Medicine• Neurology• Neurosurgery• OB/GYN• Ophthalmology• Orthopaedic Surgery• Otolaryngology• Pathology• Pediatrics• Physical Medicine &

Rehabilitation• Preventive Medicine• Preventive Medicine:

Occupational & Environmental Medicine

• Psychiatry• Radiology • Radiology Oncology• Transitional Year• Urology

SAUSHEC:• Anesthesiology• Dermatology• Emergency Medicine• General Surgery• Internal Medicine• Neurology• OB/GYN• Ophthalmology• Orthopaedics• Otolaryngology• Pathology• Pediatrics• Psychiatry• Radiology• Transitional Year• Urology

NAMI Pensacola:• Aerospace Medicine

Womack:• Family

Medicine• OB/GYNWilliam Beaumont

AMC:• General Surgery• Internal Medicine• Orthopaedics• Transitional Year

NH Jacksonville:• Family

Medicine

USA School of Aviation Medicine:

• Aerospace Medicine• Occupational

Medicine

Keesler AFB:• General Surgery• Internal

Medicine

NH Camp Lejeune:• Family Medicine

NH Camp Pendleton:• Family Medicine

NMC San Diego:• Anesthesiology• Dermatology• Emergency

Medicine• General Surgery• Internal Medicine• OB/GYN• Ophthalmology• Orthopaedics• Otolaryngology• Pathology• Pediatrics• Psychiatry• Radiology• Transitional Year• Urology

LEGEND:• US Air

Force• US Army• US Navy• Joint Base

Military GME – Internship/Residency Training Programs

NMC Portsmouth:• Anesthesiology• Emergency Medicine• General Surgery• Internal Medicine• OB/GYN• Orthopaedics• Otolaryngology• Pediatrics• Psychiatry• Radiology• Transitional Year

Updated 03 APRIL 2019

Madigan AMC:• Clinical Informatics• Emergency Medicine – Austere & Wilderness

Medicine• Emergency Medicine – Ultrasound• Faculty Development• OB/GYN – Maternal & Fetal Medicine• Pediatrics – Developmental

Tripler AMC:• Pediatrics – Neonatal/Perinatal Medicine• Psychiatry – Child/Adolescent

Darnall AMC:• Emergency Medicine – Ultrasound• Family Medicine – Obstetrics

National Capital Consortium:• Allergy & Immunology• Anesthesia Acute Pain & Regional• Dermatopathology• Family Medicine Sports Medicine• General Internal Medicine• Internal Medicine – Cardiovascular Disease• Internal Medicine – Critical Care Medicine• Internal Medicine – Endocrinology• Internal Medicine – Gastroenterology• Internal Medicine – Hematology/Oncology• Internal Medicine – Infectious Disease• Internal Medicine – Nephrology• Internal Medicine – Pulmonary

Disease/Critical Care• Internal Medicine – Rheumatology• Internal Medicine – Sleep Medicine• Neurology Clinical Neurophysiology• Neurology Child• Nuclear Medicine• OB Female Pelvic Medicine &

Reconstructive Surgery• OB/GYN – Oncology• OB – Minimally Invasive GYN Surgery• OB/GYN – Reproductive Endocrinology• Orthopaedic Surgery – Hand Surgery• Pain Medicine• Pediatrics – Endocrinology• Pediatrics – Gastroenterology• Pediatrics – Hematology/Oncology• Pediatrics – Infectious Disease• Pediatrics – Neonatal/Perinatal• Psychiatry – Child & Adolescent• Psychiatry – Forensic• Psychiatry – Geriatric• Psychiatry – Psychosomatic Medicine• Radiology – Body Imaging • Vascular Surgery

SAUSHEC:• Adolescent Medicine• Allergy & Immunology• Clinical Investigation• Emergency Medicine – Emergency Medical Services• Emergency Medicine – Ultrasound• General Surgery – Trauma/Critical Care• Internal Medicine – Cardiology • Internal Medicine – Endocrine• Internal Medicine – Gastroenterology• Internal Medicine – Hematology/Oncology• Internal Medicine – Infectious Disease• Internal Medicine – Nephrology• Internal Medicine – Pulmonary Medicine/Critical

Care• Internal Medicine – Rheumatology• Nuclear Medicine• Pain Medicine• Pathology – Cytopathology• Pediatrics – Neonatal/Perinatal Medicine• Radiology – Musculoskeletal• Sleep Medicine• Undersea & Hyperbaric Medicine

Womack:• Family Medicine –

Hospitalist

West Point (Keller ACH):• Orthopaedics – Sports

Medicine

NH Camp Lejeune:• Family Medicine – Obstetrics

NH Camp Pendleton:• Family Medicine – Sports

Medicine

NMC San Diego:• Anesthesiology – Pain Management• Internal Medicine – Cardiology• Internal Medicine –

Gastroenterology• Internal Medicine – Infectious

Disease• Internal Medicine – Pulmonary

Medicine & Critical Care• Radiology – Body Imaging

LEGEND:• US Air

Force• US Army• US Navy• Joint Base

Military GME – Fellowship Training Programs

NMC Portsmouth:• Anesthesiology – Pain Management• Emergency Medicine – Humanitarian &

Disaster• Radiology – Musculoskeletal

Updated 03 APRIL 2019

• If you would like to earn continuing education credit for this activity, please visit: http://amsus.cds.pesgce.com.

• Hurry, CE Certificates will only be available for 30 Days after this event!

How to Earn CE

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