An innovation in a professional education setting : expectations and outcomes in the United States Army Health Services Command Satellite Television Network, 1977-1985

Abstract

Technological momentum was responsible for planning, establishing and sustaining a major innovation in the delivery of education and training in a large health care system. Through historical analysis of the U.S. Army Health Services Command (USAHSC) Satellite Television Network (STN) between 1977 and 1985, the management and direction of the first use of regularly scheduled live, interactive, high resolution, satellite-delivered Graduate Medical Education (GME) and Continuing Clinical Education (CCE) were explored. The post-World War II attitude of unquestioning confidence in technology permeated both military and health care; later the health care complex and state governments mandated GME and forms of CCE as a condition to practice skills. When military physician shortages in the middle 1970s reduced the ability of USAHSC to provide health care, increased productivity through lessened GME travel became the objective of a television network. Initially, the USAHSC STN was enthusiastically supported by the Army Medical Department (AMEDD); the former promised higher physician productivity and bolstered the AMEDD's reputation as an innovative organization. As physician shortages lessened in 1978 and 1979, the purposes and missions of the USAHSC STN encouraged clinical teleconferences, continuing medical education (CME) of physicians, non-physician CCE and readiness training for enlisted medical personnel. Shifting of emphasis from GME to other purposes doomed the USAHSC STN because the substituted programs were not as essential as specialty physician education to a health care system. While physician specialists were at the heart of medical care, continuing training largely seemed as a nuisance by most health care professional groups (except nurses). Between 1981 and 1984 satellite-delivered television from the USAHSC STN became another form of continuing education. Cost was borne out of existing budgets and operations were sustained by previously assigned staff; other difficulties were transfer and retirement of supportive senior personnel, an organizational rift and a cumbersome system of decision-making...