Maintaining Proficiency in Army Medicine: A Call to Action

By Command Sgt. Maj. Victor J. Laragione
Medical Center of Excellence
March 2, 2026

Throughout my travels to various installations and engagements with medical personnel, I’ve consistently observed remarkable leadership and dedication to the mission. But, a recurring challenge has emerged: inconsistent practice and a need for repetition to maintain proficiency among medical Noncommissioned Officers (NCOs) in their Military Occupational Specialty (MOS). While pockets of excellence exist, this article addresses the difficulties faced by those still developing their skills.

The Importance of Medical NCO Proficiency

This issue extends beyond the medical community. Every Soldier, regardless of their MOS, relies on well-trained medical professionals, especially in times of crisis. Combat medics stabilize the wounded, enabling their return to the fight. Their ability to execute clinical tasks quickly and confidently is as crucial as their soldiering skills. Proficiency in both is not optional; it’s an expectation. Investing in the development of medical NCOs is a force-wide priority with significant operational consequences.

The Role of NCOs and Commanders in Training

Commanders are ultimately responsible for unit readiness, but NCOs play a vital role in training and developing Soldiers. This shared accountability underscores the importance of equipping NCOs with the real-world experience needed to achieve true proficiency. Many NCOs, while expected to be subject matter experts (SMEs), lack sufficient hands-on opportunities to master their MOS.

Early in my career, as a combat medic, I experienced this firsthand. After completing Advanced Individual Training (AIT) and airborne school, my initial duties focused more on logistics than medicine. It wasn’t until I treated my first trauma injury that I realized the limited practical medical experience I possessed. My skills improved through working with a battalion physician assistant (PA) and senior treatment NCO, participating in sick call at the aid station and troop medical clinic and assisting with trauma cases in the emergency department. These repeated experiences were essential to my growth. Unfortunately, many medics today lack similar opportunities, creating gaps in their development.

Clinical Experience: Why and How

Combat medics must be able to identify and treat disease and non-battle injuries, as well as provide trauma and prolonged field care. These capabilities are critical to conserving unit fighting strength and saving lives in both training and combat environments. Medics develop proficiency through hands-on experiences like sick-call operations, ambulance ride-alongs, and rotations through emergency rooms, inpatient wards, and specialty clinics, where they encounter diverse medical conditions and scenarios.

To build clinical competence, medics need real-world clinical exposure. This exposure fosters critical thinking and decision-making skills essential in high-pressure environments. Classroom instruction and simulations are valuable, but they cannot replicate the complexity and urgency of real patient care. Commanders wouldn’t certify a tank crew without gunnery tables and live-fire exercises; the same mindset should apply to preparing medical personnel. Medics must have opportunities to train in realistic, mission-aligned settings that test and refine their skills.

Addressing the Shift in PA Roles

The reassignment of PAs from battalion aid stations to Soldier-centered medical homes has reduced medics’ clinical learning opportunities. This disruption has limited access to consistent, quality training, leading to skill atrophy. Leaders must address this gap by leveraging military treatment facilities, civilian hospitals, and Emergency Medical Services (EMS) systems to ensure enlisted medical personnel (68-series) receive the necessary clinical rotations to develop mastery. Hands-on training is essential and must be prioritized over reading and simulations.

Sustaining Expertise Across the 68-Series

Just as combat medics must maintain proficiency in trauma care, sick call, and prolonged care, other 68-series Soldiers must stay current in their respective MOS. Surgical technicians (68D) who fail to maintain proficiency in sterile techniques, instrument handling, and surgical procedures risk compromising patient outcomes. Similarly, radiology technicians (68P) must remain current on imaging techniques and proper body positioning to avoid delays in care and increased radiation exposure.

Commanders and leaders must proactively locate opportunities for these Soldiers to gain the necessary practice. Low-density specialties, such as laboratory technicians, practical nurses, and dental assistants, face additional challenges due to limited staffing and reduced access to consistent training environments, making deliberate skill sustainment even more critical.

Challenges in Military Treatment Facilities

The 68-series career field encompasses 21 MOSs, each with unique requirements. NCOs in hospital settings often assume leadership and administrative roles, limiting their opportunities for hands-on patient care. Leaders must recognize this dynamic and ensure they have opportunities to hone their technical skills and maintain proficiency, even in environments where patient care is the primary mission.

Addressing the Competency Gap

Recent initiatives, such as the competency testing pilot conducted at the Medical NCO Academy, have revealed proficiency gaps among medical NCOs. Medicine is a dynamic field requiring continuous practice and adaptation. Unfortunately, many NCOs lack the clinical experience necessary to maintain their skills. I encountered staff sergeants with six years of service who had never treated a patient. This lack of experience hinders their ability to train junior Soldiers and jeopardizes the unit’s ability to respond effectively.

The combat medic specialist (68W) community is making strides toward strengthening clinical proficiency through enhancements outlined in Training Circular (TC) 8-800, Medical Education and Demonstration of Individual Competence (Department of the Army, 2021). These efforts build on Skills Qualification Testing, Table VIII, to create a more robust certification process.

Building Relationships and Leveraging Resources

Medical platoon sergeants must cultivate strong relationships with battalion command sergeants major (CSMs) and staff to create meaningful training opportunities. Deliberate planning and resourcing, with approved training plans integrated into the training calendar, are key to success. Local hospitals and EMS systems often have the capacity to support clinical rotations and ride-alongs, yet these opportunities remain underutilized. Division surgeon teams should work with local EMS agencies and require medics to participate in ambulance ride-alongs. They should also establish relationships with local hospitals and trauma centers, enabling medics to complete emergency room rotations.

Initiatives such as the Technician Badge and streamlined onboarding processes for MTF rotations are promising steps forward.

Conclusion: A Call to Action

Soldiers on the battlefield expect their medics to save lives. To meet this expectation, we must address competency gaps and provide medical NCOs with the clinical experience they need to become SMEs. Commanders must prioritize their medical personnel’s development. Investing in training, certifications, and clinical rotations equips medical NCOs to conserve fighting strength and maintain combat readiness. Combat medics don’t just support the mission; they create it survivable. Their preparedness allows all other specialties to operate effectively. All leaders share this responsibility and must actively uphold it across every level of the force, preparing medics not just to qualify, but to save lives and bring their teammates home.

References

Training Circular (TC) 8-800. (2021). Medical education and demonstration of individual competence. Headquarters, Department of the Army.