Forging Medical Leaders

A Proposal for the Decision-Centric Medical Staff Ride

By MAJ Graham Clark

Article published on: March 1, 2026 in the 2026 E-Edition of Pulse of Army Medicine

Read Time: < 11 mins

Abstract

The U.S. Army’s doctrinal shift toward Large-Scale Combat Operations (LSCO) demands a parallel evolution in how it develops leaders. For the Army Medical Department (AMEDD), this challenge is particularly acute. The counterinsurgency framework shaped the careers of many current leaders with its emphasis on individual casualty

evacuation to state-of-the-art facilities. However, to prepare AMEDD officers for the immense intellectual burdens of the forthcoming operational environment where mass casualties, degraded logistics, and contested lines of communication may be the norm, the AMEDD must paradoxically look to the lessons of history to create the learning laboratory of the future. To forge the adaptable and resilient leaders this nation requires, this article proposes establishing the decision-centric Medical Staff Ride (MSR) as a core professional development tool that forces rising commanders to grapple with the brutal realities of medical command in war.

Statement on the Use of Generative AI

The author used Google’s Gemini Enterprise, a large language model, to assist writing this article throughout the drafting and iterative revision process. All actions taken by the AI were under the author’s direct guidance and editorial control. The final text, including all arguments, structural decisions, and conclusions, represents the author’s own work and intellectual property. The AI served as a tool to accelerate research, test arguments, and enhance the clarity and depth of the author’s original ideas.

The 261st MMB Commanders and Staff at the Yorktown waterfront. During the Peninsula Campaign, Major General George B. McClellan used this as a logistics hub after the Confederate evacuation of Yorktown.

The Essentials

The quintessential feature of a competent military medical officer is the successful integration of their medical leadership within the military line unit. An AMEDD officer must be able to advise a maneuver commander on medical risk, plan complex non-linear evacuation chains, and build a cohesive medical system from disparate parts while simultaneously grappling with the pressures of a combat environment. Fulfilling these duties requires more than clinical expertise; it demands a deep understanding of operational art, logistics, and the chaotic nature of command in war. Staff rides, in theory, are designed to cultivate this conceptual understanding. They improve critical thinking, creativity, and decision-making capabilities. When AMEDD officers are removed from their daily clinical or administrative routines, a well-designed MSR immerses them in the operational challenges of a historical campaign. This moves the officer beyond seeing the battlefield as a series of medical vignettes and understanding it as an integrated system of systems, where every decision has cascading consequences.

Pedagogical Models

If the AMEDD is to invest the time and resources to institute a new MSR program, it is imperative to build it on the most effective pedagogical model. In a critique of contemporary staff ride practices, Stowe, Wineman, and Gelpi (2019) caution against the two most common approaches: the character-driven (role-player) model and the traditional Socratic dialogue. They argue the character-driven model often becomes a scripted recitation, while the Socratic dialogue risks becoming a passive review of events. Both models frequently fail to force students to exercise genuine critical thought or refine their decision-making skills, reducing a potential leadership laboratory to a mere “tour”.

In the current high operations tempo and resource-constrained environment, the AMEDD cannot afford to create a program that prioritizes historical narration over intellectual development. The goal of the MSR should not be to teach officers what Major Jonathan Letterman did at Antietam, but to cultivate leaders who possess the intellectual agility to innovate as he did. The pedagogical foundation for this lies in the “decision game-driven” staff ride. This model is an “intellectual reenactment” that places students in the mind of a historical commander at a critical juncture before the historical outcome is revealed. Participants are given the same limited intelligence, resources, and constraints as their historical counterparts and are compelled to develop, articulate, and defend their own course of action (COA). The focus shifts from “what happened?” to “what do you do, and why?”

Imagine an MSR focused on the Battle of Gettysburg. A decision game could present a group of AMEDD officers with the following scenario on the evening of the first day:

• You are the acting medical director for the Union army. General Howard’s XI Corps has broken, and casualties are flooding the town. Many of your forward field hospitals are now in enemy hands. Confederate forces control the northern approaches to the town, severing a key supply and evacuation route. General Hancock is attempting to rally the army on Cemetery Hill. What are your orders for the next 12 hours regarding casualty collection, treatment, evacuation, and medical rules of engagement?

This problem forces participants to synthesize information, weigh competing priorities, and make a command decision under uncertainty. The subsequent peer critique and discussion of the briefed COAs becomes the engine of learning. This methodology transforms the study of history from a passive activity into a dynamic, active problem-solving event that forges the exact skills required to manage medical operations on a future battlefield.

The 261st MMB Commanders and Staff discuss the fortifications at Fort Monroe.

Relevance of History

A common objection to history-based military education is its perceived lack of relevance. Why study 19th-century medical operations when modern medicine is defined by advanced surgical interventions, mechanized evacuation, and complex information and communication systems? This view, however, misunderstands the purpose of the professional staff ride and falls into what Sir Michael Howard, a well-known military historian, calls “the abuse of history”. The goal is to study the timeless challenges of leadership, logistics, and decision-making under pressure. Ultimately, the relevance of the MSR is found in the cognitive process it cultivates, not in its historical content. John Lewis Gaddis, another known historian and political scientist, notes that history provides a laboratory for understanding how complex systems operate under stress. A medical officer studying the collapse of the Union medical system at Second Manassas is not learning how to treat wounds in 1862. They are learning to recognize the warning signs of systemic failure: the breakdown of communication, the failure of logistics, and the point at which command authority becomes ineffective.

Furthermore, the argument of irrelevance confuses the changing character of war with its enduring nature. Carl von Clausewitz, a Prussian military theorist, argued that the fundamental nature of war as a domain of chance, friction, and human passion is immutable. The specific technologies available to a medical officer in 1862 are part of the Civil War’s character. The challenge of imposing a rational medical plan onto a chaotic battlefield in the face of fear, uncertainty, and logistical failure is part of war’s nature. Therefore, the MSR is a study of war’s unchanging nature, which is the best way to prepare for its changing character. The MSR teaches how to think about a medical enterprise as a complex and fragile system, a skill of timeless relevance.

Institutionalization

The first practical step is a pilot program, hosted by the AMEDD Center for History and Heritage or the Uniformed Services University of Health Sciences, to develop and test a handful of decision-centric MSRs focused on key historical campaigns. This approach would allow leaders to avoid dramatic increases in funding and course restructures, which is helpful in the current resource-constrained environment. The largest initial investment would be in intellectual capital: developing the decision-games and the facilitator talent required to execute them effectively. Eventually, a ‘train the trainer’ model could empower medical leaders across the force to adapt the methodology for their own units, creating annual or bi-annual training events using local battlefields or virtual environments. While the goal is universal adoption, a cadre of leaders cultivated to understand the methodology can champion its expansion over time.

The 261st MMB Commanders and Staff at the Chimborazo Visitor center, the location of a major Confederate hospital in Richmond, VA. In the photo on the right, Dr. King (left) uses the terrain model to discuss hospital operations.

The operational tempo of the modern Army demands that we pursue only the most effective and impactful developmental opportunities. The MSR is a necessity but must be designed as a decision-centric leadership laboratory rather than a battlefield tour. Current and future AMEDD officers will develop an intuitive grasp of warfare by internalizing the vicarious experiences of others, also referred to as the 5,000-year-old mind. The skills the MSR fosters, such as critical thinking, creative problem-solving, and grace under pressure, are core competencies that future medical commanders require. Finally, this transforming concept can be done with minimal investment because it does not require a revolutionary budget, but a revolutionary commitment to intellectual rigor. By formally creating, properly resourcing, and fully integrating the decision-game-driven MSR into our leader development curricula, the AMEDD can take a critical step toward preparing its officers to meet the demands of the next war, ensuring they are true medical commanders of the future.

Notes