Credentialling and Orientating Military IMGs: Lessons from an Australian Civilian Hospital
Dr Felix Ho1
1NT Health, Darwin, Australia
Biography
Felix Ho is a medical practitioner with a background in health service delivery and clinical governance. He has contributed to initiatives aimed at strengthening civil–military cooperation, particularly in the orientation and credentialling of international medical graduates working in Australian hospitals. His work centres on improving clinical readiness, regulatory navigation and sustainable workforce integration.
International military health professionals frequently deploy to Australia as part of integrated multinational teams. Maintaining clinical practice can be challenging, particularly for specialist medical practitioners, due to limited opportunities for clinical contact and the absence of Australian professional registration.
Securing registration is a complex process. Professions such as medicine and nursing require registration through their respective boards under the Australian Health Practitioner Regulation Agency (AHPRA). For doctors, international medical graduates (IMGs) must undertake an approved assessment pathway; Standard, Competent Authority or Specialist, before being eligible for registration. Once registered, IMGs complete orientation and credentialling processes to ensure they can safely and effectively contribute within civilian hospital settings.
Despite the challenges, the integration of military IMGs into civilian health environments offers significant benefits. These include enhanced skills translation, additional workforce capacity within an already pressured health system, strengthened community relationships and improved maintenance of clinical competence for deployed personnel.
This presentation outlines the experience of a civilian hospital in supporting, credentialling and orientating military IMGs. It highlights practical challenges, lessons learned and opportunities for improving collaboration between military and civilian health systems.
From Malaria Prophylaxis to Mental Health: Exploring the Role of Doxycycline-Induced Microbiome Disruption and Probiotic Mitigation in Defence Populations
Sharnay Gilbert1
1Aspen Medical, Gold Coast, Australia
Biography
Sharnay Gilbert is a Registered Nurse and former Paramedic with over 15 years of frontline clinical experience across pre-hospital and acute care environments. She joined Aspen Medical in 2024 on the JP2060 project, where her interest in military medicine was sparked through exposure to deployable healthcare systems.
She is currently the Project Lead for GP Services in Digital Health, focusing on delivering innovative, technology-enabled models of care.
Sharnay’s research interest was driven by observing the higher incidence of PTSD in defence personnel compared to civilian clinicians, despite similar exposure to trauma. This led her to explore broader biological contributors, including the impact of routine antibiotic use on the gut microbiome and its potential influence on mental health.
She is passionate about advancing practical, preventative healthcare strategies that improve outcomes for defence and veteran populations.
Mental health conditions, including post-traumatic stress disorder (PTSD), anxiety, and depression, are highly prevalent among Australian Defence Force (ADF) personnel and veterans. While psychological and environmental factors remain central to understanding these conditions, emerging evidence highlights the role of biological contributors—particularly the gut microbiome—through its interaction with the central nervous system via the gut–brain axis (1,2).
Doxycycline is routinely prescribed within defence populations for malaria prophylaxis during deployment and training in endemic regions. While effective, doxycycline is associated with alterations in gut microbiota composition, contributing to dysbiosis and gastrointestinal disturbance (3,4). Increasing evidence suggests that such disruptions may extend beyond gastrointestinal effects, influencing neuroinflammation, neurotransmitter production, and stress response systems implicated in mental health disorders (2,5).
This presentation explores the hypothesis that repeated or prolonged exposure to doxycycline in ADF populations may contribute to cumulative microbiome disruption, potentially increasing susceptibility to mental health conditions both during and after service. Factors common in military environments—including chronic stress, sleep disruption, dietary variability, and environmental exposures—may further exacerbate microbiome instability, compounding risk (6).
The gut–brain axis provides a mechanistic framework linking these effects, with microbiota influencing brain function through immune, endocrine, and neural pathways. Alterations in microbial diversity have been associated with PTSD and depression, with emerging studies identifying distinct microbiome profiles in affected individuals (5,7).
Probiotics represent a low-risk, accessible intervention with potential to mitigate antibiotic-associated dysbiosis and support microbiome resilience. Evidence supports their role in reducing antibiotic-associated gastrointestinal symptoms and suggests potential benefits in modulating mood, anxiety, and stress responses (8,9). Despite this, routine probiotic co-administration with doxycycline is not standard practice within most defence health protocols.
This presentation synthesises current evidence and operational considerations to examine the potential benefits of incorporating probiotics into routine prophylactic regimens for ADF personnel. Practical considerations—including strain selection, storage in austere environments, adherence, and clinical governance—will also be explored.
By reframing gastrointestinal side effects of prophylactic medications as potential contributors to broader physiological and psychological outcomes, this approach highlights a novel opportunity for preventative intervention. Addressing microbiome health alongside essential medication use may support both short-term wellbeing and long-term mental health outcomes in defence populations.
While further research is required to establish causality and optimise protocols, this integrative model represents a scalable strategy for enhancing force health protection and veteran care. It is relevant to military clinicians, policymakers, and researchers seeking innovative approaches to improving resilience and reducing mental health burden across the defence community.
- Cryan JF, O’Riordan KJ, Cowan CSM, et al. The microbiota–gut–brain axis. Physiol Rev. 2019;99(4):1877–2013.
- Foster JA, McVey Neufeld KA. Gut–brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013;36(5):305–312.
- Becattini S, Taur Y, Pamer EG. Antibiotic-induced changes in the intestinal microbiota and disease. Trends Mol Med. 2016;22(6):458–478.
- Abt MC, Pamer EG. Commensal bacteria mediated defenses against pathogens. Curr Opin Immunol. 2014;29:16–22.
- Hemmings SMJ, Malan-Müller S, van den Heuvel LL, et al. The microbiome in posttraumatic stress disorder and trauma-exposed controls. Psychosom Med. 2017;79(8):936–946.
- Karl JP, Hatch AM, Arcidiacono SM, et al. Effects of psychological, environmental and physical stressors on the gut microbiota. Front Microbiol. 2018;9:2013.
- Jiang H, Ling Z, Zhang Y, et al. Altered fecal microbiota composition in patients with major depressive disorder. Brain Behav Immun. 2015;48:186–194.
- Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea. JAMA. 2012;307(18):1959–1969.
- Wallace CJK, Milev R. The effects of probiotics on depressive symptoms in humans: a systematic review. Ann Gen Psychiatry. 2017;16:14.
From preparedness to response; strengthening the workforce, pre-crisis
Mrs Koryn Roberts1
1RAAF, Australia
Biography
Koz joined the RAAF twenty years ago, as a Nursing Officer and has worked as a nurse in theatre, ICU, acute neurosurgery and emergency. A passion for trauma and emergency nursing has led Koz back to school, completing a graduate certificate and masters in acute care / trauma and Emergency Nursing; knowledge she puts into practice by working as a causal in a QLD ED.
Koz’s military service has seen her posted to WLM, TDL, RIC, Wagga and AMB, providing primary, emergency, and aeromedical health services, domestically and oversea, and ran a health centre during the peak of CoVID. Posting have also included HQHSW, working in OPS, and HQCSG, CSCC, planning and coordinating the RAAFs enabling functions of operations and exercises.
Koz’s is the deputy chair of the Military Faculty in the Australian College of Nursing, providing an avenue to channel her commitment to the growth and development of nurses and the nursing profession. Koz is also a board member on the Belinda McGowan Foundation, which facilitates the placement of cuddle beds to support palliative patients and their families during their deaths.
The Bullwinkel scholarship provided me the opportunity to not only grow myself as a health leader, but the opportunity to contribute to the growth of the workforce. I chose to focus on who we can best generate a crisis ready workforce, without prior lived crisis experience.
Crisis comes in many forms, infectious disease outbreaks, mass causality events, natural disasters, and conflict.
Through robust professional development programs, we have grown a workforce of highly educated and clinically skilled health professionals. How do we best train for the darker side of health care; for the death (natural and more so, the traumatic). How do we train for the long hours, limited resources, increasing demands, and the confronting face of self-focused, panicked humans that crisis brings out. How do we prepare ourselves for this, without anaesthetising our empathic side, the side that many argue is crucial in health care? How do we grow this without causing harm through unnecessary exposure to traumatic events, without increasing the likelihood of moral injury, vicarious trauma and burnout?
This presentation will outline the research project premise, what was found through the project and the next steps.
Holistic Health and Fitness: Reimagining Military Health Through Integrated Human Performance and Readiness
A/Prof Derrick Tin1,2, Ms Terri Antonio2
1University of Melbourne, Australia, 2SERCO, ASPAC
Biography
Dr Derrick Tin is a US fellowed Disaster Medicine Specialist with a special interest on the health impact of conflict and terrorism. He is an Associate Professor of Critical Care Medicine at the University of Melbourne and the Chief Medical Officer at SERCO.
Background
Modern military capability depends on more than treating illness and injury. Operational effectiveness requires physically resilient, cognitively agile and psychologically prepared personnel capable of sustaining performance in increasingly complex environments. Traditional military healthcare systems have largely focused on the diagnosis and treatment of disease after it occurs. In contrast, the United States Army’s Holistic Health and Fitness (H2F) system represents a paradigm shift towards proactive optimisation of soldier performance through an integrated, multidisciplinary model that embeds health professionals directly within operational units. Team Serco currently delivers key components of this capability through embedded Strength and Conditioning Coaches and Cognitive Performance Specialists working alongside military leadership and healthcare professionals to optimise readiness, reduce injury burden and improve long-term force health.
Purpose
This presentation will explore the principles underpinning the H2F model, examine how integrated human performance teams enhance military readiness, and discuss the potential application of similar concepts within the Australian Defence Force and other military organisations.
Overview
The H2F model extends beyond physical fitness by integrating multiple domains of performance including physical conditioning, cognitive performance, nutrition, injury prevention, rehabilitation and occupational health. Rather than functioning as isolated services, these disciplines operate as an embedded performance team supporting soldiers throughout the training and operational continuum. Strength and Conditioning Coaches and Cognitive Performance Specialists deliver individualised performance interventions, monitor progression, educate personnel on injury mitigation strategies and work closely with unit leadership to align health initiatives with operational requirements. This embedded approach enables earlier identification of performance limitations, promotes resilience before injury occurs, and supports rapid return to duty when injuries arise.
Importantly, H2F represents a cultural change as much as a healthcare model. Health professionals become integral members of operational teams rather than external providers, fostering trust, accessibility and continuous engagement. By combining evidence-based physical training with cognitive skills development, stress management and behavioural performance strategies, the program aims to optimise both individual and collective readiness while reducing preventable musculoskeletal injuries, one of the leading causes of military attrition and lost operational capability.
Discussion
As defence forces worldwide confront evolving operational demands—including multidomain operations, increased cognitive workload, prolonged deployments and workforce retention challenges—there is growing recognition that military health systems must move beyond reactive healthcare towards proactive performance optimisation. The H2F framework provides an example of how multidisciplinary integration can support force generation by simultaneously improving health, resilience, recovery and operational effectiveness.
For Australia, this approach raises important questions regarding future workforce design, clinical governance, integration of allied health professionals within operational units, and the role of human performance as a core component of military capability. While implementation would necessarily reflect Australian organisational structures and operational requirements, the underlying principles offer valuable insights for future defence health transformation.
Conclusion
Holistic Health and Fitness represents a contemporary evolution in military health, positioning health and wellbeing as strategic enablers of operational readiness rather than solely healthcare outcomes. By embedding multidisciplinary expertise alongside military units, H2F demonstrates how integrated human performance programs have the potential to enhance resilience, reduce injury, optimise cognitive and physical performance, and ultimately strengthen force capability. As defence organisations continue to modernise, integrated human performance models may become a defining feature of future military health systems.
Joint Medic Training Continuum – Bridging workplace exposure with capability outcomes
Mr Jayden Pyper1
1ADF-Army, Australia
Biography
Warrant Officer Class 2 Pyper was born in Ouyen, Vic in 1984. He enlisted in the Army in March 2003, and after graduating Kapooka, he was allocated to the Royal Australian Army Medical Corps and initially served at the Oakey Medical Centre. He has been posted to a number of different locations in diverse clinical roles. In 2020, Warrant Officer Pyper was promoted to Warrant Officer Class 2 and posted to Employment Category and Training Design – Health Cell, where he performed the role of lead training designer for ECN 368 training continuum. He also played a key role in the Defence Force Remuneration Tribunal submission for the new employment category. Warrant Officer Pyper was awarded the CF Marks award for his efforts in this role. In 2024 he was posted to the ADF School of Health to work with standards and in the military instructor group. His operational experience includes Operation SLIPPER Afghanistan in 2008-09; Operation CATHEDRAL Papuan New Guinea in 2012; Operation HIGHROAD Afghanistan in 2018-19 and Operation COVID-19 Assist in the Melbourne health Headquarters in 2020.
Medics comprise approximately 1.5% of the Australian Defence Force (ADF) workforce, yet deliver critical health capability across deployed, domestic, and garrison settings (Army Strategic Workforce Plan, 2017). They provide primary and emergency care in austere environments, support force readiness, and contribute to domestic operations during national emergencies. Sustaining this capability over the next 5–10 years requires deliberate alignment between workforce planning, human resource development (HRD), and evolving operational demands.
Recent environmental scans identify pressures likely to influence the medic workforce, including increasing clinical expectations, distributed employment, and sustained operational tempo (Conway, 2012). Workforce planning provides a structured approach to analysing current and future capability requirements, enabling targeted investment in key risk areas (Sparkman, 2018). Within the ADF, the Systems Approach to Defence Learning (SADL) process links HRD and capability development, supporting this alignment.
The Joint Medical Continuum (JMEDC) has been designed to address these challenges by integrating the strengths of both traditional course-based training and workplace-based learning. It retains the assurance and standardisation provided by formal education, while incorporating continuous, workplace-integrated development. Learning is primarily self-paced and supported by structured workplace mentoring, an approach associated with improved competency outcomes and professional growth (Nok & Kim, 2019). Collaborative practice and case-based learning are also used to strengthen clinical reasoning and application in operational contexts (Hassain, 2012; Pendry & Salvatore, 2015).
A key feature of the JMEDC is the recognition of workplace experience as valid evidence of competence alongside formal assessment. Previous models relied heavily on course attendance for validation, even where individuals were already performing at the required standard. The JMEDC incorporates both approaches. Formal training remains essential for standardisation and governance, while workplace performance provides context, reinforcement, and depth. This combined model supports consistency without disregarding the value of operational experience.
The approach also strengthens the role of unit leadership in capability development. By embedding training and assessment within the workplace, supervisors are more directly involved in supporting skill acquisition and application. This does not replace formal training responsibilities but complements them. It encourages a learning culture in which routine activities are leveraged to build competence, and where leaders actively support development through exposure and feedback (Rowden, 2007).
The JMEDC aligns with established principles of clinical education. Effective programs extend beyond knowledge acquisition and focus on clinical reasoning, decision-making, and professional judgement (Ballenden, 2001). To achieve this, the learner must engage in repeated cycles of experience, reflection, and application within the workplace. They need to be exposed to new experiences and workplace challenges that enable them to metaphorically ‘exercise new muscle’, as information only becomes knowledge when it is combined with experience and judgement (Rowden, 2007). This deliberate integration of practice and reflection ensures that learning is contextualised and retained. It is the judgement aspect of learning that provides the linchpin to developing resilience in clinical practice. Learners must apply knowledge in varied and often uncertain environments. The inclusion of real-world experience, structured reflection, and guided mentorship supports this process. Competence is demonstrated through performance across contexts rather than isolated assessment events.
Implementation requires balance. The framework must maintain sufficient structure to ensure governance, consistency, and clinical safety, while remaining flexible enough to accommodate diverse employment settings. Content must be robust, relevant, and aligned with operational requirements. Success will depend on sustained engagement from both the workforce and unit leadership.
The JMEDC provides a practical, integrated model for developing and sustaining ADF medic capability. By combining formal training with workplace-based learning, it strengthens clinical competence, supports workforce adaptability, and aligns HRD efforts with the ADF’s strategic health objectives.
Neuropsychology Findings in Veterans Reporting Cognitive Decline
Dr Patrick Arulanandam1, Dr Jasmina Vrankovic1, Dr Leon Smith1, Dr Andrew Liu1
1Concord Hospital National Centre For Veterans’ Healthcare, Sydney, Australia
Biography
Patrick Arulanandam is a rehabilitation medicine physician based at Concord and RPA Hospitals. He is the acting medical director of the Concord Hospital National Centre for Veterans’ Healthcare. His research interests include cognitive rehabilitation, stroke rehabilitation and rehabilitation models of care.
Background
Serving Defence Force members and veterans experience high rates of subjective cognitive concerns which may be related to the physical and psychological impacts of military service. Causes of cognitive decline can include both organic (e.g., traumatic brain injury, neurodegenerative conditions) and non-organic (e.g., psychological disorders, chronic pain) factors.
Aim
This study aimed to identify the primary causes of subjective cognitive concerns in patients attending a multidisciplinary veterans’ health service, with a focus on differentiating between organic and non-organic contributors to cognitive impairment.
Methodology
Cognitive diagnosis was obtained from the neuropsychological assessments of 152 veterans who reported subjective cognitive concerns and underwent comprehensive neuropsychological assessment between 2020 and 2026. These assessments evaluated baseline cognition, general intellectual functioning, and specific cognitive domains including attention, processing speed, language skills, visuospatial skills, memory, and executive function. Cognitive impairment was defined as performance at least one standard deviation below the formally estimated premorbid baseline.
Results
Of the 152 tested patients, mean age was 48 (range 21 to 85), and 88% were male. 91 patients (60%) had intact cognition, characterised either by no objective evidence of cognitive impairment across any tasks, or some isolated low scores of uncertain clinical significance (a common psychometric phenomenon inherent to such long assessments). 37 patients (24%) had cognitive impairment from an organic cause, and 14 patients (9%) had cognitive impairment due to a psychological disorder. Ten patients (7%) showed suboptimal effort during testing, which invalidated their assessment. Organic causes of cognitive impairment in this cohort were most commonly multifactorial, including traumatic brain injury, neurological disorders, vascular disease, and substance use disorders.
Conclusion
Cognitive concerns in patients attending this multidisciplinary veterans’ health service are multifaceted. There is a high rate of intact cognitive function despite subjective concerns, so these patients may benefit from reassurance and prioritising treatment of contributing conditions. For those with objective impairment, both organic and non-organic disorders contributed. Further studies are needed to inform effective interventions and treatment approaches, particularly for reversible causes of cognitive decline.
Should Military Medicine Have a Greater Place in Medical Education?
Mr Thomas Cranfield1, Dr Andrew Mathieson1
1Australian National University, Canberra, Australia
Biography
Thomas Cranfield is a 2nd year undergraduate student at the Australian National University studying a Bachelor of Health Science, with aspirations to study medicine and serve in the ADF. His research interests lie within military medicine, military history, trauma care, medical education and Defence Health Policy.
Thomas has presented and undertaken research across a range of health topics including the quality and accessibility of veteran’s health care in Australia, the evolving health profiles of prospective applicants to the ADF and the integration of military health history and principles into undergraduate / postgraduate curricula.
Thomas aims to continue research across a range of defence related health topics and is committed to pursuing a clinical career within the Australian Defence Force. His ongoing work aims to gather evidence and raise awareness to discussions within a university cohort to opportunities and challenges facing military medicine in Australia.
Military medicine has played a pivotal role in shaping modern healthcare, contributing to advances in trauma management, blood transfusion, rehabilitation, evacuation medicine, infection control and damage-control surgery. Beyond these historical contributions, military medicine continues to provide contemporary models of healthcare delivery in austere, humanitarian, disaster and operational environments. Despite its enduring influence, military medicine receives little explicit attention within most undergraduate and postgraduate medical curricula, leaving many graduates with limited understanding of veteran health, operational healthcare, disaster preparedness and the broader systems-based challenges of delivering care under conditions of uncertainty.
This paper examines whether greater integration of military medicine into medical education could strengthen the knowledge, skills and professional capabilities expected of contemporary medical graduates. Rather than advocating military service, it considers military medicine as an educational framework through which students can better understand the evolution of modern clinical practice while developing transferable competencies in leadership, multidisciplinary teamwork, ethical decision-making, systems thinking, communication and resource-limited practice. These capabilities closely align with the Australian Medical Council (AMC) Graduate Outcome Statements, particularly in relation to clinical decision-making, professionalism, leadership, culturally safe practice and health advocacy, while also reflecting the CanMEDS Physician Competency Framework roles of Medical Expert, Leader, Collaborator, Communicator, Health Advocate, Professional and Scholar. Furthermore, the operational principles underpinning military medicine strongly complement recognised disaster medicine competency frameworks that emphasise preparedness, triage, risk communication, coordination and adaptive decision-making during emergencies.
Current medical curricula appropriately prioritise the development of safe and competent clinicians; however, opportunities remain to better integrate learning relating to veteran health, humanitarian medicine, disaster preparedness and operational healthcare. These areas are increasingly relevant as Australia experiences more frequent natural disasters, evolving geopolitical uncertainty and an ageing veteran population with complex physical, psychological and social healthcare needs. Military medicine provides authentic, systems-based examples that integrate clinical excellence with leadership, logistics, ethics, public health and multidisciplinary teamwork, offering students valuable insights into managing complexity across both military and civilian healthcare settings.
Military medicine should be viewed not as a niche specialty, but as an underutilised educational resource that supports established graduate competency frameworks. Greater recognition of its historical, clinical and societal contributions has the potential to enrich medical education, strengthen graduate preparedness for complex healthcare environments, and improve understanding of the unique healthcare needs of defence personnel and veterans. As healthcare systems confront increasingly complex humanitarian, environmental and security challenges, military medicine warrants renewed consideration as an important component of contemporary medical education.