Note: This guest post was written by DK, an Air National Guard pararescueman and doctor of physical therapy.

BK recently wrote an article in which he cautioned against overreacting to the controversy surrounding military contractor and retired Army physician John Hagmann. Like BK, I interacted extensively with Dr. Hagmann during my career as an Air Force pararescueman, having taken his Operational Emergency Medical Skills course four times. At no point during those courses did Dr. Hagmann conduct himself in what I perceived to be an unprofessional manner, although he did teach and supervise numerous procedures that could be construed as somewhat risky without proper context.

I hope to provide that context to elucidate why training civilian trauma practitioners and SOF medics must necessarily differ. The non-medical accusations made against Dr. Hagmann are a different matter altogether and beyond the scope of this article. The personal aspects of this case should not, however, obscure the medical validity, the necessity, in fact, of the training espoused by Dr. Hagmann.

Despite graduating with a clinical doctorate from an Ivy League university, I can say without hesitation that the quality and clinical relevance of my training as a SOF medic far exceeded anything I encountered in formal academia, in a fraction of the time. Between the pararescue pipeline and continuing education courses like Dr. Hagmann’s, I learned to confidently and independently conduct procedures that a civilian with a comparable scope of practice (chest tubes, surgical airways, blood transfusions, narcotic administration) might not learn for 8-10 years.

In fact, courses like Dr. Hagmann’s highlight how antiquated medical education is in this country. Any honest medical practitioner will tell you that the skills he actually uses in clinical practice were cultivated during residency and fellowships, which, in the case of an aspiring physician, begin eight years after he graduates high school.

Most academic medical programs are rights of passages in which students are required to memorize such an excessive volume of information that important concepts can be missed in an effort to retain esoteric details. Courses like Dr. Hagmann’s are principle-based and provide a sufficient theoretical background to guide clinical decision-making without overwhelming the student with facts that can be looked up in seconds with a pocket guide or smartphone.

The SOF medic simply does not have eight years to learn a surgical airway or chest tube, especially considering that the tactical and mobility aspects of the job require equally extensive training. SOF medical instructors are educators who, out of necessity, must demystify advanced skills.

The same people who regard SOF medical practices as unnecessarily extreme probably do not skydive, SCUBA dive, or fast-rope out of a helicopter to get to work. The nature of SOF medical training must reflect the reality of the job. There can be no false confidence. SOF medics bear an incredible degree of autonomy and responsibility. Even an attending physician in the emergency room has access to a team of residents, specialists, nurses, and medics when treating a critical patient.