CONTROVERSIES IN PSYCHIATRY
Summer 2021 Issue |
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Military Mental Health Training in Virginia
By J. Edwin Nieves, MD, DFAPA; Kirkland Kathe, MD, EVMS Class of 2021; and Kathleen M. Stack, MD, DFAPA
Last month, the Journal of Military Medicine published a letter from Dr. T. Porea’s, “Mentoring Military Students at Civilian Medical Schools”; focusing attention on mentoring military medical students attending civilian medical schools for a career in Military Medicine. Another important aspect in the training of both military and civilian medical students is the exposure to actual clinical services in active duty Military Treatment Facilities, or MTF’s.
Most medical students attending civilian medical schools complete nearly half of their clinical rotations in Veterans Health Administration, (VHA) Hospitals. However, few complete clinical clerkships in an active duty MTF, and thus are not exposed during their training to the clinical needs, patient presentations, and nuances of military active duty physical and mental health issues.
Eastern Virginia Medical School (EVMS), located in Norfolk, Virginia, is in an area with a large MTF presence from all branches of the Uniformed Services. EVMS is affiliated with some of them. Students complete clinical rotations in several specialties at U.S. Naval Medical Center Portsmouth (NMCP). These include psychiatry rotations in inpatient and consult-liaison psychiatry. During their senior year, medical students can also elect to complete a mental health clinical rotation at an active duty U.S. Army MTF; McDonalds Army Health Center in Fort Eustis. These settings enable EVMS students to gain invaluable knowledge about the active military duty clinical environment, symptom presentation, and diagnosis.
EVMS medical students learn the cultural nuances and terms unique to military service, such as Medical Retention Determination Point, (MRDP), Temporary Disability Retirement List, (TDRL), and “Profiling” or profile duty limitations. Each one of these terms have a particular meaning in the MTF clinical practice and often have profound implications for the service member military career. As in any other cultural environment, it is important for physicians to receive training in, understand, and show familiarity with these terms in order to engage patients and foster rapport, whether they join a MTF or civilian practice, given that nearly 12% of the general population has served in the military, and approximately 45% of post graduate medical training (residencies and fellowships) are completed in VHA Hospitals.
Additionally, active duty clinical rotation clerkships provide knowledge about the nature of soldiers’ missions and their exposure to possible trauma and injuries. Not just combat induced post-traumatic stress disorder and traumatic brain injury (TBI), the signature mental health conditions of the South West Asia combat environment, but also others.
As with any patient group, it is important to have a basic cultural competency of military service in order to establish rapport, conduct a credible and appropriate interview, and arrive at the most accurate diagnosis. Learning the relevant vocabulary is also very helpful in establishing rapport, and thus conduct a more organized interview of patients that have served in the military.
The views expressed are solely those of the author and do not reflect the official policy or position of the U.S. Army, the U.S. Navy, the U.S. Air Force, the Department of Defense, or the U.S. Government.
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