|Year : 2016 | Volume
| Issue : 2 | Page : 128-131
Educating medical students about military health: Perspectives from a multidisciplinary lecture initiative
Christos Theophanous1, Mariya Kalashnikova1, Claire Sadler1, Elizabeth Barreras1, Cha-Chi Fung1, Madeleine Bruning2
1 Department of Medical Education, Keck School of Medicine of University of Southern California, Los Angeles, USA
2 Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, USA
|Date of Web Publication||19-Aug-2016|
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Source of Support: None, Conflict of Interest: None
Background: Medical student education on military health topics is critical in ensuring optimal future care for military service members and their families. Methods: Keck School of Medicine of the University of Southern California (Keck SOM) students were invited to participate in an anonymous, voluntary, online survey ("Pre") rating their level of interest, awareness, exposure and comfort with military health issues on a 5-point Likert scale. A student-organized program of four voluntary lectures discussing military health-related topics was then implemented. Students were invited to re-take the survey ("Post") and also indicate which, if any, lectures they had attended. Results: 230 students completed the "Pre" survey. A statistically significant deviation in responses was observed in all four questions, showing high interest (mean: 3.19 ± 1.20, P = 0.002), low awareness (mean: 2.52 ± 1.15, P < 0.001), low comfort (mean: 2.66 ± 1.11, P < 0.001), and low exposure (mean: 1.80 ± 0.95, P < 0.001) to military health issues. 132 students completed the "Post" survey, including 37 lecture attendees and 95 non-attendees. A statistically significant difference in the level of interest (P < 0.05) and exposure (P < 0.05) was observed between these groups. Discussion: Medical schools that lack military health curricula may underprepare students to care for military-affiliated patients. Student-led programs can help introduce this topic before formalized curricula are instituted.
Keywords: Medical education, military health, veterans
|How to cite this article:|
Theophanous C, Kalashnikova M, Sadler C, Barreras E, Fung CC, Bruning M. Educating medical students about military health: Perspectives from a multidisciplinary lecture initiative. Educ Health 2016;29:128-31
|How to cite this URL:|
Theophanous C, Kalashnikova M, Sadler C, Barreras E, Fung CC, Bruning M. Educating medical students about military health: Perspectives from a multidisciplinary lecture initiative. Educ Health [serial online] 2016 [cited 2019 Nov 15];29:128-31. Available from: http://www.educationforhealth.net/text.asp?2016/29/2/128/188754
| Background|| |
Veteran and military-affiliated patients present unique challenges for healthcare professionals worldwide. These patients suffer disproportionately from mental illnesses such as major depression, substance abuse, generalized anxiety and post-traumatic stress disorder (PTSD). ,,,,,,, Secondary traumatic stress, partner burden and general psychological stress has also been identified among female partners of veterans suffering from PTSD.  In the U.S., military families experience poorer continuity of care as 47% of active-duty families reported three or more residence changes in five years, well above the national average. , A lack of trust for mental health professionals and worries that requesting assistance would betray the confidence of their unit among service members further complicates veteran care. 
While military physicians are specifically trained to assess the needs of service members and their families, many veterans receive care from civilian clinics. The 2010 National Survey by the U.S. Department of Veterans Affairs found that only 16% of American veterans intended to use the Veterans Affairs (VA) system as their primary source of care, while 32% had no plan to use it at all.  Further, up to 50% of the 2 million children of American military families receive their primary care outside a military medical facility.  Practitioners educated about the particular healthcare needs of this population may be better equipped to elicit pertinent health information and provide more complete care to the military-affiliated patient.
Given these clinical issues, medical student exposure, understanding, and education about military health should be closely examined, especially in countries with large veteran populations. In American medical schools, increasing attention is being given to this topic by the academic medical community. The Association of American Medical Colleges (AAMC) has organized support for the national Joining Forces Initiative through a pledge signed by medical schools showing commitment to education on military health issues.  As of November 2014, 115 medical schools have signed the pledge.
We report on a survey assessing medical student attitudes towards military health at the Keck School of Medicine of the University of Southern California (Keck SOM) and describe a student-driven education program aimed at addressing gaps in knowledge.
| Methods|| |
This study was a non-randomized, prospective survey and was exempted for review by the USC Health Sciences Institutional Review Board (HS-14-00721).
An anonymous, voluntary, online survey was distributed to all 700 medical students at Keck SOM one month prior ("Pre" survey) and three months after ("Post" survey) a voluntary, four-part lecture series covering topics related to military health. Student participation was solicited via school-wide email list-serves and student group distribution lists. The survey asked students to identify their year of training and any military affiliation, and to rate on a 5-point Likert Scale (1= "very low", 5= "very high") their attitudes in four categories: (1) "Level of interest in learning about veteran/military family health care"; (2) "awareness of military health issues"; (3)"comfort in assessing the unique needs of military patients"; (4) "exposure to military health issues through curriculum and/or rotations." The "Post" survey asked the same questions as well as which lectures the respondent had attended.
The program was designed to explore military health from the perspective of different medical specialties. Sessions were delivered between November 2013 and March 2014. Each consisted of approximately 45 minutes of presentation followed by 15 minutes for discussion. The topics included:
- Military Culture in and Outside the 'Fortress': A Primer on Military Culture - delivered by a panel of servicemen/women with backgrounds in social work
- Joining Forces: Caring for the Military Child-delivered by a faculty member with research and clinical interest in caring for military children
- Recognizing and Healing Invisible Wounds: Caring for Service Members and Veterans with PTSD-delivered by a behavioral health officer working at a military training base
- Sexual Assault in the Military-delivered by a forensic nurse with experience as a sexual assault examiner.
The program was student-organized, and each session was co-sponsored by a different Student Interest Group (SIG). Lunch was provided for attendees with funding from the American Medical Students Association Keck SOM Chapter as well as an AAMC Joining Forces grant.
"Pre" survey responses assessed baseline attitudes of students toward military health issues. A Chi-square test was performed to evaluate trends, in which "Very High" or "Somewhat High" were considered "High," and "Very Low" and "Somewhat Low" were considered "Low." A mean for each class was calculated for each question and ANOVA analysis was performed to compare responses by class. The "Post" survey compared attitudes between students who attended at least one session ("Attendees") and students who did not attend any session ("Non-Attendees") using an independent t-test. All analysis was performed using Microsoft Excel. Statistical significance was defined as a P value of ≤0.05.
| Results|| |
230 students responded to the "Pre" Survey, with 14 (6%) reporting a personal or spousal military affiliation. Most (74%) were first or second-year students. 132 students responded to the "Post" Survey, with 10 (8%) reporting a personal or spousal military affiliation. 37 "Post" Survey respondents were Attendees (24 attended one lecture, 9 attended two lectures, 3 attended three lectures, and 1 attended all four lectures).
Detailed results of the "Pre" Survey are presented in [Table 1]. ANOVA analysis comparing responses by class showed no statistically significant difference in any of the four questions, so results are aggregated across the student body. Chi-square analysis showed a statistically significant skew towards high interest in learning about military health issues (mean: 3.19 ± 1.20, P = 0.002), but low awareness (mean: 2.52 ± 1.15, P < 0.001), low comfort (mean: 2.66 ± 1.11, P < 0.001), and low exposure (mean: 1.80 ± 0.95, P < 0.001) to military health issues.
|Table 1: Preprogram survey results among Keck School of Medicine students regarding attitudes towards military health issues (n =230)|
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Attendance at each lecture ranged between 35 and 40 students. "Post" survey results are summarized in [Table 2]. An independent t-test showed statistically significant differences in the level of interest (two sample t (130) = 2.03, P = 0.04) and level of exposure (two sample t (130) = 2.72, P < 0.01) to military health issues between Attendees and Non-Attendees. No significant difference was observed in levels of awareness (two sample t (130) = 0.98, P = 0.33) or comfort (two sample t (130) = 0.79, P = 0.43).
|Table 2: Postprogram survey results of Keck School of Medicine students by attendance status to program events (n =132)|
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| Discussion|| |
This project serves as a single-campus case study of student attitudes on military health and presents findings from a student-driven, supplementary military health program. Keck SOM was a fitting location for the project as the school has signed the Joining Forces Initiative Pledge but has no core student rotations at VA Hospitals and no formal curriculum addressing military health issues.
The "Pre" survey results found that Keck SOM students are under-exposed to military health issues and have low comfort and awareness of the issues complicating veteran healthcare. Since no significant difference was observed across the four classes in any of these categories, military health education seemingly remains limited regardless of a student's stage in training. Students reported high interest in learning more on the topic suggesting a receptive audience for more programming on military health.
Our program demonstrated that a voluntary lecture series can achieve consistent attendance over several months. Although our study does not prove efficacy of our program as it does not follow a fixed cohort before and after the lecture series, the Attendees group findings may reflect an increase in interest and exposure to military health with the program. We believe the program was strengthened by its organization around clinical specialties which highlighted the cross-disciplinary issues related to military health and allowed each lecture to relatively stand alone. Collaboration with specialty student interest groups was another strength as it helped target communication for each lecture to students more likely to be interested in that session, built early support from student leaders for the program, and provided additional funding for lunch to help draw attendees. The student-faculty partnership on the projects helped in securing speakers and vetting the curriculum, and also promoted discussions about further curricular changes that could be made. Recommendations currently under consideration include a veteran standardized patient workshop for first-year students, military health sessions in the preclinical "Professionalism in the Practice of Medicine" course, and incorporation of military health lectures into clinical clerkships.
However, our study also suggests limitations to a student-led program. The "Post" survey showed no significant difference in comfort or awareness between the Attendees and Non-Attendees, and few students reported attending more than one lecture. A voluntary curriculum may be insufficient compared to a formal curriculum on the topic in fully preparing students to care for military-affiliated patients.
Assessment of our program was also limited because the "Pre" and "Post" surveys were not completed by a fixed cohort before and after the program. We recommend a follow-up study of a single cohort of attendees to evaluate the impact of a similar program on student attitudes. As our study was conducted at one institution, the generalizability of our results is also uncertain. However, we suggest that our study could serve as an assessment model for student knowledge of military health issues in medical schools internationally, as well as an example of a student-driven curriculum to help initiate discussion on the topic.
| Conclusion|| |
As many servicemen and military-affiliated families receive care from civilian providers, training future physicians to address the unique health needs of this patient population is critical. Medical schools that lack military health curricula may underprepare students to care for military-affiliated patients. In those instances, student-led programs that provide specialty-centered education on topics related to military health can help introduce this topic before formalized curricula are instituted.
We would like to thank the Keck School of Medicine Offices of Student Affairs, Curriculum, and Medical Education for their support of our study, particularly Dr. Donna Elliott, Dr. Raquel Arias, and Dr. Pamela Schaff. Additionally, we would like to thank Dr. Jo Marie Reilly for her assistance in preparing this article.
Financial support and sponsorship
The study was funded by an AAMC Joining Forces Grant and support from the University of Southern California Chapter of the American Medical Students Association.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]