April 1st, 2012

Medical schools commit to Joining Forces initiative

Marc B. Hahn, D.O., knows how fast the U.S. military can get a soldier injured overseas back on American soil. He was chief of pain management and an attending anesthesiologist on active duty at Walter Reed Army Medical Center during the first Persian Gulf War.

“We were evacuating some injured servicemen so quickly back to stateside that we were dumping out sand from their boots in the operating room,” recalls Hahn, now dean of the College of Osteopathic Medicine at the University of New England (UNE) in Biddeford, Maine.

Hahn joined a group of medical school deans who met First Lady Michelle Obama in January for the announcement of Joining Forces, an initiative to support the health care needs of service members. The program includes a commitment by 130 U.S. medical schools to increase research and training for brain injuries, PTSD and other mental health issues.

Eight of New England’s 10 medical schools are Joining Forces participants: the University of Massachusetts Medical School, Tufts University School of Medicine, Harvard Medical School, Boston University School of Medicine, Dartmouth Medical School, Yale School of Medicine and The Warren Alpert Medical School of Brown University. Those seven are members of the Association of American Medical Colleges. UNE is an affiliate of the American Association of Colleges of Osteopathic Medicine. (The University of Connecticut School of Medicine and the University of Vermont College of Medicine are not participating).

Advances in both the medical evacuation system and in treating brain and other injuries have improved outcomes. But early intervention can complicate diagnosing soldiers with PTSD if symptoms take weeks or months after an injury to surface.

“Many times we forget about the concomitant psychological trauma that goes along with any significant injury whether it’s in a wartime situation or another stressful physical situation,” Hahn says.

Nearly 70 percent of veterans get their medical care outside the Veterans Administration system, according to White House figures. So community based clinics and doctors offices are on the frontlines when it comes to treating service members returning from Iraq and Afghanistan. Maine’s only medical school, UNE is the top producer of physicians to the state; 60 percent of its graduates go into primary care.

UNE already had research and curriculum in place to expose students to issues related to PTSD and brain injuries. Associate Professor of Physiology Ian Meng, Ph.D., received an award at the 2011 American Academy of Pain Management Annual Conference for developing an animal model for PTSD.

Joining Forces, Hahn says, shows a commitment to training the next generation of physicians to be sensitive to post-war injuries and behavioral health issues. The next steps are to focus on training in these areas as part of internships and residencies and ongoing training for physicians who may not have had that exposure during their medical school or graduate medical training.

Joining Forces will only increase awareness and opportunities at the University of Massachusetts Medical School, which has an ongoing relationship with the VA to provide services to veterans and active duty soldiers in the greater Worcester and Fitchburg areas. David Smelson, Psy.D., professor and vice-chair for clinical research in the UMass Department of Psychiatry is also the site coordinator of the National Center on Homelessness among Veterans (NCHV) and director of Translational Mental Health Research at the Bedford VA.

Smelson says more research and educational training is needed in a number of areas, such as understanding the role of self-stigma as a barrier to help seeking among veteran populations. There is also a need to educate physicians on spotting serious depression among “two-hatters,” – National Guard members who work in public safety roles in the civilian world where they have everyday access to weapons.

“I just see Joining Forces as a natural extension of what we’re continuing to do,” Smelson says.

By Janine Weisman

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