Letters to the Editor
To the Editor:
Published data1,2 suggest that thousands of military personnel serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) suffer or will suffer from posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). Between 13-20% of soldiers serving in OEF and OIF were likely to experience PTSD.2 Estimated rates of TBI run as high as 19%. About 60% of veterans receive their care outside of the Veterans Affairs (VA) system.1,3 When these statistics are coupled with the fact that 2.6 million individuals served in OEF and OIF during the last decade,2 it is likely that hundreds of thousands of veterans suffer from PTSD and TBI and will be seen by non-VA health care providers.
This situation makes clear that medical schools have an important community role: to train our nation’s physicians to meet the health care needs of military service members, veterans, and their families. I am happy to report that 112 schools, all members of the Association of American Medical Colleges (AAMC), are already responding to this need. In 2011, those schools agreed to participate in a White House initiative called Joining Forces. They pledged to enrich their educational programs and research to ensure that current and future physicians can meet the challenges of caring for this special and important population.
This is a fine beginning. However, the results of an AAMC survey4 of the participating medical schools identify what I believe are significant training deficiencies. While some schools have integrated training into their curricula that fosters the recognition and treatment of PTSD and TBI, and are teaching military cultural competence, much more can and should be done. My concerns are further fueled by the survey’s data showing a dearth of CME opportunities provided by our schools to community physicians with respect to treating veterans and family members dealing with these illnesses.
The men and women who volunteer to put their lives in harm’s way deserve the best care that we can provide. As a former military physician, I am truly heartened to see how many schools volunteered to be part of the initiative, even though I see that much more needs to be done. As the chief academic officer at the AAMC, I believe our collective impact can be greater than the sum of our parts. It will take both national and local efforts to improve the care of patients with military affiliations. I hope this letter will spur all medical schools to significantly enhance their commitment to educational activities that will better meet the needs of service members, veterans, and families in their communities.
John E. Prescott, MD
Chief academic officer, Association of American Medical Colleges, Washington, DC; firstname.lastname@example.org.
1. Tanielian T, Jaycox L Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. 2008 Santa Monica, CA RAND Corporation http://www.rand.org/pubs/monographs/MG720
. Accessed December 12, 2012.
2. Institute of Medicine, Committee on the Assessment of Ongoing Effects in the Treatment of Posttraumatic Stress Disorder. . Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: An Initial Assessment. 2012. 2012 Washington DC National Academies Press http://www.nap.edu/catalog.php?record_id=13364#toc
. Accessed December 12, 2012.
3. Taylor BC, Hagel EM, Carlson KF, Cifu DX, et al. Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War. Med Care. 2012;50:342–346