To the Editor:
Dr. Lypson and colleagues1 reported that continuing education workshops, aligned with objectives of the Joining Forces Initiative, can increase knowledge and understanding of veterans’ unique health needs among Veterans Health Administration (VHA) and non-VHA employees. However, based on the U.S. House of Representatives Committee on Veterans’ Affairs hearing, “Shaping the Future: Consolidating and Improving VA Community Care,”2 held on March 7, 2017, military cultural competence remains a challenge for VHA and non-VHA community providers alike. Through medical education reform, we believe that high-quality veteran-centered care starts by empowering physicians-in-training to be more military culturally competent and responsive to veterans’ visible and invisible war wounds.
Although many physicians-in-training receive short-term training in VHA health facilities, didactic classes on military cultural competence and veterans’ unique combat and reintegration health needs are limited. This lack of understanding may impact how physicians apply clinical knowledge to practice, which negatively impacts delivery of veteran-centered care. To reduce this “knowledge–practice gap,” we propose three strategies that reinforce military cultural competence in clinical practice as an integral component to veteran-centered care.
First, medical curricula should incorporate didactic coursework about the history of U.S. military wars and conflicts, including occupational and environmental exposures. Accompanying case studies can provide—for providers addressing veterans’ health needs—information about the clinical and social contexts veterans encountered during combat deployment and the six-month or longer reintegration period. Second, required mentorship and clinical rotations of third- and fourth-year medical students with VHA providers in primary care and mental health clinics can offer additional opportunities to learn about specific physical and psychosocial health challenges as well as the effects of war wounds on veterans’ families. Third, by linking customer service principles3 with veterans throughout medical training, medical students can advance interpersonal communication skills and build rapport with veteran “customers,” aiming to enhance veterans’ experiences in service delivery.
As key health care leaders, physicians must address gaps in medical education that do not fully prepare medical students with a toolkit of competencies relevant for veteran-centered care. By expanding this essential training beyond U.S. borders, international physicians can also strengthen their clinical expertise and responsiveness to identify veterans’ visible and invisible war wounds as well as apply customer service principles in delivering health care services to veterans.
Marianne Mathewson-Chapman, PhD, MSN, ARNP
Major General (ret), Army National Guard, and independent nurse consultant, Treasure Island, Florida; firstname.lastname@example.org.
Helena J. Chapman, MD, MPH, PhD
Research scientist, Department of Environmental and Global Health, University of Florida College of Public Health and Health Professions, Gainesville, Florida.
1. Lypson ML, Ross PT, Zimmerman N, Goldrath KE, Ravindranath D. Where do soldiers really come from? A faculty development workshop on veteran-centered care. Acad Med. 2016;91:1379–1383.
3. Gittell JH. Relationship between service providers and their impact on customers. J Serv Res. 2002;4:299–311.