Impact of War on Medicine is Subject of New Elective at New York Medical College

As a captain in the U.S. Navy Reserves, it was Dr. Etienne’s firsthand experience in the U.S. military that inspired the creation of a new elective course at New York Medical College (NYMC) on the impact of war on medicine. Although many of the world’s militaries have played a role in medical development, the class focuses on the U.S. military and the pivotal role it has played in the advancement of medicine from the American Revolution to the recent conflicts in the Middle East, as well as the direction military medicine needs to go based on current and possible future threats. The virtual platform of the course also allowed for students from other medical schools to participate and bring additional perspectives to the class discussions.

Ryan Fahey, M.D. ’21, a captain in the U.S. Army, now doing his surgery residency at San Antonio Military Medical Center, worked with Dr. Etienne on planning out the course. “During my first few years at NYMC, I kept seeing names of various physicians and surgeons whom I found had their medical roots in the military,” said Dr. Fahey. “I realized that military medicine played a large role in the development of modern medicine, and I thought that our heritage needed to be passed down and remembered.”  

“When Dr. Etienne deployed during the pandemic, we often compared experiences of civilian and military handling of this unprecedented time, so when he asked me to co-teach this class, I was thrilled,” said Lisa Hirsch, M.D., clinical assistant professor of medicine and of family and community medicine. “As the armed forces evolved so did medicine, and often the military drove change due to pragmatism. The amazing thing about this course is that it relates to every field that the students are going into from psychiatry (shell shock to post-traumatic stress disorder) to emergency medicine (tourniquets) to radiology, surgery, primary care, obstetrics and ethics. Every student reflected on how military history had meaning in their chosen field.”

During the initial course, which was introduced in Fall 2021, several guest speakers also shared their insight, including retired Army Colonel Jonathan Newmark, M.D., senior medical advisor for the Office of Biodefense Research and Surety in the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, who spoke about the history and impact of chemical and biological warfare. Additionally, Rawn James, Jr., a senior civilian attorney with the U.S.  Department of the Navy and author of The Double V: How Wars, Protest, and Harry Truman Desegregated America's Military, took the class on a journey through the process of desegregating the U.S. military. Joining that discussion was Army Veteran William Frishman, M.D., professor of medicine and pharmacology and chair emeritus of the Department of Medicine at NYMC, who provided his own reflection on the topic.

The course has been extremely well received by students. “I had heard great things about Dr. Etienne from so many different parts of NYMC, so I was looking forward to getting involved in anything he was teaching. I grew even more excited as I did my inpatient psychiatry rotation at the Franklin Delano Roosevelt Campus of the VA Hudson Valley Health Care System in Montrose, New York, and loved working with veterans there. Veterans are a population we don't learn about in medical school, and I was so fascinated by their diverse experiences and how in many ways social and mental health services have failed them,” said Carly Carlin, SOM Class of 2022, who also worked at a VA hospital for spinal cord injury in the Bronx during medical school.

“Having a different group of people each week present on themes of the week, including the Revolutionary War, U.S. Civil War, WWI and II, Cold War, Korea, Vietnam, and finally modern warfare, was very valuable as a learner. I was fortunate to do a deep dive into better understanding chemical warfare. It was also especially meaningful to draw parallels to the medical advances being made during wartime and their respective context in larger social issues, whether that included racial, sexist or religious discrimination at the time. I thought Dr. Etienne picked a diversity of perspectives to present with each weekly theme and I know that now I will always remember important figures such as Dr. Mary Walker, Dr. Charles Drew and many others, who were pioneers not just in medicine but in society as a whole,” said Ms. Carlin.

“The knowledge I gained in this course not only helps me understand my own heritage in military medicine but will also aid me in treating other active-duty service members, their families and veterans,” said Isidora Monteparo, SOM Class of 2022, a second lieutenant in the U.S. Air Force, who recently matched for a transitional internship and radiology residency at Walter Reed National Military Medical Center in Bethesda, Maryland. “It also brought awareness to the unique conditions and health consequences service members face while on active service whether deployed overseas or state-side, in addition to conditions faced after their service is terminated.”

For me, the most impactful parts of the course were learning about people's personal experiences,” said Dana Krinsky, SOM Class of 2022. “Dr. Etienne shared with us about his deployment to Haiti on the USNS Comfort. Additionally, three of the students taking the course had served or will be serving in the military. Learning about how the course related to their experiences really made this course feel more personal and meaningful.”

“The course focused on the progression of the U.S. military in its goal to have a ‘ready medical force’ of medics, physicians, nurses and other health care personnel and a ‘medically ready force’ of well-nourished and physically fit soldiers. As we transitioned from era to era, we were able to appreciate developments in medicine that are today taken for granted,” said Jacob Greenspan, SOM Class of 2022. “The concept of an ambulance with medical supplies—a mundane, ubiquitous component of modern society—was an innovation of the U.S. Civil War. As an aspiring emergency medicine physician, I was struck by how much of my field was innovated on the battlefield in wars of American history. Such commonplace aspects of a modern emergency department as triage systems, portable chest x-rays, protective masks, blood transfusion, wound irrigation and antiseptic, were all discoveries that emerged as a necessary defense against the innumerable injuries and deaths that have resulted from war.”

“For me, it was interesting to see the changes that have been implemented over time, and how we adopted a much more empathic view of mental illness in the present day. Predating World War I, and even thereafter, the equivalent of post-traumatic stress disorder, which really did not appear in the medical literature until the 1980s, was typically written off as ‘cowardice’ and, in some countries, soldiers with severe cases of mental illness would be sentenced to death by firing squad,” said Daniel Bowen, SOM Class of 2022, an ensign in the U.S. Navy, who recently matched for a psychiatry and internship residency at Naval Medical Center in San Diego. “As someone who is going into the mental health field, these early shortcomings and more recent advancements very much resonated with me and made me appreciate the strides that we have made to get to where we are currently. With the continuing stigma surrounding seeking mental health care, especially in the military, it's impressive to compare the status today of the field with that of its precursors, and it's so important to always be mindful of how we can continue to optimize our practices.”

“After taking this course, I feel even more connected to the veteran population and have a better grip on what advances in the military have done for women, minorities and disabled populations,” said Ms. Carlin. “Structurally, it is fascinating to look at what such a historic institution such as the U.S. military has done for society for both veterans and civilians alike. We owe a lot in terms of both public health as well as medical technique and technology to our military, and I hope that this topic becomes even more integrated in medical education since it is impossible to separate the history of medicine from the history of medicine in the military.”

“Overall, I think the course has given me a strong sense of perspective and appreciation for the origins and evolution of my specialty, and I am both humbled and honored by the many brave Americans who gave their lives and limbs in service to our country, thereby inspiring a myriad of medical advancements that will allow me to effectively practice emergency medicine in residency,” said Mr. Greenspan.