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| 29 www.military.ie THE DEFENCE FORCES MAGAZINE EXPERIENCES OF A MEDICAL STUDENT IN THE RESERVE DEFENCE FORCES BY PTE (AR) DR. DAVID KILLILEA L ike many within the Defence Forces my first encounter with St Bricin's Military Hospital was for my entry medical. A building opened in 1913 as King George V Hospital and run by the Royal Army Medical Corps, staff then had little time to prepare for war on the continent and the later War of Independence. My time there was placid in comparison. My name is David Killilea, I am a recent graduate of UCD School of Medicine and an RDF private in the CMU. UCD allows for students to undertake electives in any medical discipline to explore interests and gain a greater understanding of which speciality they wish to pursue. For me this is psychiatry. My rotation in January of this year was with Dr Fionnbar Lenihan, consultant psychiatrist with the Defence Forces. It was through chance I met former director medical branch Col Mairead Murphy at a travel medicine conference in March 2022. She invited me to the CMU to make the introduction to Dr Lenihan. We agreed on dates, and I was sent the required paperwork for signing. Just as military life is vastly different from civilian life, military psychiatry differs greatly from its civilian counterpart. Having already completed my six-week rotation through HSE psychiatric services I was reasonably familiar with psychiatric illnesses such as bi-polar affective disorder, schizophrenia, major depressive disorder and the like. These conditions tend to be less common in the military population due to rigorous pre-screening. More common mental health issues that may be seen amongst military personnel include anxiety, suicidal ideation, mild depression, addiction and PTSD. Should one develop serious mental illness during service then an evaluation would be conducted on referral from an MO or the PSS. I learned that every effort is made to manage and incur remission of symptoms to allow a full return to duty. Nonetheless, a major difference between civilian and military psychiatry is that there is a dual duty of care. Personnel always come first but the DF's mission readiness also needs consideration during evaluation. Interventions on hand are similar to those employed by the HSE; psychotherapy, for the most part, with or without medication. One interesting therapeutic intervention I witnessed was EMDR. Eye-Movement Desensitisation and Reprocessing was developed to help ameliorate symptoms of PTSD. While PTSD can result from any traumatic incident it is more common within armed forces. PTSD requires focused therapy to soften the symptomatic burden on its carrier, with interventions taking, oftentimes, weeks if not months to achieve results. Care is currently being delivered from Dublin for those that require it, with possible future improvements to lessen the burden of travel and time off for patients. Dr Lenihan and I proposed creating a residential program whereby individuals attend a five-day course of intensive EMDR at a convenient location. Should this be successful it may become a standard model of care delivery in the DF for PTSD. I made an application to the HSE for Intern Year Academic Track and was accepted. I will be conducting this project alongside my clinical duties. This will be the first academic track project carried out with the DF. Psychological and psychiatric staff are a mix of civilian and uniformed personnel. There are two clinical psychologists and one psychiatrist working within the CMU. There are a further two attached psychiatric registrars who receive training one day per week. The HSE provides an opportunity during higher specialty training for physicians to explore 'special interests' which one is currently undertaking in military psychiatry, with the other on secondment from the Armed Forces of Malta. The department also collaborates on research and duties with MOs, PSS and RDF personnel resulting in a lively, stimulating, and collegiate environment. As an RDF member I felt very welcome throughout my time there. The medical experiences I have enjoyed as an RDF member have garnered jealously from classmates. I was able to contribute to Op Fortitude serving alongside PDF personnel through vaccinating in Citywest, I have flown as an observer with the EAS and have gained first-hand teaching on combat and psychological first aid. I have discovered how crucial and demanding the role of a military psychiatrist and MO is, and how important it is to keep military mental health services funded and appropriately staffed. I would recommend a rotation with the CMU to any medical student as well as a career in the RDF. Should any future medical student wish to rotate through a DF medical facility they are encouraged to contact, with their request; Medical Branch, CMU, St Bricin's Military Hospital, Infirmary Rd, Dublin 7, D07 DC84 I would like to acknowledge the following people for helping arrange and make possible my elective at the CMU; Dr. Lenihan, Col Murphy, Col Markey, Comdt O'Callaghan, and Lt Ecock. Dr Killilea outside St Bricins Military Hospital as part of the elective Dr Killilea vaccinating as part of OP Fortitude in City West Dr Killilea flying as an observer with EAS

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