From 2017 to 2020, Justin Coffeen served in a United States Air Force medical unit. He enlisted after leaving a clinical practice in chiropractic medicine and was honorably discharged with a 100% permanent and total VA disability rating. He entered clinical research following his discharge. The connection between military protocol discipline and the demands of GCP-compliant research is not metaphorical. It is direct.
What Protocol Adherence Means in a Military Medical Context
In a military medical unit, standard operating procedures exist because the consequences of deviation are real and traceable. A procedure performed outside its SOP is a liability in more than one sense: it may produce a worse outcome, and it is harder to defend if something goes wrong. The discipline required to follow a procedure consistently — especially under conditions of time pressure, fatigue, or ambiguity — is something military environments train deliberately.
That training does not produce compliance for its own sake. It produces compliance because the people trained understand why the procedure exists. An airman who understands that a checklist prevents the errors that experience alone allows is not following the checklist because it was mandated. They are following it because they understand what it protects against.
The Parallel in Clinical Research
Clinical research protocols function in a similar way. A protocol specifies what should happen, in what order, under what conditions, and with what documentation. It is not a suggestion. Deviation from a protocol — even well-intentioned deviation — is a protocol deviation that must be documented and reported. The reason for this is the same reason military SOPs exist: the procedure reflects design decisions that were made deliberately, and departing from the procedure introduces uncertainty that the original design was trying to control.
In a randomized controlled trial, that uncertainty has a specific name: bias. A site that consistently allows protocol deviations, or that handles deviations inconsistently, introduces variation that undermines the comparability of the data across sites. This is why sponsors monitor sites, why monitors check source documents against case report forms, and why regulatory reviewers examine deviation logs during inspections.
Documentation in High-Stakes Environments
Military medical units maintain records because the stakes of losing a record are real. A service member whose care record is incomplete at transfer may receive duplicate treatment, or may miss follow-up care that was indicated. The documentation exists for the next provider, who may be operating in a different location with no other source of information about what was done and when.
Clinical research documentation serves the same structural function. Source documents exist for monitors, for sponsors, for regulatory reviewers, and ultimately for the scientists who will use the data to support conclusions about safety and efficacy. A case report form entry that cannot be verified against a source document is not just a compliance problem. It is a data problem. The conclusion it was meant to support is less reliable.
Escalation and Chain of Command
Military environments also develop specific habits around escalation. A problem that can be handled at the team level is handled there. A problem that exceeds the authority or capacity of the team is escalated to the appropriate level — promptly, with accurate information, and without filtering for what the recipient might prefer to hear.
Clinical research has a similar structure. A site coordinator who identifies a potential safety signal escalates to the principal investigator. The investigator assesses and reports to the sponsor if reporting criteria are met. The sponsor assesses and reports to the FDA if expedited reporting is required. Each step in that chain depends on the previous step being executed correctly. A coordinator who delays escalation, or who filters the information they pass upward, interrupts a chain of responsibility that exists to protect participants.
What the Discharge Record Reflects
Justin Coffeen’s honorable discharge and 100% permanent and total VA disability rating reflect a period of service that ended with significant personal cost. He left that period with a set of professional habits — precision, documentation discipline, protocol respect, and clear escalation behavior — that he carried into clinical research. The context in which those habits were developed was more demanding than most research settings. That is not a disadvantage.
Read more about what military service taught me about working in clinical research, or about what GCP compliance looks like in practice. Learn more about Justin Coffeen.