Train as you fight, Fight as you train
Military newsletter - Number 1; 2014
Using Measurement and Feedback in Pre-Deployment Training
There is a need for strong, local implementation of systems for objective measurement and guiding feedback in both medical training and real life-saving situations. Competency-based training strengthens skills and confidence in order to prepare for real-life situations in the field.
By: Michael Sautter, Senior Manager Educational Implementation, Laerdal Medical, Norway
Hypothesising on Survival Rates: The Utstein Formula of Survival
The Utstein Formula for Survival is widely recognised as a way of predicting survival from sudden cardiac arrest. The model employs three elements in hypothesising potential survival rates: Medical Science, Educational Efficiency and Local Implementation.
In an ideal world, if each of the elements of the model were performing at 100%, 100% would survive. Realistically, however, we are more likely to see lower percentages such as 80%, 50% and 50% respectively. This means that survival rates would be down to 20%.
By virtue of its generic nature, the Utstein Formula for Survival carries relevance for most kinds of medical training and treatment within the Military Medical Corps. By utilising it in this way, it serves as an analytical tool to map strengths and weaknesses in systematic approaches to improving patient outcome.
Improving Survival Rates with Educational Efficiencies
Based on extensive research in the medical community there is enough evidence to suggest that medical science is not currently the greatest inhibitor for improved survival. The greatest impact can be achieved in the formulation and deployment of efficient educational models, and local organisation of rescue chains.
The notion of “Train as you fight – Fight as you train” is well established within the protocol-driven system of the Military. Simulation training meets the core of this concept, as an efficient platform for delivering education. Competency-based training – as opposed to training in order to comply with standards – is a core focus.
Objective Measurement and Real-Time Feedback
With this in mind, military institutions are very well suited to the implementation of systems for automated measurement and guiding feedback during training and real-life situations. When the provider is guided automatically and continuously to provide “optimal medical treatment”, there is a strong promise of improved outcomes.
The concept of “Objective Measurement and Feedback” is well-established within CPR. For most providers it is known as Quality CPR (QCPR), and comprises measurement and feedback on the following parameters:
- Minimal interruptions in chest compressions
- Adequate compression depth
- Adequate compression rate
- Excessive ventilation
This means that during a CPR training session, or during performance of CPR on a real patient, the provider will continuously be assessed and guided by measurement and feedback technology in order to provide the best possible CPR.
There is really no reason why the concept of objective measurement and real-time feedback should be limited to resuscitation. During medical simulation in general it is now fully feasible to pre-program specific patient cases along with the desired actions and protocol executions, and then provide objective measurement and feedback during and after medical simulations to drive changes in knowledge and competence towards best practice medical treatment. This ensures not only standardised delivery of education and therapy but more importantly, standardszed measurement, assessment and feedback to support “best practice” protocols.
Maintenance of competency – focusing on performance to improve care
As with any psychomotor skills, the knowledge and ability to deliver quality CPR decays over time. Short bursts of regular training can help maintain competencies - thus strengthening these skills and confidence and ultimately improving outcomes on the battlefield.
Medical Simulation in Military Training
Modern medical corps are among the best in the world in tying together training and medical treatment. Using simulation as part of pre-deployment training has many benefits that support the notion of “Train as you fight, Fight as you train”. Teaming simulation with objective measurement and feedback in pre-deployment training, and focusing on maintenance of competency, is key to the promise of further improvement of clinical outcomes.
Realistic military medical training solutions ensure you are prepared for the battlefield.
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