Page 71 - Journal of Special Operations Medicine - Winter 2014

before practicing at their previous level of clinical and the leadership desired to incorporate end-user feedback
surgical performance. With the advances in technology to increase the likelihood of participation, acceptance,
11
and training aids, many have called upon the role of sim- and utility of the program.
ulation as a sustainable, ethical, effective, and affordable
method to maintain and improve medical skills, espe-
cially those that are not common in everyday practice. 12–14 Methods

Survey Design
Similarly, advances in distributed learning have shown To evaluate SFMS’ perceptions of the current medical
promise in individualizing medical education and provid- sustainment program and the need for any change to the
ing training to Groups in different geographical areas. A program, a survey instrument was created to assess their
computer-based learning environment has been adopted attitudes about the current program and perceived bar-
by the JSOMTC for use by SFMS during the Q-Course riers and self-efficacy of sustaining their medical skills.
with the goal of continuing access following graduation. Survey best practices were used to improve the validity
While computer-based learning was initially investigated of the survey. The theoretical constructs of the Theory
16
as a teaching modality for Special Operations medics in of Reasoned Action/Planned Behavior (TRA/PB) framed
1994, it has not been incorporated into medical sustain- survey development. This theory, which focuses on in-
ment training. In fact, other than the patient simulators dividual behavior, claims that behavior intention is the
15
used during the SOCMSS course as training aids, sustain- best predictor of actual behavior. Intention, however,
ment training has not systematically used simulations or is influenced by three factors: an individual’s attitude
distributed learning techniques as part of their programs.
toward the behavior, the value placed on the behavior
by their subjective norms, and an individual’s perceived
With major combat operations coming to a close in Af- behavioral control to perform the behavior (Figure 1).
ghanistan and the current fiscal and budgetary environ- Maximizing these factors increases intention, and maxi-
ment, the future missions of Special Forces mission will mizing intention, in turn, increases the likelihood that
adjust to re-emphasize engagement with partner mili- individuals will engage in a specific behavior. 17
tary forces using small units without the logistical and
medical support previously provided in Afghanistan and Figure 1 The Theory of Reasoned Action/Planned Behavior
Iraq, which included significant area medical support by provides the theoretical construct for investigating the
large military medical hospitals and robust evacuation motivation and intention of SFMS to engage in training
systems. As military commanders rely on their SFMS to designed to sustain their medical skills (Ajzen, 1991). 17
mitigate the medical risks assumed when deploying Spe-
cial Forces teams to austere environments with under-
developed medical systems, evaluating and improving
the medical sustainment program will ultimately help to
ensure high-quality trauma and medical care in support
of Special Forces military and diplomatic missions.

From a public health and medical perspective, SFMS
often provide medical care to civilians, work with lo-
cal medical leaders to strengthen local medical systems,
and train first responders to provide medical care. Fol-
lowing the ethical principle of “First, Do No Harm,”
Special Forces leaders have an ethical and professional
obligation to ensure that the care provided by SFMS to The first factor, a medic’s attitude, is determined by
both US and non-US patients conforms to current stan- the behavioral beliefs and outcome evaluation. Behav-
dards. By validating and maintaining the medical skills, ioral beliefs assessed the respondents’ perceived value
knowledge, and attitudes of their SFMS, Special Forces of sustaining their medical training, and outcome evalu-
Command and medical leaders are able to deploy their ation explored whether respondents felt that engaging
medics with confidence knowing that their SFMS are in the behavior would lead to improved medical skills.
providing appropriate and high-quality care. The second factor, subjective norms, assessed the social
pressures associated with sustaining medical skills, by
To evaluate the efficacy of the current medical sustain- exploring how the respondent perceived others as valu-
ment program, the US Army Special Forces Command ing the medics sustaining their medical skills. Normative
medical leadership sought operational-level feedback on beliefs assessed how peers influenced the respondents,
the current medical sustainment program and any need while motivation to comply measured the impact of
to update the program. Should revisions be necessary, the Command and medical supervisors on the medic’s

Perceptions and Beliefs About Medical Sustainment Programs 61