Page 52 - JSOM Winter 2025

Total Theoretical and Practical Domains (Figure 2) would better perform at both a theoretical and practical level.
After having attended the theoretical module, the candidates It rapidly appeared that non-EMTs were as performant as the
scored a mean of 90.6% ( SD 6.5%) at the theoretical exam- EMT personnel.
ination. At the end of the 72-hour certification on-field exer-
cise, the mean of the total practical examinations was 80.1% Different intrinsic elements of the course could explain this
with an SD of 4.8%. This drop between theoretical and prac- accessibility to the lesson content to clinically naïve candidates
tical results was observed in both groups and, in this regard, and their equal ability to run medical scenarios: this dynamic
no significant difference (P=.521) has been found between the and integrative educational program facilitates immersive pro-
EMT and non-EMT candidates. cessing for both the individual and the team, combines com-
plementary learning principles, introduces solid but realistic
Subdomains in the Practicals cases from literature or extrapolated scenarios from virtual sit-
When independently analyzed, the mean results for the uations, insists on interconnectivity and repeatability between
MED LEADER function were 79.1% (SD 6.5%), 80.8% for the themes, connects clinical theories or practicals to real ex-
the MED PROVIDER (SD 6.3%) and 81.1% for the TACT perience in different operational environments, and finally, so-
LEADER function (SD 5.7%). When compared with their lidifies the skills and procedure sequences.
function as MED LEADER, the candidates scored significantly
better as TAC LEADER (Z=–3.222, P=.001, two-tailed). As Seniority in the army, initially considered a possible confound-
for the total final practical scores, no significant difference ing factor, did not appear as an influencer. This finding is in
(P=.417) was observed between the EMTs and non-EMTs. line with previous observations as published by Nichols et al.,
who stated that “A soldier’s experience alone could not predict
Best Candidates if the soldier will be successful in performing bleeding control
When defining the best scorers in pratical examination as the tasks or if they will demonstrate higher levels of casualty care
candidates with one SD (4.8%) above the mean (80.1%), cor- knowledge.” Interestingly, we observed the same equality be-
18
rected at 85%, from the nine identified candidates, eight were tween young and older candidates in both theoretical and prac-
non-EMT candidates. Interestingly, they were additionally tical scores. More specifically, while a study among American
scoring one SD above the mean scores (81.15%) for their TAC medical students showed that older students exhibited a more
LEADER function (89.03%). autonomous and motivated profile for learning and for suc-
ceeding in health profession studies, this was not confirmed
19
Predictors of the Best Results in regression analysis in a similar Japanese population. 20
The candidate category did not appear as a statistical predic-
tor for success rate (coefficient standard error = (SE) 0.041, However, the fail rate at the end of the course was (not signifi-
standardized coefficients β=0.003, t=0.876, P=.384). Equally, cantly) less important in the non-EMT group, and the majority
the seniority or age did not appear as a predictor in this linear of successful stories emerged from this latter group. However,
regression (P=.800 and P=.443, respectively). belonging to non-EMT group could not be considered a signif-
icant prognosis factor after regression analysis. There is room
for further research at this level and, at least, the following two
Discussion
particular elements should further be explored.
This study demonstrated that the integrative educational pro-
gram developed by the Tactical Medical Training Cell of the One could suspect that personal engagement, motivation, and
Belgian Defense yielded robust examination results, both on investment in the course were more favorable in the non-EMT
a theoretical and practical level. In this scaled-up educational group. In medical education, as in many other professional
program, this measured success rate of the candidates un- sectors, motivation is identified as a major determinant of the
derlines the importance of adequately selecting not only the quality of success and professional growth. 21,22 Interestingly,
teaching principles but also the core elements of the content. this motivational attitude can be influenced by educational
environment and early detection of trainee’s determinants for
Interestingly, this course appeared to suit both candidate cat- self-motivation. Persistence, self-directedness, cooperative-
23
egories: EMTs and non-EMTs. This study initially hypothe- ness, self-transcendence, and the willingness of a student to
sized that the EMTs, because of their regular clinical exposure, sacrifice for his/her medical study were positively associated

Theoretical Results Practical Results
NON-EMT EMT NON-EMT EMT

100,00 100,00 100,00 100,00
FIGURE 2 Two
domains (theoretical Mean = 90,6212 Mean = 80,062
and practical) results 90,00 90,00 80,00 80,00
between groups.
EMT = emergency 80,00 80,00
medicine technician. 60,00 60,00
70,00 70,00
40,00 40,00
20 15 10 5 0 5 10 15 20 20 15 10 5 0 5 10 15 20

50 | JSOM Volume 25, Edition 4 / Winter 2025