Page 78 - Journal of Special Operations Medicine - Winter 2014

for patient-centered, supervised sustainment training. should be considered in future studies and assessment
Obviously, any increase in sustainment or credentialing of SFMS skills.
requirements would require a decrease in other obliga-
tions. Increasing the credentialing requirements of the Finally, another limitation of this study is that respon-
medics, however, could provide justification for repri- dents may have evaluated their current and future needs
oritizing SFMS’ time to make medical sustainment a based upon their combat and noncombat experiences
greater priority, strengthen the link between operational of the past decade and these may not align with actual
and clinical care, and provide sustainment experiences needs of future deployments and operations. While
consistent with the desires expressed by operators. recent experiences may not be congruent with future
needs, there will be significant overlap in the medical
The findings of this study also suggest the need and de- requirements of stability operations and counterinsur-
sire for medical sustainment training that is readily avail- gency missions with future threats and missions. Medi-
able to individual medics so that it can be conducted in cal training planners, therefore, should interpret the
a distributed manner when opportunity becomes avail- findings of this study with this limitation in mind.
able. Given the decentralized nature of operations and
training in Special Forces, a program that provides on-
demand training in the core areas, while allowing med- Conclusions
ics to select training that will meet their perceived needs, SFMS must plan for the unexpected and train for the
could augment the training provided by the training op- worst. Sustaining their broad-based medical educa-
portunities of the current program. Similarly, establish- tion and training mitigates the risks of uncertainty by
ing a formalized program to partner with subspecialty providing well-trained, flexible, and adaptable medical
experts working in the medical treatment facilities who technicians who are a significant force multiplier when
would be willing to supervise medics on a planned or operating in small groups, far from traditional medical
short-notice basis could assist medics in meeting their facilities. Sustaining that knowledge and skill requires an
short-notice training needs or interests. While ad hoc investment in time and resources that are often in com-
training occurs at many facilities, formalizing the pro- petition with other requirements. Barriers to medical
gram could expand the available opportunities. sustainment training must be removed and the current
programs must be revised to provide timely, accurate,
Limitations relevant, and state-of-the-art methods to sustain SFMS
Limitations of this study include the response rate and skills and improve the quality of the care they provide to
how the study was distributed. While a response rate of their teammates, partner forces, and civilians around the
almost 40% provides a large sample that provided good world. These findings highlight the need for varying de-
statistical power, it failed to reach the presurvey goal of grees of change in each of the components of the current
50%. The response rate, however, was consistent with medical sustainment program. Making these changes
most Internet-based, online surveys that often receive a now will prepare SFMS for the uncertainties of future
22
response rate closer to 40%. As the survey was distrib- deployments and support mission accomplishment.
uted through medical channels, rather than directly to
potential participants, the response rate was calculated This study represents the most recent assessment of the
based upon the total potential respondents, since it was perceptions regarding the current SFMS medical sus-
not possible to confirm exactly how many potential par- tainment program and should be followed by additional
ticipants actually received the survey invitation. While research and investigation. Future research should con-
the actual response rate may be higher, the reported re- sider objectively measuring the skills and knowledge of
sponse rate represents the best estimate available. SFMS, how to best validate and sustain SFMS knowl-
edge and skills, the use of simulators and observed
The self-reported nature of the data represents another clinical skills exams as part of sustainment training, the
limitation of this study. While, by design, the study efficacy of distributed learning for SFMS medical sus-
sought each participant’s perceived belief or self-assess- tainment, and adapting current or off-the shelf medi-
ment of each of the constructs, the self-reported data cal education programs designed for physicians, nurses,
are subject to bias. As SFMS represent, as a group, a veterinarians, and other medical professionals to sustain
confident and well-trained cohort based on their com- the capabilities of SFMS.
pletion of the Q-Course, they may tend to overestimate
their abilities and confidence to provide medical care ac-
cording to current best practices. While objective mea- Disclaimer
surement of their medical knowledge and skill would The views and opinions expressed in this paper do
be helpful in crafting changes to their sustainment pro- not necessarily represent the official policy of the US
gram, it was not possible with this study design and Department of Defense, the US Army, Walter Reed

68 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014