Page 80 - Journal of Special Operations Medicine - Winter 2014

A Call for Innovation:
Reflective Practices and Clinical Curricula

of US Army Special Operations Forces Medics

Kate Rocklein, DNP, RN, CCEMTP

ABSTRACT
Background: Special Operations Forces (SOF) medics (ergo, names were redacted) expressed the need for cur-
have written and published numerous practice reflections ricular changes to teach SOF medics about the worst
that intricately describe their practice environments, clin- of clinical scenarios, such as situations in which evacu-
ical dilemmas, and suggestions for teaching and practice. ation of critically injured Soldiers to higher echelons
The lack of translation of SOF medics’ experiential evi- of care is not possible or is prolonged, due to combat
dence to their curriculum has created a gap in evidence- engagements or other complications. These experts
based curriculum development. This study analyzed SOF consistently describe the need for curriculum derived
medics’ learning and practice patterns and compared it from experienced medics’ practices, to guide force-wide
to the evidence in the interdisciplinary clinical literature. knowledge acquisition and augment student medics’
After framing the problem, the literature was reviewed professional development. Given the investigator’s clin-
to determine appropriate tools by which perceptions and ical familiarity with SOF medics’ practice and evidence,
attitudes toward reflection-centered curricula could be senior, enlisted SOF medics and SOF medic instructors
measured. Methods: A recognizable practice reflection proposed that a doctoral-prepared nurse, whose clinical
was extracted from the published SOF clinical literature specialty was trauma, could spearhead academic focus
and presented in writing to self-identified SOF medics and publication on the experiences and curriculum of
and medic instructors via a descriptive crossover design, SOF medics.
to ensure possible biases were mitigated. To measure
SOF medics’ perceptions of reflection-based curricula, Special Operations medics’ practice reflections are an
the Dundee Ready Education Environment Measure essential tool for commanders’ use in sustaining, devel-
survey instrument was used, as it has validated psycho- oping, and advancing the education and professional
metric properties and is used worldwide. Results: SOF practice of SOF medics, while ensuring that successes
medics’ averaged scores of perceptions of their medic ed- are repeated and failures are not. Military organizations
ucation indicated positive but not completely statistically have historically failed to learn from experience, and
significant preferences toward reflection-based curricula thus envision the next conflict as either a repetition of
over traditional curriculum. the last war fought, or a creation that aligns with their
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own misunderstandings and preconceptions. When
Keywords: Special Operations, medics, reflective practice, wars and conflicts end, the US military usually suffers
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curricula cognitive crises of relevance, role, and identity. Better
operational theories develop from the experience of tac-
tical failures, incoherent doctrine, and newfound “op-
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erational cognition.” New knowledge is created more
Background
by problems found during research than by a steady,
Special Operations Forces (SOF) medics practice in en- progressive advance in science. 3
vironments that are violent, austere, clandestine, and far
removed from definitive hospital facilities. What was
true almost 20 years ago—“. . . academic demands of Clinical Learning: Connections to Curricula
[Special Forces medic training] are roughly equivalent to SOF medics’ standard curriculum does not formally
those of an upper-level undergraduate curriculum in sci- use reflective practice frameworks to incorporate the
ence or perhaps to those of first year medical school”— practice reflections of seasoned practitioners, nor has
is even more challenging today. 1 enough formal and transparent academic study been
devoted to evaluating SOF medics’ perceptions toward
During this study, medics, physicians, and educators incorporating their specific clinical reflections into the
within the SOF medical community publicly and privately curricula from which they learn and teach. Failure to

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