Page 81 - Journal of Special Operations Medicine - Winter 2014

incorporate practice reflections into clinical curricula re- of teaching, namely, advanced trauma, critical care, and
duces knowledge transmission and hinders research de- clinical medical care. Those who teach SOF medics iden-
velopment related to clinical practices. Clinical learning tified that students within the medic education pipeline
4
is enhanced by sustained exposure to reports of extreme do not have the benefit of systematic exposure to ana-
and atypical cases; this knowledge allows students to lyzed experiences of senior, seasoned, experienced SOF
hone their abilities to question stereotypes, develop clin- medics who have been practicing in the unconventional
ical acumen, and to respond to ever-changing variables environments to which these SOF medic students will
within medical scenarios. 5 deploy. According to the US Army Special Operations
Command (USASOC) historian, there is no central re-
Leaders in civilian graduate medical education insist pository of archived accounts of Special Forces (SF) or
that the tradition of storytelling and reflective prac- SOF medics’ practice in theaters of combat accessible
tices in clinical teaching is imperative, despite possible to practicing medics or students to augment their clini-
perceptions that this method is unscientific or archaic. cal knowledge, or to bridge the gap between theory and
6
Though scant in scope, the literature on SOF medics’ practice. 12
philosophies of science asserts that SOF medics’ prac-
tice is clinical science in its own right and is inherently This study inadvertently aligned with the 2011 edict of
unconventional in nature. SOF medics’ practice is not the US Army John F. Kennedy Special Warfare Center
7
a subset of medicine, nor can conventional pedago- commander: Special warfare curriculum needs revision
gies such as competency- or protocol-based teaching and redevelopment to address the need for experience-
methods from civilian clinical education be generalized based curriculum. An overarching theme within SOF-
13
to SOF medics’ practice and education. The ways by generated clinical literature is that of reflective practice;
8
which SOF medics learn and practice are exceptional SOF medics and military clinicians generate their evi-
and different from those of physicians or other clini- dence from experience and tell stories to educate their
cians, because their environments of care are unlike any peers, colleagues, and student medics to increase the
encountered in even military contexts of Combat Sup- knowledge of those proximal to the storyteller. 14
port Hospitals, let alone in civilian clinical practice. 8
This peer-to-peer method of transmitting knowledge
SOF medics’ avant-garde practice characteristics justify does not benefit the student medic at Fort Bragg who
modifying accepted curricular tenets gleaned from tra- could learn from the seasoned medic in Stuttgart; most
ditional clinical education methodologies. For example, experiences are contained within individuals, shared
an essential paradigm shift in transforming clinical edu- with close colleagues, or kept within the special warfare
cation is to move away from focus on simple critical team. Curricular interventions should be conceptually
15
thinking and competency-based learning and progress based in reflective practice frameworks to address these
toward complementary pedagogies that develop clinical gaps in practice and knowledge transmission.
forethought, clinical reasoning, and alternative modes
of cogitating. 9
Genesis of the Study
Even if students are taught from a basis in competen- Influential proponents of this study are current and for-
cies, clinical education experts advise including prac- mer SOF medics, several of whom have served in senior
tice reflections as the basis for creating highest-quality medical positions within the command hierarchy and/or
testing: “. . . [presenting] clinical vignettes to students transitioned to roles as SOF providers. All proponents
that mimic actual clinical problems and assess applica- emphasized that this study provides basis for an impor-
tion of knowledge rather than simple factual recall . . . tant alternative or additive method by which leadership
accurately discriminate between high- and low-ability can advance the curricular development and clinical
students.” The perpetuation of competency-based practice of SOF medics. Specifically, in April 2013, an
10
clinical teaching methods confounds preeminent clinical Special Forces Medical Sergeant stated, “This is the first
researchers who recognize the worth of storytelling and time another clinical discipline has given us a frame-
reflection-based curriculum derived from practice expe- work for advancing our curriculum and practice.” 16
riences. The development of expertise is predicated on
6
the accumulation, analysis, and dissemination of real- This study involved reviewing over a decade of SOF
life examples gained from experience. 11 medics’ published reflections and case studies detailing
their clinical experiences, which determined their prac-
tice patterns, learning preferences, and knowledge trans-
Phenomena of Interest
mission. A method by which SOF medics were surveyed
Over 2 years of interviews with the primary investigator on their perceptions of education and curriculum was
(PI), SOF medics identified curricular gaps in main areas developed and used to measure their attitudes toward

Call for Innovation: Practice Reflections and Clinical Curricula 71