Page 82 - Journal of Special Operations Medicine - Winter 2014

traditional curriculum and incorporation of practice re- SOF medics practice in complex environments of pre-
flections into curriculum. dictable uncertainty, devoid of resources, and must be
able to do so autonomously. The very nature of special
warfare dictates that SOF medics are inventive, inge-
Conceptual Framework
nious, and adaptive to deliver care and best use the re-
The selected reflective-practice model recommended for sources available to them. “The very basis of [Special
use in modifying SOF clinical curricula is Chris Johns’ Operations] is the ability to make something out of
27
model of structured reflection. Through examination nothing.” Other key attributes include autonomy and
17
and review of habituations, practitioners are able to self-determination, as evidenced by SOF medics’ ability
change or keep their practice tendencies and develop to practice independently under fire and in remote, aus-
forethought and insight into their practice. The ex- tere environments.
18
periences of others enables novices to develop clinical
reasoning and practice patterns that are not easily iden- Given this alternate clinical environment, SOF clinical
tified otherwise. Reflective practice is the “disciplined curriculum should incorporate the approach of Benner
19
analysis of complex situations that result in strategic, et al. and use theoretical and conceptual frameworks
24
effective action.” 20 for clinical education that address reflective practice.
Algorithms, protocols, decision trees, and clinical prac-
tice guidelines cannot provide answers to every clinical
Literature Review
situation that SOF medics often encounter. They must
After extensive review of the literature specific to cur- be taught from models that develop critical reasoning.
ricular development and frameworks for clinical educa- Models for nursing and paramedic health education—
tion, the most salient model for justifying changes to SOF clinical disciplines that SOF medics mirror profession-
medics’ curricula is informed by the model of Benner et ally—that have incorporated alternative and signature
al. for transforming clinical education: Transformation pedagogies show positively influenced clinical learning. 28
21
of pedagogies and curricular structures is imperative to
the progress of the clinical discipline; the authors speak In addition to competency-based curricula, if SOF med-
specifically to reflective practices as germane to teaching ics are taught from curricula conceptually modeled in
salience and developing clinical forethought in students reflective practice and based in their actual experiences,
and practitioners. 21,22 SOF medics and practitioners in they will benefit from case studies of complex health
23
general use varying levels and patterns of knowing. As- issues in uncertain circumstances, rather than from cur-
suming the clinical proficiency of SOF medics, continu- ricula that are task oriented and found in traditional
ing competency-based and technical methods in SOF contexts. Alternative pedagogies can be further reduced
medics’ initial training and refreshment education may to a specific method of teaching via reflective practice
prove less important than the insightful and intuitive that includes stories and practice reflections, referred
ways in which SOF medics acquire and use knowledge. 24 to as narrative pedagogy. SOF medics’ clinical evidence
generates from contextual experiences that are shared
Research demonstrates that the knowledge frameworks by narrative transmission: essentially, storytelling of the
available to and used by medical students and physi- “No shit, there I was” variety. 8
cians transform with their practice. 5,24,25 As SOF medics
progress from novice to expert, their adopted archetypes Those who educate and analyze the practices of any pop-
of clinical care and understanding of disease processes ulation of clinicians must understand that traditional
change in response to the ways they approach reason- methodologies, such as a sole focus on biomedical as-
ing. 21,22,26 Outcomes from using reflective practices are pects, are oversimplified reductionism and unsuccessful,
seen in providers’ enhanced clinical decision making. overall, in preparing practitioners for practice complexi-
29
ties. Clinical educators and practitioners who obligate
When encountering routine clinical situations, expert cli- themselves to positivism, dismissing experiences funda-
nicians use a quick and automatic approach that marries mental to practice, are essentially narrowing their defi-
their experience to accepted models; this habitual diag- nitions and comprehension of reliable knowledge. 30
nostic prototype is usually useful and effective for these
24
scenarios. However, when presented with complex
clinical situations, clinicians are required to use purpose- Critical Paradigm Shifts
ful and investigative tactics that extract stored, acquired Two of the six key paradigm shifts essential to transform-
24
9
knowledge gained from reflections on practice. If ra- ing clinical education are especially salient to SOF med-
tional reasons or reclarification for the clinical condition ics’ education and training: the concepts of competency
eludes the practitioner, their regression to the simple-case, and critical reasoning. SOF medics are taught primarily
31
automatic approach may lead to poor patient outcomes. 24 by a competency-based approach, which erroneously

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