Page 84 - Journal of Special Operations Medicine - Winter 2014

hierarchy responsible for teaching SOF medics should closed to outsiders, would insist that the interloper be
heed, as the application of reflection-based curricula will frozen out of inquiry. Researchers write at length of

require adoption of these frameworks from the highest the difficulties arising from those who presume to un-
authorities within the Special Operations organization. derstand the phenomena and that influence on data. 57
Guidance given by practicing SF and SOF medics and
The majority of the literature posits that reflective prac- instructors was invaluable in framing the research ques-
tice is essential for developing communities of proficient tion and understanding their practice and curriculum.
learners and advancing clinical practice. No evidence
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was found that solidly refutes the benefits of reflective Much of this study’s initial framework consisted of inter-
practice. Despite the breadth and depth of evidence viewing SF and SOF medics from Vietnam to the present
about reflective practice, few vetted systematic applica- about their clinical practice, experiences, and concerns
tions are mentioned, and there is a noted weakness in about future medics’ curriculum and education. From
that little to no experimental research exists that mea- an epistemological perspective, speaking with SOF med-
sures the effectiveness of reflective practice in applica- ics and reviewing their published practice reflections
tion to clinical education, care delivery, or determining was a primary method of “how the knowledge that ex-
the level of practitioners’ proficiency. Although litera- ists can be made known.” Published practice experi-
58
ture supporting reflective practice is extensive, another ences also provide basis for targeted research questions,
weakness is that much of it is theoretical and not practi- which drive academic inquiry. 59
cal. Fortunately, the theoretical literature has been vet-
ted by replication and analysis by multitudes of other Professional history and experiences are inseparable
authors and investigators. 54 from practice. Essentially, before practitioners can ap-
60
proach anything objectively (read: “scientifically”), the
The evidence shows positive associations between re- historical contexts of science and practice must be ac-
flective practice and enhanced clinical decision making, knowledged, and the experiences of past practitioners
educational development, and patient outcomes. The hy- must be preserved and valued. The Stoics, Aristotle,
pothesis that reflective practice enhances the education and Plato provided early foundations in this philoso-
and, therefore, enhances the practices of SOF medics is phy of science and asserted that “historical texts have
reasonable. Furthermore, reflective practices concur with an authority that precedes our own.” Even quantita-
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the mandate issued by the previous commanding general tive studies by SOF practitioners usually include narra-
of the Special Warfare Center and School at Fort Bragg, tives and storytelling to provide gestalt and to transfer
North Carolina: “. . . actively reflect, develop experi- knowledge from one clinician to another.
ence-based improvements in curriculum, and embrace
constant personal development” [emphasis mine]. De- Realistically, there is no escaping quantitative evalua-
13
spite this directive, to date, no concrete measures exist tion in clinical training and in practice, as it is an overall
for consistently eliciting, capturing, and incorporating valid method in many situations. Despite the long-stand-
SOF medics’ practice reflections and evaluating their in- ing acceptance of quantitative evaluative methods,
tegration into curricula in real time. experts in clinical and medical education question its
continuing dominance and write extensively about this
Using the practice reflections of clinicians enables prac- phenomenon; it is recognized that “best” practice can-
titioners, students, and faculty to access the experiences not be quantified or concretely measured, that much
of those who were there and who lived it. Eventually, of practice is experiential, and that even the “highest-
55
the veterans of past, current, and future conflicts will be performing” students may not actually grasp the gestalt
inaccessible. As shown by this study, SOF medics view of the clinical picture without reflection/narrative-based
their experiences as valid curricular framework. By in- education. 9,29,34,61–64
corporating their practice-based evidence into curricula,
the storyteller is valued, as are the ultimate sacrifices
made by those who will never have the opportunity to Methods
tell their tale. Accounts of early special warfare opera- This study analyzed the ways by which SOF medics
tions in Vietnam tell of fundamentally pedagogical ap- learn, teach, and advance their practice, and compared
proaches to combat ; Special Operations’ genesis began those patterns to the evidence in interdisciplinary clini-
56
with Special Forces’ operational commitment to teach. cal literature. After framing the problem, the literature
was reviewed to determine appropriate tools by which
Should an outside investigator, especially a civilian fe- perceptions and attitudes toward reflection-centered
male, approach the Special Operations organization curriculum could be measured. A recognizable practice
with preconceived notions of their practices or practice reflection was extracted from the published SOF clinical
issues, the inherent ethos of the organization, already literature and presented in writing to self-identified SOF

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