Page 16 - Journal of Special Operations Medicine - Spring 2017

Liberating the Oppressed

Research Knowledge Differentials and Ethical Investigation
in Special Operations Forces Clinical Science

Kate Rocklein Kemplin, DNP, RN, CCEMTP;
F. Young Bowling, 18D/18Z, ATP, NRP, BHSc

ABSTRACT
Background
Special Operations Forces (SOF) medics do not have
preparation in research knowledge that enables them End-users of SOF research are medics, which imme-
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to independently initiate or generate their own stud- diately assigns rank, despite the known disconnect be-
ies. Thus, medics rely on evidence generated by others, tween rank and authority. The reality is that SOF medics
who are removed from medics’ practice environment. are enlisted and, therefore, in theory, hierarchically sub-
Here, salient literature on research self-efficacy and ordinate to commissioned officer clinicians. In no way
the genesis of institutional review boards (IRBs) are re- is that statement intended to denigrate the clinical acu-
viewed and interpreted for contextual applications to men or authority of enlisted medics, but it demonstrates
medics’ practice and initiation of studies. More pub- an immediate power differential in SOF-specific clinical
lications delving into research methods are warranted research. A analysis of 2 years of article authorship in
to promote medics’ participation and initiation of self- the Journal of Special Operations Medicine estimated
directed scientific investigation, in collaboration with that less than 13% of authors are medics and less than
research scientists. 7% of primary authors are medics. This is likely due to
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two factors: those with doctoral qualifications are sta-
Keywords: Special Operations; ethics; medics, military; re- tistically more likely to generate research output because
search; research self-efficacy they are able to invest more time toward research and
their work obligations provide more time to conduct re-
search. The biggest predictors of research output are
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one’s believed ability to conduct research (research self-
Introduction
efficacy), interest in producing research, having the time
Most believe that scientific research is “honest and self- to conduct research (versus clinical practice and other
correcting” despite recently reported research miscon- work tasks), and the demographic factors of rank and
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duct attributed to elements such as poor mentorship, qualifications. 5
unclear ethical awareness, and a combination of self-
induced perfectionism and external expectations. Many Knowledge Is Power
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research and clinical environments inadvertently induce
subordinates to unquestioningly accept the decisions Within any organization, the key to equalizing power
and opinions of those with higher rank or perceived differentials is knowledge. Basic research knowledge
expertise. The power differentials inherent within the is typically taught in undergraduate degree programs
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military rank structure can thus negatively affect novice (4-year university programs), although research ethics
researchers and clinicians of enlisted rank. This discus- and methods are usually taught at the graduate level
sion is the first in a series about the research dynam- ( master’s-level nurse practitioners and physician assis-
ics and processes important to advancing medic-driven tants); general biostatistics are included in clinical doc-
SOF clinical research. Specifically, the power dynamics torates (e.g., MD, DNP, and DPT degrees); and advanced
of rank and research knowledge are identified as barri- multivariate statistics are reserved for doctoral degrees
ers to medics producing research output. An historical in research science (e.g., PhD). Designated doctrine for
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overview of research ethics is presented to introduce the enlisted military occupational specialties does not typi-
IRB and the main principles of what developed into in- cally include content on research or how studies are
formed consent. generated or statistical analyses performed. Thus, most

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