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skill proficiency, given the medics’ experience in prehospi- experience and also explore incorporating instruction on more
tal medicine. We believe these determinations made by mu- complex triage skills for use during mass casualty events,
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tual agreement between multiple healthcare providers offer a novel devices related to TCCC such a junctional tourniquets
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reasonable assessment of the skill levels of our participants. or novel airway devices. 31–34 However, access to certain device
Unfortunately, the exploratory nature of this performance im- technology by partner forces may be a limiting factor.
provement study, coupled with the profound language barrier
faced by the instructors, precluded a more systematic evalua- Conclusion
tion of participant performance. Moreover, the post hoc na-
ture of these assessments makes them susceptible to recall bias. We report the experience of a simple training curriculum
Finally, although participants began to demonstrate percep- designed to teach basic medical skills to members of a for-
tion of situational components of their skill performance in eign military without prior specialized medical training. We
accordance with advanced beginner proficiency at the end successfully delivered this training to members of the Turk-
of training, we do not know the length of time after training ish, Azerbaijani, and Albanian militaries in Kabul, Afghani-
completion over which this proficiency persisted. stan. Our curriculum resulted in significant improvements in
instructor-assessed proficiency and self-reported comfort level
Our other outcome measure of self-reported comfort level also for all four basic medical skills. Although our outcome mea-
has important limitations insofar as it does not necessarily re- sures have important limitations, this curriculum may prove a
flect true proficiency with the skills being taught. We believe useful framework for future medics and physicians designing
it is valuable for nonmedic servicemembers to have some level training curricula for members of foreign militaries.
of familiarity and confidence with these procedures before
needing to perform them in a combat scenario. Nevertheless, Disclaimer
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there is a substantial body of literature indicating there is often The view(s) expressed herein are those of the author(s) and
poor correlation between confidence and competence in skill do not reflect the official policy or position of the Australian
performance. This discordance appears far more pronounced Army, Australian Government, Brooke Army Medical Center,
for skills in which respondents have relatively little experience, the US Army Medical Department, the US Army Office of the
a situation that absolutely applies to the learner population we Surgeon General, the Department of the Army, Department of
studied. 21–24 Furthermore, there is a robust body of literature Defense, or the US Government.
specifically highlighting this discordance for the skill of tour-
niquet application, which, as noted, is also the skill for which Conflicts of Interest
we observed the most significant growth in participant self- The authors have nothing to disclose.
reported confidence after the training. 25–27 Subsequent studies
repeating or refining our curriculum would benefit from more Author Contributions
objective measures of skill performance. M.D.A., T.L., S.G.S., and L.J.H. designed the initial training
curriculum and submitted the performance improvement pro-
Our assessment of only a single class of students in this pi- tocol. M.D.A., T.L., T.P.S., M.M., D.B., H.R., Z.T.-W., and
lot study designed to demonstrate proof of concept is another A.N.C. implemented the training curriculum and administered
limitation, for several reasons. First, our findings may not be the survey instrument. All authors helped to draft the manu-
generalizable to training missions focused on alternative skills, script and approved the final version. M.D.A. assumes respon-
but it may offer a useful framework from which to build fu- sibility for the paper in its entirety.
ture training curricula. Second, we collected data during the
last of five classes; it is possible that the instructors refined References
their teaching technique during the prior four iterations and 1. Collins JM. Special Operations Forces: An Assessment. Washing-
ton, DC: National Defense University; 1994.
that our results would have been less favorable had we col- 2. Gates RM. Helping others defend themselves: the future of U.S.
lected data on an earlier class. Therefore, our results may not security assistance. Foreign Affairs. 2010;89:2–6.
be generalizable to circumstances in which instructors must 3. North Atlantic Treaty Organization. Resolute Support Mission
deliver one-time training without the benefit of time in a in Afghanistan. 13 October 2016. http://www.natolibguides.info
single setting and trainee population in which to refine their /transition. Accessed 2 November 2017.
teaching techniques. Third, we designed this project for non- 4. Johansson A, Oden A, Dahlgren LO, et al. A comparison of ex-
medic servicemembers of three militaries; it is unclear whether periences of training emergency care in military exercises and
competences among conscript nurses with different levels of edu-
healthcare providers might extrapolate these findings to other cation. Mil Med. 2007;172:1046–1052.
militaries or foreign medic forces. 5. Bordes J, Joubert C, Esnault P, et al. Coagulopathy and trans-
fusion requirements in war related penetrating traumatic brain
Future research should examine the utility of using this cur- injury. A single centre study in a French role 3 medical treatment
riculum as a precursor to more advanced medical training. facility in Afghanistan. Injury. 2017;48(5):1047–1053.
Prior research in Afghanistan has reported experience teach- 6. Joubert C, Dulou R, Delmas JM, et al. Military neurosurgery in
ing more complex medical skills such as advanced techniques operation: experience in the French role-3 medical treatment fa-
cility of Kabul. Acta Neurochir (Wien). 2016;158:1453–1463.
for airway management to ANA medical providers. Because 7. Mathieu L, Bertani A, Rongieras F, et al. Wartime paediatric ex-
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we designed our curriculum for non–English-speaking, non- tremity injuries: experience from the Kabul International Airport
medic, battlefield first responders, we felt such advanced skills Combat support hospital. J Pediatr Orthop B. 2015;24:238–245.
would exceed the scope of this pilot project. The success of 8. Benner P. From novice to expert. Am J Nurs. 1982;82:402–407.
this project sparked interest within the US coalition and Turk- 9. Dreyfus SE. The five-stage model of adult skill acquisition. Bull
Sci Tech Soc. 2004;24:177–181.
ish leadership to explore the possibility of developing a more 10. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
advanced course based on the Tactical Combat Casualty Care (2001–2011): implications for the future of combat casualty care.
(TCCC) curriculum. Future efforts might report on this J Trauma Acute Care Surg. 2012;73:S431–437.
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