Page 52 - JSOM Fall 2019

The second minor finding involves spiral learning. Spiral Author Contributions
14
learning is an educational approach that introduces a topic, All the authors conceived and designed the study, analyzed
touches on it for a while, then moves on, and returns to it, data, participated in writing the manuscript, and approved
perhaps repeatedly. The idea is that if a topic is not learned at the final version of the manuscript. JFK provided supplies for,
first, the student can learn more afterward. With each learning managed, and oversaw the study; and collected data.
session, the student can develop their understanding and level
of skill. Spiral learning is inherent to practicing and to clinical References
practices. However, implementation of tourniquet skill train- 1. Esmarch F. First Aid to the Injured: Six Ambulance Lectures.
ing has had mixed results recently. 9,19,20 To establish the idea of Translated HRH Princess Christian. 6th ed. London, UK: Smith
spiral learning concretely and visually for our instructors who Elder & Co; 1898.
had little exposure to the nuts and bolts of spiral learning and 2. Caterson EJ, Carty MJ, Weaver MJ, et al. Boston bombings: a
surgical view of lessons learned from combat casualty care and
deliberate practice, we demonstrated them graphically through the applicability to Boston’s terrorist attack. J Craniofac Surg.
a data model of separate practice sessions. Students learned in 2013;24(4):1061–1067.
quantifiable packets of learning to generally improve over time, 3. Zideman DA, Singletary EM, De Buck ED, et al. Part 9: First aid:
but they also had interludes of skill decay between practice ses- 2015 International consensus on first aid science with treatment
sions. It was useful to measure inter- and intrasession changes to recommendations. Resuscitation. 2015;95:e225–e261.
relay educational concepts to instructors. However, this study is 4. Jaffer U, Aslam M, Kasivisvanathan V, et al. Evaluation of rapid
training in ultrasound guided tourniquet application skills. Int J
not devoid of limitations, such as the basis being preclinical sim- Surg. 2012;10(9):563–567.
ulation of caregiving and study of two learners, both advanced. 5. Mackenzie CF, Garofalo E, Shackelford S, et al. Using an indi-
vidual procedure score before and after the advanced surgical
The future directions for research include several opportunities skills exposure for trauma course training to benchmark a hem-
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errors such as an apparently learning-sensitive measure called 6. Kragh JF Jr, Dubick MA. Skill decay or maintenance between
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variable error looks promising. In a pair of established sciences ikin model. Am J Emerg Med. 2016;34(9):1897–1899.
of ergonomics 15–17 and motor learning, 18–20 investigators may 7. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emergency
find workable frameworks to ground attempts to develop best tourniquets to stop bleeding in major limb trauma. J Trauma.
practices in preparing first aid providers. Acquiring a dataset 2008;64(2 suppl):S38–49.
in deliberate practice of self-applied tourniquets, such as ei- 8. The White House. Fact Sheet: Bystander: “Stop the Bleed” broad
ther with both hands or with one-handed application, may private sector support for effort to save lives and build resilience.
6 October 2015. https://obamawhitehouse.archives.gov/the-press
allow an analysis to aid the guidance of instructors in teaching -office/2015/10/06/fact-sheet-bystander-stop-bleed-broad
lay learners how to efficiently acquire or develop skill in tour- -private-sector-support-effort-save. Accessed 2 May 2019.
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such as wounds drawn with a red marker to focus the atten- 11. American College of Surgeons. Bleeding Control website. https://
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in simulated first aid: user judgment. J Spec Oper Med. 2018;
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aid tourniquets, but turning attention to gauging wound– simulate tourniquet use on a limb with and without bone. J Spec
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This project was funded by the US Army Medical Research 17. York JL, Biederman I. Motor performance in detoxified alcohol-
and Materiel Command. ics. Alcohol Clin Exp Res. 1988;12(1):119–124.
18. Schmidt RA, Lee TD. Motor Control and Learning: A Behavioral
Disclaimer Emphasis. 4th ed. Champaign, IL: Human Kinetics; 2005.
The opinions or assertions contained herein are the private 19. Baruch EN, Benov A, Shina A, et al. Does practice make per-
fect? Prospectively comparing effects of 2 amounts of practice
views of the authors and are not to be construed as official or on tourniquet use performance. Am J Emerg Med. 2016;34(12):
reflecting the views of the Department of Defense or US Gov- 2356–2361.
ernment. The authors are employees of the US Government. 20. DeForest CA, Blackman V, Alex JE, Ret al. An evaluation of
This work was prepared as part of their official duties and, as Navy en route care training using a high-fidelity medical simu-
such, there is no copyright to be transferred. lation scenario of interfacility patient transport [published online
ahead of print 14 March 2018]. Mil Med. doi:10.1093/milmed
/usx129.
Financial Disclosure
The authors have indicated that they have no financial rela-
tionships relevant to this article to disclose.

50 | JSOM Volume 19, Edition 3 / Fall 2019