Page 50 - JSOM Winter 2021

to ‘Always’. For increased salience, trainees were advised to Training Satisfaction
interpret ‘competition’ items as the use of skills during oper- A training satisfaction questionnaire was developed to mirror
ations, real-world events, and simulations with an evaluation salient items in the Client Satisfaction Questionnaire (CSQ-8),
component (including the Adaptive Environmental Simulation an eight-item measurement of global satisfaction used widely
during training). They were also advised to regard ‘practice’ in evaluating client satisfaction with care. It is utilized in the
items as those skills used during self or unit-based practice, SIT-NORCAL (HSR) protocol measurement system (see Part
drills, educational upgrade training, and physical training. 1). Items include feedback on the trainee’s perception of
16
training in five domains: training quality, value, amount, occu-
Incorporation of Heart Rate Variability Biofeedback pational relevance, and salience, as well as whether they would
To further engage trainees in objective self-monitoring and im- recommend the training to others. Additional information was
prove immediate feedback in response to skills practice, the gathered on perception of relevance for each of the modules
emWave Desktop (HeartMath, www.heartmath.com), a heart in the training, and open feedback areas were incorporated to
rhythm monitoring system, was installed on laptops for use by allow for additional recommendations for enhancing training.
participants during training (Phases I and II). It was also used
as a demonstration tool to increase physiological awareness Procedures
in response to training. One or two trainees demonstrated the
use of the skill being practiced (e.g., diaphragmatic breath- Intervention Implementation and Maintenance (Unit
ing retraining, progressive muscle relaxation). Results were Tailoring and Engagement Procedures)
monitored continuously throughout the skills practice and Following Phase 0, the resultant draft of the protocol was ini-
utilized as a visual learning tool for the group to enhance dis- tiated with a group of USAF EOD personnel in Southern Cal-
cussion, insight, and adaptive skills practice. All trainees were ifornia (n = 10, 2019) by one of the SMEs from Phase 0 who
measured pre- and post-training, given the instructions to had transferred during protocol development. Planning and
‘use every skill they know to relax for 10 minutes.’ Measure- final protocol tailoring occurred intermittently over 1 month
ments for both achievement scores and efficiency scores (time (via email and phone) with both SMEs from Phase 0 to ensure
required to threshold over an achievement score of 40) were fidelity across simulation components and advancement from
recorded and incorporated into trainee feedback. During the lessons learned.
Adaptive Environmental Simulation, the device was attached
to the back of a flak vest worn by the trainee, with the readout Training Sequence
facing the observer, who was trained to interpret color-coded Overarching training goals identified by the RAND study were
1
readouts (red = stress, blue = neutral, green = calm) from the utilized in anchoring the design and development.
trainee’s response to elements within the simulation.
Phase I: Education/Conceptualization
1. Increase battlefield airmen’s conceptual understanding of
Adaptative Capability
The SIT-NORCAL protocol was established as a health and how stress affects their emotions, thoughts, decision mak-
human performance hybrid. Therefore, the Situational Adap- ing, and performance.
tation to Stress Scales (SASS) were designed as a hybridized Phase II: Skills Acquisition and Consolidation
measurement system capable of measuring across a spectrum 2. Increase battlefield airmen’s repertoire of behavioral and
of skills and abilities targeted by a hybrid protocol. The SASS cognitive skills that can aid performance under stress.
system measures adaptive capability, despite the impact of Phase III: Application and Follow Through
physical and psychological stress. The SASS for Health Sus- 3. Provide opportunities for battlefield airmen to practice
tainment and Restoration (SASS-HSR) was originally designed these new skills while performing job duties under stressful
for measuring training impacts on adaptative and functional conditions that approximate the operational environment.
capability in the SIT-NORCAL (HSR) protocol. The ini-
15
tial baseline measurement is a 9-item Likert self-report scale Educational, Catalytic, Adaptive, and Simulation elements
measuring how well trainees perceive they are performing were integrated into the training sequence. Core educational
before SIT (score range 9–45), where higher scores indicate concepts were selected based on those likely to confer the
higher perceived skill or ability. Post-training measurement greatest advantage in expanding core capacities. These con-
is an 18-item scale, where the original nine items from the cepts were then sequenced and organized strategically to en-
baseline measurement are completed to measure perceived sure self-awareness and that physiologic regulation skills were
change. Items 10–18 are designed to measure perception of mastered prior to engaging cognitive skills, as these require
17–20
pre-training ability and performance (insight/hindsight; i.e., greater levels of physiological awareness and control.
how well participants feel they were actually performing at Biomechanical Control skills in Phase I (e.g., Human Physiol-
Time 1, pre-training, given the skills and knowledge they ac- ogy/Cognitive Neurobiology, Self-Awareness, Diaphragmatic
quired in SIT-NORCAL [HP]). The wording in items nine and Breathing, etc.) are trained prior to introducing the higher-level
18 from the original SASS-HSR was augmented for salience cognitive skills in Phase II (Mental Agility/Flexibility). This en-
in the human performance context (SASS for Human Per- sures the trainee has adequate self-awareness, a grasp of how
formance [HP]). Additionally, all items were used as anchors to manipulate their physiology when the fight/flight response
for the development of an expanded measurement system for is activated, and skill mastery in deploying the prescribed
exploring specific training impact and the ability to deploy countermeasures. This enables rapid recognition and resto-
target skills during the Adaptive Environmental Simulation ration of bioavailable oxygen required to ‘power’ key brain
(SASS- Simulation (SIM)), and Real-World events (SASS-RW). functions related to physical and psychological performance.
Open feedback areas were incorporated to allow additional
information to be generated by trainees and further training A recognized example is that poor breathing regulation re-
opportunities to be identified. duces speed of information processing, fine motor dexterity,

48 | JSOM Volume 21, Edition 4 / Winter 2021