Page 45 - JSOM Winter 2023

The Impact of Progressive Simulation-Based Training
on Tourniquet Application

3
2
Rebekah Cole, PhD *; Karly Steffens ; Zachary Flash ;
1
4
Sean Conley, DO ; Melissa Givens, MD, MPH 5

ABSTRACT
The Advanced Combat Medical Experience (ACME) is a task trainers and on their peers in a classroom. Next, students
progressive simulation-based training held for second-year progress to high-fidelity mannequins as they conduct medical
medical students at the Uniformed Services University (USU). care while under fire (Care Under Fire) and initial patient sta-
This study explored the impact of participating in ACME on bilization (Tactical Field Care) phases of TCCC in a simulated
students’ tourniquet application skills. A panel of emergency outdoor combat field environment.
medicine physician experts developed an assessment to evalu-
ate the participants’ performance. Trained raters then scored Tourniquet application training is especially important to mili-
students’ tourniquet application performance before and after tary medicine today because massive hemorrhage is the number
participating in ACME. We conducted a Wilcoxon signed-rank one preventable cause of death on the battlefield. Tourniquet
4
test to detect any significant difference in the participants’ pre- application directly results in decreased preventable battlefield
test and posttest ratings as well as time it took them to apply mortality from exsanguinating hemorrhage. Since tourniquet
5
the tourniquet. Our results indicated a significant difference application is a time-sensitive life-saving TCCC skill, it is crit-
in the pre- and posttest ratings of students as well as the time ical to ensure effective training. Progressive simulation-based
it took them to apply the tourniquet. This study confirms the training like ACME is an effective teaching approach for civil-
effectiveness of progressive simulation-based education for ian students’ medical skills. 8–10 However, there is a gap in the
teaching TCCC skills to military medical trainees. professional literature regarding the effectiveness of simula-
tion-based training on tourniquet application among military
Keywords: simulation; education; medical student; medical medical trainees.
education; tourniquet; combat; ACME; Advanced Combat
Medical Experience
Purpose Statement, Research Question,
and Hypothesis
The purpose of this study was to investigate military medical
Introduction
students’ ability to effectively apply a tourniquet after partic-
Simulation-based education is commonly used in medical edu- ipating in ACME to better understand the impact of progres-
cation because it allows trainees to develop confidence as they sive simulation-based training on students’ skill development.
learn in a safe and systematic environment, while receiving im- Our study was guided by the following research question:
mediate feedback from experts in the field. One approach to What is the impact of progressive simulation-based training
1
simulation education is progressive simulation-based training, on military medical students’ tourniquet application skills? We
which allows medical students to be gradually introduced to hypothesized that students’ participation in ACME would in-
new concepts and skills. This type of progressive training is crease their tourniquet application performance ratings and
2
more effective and resource-efficient in teaching students clin- decrease the time it took them to apply a tourniquet.
ical skills, compared to solely using high-fidelity simulation
training. 3
Methods
One example of progressive, simulation-based training is the Participants
Advanced Combat Medical Experience (ACME), which is The participants in our study were 150 second-year military
completed by second-year military medical students at the medical students at the Uniformed Services University of
Uniformed Services University (USU). The ACME curriculum Health Sciences (USUHS), Bethesda, MD. All participants had
focuses on Tactical Combat Casualty Care (TCCC) and begins received tourniquet training seven months before this study,
with a didactic overview in which students receive instructions at the beginning of their first year of medical school. This
from specifically trained instructors (e.g., teaching assistants training occurred during the Combat Medical Skills (CMS)
[TAs] and TCCC-certified noncommissioned officers [NCOs]), course, which is a familiarization level course for individual
and clinical experts (physician faculty) on how to use TCCC skills within TCCC in which students practice tourniquet
algorithms and protocols for each skill. After receiving these application as a stand-alone skill in a controlled classroom
instructions, the students practice their skills on low-fidelity setting.
*Correspondence to Rebekah.cole@usuhs.edu
2
4
3
5
1 Dr Rebekah Cole, 2LT Karly Steffens, 2LT Zachary Flash, Dr Sean Conley, and COL (Ret) Melissa Givens are all affiliated with the Depart-
ment of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
43
43