Page 70 - JSOM Summer 2024

FIGURE 1 A typical scenario during the tactical medicine block of FIGURE 2 A comparison of two evaluation criteria. LEFT: TC
training at the Pararescue apprentice course. evaluation method in which all errors have equal weight, with any
two errors resulting in failure. RIGHT: The AWC method is based on
a 100-point grading system, with 70 points required to pass.

Students role-play as patients. They wear coveralls that require cut-
ting to practice exposure and use simple moulage to indicate inju-
ries (in this case, burns). Instructor injects are added to clarify patient
presentation.
single medic polytrauma scenarios. These scenarios occur out-
doors during daylight. The students have a standard loadout Line items highlighted in yellow represent critical errors and result in
of a medical ruck, kit, plates, helmet, and rubber rifle (Figure the subtraction of 31 points. All other errors are considered minor and
result in the subtraction of 11 points.
1). The scenarios occur with one student, one instructor, and
an additional student with basic moulage acting as the patient. Following the crawl, walk, run adage, practice scenarios fol-
Scenarios are approximately 30–40 minutes. low a progression in complexity—single injury, double injury,
triple injury. Evaluation scenarios are medium complexity and
Instructor baselining and standardization are critical to medical devoid of ambiguity. We only evaluate students on injuries/
training evaluation. Before evaluating students independently, skills that they were exposed to during practice scenarios.
instructors must complete AETC’s task qualification (TQ) pro-
cess. The TQ process requires candidate instructors to shadow For this study, we sampled 8–12 students for two classes
qualified instructors for three different medical scenario types, during each training day. The number of students sampled per
averaging 10–15 individual shadowed scenarios. Additionally, day varied based on the number of instructors available for
the instructor cadre is baselined on the expectations for indi- scenario rotations. Students rotated through evaluators during
vidual skills or tasks within a medical training scenario. practice scenarios, and data were collected from the same
two instructors daily. In order to comply with AETC training
As a general rule, student verbalization of patient care is min- requirements, we used a post-test-only, no-control-group de-
imized as much as possible, and students are held to stan- sign, which has shown to be adequate for certifying a level of
dards of care found in the Pararescue Medical Operations performance. 10
Handbook. For commercially produced devices (e.g., tour-
9
niquets, junctional tourniquets, Kendrick traction devices, Evaluation Methods
SAM splints), the students must adhere to the manufacturer’s A variety of methods have been proposed to evaluate com-
instructions for application. Failure to do so would result in plex psychomotor skills such as combat medicine delivery.
losing points for the task associated with that device. Perfor- Two commonly used rating methods for medical evaluations
mance expectations of other skills are established early in the are checklist-based methods and global (or holistic) scoring.
2
course so students and instructors know the standard prior Checklist-based methods reduce variability among evaluators
to evaluations. For instance, hypothermia treatment using a and scenarios, while global scoring is more individualized,
wool blanket requires the student to fully wrap the patient variable, and nuanced.
within the blanket anteriorly and posteriorly, exposing the pa-
tient only as required for assessments and treatments. Failure A comparison of these methods can be found in Table 1. Evalua-
to perform this skill to this standard would result in failing the tion metrics may exist on a continuum between the checklist and
scenario for 2f, “Treat Hypothermia” (Figure 2). global assessment methods, with varying methods of weighting
and scoring. For instance, some Fire Department emergency
To further emphasize instructor standardization, instructors medical services evaluations rely on a checklist with tasks scored
meet to conduct an internal debrief for ~5 minutes following from 1 to 5, while Joint Trauma System Tactical Combat Casu-
a scenario to maintain clear and uniform standards. Following alty Care assessments use checklists in which critical tasks are
the instructor debrief, we debrief students for approximately “must-do” items and others are “should-do” items. 11,12
5–10 minutes. To ensure all students get at least one practice
round daily, we repeat this process 5–7 times during each day We blended the checklist and global assessment methods, then
of medical scenarios. incorporated principles from the well-established U.S. Army

68 | JSOM Volume 24, Edition 2 / Summer 2024