Page 58 - JSOM Fall 2024

The categories with the highest proportion of participants in- 2021–2022) are perhaps outdated in some ways, but the im-
dicated that more training would make them more proficient plementation of TACMED Division programs by SOF com-
as SOF medics included critical care and environmental. For mands somewhat ameliorates these concerns. Additionally, the
the overwhelming proportion (89%) of individual medical present data were acquired during a time of relative peace.
knowledge and procedural skill items, more than 75% of SOF This is important because of the so-called Walker dip, which
medics indicated that more training would make them more refers to an improvement in medical skills and knowledge
proficient. For only two items (NPA and OPA), less than 50% during major conflicts followed by atrophy and loss during
of SOF medics indicated that more training would make them peacetime. 8
more proficient. These findings suggest that SOF medics may
need more training in most categories and in most knowledge Area for Future Research
and procedural skills. The present study should be replicated in the context of the
TACMED Division programs so that SOF medic training can
SOF medics want more training in all areas. When asked to remain up to date with the demands of a changing battlefield.
specify their personal area of greatest need, the most common In this context, it is vital to determine whether the TACMED
responses were expressed as “any and all” or “more more Division program with ongoing SOF medic feedback can re-
more,” for example. Prolonged casualty care, trauma and hem- duce or eliminate the Walker dip.
orrhage control, pharmacology, airway (rapid sequence intuba-
tion, ventilation, cricothyrotomy), and blood transfusion were The impact of the TACMED Division programs can be op-
the most commonly listed specific items of greatest need. SOF timally assessed by utilizing the survey methodology of the
medics also revealed that they wanted more training in realistic present study at three time points: before training, after train-
scenarios and more clinical training with live patients, whether ing, then after a follow-up period (pre-post with follow-up
from sick calls or rotations at local hospitals. SOF medics want design). This strategy will assist TACMED Division program
to be trained by experienced SOF medics and desire more cross- commands in determining which aspects of the training are
training with SOF medics in other service branches. These find- most impactful, which are least impactful, and which compo-
ings somewhat overlap with a study of 18Ds from a decade ago, nents of the training “stick.” In this context, it is important
which highlighted the preferences for sustainment programs to supplement self-report data with objective measures and
that include hands-on training, actual patient care, and care in third-party reports, so that all data sources can be triangulated
clinical settings, all provided by subject matter experts. 7 to determine whether additional training for SOF medics is
needed in specific areas.
Lastly, the participating SOF medics expressed great apprecia-
tion for the opportunity to share their views, with the hopes of The present study found that SOF medics prefer training with
improving SOF medic refresher training. Combined, the pres- actual patients and realistic scenarios over cadaveric models,
ent findings demonstrate the need for improved SOF medic classroom lectures, and high-fidelity simulation equipment. It
sustainment training. is crucial to determine whether these preferences translate to
improved outcomes with battlefield casualties. Additionally, the
Birth of the TACMED Divisions present methodology can be replicated with other battlefield
In response to the SOF training needs identified in the present providers (e.g., Army medics, Navy Corpsmen) to determine
study during the years 2021 to 2022, SOF has subsequently de- whether bottom-up feedback can improve their training as well.
veloped two TACMED Divisions at the SOF Echelon III level.
The two TACMED divisions have a shared mission to advo- Conclusion
cate and provide for improved SOF medic training opportuni-
ties. The TACMED Divisions have implemented sustainment The present survey of 57 SOF medics found large differences
courses that include whole blood training, environmental med- among the 70 knowledge and procedure items in both levels of
icine courses, realistic medical lane scenarios during unit-level confidence and in perceived need for more training to increase
training, clinical and trauma rotations, and professional devel- proficiency as a SOF medic. Open-ended responses revealed
opment for the Echelon IV Command’s work-up cycle. This that SOF medics want more training in all areas, but partic-
comprehensive learning model utilizes didactics, simulated sce- ularly in hands-on experience with actual patients and realis-
narios, and actual hands-on patient contact, greatly contribut- tic scenarios, taught by experienced SOF medics. In response
ing to the SOF medic sustainment training experience. to present findings, TACMED Divisions have developed im-
proved sustainment training courses for SOF medics. The
The birth of the TACMED Divisions does not end this line of present study’s combined findings highlight the importance of
investigation. It is vital that the TACMED Divisions acquire acquiring and implementing bottom-up feedback from SOF
and analyze bottom-up data from SOF medics so that SOF medics to optimize the evolution of their sustainment training,
medic training can constantly improve as the demands shift all toward preserving the life of the warfighter.
over time on the changing battlefield.
Acknowledgments
Limitations The authors thank CAPT Lanny Littlejohn, CDR Joseph Ka-
This study was limited by the sample. While the number of leiohi, Steven Elliot, and CAPT Richard Schreckengaust for
study participants represented a large portion of the entire their contributions to this study.
SOF medic force, the views of SOF medics who did not partic-
ipate remain unclear. This is important because participation Author Contributions
was voluntary, so self-selection bias may have influenced re- IY wrote the initial draft and coordinated manuscript develop-
sults. All study data were self-reported, which might not reflect ment. DA assisted with data collection, analysis, and draft ed-
actual proficiency or training need. The study’s data (collected iting. JC and WP provided professional consultation, assisted

56 | JSOM Volume 24, Edition 3 / Fall 2024