Page 47 - JSOM Spring 2025

et al. (2018) examined the existing body of research and iden- Methods
tified themes related to successful and unsuccessful MIHT
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collaborations. Findings highlighted the importance of hu- We selected an existential phenomenological design to frame
mility and “comfort with discomfort” in the team’s ability to our study, aiming to explore and understand the consciousness
collaborate under challenging conditions. In a qualitative in- of the participants in the context of the MMO-NCO relation-
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vestigation, Hamwey et al. (2021) employed grounded theory ship. Our goal was to authentically portray their lived expe-
methodology with military healthcare providers to explore the riences by analyzing the data and reporting our results with
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dynamics of camaraderie within MIHTs. Six themes were integrity. Throughout this process, we engaged in continuous
identified as critical for team success: confidence in competent self-reflection to bracket our biases and ensure that we accu-
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peers, shared goals, mutual respect, desire to help one another rately represented the participants’ perceptions.
improve, personal-professional overlap, and bonds of military
service, illustrating the inherent interpersonal nature of military To recruit participants, we used convenience and snowball sam-
16,17
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medicine. Furthermore, a comprehensive literature review by pling, focusing on medical NCOs serving as faculty support
Varpio et al. identified characteristics for MIHT success. The at an educational activity conducted by the Uniformed Services
primary factors were effective communication, supportive team University in October 2023. We conducted an in-person, one-
environments, shared role understanding, and equity among hour focus group with eight NCOs as well as individual one-
team members. These characteristics align closely with those hour in-person interviews with each NCO participant. NCOs
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identified in civilian interprofessional healthcare, but their sig- recruited were experienced enlisted members from a mix of
nificance is heightened in the military setting due to the unique conventional and special operations units with significant op-
operational demands, diverse environments, and the necessity erational experience and a range of 1–9 deployments each (see
for mission-specific approaches. While this research provides Appendix A for further participant demographics). This repeat
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valuable insights into the dynamics of MIHTs, it does not ex- interviewing process enabled us to build rapport and trust with
plicitly address the challenges and intricacies of the MMO and our participants to gather in-depth information from each of
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medical NCO relationship. them. The data from the focus group and individual inter-
views were transcribed by an automated transcription service.
Various research studies have investigated the relationship
between physicians and paramedics within civilian healthcare In qualitative research, sample size typically ranges from 1–33
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settings. A survey conducted by Foerster et al. examined the participants. In this type of research design, saturation deter-
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professional relationship between paramedics and physician mines sample size rather than any sample size calculations.
medical oversight and found that a mutual lack of trust neg- Upon collecting and reviewing the data from our eight par-
atively affected patient outcomes and healthcare efficiency. ticipants, our research team determined that data saturation
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Similarly, a 2014 qualitative study using semi-structured in- had been reached, indicating that no further participants were
20,21
terviews explored the collaboration between paramedics and needed for our study. Our research team then applied qual-
physicians and found that paramedics consistently expressed itative phenomenological analysis methods to interpret our
14,22
concern about the lack of respect and trust exhibited toward data. First, we read through the focus group and interview
them by physicians. Additionally, a mixed-methods study transcripts, coding significant words, statements, and phrases
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conducted in 2018 identified collaborative practice between directly related to the research question. These codes were then
paramedics and physicians as essential in ensuring the safe compiled and organized into categories, which formed the fi-
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handover of patients. The study examined the impact of an nal themes of our study.
interprofessional clinical skills (ICS) simulation exercise on the
collaboration between paramedics and medical students, find- Finally, to confirm the accuracy and validity of our data
23
ing that the ICS exercise significantly enhanced mutual respect, and emerging themes, we conducted member checking. We
understanding of roles, and collaborative practice, promoting emailed each participant the transcripts from their individual
patient safety and reducing medical errors. While this research interview and focus group session, allowing them to verify
highlights the importance of collaboration between health- the data and add additional quotes if desired. This process
care professionals, the demands placed on medical NCOs enhanced the trustworthiness of our findings by ensuring the
introduce different challenges. 5,12 Unlike civilian paramedics, participants’ perspectives were accurately represented. Our re-
medical NCOs frequently operate in austere, high-pressure search team also engaged in constant self-reflection throughout
environments—such as combat zones and remote deployment the study to ensure that our own biases did not influence our
locations—where they must make immediate medical deci- interpretation of our participants’ realities, a standard reflective
sions with limited resources. These demanding conditions practice within qualitative research to enhance the credibility
12
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may necessitate a more flexible scope of practice and a closer of results. This study was determined to be exempt by the In-
working relationship with MMOs to ensure effective patient stitutional Review Board at the Uniformed Services University.
care. 1,5
Results
While this relationship between the paramedic and physi-
cian has been studied in civilian settings, there is a gap in the Three themes arose from the evaluation of collected data:
professional literature regarding the medical NCO-MMO re- 1) open communication; 2) trust in training; and 3) mutual
lationship in military medicine. Examining the intricacies of mentorship.
this dynamic could improve education and training, ultimately
strengthening NCO-MMO collaboration and performance. Theme 1: Open Communication
To explore this relationship, we investigated the perspectives The participants first shared that effective communication is
of medical NCOs regarding their interactions and experiences a critical element of the MMO-NCO relationship, with one
with MMOs. stating, “Good communication . . . I think that that helps

Interprofessional Dynamics in Military Medicine | 45