SD3 Education Research Study

SD3 is an educational study funded by the Department of Defense (DoD) as part of the Combat Medical Skills Sustainment Consortium (CMSSC).

Introduction

Pre-hospital combat casualty care skills are part of many military medical training programs. The definition of proficient performance has never been established. The Combat Medical Skills Sustainment Consortium evaluated 20 trauma critical care skills identified by the military as priorities for casualty care to establish a methodology for determination of skill proficiency utilizing simulation.

Materials and Methods

We performed a prospective cohort study evaluating 20 skills with four skills assigned to each of the five academic centers. Checklists were developed for each skill via subject matter expert literature review and iterative item testing, refinement and calibration using modified Delphi process. Study participants were recruited with military and civilian backgrounds and a range of procedural skill experience. Trained raters scored participants either in real time or asynchronously using time synchronized video recordings which included simultaneous skill assessment, casualty anatomic/physiologic data, equipment preparation area and in some cases de-identified participant physiologic data (HRV and RR). Data was compared across experience levels (e.g. from novice to expert) and analyzed to calculate the validated score for skill proficiency.

Results

Literature review revealed a lack of validated performance standards for these skills. Checklists and simulations were designed for Role 2 level of resources. Approximately 40 participants were included for each skill (total n = 1511 cases) to determine the proficiency score. Across all skills, rigorous task and context analysis was necessary to generate relevant simulations and checklists, clearly defining all parameters of the simulation and training. Raters supported high interrater reliability and reproducibility. We plan to present data from all 1511 simulations.

Conclusions

This study outlines methods for defining proficiency standards in trauma critical care skills and validates assessment instruments for life-saving medical skills. Integrating these instruments into longitudinal training assessments may be critical to attain and maintain medical readiness for combat and civilian acute care. The lessons learned by the CMSSC provide valuable insight into conducting research necessary to create validated training simulation and performance assessment tools.

Learning Objectives:

• Describe high priority medical skills in combat trauma care for which proficiency measurement tools to distinguish novice from expert have been developed.
• Describe common challenges and mitigation strategies to deliver assessment instruments for combat settings developed by military-civilian partnerships.
• Describe future directions including training methods and decay mitigation as part of longitudinal medical readiness program and assessment of checklist performance in clinical practice.