The impact of simulation-based training on medical students' whole blood transfusion abilities.

BACKGROUND: Whole blood transfusion has been found to increase the likelihood of patient survival within both military and civilian medicine contexts. However, no whole blood transfusion training curriculum currently exists within undergraduate or graduate medical education in the United States. The purpose of our study was to: (1) determine the impact of simulation-based training on medical students' abilities to conduct whole blood transfusions; and (2) determine the impact of simulation-based training on medical students' confidence in conducting whole blood transfusions. STUDY DESIGN AND METHODS: We assessed 157 third-year military medical students' ability to conduct whole blood transfusion before and after Operation Gunpowder, a 2-day high-fidelity prolonged casualty care simulation. We conducted a paired samples t-test to compare the students' pre- and post-simulation performance scores as well as self-reported confidence and stress ratings. RESULTS: There was a significant difference in students' scores at the beginning of the course (M = 20.469, SD 6.40675) compared to their scores at the end of the course (M = 30.361, SD = 2.10053); t(155) = -18.833, p < .001. The effect size for this analysis (d = 6.56) was large. There was a significant difference (p < .001) between the pre- and post-ratings for all self-reported confidence and stress survey items. DISCUSSION: Our results suggest that simulation-based training is an effective means of training medical students to conduct whole blood transfusiontraining in a limited resource simulated environment where blood inventories may be limited.

Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments: A Novel Training Curriculum.

INTRODUCTION: Providing resilient Damage Control Resuscitation capabilities as close to the point of injury as possible is paramount to reducing mortality and improving patient outcomes for our nation's warfighters. Emergency Fresh Whole Blood Transfusions (EFWBT) play a critical role in supporting this capability, especially in future large-scale combat operations against peer adversaries with expected large patient volumes, restrictive operating environments, and unreliable logistical supply lines. Although there are service-specific training programs for whole blood transfusion, there is currently no dedicated EFWBT training for future military medical officers. To address this gap, we developed, implemented, and evaluated a training program to enhance EFWBT proficiency in third-year military medical students at the F. Edward Hebert School of Medicine at the USU. MATERIALS AND METHODS: After reviewing both the 75th Ranger Regiment Ranger O-Low Titer program and the Marine Corps' Valkyrie program, along with the relevant Joint Trauma System Clinical Practice Guidelines, we created a streamlined and abbreviated training curriculum. The training consisted of both online preparatory materials as well as a 2-hour in-person training that included didactic and experiential learning components. Participants were 165 active duty third-year medical students at USU. Participants were assessed using a pre- and post-assessment self-reported questionnaire on their confidence in the practical application and administrative oversight requirements of an EFWBT program. Participants' performance was also assessed using a pre/post knowledge assessment consisting of 10 multiple choice questions identified as critical to understanding of the academic principles of EFWBT along with the baseline questionnaire. RESULTS: Differences in the mean scores of the pre- and post-assessment self-reported questionnaire (increased from 2.32 to 3.95) were statistically significant (P < .001). Similarly, there was a statistically significant improvement in student test scores, with the mean score increasing by approximately 3 points or 30%. There was no significant difference in student confidence assessment or test scores based on branch of service. Students who had previously deployed did not show a statistically significant difference in scores compared to students who had not previously deployed. CONCLUSIONS: Our results suggest that the implementation of streamlined EFWBT training into the undergraduate medical education of future military medical officers offers an efficient way to improve their baseline proficiency in EFWBTs. Future research is needed to assess the impact of this training on real-world applications in forward-deployed environments.

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments.

BACKGROUND: Blood is a highly valuable medical resource that necessitates strict guidelines to ensure the safety and well-being of the recipient. Since the onset of the war in Ukraine there has been an increased demand for training in emergency fresh whole blood transfusion (EFWBT) to improve damage control resuscitation capabilities. To meet this demand, we developed, implemented, and evaluated a training program aimed at enhancing Ukrainian EFWBT proficiency. METHODS: Eight Ukrainian healthcare professionals (UHPs), including six physicians and two medics, completed our training, derived from the Joint Trauma System Clinical Practice Guidelines, Tactical Combat Casualty Care (TCCC) Guidelines, 75th Ranger Regiment Ranger O-Low Titer (ROLO) program, and Marine Corps Valkyrie program. Participants were assessed on their confidence in the practical application and administrative oversight requirements of an EFWBT program. A cross-comparison was conducted between a larger data set of third-year medical students from the Uniformed Services University and the UHPs to determine the statistical significance of the program. RESULTS: The difference in mean scores of UHPs during preand post-training was statistically significant (p<0.001). Additionally, the average rate of improvement was greater for the UHPs compared with the third-year medical students (p=0.000065). CONCLUSION: Our study revealed that the application of an EFWBT training program for UHPs can significantly increase confidence in their ability to conduct EFWBTs on the battlefield. Further larger-scale research is needed to determine the impact of this training on performance outcomes.

Ukrainian Healthcare Professionals' Experiences During Operation Gunpowder: Implications for Increasing and Enhancing Training Partnerships.

Because of the diverse backgrounds of their healthcare professionals, Ukrainian military medicine needs expanded and enhanced military medical training to increase their readiness in the war against Russia. During March 2023, eight Ukrainian healthcare professionals participated in Operation Gunpowder, a high-fidelity prolonged casualty care simulation conducted by the USU as a part of its Military Unique Curriculum. In order to evaluate their experiences, we interviewed each healthcare professional and analyzed the data to determine common themes. The participants first described the challenges of operational medicine in Ukraine. They then described the benefits of simulation training such as learning how to navigate a resource-limited operational environment, learning prolonged casualty care, and enhancing leadership and teamwork. Finally, they discussed how they planned to implement training such as Operation Gunpowder in Ukraine in order to increase force readiness. After experiencing the prolonged casualty care simulation training, the Ukrainian participants believed Operation Gunpowder to be a valuable training tool due to its ability to help them overcome the current challenges they are facing in their war against Russia. They described how they would integrate similar training in Ukraine, and follow-up correspondence revealed the success of these efforts. Other universities and institutions are likewise called to use their knowledge and resources to help train Ukrainian health professionals using simulation-based training or other education modalities.

Operation Bushmaster's Impact on Military Medical Student Deployment Readiness.

INTRODUCTION: Operation Bushmaster is a high-fidelity simulation held for fourth-year medical students at the Uniformed Services University. No past research has examined this multi-day simulation's ability to prepare military medical students for the complexities of their first deployment. This qualitative study, therefore, explored Operation Bushmaster's impact on military medical student deployment readiness. METHODS: We interviewed 19 senior military medical personnel serving as faculty members at Operation Bushmaster during October 2022 in order to explore how Operation Bushmaster prepares students for their first deployment. These interviews were recorded and transcribed. Each research team member then coded the transcripts and came to a consensus on the themes and patterns that emerged from the data. RESULTS: The following themes described the ways in which Operation Bushmaster prepares military medical students for their first deployment: (1) primes them for the stress of the operational environment; (2) teaches them to navigate austere conditions; (3) facilitates their leadership development; and (4) provides them with a deeper understanding of the military's medical mission. CONCLUSION: Operation Bushmaster immerses students in a realistic, stressful operational environment, challenging them to develop an adaptive mindset and efficacious leadership skills that they will utilize during future deployments.