High-Fidelity Simulation Field Research Helps Ensure Student Military Medical Readiness
High-fidelity simulation field exercises at the Uniformed Services University, led by Dr. Rebekah Cole, prepare medical students for real-world combat medical challenges by developing their skills, confidence, and readiness for deployment through progressively immersive and rigorous training experiences.
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Fourth-year medical students demonstrating Tactical Combat Casualty Care skills on a first-year medical student casualty role player during a simulated improvised explosive device ambush scenario. (Photo credit: Tom Balfour, USU) |
October 29, 2024 by Vivian Mason
In a combat environment, few things are more heart-wrenching than a physician looking into a soldier’s pleading eyes for help. What can prepare a doctor for that?
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| A fourth-year medical student escorts a role player with a simulated burn injury to the Casualty Collection Point. (Photo credit: Tom Balfour, USU) |
During the MFP-101 (First-Year Patient Experience), first-year medical students act as patients who are treated by the fourth-year medical students participating in Operation Bushmaster. They are also exposed to the realism of the operational environment, many for the first time.
At the Advanced Combat Medical Experience, second-year medical students practice hands-on medical skills while under fire for the first time, thus increasing their confidence as they begin to form their professional identity.
Operation Gunpowder, the third-year medical student exercise, students are involved in more complex tactical field care, and perform as a team to engage in prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care.
During Operation Bushmaster, fourth-year medical students solidify their professional identity as leaders and physicians, culminating in the confident development of readiness for their first deployment. It’s designed to test a medical student’s medical knowledge, leadership skills, and “grace under fire.”
All of this training allows students to develop and grow, while opening them up to a deeper understanding of the unique responsibilities and pressures of the role of the military physician.
Rebekah Cole, Ph.D., M.Ed., director of research in USU’s department of Military and Emergency Medicine, conducts quantitative and qualitative field research during high-fidelity military medical simulations to determine their impact on student readiness.
High-fidelity military medical simulation is a realistic and interactive medical learning experience. It utilizes real-world settings to recreate actual patient scenarios. The primary goal is to mirror the complexity and unpredictability of far-forward clinical settings, thus allowing students to practice and refine their skills without the risk of patient harm.
“The military-specific curriculum is what makes USU so unique and special,” Cole says. “My job is to evaluate the impact of this curriculum on medical student learning as they progress from their first to fourth years, then after they graduate, and then on to their first deployment.”
In her research, Cole often tests the students’ skills before and after the exercises, as well as interviewing them to learn more about the students’ experiences that revolve around teamwork, leadership, and professional identity. But her research doesn’t stop there; when students graduate, go out into the field, and are deployed, Cole and her team spend time talking with them to see if what is being taught to them is really working.
“I have a really great team,” Cole says. “And, I enjoy rolling up my sleeves and going to Gunpowder and Bushmaster so I can get into the mix of it with students while trying to learn as much as possible about how they are impacted by these experiences.”
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Dr. Cole (in blue jacket) transits with third-year medical students on a Light Medium Tactical Vehicle (LMTV) during Operation Gunpowder. (Photo credit: Dr. Rebekah Cole, USU) |
Operation Bushmaster simulates a six-month deployment in five days, as students go through exactly what it would be like on a real deployment. They see thousands of patients and care for them during multiple mass casualty events. It’s very lifelike because “real patients” (i.e., portrayed by first-year medical students) are used.
The full Patient Experience curriculum for first-year medical students teaches them about the different symptoms that the various patients might have. It covers a wide range of illnesses. Students learn more about the illnesses since they’re playing a role. This gives the fourth-year “health care providers” a good variety of conditions to be exposed to, primarily running the gamut of what they might see during a real deployment.
Each year, the department of Military and Emergency Medicine explores the possibilities of future conflicts, and how they can best prepare students for what the next war might look like. “It’s our job to make sure we’re meeting our objectives—not only for the department, but also for the university,” says Cole. “The main focus is readiness. So, we want to make sure that when our students finish Bushmaster and graduate, they’re really ready for their first deployment. And, we want to be able to prove that quantitatively.”
That’s one reason why she and her team do a lot of pre- and post-assessments of student skills on things such as whole blood transfusion, which is a skill they’ll need for medical care during future conflicts in far-forward operational environments.
Students’ skills are assessed as soon as they get to Operation Gunpowder. They go through the simulation, practicing various skills under different conditions. Then, they’re tested again at the end so that Cole and her team can compare the differences between the pretest and the posttest.
This 360⁰ approach applies to her qualitative research as well. Emphasizes Cole, “We interview students throughout the exercises so we can see how they’re developing, growing, and learning throughout the experience.”
From the outset, mental health plays a huge role. Research is concerned with focusing on how students handle stress because combat and war scenarios are inherently stressful. “This past year,” says Cole, “we received a grant to teach the students mindfulness techniques before they deployed to Gunpowder and Bushmaster. We wanted to see how that helped them to manage the stress and perform better in an operational environment.”
Students are also evaluated by faculty, and they receive feedback from them while they’re performing the military exercises. They’re able to take that feedback and change what they need to in order to be successful during the exercise. Students become confident in their strengths, and continue developing and growing based on faculty feedback.
Cole’s research shares that, “After Bushmaster, students explicitly say that they are ready for deployment. It’s a big accomplishment to complete Bushmaster, so it’s great to see the students really grow in their confidence and professional identity so that they will be able to lead healthcare teams during future conflicts.”
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A moulage artist creates simulated trauma wounds to a casualty role player. (Photo credit: Tom Balfour, USU) |
No other school has this type of medical education experience. “Bushmaster is one of a kind training, different from any type of medical training throughout the military,” says Cole. That makes it not only an exceptional experience, but also a beneficial one for USU students when they deploy for the first time.
USU alumni who have been on deployment described this experience positively and relayed the familiarity of their involvement because they already had exposure while participating in Operation Gunpowder and Operation Bushmaster.
Students are eager to share their experiences, not only as students, but also as graduates. Often, alumni come back and share their stories first hand, discussing how their USU experience prepared them for the conditions they encountered while still demonstrating their leadership skills.
“We’ve also done research on the benefits of teaching at Bushmaster for the faculty that come each year,” adds Cole. “They find it really rewarding not only to see the students developing, but also to learn and review skills for their own preparedness for deployment.”
Cole has been involved with this research for about three years. “I was very excited to come to USU to be in a military environment. The second week I was here, I got the opportunity to attend Bushmaster. It was quite inspiring to watch. Over the course of the week, I could so clearly see the students changing.”
She continues, “It became my personal mission to be able to put that change on paper both in words and by using numbers to really show the impact that Bushmaster had on their readiness.”
Bushmaster is a phenomenal experience. “As you see the students transform,” marvels Cole, “you see them come together as a team. Individually, you see them become more confident. You see them grow as leaders. All of that’s easily visible. Just putting it on paper and telling that story to the world has been the best part of my job.”
And, Cole believes that it’s important to tell the world how unique and important the work done at USU is. “We need support for military medical education and for the work we do at these training events. The more the world knows about it and understands the impact of our military unique curriculum, I think the better prepared the next generation of military providers will be for any future, large-scale combat operations they may face.”
For Cole, it’s difficult to hide her enthusiasm for her research, her team, and the students. She relishes going out into the field at Operation Gunpowder and Operation Bushmaster. “I think USU students are one of a kind. Every time I talk with them, I’m really reminded of that. The work that we do can be challenging, but we can see the students change and that is so rewarding. It’s a huge privilege for me to be able to tell their story, and also the story of how well the department of Military and Emergency Medicine and the university prepare our students for future deployments.”
