Effect of Novel Continuing Medical Education Curriculum on Attitudes and Understanding of Primary Care Medicine for the Naval Surface Provider.

Abstract

Naval Surface Forces provide care in austere environments with unique facility, personnel, and material limitations that can put the patient at risk without proper consideration of these circumstances. Tailored shipboard education currently exists but is greatly dependent on the time, preferences, expertise, and ability of a single teaching officer, allowing for significant variability in the level of training. One hundred and twenty-two individuals were trained in 19 topics presented over 12 months through the Naval Surface Forces Pacific Command Medical Readiness Division to all surface providers on Naval Base San Diego. Participants completed pre- and post-course assessments for each training session based on the objectives of the lesson, as well as reassessments and subjective course critiques every 3 months. Fifteen of 19 courses showed more than 20% improvement, with a range of improvement from 21 to 67%, and an average of 30% (95% confidence interval: 26.1-33.8, p < 0.001). Short-term follow-up showed higher-than-baseline scores at 6-, 9-, and 12-month follow-up; these were significantly higher than nonattendees (p = 0.003, 0.05, 0.004, respectively). Students who reported being either very confident or very confident and comfortable with teaching the content increased from 40.6% before the course to 60.8% after the course. Pre- (p = 0.02) and post- (p = 0.01) course level of confidence was directly correlated to students' assessment of the courses' applicability, with increasing level of confidence correlating to a perceived increase in applicability of the material. This study demonstrates improvement in Naval surface provider knowledge and attitudes in a variety of subject areas after implementation of a novel curriculum tailored specifically to address the unique considerations for practice at sea. Material was beneficial to all trainees despite significant differences in training background. Confidence gained as a result of the course was directly correlated to perceived relevance of the material, but not to educational background. Future work could investigate the use of curriculum in deployed providers and incorporation into current training of the OPNAVINST 6400.1c, Appendix A.