Introduction to Wilderness Medicine-A Medical School Elective.

Abstract

This curriculum provides a capstone experience for fourth year medical students, integrating aspects of the basic sciences and clinical skills in the care of wilderness medicine conditions. The duration of this course is 2 weeks. Since passage of the Wilderness Act of 1964, leading to the protection and expansion of wilderness areas, there has been steady growth in participation in outdoor recreational activities.1 Between the years of 2000 to 2009, there was a 7.5% increase in the total number of individuals participating in outdoor recreation. Notably, during this same timeline, there has also been a 7.1% increase in the total number of people participating in "nature-based outdoor recreation." 2 Acknowledging this rising interest in the outdoors, along with increasing accessibility to remote locations, it has become clear that healthcare providers must now attain the ability to both identify and treat conditions unique to these environments.In addition to discrete medical conditions unique to environmental medicine, the practice of wilderness medicine also encompasses the management of the familiar, the "bread-and-butter" medical illnesses, occurring in the unfamiliar, nonclinical environment. Management of these conditions requires both a knowledge of core life support principles and an adaptability and awareness of the non-medical factors affecting a patient's care.Wilderness Medicine also teaches core principles of austere medicine - healthcare administration in a resource-limited environment. The skills acquired in a wilderness medical course provide not only training in the wilderness setting, but also encompass medical care necessary in instances of disaster relief, terrorist events, and international medical missions.3 Additionally, management of discrete wilderness medicine conditions provides a context to review toxicologic biomechanisms and pathophysiology shared by other, more common conditions.For these myriad reasons, a wilderness medicine elective in medical school provides students with more than a divergent experience; it provides a review and expansion of core medical principles increasingly applicable to all specialties. The primary objective of this course is to provide fourth year medical students an introduction to wilderness medicine. Students will be able to: explain fundamental concepts of practicing medicine in austere conditions; identify and initiate treatment for common wilderness medicine conditions; and utilize the non-medical aspects of providing care in austere environments. The educational strategies used in this curriculum include a combination of lecture-based and experiential learning activities, structured through the lens of Kolb's theory of experiential learning. Core knowledge is preferentially imparted during outdoor experiential components, allowing adaptable, true-environment training. Sessions are complemented by assigned pre-reading in Auerbach's Wilderness Medicine4 textbook to create a flipped outdoor-classroom experience. In addition to a final examination, the course will include a final multi-day expedition designed to allow students an opportunity to demonstrate their wilderness medicine knowledge. The course format opens it to adaptation as a longitudinal curriculum. Finally, this course may be adapted to serve resident education purposes. This curriculum has been used and vetted at the authors' institutions with over 50 medical students. All individual comments were reviewed for applicability, trends noted, and the course was further refined. Student final assessment scores were reviewed to refine the content taught and clarity of assessment. The current iteration of the curriculum received the following on a 5-point Likert scale by students on post-course evaluation forms: 4.91 for overall educational experience, 4.82 for curriculum effectiveness, and 5.00 for effective faculty instruction. As a result of comments, the use of the flipped-classroom model throughout the course has increased. Topics frequently encountered in spontaneous discussion due to regional importance have been included. Overall, this course has proven both popular and successful. Due to the dynamic and divergent nature of this as a medical school course, the authors have noted increased levels of student engagement with the material. Increasing reliance on the flipped-classroom model with student-led scenarios and discussions has increased students' ability to recall and apply their knowledge to scenarios during the final expedition. The broad range of conditions included in wilderness medicine provides a unique framework to highlight the relevance of the basic medical sciences and review core medical principles. Wilderness trauma stabilization, patient transportation, acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, hypothermia, frostbite, orienteering, survival skills, expedition medical kits, marine envenomation, decompression illness, plant toxidromes, snake envenomation, arthropod envenomation, high-angle rescue, search and rescue, heat illness, lightning strike, tick-related illness, disaster response, international medicine.4.