Novel Design of an Austere Medicine Elective

Abstract

Introduction:Clinicians with knowledge, skills and attitudes required in austere environments better serve their patients regardless of setting. Few opportunities traditionally exist for medical students to learn about wilderness, disaster medicine, or environmental illness. Events related to climate, disasters, and COVID-19 reinforce the need for physicians to develop tools for practice in resource-limited settings. We created a medical student elective which delivered core content related to wilderness medicine, environmental illness and disaster preparedness and response, along with overarching skills including improvisation, teamwork, and resource allocation.Method:Content experts partnered with educational design specialists to create a new student experience. We identified key impact areas using an analysis of courses at peer institutions, informal surveys, and published literature. Learning objectives were informed by relevant skills and content, as well as the cross-cutting goal of teaching students to perform in resource-limited settings.A four-week curriculum was conceptualized, including lectures, workshops and skill sessions, synchronous and asynchronous online experiences, and a five-day backcountry trip focusing on in situ simulation and skills training. The course was offered in May 2021 and May 2022. Students completed post-course surveys regarding the utility of course elements, as well as teaching effectiveness.Results:Overall satisfaction was 3.64/4.00. Self-reported competence increased in the domains of diagnosis and pathophysiology, treatment, teamwork, and resource management and improvisation. Qualitative data suggested that students are generally under-exposed to wilderness, environmental and disaster content. Self-reported helpfulness of learning activities was greatest for small-group outdoor workshops, and least for large teleconference-based sessions.Conclusion:Strengths included interactive coursework reflecting teamwork, open access learning modules, and rubric-based assessment structures. Limitations include pandemic-related restrictions in group activities as well as limited objective measurements of knowledge and skills. Future goals include increasing in-person learning, dissemination of the curriculum to larger groups of learning, and development of reproducible performance measures.