TF-15 Wilderness Medicine: Foundations in Leadership and Austere Medical Care

Abstract

Wilderness medicine is a growing subspecialty within emergency medicine. Increasingly, academic departments are developing robust programming through research initiatives, undergraduate to postgraduate curricula, and community outreach offerings. Wilderness medicine, defined as the delivery of medical care in resource-limited and austere environments, requires a knowledge base and skill set essential in general emergency medicine. Furthermore, the organized delivery of care in this context relies on non-technical skills in team leadership and communication critical to highly reliable systems across the contemporary health care landscape. We developed an experiential 4-week credit bearing elective for senior medical students, leveraging their personal passion for the outside world to drive a foundational introduction to the medical subspecialty. This senior medical student elective in wilderness and environmental medicine will serve as a comprehensive introduction to the subspecialty covering foundational content related to pathophysiology, epidemiology, therapeutics, and social factors in the human interaction with austere environments; develop skills in operational team leadership related to expedition medicine and search and rescue operations; and provide valuable space to combine students’ personal and professional passions. Our 4-week immersive curriculum includes a 17-day didactic portion followed by a 10-day field practicum. Knowledge base and skill concepts are first introduced through lecture, discussion, and interactive workshops. Content selection is curated from the Wilderness Medical Society’s requirements for the Fellow of the Academy of Wilderness Medicine (FAWM) and expert input. Knowledge acquisition is reinforced through application in high-fidelity simulation in the outdoor environment. Assessment of leadership skills and medical care is through direct observation. Group debriefing following each simulation further anchors learning. The didactic portion builds toward a 10-day field expedition largely planned by the students under direct guidance of course faculty. Each student has an opportunity to serve as expedition leader of the day. Additional medical simulation and skills workshops are utilized during in the field. A summative written exam assesses student retention of content. An observed and self-assessment tool for team leadership skills is used to appraise development and identify areas for further growth. We hope that participation in the course will introduce students to the subspecialty of wilderness medicine through an engaging, comprehensive and interactive experience. We believe this course will provide a non-traditional platform for refining essential skills in patient care, team-based operations, and the human factors influencing judgement, risk and error— all tools that will serve students well throughout their careers.