IntroductionPhysicians frequently take on leadership roles in many different healthcare teams and settings. Developing such leadership skills as situational control, resource utilization, and conflict management is a vital part of medical education. Wilderness medicine focuses on the delivery of care in remote environments where situations are often tenuous, resources are scarce, and effective leadership and teamwork are essential. Wilderness medicine education during medical school may provide tools and knowledge to improve leadership ability. This study evaluated the perceived effect of a 1-mo wilderness medicine elective on medical students' leadership skills.MethodsFourth year medical students taking a 1-mo wilderness medicine elective between 2019 and 2023 were asked to take pre- and postcourse surveys evaluating their perceptions of their leadership skills. A different group of students taking an art of medicine through the humanities elective were used as a control group. The results were evaluated for pre- and postsurvey differences as well as between-group differences.Results and ConclusionsSeveral pre- and post-course survey questions aimed at assessing perceived skill improvement in situational control, resource utilization, and conflict management showed statistically significant differences in the students taking the wilderness medicine elective, whereas this was not found in the control group. This suggests that students taking the wilderness medicine course perceived an improvement in their leadership skills after participating in a wilderness medicine course, whereas students taking the art of medicine through the humanities course did not perceive this improvement. This suggests that wilderness medicine education can provide value to medical student education.

Wilderness Medicine and Surgery: A Lifesaving Skill Set for Extreme Environments.

Currently, no standardized curriculum exists within Graduate Medical Education (GME) to prepare military physicians for practicing in deployed settings after graduation. Tactical Combat Casualty Care (TCCC) Tier 4 is intended for physicians and other providers but there has been limited availability of these courses, making its impact on deployment readiness unclear. The Prolonged Casualty Care (PCC) Guidelines, while comprehensive, have no hands-on training required to accompany them which may limit their utility for an inexperienced physician. Operational medicine courses provided through the Uniformed Services University (USU) are typically limited to their own medical students and not broadly available across military GME programs. The overlap between operational medicine and wilderness medicine is well-recognized because of the shared challenges of austere environments, limited resources, and dynamic patient care priorities. The objective of this study is to assess whether wilderness medicine training-either formally during medical training or pursued independently-improves military family medicine physicians' confidence in providing patient care in low-resource deployed settings. This is an IRB exempt cross-sectional study of registered attendees of the 2023 Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting, who completed a voluntary, anonymous online omnibus survey. The main outcomes measured were current or prior wilderness medicine training and confidence in providing care in a low-resource deployed setting. Statistical analyses included descriptive statistics, nonparametric Somers' d, and ordinal logistic regression. Noteworthy results from the 305 respondents include those who reported formal wilderness medicine training (n = 83) were more likely to be "Very" or "Extremely" confident in providing care in a low-resource deployed setting (38.5% and 16.9%, respectively) compared to those who had no wilderness medicine training (25.7% and 7.7%; P = .003). Of respondents who reported no deployment experience (n = 127), those with formal wilderness medicine training were more likely to report "Very" or "Extremely" confident in providing care in a low-resource deployed setting (18.2% and 3.0%, respectively) compared to those who had no wilderness medicine training (2.1% and 2.1%; P = .005). Wilderness medicine training is associated with a statistically significant increase in self-reported confidence for providing care in a low-resource deployed setting among military family medicine physicians, including those who have never deployed. These observational findings support the need for more research into whether wilderness medicine training translates to improved patient outcomes in operational settings. More research is needed to determine if there are specific aspects of wilderness medicine training that are more impactful than others and if a similar confidence increase is seen among other specialties with wilderness medicine training.

BackgroundIn India, emergency medicine is a developing specialty and is not yet integrated into undergraduate medical education (bachelor of medicine and bachelor of surgery [MBBS]). Against this backdrop, introducing wilderness medicine may seem premature, but its relevance is clear given the country's vast rural geography and limited prehospital care. This study evaluated the impact of a 1-d wilderness medicine elective on medical students' motivation, self-directed learning, and satisfaction.MethodThis mixed-methods study involved 53 MBBS students from a tertiary care teaching institute divided into 3 independent batches that sequentially underwent wilderness medicine training across 3 curricular iterations. Data collection included pre- and post-tests, surveys using validated scales, and qualitative feedback from focus group discussions.ResultsConfidence improved significantly (P<0.001) in scene size-up (2.66±0.99 to 4.22±0.53), first aid (2.66±0.99 to 4.22±0.53), identification of life-threatening emergencies (2.66±0.94 to 4.20±0.51), and first aid kit preparation (2.39±1.07 to 4.29±0.72, all scores out of 5). The module was highly valued, with strong support from the learners for its inclusion in the curriculum (4.14±0.94 to 4.86±0.35; P<0.001) and reported high satisfaction and demonstrated intrinsic motivation.ConclusionsThe elective module enhanced students' confidence and engagement, supporting its integration into undergraduate curricula. Further research is warranted to assess long-term impact and scalability. Further research is needed to validate these findings and assess the long-term effects on clinical practice.

Surviving the Wild: Gamification of Wilderness Medicine Training for Emergency Medicine Residents

Introduction-Wilderness medicine (WM) is a growing field offering advanced training and recognition through graduate medical education (GME) WM fellowships and the Fellow of the Academy of Wilderness Medicine (FAWM) professional designation. GME fellowships, introduced in 2004, provide immersive, structured training and experiential learning opportunities. The FAWM designation, established in 2005, is earned through approved educational activities. This study compared alumni outcomes between these pathways.Methods-A cross-sectional survey was conducted among GME fellowship graduates and FAWM recipients. Inclusion criteria were GME fellowship alumni or individuals with FAWM recognition. Exclusion criteria included incomplete surveys. Respondents were surveyed on demographics, academic output, and satisfaction with their training. Data analysis included χ2 tests for categorical data, analysis of variance for publication comparisons, and ordinal Likert scales for satisfaction.Results-Of 321 responses, 281 were included. GME alumni expressed greater satisfaction with mentorship and research opportunities; 95% of FAWM-only respondents reported exposure to career opportunities unknown prior to fellowship. There was no detectable difference (P=0.523) between FAWM-only respondents' number of WM-related publications. Overall, 93% of FAWM-only respondents and 76% of GME alumni would repeat their fellowship. Both groups demonstrated high proficiency in WM, with 89% feeling proficient.Conclusion-Both GME and FAWM pathways support WM education and career development. However, GME fellowships provide enhanced academic involvement, mentorship, and performance of relevant clinical skills. FAWM introduced new wilderness careers and had higher alumni satisfaction. These findings highlight the complementary roles of GME fellowships and FAWM recognition in advancing proficiency and professional growth.

IntroductionWilderness medicine is a growing field focused on delivering quality medical care in austere environments. Simulation-based education has proven effective in emergency and wilderness medicine, particularly in graduate medical education. We propose that introducing wilderness medicine concepts earlier in medical education as part of a high-fidelity simulation for medical students could both increase interest in wilderness medicine and have widely applicable educational benefits.MethodsWe developed a novel 1-day case-based simulation curriculum to be performed in a wilderness environment and invited undergraduate medical students to participate. A 25-question survey was administered before and after the simulation to assess subjective change across various topics.ResultsThe 10 of 12 students who responded to the survey indicated that the simulation significantly increased their confidence in managing urgent medical cases and increased their interest in the wilderness medicine field. All students agreed that simulation was an effective way to learn this material.DiscussionImplementing a wilderness medicine simulation in medical curricula appears feasible and provides a comprehensive model that can be easily adapted to other institutions.

Introduction-Wilderness medical education for medical students is generally intended for senior medical students during their clinical years. Several universities have established elective rotations for clinical students or longitudinal 4-y tracks, but these opportunities are frequently restricted to a limited number of students. This novel program sought to fill a deficit of wilderness medicine curricula for preclinical medical students by creating a longitudinal course over one academic year.Methods-This curriculum includes a certification series of didactic lectures on core wilderness medical topics interspersed with hands-on skills sessions and simulated patient scenarios led by emergency medicine-trained faculty. Established medical education strategies were employed to improve learning, including spacing, interleaving, gamification, review quizzes, and frequent low-stakes assessments.Results-During the first 3 y of this innovative teaching method, 48 preclinical students completed all components of the course, with another 20 students in progress for this academic year. Postintervention surveys have yielded positive feedback, with students reporting improved confidence on patient assessment, increased wilderness medical knowledge, and the acquisition of procedural skills.Conclusions-Implementing a 1-y longitudinal wilderness medicine curriculum for preclinical medical students allows learners to gain valuable skills while building their confidence to assess and treat patients in a wilderness environment. The curriculum can be designed to incorporate best practices in medical education and adapted to a variety of practice situations and learners.

Abstract Background: The increasing frequency of natural disasters, pandemics, and geopolitical conflicts highlights the importance of military and disaster medicine. Taiwan’s vulnerability to frequent natural disasters and potential geopolitical threats emphasizes the need for an integrated medical education curriculum that prepares healthcare professionals for large-scale emergencies. Traditional lecture-based teaching may be insufficient, requiring innovative approaches. Aim: This pilot study focused on four core components: combat casualty care, disaster medicine, emergency medical services, and wilderness medicine, to enhance student motivation and learning outcomes in military medicine by integrating Kolb’s learning cycle with diverse teaching methods. Methods: One-week summer program was developed for 3rd-year medical and nursing students, structured around Kolb’s learning cycle. The teaching modalities included lecture-based teaching, hands-on practice, simulation-based training, and gamified learning. Each component followed Kolb’s framework, applying concrete experience, reflective observation, abstract conceptualization, and active experimentation. Posttraining surveys measured perceived learning effectiveness, practical skills development, and overall satisfaction. Results: Among 101 participants, simulation-based training and gamified learning received the highest ratings for perceived learning effectiveness (3.84/5 and 3.81/5). Hands-on practice followed (3.80/5), whereas lecture-based teaching scored lowest (3.62/5). Program diversity scored highest in satisfaction (3.88/5), demonstrating the value of interactive teaching strategies. Conclusion: Integrating Kolb’s learning cycle with diverse teaching methods enhances critical thinking, decision-making, and practical skills essential for military medicine. Future experiential programs should explore virtual and augmented reality to further improve engagement and preparedness for real-world challenges.

IntroductionWilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.MethodsA survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the χ2 test, where P < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where P < 0.05 was considered significant.ResultsThe response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.ConclusionsDespite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.

IntroductionClimbing chalk is widely used by rock climbers and athletes to improve grip. It has been observed that climbers sometimes apply magnesium carbonate chalk to small wounds to stop bleeding, suggesting that climbing chalk may exhibit hemostatic properties useful for small cuts and scrapes. This study aimed to investigate and compare the effects of different types of climbing chalk on prothrombin time (PT) and activated partial thromboplastin time (aPTT).MethodsThree types of climbing chalk were randomly selected for comparative analysis of hemostatic properties, with talcum powder used as a negative control. PT and aPTT testing were conducted on normal plasma samples containing varying concentrations of climbing chalk (from 0.125 mg/mL to 4 mg/mL). Statistical analyses of the results were performed using two-tailed t-tests, Welch's analysis of variance (ANOVA), and Games-Howell post-hoc analysis.ResultsResults indicated that climbing chalk had no significant effect on PT but did significantly reduce aPTT compared to the negative control. Additional analyses revealed significant differences in aPTT results between different types of chalk and between higher and lower concentrations of chalk.ConclusionsMagnesium carbonate-based climbing chalks appear to have a procoagulant effect on hemostasis, likely by affecting the intrinsic pathway of the coagulation cascade. While further research is needed to better understand its coagulative properties, climbing chalk shows potential as a hemostatic agent for minor wounds in wilderness medicine.

Unmanned aerial vehicle (UAV) paired with LiDAR sensor to detect bodies on surface under vegetation cover: Preliminary test.

IntroductionWilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.MethodA scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.ResultsOf the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.ConclusionMost UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.

End-of-life care presents unique challenges in austere or resource-limited environments where traditional medical resources are scarce or absent. This review explores the complexities of providing end-of-life care under such constraints, including recognition of the dying patient and techniques to alleviate suffering and allow death with dignity in under-resourced or expeditionary environments. Moreover, it presents these techniques in an accessible manner for providers without formal hospice training to use. Based on a literature review of hospice and palliative medicine, insights from the body of literature in wilderness and austere medicine, and the authors' experiences in practicing in austere environments, this paper discusses practical approaches to symptom management, ethical considerations in end-of-life decision making, and accessible interventions with limited resources. By addressing these challenges and offering management recommendations, this review aims to enrich the literature and provide guidance for general medical providers who may lack formal palliative and hospice care training and yet find themselves in the situation of navigating end-of-life care in challenging and austere environments.

Wilderness medicine elective rotations for graduate medical students are gaining popularity. The number of electives continues to grow, each with varying curriculum, format, and means of assessment. Previous curriculum guidelines attempted to standardize the knowledge-based competency for medical students in this field. Concurrently, medical education has evolved, emphasizing learner-centric and outcome-based observable competencies. Competencies based on individual qualities have since been complemented by practice-specific activities called entrustable professional activities (EPAs), which may consist of smaller observable practice activities (OPAs). This has allowed educators to use a holistic approach to determine that an individual can be fully entrusted to carry out an unsupervised activity. We surveyed current graduate-level wilderness medicine elective directors to determine expert panel recommendations for the EPAs of wilderness medicine for graduate medical students. The aim was to create EPAs and OPAs that experts deem fundamental for a wilderness medicine elective rotation and align them under the framework of entrustable practice in medical education. By mapping wilderness medicine EPAs and OPAs to competencies, we can better measure developmental progression and degree of entrustment in graduate wilderness medicine electives.

Wilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, the Wilderness Medical Society (WMS) has aggregated research findings and created guidelines on prevention measures and therapeutic options for acute altitude illness, frostbite injuries, and avalanche and non-avalanche snow burials. As new research emerges, some guidelines have been updated to reflect the most current and sound scientific conclusions. In this review, we have synthesized the evidence-based guidelines and have reviewed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. Further research efforts can expand the scope of evidence-based practice in travel medicine and ideally standardize the implementation of recommendations within both pre-travel and post-travel medical practices.

Wilderness medicine (WM) education is an important aspect of training for sports medicine fellows, preparing healthcare providers to address medical challenges in remote and austere environments. It is traditionally taught in immersive, in-person settings. The COVID-19 pandemic prompted a rapid shift toward virtual education platforms, challenging traditional teaching methods. This study evaluates the efficacy of a virtual WM boot camp to teach WM concepts, converting an established in-person program into a national, virtual educational opportunity. Participants included Primary Care Sports Medicine fellows and attendings located in the USA, with data collected over two years (2020 and 2021). Pre- and post-surveys assessed comfort levels and knowledge before and after attending the virtual boot camp. Results indicate significant improvements in comfort and knowledge across various WM topics for both fellows and attendings. Limitations include the absence of hands-on experiences and the inability to fully replicate simulated scenarios. This study underscores the adaptability and potential of virtual education in WM and discusses the benefits of virtual over in-person education. It further demonstrates the potential for virtual training in medical education more broadly, optimizing medical training in a post-pandemic era.

IntroductionA multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course.MethodsA descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist.ResultsThe subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario.ConclusionsThis study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.

French Guiana is a French territory in South America covered by 90% of tropical forest. Despite regular first aid standards training, some of the workers in isolated areas remain untrained in common problems they may encounter. We present here the knowledge assessment of these workers concerning first aid and a new training program. Thirty-two workers operating in remote areas attended a 1-d training course. The program covered infectious diseases, wildlife envenomation, and first aid and basic life support with a wilderness medicine focus. Questionnaires were issued to assess their knowledge and satisfaction with the course. The learners were 78% male and of intermediate age (26-55 y). The most common profession was forester (53%). Professionals had been working in remote areas for 12 (4-19) y, and 91% had already received first aid training. The common life-threatening emergencies were not well known; only 6 learners (19%) knew how to recognize a cardiac arrest, 7 (22%) recognized symptoms of severe anaphylaxis, and 23 (72%) performed maneuvers not recommended in cases of upper airway partial obstruction. A total of 26 learners (81%) completed the satisfaction questionnaire. The training met the learners' expectations. However, 92% would like further training, and 96% requested regular renewal. This training was the first step toward the creation of a specialized wilderness first aid course. This work supports the need to reinforce training for nonmedical personnel by integrating regionally specific topics. This experience permitted the rise of a working group that proposed a medical kit as well as first aid protocols for workers in isolated areas.

Background Climate change threatens humanity's health and well-being. While climate change topics have been increasingly incorporated into undergraduate medical education, it is unclear to what extent they have been incorporated into graduate medical education (GME) curricula in the United States. Objective To examine how climate change has been incorporated into GME curricula in the United States. Methods We conducted a scoping review of published literature from January 2013 through November 2023. PubMed and Scopus were searched, with articles assessed by 3 reviewers in a blinded fashion. Resources were included if they described how climate change is incorporated into GME curricula in the United States, and if they discussed topics such as disaster medicine, mass casualty events, environmental medicine, public health, health policy, wilderness medicine, quality improvement, and sustainability. Articles were analyzed using descriptive numerical analysis and qualitative assessment to identify article characteristics and themes. Results The inclusion criteria generated 17 articles that examined climate change incorporation into GME curricula and curriculum interventions covering topics used for inclusion. The most common type of article (5 of 17, 29%) employed surveys of program directors on the inclusion of climate-related topics. Conclusions Published accounts of climate-related topics in US GME program curricula are few. More content is found in topics related to emergency medicine. Curricula frameworks have been proposed for pediatric and internal medicine residency programs, but we know little about their efficacy. Future scholarship should fill these gaps to educate learners to improve health care sustainability and resiliency.