Elsevier

Injury

Volume 49, Issue 1, January 2018, Pages 93-96
Injury

Full length article
The potential of blended learning in education and training for advanced civilian and military trauma care

https://doi.org/10.1016/j.injury.2017.11.003Get rights and content

Abstract

Introduction

In the field of advanced care of the complex trauma patient, there is an emerging need for focused education and training. However, several hospitals do not support further education and training in this field, and the challenge of releasing time for physicians and nurses is well-known. Educational strategies using blended learning, which combines traditional classroom methods with modern computer-assisted methods and media, have not yet been widely used. This study analysed the educational challenges and areas for improvement, according to senior physicians and nurses, and investigated the potential use of blended learning.

Method

The setting was an international course, Definitive Surgical Trauma Care (DSTC) – Military Version, part of a programme which prepares health professionals for work during extreme conditions. The sample consisted of senior physicians and nurses, participating in the course in September 2015. A survey was completed, interviews were performed and a post-course survey was conducted 18 months later in March 2017.

Results

The most difficult aspect of learning how to manage the complex trauma patient, was the lack of real practice. Even though the respondents were knowledgeable in advanced trauma, they lacked personal experience in managing complex trauma cases. Cases presented during the course represented significantly greater complexity of injury compared to those usually seen in hospitals and during military deployment. The following educational challenges were identified from the study: (1) Lack of experience and knowledge of advanced trauma care. (2) Lack of the use of blended learning as support for education and training. (3) Limited time available for preparation and reflection in the education and training process. (4) Lack of support for such education and training from home hospitals. (5) The unfulfilled requirement for multidisciplinary team-training in the military medical environment.

Conclusion

Educational strategies and methods, such as blended learning can support education and training, and the learning process by unlimited practice in reasoning and decision making in virtual patients. It can also provide flexibility and mobility for senior health professionals and their home hospitals, and contribute to an improved military pre-deployment training with less time strain on the civilian home hospitals.

Introduction

In the Nordic countries where expertise, trauma volume and the experience in the management of major trauma are limited, there is an increasing need for training and education in advanced civilian and military trauma care, to meet the new demand on society [1], [2]. In several European countries, the number of military health care providers is limited, and their armed forces make extensive use of civilian physicians and nurses, who are deployed as needed. As a result, increased civilian and military interchange has also been called for [3]. Hospitals do not always support education and training in this field and the challenge of releasing time for physicians and nurses is well-known [4], [5]. It is critical to provide adequate education and training to prepare civilian health professionals for the extreme environment they will face when deployed with the armed forces. The military medical environment is characterized by multiple casualties, need to work under hostile fire, in darkness, extreme cold or heat, and with shortcomings in available medical resources such as equipment, and delays in transport to hospital [6]. Collaboration with other professionals such as military officers or medical personnel from other nations is also frequently challenging. Earlier studies have identified a lack of common understanding between civilian health care personnel active within military medicine, and professional military personnel [5]. It is therefore essential that health professionals be supported in education and training, to understand, and be prepared for the extreme environment in which they will be working.

New strategies of how to provide a more flexible education and training for health professionals in the multidisciplinary field are needed [4], [7]. Blended learning (BL) mixes various learning styles and environments during the learning process. BL is a flexible type of learning that combines traditional classroom methods with modern computer-assisted methods and media [8]. BL is therefore able to provide improved support, collaboration, flexibility and mobility [8], [9]. The armed forces in the Nordic countries have been proactive in the development of technology, and its application in several fields of military interests, both within education and training itself. However, despite the rapid development of digital technologies, traditional didactic education has only taken advantage of it to a very modest extent, nor has it taken place to the same extent in the field of military medicine [4], [7], [10], [11], [12], [13]. This study analysed the educational challenges, as expressed by senior physicians and nurses, and investigates the potential use of blended learning in advanced civilian and military trauma care.

Section snippets

Study setting and sample

The setting was a military version of a high-end international course, the Definitive Surgical Trauma Care Course (DSTC) [14]. The DSTC is internationally well-established, and the course aims at teaching techniques particularly applicable to the patient who requires surgery and intensive care for major trauma. It contains a mixture of didactic lectures, group discussions, and practical wet tissue training. DSTC is one of several courses in a military medical programme preparing physicians and

Results

Outcomes from the thematic analysis are presented as identified educational challenges, indicating areas for improvement, and the potential for blended learning.

Discussion

According to the health professionals, the most difficult aspect of learning how to manage complex, advanced trauma cases with competing management priorities, was the lack of real practice. Even though the respondents were experienced and educated in advanced trauma, the surgical trauma cases in the DSTC course differed significantly in their greater complexity, compared to many trauma cases in hospitals and military missions. The DSTC course contributed to the understanding of different and

Conclusion

Educational strategies and methods, such as blended learning can improve education and training by combining computer-assisted methods and media, with traditional classroom methods. Blended learning can support the learning process with unlimited practice in reasoning and decision making through virtual patients. It can also provide flexibility for senior health professionals and their home hospitals, and contribute to improved military pre-deployment training with less time strain on the

Conflict of interest statement

The authors declare no conflict of interest.

Acknowledgements

Sincere appreciation for support of the study to: Anders Sjöholm, Director of Research and Development, Swedish Armed Forces Headquarters, Medical Branch. Per Örtenwall, MD PhD, Regional representative for DSTC faculty and Swedish Armed Forces Centre for Defence Medicine. The course participants at DSTC – military version in Sweden during the fall 2015 and spring 2017.

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