Development of the Patient Encounter/KSA Form for the Military Unique Curriculum in Honduras and Military Emergency...

Maintaining a ready military medical force is challenging for today's armed forces. A major barrier for achieving readiness is inadequate access to critically ill medical and trauma patients particularly in an environment mimicking the resource constraints of a combat zone. The Military Unique Curriculum in Honduras and Military Emergency Skills in Honduras (MUCH/MESH) Programs seek to bridge this gap in capability. The Center for Global Health Engagement (CGHE) Assessment, Monitoring, and Evaluation Team (AM&E) led a project in collaboration with MUCH/MESH to develop a streamlined tool to capture KSAs completed by program participants. In addition, the tool aimed to collect contextual information relevant to medical operations in austere environments.

From February 2023 to May 2024, the AM&E Team piloted the Patient Encounter and Knowledge, Skills, and Abilities checklist (E-KSA). In total, the AM&E Team collected data from 9 rotations. Military medical readiness standards, previous MUCH/MESH data, and subject matter expertise were used to develop the tool. To assess the E-KSA's ease of use for individuals with little to no research experience, rotations 7 and 8 paired an AM&E team member with a CGHE staff member whose job duties did not include research or data collection. Rotation 9 used 2 non-AM&E staff to collect data.

The AM&E Team iteratively revised the E-KSA checklist during the first six rotations. With each revision, the team incorporated more options to capture medical and contextual information and revised KSA options to be reflective of the environment. The final version of the E-KSA received positive feedback from the non-AM&E staff tasked with using it. They emphasized the helpfulness of the training and materials and found the format of the checklist enhanced its utility. Opportunities for improvement of the checklist and training included: adding Spanish language terms to the E-KSA checklist, creating additional case examples for training, and reinforcing best practices for data collection during the training using a variety of methods.

This project demonstrated the feasibility of use of the E-KSA checklist by AM&E and non-AM&E observers. Furthermore, the checklist encompassed medical readiness requirements for both the Army and Air Force, which streamlines the collection of KSA data. KSAs can be acquired at U.S. medical facilities or through simulation, but rarely in austere, resource-limited environments akin to combat. The E-KSA checklist systematically documented limitations that can influence complex medical decision-making in such an environment. Limitations of this project included: limited time for data collection, potential language barriers, potential for limited portability to other environments, and use of handwritten notes. Future research should test the generalizability of the checklist by deploying it in other comparable short-term rotational military medicine programs, as well as explore alternative means of administration.