Bridging the Deployment Readiness Gap: A Narrative Review of Train-the-Trainer Best Practices to Inform a Critical...

The United States Air Force's (USAF's) Critical Care Air Transport (CCAT) capability has faced significant readiness challenges due to declining operational experience from decreasing global deployments since 2010. This experience erosion-the "Walker Dip"-is compounded by the loss of subject matter experts needed to lead unit sustainment training, further heightening the risk of patient morbidity and mortality in future large-scale conflicts. To bridge this readiness gap, we aimed to identify and synthesize best practices of the train-the-trainer (TTT) model from the literature to inform the development of a CCAT educator course.

We conducted a narrative review of the literature on TTT programs, querying PubMed and CINAHL for articles published from 2001 through January 2025, using the terms "skills and train-the-trainer," with a focus on content relevant to CCAT training and skills sustainment. Guided by the research question of current best practices, we reviewed and synthesized data from 37 relevant articles, including 4 systematic reviews. Thematic analysis was employed iteratively to identify and refine best practices.

The review identified 29 best practices organized across seven core themes: Program Development, Implementation, Learning Competencies, Instructional Methods, Evaluation, Educator Toolkit, and Community of Practice (CoP).

Our synthesis offers an evidence-informed cohesive framework spanning the life cycle of a TTT program, from design through longitudinal implementation, addressing sustainability concerns. Key elements for success included stakeholder support, learning competencies, experiential hands-on practice, educator toolkit, and CoP. Future studies should compare program components, evaluate the optimal blend of methods, explore virtual options, and assess long-term system impact. By applying best practices to developing a CCAT educator course, we aim to empower local units to deliver critical sustainment training and close the operational readiness gap across the USAF enterprise, saving lives and bringing heroes home.