A Prospective Trial of Low-Dose, High Frequency Training

Introduction: The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Emergency Medicine (EM) Graduate Medical Education (GME) educational cur riculum previously focused almost exclusively on standard civilian trauma and pathology, resulting in military emer gency physicians receiving combat casualty care-focused training as needed prior to deployment. Previously, military EM GME graduates expressed disappointment with the lack of deployment and en route care training provided during their residency and discomfort while providing care during deployments. The constant evolution of the practice of Tactical Combat Casualty Care (TCCC), and the fact that most combat-related deaths occur in the prehospital environ ment, necessitates ongoing training of military EM physi cians. To combat this identified knowledge and skills deficit, we incorporated brief, frequent episodes of military unique EM curriculum into the standard GME over the course of the academic year. We hypothesized that this low dose, high frequency (LDHF) training model would improve knowledge and skill retention through short simulation and case-based scenarios over an extended time frame. Materials and Methods: SAUSHEC EM residents in all PGY levels were provided TCCC and deployment medicine-focused lectures and simulation scenarios during standard EM training sessions. Following selected training sessions, each resident was asked to complete 1) a ques tionnaire to rate their self-assessed operational medicine and leadership skills and 2) a multiple-choice test of TCCC topics. Over the academic year, residents were asked to repeat the questionnaire and multiple-choice test. Paired t-tests were used to compare consecutive scores on the self - reported skill and knowledge assessments. McNamar's test for paired proportions was used to compare the proportions of residents rating themselves as "acceptable" or better on the self-assessed skill questionnaire over consecutive surveys. Results: We analyzed data from 48 participants from September 2020 to May 2022. All participants completed 2 to 5 questionnaires, with a median of 16 weeks between them. Participants also completed at least 2 TCCC tests, with either ~6 months or ~1 year between tests. On their first self-assessment, participants on average rated their operational skills as 4.0/10 which significantly increased to 5.6/10 (p < 0.0001) by their second self-assessment. Similarly, the LDHF training model significantly improved participants' self-assessed medical director/leadership skills, with the average increasing from 2.9/10 to 4.6/10 (p < 0.0001) from their first to second survey. Participants also saw a sig nificant increase in their scores on the TCCC multiple choice test between their first and second exam (49% correct to 57% correct, p = 0.0009). Conclusions: The LDHF curriculum for operational med icine training significantly improved clinician confidence and operational medicine knowledge and may improve the military EM clinicians' ability to care for patients during deployment.