In Reply to Drs Hill and Votta

Thank you, Drs Hill and Votta for your recent letter to the editor, “Addressing Obstacles to Wilderness Medicine Education for the Preclinical Medical Student.” ¹ This letter raises several valid and important considerations regarding institutional support and funding, elective credit, and timing of wilderness medical courses in an era of reduced preclinical curricula. I appreciate the opportunity to continue a discussion regarding these points that build on questions explored in the earlier article describing a longitudinal preclinical wilderness medicine course. ²

From reading your reply, it is evident that wilderness medicine has been integrated into the curriculum at your institution and within your department as a section. My programs are still in their infancy—this was the fifth academic year of offering a preclinical wilderness medicine course through our wilderness medicine student interest group (WMIG) and the fourth year of offering a wilderness medicine elective to our emergency medicine residents. As the sole faculty member coordinating these experiences, balancing ambitious goals with realistic expectations is a constant consideration. The aspiration is to one day grow the University of Louisville’s wilderness medicine education into student electives, residency tracks, and a dedicated wilderness medicine section within our department.

Previously, community physicians made an unsuccessful attempt to create a wilderness medicine elective for senior medical students at our institution. At that time, the WMIG was inactive. On joining the university as faculty, as was correctly surmised in the recent letter to the editor, I sought an approach that required the least funding and red tape to accomplish the goal of teaching wilderness medicine to students and residents. I appointed myself as the WMIG faculty advisor and declared that a modified Advanced Wilderness Life Support (AWLS) course would occur. The continued enthusiastic response from students has been noted and promoted by the medical school. Now, with a proven track record of interest and completion of a wilderness medicine certification, the hope is to soon transition this program into an official elective within the medical school. Ideally, this path could unlock resources such as funding for certification examinations and supplies, means for additional faculty support, and a path for an interdisciplinary elective offering with the school of nursing.

Discussion of reproducibility challenges in a shortened 1.5-y preclinical curriculum raises an excellent point. In our WMIG, many M1 students attend some didactic sessions and workshops and opt to complete the full certification course as an M2. The letter suggests that a shortened preclinical curriculum may limit the involvement of M2 students or require an accelerated pace of the longitudinal curriculum. As the University of Louisville prepares to move toward a shortened M2 year, these challenges will need to be addressed in the upcoming academic year.

Several additional strategies may address these challenges and merit consideration. In the WMIG, all lunchtime didactics are recorded and posted on a WMIG Teams channel for review. The minimum in-person attendance policy could be revised to allow M2 students to continue the course asynchronously. Previous years’ didactics can be accessed, and M2 students could self-study the remaining topics in advance. Under this model, 2 separate hands-on final assessment dates could be held near the conclusion of the M1 and M2 years, with students being allowed the option to attend either. While this would duplicate efforts for faculty and volunteers, it would allow continued annual cohorts. Alternatively, AWLS does not require a hands-on component for certification and can be taken online. The in-person component for the WMIG’s course could be removed, although this likely would significantly reduce the educational value for the preclinical students, who routinely rank the hands-on scenarios as the highlight of the course.

In a third option, a wilderness first aid or a basic wilderness life support course could replace the AWLS curriculum. This would allow a more rapid pace that could be completed within the first half of the academic year. I have considered initiating this and offering the AWLS certification as a senior student elective rotation. However, a course designed for laypersons may be perceived as too basic by medical students, potentially reducing engagement.

Another option would be to develop a point-based certification series in conjunction with the medical school, in which students could attend didactics, workshops, or other offerings cumulatively over their preclinical and/or clinical years. This has been implemented with positive response for disaster medicine ³ and could be a viable method to give further credence to the students’ experiences longitudinally in medical school. This would give students the flexibility to focus on topics that are the most meaningful to them.

Similarly, a micro-credentials model could be developed, and students could work toward achievement throughout their medical school careers.^4,5 The WMIGs’ lectures and workshops would be featured within a more asynchronous model, with attendance at workshops and simulations as schedules permit. Core skills and knowledge assessments could each represent a micro-credential, with stacking of credentials to ultimately achieve an institutional wilderness medicine certification.

This exchange highlights the shared commitment across institutions and among educators to expand and strengthen wilderness medicine education. While notable challenges remain, continued collaboration and dialogue among educators will be essential to developing creative solutions.