Wilderness & Environmental Medicine

Wilderness medicine (WM) is the study of medicine in austere environments. There are several US multidisciplinary courses that teach WM to people from varying medical backgrounds. However, WM topics are covered to different extents. This study's purpose was to compare WM components among US multidisciplinary training courses.

The American College of Emergency Physicians WM fellowship curriculum's 19 components and the Fellowship of the Academy of Wilderness Medicine's 12 core and 16 elective competencies and their credits were used as two control lists. Curricula from 10 US multidisciplinary courses were analyzed for WM components. Using descriptive analysis, each course curriculum was compared with the controls.

This study examines WM components in 10 courses. The greatest number of American College of Emergency Physicians WM fellowship topics (14 of 19) was covered by the Paramedic course and the fewest number (4 of 19) by the Tactical Combat Casualty Care–Combat Lifesaver course. The greatest number of Fellowship of the Academy of Wilderness Medicine core credits (56) was offered by the Paramedic course and the fewest number (24) by the Tactical Combat Casualty Care–Medical Personnel course. The greatest number of Fellowship of the Academy of Wilderness Medicine elective credits (83) was offered by the Paramedic course and the fewest number (25) by the Tactical Combat Casualty Care–Combat Lifesaver course.

This research analyzed WM components in US multidisciplinary courses and demonstrated that each covers WM topics to varying extents. This shows an opportunity for these courses to expand their WM education within their scope. It also demonstrates competencies offered by different courses for interested trainees.

Wilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.

A scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.

Of the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.

Most UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.

Wilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.

A survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the χ² test, where P < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where P < 0.05 was considered significant.

The response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.

Despite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.

—Wilderness medical education for medical students is generally intended for senior medical students during their clinical years. Several universities have established elective rotations for clinical students or longitudinal 4-y tracks, but these opportunities are frequently restricted to a limited number of students. This novel program sought to fill a deficit of wilderness medicine curricula for preclinical medical students by creating a longitudinal course over one academic year.

—This curriculum includes a certification series of didactic lectures on core wilderness medical topics interspersed with hands-on skills sessions and simulated patient scenarios led by emergency medicine-trained faculty. Established medical education strategies were employed to improve learning, including spacing, interleaving, gamification, review quizzes, and frequent low-stakes assessments.

—During the first 3 y of this innovative teaching method, 48 preclinical students completed all components of the course, with another 20 students in progress for this academic year. Postintervention surveys have yielded positive feedback, with students reporting improved confidence on patient assessment, increased wilderness medical knowledge, and the acquisition of procedural skills.

—Implementing a 1-y longitudinal wilderness medicine curriculum for preclinical medical students allows learners to gain valuable skills while building their confidence to assess and treat patients in a wilderness environment. The curriculum can be designed to incorporate best practices in medical education and adapted to a variety of practice situations and learners.

The Diploma in Mountain Medicine (DiMM) is an educational program designed to enable healthcare professionals to adapt their practice to the mountain environment. The purpose and nature of student assessment are not explained in the regulations. Understanding the intentions of the administrators who wrote the assessment regulations would enable students to be assessed more consistently and in keeping with the objectives of the program.

This study used qualitative methods. Interviews were used to collect the opinions of members of the DiMM program administrative group. Thematic analysis was used to identify themes in the data and to produce a narrative description concerning the purpose, nature, and challenges of assessment.

The major themes identified included the importance of using assessment to measure student progress and outcome, the intention to assess competency, the importance of standardization in assessment, and the identification of core knowledge and skills. The need to be sensitive to cultural differences in education was a complex issue that limited the development of learning outcomes and the definition of a level of learning for the program.

There is variation in the content, level of learning, and outcomes assessed on DiMM courses. Cultural and educational diversity of the courses were complex issues that confounded consistent student assessment. In the future, clear statements about the aims of assessment, the academic level of study, and the content of learning would enhance the educational rigor and value of the program. The use of consensus methodology would be beneficial in achieving these objectives.

Wilderness medicine (WM) is a growing field offering advanced training and recognition through graduate medical education (GME) WM fellowships and the Fellow of the Academy of Wilderness Medicine (FAWM) professional designation. GME fellowships, introduced in 2004, provide immersive, structured training and experiential learning opportunities. The FAWM designation, established in 2005, is earned through approved educational activities. This study compared alumni outcomes between these pathways.

A cross-sectional survey was conducted among GME fellowship graduates and FAWM recipients. Inclusion criteria were GME fellowship alumni or individuals with FAWM recognition. Exclusion criteria included incomplete surveys. Respondents were surveyed on demographics, academic output, and satisfaction with their training. Data analysis included χ² tests for categorical data, analysis of variance for publication comparisons, and ordinal Likert scales for satisfaction.

Of 321 responses, 281 were included. GME alumni expressed greater satisfaction with mentorship and research opportunities; 95% of FAWM-only respondents reported exposure to career opportunities unknown prior to fellowship. There was no detectable difference (P=0.523) between FAWM-only respondents’ number of WM-related publications. Overall, 93% of FAWM-only respondents and 76% of GME alumni would repeat their fellowship. Both groups demonstrated high proficiency in WM, with 89% feeling proficient.

Both GME and FAWM pathways support WM education and career development. However, GME fellowships provide enhanced academic involvement, mentorship, and performance of relevant clinical skills. FAWM introduced new wilderness careers and had higher alumni satisfaction. These findings highlight the complementary roles of GME fellowships and FAWM recognition in advancing proficiency and professional growth.

Fourth-year medical students from the University of Kansas School of Medicine have the opportunity to complete a rotation at the Philmont Scout Ranch. To be prepared for this rotation, the students need to be taught a set of skills so that they are capable of evaluating and initiating treatment of patients in the infirmary and backcountry. We aimed to demonstrate that the training provided to the medical students improved confidence in the required skills.

The training curriculum was developed by three Philmont physicians involved in medical student education and included skills videos, virtual training sessions, and an in-person training weekend. The necessary skills were identified by these physicians. Surveys on the confidence in these skills were administered to the medical students before training, after training, and after rotation. Paired t-tests were done to compare the confidence levels before and after training as well as before training and after rotation.

A total of 23 responses were gathered from the pre-training survey, 21 responses from the post-training survey, and 20 responses from the post-rotation survey. There was a statistically significant increase in the confidence level of all the skills from pre-training to post-training and of all the skills except suturing from pre-training to post-rotation.

The training curriculum successfully improved the confidence of third-year medical students with unfamiliar skills and helped prepare them for their rotation at Philmont. Further refinement is needed to improve complex mastery of all the skills and standardize the training.

In India, emergency medicine is a developing specialty and is not yet integrated into undergraduate medical education (bachelor of medicine and bachelor of surgery [MBBS]). Against this backdrop, introducing wilderness medicine may seem premature, but its relevance is clear given the country's vast rural geography and limited prehospital care. This study evaluated the impact of a 1-d wilderness medicine elective on medical students’ motivation, self-directed learning, and satisfaction.

This mixed-methods study involved 53 MBBS students from a tertiary care teaching institute divided into 3 independent batches that sequentially underwent wilderness medicine training across 3 curricular iterations. Data collection included pre- and post-tests, surveys using validated scales, and qualitative feedback from focus group discussions.

Confidence improved significantly (P<0.001) in scene size-up (2.66±0.99 to 4.22±0.53), first aid (2.66±0.99 to 4.22±0.53), identification of life-threatening emergencies (2.66±0.94 to 4.20±0.51), and first aid kit preparation (2.39±1.07 to 4.29±0.72, all scores out of 5). The module was highly valued, with strong support from the learners for its inclusion in the curriculum (4.14±0.94 to 4.86±0.35; P<0.001) and reported high satisfaction and demonstrated intrinsic motivation.

The elective module enhanced students’ confidence and engagement, supporting its integration into undergraduate curricula. Further research is warranted to assess long-term impact and scalability. Further research is needed to validate these findings and assess the long-term effects on clinical practice.

A multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course.

A descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist.

The subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario.

This study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.

Search and rescue (SAR) personnel in the United States are mostly volunteers, many of whom work in nonmedical professions. Because SAR volunteers respond to missions intermittently, their opportunities to provide patient care and maintain medical skills are limited, highlighting the need for ongoing training. This study explored the effect of high-fidelity simulation training on the medical skill comfort level of SAR volunteers.

Twenty SAR volunteers participated in high-fidelity training scenarios in an academic medical simulation center. The scenarios included care of both a trauma and a medical patient along with dedicated time to practice perishable medical skills. Participant comfort level in performing patient assessments and medical skills was measured using a 5-point Likert scale, via surveys administered before and after the simulation training.

A significant increase (P<0.05) in participants’ comfort level was observed across nearly all measured medical skills when comparing pre- and post-training survey responses. Participants reported the highest comfort level in obtaining vital signs and the lowest comfort level in splinting a fractured extremity. All participants stated that they would like more SAR trainings in this format in the future and that the training modality helped identify gaps in their medical skills.

High-fidelity simulation training improved the comfort level of SAR volunteers in executing medical skills. For SAR volunteers with limited opportunities to provide direct patient care, simulation training showed promise as a modality for continuing medical education to improve confidence, reinforce team dynamics, and refresh skills.

Physicians frequently take on leadership roles in many different healthcare teams and settings. Developing such leadership skills as situational control, resource utilization, and conflict management is a vital part of medical education. Wilderness medicine focuses on the delivery of care in remote environments where situations are often tenuous, resources are scarce, and effective leadership and teamwork are essential. Wilderness medicine education during medical school may provide tools and knowledge to improve leadership ability. This study evaluated the perceived effect of a 1-mo wilderness medicine elective on medical students’ leadership skills.

Fourth year medical students taking a 1-mo wilderness medicine elective between 2019 and 2023 were asked to take pre- and postcourse surveys evaluating their perceptions of their leadership skills. A different group of students taking an art of medicine through the humanities elective were used as a control group. The results were evaluated for pre- and postsurvey differences as well as between-group differences.

Several pre- and post-course survey questions aimed at assessing perceived skill improvement in situational control, resource utilization, and conflict management showed statistically significant differences in the students taking the wilderness medicine elective, whereas this was not found in the control group. This suggests that students taking the wilderness medicine course perceived an improvement in their leadership skills after participating in a wilderness medicine course, whereas students taking the art of medicine through the humanities course did not perceive this improvement. This suggests that wilderness medicine education can provide value to medical student education.