Introduction to Wilderness Medicine-A Medical School Elective.
This curriculum provides a capstone experience for fourth year medical students, integrating aspects of the basic sciences and clinical skills in the care of wilderness medicine conditions.
The duration of this course is 2 weeks.
Since passage of the Wilderness Act of 1964, leading to the protection and expansion of wilderness areas, there has been steady growth in participation in outdoor recreational activities.1 Between the years of 2000 to 2009, there was a 7.5% increase in the total number of individuals participating in outdoor recreation. Notably, during this same timeline, there has also been a 7.1% increase in the total number of people participating in "nature-based outdoor recreation." 2 Acknowledging this rising interest in the outdoors, along with increasing accessibility to remote locations, it has become clear that healthcare providers must now attain the ability to both identify and treat conditions unique to these environments.In addition to discrete medical conditions unique to environmental medicine, the practice of wilderness medicine also encompasses the management of the familiar, the "bread-and-butter" medical illnesses, occurring in the unfamiliar, nonclinical environment. Management of these conditions requires both a knowledge of core life support principles and an adaptability and awareness of the non-medical factors affecting a patient's care.Wilderness Medicine also teaches core principles of austere medicine - healthcare administration in a resource-limited environment. The skills acquired in a wilderness medical course provide not only training in the wilderness setting, but also encompass medical care necessary in instances of disaster relief, terrorist events, and international medical missions.3 Additionally, management of discrete wilderness medicine conditions provides a context to review toxicologic biomechanisms and pathophysiology shared by other, more common conditions.For these myriad reasons, a wilderness medicine elective in medical school provides students with more than a divergent experience; it provides a review and expansion of core medical principles increasingly applicable to all specialties.
The primary objective of this course is to provide fourth year medical students an introduction to wilderness medicine. Students will be able to: explain fundamental concepts of practicing medicine in austere conditions; identify and initiate treatment for common wilderness medicine conditions; and utilize the non-medical aspects of providing care in austere environments.
The educational strategies used in this curriculum include a combination of lecture-based and experiential learning activities, structured through the lens of Kolb's theory of experiential learning. Core knowledge is preferentially imparted during outdoor experiential components, allowing adaptable, true-environment training. Sessions are complemented by assigned pre-reading in Auerbach's Wilderness Medicine4 textbook to create a flipped outdoor-classroom experience. In addition to a final examination, the course will include a final multi-day expedition designed to allow students an opportunity to demonstrate their wilderness medicine knowledge. The course format opens it to adaptation as a longitudinal curriculum. Finally, this course may be adapted to serve resident education purposes.
This curriculum has been used and vetted at the authors' institutions with over 50 medical students. All individual comments were reviewed for applicability, trends noted, and the course was further refined. Student final assessment scores were reviewed to refine the content taught and clarity of assessment.
The current iteration of the curriculum received the following on a 5-point Likert scale by students on post-course evaluation forms: 4.91 for overall educational experience, 4.82 for curriculum effectiveness, and 5.00 for effective faculty instruction. As a result of comments, the use of the flipped-classroom model throughout the course has increased. Topics frequently encountered in spontaneous discussion due to regional importance have been included.
Overall, this course has proven both popular and successful. Due to the dynamic and divergent nature of this as a medical school course, the authors have noted increased levels of student engagement with the material. Increasing reliance on the flipped-classroom model with student-led scenarios and discussions has increased students' ability to recall and apply their knowledge to scenarios during the final expedition. The broad range of conditions included in wilderness medicine provides a unique framework to highlight the relevance of the basic medical sciences and review core medical principles.
Wilderness trauma stabilization, patient transportation, acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, hypothermia, frostbite, orienteering, survival skills, expedition medical kits, marine envenomation, decompression illness, plant toxidromes, snake envenomation, arthropod envenomation, high-angle rescue, search and rescue, heat illness, lightning strike, tick-related illness, disaster response, international medicine.4.
Pittman MA
，Slone T
，Wilson M
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Death Pronouncement: Preparing Incoming Residents for Duties When Life Ends.
Introduction Undergraduate Medical Education (UME) prepares future residents for many aspects of medical practice, but it is rarely all-inclusive. Death pronouncement (DP), a highly important aspect of clinical training for residents, seems to be inadequately addressed and taught in undergraduate institutions. Studies have indicated that most first-year residents received minimal DP training and felt unprepared for this duty. Despite being a challenging situation, a formal teaching course is not universally taught, with most institutions merely delivering point-of-care DP instruction to medical trainees provided by supervising faculty, senior residents, and nurses. Our primary objective was to provide formal education in Duties When Life Ends (DWLE), with the goal of enhancing familiarity, knowledge, and confidence in addressing the circumstances surrounding death for graduating medical students transitioning to residency. Methods As a part of a Transition to Residency (TTR) course for students entering nonsurgical specialties, we developed a curriculum to provide formal education to fourth-year medical students in DWLE that included a two-hour didactic session delivered virtually, followed by an in-person simulation session. The didactic session covered the history, processes of DP, death physical examination, identification of medical examiner (ME) case, education on how to deliver death news to family, information about autopsies and organ donation, distinction between the cause and mechanism of death, and documentation of death notes and certificates, as well as provider self-reflection and appropriate coping mechanisms for patient death. In the 45-minute simulation, students were divided into small groups and given a case summary. During the first half, they performed a physical examination and a verbal pronouncement on cadavers, followed by an interactive small group session where students reviewed the case and worked to identify the cause of death, determine if the death was a medical examiner's case, deliver death news to the family, and complete a death progress note and certificate. Pre- and post-session questionnaires were administered, assessing three components: process familiarity, knowledge, and confidence. Finally, participants assessed course usefulness and had a free response opportunity for comments and feedback. Results Overall, 198 students participated in all sessions, with 182 completing both pre- and post-session questionnaires. Pre-survey revealed that 70% of participants reported witnessing DP previously, with only 20% being familiar with the process of DP and 6% with documentation. Following the intervention, a comparison of the pre- and post-course questionnaires assessing process familiarity, knowledge, and confidence using a five-point Likert scale demonstrated statistically significant improvement in the mean scores in all three domains, with reported course usefulness of 96%. Conclusion A DWLE curriculum, as a part of the TTR course, was effective in improving self-reported familiarity, knowledge, and confidence regarding physician duties associated with patient death. The curriculum was well received by students. The incorporation of DWLE curriculum into TTR courses allows for vital preparation and education in the duties related to patient death. This may make a stressful process somewhat less stressful and may aid future physicians in developing competence in conducting these final physician duties.
Kaloti Z
，Nabaty R
，Mohamed A
，Surapaneni S
，Gaynier A
，Levine DL
... -
《Cureus》
Teaching Pediatric Palliative Care Communication Skills to Fourth-Year Medical Students Through Role-Play.
Despite growing recognition of pediatric palliative care's importance, training in palliative care communication remains a gap in medical education. Graduating medical students frequently feel unprepared to initiate or facilitate goals of care conversations with their patients, particularly in pediatrics.
We created a 3-hour session featuring an introductory lecture on pediatric palliative care, communication drills on responding to emotion, and small-group case-based discussions utilizing role-play, targeting fourth-year medical students as the primary learners. Senior residents were also given the opportunity to develop skills by role-playing the patient parent and cofacilitating case discussions alongside palliative care faculty. Students evaluated session utility and their own confidence through pre- and postsession surveys using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).
Twenty-six students were included in the analysis over 3 years. All agreed that the session was useful (M = 4.9). Students showed significant improvement in confidence in explaining pediatric palliative care (presession M = 3.2, postsession M = 4.1, p < .001), understanding the family experience (presession M = 2.7, postsession M = 4.1, p < .001), and eliciting goals and values from families whose children face serious illnesses (presession M = 3.1, postsession M = 4.1, p < .001). Pediatric resident cofacilitators also felt the session benefited their own teaching and communication skills.
This 3-hour interactive session on pediatric palliative care utilizing communication drills and role-play was effective in improving fourth-year medical students' confidence in communicating with families of children facing life-threatening illnesses.
Cowfer B
，McGrath C
，Trowbridge A
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ResearchGate
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