Medical Student Electives in Wilderness Medicine: Curriculum Guidelines

Resident Wilderness Medicine Curriculum Consensus Guidelines: Summarization and Recommendations for Resident Rotations in Wilderness Medicine

INTRODUCTION

Wilderness medicine education is one of the fastest growing facets of both graduate and undergraduate medical education. Currently, there are curriculum guidelines for both student electives and fellowships in wilderness medicine. However, there are no guidelines for resident elective curricula. The student/resident education committee of the Wilderness Medical Society (WMS) convened a task force to develop curriculum guidelines for these electives.

METHODS

A survey of previously described core wilderness medicine topics was sent to a cohort of educators involved in wilderness medicine resident electives. They were asked to rank topics on the basis of their importance of being included on a Likert scale. Multivariate analysis of medians was used to distinguish among topics to determine which topics were voted most and least necessary for a curriculum.

RESULTS

Of the database members contacted, 35 responded to the survey. The described current state of residency electives was that 16 institutions offered their own elective (46%). For subject preferences, multivariate analysis of scoring distribution medians demonstrated a significantly higher pattern of responses (P<0.01) for subjects with a median of 3 (must include) than for the lowest-scoring subjects that had a median of 1 (can include). Every topic was rated "must" by at least 1 respondent. Topics were further subdivided into an educational framework reflecting a common approach to education of wilderness medicine fellows focusing on education, leadership, knowledge, and skills.

CONCLUSIONS

There was a wide variety in the ranking of topics; however, there were multiple topics on which a consensus for inclusion was reached. These topics are organized and presented here as a suggested curriculum by the student/resident education committee of the WMS.

Wilderness Medicine Physician Education: How an Elective Can Spark a Fire

Background

Wilderness medicine (WM) electives offer an opportunity for medical trainees to learn an additional skillset outside of the traditional medical education curricula. Prior literature has yet to detail how participation in WM electives during medical training informs future training (i.e., master’s degree, fellowship) or career involvement in the field.

Methodology

A 25-question survey was completed by former participants of 25 WM electives based in the United States. Survey questions focused on the demographics, motivations, current involvement, and additional WM training among those who participated in WM electives. The survey was completed by 102 eligible participants.

Results

Of the 102 participants, 53% had been engaged with WM since completing their elective; 18% of the participants had completed additional formal training in WM (i.e., master’s degree, fellowship). Further, 95% of participants felt that the elective enhanced their resilience and critical thinking. Of those currently most involved in WM (n = 26), half (46%) were unsure about integrating WM into their careers prior to their elective. Among the uncertain yet highly engaged cohort, 98% cited the elective as the reason they stayed involved in WM.

Conclusions

These findings underscore the importance of WM electives in fostering interest among medical trainees in WM, and suggest that participation in WM electives may promote further involvement after medical school and residency.

A National Survey of Wilderness Medicine Curricula in United States Emergency Medicine Residencies

INTRODUCTION

Wilderness medicine (WM) is a growing subspecialty of emergency medicine. In 2018, we surveyed all 240 emergency medicine residencies in the United States to assess the scope of WM education in emergency medicine training programs in light of the nearly 30% increase in the number of residencies since 2015.

METHODS

A survey was e-mailed to the Council of Residency Directors in Emergency Medicine listserv and individual program directors of each of the 240 residencies. The survey included questions on educational content, format, number of hours taught, availability of conference credit, offering of an elective or fellowship, and several predefined WM curricula. We evaluated differences between 3-y and 4-y residencies using the χ² test, where P<0.05 was considered significant.

RESULTS

We had a response rate of 57% for completed surveys. Analysis showed 63% of respondent programs teach WM material. The majority (86%) partially or completely developed their curriculum, with 33% offering at least 1 of the predefined curricula. Thirteen percent taught with lecture only, 2% taught by hands-on only, and 85% used a combination of the 2. WM electives were significantly more likely to be offered by 4-y than 3-y residencies (P=0.009).

CONCLUSIONS

Almost two-thirds of respondent residency programs teach WM material. Of these, only one-third teach any of the predefined curricula. Four-year residencies are more likely to offer WM electives but are otherwise comparable to 3-y programs.

Wilderness Medicine Education in the Time of Social Distancing and COVID-19

Wilderness medicine (WM) education has traditionally been conducted as in-person training. The current COVID-19 pandemic has forced medical schools to cancel clerkships and clinical electives and pivot to remote education. With online media modalities, it is possible to conduct a WM student elective remotely. The use of recorded audio lectures, instructional videos, choice-based simulations, and video conferencing allows students access to nearly all necessary content under the guidance of instructors. Although hands-on practicums are still essential to WM education, the process outlined here enables a temporary alternative during the time of necessary social distancing.

Medicine in Extreme Environments: A New Medical Student Elective Class for Wilderness, Aerospace, Hyperbaric, Exercise, and Combat Medicine

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.