Acute Fatigue Responses to Occupational Training in Military Personnel: A Systematic Review and Meta-Analysis

Optimising Combat Readiness: Practical Strategies for Integrating Physiological and Psychological Resilience in Soldier Training

This narrative review examines the intricate psychophysiological interplay between cognitive functions and physical responses within military personnel engaged in combat. It elucidates the spectrum of responses elicited by symmetric and asymmetric warfare alongside specialised combat scenarios, including close-quarters and subterranean warfare. Central to this discourse is the emphasis on integrating training programs beyond physical conditioning to encompass psychological resilience and decision-making efficacy under duress. The exploration further ventures into applying advanced technologies such as virtual reality and wearable devices, highlighting their pivotal role in augmenting training outcomes and supporting soldier health. Through a detailed analysis of psychophysiological variations across different military branches of service, the narrative review advocates for bespoke training regimens and support frameworks tailored to address the unique exigencies of each service branch. Concluding observations stress the importance of evolving military training paradigms, advocating for adopting realistic, immersive training simulations that mirror the complexities of the contemporary battlefield. This synthesis aims to contribute to the ongoing discourse on optimising military training protocols and enhancing the operational readiness and well-being of armed forces personnel. This narrative review is essential for military psychologists, trainers, and policymakers, aiming to bridge the gap between theoretical knowledge and practical implementation in military training programs.

Changes in physical performance, body composition and physical training during military operations: systematic review and meta-analysis

Systematic review and meta-analysis applying PRISMA guidelines with a PICOS format was constructed to provide an overview of changes in physical performance, body composition and physical training in soldiers during prolonged (≥ 3 months) military operations. Twenty-four studies out of the screened 4431 records filled the inclusion criteria. A small decrease in endurance performance was the most consistent finding (Hedge's g [g] - 0.21, 95% CI - 0.01 to - 0.41) while small overall increases in maximal strength of the lower (g 0.33, 95% CI 0.16-0.50) and upper body (g 0.33, 95% CI 0.19-0.46) were observed. In addition, small increases in strength endurance (push-up, g 0.34, 95% CI 0.15-0.52; sit-up g 0.26, 95% CI 0.07-0.44) were observed. The overall changes in body composition were trivial. Heterogeneity in the outcome variables varied mainly between low to moderate. Large inter-individual variations were observed in physical training volume, including decrements especially in endurance training frequency and volume. A reduction in total training load was often associated with negative changes in body composition and physical performance according to the principle of training specificity. Individuals with higher initial fitness level were more susceptible to decrements in their physical performance during operation.

A Mixed-Methods Systematic Review of Group Reflective Practice in Medical Students

BACKGROUND

Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and professionalism in medical students.

METHODS

Electronic searches of empirical studies published between 1 January 2010 and 22 March 2022 from Medline, Embase, and PsychINFO databases were conducted. Empirical studies of any design (qualitative or quantitative) which included RP (1) involving medical students; (2) with a focus on fostering empathy, or professionalism, or personal wellbeing; and (3) provided in a group setting were included. Duplicates, non-English articles, grey literature and articles using RP to examine pedagogy and specific technical skills were excluded. Both authors screened articles independently to derive a final list of included studies, with any discrepancies resolved by discussion, until consensus reached. Articles were rated for methodological quality using the Attree and Milton checklist for qualitative studies; the Oxford Centre for Evidence-Based Medicine criteria, and the Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative studies.

RESULTS

Of 314 articles identified, 18 were included: 9 qualitative; 4 quantitative and 5 mixed methodology. Settings included United States (6), United Kingdom (3), Australia (3), France (2), Taiwan (2), Germany (1), and Ireland (1). Themes were (i) professionalism: bridging theoretical paradigms and practice; (ii) halting empathy decline; (iii) wellbeing: shared experience. Additional themes regarding the "successful" delivery of RP groups in facilitating these outcomes also emerged.

CONCLUSIONS

This first systematic review of group RP in medical students shows that RP may bring theory to life in clinical dilemmas, while fostering collegiality and mitigating against isolation amongst students, despite the absence of studies directly examining wellbeing. These findings support the value of RP integration focusing on emotive and humanitarian processes into contemporary medical education for medical students.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022322496.