Expectations of WMA Instructors

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Expectations of WMA Instructors ...............................................................................2 Intent and Purpose of the Evaluation Process and Evaluation Form......................9 Assistant Instructor’s Feedback for Lead Instructor ...............................................12 Evaluation Form for Lecture .....................................................................................14 Evaluation Form for PAS (2:1) Drills ..........................................................................18 Evaluation Form for Skill-Based Exercise ................................................................22 Overall Assessment of the Assistant’s Progress as an Instructor ...........................25 Appendix A: Goals and Objectives - Definitions and Examples ........................27 Appendix B: Lesson Plan Template ........................................................................34 Appendix C: Lesson Plan – Nervous System Lecture ............................................36 Appendix D: Lesson Plan (PAS Drill) .......................................................................39 Appendix E: Continuum of Student Learning ........................................................42 Appendix F: WMA Student Skills Checklist ............................................................48 Appendix G: The Art (and Science?) of Giving Feedback..................................50 Appendix H: Preparing, Facilitating, and Debriefing Quality Scenarios ............51

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WMA expects instructors to have strong foundations in three general areas: emergency medicine, backcountry travel, and teaching. Prior to becoming WMA instructors, it is assumed that instructor candidates will have fairly extensive backgrounds in the first two areas (emergency medicine and backcountry travel). Once candidates become instructors, it is expected that they will continue to develop their teaching skills, as well as their knowledge of the WMA curricula. This document provides an overview of the kinds of teaching competencies that WMA instructors should acquire over time; however, it is not a detailed checklist of the types of skills that every WMA instructor must have at the time she is hired.

It is essential that instructors always keep in mind that the purpose of WMA’s courses is to help students obtain and retain new information that they can use at a later date, after a course ends. To be successful in achieving this purpose, instructors need to be intimately familiar with the WMA curricula, and they also need to be skilled at presenting course materials.

Knowledge of WMA Curricula. WMA instructors should understand the difference between goals and objectives, and they should teach with course goals and objectives in mind. A course goal is a single overall statement that describes what students will gain from a course. Objectives describe the measurable steps that learners will take on the way to reaching a goal. For example, the following statement might be a goal of a wilderness medicine course: “This course will provide a cognitive base and will introduce basic skills, so that participants will be better able to assess and manage a variety of trauma-related injuries, environmental challenges, and medical emergencies.” An objective, on the other hand, might read, “By the end of this course, students will be able to demonstrate proper technique for stopping bleeding and cleaning a wound.” Ultimately, if learners achieve all course objectives, one can be confident that the course goal also was achieved. WMA instructors are expected to have a clear understanding of the goals and learning objectives of every course they teach (e.g., WFA, WAFA, or WFR). (See Appendix A: Goals and Objectives of WMA Courses.) If an instructor teaches more than one type of course, he is expected to know the differences between the goals and objectives of each course type. Because the WMA PowerPoint slides are a primary method for disseminating information, instructors are expected to be thoroughly familiar with the slides, including the key learning points of each. Instructors also should be able to clearly differentiate Rev 04/2012

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between need-to-know and nice-to-know information for each course topic. (For assistance in this area, refer to the slides marked with asterisks, as well as the instructor notes that accompany each slide.) In addition, instructors are expected to be thoroughly familiar with all supplemental teaching resources that are relevant to each course they teach. This might include, but would not be limited to, information found in the WARM textbook, in the WMA field guide, and in the WMA workbook. If instructors would like to use non-WMA sanctioned resources (such as videos or texts) as part of their courses, they must first receive permission from the WMA office. Instructors are expected to stay current on changes that occur over time to WMA’s curricula, emphasis points, and teaching resources. This can be achieved through a variety of methods, such as attending IMs, reading e-mails sent from the WMA office, reviewing new materials as they are released, and contacting WMA’s office personnel. If and when instructors find discrepancies (content differences) between what they teach and what other instructors teach, they are expected to contact the WMA office for clarification. Differences in style (how one teaches) generally are allowed.

General Presentation of Materials. Although WMA instructors are not required to write and use formal lesson plans, they are expected to be familiar with lesson planning and should be able to use lesson plans appropriately. (See Appendix B: Sample Lesson Plans.) Instructors should be able to present material in a clear, organized, and logical manner/order. Not only are instructors expected to have a clear understanding of the differences between need-to-know information and nice-to-know information (see above), but they also are expected to clarify these differences for students via lectures, PAS drills, scenarios, and debriefs. Curriculum should be presented and emphasized accordingly. For example, need-to-know information typically should be presented early on in a lecture, and the majority of time spent and examples provided during the lecture should focus on need-to-know material.

Oratory Skills. WMA instructors are expected to be engaging presenters. They are expected to be able to hold the attention of students, to vary their tones enough so that students do not become bored or confused, and to limits “ahs” and/or other distracting mannerisms.

Use of PowerPoint Slides. WMA instructors are expected to refer to PowerPoint slides frequently, but they should limit the amount of time they spend reading from the screen and turning their backs to their audiences. Instructors should understand the intent of each slide. (The intent is provided in the instructor notes that accompany the slides.)

Listening Skills and Creating Positive Learning Environments. WMA instructors are expected to have good listening skills. Instructors should not interrupt students while they are speaking and should allow students to finish speaking before attempting to answer questions. In addition, instructors should answer questions directly whenever possible; Rev 04/2012

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that is they should answer yes/no questions with a yes or no answer before moving on and explaining themselves or identifying exceptions. Instructors should create atmospheres in which it is acceptable for students to express themselves, to ask questions, and to make (and learn from) mistakes. Instructors also should be skilled in answering a variety of questions, including but not limited to, inquiries that seem basic or out-of-context, what-if questions, questions that do not have right or wrong answers, and questions that may seem controversial or inappropriate. Instructors should be able to assess nonverbal communication. They should be able to read body language and understand non-verbal indicators (such as voice tone) that indicate embarrassment, stress, or lack of understanding. WMA instructors are expected to maintain professional classroom behaviors and appropriate student-instructor relationships throughout a course. This includes, but is not limited to, the following: Instructors should use humor appropriately; they should limit their use of profanity; they should not favor certain students over others; they should not use potentially offensive or discriminatory remarks; they should be able to tactfully address side talking or other disruptive student behaviors; and they should be able to tactfully confront students who use profanity excessively or who display other potentially offensive habits.

Time Management. WMA instructors should be able to effectively manage time and the flow of classroom activities. Instructors should understand that very little learning and retention takes place after 45 minutes of lecturing; thus, lectures should be kept to a reasonable length of time (generally an hour or less). Instructors should incorporate regular breaks and should limit the breaks to an appropriate length of time. If instructors need to leave the classroom (to prep patients, for instance), then they should be able to offer ideas to students who will be left behind so that the time can be used constructively by everyone.

Use of Case Studies and Stories. WMA instructors should be able to effectively use applicable case studies/stories to make points. Before deciding to use a case study, however, an instructor should consider the story’s relevance and applicability. Instructors should be able to guide student learning by emphasizing each case study’s teaching points and by asking questions that require critical thinking. Although many instructors assume that learning points are obvious to students, studies have shown that this often is not the case. (*Insert citation here.) In fact, students learn better when instructors clearly spell out the learning points associated with case studies, analogies, and metaphors. Instructors should curb war stories that have limited applicability to a topic’s objectives.

Facilitating Skill-Based Exercises and Evaluating Student Performance. WMA instructors should be familiar with the fundamentals of pedagogy and sequential Rev 04/2012

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learning, and these concepts should be used when presenting and evaluating skillbased exercises. Pedagogy is the effective process of teaching whereby stated goals and objectives are achieved and students’ backgrounds and experiences are taken into account. A detailed description of sequential learning is provided below. Sequential learning, sometimes referred to as the student learning progression, includes the following: 1) recognition, 2) recall, 3) understanding, and 4) critical thinking. Students start by learning to recognize an ideal when the ideal is compared to something non-ideal. Beginning students, for example, will learn to recognize a well-built splint before they are able to explain why one splint is better than another. After they master this first step, students learn to recall. For instance, they will be able to build a splint that is identical to one they have seen before. When students progress to a level of understanding, they will be able to use new or improvised materials to build splints, and they will be able to evaluate splints for their effectiveness. Only after students have progressed through these first three stages will they be able to think critically, a skill that will allow them to use all new materials to immobilize and package a different limb while working in a potentially hostile environment. Students who think critically also should be able to identify treatment and environmental factors that can make ischemia more or less likely when they are managing unstable extremity injuries. For instance, they should be able to note that tight splints, cold weather, and a history of frostbite can all contribute to ischemia, whereas a soft, adjustable splint, removal of jewelry, and hydration can improve perfusion. To help support student learning, WMA instructors should be highly effective in demonstrating skills, and they should be able to perform the skills without error. Further, given that students first must master stages one and two (recognition and recall) before they can move on to stages three and four (understanding and critical thinking), instructors should take steps to ensure that learning is sequential. That is, students should see a skill demonstrated, and then they should be asked to mimic the skill as it was presented. After students are able to mirror the skill, instructors should challenge them to perform it in a modified context (e.g., using different equipment, in a different environment). For additional information on the student learning progression, see Appendix C: Overview of Student Learning, and Appendix D: Emphasizing Critical Thinking Skills in WMA Courses. Prior to allowing students practice time, instructors should identify skill objectives so that the students know what is expected of them. Instructors should understand the ramifications of taking “shortcuts” when demonstrating skills (i.e., saying, “if this was ‘for real,’ I would …” ), and they should try to eliminate this practice. Instructors should be skilled in offering positive feedback as well as constructive feedback to students, and the feedback should be based on objective criteria. (See Appendix E: WMA Skills Checklist). When giving feedback, instructors should explain to students why their answers or performances meet or fall below expectations, and they should give students opportunities to correct mistakes. Studies have shown that significant increases in student learning occur when students are given an opportunity to work on a task until it is completed and accurate (*Insert citation here). How and when remediation will take place, whether it will be immediate, later that day, or later Rev 04/2012

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in a course, will be left up to instructors. Repeat lessons might involve similar tasks or they might include totally different teaching methods (for more information on providing feedback, see Appendix F: The Art – and Science? – of Giving Feedback).

Creating, Presenting, and Debriefing PAS Drills. WMA instructors should be able to create PAS drills so that teaching points are appropriate to the curricula. Key teaching/learning points should be emphasized, and drills should be used to help students assimilate these points. Instructors are expected to have effective debriefing skills and they should understand how to guide student learning via debriefs. Instructors also should be skilled in offering positive feedback as well as constructive feedback to students, as noted above, and specific feedback should be based on objective criteria such as those found in Appendix E: WMA Skills Checklist. Instructors should give students opportunities to correct mistakes. How and when remediation takes place will be left up to instructors.

Creating, Presenting, and Debriefing Scenarios. WMA instructors should be effective at creating scenarios that are appropriate to course content and student abilities. Steps involved in this process might include, but would not be limited to, the following: clearly identify primary teaching/learning points; include both assessment and treatment roles in patient profiles; give consideration to the roles students take or are assigned (e.g., primary caregiver, incident commander, or patient), and prep students appropriately for their roles. If more than one scenario is used in a single course, each scenario’s teaching points should reflect where students are in their learning progression. (For additional information, refer to Appendix C: Overview of Student Learning, and Appendix G: Preparing, Facilitating, and Debriefing Quality Scenarios.) Instructors should be skilled at using video recordings to highlight teaching points and to assist in debriefing scenarios. It is expected that instructors will use video recordings during WAFA, Bridge, WFR, WEMT, and WALS scenarios. Instructors should determine teaching points prior to video recording, and questions used during video recording should address these points. Instructors should be careful not to embarrass students during video recordings and debriefings. For ideas on how to effectively use video recordings, refer to Appendix G (Preparing, Facilitating, and Debriefing Quality Scenarios).

As noted earlier, it is essential that instructors keep in mind that the purpose of WMA’s courses is to help students obtain and retain new information that they can use at a later date, after a course ends. To know whether or not an instructor’s teaching methods have been effective, students should be evaluated to see if the information has been retained, if the knowledge can be applied, and if the basic skills can be performed correctly. An evaluation of a student’s progress should be based on course objectives. The methods instructors choose to evaluate participants, whether it be by quizzes, observation, formal skill testing, or final exam, is up to them, but all instructors are Rev 04/2012

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encouraged to incorporate myriad assessment techniques throughout each course. (For ideas on assessment tools, see Appendix H: Sample Assessment Tools and Methods.) WMA instructors should be able to identify where students or groups are on the learning continuum (i.e., recognition, recall, understanding, and critical thinking). Instructors should have the ability to anticipate where students are likely to stumble when it comes to concepts or skills that are difficult to master. They also should be skilled at preventing such foreseeable problems. WMA instructors should have the ability to modify their plans according to student progress. They should be effective at watching groups for fatigue or errors, and they should be willing and able to assist students who struggle.

In addition to meeting the expectations outlined in this document, WMA lead instructors also need to support assistant instructors in their professional development. Lead instructors should keep in mind that assistant instructors are, in essence, students who are learning to teach. As students, assistant instructors need opportunities to practice and need to be allowed to make mistakes. Assistant instructors need direct and ongoing feedback, and they should be given opportunities to correct errors.

Prior to a Course Start. A lead instructor is expected to contact an assistant instructor prior to a course start to find out where that assistant is in regard to instructor development. By obtaining an accurate baseline of an assistant’s skill level and experience, a lead instructor can come up with a plan of action that best meets the assistant’s professional goals. That is, if an assistant is fairly new to teaching, she might benefit most from developing a better understanding of the curriculum and from learning to differentiate between need-to-know and nice-to-know information. An assistant instructor who is at the level of recall should be able to mimic what he has seen other instructors do. An assistant who is at the level of understanding in the learning continuum should be encouraged to teach lectures and to create PAS drills or scenarios that are different from what she has observed. Finally, an experienced assistant instructor who is ready to upgrade to lead instructor status should be encouraged to create his own lesson plans, to incorporate new and creative teaching methods, and to complete a self-assessment after each course. Before a course starts, lead and assistant instructors should divide teaching assignments. The assignments should be based on the following priorities: 1) the needs of the students, 2) the professional development goals of the assistant, and 3) the needs of the lead instructor (such as convenience or emotional satisfaction).

Prior to and During an Assistant Instructor’s Presentation(s). Once topics are assigned, lead instructors are expected to ensure that assistant instructors are familiar with course goals and objectives and are able to differentiate between need-to-know and nice-to-know information. This step should occur before assistants present material Rev 04/2012

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to students. Lead instructors should ensure that assistants are familiar with the learning points that commonly challenge students and are developing tools for managing such challenges. Lead instructors also should help assistants minimize content errors. Whenever possible, lead instructors are expected to avoid interrupting assistant instructors who are presenting information to students. Assistants should be allowed to make mistakes as long as the mistakes are relatively minor in nature, do not affect the integrity of the curriculum or the safety of the students, and can be corrected later. It is preferable for assistant instructors to correct their own mistakes, whenever possible. In order to help assistants grow professionally, lead instructors should take time to explain to assistants why they do things the way that they do. Leads might, for instance, explain why particular patient profiles are chosen, or why make-up is used in certain instances but not in others. Lead instructors should keep in mind that an assistant who mirrors her role model is still at a relatively elementary stage in her professional development. In fact, lead instructors should encourage assistants to develop their own styles of teaching.

Following an Assistant Instructor’s Presentation(s) and Throughout a Course. Lead instructors are expected to provide ongoing feedback to assistant instructors, and the feedback should be based on the TOAST principles: timely, objective, well aimed, specific, and tactful (See Appendix F: The Art – and Science? – of Giving Feedback). Whenever possible, instructors are expected to provide opportunities for assistants to “try again” so that assistants can ultimately learn from their errors and achieve success.

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The intent of the WMA evaluation process and the purpose of filling out these forms is threefold: 1) By completing these forms, you will be providing valuable feedback to assistant instructors. Assistants can use the feedback they receive to modify and improve their techniques. They can also use the feedback to develop a solid understanding of where their focus for improvement should lie. 2) Your feedback can help WMA’s administrative personnel assess each assistant’s progress. Just as “trends over time” is an important concept in wilderness medicine, an assistant’s “trend over time” (i.e., learning progression) also is important to gauge. By gathering numerous evaluations from a variety of sources (e.g., from various lead instructors, from students, and from selfassessments), WMA can develop a better understanding of an assistant’s needs, strengths and progress. Completed evaluations can be used to assess whether or not assistant instructors are meeting WMA’s various expectations. (For details, see Expectations document.) 3) Given that WMA International now teaches courses in a number of countries and is planning on expanding its offices to include locations outside of North America, it is critical that WMA create and implement a workable quality control system for assessing its instructors. We would like this system to be minimally burdensome yet functional. Your cooperation in filling out these forms this can help us achieve this goal. We believe that your buy-in to this process is crucial to WMA’s success. WMA has grown to the point that we can no longer rely on instructor word-of-mouth and /or a few phone calls to stay on top of each assistant’s status. By taking a more assertive approach toward quality control, we hope to maintain an accurate and up-to-date assessment of the entire WMA employee pool, and we hope to maintain the high quality of instruction that has historically been our strength.

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The following text provides directions for completing and returning the evaluation forms. If you have any questions, please be sure to contact the WMA office for assistance.

What to Evaluate. Lead instructors are expected to evaluate each assistant instructor in three categories per course. The categories include one lecture, one non-lecture, and an overall assessment of an assistant’s progress as an instructor. A non-lecture is either a PAS drill or the demonstration of a skill. Evaluation forms are one page in length (single page, double-sided). These forms are included in course paperwork and are available on the WMA website. There are no more than 12 questions on each evaluation form. Some questions require simple yes-no answers. Some questions require thoughtful responses. Please keep in mind that the more specific the feedback, the more beneficial it is to the recipient.

When to Evaluate. The first two evaluation forms (lecture and non-lecture) are to be completed at the time of an assistant’s presentation (not later). By completing these forms at the time one observes an assistant in action, a lead instructor can give his or her undivided attention to the assistant and he or she can provide examples that are fresh and specific. By closely observing an assistant and by sharing those observations with the assistant that day, the feedback will be more timely. The third evaluation form (the assessment of the assistant’s progress) can be completed at anytime during a course. The only requirement is that it be completed by the end of the course. A lead instructor can fill out the forms by using any one of three methods: a. By completing the evaluation forms that are available on WMA’s website; b. By using the forms that are included in your course paperwork; or, c. By typing feedback onto an electronic form which can be obtained from the WMA office. This new process will result in more specific and timely feedback, and it will eliminate the need for leads to complete a feedback form on the last day of class.

What to do with the Feedback. Lead instructors are expected to show all three evaluation forms to assistants as soon as they are able. Ideally this would occur immediately following an assistant’s presentation, and ideally the feedback would lead to a productive debriefing session between a lead instructor and an assistant. At the very least, assistants should be able to review the evaluations prior to the end of that day.

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If you complete the forms by hand, you will need to send the forms to WMA along with course paperwork. If you don’t have easy access to the internet, WMA will help you download blank forms onto your computer. You can then email the completed evaluations to WMA when you are able. If you use the WMA website to complete the forms, no additional action will be required of you.

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This form is designed to be used alongside the document titled Expectations of WMA Instructors. Please read the Expectations document in its entirety and pay close attention to the final section, Expectations of Lead Instructors: Supporting the Development of Assistant Instructors, before completing this form. The purpose of this form is to help assess whether or not lead instructors are meeting expectations in their roles as coaches and helpers. The final section of the Expectations document will be used as the basis for the feedback that you provide here. The bullet points on this feedback form summarize the expectations that are outlined in the final section of the Expectations document and have been provided here as prompts for your comments. It is not necessary to comment on every individual bullet point, but when you have observations that illustrate whether or not an instructor exceeds, meets, or does not meet an expectation, please share them. Your observations will assist your fellow instructor in his or her professional development. Feedback is most beneficial when it is timely, objective, aimed at the right person, specific, and tactful (TOAST). Consequently, you are highly encouraged to cite specific examples from a course and to note observations during a course and on an ongoing basis, rather than waiting until the end of a course. Course Type: _______________________

Course Dates: ______________________________

Course Sponsor: ________________________________________________________________ Form Completed by: _____________________________________________________ Feedback for (Lead Instructor): ____________________________________________________

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Prior to a Course Start: Contacts assistant to assess where the assistant is on the instructor development continuum. Assigns teaching topics in a way that prioritizes the needs of the students first, the developmental goals of the assistant instructor second, and his or her own needs third. Takes steps to ensure that the assistant is familiar with course goals and objectives. Comments: _______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Prior to and During an Assistant Instructor’s Presentation(s): Aids assistant in identifying need-to-know versus nice-to-know information Ensures that assistant is familiar with learning points that commonly challenge students, and helps to equip assistant with tools for managing these challenges Helps assistant to minimize content errors while allowing for style development Minimizes interruptions during presentations Allows assistant to make minor mistakes as long as those mistakes do not affect the integrity of the curricula or the safety of students, and can be corrected later Comments: _______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Following an Assistant Instructor’s Presentation(s) and Throughout a Course: Provides assistant with opportunities to correct mistakes Provides feedback on an ongoing basis that is timely, objective, aimed at the assistant, specific, and tactful Provides opportunity for remediation Comments: _______________________________________________________________________________ _____________________________________________________________________________________ Rev 04/2012

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TOPIC (circle one):

General Principles Circulatory System Respiratory System Nervous System Asthma Allergies and Anaphylaxis Musculoskeletal Wounds and Burns Thermoregulation Name of Evaluator: Name of Assistant Instructor: Date:

Type of Course:

1. Does the assist have solid knowledge of the key points (i.e., “need to know” information) WMA would like emphasized for this lecture? Yes

No

_____________________________________________________________________________________ _____________________________________________________________________________________

2. Does the assistant begin the lecture by summarizing key points and does the assistant end the lecture by summarizing the key points?

Yes

No

_____________________________________________________________________________________ _____________________________________________________________________________________

3. Does the assistant effectively explain to the students why this lecture and the key points are important and applicable?

Yes

No

4. Provide a summary of your assessment of the assistant’s overall knowledge and presentation of this topic: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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5. Does the assistant go under or over the time allotment for this lecture, or were they right on? If they went under or over, describe why this occurred. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

6. How much time (how many minutes) was spent on “need to know” information? _____________________________________________________________________________________ _____________________________________________________________________________________

7. How much time (how many minutes) was spent on “nice to know” information? _____________________________________________________________________________________ _____________________________________________________________________________________

8. Case studies, examples, and videos are often used to emphasize points during a lecture. If any of these methods was used, describe why it was relevant and effective or irrelevant and ineffective. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

9. WMA expects instructors to limit reading from slides and turning their backs to the audience during lectures. How well does the assistant achieve this expectation? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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New instructors commonly feel the need to say something about every slide in a PowerPoint presentation, even though some slides have been designated as “nice to know,” or a lecture is running long, or a slide is redundant to what’s already been presented. Additionally, some assistants are not familiar with the intent of all of the slides in a lecture, and they end up stumbling when it comes to explaining the slide to students.

10. Describe your impression of the assistant’s familiarity with the slides, his or her understanding of the intent of the slides, and of his or her ability to move through the slides at an appropriate pace and thoroughness. Please be specific. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

11. WMA instructors are expected to be engaging lecturers, to vary their voice tones, and to limit “ahs” and/or other distracting mannerisms. How well does the assistant instructor achieve this expectation during this lecture? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

12. WMA expects instructors to let students finish asking a question before the instructor begins to answer the question. Does the assistant consistently let students finish their questions? Yes

No

Comments:

_____________________________________________________________________________________ _____________________________________________________________________________________ Rev 04/2012

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13. It is important that WMA instructors can assess whether or not students understand the material that is presented in a lecture. Describe the assistant’s ability to accurately read an audience in regard to their understanding. Please be specific. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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TOPIC: Please describe the drill observed (e.g., one patient and two rescuers working on a respiratory system problem) Name of Evaluator: Name of Assistant Instructor: Date:

Type of Course:

New instructors often simply mimic what they’ve seen other instructors do. Ultimately, however, it is important that an instructor has a solid understanding of the intent of each drill he or she conducts. Is the goal of the drill, for example, to have students practice their assessments? Or is it to write comprehensive SOAP notes, to hone their treatments, or to determine whether or not a patient would require an urgent evacuation?

1a. Does the assistant identify and articulate to the lead instructor the key teaching points of the drill prior to the execution of the drill? If so, please list the key teaching points here. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

1b. If teaching points were not identified, in what ways did this affect the success of the drill? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ In order for 2:1 drills to run smoothly, for confusion to be minimized, and for teaching points to be highlighted, patients must be given decent briefings of their roles.

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2. How effective was the assistant in briefing the patients on their roles? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

3. How well did the assistant instructor manage or provide direction for the studentrescuers who were left unsupervised? That is, was the time well managed, were the student-rescuers given educational or course-related tasks, or did the student-rescuers spend most of the prep time sitting around? (Examples of educational tasks might include asking students to complete a case study from the workbook, asking them to practice vitals, etc.). Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

4. In order for a 2:1 drill to run smoothly, rescuers also need to be briefed regarding their roles. How effectively were the rescuers briefed prior to the start of the drill? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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5. Did the rescuers understand the goal and objectives of the drill? (E.g., was it clear to rescuers that the goal was to write a comprehensive SOAP note, or was the goal to provide quality treatment, or was the goal for rescuers to determine whether or not a patient would require an urgent evacuation?) Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Ideally, instructors will provide some guidance and feedback during the execution of a drill; however, the amount of interaction, correction, and interruptions should be kept to a minimum so that students can attempt to practice and achieve success on their own. Too little assistance from an instructor can lead to frustration on the part of the students. Too much feedback (especially feedback that is directed to an individual or small group) can lead to time management problems. Typically, it works best when 2:1 drills are debriefed with a whole class after the drill ends. Debriefing with small groups during drills often is done at the expense of the class as a whole.

6. Keeping the above text in mind, how well did the assistant do in executing the drill? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

WMA instructors should be in the habit of providing effective feedback to students. Effective feedback is timely, objective, aimed at the right person, specific, and tactful (TOAST). Often feedback is too vague, generic (given to a group, not an individual) and subjective.

7. Please give one or two examples of quality feedback the assistant provided during the debrief. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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8. How effective was this drill in bettering the students’ understanding of course material? Please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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TOPIC (circle one):

Splinting Wound Cleaning Spine Assessment Hypo Wrap Shoulder Reduction Spine Packaging (backboard or litter) Physical Exam (head to toe assessment) Name of Evaluator: Name of Assistant Instructor: Date:

Type of Course:

1. Does the assistant have all equipment / supplies prepped ahead of time? Yes

No

2. Does the assistant explain to the class the exercise’s goal and objectives so that students know what is expected of them and they know how they will be evaluated? Yes

No

If not, please explain. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Instructors should understand the ramifications of taking shortcuts (i.e., saying “If this was for real, I would …”) when demonstrating skills, and shortcuts should be avoided whenever possible.

3. Does the assistant demonstrate the skill from start to finish without interruption? Yes

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As a normal part of student learning (i.e., recall), students will mimic exactly what they see. With this in mind, WMA instructors should be highly effective in demonstrating skills and performing the skills without error.

4. Does the assistant perform the skill or demo without error? Yes

No

5. If mistakes (even minor mistakes) were made during the demonstration, please identify them here so that the assistant knows what can be done to improve. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

6. Does the assistant provide clear, simple, step-by-step directions to the students prior to letting them attempt the skill on their own? Yes

No

WMA instructors should incorporate sequential learning into their skill demonstrations and practice sessions. That is, students should see a skill demonstration and then mimic the skill as presented. After students are able to mimic the skill, instructors should challenge then to perform it in a modified context (i.e., different equipment, different environment).

7. In what ways does the assistant take steps to ensure that learning is sequential? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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WMA instructors should be in the habit of providing effective feedback to students. Effective feedback is timely, objective, aimed at the right person, specific, and tactful (TOAST). Often feedback is too vague, generic (given to a group, not an individual) and subjective.

8. Please give one or two examples of quality feedback the assistant provided to students during or immediately after the student practice session. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Students should have a good idea of what is expected of them, they should understand what is meant by acceptable performance, and they should know how they will be evaluated. Additionally, feedback should be based on objective criteria.

9. Is the assistant’s feedback to students based on objective criteria? Yes

No

Adult learners tend to benefit tremendously if/when they are given opportunities to “try again” after being evaluated. That is, they learn from their mistakes, but they learn best when they are given opportunities to correct their mistakes.

10. In what ways does the assistant create opportunities so that students can learn from and correct their mistakes? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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OVERALL ASSESSMENT OF THE ASSISTANT’S PROGRESS AS AN INSTRUCTOR Name of Evaluator: Name of Assistant Instructor: Date:

Type of Course:

As our students move through the learning progression, so do we as instructors. New assistants generally are in the recognition phase during their first couple courses. That is, they can recognize what a good instructor is and what one looks like, but they are not able to explain exactly what makes one instructor better than another nor do they truly understand what makes an instructor good in the first place. With greater exposure to teaching and more practice, an assistant is able to move to the recall stage. This does not have to with their knowledge of the curricula. Instead, it has to do with their knowledge of how to teach the curricula. Assistants at this stage will begin to mimic what other instructors do. Lead instructors should be aware: Just because an assistant mimics a lead’s style does not mean that the assistant understands how to teach. By definition, assistants at the recall level still lack the ability to understand what makes for good teaching. When instructors move to the level of understanding, they have the ability to create, facilitate and debrief effective drills and scenarios; they are able to accurately assess students’ understanding of material; and they can modify what and how they teach to better reach the students who are struggling. Once instructors move beyond the level of understanding, they can begin to critically think: That is, they can think on the fly. They can create effective PAS drills with minimal preparation. They can create and facilitate fun and challenging scenarios that emphasize key learning points. They can modify drills that they’ve seen or used in the past to better meet the needs of each class. In your opinion, where along the learning continuum (recognition, recall, understanding, critical thinking) do you think the assistant is at this time? Please thoroughly explain your answer. _____________________________________________________________________________________ _____________________________________________________________________________________ Rev 04/2012

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_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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Definition and Example of a Goal: A goal is a desired outcome. It usually is a somewhat global or abstract concept that is hard to measure. For example, a goal of the Wilderness First Responder is to provide a framework so that participants will be better able to assess and manage a variety of traumatic and non-traumatic injuries in non-urban environments.

Definition and Example of an Objective: Objectives, by definition, are measureable benchmarks that can be used to let one know whether or not a goal has been achieved. Consequently, objectives need to include verbs or action words, and they need to include timelines. For example, an objective might read, “By the end of the course, students will be able to differentiate … they will be able to explain … they will be able to demonstrate …”

Purpose of Goals and Objectives: Goals provide a purpose or intent of a course or a lecture. Objectives provide a means for evaluating success. An instructor’s assessment of student success, in fact, and the questions used on quizzes and exams, should correlate directly with course objectives. Assuming objectives are well-written, one should be able to reason that if all objectives are achieved, the corresponding goal has been met.

Example of a WFR sub-goal and corresponding objectives: A sub-goal of the WFR course is to help students learn the signs, symptoms, and causes of asthma, and to learn to respond appropriately in asthma-related emergencies. The corresponding objectives for this goal might read as follows: By the end of the course, students will be able to differentiate the signs and symptoms of a patient who is experiencing respiratory distress from the signs and symptoms of a patient who is in respiratory failure due to an asthma attack. Students also will be able to demonstrate the proper treatment for respiratory distress versus respiratory failure due to an asthma attack. A determination of whether or not the asthma sub-goal is met would require evaluating whether or not each of the correlating objectives has been achieved.

GOALS AND OBJECTIVES: WILDERNESS FIRST RESPONDER Course Description: The Wilderness First Responder provides the knowledge and skills necessary for caregivers to administer basic emergency and medical care in nonurban environments. The course curricula provides an introduction to anatomy and physiology, assessment and management of life-threatening injuries and conditions, assessment and management of non-life-threatening injuries and conditions, appropriate short-term to multi-day patient care, and evacuation considerations. Rev 04/2012

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Overall Course Goal: The goal of the Wilderness First Responder is to provide a cognitive base, to introduce treatment options, and to provide opportunities for practice, so that participants will be better able to assess and manage a variety of traumatic and non-traumatic injuries in non-urban environments.

SUB-GOALS AND OBJECTIVES OF THE WILDERNESS FIRST RESPONDER Sub-Goal #1: Overview of Wilderness Medicine. Sub-goal #1 is to help students understand that there are general principles of medicine and physiology that can apply in nearly all backcountry emergency situations. By learning to apply these concepts, students will be better equipped to assess patients and anticipate problems.

Overview of Wilderness Medicine—Objectives: By the end of the course, students will be able to identify what is meant by a wilderness environment. Students will be able to identify how assessment and patient care differs between urban environments and wilderness environments. Students also will be able to describe problems that can and often are associated with delayed transport evacuations (such as swelling, temperatures, terrain, and the use of improvised materials).

Sub-Goal #2: The Patient Assessment System. Sub-goal #2 is to provide students with a system for collecting and organizing data in a manner that supports the development of an assessment and treatment plan.

The Patient Assessment System—Objectives: By the end of the course, students will be able to identify the parts of the patient assessment system. They will be able to demonstrate how to complete a physical exam for traumatic and non-traumatic patients. They will be able to demonstrate how to take vital signs and how to gather a SAMPLE history. They also will be able to identify things that can negatively affect or skew a patient assessment.

Sub-Goal #3: Organizing a SOAP note, Creating a Treatment Plan, and Effectively Communicating Key Information. Sub-goal #3 is for students to learn how to organize, assess, and summarize patient data in a format that allows for efficient planning and effective communication.

Organizing a SOAP note, Creating a Treatment Plan, and Effectively Communicating Key Information—Objectives: By the end of a course, students will be able to fill out a SOAP note. Students will be able to demonstrate how to create an accurate problem list and to develop a treatment plan by using the information obtained via a patient assessment. Students also will be able to identify anticipated problems that might develop if a patient’s definitive treatment is delayed. Students will be able to demonstrate how to effectively communicate their assessments as well as their plans for caring for various patients.

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Sub-Goal #4: Basic Life Support. Sub-goal #4 is for students to be able to provide a rapid assessment of the critical systems and to be able to provide basic life support to patients who are experiencing critical system problems.

Basic Life Support—Objectives: By the end of the course, students will be able to demonstrate the ability to assess the critical systems and to determine the need for rapid interventions. Students will be able to demonstrate proficiency in opening an airway, rescue breathing, foreign airway obstruction, and CPR. Students also will be able to demonstrate proficiency in using an AED.

Sub-Goal #5: Assessing and Managing Circulatory System Injuries. Sub-goal #5 is to help students better understand how the circulatory system works so that they’ll have the ability to assess whether or not a patient’s circulatory system has been injured, and so that they’ll have a basic understanding of how to manage circulatory injuries.

Assessing and Managing Circulatory System Injuries—Objectives: By the end of the course, students will be able to describe how the circulatory system works, and they will be able to explain the importance of blood pressure and perfusion. Students also will be able to identify how vital signs can be used to help determine if the circulatory system is working normally or abnormally. Students will be able to demonstrate how to provide basic treatment or management skills to a patient that is experiencing a variety of circulatory system problems.

Sub-Goal #6: Assessing and Managing Respiratory System Injuries. Sub-goal #6 is to help students better understand how the respiratory system works so that they’ll have the ability to assess whether or not a patient’s respiratory system has been injured, and so that they’ll have a basic understanding of how to manage respiratory injuries.

Assessing and Managing Respiratory System Injuries—Objectives: By the end of the course, students will be able to describe how the respiratory system is used to oxygenate and perfuse the human body. Students will be able to describe the difference between respiratory distress, respiratory failure, and respiratory arrest. Students will be able to list the parts of the respiratory system and they will be able to list the most common thing(s) that can go wrong with each part. Students will be able to demonstrate how to provide basic treatment to a patient who is experiencing respiratory distress.

Sub-Goal #7: Assessing and Treating Asthma. Sub-goal #7 is to help students learn the signs, symptoms, and causes of asthma, and to learn to respond appropriately in asthma-related emergencies.

Assessing and Treating Asthma—Objectives: By the end of the course, students will be able to differentiate the signs and symptoms of a patient who is experiencing respiratory distress from the signs and symptoms of a patient who is in respiratory failure due to an asthma attack. Students also will be able to demonstrate the proper treatment for respiratory distress versus respiratory failure due to an asthma attack.

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Sub-Goal #8: Assessing and Managing Nervous System Injuries. Sub-goal #8 is to help students better understand how the nervous system works so that they’ll have the ability to assess whether or not a patient’s nervous system has been injured, and so that they’ll have a basic understanding of how to manage nervous system injuries.

Assessing and Managing Nervous System Injuries—Objectives: By the end of the course, students will be able to describe how the STOPEATS acronym applies to the nervous system. Students will be able to identify early, reliable indicators of a traumatic brain injury as well as early indicators of increased intracranial pressure. Students will be able to demonstrate an ability to assess brain injured patients during hands-on exercises. Students will be able to describe the signs and symptoms of post-concussive syndrome. Students will be able to list at least three common indicators of stroke and will be able to demonstrate how to manage a patient who is seizing or who has seized.

Sub-Goal #9: Assessing and Managing Potential Spinal Column/Cord Injuries. Sub-goal #9 is to help students to learn to differentiate spinal column injuries from spinal cord injuries, and to learn to assess and manage patients who might have experienced spine-related injuries.

Assessing and Managing Potential Spinal Column/Cord Injuries—Objectives: By the end of the course, students will be able to describe the difference between the spinal column and spinal cord injuries. Students will be able to describe what is meant by a reliable patient. Students will be able to demonstrate a complete spine assessment—including an assessment of pain, point tenderness, and a motor-sensory exam—during hands-on exercises. Students also will be able to demonstrate how to move and roll a potentially spine-injured patient, and they will be able to demonstrate the ability to secure a potentially spine-injured patient onto a backboard or into a litter while working with other caregivers.

Sub-Goal #10: Assessing and Treating Soft Tissue Injures. Sub-goal #10 is to help students understand the purpose of skin and the potential consequences of skin injuries. The goal also is to help students become familiar with the normal healing process, to learn what hinders normal healing, and to learn how to manage and treat a variety of skin injuries.

Assessing and Treating Soft Tissue Injuries—Objectives: By the end of the course, students will be able to identify the normal healing process in soft tissue injuries as well as barriers that can affect the normal process. They will be able to identify and demonstrate steps to expose injury sites, to stop bleeding, and to clean and bandage wounds while using BSI techniques. Students will be able to identify wounds that have a high risk for infection and will be able to identify how the assessment and treatment of those wounds might differ from normal wound care. Students will be able to describe as well as demonstrate proper treatment of burns and blisters. Students also will be able to identify the context and situations in which removal of impaled objects is appropriate.

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Sub-Goal #11: Assessing and Managing Musculoskeletal Injuries. Sub-goal #11 is to help students learn to differentiate a stable (i.e., useable) from an unstable (i.e. nonuseable) extremity injury and to learn how to manage or treat each.

Assessing and Managing Musculoskeletal Injuries—Objectives: By the end of the course, students will be able to identify commonly injured bones and joints. They will be able to demonstrate the ability to assess whether or not an injury is stable or unstable. Students also will be able to demonstrate how to assess distal perfusion, and they will be able to describe the potential ramifications of ischemia. Students will be able to demonstrate how to treat and manage stable and unstable injuries while in the field. They also will be able to identify anticipated problems that can occur when treating unstable extremity injuries for prolonged periods and/or in challenging environments, and they will be able to identify how inappropriate treatment can contribute to these anticipated problems.

Sub-Goal #12: Assessing and Managing Simple Dislocations. Sub-goal #12 is to help students learn to appropriately assess and manage simple dislocations of the shoulder, patella, and digits.

Assessing and Managing Simple Dislocations—Objectives: By the end of the course, students will be able to list the types of dislocations that potentially can be reduced in the field. They will be able to explain how the mechanism of injury can affect the severity of the injury and can affect one’s choice of treatment. Students will be able to demonstrate appropriate techniques for reducing shoulders, patellas, and digits, during hands-on exercises, including steps for obtaining consent, assessing perfusion distal to the injury, and documenting the treatment provided.

Sub-Goal #13: Assessing and Treating Thermoregulation Injuries. Sub-goal #13 is to help students understand the body’s normal thermo-regulation processes so that they can learn to prevent, assess, and treat thermoregulation injuries.

Assessing and Treating Thermoregulation Injuries—Objectives: By the end of the course, students will be able to identify the body’s normal thermoregulation compensation mechanisms. Students will be able to identify internal and external sources that can affect normal thermoregulation. They will be able to differentiate the symptoms of mild hypothermia from severe hypothermia, and they will be able to list steps involved in the treatment of each. Students will be able to differentiate the symptoms of heat exhaustion from heat stroke, and they will be able to list the steps involved in the treatment of each. Students also will be able to list symptoms of and treatment for exertional hyponatremia.

Sub-Goal #14: Assessing and Treating Frostbite. Sub-goal #14 is to help students learn to understand what leads to frostbite, to recognize steps that can help to prevent frostbite, and to learn how to treat cases of cold injuries—from frost nip to full-thickness injuries to trenchfoot.

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Assessing and Treating Frostbite—Objectives: By the end of the course, students will be able to differentiate superficial frostbite from partial-to-full-thickness frostbite. They will be able to identify steps that can help in the prevention of frostbite. Students will be able to describe the symptoms associated with trenchfoot. They also will be able to describe or demonstrate how to provide field treatment for superficial frostbite, fullthickness frostbite, and trenchfoot.

Sub-Goal #15: Assessing and Managing Submersion Injuries. Sub-goal #15 is to help students learn basic physiology of submersion injuries so that they are better able to prevent, assess, and manage submersion incidents.

Assessing and Managing Submersion Injuries—Objectives: By the end of the course, students will be able to identify the steps involved in assessing and treating submersion injuries. They also will be able to identify the anticipated problems that could develop after their initial assessments and treatments.

Sub-Goal #16: Assessing and Managing Toxins, Bites and Stings. Sub-goal #16 is to help students understand how various toxins can enter and harm the human body so that they can treat or manage a toxin, bite, or sting incident while in the field.

Assessing and Managing Toxins, Bites, and Stings—Objectives: By the end of the course, students will be able to identify how various toxins enter the body. They will be able to identify toxins that are most commonly found in wilderness environments. Students also will be able to identify the steps involved in assessing and treating toxins, bites, and stings, and they will be able to identify the anticipated problems that could develop after the initial assessment and treatment.

Goal #17: Assessing Allergies and Anaphylaxis. Sub-goal #17 is to help students learn to differentiate local allergic reactions from anaphylaxis, and to learn the appropriate treatment for each, so that they are better prepared to deal with anaphylactic emergencies in the field.

Assessing Allergies and Anaphylaxis—Outcomes: By the end of the course, students will be able to identify what is meant by a normal immune response. They also will be able to identify common antigens as well as the body’s normal response to antigens. Students will be able to identify steps involved in assessing and treating a local allergic response as well as an anaphylactic reaction, and they will be able to demonstrate proper steps for treating anaphylaxis during hands-on exercises.

Sub-Goal #18: Understanding Backcountry Medicine. Sub-goal #18 is to provide students with basic guidelines for assessing and managing common non-traumatic conditions and emergencies which might include, but would not be limited to, diabetes, chest pain, ailments of the GI/GU system, respiratory infections, and ailments of the eyes, ears, nose, and throat.

Understanding Backcountry Medicine—Objectives: By the end of the course, students will be able to identify common GI/GU ailments, respiratory infections, and, Rev 04/2012

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ear, nose and throat problems that can occur in backcountry situations, and they will be able to identify steps that can be taken to prevent each. Students also will be able to identify which signs and symptoms, associated with GI/GI ailments, respiratory infections, and ear, nose, and throat problems, might lead a caregiver to call for an urgent, or high-risk evacuation. Students will be able to identify steps involved in assessing and treating hypoglycemic and hyperglycemic diabetic emergencies. Students also will be able to demonstrate assessment techniques and treatment options in the event a patient is experiencing chest pain.

Sub-Goal #19: Medico-legal Considerations. Sub-goal #19 is to help students understand how certain laws can and will affect first aid providers and how these laws should guide their actions.

Medico-legal Considerations—Objectives: By the end of the course, students will be able to define the following terms: duty to act; negligence; scope of practice; and authorization. Students also will be able to describe what is meant by a good Samaritan. Students will be able to explain how medical laws apply to them.

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Template from: http://www2.honolulu.hawaii.edu/facdev/guidebk/teachtip/lesspln3.htm

TOPIC/EXERCISE: INSTRUCTIONAL GOAL - Identify the overall goal/purpose of the lecture/exercise. Refer to Appendix A for assistance.

RATIONALE - Clarify in your own mind why this information is important and how it is applicable to the students.

LESSON CONTENT - Identify the lesson’s ‘need to know’ items. These can be followed by ‘nice to know’ items. Make sure that the lesson’s focus is on the ‘need to know’ material.

PERFORMANCE OBJECTIVES - List the knowledge or skills that students will be expected to obtain or perform. Use action verbs when describing measurable outcomes. Refer to Appendix A and/or Appendix F for assistance.

INSTRUCTIONAL PROCEDURES: A. What will you do to get the students’ attention? B. What methods will you use to teach this lecture/exercise? C. How will you assess whether or not students understand the information? D. How you will get the students to participate or be engaged? E. Closure (How you will end the lesson? Will you summarize the need to know?

EVALUATION PROCEDURES - What will you do to determine if the material has been learned and objectives achieved?

MATERIALS AND AIDS - What will you need in order to teach this lesson? PREPARATION - What can you do ahead of time to prepare for this lecture/exercise so Rev 04/2012

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that it is conducted efficiently?

TIME - How much time will this lesson take?

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Template from: http://www2.honolulu.hawaii.edu/facdev/guidebk/teachtip/lesspln3.htm TOPIC/EXERCISE: Nervous System INSTRUCTIONAL GOAL - Identify the overall goal/purpose of the lecture/exercise. Refer to Appendix A for assistance.

The goal of this lecture is to help students learn to accurately assess if a patient’s nervous system has been injured. It will also provide information on how to manage traumatic brain injuries, strokes, and seizures.

RATIONALE - Clarify in your own mind why this information is important and how it is applicable to the students. It is common for people who work and play outdoors to hit their heads on occasion, but laymen generally are not able to accurately assess the severity of these injuries. Laymen tend to make evacuation decisions based on the appearance of external damage— such as blood or external swelling—which might or might not indicate brain injury. As a result, patients with minor external head wounds sometimes are inappropriately evacuated from the field. Additionally, laymen sometimes respond too slowly to serious brain injuries (due to lack of understanding). Unfortunately, a slow response or inappropriate treatment (such as not moving an unconscious patient who is in a headdown position for fear of doing more harm, or offering aspirin to a head-injured patient who experiences a bad headache) can exacerbate the situation.

LESSON CONTENT - Identify the lesson’s ‘need to know’ items. These can be followed by ‘nice to know’ items. Make sure that the lesson’s focus is on the ‘need to know’ material. The need to know information in this lecture is as follows: Early indicators of a traumatic brain injury, and appropriate treatment or management of a traumatic brain injury; Early indicators of increased ICP, and appropriate treatment or management of increased ICP; Rev 04/2012

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Signs and symptoms of a stroke, and appropriate treatment or management of a stroke; and Types of and causes for seizures, and appropriate management/treatment of a patient who is experiencing (or has experienced) a seizure. Additional need-to-know information: symptoms of post-concussive syndrome; generic causes of brain dysfunction and use of the acronym STOPEAT as an assessment tool.

PERFORMANCE OBJECTIVES - List the knowledge or skills that students will be expected to obtain or perform. Use action verbs when describing measurable outcomes. Refer to Appendix A and/or Appendix F for assistance. By the end of the lecture, students will be able to describe how the STOPEATS acronym applies to the nervous system. Students will be able to identify early, reliable indicators of a traumatic brain injury as well as early indicators of increased intracranial pressure. Students will be able to list at least three common indicators of stroke. Students will be able to describe how to manage a patient who is seizing or who is post-ictal.

INSTRUCTIONAL PROCEDURES: A. What will you do to get the students’ attention? B. What methods will you use to teach this lecture/exercise? C. How will you assess whether or not students understand the information? D. How you will get the students to participate or be engaged? E. Closure (How you will end the lesson? Will you summarize the need to know? A. Asking students who have received a blow to the head or been concussed to raise their hands can be used as an appropriate introduction. Not only will this engage students immediately, by emphasizing the need for proper assessment, students will quickly recognize the applicability of the topic. B. This subject will be presented via lecture and case studies. C. Assessments will be made through observations and questions. D. I will use the students’ real-life stories as examples in order to engage them. I will also use a personal case study, with students taking on the role of rescuers, to help them understand how to use the STOPEAT acronym. E. I will play a short game to end the lecture. Students will be asked to recall the need-to-know information.

EVALUATION PROCEDURES - What will you do to determine if the material has been learned and objectives achieved?

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The only evaluation I will use during the lecture will be conducted via observing and questioning students, and via a short game I will facilitate at the end of the lecture. Given the importance of this material, however, I will use a variety of techniques at a later date to evaluate student understanding. I will ask students to recall need-to-know information on a quiz. Students also will be required to apply the information during 2:1 drills and scenarios. EVALUATION PROCEDURES - What will you do to determine if the material has been learned and objectives achieved? The only evaluation I will use during the lecture will be conducted via observing and questioning students, and via a short game I will facilitate at the end of the lecture. Given the importance of this material, however, I will use a variety of techniques at a later date to evaluate student understanding. I will ask students to recall need-to-know information on a quiz. Students also will be required to apply the information during 2:1 drills and scenarios.

MATERIALS AND AIDS - What will you need in order to teach this lesson? I will need a Power Point projector, screen (or white wall), and computer (with slides). I would also like to have the following available: a skull, along with white board and dry erase marker.

PREPARATION - What can you do ahead of time to prepare for this lecture/exercise so that it is conducted efficiently? I am able to present this lecture with little to no preparation.

TIME - How much time will this lesson take? This lecture, including follow-up questions, should take no more than one hour.

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Template from: http://www2.honolulu.hawaii.edu/facdev/guidebk/teachtip/lesspln3.htm TOPIC/EXERCISE: Patient Assessment System drill, which will include an assessment of nervous system injuries and wounds.

INSTRUCTIONAL GOAL - Identify the overall goal/purpose of the lecture/exercise. Refer to Appendix A for assistance.

By using two different patient profiles, each of which will include a blow to the head, students will be given the opportunity to practice patient assessment drills, and to apply the concept of brain injury assessment during patient assessment. One patient will have a significant head/scalp wound with no brain injury; the second patient will have a brain injury with early indicators of increased ICP but will have minimal external damage. This exercise will also be used to help students practice assessing skin injuries. This exercise will be used early in the course. It will require recall of information–from the PAS, nervous system, and wounds lectures. It will also help hone students’ understanding of the nervous system.

RATIONALE - Clarify in your own mind why this information is important and how it is applicable to the students. Laymen tend to make evacuation decisions based on the appearance of external damage, which might or might not indicate brain injury. As a result, patients with minor external head wounds are sometimes inappropriately evacuated from the field. Additionally, laymen sometimes respond too slowly to serious brain injuries (due to lack of understanding). This exercise will be used to help students learn to accurately assess brain injuries and skin injuries that they might see in the field. It will also be used to help students learn to recognize what can or cannot be done to treat these types of injuries in the field.

LESSON CONTENT - Identify the lesson’s ‘need to know’ items. These can be followed by ‘nice to know’ items. Make sure that the lesson’s focus is on the ‘need to know’ material.

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• The three parts of the Patient Assessment System; • Early indicators of a traumatic brain injury, and appropriate treatment or management of a traumatic brain injury; • Early indicators of increased ICP, and appropriate treatment or management of increased ICP; • Assessment and treatment of wounds. Although students will be asked to identify anticipated problems and treatment options, this primarily is an assessment drill.

PERFORMANCE OBJECTIVES - List the knowledge or skills that students will be expected to obtain or perform. Use action verbs when describing measurable outcomes. Refer to Appendix A and/or Appendix F for assistance. By the end of the exercise, students will be able to demonstrate how to perform a proper patient assessment. Students also will be able to accurately differentiate the signs and symptoms of a head wound/laceration from a minor traumatic brain injury from increased ICP. Students will be able to describe the steps associated with wound care.

INSTRUCTIONAL PROCEDURES: A. What will you do to get the students’ attention? B. What methods will you use to teach this lecture/exercise? C. How will you assess whether or not students understand the information? D. How you will get the students to participate or be engaged? E. Closure (How you will end the lesson? Will you summarize the need to know? A. This exercise requires that all students participate. Half of the students will assess patients who have head wounds; the other half will assess patients who have brain injuries. Once the assessment is completed, all caregivers will switch patients. Ultimately, all caregivers will get to assess both Patient A (head wound) and Patient B (brain injury). B. This exercise will be conducted in a 2:1 format. Rescue teams will work in groups of two. Each rescue team will evaluate one patient at a time. C. I will observe and monitor the caregivers for their levels of understanding. During the debrief session, I will ask follow-up questions to assess their levels of understanding. D. By using moulage and prepping the patients so that they “act” appropriately, rescuers will be engaged. Additionally, I will take steps to make sure that both patient profiles (head wound and brain injury) are similar in complexity so that rescuers will finish with their assessments at roughly the same time. This will make it Rev 04/2012

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more likely that everyone remains busy and engaged. E. I will finish the exercise by conducting a debrief session, during which I will have students present their assessments, and I will reiterate need-to-know material.

EVALUATION PROCEDURES - What will you do to determine if the material has been learned and objectives achieved? Evaluation will be conducted via observation and questioning.

MATERIALS AND AIDS - What will you need in order to teach this lesson? Moulage; an open area; gloves; SOAP notebooks; writing utensils

PREPARATION - What can you do ahead of time to prepare for this lecture/exercise so that it is conducted efficiently? I will need to create patient profiles prior to conducting this drill. I also will need to keep caregivers appropriately occupied while the patients are being briefed and readied.

TIME - How much time will this lesson take? This drill, including prep time and debrief session, should take no more than 90 minutes.

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Information taken from Benjamin S. Bloom Taxonomy of Educational Objectives The following are sequential levels of student learning and competence: 1) recognition, 2) recall, 3) understanding, and 4) critical thinking. It is important for all WMA instructors to understand these differences and to consider where students are, or should be, as they progress through a course.

Recognition. The most basic or elementary learning is when a student is able to recognize familiar information, but he cannot come up with a fact or answer on his own. This skill is known as recognition. An example of recognition would be when a WMA student is able to pick out a correct answer from a multiple choice list, but he is unable to recall the same information without a list, or without a prompt. A WMA student who has achieved this elementary level might be able to (more or less) recognize when someone is doing a skill correctly (such as splinting an injury or assessing a spine), but she would be unable to perform the same skill without help.

Recall. A skill that is slightly more advanced than recognition but is still quite basic is the ability to recall. Students who are able to recall information can retrieve facts, definitions, and/or lists from memory, but they might not be able to grasp meaning from the facts, or they might not be able to apply the data on their own. For instance, WMA students who are functioning at the recall level would be able to list the early indicators of increased ICP on a quiz, but they might not be able to recognize a patient who is presenting with symptoms of increased ICP during a scenario. Students who can copy or mimic an instructor’s splint (i.e., they can build splints that are identical to an instructor’s model) are performing at the recall level. These same students likely would struggle if asked to splint a different body part using different materials. Many WFA students reach only the recall level during courses.

Understanding. Students who move beyond recall develop an ability to understand information. Students who understand concepts can evaluate ideas and information, and they can explain to others the how and why of a concept. A WMA student who understands the concept of volume shock, for instance, would be able to interpret relevant facts (such as a patient’s changing vital signs), he would be able to accurately assess a patient who is experiencing compensated volume shock, and he would be able to predict probable outcomes (de-compensation) in the event the cause of the volume shock is not addressed.

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In another example, students who truly understand the principles of splinting are able to use materials other than what they’ve seen the instructor use to demonstrate how to build effective splints. They can apply splinting principles to a variety of extremity injuries, even if they have not seen an example of that body part splinted. Instructors should keep in mind that almost all students will move through the studentlearning continuum in this order—recognition, then recall, and then understanding. In other words, is it okay to let beginning students struggle and perform poorly when they are first introduced to a new topic or new skill. It is only after students have assimilated a concept that they’ll be able to perform with proficiency in a new environment or under different and more challenging circumstances. Instructors should also keep in mind that WFR students are expected to reach a level of understanding in nearly all course topic areas if they hope to earn certification. What this means is that instructors should not be content if, by the end of a WFR course, students are only able to mimic skills they’ve seen but are not able to apply concepts broadly. In fact, many WFR students achieve an even higher level of learning during courses, and instructors should push WFR students to use critical thinking skills whenever it is possible.

Critical thinking. Ideally, WFR, WEMT, and WALS students will have honed their critical thinking skills by the end of their courses. Students who reach this level will be able to evaluate their decisions and their performances; they will be able to compare and contrast ideas; they will be able to appropriately argue points of view; and they will be able to justify difficult choices. For example, picture a scenario in which a WFR student is asked to assess and treat a backcountry skier who has broken his arm. A WFR student who has well-developed critical-thinking skills would not only be able to assess and manage the unstable extremity injury, but she also would be able to consider and apply additional concepts—such as those associated with cold-weather injuries and thermoregulation— and she would be able to respond accordingly. She might ask the arm-injured patient if he has a history of cold-injury in his affected fingers, for instance. She might also ask the patient if he is taking any drugs or medication (such as caffeine or nicotine) that might increase the likelihood of frostbite. Not only would the caregiver be able to build an effective, adjustable splint, but she also would remember to remove rings first, she might consider applying a heat pack to the fingers, and she would take steps to make sure that the patient is fed, hydrated, and well insulated. In other words, students who think critically can apply what they’ve learned to a variety of situations, even ones that differ considerably from what they’ve seen in class.

WMA instructors who teach multi-day courses should help students move through the continuum of student learning as their classes progress, and they should consider ways of incorporating critical-thinking opportunities into lectures, labs, scenarios, quizzes, and/or homework assignments. For those instructors who are not sure how to do so, examples that might help are provided. Rev 04/2012

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Consider having students prioritize patients. To push students to compare, contrast, and to analyze information, an instructor might ask students to decide which of two patients requires a more urgent evacuation. For example, the Incident Commander (IC) of a scenario might be asked which of the following patients has a more serious injury that requires a more urgent evacuation: Patient One, who has a slightly angulated forearm fracture but who has good perfusion; or Patient Two, who has an unstable but anatomically in-line forearm injury and is experiencing tingling and numbness in the fingers. The IC might then be asked, on camera, to explain and justify her decision. To challenge high-performing students, instructors should try to use patient profiles in which levels of severity or decisions are not obvious. The IC of a scenario might be asked to prioritize the following patients, for example, both of whom were hurt in the same fall, but only one of which can be evacuated that night: Patient A hit her head while tumbling down a steep gully. She is alert and oriented and has no signs of a traumatic brain injury. Upon exam, she presents with no abnormal signs or symptoms and has no neck or back pain. She does, however, have point tenderness on C7. Patient A has no signs of neurological deficit and is cooperative in her own treatment. Patient B hit his head while tumbling down a steep gully and was knocked unconscious for around 10 minutes. Fifteen minutes after waking up, he is alert and oriented but complains of a moderate (6 out of 10) headache. Although he sprained his ankle badly during the fall, he was able to pass his spine assessment and is experiencing no other abnormal signs or symptoms. Unfortunately, he cannot bear weight on his injured ankle. While both Patient A and Patient B might be in need of evacuation, an instructor can use this type of exercise to help students recognize that the environment, terrain, available resources, and one’s ability to manage a situation while in the field should all be taken into account when making backcountry decisions. For example, even though Patient A appears to have an unstable cervical spine injury, it is theoretically possible that she could be stabilized in the field and could safely spend the night in the backcountry. High-functioning students would acknowledge that if Patient B’s headache worsens and/or if he develops any other indicators of increased ICP, prioritizing Patient B over Patient A would be the wise choice. On the other hand, if resources are limited (thus back boarding and stabilizing Patient A would be near impossible), and Patient B reports having a dehydration headache prior to his fall, an IC might decide to evacuate Patient A first and leave Patient B behind. Whether or not a WFR student would ever need to make this type of decision in the field is irrelevant: This exercise requires critical thinking and helps students develop this skill. In addition to having students prioritize patients, an instructor should ask students to justify their decisions, to provide pros and cons for their choices, and/or to come up with

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detailed treatment plans for managing any patient(s) who remains in the field. Case study #40 (in the green WMA workbook) can be used for this type of exercise.

Have students explain why certain anticipated problems are more (or less) likely than others to occur, and have students come up with a plan for preventing anticipated problems from occurring. To push students to think ahead and to explore “what if” scenarios, an instructor might consider emphasizing anticipated problems when conducting skill sessions. For example, instructors might use drills or scenarios to remind students that cold temperatures, certain drugs/medications, tight splints, and even immobilization itself can exacerbate ischemia in injured extremities. Students who can think critically will be more likely to take off rings before swelling occurs; they might take off constricting, hard-shell boots early on; they will build splints that are adjustable; and/or they might encourage patients to wiggle fingers/toes in order to stimulate circulation. While not all students will be able to achieve this level of thinking in a WFR course, this higher-level skill is ideal.

Include evacuation decision-making problems. To push students to compare, contrast, and argue, instructors can have students organize injuries into injury types: urgent, non-urgent, and field manageable. An urgent evacuation is one in which the time it takes to reach definitive care could make a significant difference in a patient’s outcome. An example would be a patient who is experiencing increased ICP. A patient who has broken an ankle and is experiencing significant ischemia in his toes might also require an urgent evacuation. In other words, both of these injury types require advanced interventions sooner rather than later. A non-urgent evacuation is one in which a patient should receive more in-depth treatment for an injury, but the time it takes to reach definitive care will probably make little difference in the patient’s long-term recovery. An example of a non-urgent evacuation might be a patient who has fractured her left forearm but is experiencing very little swelling in the arm and hand, and has good perfusion distal to the injury. This patient likely would be able to assist in her own care (at least to some degree), and might be able to walk out to a trailhead. Whether or not this patient sees a doctor for her injury the day it happened or a day later probably will make little difference in how quickly (or well) her arm heals. A manageable injury or incident is one in which a caregiver’s field treatment is likely sufficient to resolve the problem. For instance, a person who falls into cold water but is then fed, hydrated, and insulated probably wouldn’t need to be evacuated at all. The same would be true of a patient who receives appropriate treatment for a minor wound or for a stable extremity injury. By asking students to figure out why certain injuries or conditions require a rapid response, an instructor will be forcing them move beyond recognition, recall, and even understanding. The value of this technique lies in the fact that it can help WFR students learn to trust their assessments and respond accordingly. One of the goals of a WFR class is for students to learn to differentiate serious injuries from non-serious injuries, and to respond appropriately. All too often, even WFR-trained caregivers request dangerous, costly, and unnecessary evacuations. Rev 04/2012

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WFR graduates are expected to know that some injuries are so serious that they cannot be treated in the field, and by the end of a course, WFR students should be able to provide examples of these types of injuries. Conversely, WFR students also need to learn to trust that a patient who hit his head but was never knocked unconscious and is showing no signs of increased ICP might actually be okay, regardless of the fact that he has a large bump and bruise on his temple. In fact, depending on what was found during the patient assessment, his injury might be considered minor, could be managed in the field, and would not require an evacuation at all.

The following are additional examples of higher-level thinking skills, based on Bloom’s Taxonomy.

Evaluate: In order for a WFR student to be able to evaluate something, he must be able to recognize an ideal—such as the efficacy of a splint, or the soundness of a plan of action—and he must be able to compare and contrast how that which is being evaluated compares to the ideal. This process requires critical thinking. After presenting (role modeling) “ideal” examples, instructors can ask students to evaluate a variety of additional skills, decisions, or items, the see throughout a course. These items might include, but would not be limited to, a written SOAP note and treatment plan, a splint, or a decision to urgently evacuate a patient. Instructors can follow up by asking students to justify their evaluations.

Compare and Contrast: To compare and contrast suggests that two objects or ideas are compared to each other, and similarities as well as differences are noted. In order for compare and contrast to be considered a critical thinking skill, one must compare and contrast objects/ideas not only to each other, but also to an ideal. That is, asking students to note similarities and differences between two items is asking them to perform at a relatively basic level. However, asking students to compare and contrast how two or more items compare to an idea is to promote critical thinking. Once students have seen an example of a well-built splint, an instructor might ask students to compare two improvised examples of a similar splint and have students provide a list of pros and cons of each splint type. They could have students decide which of the two would work better in a given scenario and explain why they came to that conclusion.

Explain: In order to assess a student’s understanding of material, an instructor might ask that the student explain the hows and whys behind certain concepts or principles. For instance, instructors can ask students to explain how and why dehydration can contribute to frostbite, or why a patient who experiences an inhalation burn injury might go into respiratory failure. Students who have the ability to explain such concepts and can do so accurately might then be asked to try to teach that concept to his or her peers. This latter technique tends to be especially effective for honing critical thinking skills.

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Argue: To argue a point is not necessarily the same as to stand one’s ground. Instead, arguing a point is what occurs when people debate: It implies that one has evaluated options, considered opposing views, and has reached a conclusion. Instructors can integrate “arguing” by having students take a position on a matter (such as whether or not a patient should be urgently evacuated) and then engaging in a debate. The goal is not to declare a winner and loser, but to help students become better thinkers. With this in mind, an instructor might ask students to justify certain decisions, refute alternate views, or to argue in favor of one plan over another.

Assimilate: A person who has the ability to assimilate can take what’s been learned in situation A and can apply it to situation B. In many ways, this is exactly what WFR instructors are expecting of most students, and there are a variety of techniques an instructor can use to hone this skill. Combining a challenging spine assessment with spine management skills is an example. For instance, an instructor might start by demonstrating a spine assessment. Afterwards, students would practice this skill in groups of three, in a well-lit area that is free from distractions. The instructor would also need to introduce spine management to the group, and students would be given the opportunity to practice moving a potentially spine injured patient during controlled drills. The instructor might then conduct a field drill in which students are asked to perform a spine assessment, without assistance, on a reliable and cooperative patient who is found standing or is found in some other awkward position. Solo performance of one skill or the other (spine assessment or spine management) would require an understanding of the concept, but integrating the two can test whether or not students have actually assimilated the material.

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Wilderness Medical Associates® Student Skills Checklist – WFR/Challenge Student Name:_________________________Course:_____________Dates:____________ Sponsor:_______________________Instructors:__________________________________

PAS/ BLS Scene Recognize and safely manage scene dangers including personal protective equipment. ! Establish number of patients. ! Determine MOI. !

Initial Assessment Rapidly assess Critical Systems status (Circulatory, Respiratory, Neurologic).

!

Basic Life Support ! Demonstrates ability to assess the Critical Systems and determine need for interventions. ! Demonstrates rapid repositioning of patients with Critical Systems problems and potential spine injury. ! Demonstrates proficiency in CPR and FBAO according to AHA standards.* ! Demonstrates proficiency in NPA and OPA use.* ! Demonstrates proficiency in BVM use and PPV. technique.* ! Demonstrates proficiency in AED use.* Focused Assessment Accurately completes physical exam for traumatic and nontraumatic patient. ! Vital signs (P,R,S,C,T). B/P and lung sounds if applicable. ! SAMPLE History !

Treatment and SOAP formatting ! Create an accurate problem list. ! Create an accurate anticipated problem list. ! Create a treatment plan. ! Fill out a SOAP note.

Musculoskeletal System Stable Injuries Assess distal CMS before beginning treatment. ! Assess musculoskeletal injury and correctly identify stable injuries. ! Appropriately and effectively treat stable injuries. ! Re-assess distal CMS upon completion of treatment. !

Unstable Injuries Assess distal CMS before beginning treatment. ! Assess musculoskeletal injury and correctly identify unstable injuries. ! Appropriately and effectively treat unstable injuries, including: ! Lower leg, ankle and knee. ! Upper arm, forearm, and wrist. ! Re-assess distal CMS upon completion of treatment. !

Shoulder Dislocation Reduction Verify wilderness context and obtain consent from patient. ! Check distal CSM before proceeding with reduction, including sensation in deltoid region. ! Demonstrate ability to reduce dislocation using traction, abduction and external rotation. ! Demonstrate alternative method of reduction (hanging, scapula manipulation). ! Stabilizes area post reduction and re-assess distal CSM. !

Patella Dislocation Reduction Verify wilderness context and obtain consent from patient. ! Check distal CSM before procedure (not critical). !

! !

Demonstrate appropriate patella reduction technique. Stabilizes area post reduction and re-check CSM.

Digit Dislocation Reduction ! Verify wilderness context and obtain consent from patient. ! Check distal CSM before procedure. ! Demonstrate appropriate digit reduction technique. ! Stabilizes area post reduction and re-assess distal CSM.

Spine Assessment/Tx Assessment Verify context and obtain consent from patient. ! Demonstrate ability to roll patient in a spine stable manner for assessment purposes with a second rescuer. Demonstrate spine assessment guidelines by evaluating: ! patient’s mental status and reliability. ! spine pain and/or tenderness ! Motor/ sensory exam (as outlined in text) ! Document findings upon completion of procedure. !

Extrication/Immobilization Demonstrates ability to measure and properly apply both a: ! manufactured cervical collar ! improvised cervical collar ! Demonstrates ability to participate and lead in a rescue team which can properly move a potentially spine injured patient from various body positions onto backboards and litters. ! Demonstrates ability to participate and lead

* These Skills are included in BLS level CPR course required for the Challenge™ Course. They will therefore not be covered in the Challenge™ Course. ©2003, Wilderness Medical Associates

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in a rescue team properly immobilizing a patient in both a backboard and litter.

Wilderness Rescue Patient and Litter Carries Demonstrates ability to create a “piggy back” carry system using webbing, rope and other available materials. ! Demonstrates ability to participate in a rescue team on rough terrain using appropriate carrying and passing technique !

Improvised Litters Demonstrates ability to build improvised stretchers and litters for non-spine injured patients. ! Demonstrates ability to build a “hypothermia wrap” in a litter or backboard. !

Wounds and Burns !

! !

Using BSI technique, shows ability to expose bleeding area and apply well-aimed direct pressure (WADP). Demonstrates ability to create a pressure bandage. Identify the context and situations in which removal of impaled objects is appropriate.

Allergies/Anaphylaxis (sticks lab) ! !

! !

Prepares injection site Examines syringe for presence of excessive air and purges appropriately. Successfully performs injection. Disposes of syringe appropriately.

* These Skills are included in BLS level CPR course required for the Challenge™ Course. They will therefore not be covered in the Challenge™ Course. ©2003, Wilderness Medical Associates

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WMA instructors are asked to provide feedback – to students as well as assistant instructors – on a seemingly ongoing basis. But feedback takes time, and telling someone that he or she has fallen short of a mark can feel uncomfortable. Given these negatives, it seems fair to ask, does feedback actually aid in the teaching/learning process? And if so, has any research been done that has assessed whether or not one type of feedback is more effective than another? The answer to both questions is yes. There has, in fact, been plenty of research conducted on the topic. In short, the who, what, when, where, and why of giving feedback can all affect student learning and progress. Key Research Findings 1. Feedback has been shown to be one of the most significant activities an instructor can engage in as a means to improve student achievement (Hattie, 1992). 2. Objectives and established criteria provide students with helpful benchmarks for success, making desired learning outcomes clearer to them (Crooks, 1988; Wilburn & Felps, 1983). 3. Effective learning occurs when students evaluate their work against established criteria (Trammel, Schloss, & Alper, 1994; Wiggins, 1993). That is, feedback is most useful when standards or expectations (such as the WMA skill checklist) are compiled and feedback is based on how a person’s work measures up to those standards/expectations. 4. When feedback is corrective in nature (it explains where errors exist and why something is considered wrong) significant increases in student learning occur (Lysakowski & Walberg, 1981; Walberg, 1999; Tennenbaum & Goldring, 1989). 5. Asking students to continue working on a task until it is completed and accurate enhances student achievement (Marzano, Pickering, & Pollock, 2001). 6. Delay in providing students feedback diminishes its value for learning (BangerDrowns, Kulik, Kulik, & Morgan, 1991).

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A WMA scenario should not be a collection of concurrent 2:1 drills that have been randomly put together. Teaching points associated with scenarios, in fact, can differ significantly from the teaching points associated with 2:1 drills. While short drills often are used to help students improve their skill proficiency, scenarios are ideal for honing critical thinking. Well-written scenarios generally are more effective than are 2:1s for teaching concepts such as “trends over time,” or for teaching the importance of on-going patient assessment and re-evaluation. Scenarios also are an effective tool for teaching the importance of developing good habits/systems, the incident command system, and for demonstrating how well-written SOAP notes can improve communication during a chaotic event. In order to emphasize critical thinking skills, scenarios should include myriad problemsolving opportunities, and the problem-solving challenges within each scenario should become more difficult as a course progresses. In a course’s first scenario, for instance, an instructor might ask students to recall the parts of the three PAS triangles and to demonstrate basic skill proficiency. As a course progresses, an instructor might expect that students can accurately assess and treat a patient. By the third scenario, an instructor might expect students to be able to justify their assessments, to accurately critique their own treatments, and to provide a realistic list of anticipated problems that could occur over time and/or during transport.

The following are examples of how critical thinking skills can be incorporated into a scenario fairly easily.

1) Using scenarios to emphasize key learning points associated with the scene size up. Even though the scene size up is addressed in all WMA classes, the importance of the scene size up data is not always reinforced during 2:1s. Scenarios, in fact, provide excellent opportunities for instructors to emphasize the importance of knowing “what happened” to a patient. While this teaching point can be incorporated into 2:1s, by creating scenarios that involve unclear or ambiguous mechanisms of injury, caregivers can be forced to dig deeper, to ask more directed questions, and to practice their powers of observation—skills that can be quite beneficial in wilderness medicine. Imagine, for example, a caregiver who finds an unconscious patient whose history is unknown. Caregivers who must learn from bystanders that their unconscious patient fell 10 feet and has not responded to questions for 10 minutes should be praised for their detective work and can be Rev 04/2012

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rewarded on film during the video process. Students who are not able to gather pertinent MOI information and who struggle, on the other hand, can be gently guided along until they achieve success. Scenarios also are more effective than 2:1s in helping students recognize scene safety issues that aren’t currently a problem but might develop as a scenario progresses. Anticipated hazards might include approaching darkness or cold temperatures. Scenarios often can be used more effectively than 2:1s to help students practice identifying resources that are available to them. An instructor might, for instance, place a satellite phone in the pack of an unconscious patient. Care-givers who take steps to locate resources, including those in a patient’s pack, should be praised and an appropriate reward might be for them to use the phone to call for a rescue that day. Caregivers who never look through the pack and never find the phone, on the other hand, might be required to continue with the scenario and would need to plan as if they had to spend the night in the field.

2) Using scenarios to emphasize key learning points of the second triangle. Even though significant time is used to address critical system problems in any WMA class, once there are multiple patients and chaos on a scene, caregivers sometimes fail to address initial assessment problems with the urgency they deserve. In order to help students assimilate this teaching/learning point, instructors can create scenarios that require students to assess and treat critical system problems that might not be immediately obvious. Submerged patients who have a heart beat but are not breathing, for instance, can be used to help students practice in the event first and second triangle problems occur concurrently.

3) Using scenarios to emphasize the concept of “trends over time.” The concept of “trends over time” is difficult to teach effectively through lecture and 2:1s because the concept is abstract and students learn in theory only. Scenarios, on the other hand, provide an environment conducive to showing students how timerelated concepts work. In order to incorporate “trends over time” learning points, instructors should take steps to prep students/patients so that their conditions either worsen or improve as scenarios progress. Patients might be given four separate sets of symptoms or vital signs, for instance, to reflect a move toward or away from homeostasis. Additionally, patients with extremity injuries might develop swelling and ischemia by the end of a scenario. Instructors should remember that the concept of “trends over time” is beyond beginning learning. As a result, beginning students who are asked to create their own patient profiles likely will struggle. It can be acceptable for students to come up with their own vitals/trends, but if this is allowed, it is probably best for an instructor to quiz the student/patient ahead of time to make sure that the vitals/trends are accurate and represent the scenario’s learning points. Rev 04/2012

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4) Using scenarios to develop proficiency and encourage thoroughness. Two-onone drills certainly can be used to help students develop treatment skills, such as taking vitals, splinting, and/or cleaning wounds. However, 2:1 drills are almost always conducted in benign environments. For example, 2:1 drills are sometimes held indoors where rooms are warm and well lit. Even when drills are held outdoors, myriad equipment is usually available and distractions (such as multiple patients and/or panicked bystanders) are minimal. Scenarios, on the other hand, require students to perform under pressure, often with limited resources. Additionally, multi-casualty scenarios add an element of chaos and confusion. When scenarios are conducted in inclement weather, students are required to keep patients warm and covered, and they must deal with issues such as resource protection (e.g., keeping equipment dry and organized), for real. As a result, scenarios provide a great opportunity to test students on the thoroughness of their assessments, on the quality of their SOAP notes, and on the soundness of their treatments. To evaluate student proficiency and thoroughness, instructors might consider adding details into a scenario that could make a difference in outcome but could easily be overlooked. He might, for instance, leave a ring on the finger of patient who has a broken arm. A concussed patient might have a history of a recent TBI, but the patient could be told to disclose the history only if asked directly. A trauma patient might be taking Coumadin or some other medication that would be important to note. And/or a patient who broke her leg might have a long history of diabetes which has resulted in poor perfusion of her extremities. While the diabetes might or might not affect the patient’s perfusion in the scenario, the patient’s history could be used to provoke thought and thus improve critical thinking. Even though some students will not be advanced or thorough enough to find and address these types of details, these types of scenario additions can be used to help students think more critically and to understand why thoroughness is ideal.

5) Using scenarios to emphasis the importance of SOAP notes and effective communication. It is often challenging to convince students of the importance of writing down their findings and organizing their thoughts into SOAP notes. And while instructors can mention that communication breakdowns commonly occur during real incidents, this point is difficult to teach in a classroom setting or during 2:1 drills. Because patient hand-offs (i.e., caregivers moving to a new patient, or setting patients aside once primary care is finished) are common in real as well as simulated multi-casualty scenarios, instructors can watch for instances in which patients are handed off during scenarios. If well-written SOAP notes are forwarded with a patient, instructors can film the handoff and can ask questions on the film which highlight the benefits of good note-taking. If SOAP notes are not used or forwarded, an instructor can use videotape to demonstrate how easy it is for certain details to be dropped during a hand-off process. In fact, there is probably no better method for teaching the importance of effective Rev 04/2012

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communication than multi-casualty scenarios. To highlight this, instructors might consider having rescuers arrive at a scenario site in small, staggered groups (two or three at a time), over a 10 to 15 minute period. Using this technique, instructors can watch for students who effectively pass along critical information to the next wave of helpers. These successes can be filmed and then shown to the group or brought up during the debrief process.

In addition to incorporating critical thinking into scenarios, the following text provides thoughts for instructors to consider when creating, facilitating, and debriefing scenarios.

A scenario’s teaching points should go beyond basic patient assessments and treatment. Instructors should ask themselves certain questions when they sit down to write simulations. To start: what key concepts are you hoping to highlight? Which concepts are students struggling with? And how can a scenario be used to address these points? Once teaching/learning points are identified, instructors can begin to come up with ideas for storylines and patient profiles. During this process, instructors need to consider additional points, such as, what does a “successful” scenario look like? By imagining success, an instructor is often better able to anticipate what might go wrong; he might be able to prevent problems (if so desired); he might come up with a plan for how/when to end a scenario; and he can begin to formulate questions that can be used during the videotape process to emphasize his teaching points.

Which would work better: a single scenario or two split sims? Consider which would lead to greater success: a single, large scenario or smaller split simulations. There are pros and cons to each, and which is the better of the two often will depend on the size of the class, the availability of resources, and the environment. For example, it can be challenging to come up with a single scene that involves many patients yet seems realistic. Further, scenarios that involve more than six patients tend to be quite chaotic, so an instructor should decide if the chaos can be used to emphasize teaching points or would take away from them. Mirrored or split simulations, on the other hand, often require more equipment (such as litters and packaging equipment). In addition, it can be difficult to find an environment (such as a cliffband or lake front) that works well for two separate scenes. Instructors also should remember that they will likely need to run back and forth between the two scenes, so mirrored simulations should be run in close proximity.

Consideration should be given to the roles students will play, and students should be prepped for their roles. While it can work out fine for an instructor to randomly select patients and caregivers minutes before a scenario starts, this randomness can sometimes affect student learning and outcomes. Further, if/when students are not adequately prepped ahead of time, instructors might need to deal with unanticipated consequences. For instance, students who are told to slowly Rev 04/2012

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deteriorate over an hour-long scene might deteriorate too quickly, much to an instructor’s dismay. As a result, the instructor might have to make a tough choice: step in and stop action or allow the patient to “die.” To avoid these types of situations, instructors shouldn’t assume patients will know how to accurately present their conditions or profiles, and instructors should anticipate the types of mistakes that students will make. If accurate presentation of patient profiles will make a difference in the teaching points an instructor hopes to address, steps should be taken to increase the probability for success. Roles (and vitals) that are written out ahead of time tend to help. Showing students their patient roles ahead of time (this giving them time to think about the roles and formulate questions) tends to help as well. Prepping caregivers about roles and expectations can be important as well. Nonprepped “helpers,” for example, might take over the role of primary caregiver simply because his partner seems to lack confidence. This act might be appropriate in a first scenario. The same act might be unacceptable, however, during a third scenario, especially if a passive student needs to practice leading or needs to be evaluated. In the event a student is not ready to take on a lead role in a scenario, an instructor can take steps to make sure that the student is assigned a helper role. This would limit the chance that the student will fail on film. Further, instructors can take steps so that multiple students who are struggling are not all assigned primary roles in the same scenario.

Patient profiles and caregiver assignments should include assessment and treatment. Instructors might notice that some WMA students enjoy the assessment part of patient care but are not particularly interested in (or good at) treatment. Conversely, students who are good at hands-on skills sometimes struggle with problem-solving and find patient assessment confusing. These students sometimes try to blend into the woodwork during assessment drills, but they shine when they are asked to build a splint. Instructors need to remember that, in order to receive certification, students must demonstrate that they can assess and treat patients. To make sure that this occurs, instructors should take steps to make sure that patient profiles include both assessment and treatment components. Further, instructors should take steps to make sure that each primary caregiver completes both of these components during a scenario. Specifically, instructors should take steps to make sure that each patient’s treatment plan requires more than a call for evacuation. For example, even though it is worthwhile for WFR students to be able to assess symptoms of appendicitis, this profile will require minimal field treatment, and these types of patients should be avoided during scenarios. Not only would an appendicitis profile potentially leave a caregiver feeling shorted (with few options and limited chance to assist the patient), it would also likely lead to poor time management: i.e., some caregivers would complete their field assessments and treatment quite early in the scenario while others would need far more time to complete.

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The role of incident commander. Often limited attention is given to the incident command system and role of incident commander (IC) in scenarios. However, by incorporating an IC into simulations, instructors can incorporate teaching points that are difficult to address in lectures and drills. For instance, ICs can help facilitate communication among caregivers, and ICs can help primary caregivers focus on need-to-know information. ICs can ask primary caregivers to “cut to the chase” and articulate only the most important information during on-scene briefings. ICs can also be used to provide leadership and direction. In reality, not all students will play IC nor would they be able to perform well as IC given that this position almost always requires critical thinking. Nonetheless, this role can be used to effectively challenge students who are doing well; at the same time, the role can introduce and role model critical thinking skills to the students who are struggling. By requiring an IC to prioritize patients and divvy up resources, for example, WMA instructors can force students to compare and contrast patient profiles as well as justify their decisions. Knowing this, WMA instructors should carefully select who will play IC so that they are able to capitalize on teachable moments and do not embarrass ill-suited ICs who perform poorly. Of, an instructor might let the students select an IC. If this latter strategy is chosen, it is wise to wait until the second or third scenario so that students have had time to know each other. Students who are able to watch their peers in action and can evaluate their performances and leadership skills often choose well.

Use of a video camera. Many of WMA’s newer instructors have commented that are not sure what to film during scenarios or which questions will lead to the best learning. In order to improve one’s line of questioning, it often helps if an instructor refers to a scenario’s primary teaching points prior to turning a camera on. That is, what do you really want students to learn from the scenario? What concepts do you want to emphasize? When an instructor keeps her teaching points in mind, she can formulate questions ahead of time, and she can anticipate ways in which to capture these points on film. It should go without saying that an instructor should avoid embarrassing students on film whenever possible. In fact, instructors shouldn’t hesitate to prep students ahead of time regarding the questions they might ask. For instance, before one begins filming, an instructor might let a student know exactly what he will be asking. He might even clarify with a student which teaching points he’s hoping to make. With practice, an instructor can do this while still allowing students to feel appropriately challenged and stressed. If a student becomes is obviously confused during an interview, an instructor might consider putting a camera on pause. Students who stumble badly during taping know they’ve done poorly: They do not need for their mistakes to be displayed in front of an audience to confirm the fact. Instructors should feel free to fast-forward their tapes during debriefs if/when they believe that there would be limited value in showing a bad interview.

Rev 04/2012

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In summary, instructors should always keep the following in mind: The primary purpose of videotaping scenarios is to emphasize teaching points. It is used to help students develop a better understanding of where they fall below expectations, to remind them what they need to work on, and to highlight what they do well.

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