By Jerome Pomeranz, MD, Central Maine Healthcare, Central Maine Family Medicine Program, Lewiston, ME; Aliza Wolfe, University of New England College of Osteopathic Medicine, Biddeford ME

Introduction 

Medical education extends beyond the class—or exam room. It can even apply to those not enrolled in UGME or GME, such as occasions when laypeople are first on the scene of an accident. Their actions prior to the injured reaching medical care can influence morbidity and mortality outcomes.¹ When more laypeople have medical education, the whole community has better health outcomes in certain situations.¹ Longstanding guidelines for wilderness care exist,^2,3 and in several countries medical students involved in community education have achieved higher test scores and are more likely to practice in underserved areas.⁴ This project is part of a larger Wilderness Medicine curriculum needs assessment. For this component, the authors (a medical student and faculty advisor) identified educational needs of local outdoor pursuit groups and provided tailored information to address knowledge gaps. identified educational needs of local outdoor pursuit groups and provided tailored information to address knowledge gaps.

Methods and Results

This was a curricular needs assessment, conducted as part of a larger evaluation of an existing Wilderness Medicine curriculum, which did not require IRB oversight. Qualitative data was collected via key informant interviews from representatives of various local organizations involved in wilderness-based activities including: a local walking group, a college outing club, a state outdoor adventure club and a regional outdoor club.  The interview protocol included an explanation of the interview's purpose, a privacy notice and nineteen questions covering the organization, what medical knowledge they provide members, and what they might want to provide in the future. Following the interview, individualized educational resources were collated to address specific barriers the organizations face. organizations face.

The more established groups (regional and college outdoor group) were the best resourced and had medical education protocols in place that included first aid with CPR, large bleed management, handling traumatic injuries, and Wilderness First Aid (for leaders). However, another well-established group (the state outing group) relied completely on volunteers and had not been able to gain the same traction. Another volunteer-led group (local walking group), also the smallest and newest, had similar problems relying completely on volunteers, especially recruiting members.

For those organizations still developing, education was focused on fundamentals like CPR training, heart attacks and strokes. Individualized educational resources were provided as well. The local walking group, for instance, had recommendations tailored towards stretching, while the regional organizations focused on dealing with psychiatric concerns. Of note, all groups were recommended to share the American Red Cross First Aid App with their members because it is available at no cost, does not require an internet connection, and has checklists for untrained individuals to use in a variety of medical emergencies.⁵

Conclusions

Expanding medical education efforts beyond formal education programs such as medical schools will benefit a wider array of stakeholders. Incorporating medical students into that effort can provide a unique and exciting opportunity for students to learn by teaching. The community groups in our study will expand knowledge and resources to improve their organizations, while members will become more competent in an emergency. That same competence aids the public, who are safer when more individuals are educated on how to respond to medical emergency situations. Moreover, broader implications include: (i) the medical learner finding more purpose in seeing how their medical education can benefit the larger community, and (ii) the family medicine educator would have access to expanded knowledge about local organizations that would benefit our out-patient patients and residency patients in achieving their health goals. 

References

1. Orkin A, Venugopal J, Curran J, et al. Emergency care with lay responders in underserved populations: A systematic review. Bulletin of the World Health Organization. 2021;99(7). doi:10.2471/blt.20.270249
2. Otten E, Bowman W, Hackett P, Spadafora M, Tauber D. Wilderness Prehospital Emergency Care (WPHEC) curriculum. Journal of Wilderness Medicine. 1991;2(2):80-87. doi:10.1580/0953-9859-2.2.80
3. Johnson DE, Schimelpfenig T, Hubbell F, et al. Minimum guidelines and scope of practice for Wilderness First Aid. Wilderness & Environmental Medicine. 2013;24(4):456-462. doi:10.1016/j.wem.2013.05.003
4. Strasser R, Worley P, Cristobal F, et al. Putting communities in the driver’s seat. Academic Medicine. 2015;90(11):1466-1470. doi:10.1097/acm.0000000000000765
5. Mobile apps & Voice-Enabled Skills . Red Cross. Accessed March 19, 2024. https://www.redcross.org/get-help/how-to-prepare-for-emergencies/mobile-apps.html.