The ability to provide point of injury care to wounded personnel is a critical strategic and humanitarian requirement for the Department of Defense. Typically, this task falls to whomever is closest in proximity to the wounded regardless of their duty station; thus, the ability to train novices on critical treatment tactics is vitally important. A large multicenter research initiative within the DoD focuses on combat casualty care training that will optimize materials and topics as well as understand the tools and technologies that have the potential to accelerate the learning curve. The goal is to provide appropriate, prompt, and effective training while maintaining or improving fidelity and lowering costs of training and education.

To help better understand how trainees learn new skills in a medical education program, the Naval Air Warfare Training Systems Center was asked to examine two of the most common injuries seen in combat, bleeding and airway compromise. Funding was obtained through the Defense Health Program Enhancement initiative, managed by the United States Army Medical Research and Materiel Command. This effort is part of a larger goal of providing optimal medical training based on the scientific analysis of combat training systems. Funding was obtained through the Defense Health Program Enhancement initiative, managed by the Joint Program Committee-1. JPC-1 plans, coordinates and oversees a responsive world-class tri-service science and technology program focused on improving military medical training through medical simulation, educational gaming, and objective training metrics as well as improving health information sciences through increased interoperability, strategic planning, process development, and medical applications.

As one of many outcomes of this study, Dr. Katrina Ricci, Principal Investigator of the project, and her team submitted an abstract, entitled "Generalizability Theory as a Formative Guide for Developing Trauma Procedure Performance Assessments," to the International Meeting on Simulation in Healthcare. Dr. Ricci states, "The development and validation of metrics for the medical training community is critical given the current emerging modeling and simulation technologies proposed to replace or supplement traditional training approaches. We need to ensure that our medical personnel are provided the best training possible and to do so requires sound, valid research approaches. The funding provided by this research effort allowed our team to demonstrate an approach for estimating the reliability of assessment protocols involving expert ratings of trainee performance." The submission was awarded Second Place Research Abstract, and was presented at the meeting in January. A complete manuscript has been submitted for publication.

Dr. Ricci, who is Head of the Training and Human Performance Research and Development Branch, and her team worked in conjunction with Military medical education professionals at the Joint Special Operations Medical Operations Center at Ft. Bragg, North Carolina. The NAVAIR group developed rating instruments for hemorrhage control and surgical airway procedures, as performed by military point'of'injury care providers, then deconstructed each task to develop a detailed sequence for each task. The NAVAIR concluded that, "Generalizability theory draws attention to the fact that 'reliability' is not a fixed value for a given measurement approach, but rather is contingent on who is measuring, when they are measuring, who is being measured, etc."

Dr. Kevin Kunkler, Contracting Officer Representative from the USAMRMC's Telemedicine and Advanced Technology Research Center (TATRC), believes, "The work that Dr. Ricci and the NAVAIR research team accomplished provides a solid foundation upon which additional intramural and extramural research may be performed." The NAVAIR project and the results from Dr. Ricci's team laid a foundation for other organizations to carry forward research to examine the effectiveness of medical training and measure how the training is received. The ability to adequately measure whether a trainee has learned what the instructor has attempted to teach is paramount. This approach has applications for both the military and the private health care sector.