Unveiling Readiness of Medical First Responders in Simulation Trainings: Insights beyond Queries
Authors: Malfait Annelien , Van Puyvelde Martine , DETAILLE Frederic , Neyt Xavier , Waroquier Francois , Pattyn Nathalie 
Published: October 2023

In military deployments, medical professionals face complex operational situations that are not encountered in civilian health care practice. Defence Departments invest a huge budget of time and money to the training of military medical personnel in order to ensure medical proficiency and successful care of patients in this specific context, However, these previously trained skills may have decayed through disuse. Although past research efforts have provided a greater understanding of the mechanisms underlying skill acquisition and decay, there are still no detailed models of skill acquisition and skill decay, no understanding of mediating or mitigating factors, and more importantly no mitigation strategies in military medical tasks (Perez et al., 2013). The current paper describes the methodology to quantify performance in the framework of a project addressing this need for further research in emergency military medical care, specifically understanding and quantifying medical skill acquisition and skill decay. Method In a first descriptive part, skill acquisition and practice were investigated in a qualitative way by observation and in-depth interviews with emergency medical personnel (N = 23, nurses and physicians, from civilian and military backgrounds). In a second part, a set of methodologies was designed to objectify skill acquisition, not only by measuring outcomes (e.g. the successful intubation of a patient), but also refining the technical analyses of skills and assessing the psychophysiological readiness of the performer.Results For the first, qualitative study, all the interviewees described as a major impact on performance several examples of (extreme) stressful and/or dangerous events that they experienced during mass events, accidents, events with serious injuries and/or vulnerable victims (e.g., children), the situational context in combination with extreme high workload and patient flux. In military respondents, additional war-related aspects such as difficult and dangerous working circumstances and war-specific injuries were described. Being exposed to danger was often mentioned, even in civilian participants. Overall, personnel is continuously searching to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress; which are quoted as a major impact on performance, but without the awareness of own performance degradation. Based on these results, we decided to include an assessment of the psychophysiological allostatic load during the performance of specific skills, in order to factor this variable in when quantifying performance during simulation trainings. Considering the physical load during these trainings (running to the casualty, carrying equipment), measuring individual physiological activation does not make much sense regarding signal-to-noise ratio. Hence two other methods were adopted, which rely on the systemic measures of psychophysiological functioning. These were recordings of facial expression on the one hand, and voice analysis on the other hand. Facial expression is recorded through an add-on of the recording system equipping the simulation multi-room observation lab: the Noldus-Viso (© Noldus) system (i.e., a synchronized 4 high-quality camera system) that allows for real-live observation with a marker interface system and retrospective micro-analyses (The Observer XT) based on in-depth coding of interventions and skill performance. This combination of analyses on a macro and micro level will deliver information on what (macro) went well and what went wrong but also why (micro). The Noldus suite includes an automated emotion and action unit (AU) coding software (FaceReader7). In addition, voice recording is used and our model of Voice Stress Analysis is applied (Van Puyvelde et al., 2018). Conclusion The novel content of this project is to integrate what are usually termed “hard” and “soft” skills. Indeed, emergency medicine, and especially so in military contexts, still suffers from a historical “macho” culture. The evaluation methodology designed for the current project allows for a detailed skill acquisition analysis, by coupling the macro-outcome to micro-recordings of performance coupled to facial expression and voice recordings that offer a unique insight in health care providers’ performance.References Perez RS, Skinner A, Weyhrauch P, Niehaus J, Lathan C, Schwaitzberg SD, Cao CG. Prevention of surgical skill decay. Mil Med. 2013 Oct;178(10 Suppl):76-86. doi: 10.7205/MILMED-D-13-00216. PMID: 24084308.Van Puyvelde M, Neyt X, McGlone F, Pattyn N. Voice Stress Analysis: A New Framework for Voice and Effort in Human Performance. Front Psychol. 2018 Nov 20;9:1994. doi: 10.3389/fpsyg.2018.01994. PMID: 30515113; PMCID: PMC6255927.