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First Aid (WFA) courses are taught by multiple individuals and programs. They have become a standard for people
working and recreating in the outdoors.
Are they effective? Can the
participants remember the information?
Can they perform the skills?
investigate these questions NOLS Wilderness Medicine Institute (WMI) conducted a
research project to measure retention of WFA skills and knowledge. There
is literature on skill and knowledge retention in CPR and first aid, but
nothing we could find on WFA courses.
was conducted with our colleagues at the University of Utah; Scott Schumann PhD,
Jim Sibthorp PhD and Rachel Collins MS. At the conclusion of an open
enrollment WFA course the study participants were given a written exam and an
assessment of their confidence in their ability to perform their WFA skills.
At either 4, 8 or 12 months post course they returned to complete a scored
skills-based scenario, familiar to anyone who has taken a WMI WFA course.
They also repeated the WFA
knowledge and self-efficacy measures they took at the original
training. You can read the detailed study methodology, results and
limitations at the Journal of Wilderness and Environmental Medicine http://wemjournal.org/.
are not surprising.
• We quickly
forget what we do not practice. The longer the time from training, the more we
tests do not correlate with performance on practical tests.
opinions on our competence may not correlate with our practical
The study participants
demonstrated poor skill proficiency when taking vital signs, obtaining a
medical history, and conducting the focused spine assessment (a selective spine
immobilization protocol). These results are consistent with studies that
show first aid knowledge and skills, or any skills or knowledge for that
matter, deteriorate in the absence
of repeated practice.
The poor skill
retention seen in this study brings an interesting perspective to the
complaints we hear about the burden of biannual recertification of WFA/WFR.
The American Heart Association suggests practicing medical professionals
refresh their BLS skills more frequently than every 2 years. We cannot
assume that laypeople will retain their skills any better than practicing
professionals. Bravo to those
organizations with ongoing training for their staff.
The study did
not look at teaching competency, but it does beg these questions. The
content may be basic first aid, but in our (albeit biased) opinion the volume
of stuff in a WFA requires a skilled educator to have any chance for competent
graduates. WFA courses are taught
by skilled educators and outdoor medicine practitioners, and they are taught by
people who obtain a WFA instructional credential online with no verification
they can teach effectively, have ever touched a patient or spent a night
outdoors. Buyer beware.
results raise the question of the appropriate role for this certification. The WFA course was designed as an
introductory layperson first aid course for those close to help or assisting a
more highly trained provider and is described in this context in the Scope of Practice
document. It has unfortunately
evolved into a wilderness trip leader credential.
We must also
pause and ponder all the content people want crammed into this course. Of everything we could teach, what
needs to be learned by a layperson to practice wilderness first aid? We have grown to expect more from this
course than we can deliver in 16 hours of instruction.
doesn't find these results discouraging, nor did we choose, as can happen
in product research, to bury the negative results. We empirically assessed and now report our outcomes. We
have already revised our WFA curriculum.
We cut unnecessary content detail, including the focused spine
assessment. We found more practice
time in a busy agenda. We are
developing other educational tools to increase retention. We're excited
to continue to evolve an important curriculum that is accurate, realistic and
Wilderness Medicine Institute
Reference: Schumann SA
, Schimelpfenig T
, Sibthorp J
, Collins RH
An examination of wilderness first aid knowledge, self-efficacy, and skill retention
Wilderness Environ Med
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