Evaluation of Knowledge, Skills and Attitudes at the Navy Trauma Training Center

Purpose: This study will evaluate knowledge, attitude, and skill outcomes of the Navy-civilian collaboration at Navy Trauma Training Center (NTTC) at the Los Angeles County+University of Southern California (LAC+USC) Medical Center. The mission of NTTC is to provide advanced trauma training for application across the range of military operations while exposing military medical personnel to high-volume and high-acuity trauma. NTTC attendees include physicians, registered nurses (RNs), hospital corpsmen, physician assistants (PAs), and special operations combat medics (SOCM). The need to determine measurable value for Department of Defense activities is essential in order to gain and maintain the trust of the American taxpayers and Congress. An ideal study would evaluate the effectiveness of all military-civilian trauma training programs; however, funding and logistic challenges preclude such an approach.

Specific Aims:

The primary aims of this study are to:
1. Evaluate the outcomes of the military-civilian collaboration at NTTC by measuring participant knowledge and attitudes on days 1, 10, and 20 with a written test and surveys assessing self-confidence and perceived stress.
2. Determine the knowledge degradation and change in attitudes of participants at 3 and 6 months after NTTC completion with a written test and surveys assessing confidence and perceived stress.
3. Compare the experiences of NTTC participants on days 10 and 20 using daily clinical experience logs. The secondary aim of this study is to evaluate the ability of NTTC participants to apply knowledge and skills in complex trauma care simulations on days 0, 10, 20 using the Tactical Combat Casualty Care (TCCC) checklist.

Design: This is a prospective, observational study with repeated measures using a convenience sample.

Rationale: Despite NTTC’s dominant role in Navy trauma training for over 10 years, no systematic evaluations of knowledge gains were identified. Likewise, while anecdotal stories of perceived value of actual trauma care experience exist, no quantified record of trauma care experiences per NTTC participant was identified that would enable valid comparison to other training opportunities. This study will provide needed data to advance both the culture of scientific inquiry and scholarly knowledge application. Further, this study of mission critical priorities will enable data driven policy decisions while building the military nursing research science base and research capacity.

Methods: Two validated written tests will be utilized to assess participants’ trauma care knowledge. The validated Perceived Stress Scale and a validated confidence survey specific to the participant’s perception to care for trauma patients and perform related procedures/skills will be used to assess attitudes. Clinical experiences will be recorded on a standardized clinical log following all clinical rotations. Psychomotor skills will be measured in a subset of participants using simulation evaluated with the standardized Navy Medicine TCCC checklist.

Relevance to Military Nursing Science: Effective trauma care training for military medical personnel is vital to force readiness. This study will provide quantified outcomes of the Navy Trauma Training Center using validated measures of knowledge, confidence, and stress. Longitudinal measures will provide information on how quickly the new knowledge degrades in the six months following training. Regardless of where the next conflict arises, US military nurses will deploy to hostile environments to provide care for the casualties of war. This prospective, observational
study of critical learning outcomes achieved at the Navy Trauma Training Center will provide objective data to enable more informed trauma training policy decisions for nurses and other military healthcare providers.