Increasing the Effectiveness of “Stop the Bleed” Training Through Stepwise Mastery Learning with Deliberate Practice

• Published in: Journal of surgical education 2020-09, Vol.77 (5), p.1146-1153
• Main Authors: Muret-Wagstaff, Sharon L., Faber, David A., Gamboa, Adriana C., Lovasik, Brendan P.
• Format: Article
• Language: English
• Subjects: Interpersonal and Communication Skills; Medical Knowledge; Patient Care
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2020.03.001

The Stop the Bleed (STB) Campaign supported by the American College of Surgeons Committee on Trauma (ACSCT) and numerous other national organizations aspires to translate lifesaving military successes into reductions in civilian hemorrhagic deaths. While a curricular framework has been described, precise approaches to hands-on training are not specified and training success rates are not yet optimized. Our aim was to test the feasibility and effectiveness of an STB program enhanced by stepwise mastery learning with deliberate practice. Learners participated in an STB program combining evidence-based training models: the Peyton 4-stage model and simulation-based mastery learning with deliberate practice. ASCTC-certified STB coaches used a 3-point, behaviorally explicit checklist to test 4 skills: apply direct pressure; apply standard and improvised tourniquets; pack a wound. An anonymous questionnaire was administered. Simulation Center, Emory University School of Medicine. College students (N = 30) with no previous trauma training. 100% of participants reached mastery level for all 4 hemorrhage control skills within 4 tries. Additionally, 87% could state a definitive sign of life-threatening bleeding. 76% predicted comfort using a tourniquet in a real-life emergency; among 6 who would be very uncomfortable, 5 nonetheless would definitely recommend the course. We demonstrate feasibility and increased effectiveness of an STB course using evidence-based procedural training techniques. Adopting these techniques in current STB programs could close the current trainee performance gap and substantially increase the annual number of successfully trained laypersons over current reported levels with no increase required in enrollees, programs, or resources. Future studies should address the challenges of knowledge retention and skill decay, just-in-time innovations, implementation science methods to broaden access, and barriers to responding to real-life crisis events. Surgery education leaders can close performance gaps and make a unique contribution to the Hartford Consensus principle: No one should die from uncontrolled bleeding.