Bringing wilderness to the city

Most teaching faculty work at academic programs, which typically aren’t in areas considered “wilderness” by the average layperson. Thus, teaching wilderness and austere medicine in an urban environment is necessary for those of us who can’t get our departments to pay for that month in Costa Rica. Add to the fact that many smaller departments don’t have multiple faculty willing or able to teach wilderness, as they likely have their own niche (or two).

So how do you teach wilderness medicine without the wilderness, with finite group of teachers? A pair of doctors from Dundee devised a strategy and then gave a course, so maybe we can get some insight from them. Their’s was a 2 week course, but could likely be expanded for a 4 week course without much difficulty.

Like any good course, they broke it down to the theoretical and the practical. There was emphasis on leadership models, and the usual environmental topics. The students were also tasked with evaluating objects for expedition kits. As expected, there were simulated scenarios, but in a twist not many do, they used the students themselves as both the patients and the providers. Similar to many other rotations, they have the obligatory overnight camping trip. Of note, they point out that some of the scenarios aren’t the sexy “wilderness” topics, but instead the mundane but common complaints. Knowing how to treat chest pain in the woods is much more important than treating the sting of something that lives in a finite geographic range on the other side of the planet.

Students evaluated the rotation via questionnaire. They thought it was useful (at least, the ones who filled out the surveys did), but some requested more scenarios. Comparable to my own personal experience with a wilderness rotation, their students felt the camping was the best part of the rotation. Teacher assessment of students indicated that there was improvement in clinical decision-making by the students over the course of the rotation.

In the end, this shows that simulation continues to be the mainstay of most experiential education when scenarios cannot be experienced in real life. You can make things work when they might not be the “best” option, which is the heart and soul of wilderness medicine to begin with.

Lockwood P, Middleton P. Teaching wilderness and outdoor medicine in a city. Clin Teach. 2013 Dec;10(6):389-93. [PMID 24219524]