To the Editor:
The Nordic countries are characterized by large landmasses of sparsely populated areas, with both geographic and environmental challenges. In particular, the Scandinavian subcontinent is interjected with vast mountain regions, arctic climates, and a varied coastline dotted with fjords and peaks. It is these variations that are both a strength and weakness when considering recruitment and competence development of medical personnel. 1 –3
We know that shortages in staffing to primary health care facilities are often solved with locum personnel, many of whom may not be accustomed to working in such remote conditions.1,2 To create a more stable staffing situation in such communities, it is imperative to recruit young physicians, nurses, and other paramedical personnel intent on sowing roots in said locations. It has previously been shown that wilderness medical training programs are very popular among young medical professionals and that in many areas, such programs have been used as methods of recruitment to rural locations. 2
Our initial goal was to import and establish advanced wilderness life support (AWLS) in Scandinavia, which we were convinced had the potential to revolutionize rural and wilderness medicine training for primary care providers in much the same way as advanced trauma life support (ATLS) has for surgeons. 3 We were equally convinced that medical providers would potentially find that rural arctic areas could be interesting testing grounds for their newly learned skills. 4
The first step was achieved when we completed the first AWLS course in Abisko, Sweden, September 22–25, 2011. We have subsequently held courses March 22–25, 2012, and June 13–16, 2013, in Narvik, Norway. 5 The second step was to establish wilderness medicine training for nursing students. It was postulated that establishing such training at Narvik University College, located in Narvik, Norway, on the Ofoten Fjord would directly increase the recruitment of nursing student candidates.
We assembled a project group in spring of 2011 that included the authors and the dean of the nursing college for the purpose of establishing a wilderness medical training course at Narvik University College. It was proposed that the course would be offered as an elective during the final semester of education as an alternative to the established “medical prevention project.” The course was proposed to include two steps. The first would entail the instruction of AWLS over a period of 6 weeks, allowing the Norwegian students time to thoroughly investigate the English language-based course literature. To satisfy the Norwegian requirements that all Bachelor level courses include a written essay, the second step was for the students to divide into project groups and author a prevention-based research project based on wilderness medicine. The college agreed to contract a 3-year project with us, and all senior students would be given the option to take the elective education. The first course was held in spring of 2013. Intense marketing both in the local press and in the college recruitment materials was initiated.
Although all lecture and course materials were in English, we communicated with the students solely in Norwegian. While maintaining the core curriculum for AWLS, we added information that was more relevant for our audience. While maintaining the US-based statistics, we also added Scandinavian and, in particular, Norwegian statistics. As we had 8 fatalities due to avalanches in Norway during the 2012–2013 season, such numbers were equally as vital in grabbing students’ attention. 6 The “animal bites and stings” lecture also included potentially dangerous Scandinavian animals such as the adder (Vipera berus). Further planned additions to future lecture material will include Scandinavian toxic plants such as nettle (Urtica sp) and typical Scandinavian wilderness-related diseases such as epidemic nephropathy and tularemia.
Nineteen students attended the course during the period of March 6, 2013, to April 25, 2013. Eighteen of the 19 students passed both the practical and the written portion of the examination. The remaining student was hindered by sickness. The highest score was minus 0 and the lowest score was minus 9. The score range was 86.2% to 100% correct. The students considered that the subject matter increased level of comfort with handling wilderness medical cases. The school of nursing at Narvik University College experienced a 28% increase in applicants according to the national report on application to tertiary education released April 22, 2013.
Although the statistics showing an increase in applicants to the education are very encouraging, it is at this point impossible to give further meaning to these numbers. The wilderness medicine course was first advertised in 2012, and the students who will have potentially been swayed in their application to Narvik University College will not matriculate to the wilderness medicine course until 2015. We will continue to follow the trends in numbers of applicants. At the culmination of the first “recruited” matriculating class in 2015, we aim to investigate and publish whether the wilderness medicine course was paramount in these students’ choice of college campus.