To the Editor:
Wilderness medicine (WM) skills are becoming more important as access to wilderness settings and interest in outdoor recreation increases. With an expanding interest in and increasing public accessibility to outdoor recreation, there has been a documented increase in outdoor incidents requiring some form of medical attention. 1 Thus, it becomes increasingly important for laypersons and healthcare professionals alike to be comfortable participating in medical scenarios outside of the clinical setting. There are many unique challenges associated with providing care to patients in austere situations that also resemble the challenges one might face while providing care in any nontraditional settings, such as during natural disasters or on expeditions. 2 Medical programs around the nation are finding that WM education, in addition to its recreational applications, is ideal training for those wishing to practice in developing nations and have begun promoting WM within their programs. 3 This form of training provides a unique skill set that is applicable to a wide variety of environments and clinical settings and can be taught in a conference setting. Unfortunately, there are significant barriers to access adequate WM education. 4 After 6 years of conducting regional WM conferences in the southeast, we propose that the model of regional student-organized conferences is a successful and reproducible solution to improving WM education.
As the field of WM has become more accepted in academia, both nonprofit organizations, such as the Wilderness Medical Society (WMS), and commercial organizations have coordinated student electives, national conferences, and commercial courses across the United States. 5 There are, however, many financial and logistical barriers to students interested in these options. 4 Student electives are typically only available for senior level medical students and last 2 to 4 weeks. 5 Commercial courses often cost more than $1000. National conferences are frequently open to students at reduced rates; however, they still can be very costly once travel expenses are counted. 5 Additionally, the majority of these electives, national conferences, and commercial courses occur in the western United States, which can increase the burden for students who do not live in that region.
To overcome these barriers, there has been a recent push to support regional WM organizations that can offer affordable and accessible training. The growth of regional organizations is proving to enhance WM advocacy and offer better training among peers. This interest in affordable WM conferences has created a unique situation in which student WM interest groups and regional organizations can work to fulfill that need. Regional organizations have recognized that regional conferences provide training and networking in a manner that is more accessible to the general public. 3
In 2008, the Southeastern Student Wilderness Medicine Conference was established and drew 120 attendees from 14 states and Canada. The majority of registrants were medical students (60%), with other levels of healthcare professionals present as well (Table). The conference took place over 1 weekend with students arriving Saturday morning for course registration. The morning consisted of a keynote speaker followed by several small-group breakout sessions, in which students received focused, hands-on instruction in the subjects of their choosing. The final day consisted of several hours of WM scenarios based out of a local park. Groups of fewer than 10 students rotated through a network of WM scenarios in which they applied knowledge gained the previous day to simulated incidents.
Percent of attendees by medical background
EMT, emergency medical technician; PA, physician’s assistant.
The conference has continued to grow for the past 5 years with attendance at the Fifth Annual Southeastern Student Wilderness Medicine Conference reaching 232 students. Despite the size, students still had many opportunities for small-group instruction, giving the conference a smaller feel. The incremental increase in attendance during the past years supports the argument that there is a significant level of interest in WM subjects and that the main barrier to WM training is access to affordable and effective instruction. An additional student WM conference was also hosted in 2011 and 2012 in the mid-Atlantic region using a similar model.
The conference remains affordable as all of the instructors are volunteers and are not financially compensated for their participation. The conference allows new educators, such as residents, an opportunity to teach and become more involved with WM. Student travel costs are minimized as the conference is designed as a regional event and typically moves within the region annually. Student organizers also are able to gather local sponsorships, which offset associated conference costs. Meals and t-shirt options are carefully reviewed to ensure the costs remain low.
Before and after conference surveys were administered at the Fifth Annual Southeastern Conference to evaluate students’ perceived comfort levels with general WM subjects. The categories included identifying snakes, treating snake envenomations, treating mammal bites, treating heat stroke, treating hypothermia, treating frostbite, treating lightning victims, taking lightning precautions, treating common dislocations, building litters and transporting patients, performing a trauma assessment, maintaining C-spine precautions, recognizing possible myocardial infarctions, treating anaphylaxis, and hypoglycemia management. There was a statistically significant difference between the before and after conference survey comfort levels in all categories. It was concluded that attendees had a significant improvement in their perceived comfort levels, which is a marker of the conference’s success. Each year the student attendance at the conference has steadily increased. Registration has increased from 120 students in the first year to 232 students in the fifth year, which is yet another marker of success.
Although this regional conference model has been successful in the southeast, there remains great opportunity to replicate this model in other regions. We hope this conference will serve as a model to other organizations throughout the nation for providing affordable and effective WM training for students. The keys to this model’s efficacy are the low cost and regional locations, which allow medical students easy and affordable access. By increasing access to WM training, we can build a safer and more rewarding community among outdoor enthusiasts.