Development of a Critical Skills Assessment for Military Medical Field Settings

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Objectives: To develop a method of measuring medical decision making in a military field setting that would allow an evaluation of the impact of sleep deprivation, fatigue, and other stressors on critical skills deterioration. Methods: Thirty-seven students who were enrolled in a Doctor of Nursing Practice (DNP) program or a Bachelor of Science in Nursing (BSN) program participated in this study. Over the course of three days, student participants were sent five questions in the morning and five questions in the evening. On the fourth day, students were sent 10 questions in the morning and 10 questions in the evening. DNP students received medication calculation questions and BSN students received Basic Life Support (BLS) questions. All questions were drawn from standardized test bank sources, were multiple choice, and were thoroughly reviewed by the research team for relevant content prior to study testing. Results: Twenty-five (50%) and twenty-eight (56%) of the 50 BLS and medication calculation questions met the selection criteria of average response times between 10 and 50 seconds and accuracy of at least 80%. From these, 16 questions were selected from both sets with smaller standard deviations, minimum response times of at least 5 seconds and maximum response times less than 90 seconds. Implications: In order to test the impact of sleep deprivation, fatigue, or any other stressors on critical decision making skills of military medical personnel during field training operations it was necessary to develop a test battery of questions that are sensitive enough to detect variation due to human factors. Our study accomplished this objective, and the resulting medication calculation and BLS questions can be used to readily assess deterioration in critical decision making skills within a field setting. Key Words: Critical Skills, Disaster Training, Sleep and Fatigue

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