Our curriculum is broad and attempts to cover a wide swath of topics. Typical to an introduction in wilderness medicine.
Medical topics include:
- Patient assessment diamond: rapid and complete assessment of patients with medical or traumatic illnesses with a focus on rapid care and extrication. This is a specialized assessment tool we personally developed and many students have found it extremely useful both for use on the course, but also for their personal use in the hospital setting.
- SOAP notes and rapid documentation
- Spine assessments and clearance
- Heat illness and injuries
- Hypothermia and cold injury
- Altitude illness
- Allergies and anaphylaxis
- Lightning injuries
- Major trauma: chest, abdominal, head and spinal injuries
- Wilderness orthopedics: usable vs non-usable injuries, fractures/dislocations and splinting
- Moving patients: lifts, rolls, beaming and stemming
- Packaging patients: Stokes litters, toboggans, improvised litters, spinal immobilization
- Submersion and Immersion injuries
- Incident Command structures and coordinating care as a team
- Search and rescue considerations
- Wilderness wound care and soft tissue injuries
- Wilderness medical kits
- Hypothermia and hypothermia wraps
Wilderness activity topics include:
- Basic map/compass skills, orienteering and navigation
- Survival and the rule of 3s
- Knots for wilderness medicine
- Food planning and prep
- Light weight travel tips
- Water management
- Considering weather effects on trip plan
- Basic canoe paddling technique
- Calm water rescue intro
- Swift water rescue intro
- Packing a pack
- Blister care
The best learning occurs when you teach. With that in mind each student will select a topic which they will research and then prepare a presentation to be given during our wilderness evolutions. This is also an opportunity for students to explore an area of particular interest and develop a deeper knowledge of this area. Students will have resident/faculty guidance for these. Topics include (but are not limited to):
- Blister/Foot care
- Water purification
- Gender specific wilderness medical concerns
- Wilderness dermatology
- Dive medicine
- Mammalian injuries
- Diarrhea and communicable diseases
- Special population care (e.g. kids, the elderly and pregnancy)
- Dental/ENT emergencies
- Frostbite and non-freezing cold injuries
- Sun induced injuries (snow blindness, sun bumps, sun burn).
Simulation-based education has become a standard of medical training. Years before medical schools and residencies embraced simulation, or had sim centers, wilderness education used simulation to learn, practice and improve skills. We have been doing simulations in our course for more than 20 years. Students fill all roles: incident commander, direct patient care, equipment specialist, etc. while managing simulated patients from time of injury to packaging and transport. Students also have the opportunity to experience being a patient so they can learn what parts of medical care are important for patient comfort. Group debriefs after each scenario foster a collaborative and supportive learning experience.
A large portion of our key topics noted above are covered by lectures given by faculty and residents. Many of these are given on the wilderness evolutions and may vary from chalk talks (given with a plastic bag and dry erase marker over a sleeping pad) to group discussions. We also will have didactics in Portland during the ED based time, these include our wilderness medicine conference day that is coordinated with the residency as well as specific lectures covered in classrooms or outdoors in the Portland area.
As with any ED elective, students receive direct bedside teach during their ED time. There is a resident assigned to the teaching role who will be working directly with students to maximize their educational opportunities in the ED. Students also are able to work directly with our ED faculty. During the wilderness evolutions, students are given direct supervision and education during simulations as well as their topic presentations.
In addition to the wilderness medical topics and skills that students will build, they will learn and develop experience in non-medical but critical wilderness skills. This largely occurs as students are intimately involved in the preparation and running of this trip. This is not a guided experience, but rather a group that will work together to a common goal. Students have the opportunity to help plan and learn things such as route planning on land and in the water, coordinating around weather forecasts, group dynamics, food planning for groups, and transportation issues.
Students will spend two weeks rotating in our ED, similar to a typical ED rotation; however, during this time our conference days and didactic learning will be wilderness-medicine focused. Students will be guided through their ED time and taught by a dedicated resident as well as directly by our ED faculty.
MMC is the only level 1 trauma center or comprehensive stroke Maine. We are also the oldest residency in northern New England.
You can read more on our residency webpage: www.mmcemresidency.org/med-student-rotation
During the mountain evolution, we will hike in the legendary Baxter State Park. Starting at the north of the park, which is less frequently visited, students are shown some of the gems of the Maine woods. Traveling south, we see mountain streams, waterfalls, and backcountry lakes (which are frequented by moose). Eventually, we arrive at the south of the park and, weather permitting, climb the infamous Mount Katahdin.
After hiking, we travel to Greenville, Maine, for a day of changeover. Then collect canoes (anyone heard of a little Maine company named Old Town?) and start down the West Branch of the Penobscot. This section of river is famous for its fishing. We will also have the opportunity to see beaver dams and, of course, the potential for moose. We spend 5 days traveling from Roll Damn to Chesuncook Lake.
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