A while back, Australian SAS operator and medical doctor Dan Pronk shared his insights and experiences on SOFREP regarding the importance of reality-based training in developing skills and optimizing performance. What follows are his insights: 

In any profession, the ability to perform tasks and respond effectively to challenging situations is directly linked to the quality of training one receives. Whether in the medical field, law enforcement, or the military, the concept of “train as you’re going to fight” has long been touted as a fundamental principle for preparing individuals to excel under pressure. This approach takes on even greater significance for special operations combat medics, as the ability to save lives in high-stress combat-trauma environments is absolutely critical. The method employed to achieve the highest level of skill acquisition in such scenarios is known as reality-based training (RBT), and it has proven to be an invaluable tool in optimizing performance.

The Power of Repetitive and Realistic Training

The notion that repetitive and realistic training is essential for optimal skill performance is not a new revelation. As far back as the mid-600s B.C.E., the Greek lyrical poet Archilochos emphasized the significance of training in determining one’s level of competence. The oft-repeated proverb, “We don’t rise to the level of our expectations, we fall to the level of our training,” also underscores the importance of rigorous and practical preparation.

In the realm of tactical medical training, particularly among military units, the effectiveness of RBT has been vividly demonstrated. When special operations combat medics find themselves facing real-life trauma situations, the skills they have acquired through RBT come to them instinctively, allowing them to act decisively and effectively, often without having to exert much conscious thought. However, this level of proficiency is not achieved by chance; it is the product of a deliberate and structured training process that ingrains the necessary skills.

combat medic training
(Image source: DVIDS)

Understanding the Phases of Skill Acquisition

To comprehend the efficacy of RBT, one must understand the four levels of integration during skill acquisition, as described by Grinder (Murray, 2006). These levels are:

  1. Unconscious incompetence: The individual lacks awareness of what they don’t know.
  2. Conscious incompetence: The person realizes their lack of skill and cannot perform the task.
  3. Conscious competence: The individual can perform the task but requires focused effort and concentration.
  4. Unconscious competence: The person can execute the skill automatically and without conscious thought.

For special operations medics, reaching the level of unconscious competence is paramount for reliable performance in high-stress combat-trauma situations. The ability to perform life-saving medical procedures, such as arterial tourniquet application, instinctively and without conscious effort allows the medic’s higher-order cognitive functions to remain focused on other critical aspects of the tactical environment.

Structured Escalation of Training

Achieving unconscious competence in a combat medic’s skillset requires a well-structured escalation of training. Starting at a level of unconscious incompetence, where the medic is relatively unaware of the full scope of their role, they must progress through conscious incompetence, where they become aware of their inadequacies and are motivated to learn and improve.