Taking the example of training a special operations combat medic to operate at the highest level under duress, I am going to start with them posting into an SO unit at a training level of unconscious incompetence. At that stage in their career, they will have passed their basic medic training, and generally served in one or two other units prior to posting into SO. They may have a basic understanding of the combat medic role in a special operations unit, however they are generally oblivious to the specifics and full implications of the role.
The first step toward reaching unconscious competence is opening the medic’s eyes to the full spectrum of what is expected of them in the role, and thus moving them to a state of conscious incompetence. This can be a humbling and somewhat demoralizing experience for the medic, when all of a sudden they realise that they are inadequate for the role at their current level of training. As instructors, it is important to manage this stage of an individual’s training well, in order to build rather than destroy confidence. For the right medic, however, the move to conscious incompetence is highly motivating to learn the requisite skills and become a proficient operator.
Once a medic knows what they don’t know, the next step is to start filling the knowledge gaps with appropriate training. This stage involves a progressive introduction to skills, which is best provided initially with theoretical lessons and individual practical skills practice. It is appropriate to use classroom-based lessons initially at this level of training, and it is important to ensure that the medic has a firm grasp on the basic individual skills before progressing to RBT scenarios. Progression too rapidly to RBT will overwhelm the medic and once again destroy rather than build confidence, however it is equally important to move quickly on to RBT once the basic skills have been mastered.
At this stage, the medic has reached a state of conscious competence, and will be able to perform their role well in a training context, however it will take their full concentration to do so. They will often be largely oblivious to the overarching tactical context of the scenario around them, and can easily be distracted from the task at hand by asking them a question. A good test that I used to use to assess whether a medic was at the level of conscious competence was to ask them for casualty information while they were involved in a scenario. At this point, the consciously competent medic would stop doing what they were doing and look up to give me the casualty information. When prompted to keep treating the casualty and tell me the information, they would go back to treating with competence but would stop talking.
This was an excellent illustration that they couldn’t manage both tasks simultaneously due to their higher level thought being devoted to the function of casualty treatment, with no processing capacity left to generate and verbalize the casualty information. It was at the point when a medic could be performing their casualty management while reeling off casualty information to me that I was confident that they had reached unconscious competence, and were approaching readiness for their full role as an SO medic.
Once the medic had reached a state of unconscious competence on a daytime single-casualty scenario, the next step was was to start introducing additional factors, such as low-light conditions, multiple-casualty scenarios, and higher-fidelity training models such as live tissue. Every scenario was done with the exact same equipment as the medic would be carrying on the job, and always with the exact same uniform, body armor, helmet, rifle etc. that the medic would be using.
Tourniquets and other medical equipment would be positioned consistently on the medic’s kit throughout training as to program the muscle memory to reach instinctively to the right spot for any given piece of equipment, even in the dark. If the medic was being deployed to a cold climate, training was done in the cold, as to experience firsthand the challenges of medically managing a trauma casualty in cold environments.
If the medic was being deployed to a hot environment, once again, training was done for that environment, so there were no surprises when they reached their destination.
https://www.youtube.com/watch?v=q5qGYw7xF8A
Once the skills were mastered during the day, training was done in low-light conditions such as smoke and night.
(The following video highlights the complexities of providing care under fire on night vision, using high-fidelity simulation.)
https://www.youtube.com/watch?v=tvLAPNZZ8d4
Training was done in helicopters. The following series of screen shots are taken from a tactical evacuation training activity done as pre-deployment validation before one of my trips. Less than a month later, I found myself in the back of a Black Hawk in Afghanistan with the exact same medic across from me, managing two IED blast victims similar to the ones in this training scenario. It went smoothly that day because we had trained as we were going to fight.
Training was also conducted on the water.
https://www.youtube.com/watch?v=ukW7unUIFcs
And by the time the real scenario came around, the medic would have reached a state of unconscious competence, and be prepared to respond appropriately to a casualty situation in a complex tactical environment. (The gunshot wound casualty in the following video is the AK-47 wound case study previously published here on SOFREP.)
https://www.youtube.com/watch?v=LO6302s2nFs
In this article I have chosen to use the example of training a special operations combat medic to illustrate Grinder’s levels of skill acquisition and the crucial importance of reality-based training, however the principles are equally applicable to any operator in any field. Training should be graduated at first, and then when the basic skills are solidified, RBT should be introduced in scenarios as close to the real environment as possible. I have been incredibly privileged to have been a part of military units that had access to budgets and equipment that allowed us to create high-fidelity training scenarios, however I feel that the same training outcomes can be achieved with a far smaller budget, and with less access to toys.
The key to creating a meaningful training environment is to engage the student with a scenario that is relevant to them, and if you can achieve that, the realism is of less importance. I have watched medics 100 percent engaged in trauma scenarios using very low-fidelity training models because they could see the relevance in the training. Likewise, I have watched students fail to engage in live-tissue training sessions, with real arterial bleeding from an animal model, because they failed to see the relevance of the training to them. If relevance and realism can be achieved in a training environment, then student engagement and positive training outcomes are almost guaranteed.
Finally, I’d like to address the idiom, “Those who can, do; those who can’t, teach.” Although this is sadly true in some instances, I feel it is only a half truth overall. Those who have done, and then choose to teach others, are the key to retaining corporate knowledge in an organization, and ensuring that hard-won lessons do not have to be relearned. In the instance of a special operations combat medic, relearning lessons can mean an unnecessary death of a teammate on the battlefield.
Those who have done, and then choose to teach, have the power to multiply their capability exponentially by imparting their skills on the next generation. I can think of many instructors over my years in the military who I owe an infinite debt of gratitude to for investing their time in me to ensure that in my moment of need, I had the skill set to rise to the challenge. To those instructors, and to all those out there who invest their time in a similar fashion, thank you for training others as they are going to fight.
Questions and comments are welcome. Cheers.
References
Artwohl, A, Christensen, LW 1997, Deadly Force Encounters: What cops need to know mentally and physically to prepare for and survive a gunfight, Paladin Press, Boulder, CO.
Murray, K 2006, Training at the Speed of Life. The definitive textbook for military and law enforcement Reality Based Training, Armiger Publications, Gotha FL.
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