I recently had to recertify for one of my key medical competencies at work, with the one-day training course being run at the regional hospital I work at. Although the training was delivered by an outstanding instructor, and was highly engaging, it was run in a conference room with equipment that belonged to the training provider, and differed slightly to the kit we use in our facility. Furthermore, the group recertifying that day were not likely to be the ones working together when an emergency occurs. It got me thinking that a better way to have run the training would have been in the teams we actually work in, in our hospital’s actual resuscitation bay, with the equipment we use on a day-to-day basis.

The realisation that repetitive and realistic training is fundamental to optimal performance of a skill is not new. In the mid 600s B.C.E, the Greek lyrical poet Archilochos is credited with the quotation, “We don’t rise to the level of our expectations, we fall to the level of our training.” Furthermore, we often hear the old adage, “train as you’re going to fight,” but how many of us actually apply it to our role?

Training as we were going to fight was something that we did very well during tactical medical training in the military units I served with, so much so that by the time most of us found ourselves in a real-life tactical trauma situation, we found that the skills required came to us instinctively, and often without much conscious thought.

This didn’t happen by chance, and while I didn’t appreciate it when I first went through the training pipeline myself, there was a very deliberate process in place to program the requisite skills into us, to give us the best chance of success under the duress of a battlefield trauma medical situation. The training philosophy applied is known as reality-based training (RBT), and is best described in the definitive text on the subject, “Training at the Speed of Life,” written by Kenneth Murray (2006). To understand how RBT works, it is useful to have a brief look at some of the theory behind it.