Modeling Framework Used to Analyze and Describe Junctional Tourniquet Skills.

Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users' skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.