Gap ExMC 3.01: We do not know the optimal training methods for in-flight medical conditions identified on the Exploration Medical Condition List taking into account the crew medical officer’s clinical background (Closed)
Last Published:  07/27/17 09:48:09 AM (Central)
Responsible Element: Exploration Medical Capability (ExMC)
Status: Closed
Closure Rationale
Gap Closure Synopsis

This gap existed to explore the optimal means of preparing crew medical officers (CMOs) for the potential medical conditions on the Exploration Medical Condition List (EMCL) that a crew might face during an exploration mission. For this gap, the term “medical” encompasses dental and behavioral health conditions. Evidence from published reports on medical education, training, and validation, in addition to results from a survey on topics related to ISS crew medical officer (CMO) training completed by selected subject matter expects in the above categories, has been documented in the white paper “Identifying Medical Training Methods for Exploration Missions” (Blue et al.). This publication provides sufficient closure to this gap by identifying training and validation methods that could be applied effectively for the training of both crew and ground support teams and is summarized below.


In general, there was a consensus from the literature and the SMEs that CMOs would be best trained using scenario-based simulation exercises, with increased time dedicated to CMO training.  While some materials may be presented in didactic lecture style, the majority of medical training would be best presented in the form of hands-on simulation.  Ideally, CMOs should be specifically trained to utilize adjunctive capabilities, including telemedical consultation with ground support and just-in-time on-board software to best address a given medical contingency.  Incorporating high-fidelity simulation sessions into the training flow would provide the necessary skill utilization that has been demonstrated to improve retention times for practitioners of all levels.  Non-experienced crew members, such as the non-CMO astronauts, would need to undergo simulation refreshers every 6 months to ensure emergency skills retention.  Experienced crew members are likely to be able to go longer periods of time without the need for review, but it is recommended that they still undergo simulation refreshers at least every 9-10 months for critical or emergent procedures.


SMEs suggested that pre-mission training time could be increased to 80-120 hours of dedicated medical training for CMOs to ensure a high-degree of familiarity and comfort with medical hardware, procedures, high-likelihood conditions, and mission-specific risks. At the same time, it is recommended that non-CMO crew members should undergo, at a minimum, familiarization with on-board medical hardware, resources, and emergency procedures, for the possibility of CMO incapacitation and the potential need for medical autonomy by non-CMO crew members.  One approach to this training would be to utilize the non-experienced CMO training flow already in place for ISS missions, with tailoring to mission-specific hardware and procedures for the exploration mission at hand.


The review for this gap also concluded that all training methods and crew member competencies should be validated via examination methods. Multiple evaluation techniques could be tailored to evaluate CMO performance after progression through the training flow.  Techniques that rely upon expert evaluation, observed performance, and trainer feedback are considered to be the most reliable means for data acquisition in current medical training schemes.  The materials reviewed indicate that direct observation of clinical activity, Objective Structured Clinical Exams (OSCEs), and simulations are likely to be the most reliable and successful means of evaluation.  Simulation in particular would be recommended, as it would serve both as an evaluation and an opportunity to practice the skills learned, improving knowledge retention. 


Rationale for Closure

Optimal medical training and validation methods have been successfully identified and described, with significant levels of support from available literature and current terrestrial practices.  As analog environments and studies effectively answer the questions posed by this gap, further study of appropriate training methods is not required. The HRP gaps of SHFE-TRAIN-01, SHFE-TRAIN-02, and SHFE-TRAIN-03, within the SHFH element, further addresses the broader questions related to training. ExMC will continue to contribute to HRP’s work within these gaps. Additionally, ExMC’s technology watch gap, Gap 3.03, will sync emerging training methods pertaining to specific conditions on the EMCL, and the ExMC Gap 2.02 will address physician and non-physician training impacts to clinical outcomes.

 

Tasks and Supporting Reports Completed

Rebecca Blue; Laura Bridge; Natacha Chough; James Cushman; Muska Khpal; Sharmi Watkins. Identification  of Medical Training Methods for Exploration Missions, 1/1/2014, NASA Johnson Space Center.


Closure Documentation:
Description
1)  Initial State 
Due to the stringent astronaut screening process and pre-flight medical care, the human space flight program has fortunately not yet seen traumas or severe illness requiring on-orbit medical emergency care. Therefore, it has been difficult to determine the effectiveness of the full breadth of CMO skills training given to the crew regardless of their medical background (i.e., physician astronaut vs. non-physician-astronaut). This gap focuses on the identification of the best training methods and validation techniques used terrestrially for the medical skills that will be needed for exploration missions.


2Interim stages

1

Determine the clinical skills required to address the conditions on the EMCL.

2

Determine terrestrial methods for medical training and validation techniques.

3

Complete a survey of subject matter experts on preferred methods for medical training and validation techniques.

4

Develop a white paper outlining the current knowledge of medical training methods and validation techniques for CMO and ground personnel.


3)  Approach
A review of the skills needed to address the conditions on the EMCL will be conducted. A literature review regarding the current knowledge of medical training methods and validation techniques for the determined medical skills will be conducted. A report documenting the findings of the reviews will be produced.


Target for Closure
Delivery of while paper to identify the best training methods and validation techniques for the skills needed to address the Exploration Medical Condition List (EMCL) for CMO and ground personnel.
Mappings
Risk Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions
You are here! Gap ExMC 3.01: We do not know the optimal training methods for in-flight medical conditions identified on the Exploration Medical Condition List taking into account the crew medical officer’s clinical background (Closed)
Completed

Documentation:
No Documentation Available