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WFA Retention Study Oct 2012

WFA Retention Study

September 2012


Wilderness First Aid (WFA) courses are taught by multiple individuals and programs.  They have become a standard for people working and recreating in the outdoors.  Are they effective?  Can the participants remember the information?  Can they perform the skills?


To investigate this question NOLS Wilderness Medicine Institute (WMI) conducted a research project to measure retention of WFA skills and knowledge.  There is literature on skill and knowledge retention in CPR and first aid, but nothing we could find on WFA courses.


The research was conducted with our colleagues at the University of Utah; Scott Schumann PhD, Jim Sibthorp PhD and Rachel Collins MS.  At the conclusion of an open enrollment WFA course the study participants were given a written exam and an assessment of their confidence in their ability to perform their WFA skills.   At either 4, 8 or 12 months post course they returned to complete a scored skills-based scenario, familiar to anyone who has taken a WMI WFA course.   They also repeated the WFA knowledge and self-efficacy measures they took at the original training.   You can read the detailed study methodology, results and limitations at the Journal of Wilderness and Environmental Medicine


Our findings are not surprising. 

• We quickly forget what we do not practice. The longer the time from training, the more we forget. 

• Written tests do not correlate with performance on practical tests.

• Our opinions on our competence may not correlate with our practical performance. 


The study participants demonstrated poor skill proficiency when taking vital signs, obtaining a medical history, and conducting the focused spine assessment (a selective spine immobilization protocol).  These results are consistent with studies that show first aid knowledge and skills, or any skills or knowledge for that matter,  deteriorate in the absence of repeated practice. 


The poor skill retention seen in this study brings an interesting perspective to the complaints we hear about the burden of biannual recertification of WFA/WFR.  The American Heart Association suggests practicing medical professionals refresh their BLS skills more frequently than every 2 years.  We cannot assume that laypeople will retain their skills any better than practicing professionals.  Bravo to those organizations with ongoing training for their staff.


The study did not look at teaching competency, but it does beg these questions.  The content may be basic first aid, but in our (albeit biased) opinion the volume of stuff in a WFA requires a skilled educator to have any chance for competent graduates.  WFA courses are taught by skilled educators and outdoor medicine practitioners, and they are taught by people who obtain a WFA instructional credential online with no verification they can teach effectively, have ever touched a patient or spent a night outdoors.  Buyer beware.   


These results raise the question of the appropriate role for this certification.  The WFA course was designed as an introductory layperson first aid course for those close to help or assisting a more highly trained provider and is described in this context in the Scope of Practice document.  It has unfortunately evolved into a wilderness trip leader credential.


We must also pause and ponder all the content people want crammed into this course.  Of everything we could teach, what needs to be learned by a layperson to practice wilderness first aid?  We have grown to expect more from this course than we can deliver in 16 hours of instruction.


WMI doesn't find these results discouraging, nor did we choose, as can happen in product research, to bury the negative results.  We empirically assessed and now report our outcomes.  We have already revised our WFA curriculum.  We cut unnecessary content detail, including the focused spine assessment.  We found , more practice time in a busy agenda.  We are developing other educational tools to increase retention.  We're excited to continue to evolve an important curriculum that is accurate, realistic and practical.




Tod Schimelpfenig

Curriculum Director

NOLS Wilderness Medicine Institute

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