Text from 2nd edition by SANDRA ROBERTS, revised and updated by Nebojša Nikolić
D.3.1 Current requirements
International Maritime Organisation courses
The International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW) Code Part A, Chapter VI sets out the legal basis for the training of nautical officers in first aid and medical care on board. It provides the mandatory minimum requirements/standards of competences necessary for the officer responsible for medical care on board. They are specified as ‘competences, knowledge, understanding and proficiency and the methods for demonstrating achieved competences’ and ‘criteria for their evaluation’ are outlined. After the adoption of STCW in 1978, the IMO designed a series of model courses detailing training requirements in accordance with the objectives set out in the Code.
Each model course includes a
- course framework detailing the scope, objective, entry standards, and other information about the course
- course outline or timetable
- detailed teaching syllabus including the learning objectives and competences that should be achieved
- guidance notes for the instructor.
Three model courses related to training in first aid/medical help on board are fully compliant with the relevant sections of the Code, including the Manila amendments 2010. However, the course contents have not been revised for many years and do not necessarily reflect current good practice in casualty management. The model courses relating to medical care are:
ELEMENTARY FIRST AID
(Model course 1.13)
This model course provides training in elementary first aid at the support level and is based on the provisions of table A-VI/1-3 of the STCW Code. It includes medical emergency and basic training for all seafarers who are to serve aboard sea-going merchant vessels and consists of up to 15 hours of training.
MEDICAL FIRST AID
(Model course 1.14)
This model course provides more advanced first aid training aimed at those seafarers designated to provide first aid on board. It is based on the provisions of table A-VI/4-1 of the STCW Code. The course consists of approximately 20 hours of teaching and will give sufficient knowledge and skills for effective action in the case of accident or illness, until the person who is in charge of medical care arrives.
(Model course 1.15)
This model course provides the most advanced level of training and is required for those designated to take charge of medical care on board. This should enable a seafarer to have enough knowledge of illness and injury and of the medical stores and equipment on board, to be able to
- diagnose medical problems
- provide medical care to the sick and injured while they remain on board
- communicate effectively with telemedical assistance services ashore
- participate in coordinated schemes for medical assistance to ships.
It is based on the provisions of table A-VI/4-2 of the STCW Code and provides advanced medical care training for the person in charge of medical care on board a ship. This is usually the Master, the Chief Officer or the second mate. In order to achieve this competency, seafarers must have completed all 3 courses and have to participate in refresher medical training at least every 5 years. This course consists of approximately 40 hours of training. Other ranks and departments on board may have to complete this training once or more depending on the flag State requirements.
In addition to being required for specific roles on board, different levels of training are required to achieve Certificates of Competency. There are also different requirements for deck and engineering officers. Further information is available in Ch. 4.3.
The duration and content of the training may be extremely variable, influenced by the requirements of the maritime administrations, depth and quality of training provision, and the seafarer’s level of engagement with the training.
Theoretical knowledge is limited, with poor retention. The efficacy of training is dependent on the level and quality of practical instruction and exercises during the course and is further influenced by the medical equipment available for use on board.
Different national practices
First aid training is similar all over the world and follows the requirements, guidelines and standards of major organisations such as the European Resuscitation Council, the International Red Cross, or the American Heart Association.
In contrast, the medical care training given to nautical officers varies hugely from country to country. In the majority of places, training is given in the format of intensive courses; in some, the training hours, are included in other training programmes in nautical schools. The total amount of medical lessons and practical exercises varies a lot from country to country, with the majority only including the minimum requirements as stated in the international regulations and presented in the IMO Model Courses.
Many experts have questioned if the medical care course, when limited to 40 hours as suggested, is sufficient to fully meet the requirements of STCW. There are institutions that have found it necessary to extend the duration of that course to 70, and even 100 hours, trying to improve the skills of the trainees. Some nations have produced not only their own medical guides but also designed their own training programs that are surpassing the requirements of the Code, using IMO Model Courses only as the development tool they were intended to be. For example, in Finland, training courses are of 19, 20 and 40 hours duration,theory and practice, depending on the position of the seafarer. The Master, who is responsible for the medical care of his crew, undertakes a 5 day training course in medical matters and refresher training every year. In Spain, from the “Instituto Social de la Marina” there are three courses, FORMAC I, II and III (20, 30 and 40 hours respectively) and a refresher course every five years as recommended in the STCW Convention. Refresher courses on line are also used. In Croatia, medical training of future officers is provided in maritime academies as one year semester subjects with a total length of 52 hours, and also in the form of 3 courses of 12, 21 and 40 hours, in various educational facilities approved by the Ministry of Transport. A 5 year refresher course is given according the international regulations. In the USA, a course of Elementary first Aid is 7 hours of teaching, Medical First Aid, 35 hours and the Shipboard Medical Person In Charge Course is 77 hours of training.
D.3.2 Effective training
One of the major factors in the successful treatment of a sick or injured person on board ship
is the extent of medical knowledge of the ship’s officer in charge of medical care.
Each teaching method has its own advantages and disadvantages, with no single best way of teaching and learning. To be effective, learning must involve constructive mental activity and should not exceed the capacity of novices. Effective curriculum development requires moving away from didactic teaching methods towards a practical learning pathway based on experience, placing emphasis on knowing how rather than knowing all.
Current courses demonstrate that it is possible to adequately train designated providers to a certain level. The main obstacle is that officers must sometimes perform procedures outside of their usual scope of practice. They must use complex telemedical technologies to communicate with medical practitioners on shore to perform an unfamiliar task whilst also continuing to monitor the patient and communicate the patient’s status. All of these factors lead to a potential increase in errors. One possible solution is to use simulation in the medical training of marine medical practitioners. Contextualised simulation practice minimises the demands on the working memory by facilitating the development of automatic schemas in the long-term memory. This has been shown to improve performance in real-life settings. Students set great store of knowledge/competences by simulation-based learning on a mannequin in contextual settings, and the opportunity to apply theoretical knowledge in a safe and realistic setting. However, the most important factor in generating learning using simulators is to construct scenarios that provide an opportunity to generate and maintain needed competences in emergencies for example, a health incident on board, evacuation techniques and the transport of casualties.
Therefore, in many maritime schools with an extended course, simulation becomes an important part of the training of medical personnel on board ships.
D.3.3 Revision if the IMO Model Courses
Rapid scientific advances and the subsequent changes in recommended medical care require frequent adaptation in the training and education of professional as well as non-professional first aiders. The curriculum for medical training courses should reflect any change in medical guidelines and therefore model courses are revised at regular intervals. The Revised guidelines for the development, review and validation of model courses (MSC-MEPC.2/Circ.15) set rules for such a revision and these apply to IMO model courses 1.13, 1.14 and 1.15.
Until recently, the main obstacle in creating a universally acceptable training program was the differences in training programs and methods of education between different countries. Outcome oriented learning is a system where different parties with different teaching traditions agree not on the training programs, but on the learning outcomes. Therefore, all students leave the training course with the same competences regardless of the program they underwent. Several methods can be used to define the learning outcomes. In the MEDINE 2 project on medical education in Europe, the concept of Miller’s pyramid was used to define the learning outcomes for the first three years of medical training. Miller’s Pyramid has four levels: Knows, Knows how, Shows how and Does. In recent years, this framework has found a third dimension to incorporate the domains of Bloom’s taxonomy. It is the universally accepted approach used in the teaching syllabus composition and it classifies the teaching goals into six levels (Remember, Understand, Apply, Analyse, Evaluate and Create) from the perspective of cognition.
As the Model courses are essentially medical training courses that result in clinical competences, it may be possible to use this in the process of defining learning outcomes / competences in those Model courses too. If the learning outcomes are defined, each country will be able to design its own training programs or textbooks to achieve the same learning outcomes as the IMO model courses.