TTMWL: Episode 7 — “Standardizing Content and the Issues of Instructor Drift” with SOCOM’s Harold Montgomery

Training the Modern Workforce Live is a weekly show discussing training and talent development solutions and best practices. Hosted by Allogy CEO Colin Forward, each episode features an informative conversation with a prominent guest in the training world.

Watch the full video interview above, listen on any of the platforms below, or continue reading to see the full transcript (edited for clarity).

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About Harold Montgomery, President Emeritus of SOCOM

Harold Montgomery is the joint program manager for Tactical Combat Casualty Care with the Defense Health Agency. He’s a retired Army special operations medic with multiple deployments to Afghanistan and Iraq. He served as the senior medic for the 75th Ranger Regiment and as the senior enlisted medical advisor for the U.S. Special Operations Command.

Episode Transcript

Adam Wagner:
Hello, everyone, and welcome back to Allogy’s podcast, Training the Modern Workforce Live, the weekly show discussing training and talent development solutions and best practices. Each episode, we’ll talk about a different training topic and make sure to keep an eye out for special guests and interviews from top training professionals.

With me, as always, I have Colin Forward, CEO of Allogy. For the last decade, Colin has provided major U.S. hospitals and federal agencies with distance learning solutions. He studied mobile technology under Dr. David Metcalf while earning a degree in computer science and his MBA.

And joining Colin this week is Harold Montgomery, the joint program manager for Tactical Combat Casualty Care with the Defense Health Agency. He’s a retired Army special operations medic with multiple deployments to Afghanistan and Iraq. He served as the senior medic for the 75th Ranger Regiment and as the senior enlisted medical advisor for the U.S. Special Operations Command.

This week, we’re gonna be talking about curriculum drift, or instructor drift, and standardizing training content. We’ve got some great questions on deck already, but feel free to ask any questions that may come up in the chat and we’ll get to as many as we can. All right, Colin, over to you.

Colin Forward: Alright, thanks, Adam. And thanks, Monty, for joining us today. I don’t know that I’ve ever heard that version of your resume, but I do think that it gets a little bit more impressive every time I hear it. So, we’re happy to have you on the show. I mean, I think you’re going to have a lot of interesting insights to share with the folks listening in.

So, for starters, why don’t we kick it off by you sharing a little bit about what you’ve been working on for the last few years that we’ll be talking about today?

Harold Montgomery: Sure, Colin. Thanks. The Tactical Combat Casualty Care (TCCC) curriculum has been implemented throughout the DoD in different fashions for about 15 years now. TCCC originally came out in 1996 and was really a turning point in military medicine, and it took a while for true curriculum to be built.

It really wasn’t until 2008 that there were legit courses that were called TCCC out there. And even those, many of them were homegrown or just following general templates, but we didn’t really have standardized content. All of the guidelines from TCCC were coming out of the committee on TCCC—very specific procedures and indications for treatments and that kind of thing for combat casualty care.

But the training, it was getting to a point that it was all over the place. So starting back in 2016, we really tried to take hold of this and get a cohesive, standardized content initially rolling. That’s where we’ve been with this. And what we’re trying to do is get a good standardized content that can be delivered in a standardized way to our very diverse population that’s basically all around the world at any given time.

Colin Forward: Okay. So I just want to kind of ask around the corner to that a little bit because I think you might be a bit understated. We’re talking about a global training operation really, right?

Harold Montgomery: Yes. I mean, for the All Service Members scope of TCCC, we’re talking about 2.2 million people just in the DoD. That’s not counting partner-nation forces and the adaptation of TCCC in civilian EMS and law enforcement, that kind of thing. So, I mean, easily we’re talking about effecting a few million people and their training.

Colin Forward: Okay. Wow. So you’ve got a huge, diverse training audience. They’re all around the globe. It sounds like your trainers are probably about as diverse and distributed. And then, you’ve also got all of the complications that come with coordinating these things through multiple services, through multiple governments. Right? So that process started years ago, and now you’ve been working on content standardization and, I’m guessing, there’s been a lot of work going into making sure that the delivery is standardized as well. Right?

What Is Instructor Drift?

Harold Montgomery:
Yes, definitely, so that we can kill the old problem of instructor drift. So I’ll take a step back there. That was one of our problems for the longest time was our trainers out there. We basically had four types of trainers. There’s one that is up-to-date and on top of the latest guidelines and teaching the current news. There’s one that was teaching what they knew from the time that they learned it. So if they went through TCCC training in 2010, well, they were teaching 2010 TCCC, but they were teaching it now. Well, it’s outdated. Then, you have the third type that will pick and choose parts of training. They would teach parts that they were comfortable with and omit parts that they were uncomfortable with or didn’t agree with. And then, the worst offender of all was the interpreting instructor who just interpreted TCCC or the content as they saw fit.

So, I mean, that was our key drive for having the standardized content, whether that standardized content was a video, a podcast, skill sheets, or different grading methods and assessment methods. The key was having that very standardized. So even though much of the origin of TCCC training was homegrown and people taking the initiative down at ground level, in the long run, we were trying to overcome that a little bit so that we can narrow the focus back to where it needed to be and not so much the interpretive side of the house or the drift of instruction here and there.

Colin Forward: Okay. So we talk about instructor drift and curriculum drift quite a bit. It seems like Joint Trauma System (JTS) has, honestly, really put the concept out there. Even when we’re looking online for other examples or the literature about pedagogy, about instructor drift, JTS kind of seems to float to the top. And it strikes me that one of the reasons for that might be because the consequences are so severe. So maybe you can talk about what the impact is for the type of training that you’re delivering when you do have instructor drift?

How Can Instructor Drift Negatively Impact Training?

Harold Montgomery: Well, that’s pretty simple. I’ll narrow that down to just one procedure: the application of a tourniquet, which can quite literally mean the difference between life and limb. The casualty can bleed out and bleed to death if you don’t apply the tourniquet. However, if the tourniquet is applied wrong or for too long or is not applied correctly, then you can cost a limb that might not already be injured or something like that. So, I mean, there are issues that come into play with that.

And that’s actually one of the prime examples of an instructor drift that we had just a few years ago where a medic had attended one of the hybrid courses out there, which they basically were told, “Well, yes, you apply a tourniquet in care under fire and save the casualty’s life but never take that tourniquet off.”

And it’s like, “Well, no, actually that’s not what TCCC teaches at all.” Yes, it does teach to apply rapid tourniquets initially to save the life and limb, but it doesn’t teach to never bother to reevaluate that tourniquet. Alright, and that’s what this other course had been doing. They were saying it was a fire and forget; once you put it on there, it’s on there. Don’t do anything with it. And yet, the TCCC guidelines and the actual TCCC course teaches, “No, once you’re out of the firefight, once you’re out of the hostile situation, go back and evaluate that tourniquet.”

And you’re looking at a couple of different options. Does it need to stay in order to save the casualty’s life—which is the case in some cases, especially on amputation or something—or can you convert that tourniquet to a pressure dressing? There was actually a sailor in Africa that lost a leg from an injury that, yes, initially probably required a tourniquet, but half an hour later, once things were more stable where that injury could have been better treated and managed, the tourniquet could have been loosened and a pressure dressing applied in its place. That didn’t happen because that individual had been taught to put it on and never remove it.

So that’s one of our prime examples of instructor drift that doesn’t get the right point across from what TCCC training and the guidelines are supposed to be focusing on.

Colin Forward: Yeah. So we’re talking about the difference between, what, life and death, really, with making sure that people are staying on task here, so to speak, with training. And my understanding is that’s one of the largest causes of deaths in Iraq and Afghanistan. Is that right? Just that these are preventable.

Harold Montgomery: Yes. So our focus with TCCC and then all of this curricula is preventable combat death. So what are the injury patterns that we can take relatively easy steps and measures to control the situation, control the injury, to prevent death. And hemorrhage is the number one killer, but hemorrhage from extremity wounds or from arms and legs is very easy to control with a tourniquet or hemostatic dressing if applied quickly and efficiently and effectively, and you can save someone’s life very quickly. Whereas in years past and wars past, we lost a significant number.

I mean, if you look at the data from Vietnam, of the 52,000 names that are on that wall in Washington, D.C., there’s upwards of about 5,000 that bled out from something that all they needed was a tourniquet. You know, and we’re trying to prevent that kind of a pattern again.

Colin Forward: So it’s obviously very important work. I think the relative severity of the impact of instructor drift in this setting is really clear. I have to say, from my experience working with folks in military medicine, it’s certainly not for lack of motivation. I mean, this is definitely one of the most engaged, most motivated learning populations I’ve ever encountered. But this has taken years. This has been a years-long process to try and avoid some of the things that are leading to these preventable deaths.

So maybe you can help us understand at a high level the process that you’re undertaking in order to standardize the curriculum and training delivery?

What Are Some of the Difficulties In Standardizing Content Across a Diverse Audience?

Harold Montgomery: Well, I mean, it’s a few different issues. So in one sense, we’re tailoring training and curricula that is different from what is taught a little bit in normal medical activities. So, I mean, much of civilian medicine and much of the basics of military medicine, including how our doctors and nurses and PAs and even our medics are trained, they’re trained from a civilian perspective. So they get the licenses and certifications that they need and that kind of thing. But you’ve got to take all of that training and knowledge and morph it into the military environment—or the combat environment specifically.

So you’ve got to take it from a car accident on the freeway that has EMS arrive and some minor treatment and put them in an ambulance and deliver them to a hospital 15 minutes later to an environment where you’re in the middle of a firefight, you have five casualties, you’ve got to decide who to treat first in the midst of a firefight, do that treatment, consolidate them, continue managing, and then evacuate them. And your evacuation might be 15 minutes away; it might be 15 hours away.

There’s a lot of elements in that austere environment that puts the perspectives very differently. And we’ve got to modify the knowledge and the know-how and take what they already know and apply it to that different kind of setting. And that takes the training and the right kind of curricula to get that point across where they’re converting, in their minds, how they were trained in one way to apply some of those same kinds of skills in a different way.

Colin Forward: Yeah. So the challenges that you’re undertaking right now, I think that they show up in different ways for people who are responsible for training and professional development initiatives in any environment, whether it’s medicine or company onboarding or any kind of professional development or training. And a lot of people, I think, at this point realize—especially in a year like this—that the approaches that used to be someone’s go-to, like an in-service, face-to-face, classroom-style training, are just not an option.

And even though they might not be at the same scale that the Joint Trauma Service is working on, or they might not be the same sort of life or death impact that you’re dealing with, I think that there are probably a lot of analogies for how you size up the problem and then how you start taking steps to address the fragmentation of the content and the training delivery and instructor training.

So, I’m thinking maybe we go back five years or so, and we look at how JTS approached this problem.

How Do You Standardize and Structure Content Across a Diverse Audience?

Harold Montgomery: Well, I think a lot of that went back to the analysis of our target audience, and you kind of described it there. I mean, DoD is unique in the sense of the kind of people that is there. But I think it’s descriptive of any large workforce that is working in dispersed areas, so to speak. So, I mean, if you take our target population, it’s lots of individuals who are at various stages in their career.

So you may have some who are initial enlistees. They literally just graduated high school a few months prior, and now they’re coming into the Army, Navy, or Air Force. Everything is new to them. Everything is new, from shooting their rifle to tactics and techniques to marching to this medical training that we’re trying to introduce to them. And then, you’ve got those that are, you know, five, 10, 15 years into a military career. So we’re doing this in a sustainment training pattern for them. And let’s split that same body into two groups: nonmedical people and medical people.

So the nonmedical, which has two tiers of TCCC, they have no medical background, so anything we present to them—

Colin Forward: I’ve got to stop you real quick. TCCC?

Harold Montgomery: Oh, Tactical Combat Casualty Care. I thought I said that before at some point, didn’t I?

Colin Forward: Just making sure.

Harold Montgomery: Okay.

Colin Forward: You’ve got a very diverse audience for sure. 

Harold Montgomery: Oh, yeah, definitely. Definitely. But, I mean, it’s split in two in the non-medical folks that you can’t count on them having any kind of basic knowledge of anatomy, physiology, health, and that kind of thing. So you’ve always got to start at the basics. “Oh, when your patient has a high pulse rate?” Well, it’s like, “Wait, do they know how to take a pulse? Do they know what a pulse rate is and what that means?”

Whereas, when you’re talking to a medical person, well, they should know both how to take it and what a high pulse rate or a low pulse rate means and physiological issues and that kind of thing. So two different audiences in that sense, and then, like I said, where they are in different stages of their career of, “Have they had this kind of training before? Is this refresher training? How long has it been since their last refresher training?”

Which a lot of that has been key to this curriculum development. And we look at that on the onset as being able to deliver the same curricula, the same content, in four different ways, from a schoolhouse through an institution where anything that we’re doing is an adjunct to them sitting in a classroom in a schoolhouse building to the unit-based or what we call installation-based where various students from units on an installation come to one place and conduct training. For the Army, we have the MSTCs, or the medical simulation training centers, and that kind of thing where different personnel from different units come to one place and conduct training for a week or two weeks or whatever. Then, you’ve got the in-unit training where it’s just Sergeant Smith has two hours to train today, so what content can he use, and is that standardized content? And then, the fourth is the individual, on-demand.

So from the onset, we wanted to be able to deliver content that fit all of those categories for this very diverse population that, oh, by the way, they’re in different stages of their careers, but they’re also all around the world, literally, in either a pre-deployment stage or they’re getting ready to deploy, either going out to sea or going to a combat zone or whatever to being in that deployed setting and what kind of training and refresher can they do while they’re deployed.

So all of those were key factors that went into building the content and then the requirements to deliver that content from the get-go.

Colin Forward: Yeah. And so I should acknowledge that you’re not exactly in the sustainment period of this whole modernization/standardization process, right? This is still something that you’re kind of in the middle of that timeline. And it’s a huge project. So, I mean, I think you did a good job of characterizing what goes into identifying these personas—these multiple different groups of your training population and their different needs. So that’s a really awesome place to start because I think that that’s got to provide some really great input into the types of content and the types of considerations for training.

So once you have your population sort of mapped out, you understand their needs, the different modalities that they might be engaging in this training content with:

How Do You Go About Making Sure That the Content Itself Is Adhering to Some Sort of Standard?

Harold Montgomery:
Well, that was a challenge in itself because we were taking, you know, existing curricula and—well, curricula is probably not the best word because a lot of those things had not been developed in a true curriculum development manner. They had just been individuals who put trainings together or put slides together or threw some videos together, and it wasn’t very cohesive. But there was a lot of good material, good thought-through things, and good ideas that we didn’t just want to scrap. So we did take a hard look at all of that existing content, much of it coming out of JTS itself.

We had a huge PowerPoint-based slideshow and course that was solely based on PowerPoint but not heavy on the hands-on stuff. And as we started looking at it, it’s like, “Okay, what parts of this literally 690 slides needs to be delivered to those different populations?” You know, your most basic infantryman to the infantryman in a squad that we’re identifying as a combat lifesaver to what does a medic need to know to what does a supervising or a senior medic need to know.

And basically, we had one slideshow that was for all of them, and it was overwhelming to some and underwhelming to others. And what parts that needed to be delivered of the content. So, I mean, we took a really hard look at all that existing material and some best practices.

So, I mean, across the DoD, we call it “pockets of excellence” and “pockets of idiots” that happen out there where it’s like, “Here’s a place that is really on top of it. They’ve got great ideas. That’s a pocket of excellence.” And then there’s a bunch of idiots over here, and it’s like, “What are they doing?”

And trying to pick from both of those because when you take the global view, and it’s like, “Okay, what are they doing right? And what are they doing wrong?” Bring those together, and let’s fix the problem either by adopting the right or correcting the wrong and bringing those together, and that’s where we really wanted to set out on our development.

Colin Forward: I want to dig into that a little bit because we’ve talked to some folks, even on this podcast, where they’re part of a company or an organization where they’re trying to practice social learning, bringing in subject matter experts from around their organization to help create some of the training content.

The military can be really siloed. It’s obviously a very hierarchical organization. So when you’re talking about bringing together those groups, particularly the pockets of excellence, what does that look like? How are you working with those groups?

What Does Successful Collaboration Look Like When Standardizing Content on a Large Scale?

Harold Montgomery: Well, on the curriculum-development side, I mean, I’ve got to take that in two phases because there’s the part where we write the guidelines in the first place, and that’s the Committee on Tactical Combat Casualty Care, or the CoTCCC, as we call it. So it is already a gathering of SMEs who are trauma experts—trauma and combat medicine experts. So they’re the ones who define what these guidelines are in the first place, the clinical practice guidelines or CPG or whatever term you want to apply to it.

I mean, generally, they publish what we call the TCCC guidelines, which is what this curriculum is based off. So, I mean, them coming up with a firm, hard-set, “Here are the guidelines; here are the requirements for what needs to be taught.”

The next phase, the key is they are not educators. They aren’t trainers. They aren’t curriculum developers. They’re doctors, nurses, PAs, and a lot of combat medics with a lot of experience in both combat and trauma. So they’re coming up with that guideline, but then you need people who know how to develop curriculum, who also need to have levels of experience.

And I think it was that group that we really tried to integrate well in the, “Okay, let me get people who know how to build curriculum. Let me bring in a few of these folks from the committee who know what they’re talking about when it comes to being a combat medic, combat trauma,” mixed in with folks like yourselves where it’s like, “Okay, how can we deliver this kind of content?”

And bringing that group together is really what was new here, and certainly new for me and new for the JTS and how we were going to try to deliver this content of getting the right kinds of experts in the field. That’s not to say we all agreed every day because we didn’t, and when the topics and the issues came up, who can solve the problem and that kind of thing. I mean, there was a lot of turmoil, and we felt that over the three years we’ve been developing all of this. And I think that just happens anytime you have a lot of experts come in, you know, experts in their field. Bring them all into one room, and you’re going to have some conflict, but it’s good conflict.

Because when I look at it at the end, it’s like, “Okay, so yeah, we argued and busted heads for a while, but what do we have in the end? We have a great product for the users and the learners going out to them at the other end of it.”

Colin Forward: Wow. I love the way you put that. I mean, that, I think, really speaks to what you’ve achieved here in this kind of environment. I mean, I know things are kind of shifting around as far as who’s responsible for what, with the new Defense Health Agency (DHA) that’s playing a new role in sort of coordinating all these different services. And what you’re describing is really the military being able to adopt some new sort of cutting-edge approaches to professional development and training and bringing in these experts in different areas of training that the medical content itself, training delivery, that kind of thing, and then coming up with a solution that seems to be getting pretty good traction. So that seems like a good transition to start talking about Deployed Medicine, what it is, and why it was created, and how you’re going about growing that platform.

What Key Factors Led to Deployed Medicines Remote Training Adoption?

Harold Montgomery: Certainly. So I mean, Deployed Medicine, as we kicked off the effort, it was to try to find a way to deliver the content, as I said before, in those four methodologies—in a schoolhouse, in a local training site, unit-based, and individual—so that it met all of those demands while targeting the next generation.

And I mean, that’s been my key to all of this. It’s like, I’m not building something for me. I’m not building something for when I was a junior medic—a long time ago—to focus this on the next generation and what do they need now, a year from now, five years from now, and how do they learn.

So, I mean, we really tried to take a hard look, and I look at the stuff my own 15-year-old son looks at on his phone and devices to try to see, “Okay, well, 15 — he’s three years away from being military age.” So, I mean, that’s my five-year target range, right there. It’s the kids who are in high school. How are they operating?

And actually, this past year has been a pretty darn good year to look at how can high-schoolers diversify how they’ve done it. So, I mean, I’ve seen my own son and the way their school has presented stuff in the brick-and-mortar transition to a virtual to the use of apps and zoom content and this kind of being able to deliver the same old high school content that we’ve all had for decades and years and years and years in a completely different way.

And I mean, it’s been a good check on everything that we’ve been building because, quite frankly, it’s right in line with it. And to be honest, I think we’re a little ahead of the game on what many many schools across the nation were of being able to adapt to can I have my student in front of me in a classroom, or can I connect with my students through an app or a website or an online tool—or you guys probably know the better name.

I’m not a developer; I’m a medic. So what is that connection we’re doing to be able to keep engaged, keep reaching out to them with the right information, but then engaging them, and them being engaged to come back to the content and get involved with it?

So, I mean, I think it’s been key, and this has been a good year to check ourselves. I mean, not a great year by any means, but it has served a purpose in us being able to check our azimuth that we’re on the right track.

Colin Forward: Yeah. So you’re talking about bringing the whole operation into 2020. It wasn’t necessarily that far behind, but there’s a big gap between emailing PowerPoints as attachments and hoping that everything’s up to date and what you’re doing with Deployed Medicine.

And I think I owe the listeners a disclaimer: Deployed Medicine is built on Allogy’s product, Capillary.

But what I think is really interesting about it is that JTS and the Defense Health Agency have created this brand, this new product that is a DoD-owned and managed product, and that’s how you’ve gone about addressing this issue of fragmentation and making sure that the content is standardized. So can you talk a little bit about the decision to create this new outlet with this new brand name and logo and identity that is publicly available and also delivering standards-based content?

What Training Problems Were You Trying to Solve When Developing Deployed Medicine?

Harold Montgomery: Well, I’ll start in reverse there. So one of the key parts that we had to make hard decisions on early was— I mean, DoD has lots of platforms, lots of web-based platforms at its luxury. But the vast majority of that is all CAC card-based access. And much of the training is that way.

And that’s good in some sense in that, “Okay, you have an automatic registration in that I know exactly who my student is and their record and that kind of thing.” But on the flip side, they can only access it from sitting down at a computer and being able to access it directly. And then, it’s all web-based, so you count out the mobile platforms because your average Joe does not have the funds to go out and buy the CAC card adapter for their personal iPad or something like that.

So, I mean, a key part was trying to be able to engage them and reach them on what they already have. And if you look at just about any kid—I say kid, but anyone from the ages of probably almost 10 to 40—in their pocket, they have some sort of mobile device that is connected to something. So, I mean, that was a key aspect that we wanted to look at early on is their accessibility and that they didn’t have to sit down at a computer.

When we were presenting this to the decision-makers, all of them go in every day and pop their card into a computer, log in, and then they’re working. That’s easy for them to do in the cubicle farms of all the headquarters. The medic assigned to an infantry unit doesn’t have that luxury.

They’re probably sharing a computer or maybe three or four computers that are hooked to the internet with about 40 other people at any given time. And some of those 40 people are higher-ranking officers and NCOs that use it a lot more than everybody else. So him getting a chance to get in on a work computer—it’s minutes at a time. It’s literally to check messages, shoot a message off, look at a quick website, download something to be able to look at later, and that kind of thing.

So to be able to get the kind of engagement we wanted, for them to actually be able to watch videos, look at classes, review material, and that kind of thing, it couldn’t be based on them accessing a government computer only and getting in with their CAC card.

And the thing is, we’re not talking about security or sensitive information here. We’re just talking about medical training. So, I mean, this isn’t classified; there’s nothing overly sensitive about the content. It’s already out in the open. I mean, much of the material is published on civilian medical sites and that kind of thing as it gets out, but it gets dated that way, too, because it’s out of control.

So, I mean, that was another aspect that we looked at as well—the one ring to rule them all, so to speak, of one site where all of this material is. Because that’s another crime that we committed ourselves: as we developed all those old courses and even the old PowerPoints, we would just blast that out to the masses. You know, here’s the latest PowerPoint; here’s the latest class on this.

And the thing is is we were actually causing some of that dated and out-of-date training because if they didn’t get the next message, they didn’t get the new slide. Or if they hung them on a website, then you’ve got a website out there with the old material versus one of the key things we wanted to do with this was one site, one place where everybody comes to or links to so that if they want to put links on their website, it’s linked to us.

So if we update something today, everybody’s updated at once. There’s no more blasting out PowerPoints, no more blasting out content and hoping that people check their inboxes and look at the new training, adopt the new training, and implement the new training. This way, it’s one place for all of it, and everybody is able to access it.

Colin Forward: Yeah, that was great, and given my disclaimer, I think the next question is going to sound like I’m fishing for compliments, but I feel like this is important. So now, you’re pretty much in the scaling phase, right? You’ve kinda got the infrastructure in place, you’ve got the process, and you know your audience that you’re trying to reach. So what kind of results are you getting? What does it look like now that you’ve got that consolidated outlet for standards-based content?

What Successes Are You Seeing with Deployed Medicine Currently?

Harold Montgomery: So, so far so good. I mean, we’re about halfway through the courses that we’re developing when we developed the two courses for nonmedical personnel. So that’s truly our largest population. So when you’re talking DoD, that’s everyone from your infantryman to the sonar tech on a submarine and everybody in between. That’s our All Service Members course, and we’re trying to get that implemented.

But I mean, so far the popularity of being able to access all of the material any time during the class that they’re being exposed to. So, I mean, that’s an aspect I think was on our list of things that we were trying to achieve, but I think what’s really been a hallmark red flag of, “Hey, look what we did,” is when I’m sitting in a classroom and I watch a video or I see a slide or an instructor presents something, but it’s gone like that in your normal setting versus, “What did he say in that video? I can just pop it up and watch the video again.” And that’s one of the feedback loops we’ve already gotten is the ability to do immediate reinforce training, to reinforce learning that was kind of a vacuum before.

And I think that may be something that we’re setting a new standard here, a new way of doing things. You don’t just spend an hour in class and that’s your only exposure. The ability to do immediate refresher or immediate reinforcement or reinforcement a week from now, a month from now, or whatever, but where you’re still getting the same content but keeping it fresh in the head. It was on our list of things to do, but I mean, it’s really one of those, “Wow, we did that.” And we’re starting to get that feedback loop now, and I think as we do the next set of courses here, we’re going to get that even more because we’re going to be getting that from the people who are truly focused on this training.

The non-medical people, keep it in mind, this is side training. This isn’t their main training at all. An infantryman’s purpose is to shoot his rifle and engage the enemy. Medical training is something else. As we transition this to medical people, where this is their purpose in life, I think we’re going to get even more feedback on that, of the, “Wow, this helped me know my job and do my job better.” You know, I think that’s the next phase of this, that same feedback loop from the same initiative.

Colin Forward: So, I mean, it sounds like you’re having some good initial success, some good uptake. I’m wondering if, I mean, you’re talking about some really strong pedagogy. You’re talking about just-in-time learning; you’re talking about attacking the forgetting curve and making sure that skills decay isn’t becoming an issue. So those are all great things, and I think that those are probably things that you set out to address in the first place. Have there been any surprises, good or bad, so far with rolling out this kind of program?

One thing that I didn’t see coming was how many third-party audiences that aren’t really part of your mission have really found value in this outlet. I don’t know if that’s more of a benefit or a headache for you, but it was one of those things that I didn’t see coming when I knew that we were trying to work to support this population of combat medics.

Harold Montgomery: I guess one of the surprises was people wanting to jump on board our relatively fast-moving train before we’re finished laying the track, so to speak. So we’re still building the curricula and our branding and models that we want for curricula, and we’re still building the app and the website and the requirements for those. I mean, every time we put our heads together, we come up with additional things that we want this thing to be able to do down the road. And we’re still building things. And yet, people are wanting to get on board with what we’re doing and how we’re doing it now.

And in one sense, we’ve got to pause the initiatives and pause the progress to help them out and also both encourage and discourage. So encourage them, it’s like, “Okay. Yeah, we want you, and we want you onboard, but you’re not ready. Your content isn’t ready, and you need to go back and develop some more stuff, or we’re not quite ready for what you want to do.”

So, I mean, there are some things later in the stage of the project like branching scenarios and decision-making scenarios, and we want to be able to build in. It’s like, “Well, we want those, and it’s all on the target list of things to do, and other entities want that, but they want it now.” And because they’re jumping on the train late, they don’t understand. It’s like, “That’s on the list of things to do, but we’re not there yet. So you may just want to pause and come back in a few months.”

I think what’s been the real eye-opener is people want to use the platform and replicate our collections, but they aren’t ready. You know, and they don’t have the right content that is just ready plug-and-play that is exactly what we’ve been developing for these last couple of years. We’re developing it for this platform, so we know what we’re doing now. And they just want to put on videos, and it’s like, “Well, wait a second. We don’t need an hour-long video.”

Everything we do is tailored to the modern learner of, “Hey, if your thing is 10 minutes or more, it’s too long, you know. No one’s going to sit and watch that.” You’d do two-to-five minute videos, and they want to come to us with, “Here’s a 30-minute video or a 30-minute production or 300 PowerPoint slides.” It’s like, you need to go back and redo this. It’s not fitting the mold of what we’re building here. Which, I mean, at least you’re discouraging it, but then it leads to them opening their eyes of, “Wow, this is not exactly tailorable content that is ready to launch,” or, “It is death by PowerPoint,” that’s out there that we’re trying to overcome with the project, but it helps them open their eyes that they need to re-tailor the products.

Colin Forward: Yeah, I love what you’re saying there because it sounds like you have a problem that a lot of people would love to have, which is you’ve got a lot of enthusiasm, people are embracing the program, people want to participate, and you’re making sure that the bar is set at a certain level so that the content is good, it adheres to a standard, and you’re also supporting good mobile training.

So I’m going to send you into a minefield a little bit here, and you can totally decline to answer, but I mean, pushback is just something that people have to deal with any time they’re rolling out a new program—especially when you have all these different roles involved: the people who are in charge of the standard, the people doing the training delivery, the people who are supposed to be embracing this training.

What Kind of Issues Have You Encountered or Are Anticipating in Scaling the Program?

Harold Montgomery:
Well, any change in the DoD is a lengthy process sometimes as it is. Plus, and it’s a little saying I keep up on my computer, and it’s one of the things we’ve always anchored TCCC mindset to is, “Nothing gets a pass because it’s the way we’ve always done it.” Alright, it’s just not that simple. Just because this is how we’ve always done things shouldn’t be the reason that it’s the only way you do things. I mean, sometimes you’ve just got to stop and check yourself and say, “Is this the right way to do this?

One of the key lessons learned, and it’s kind of something that we really anchored TCCC mindset to, both from the guidelines, the curriculum, anything we’re doing, whether it’s a piece of equipment, a treatment, or whatever is, “Hey, just because we’ve always taught it this way, just because medicine has always done it this way, is it right? Is this science-based, is it evidence-based, is it training-based, is it skills-based, is it situation-based? Or is it just the way we’ve always done it and we need to change?”

So, I mean, that’s a constant throughout DoD. And then, I think that the bigger challenge—and it’s the constant challenge—is I say DoD and you almost think, “Oh, one entity.” It’s like, “No, that is now tribes of entities throughout the DoD.” So you’ve got obviously the military services: Army, Navy, Air Force, and Marines. And then, each within those, you’ve got layers of tribes almost between the combat-arms folks, the support elements—even Navy shore folks and go-to-sea folks. I mean, there are lots of different varieties of people and how they train and the kind of missions that they have.

So I think that’s one of the challenges that any large workforce is going to have is tailoring content and scaling and scoping it to, “Okay, what does everybody need?” Which, I mean, from a TCCC perspective, that was the all service members. What are the basics that I need everyone to be able to know, to the next one of, “Okay, what do I need some of those people to know?”

And then, when I’m getting into my expert fields and branching tribes or specialties, “What do I need this specialty to know versus this specialty, and that kind of thing.” So I think a lot of that comes into tailoring and delivering the different kinds of content and everything as well.

Colin Forward: Yeah, I think folks in training capacities are running into that kind of issue pretty much everywhere right now, whether you’re at a large hospital or a big corporation, you’re responsible for all these different functions—everything from finance to service delivery, whatever that may look like. So, I can only imagine all of the different interests that you have to weave into that conversation to have the kind of success it seems like you’re having with Deployed Medicine.

Harold Montgomery: Yeah, and I tell you, I think, probably one of the other challenges, especially within DoD that we’ve had in a large workforce, is trying to keep any of this from being a perception of online, check-the-block training. Okay, because that is something that has become very prominent within DoD. I mean, we have everything from HIPPA training to sexual harassment training to all sorts of check-the-block requirements that are mostly human resources based in some way or another that people have to get online to train. And quite frankly, many of them are the “Slide, click, slide, click, slide click. Check on learning one, two, three. Oh, A, B— Oh, I missed it? Oh, I got it right.”

I mean it’s just that rapid here’s a one-hour course that I can get done in seven minutes. Did I learn anything? No. Did I check my block? Yes. Do I have credit for something?

So a struggle is making sure that everything that we’re building isn’t that. It isn’t perceived as that, but there are those out there who want to just fit into that category. You guys are making online TCCC Training, which splits into two different mindsets: for some people, it’s just check the block. “Okay. You did TCCC training.” And then others who know what it is, it’s like, “TCCC is incredibly hands-on based. If you don’t know how to do the skill, it doesn’t matter what you know, it matters whether you can do it or not. So it can’t be online.”

It’s like, “Whoa, hang on folks.” It’s a little in between. We’re using online and on-demand capabilities to enhance the ability to do the hands-on training, you know?

So I think that’s probably been and going to continue to be a struggle as we implement this farther is that in people’s minds, it doesn’t sway in any one of those only directions, and they get tunnel vision on thinking that it’s, “Okay, check-the-block online stuff or it’s ignoring the hands-on.”

Colin Forward: Yeah. Well, I think you really nailed it there. I think that’s something that a ton of people can relate to. And that’s a challenge with keeping very diverse training populations engaged.

So I think that’s a great note to wrap on. Really appreciate you chatting with us today. I think that it’s very important work that you’re doing, and I’ve really enjoyed being part of what’s going on with Deployed Medicine. So really appreciate you joining us today. I think that there’s a lot of people that can learn something from this conversation, and I wish you continued success with what you’re doing for combat medicine.

Harold Montgomery: Certainly. Thank you. And the work isn’t over, we’ve got a lot to do yet. Thank you.

Adam Wagner: Thanks, everyone. This was Training the Modern Workforce Live, presented by Allogy. Remember to join us every week for more discussions on all things training and continued learning. If you’d like to explore previous episodes, subscribe to our YouTube channel or like us on LinkedIn and Facebook. And if you’d like to connect with one of our learning specialists to see how Allogy could help improve your training, head to allogy.com and schedule a demo.

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