title: The challenges of military medical education and training for physicians and nurses in the Nordic countries - an interview study.
abstract: BACKGROUND
  Development and use of e-learning has not taken place to the same extent in military medicine in the Nordic countries. The aim was to explore the similarities and differences in education and training in military medicine for health professionals in the Nordic countries, and more specifically to identify the specific challenges regarding education and training of military medicine, and how e-learning is used at present and the opportunities for the future.
  
  
  METHODS
  Key educators within military medicine in the Nordic countries, as approved by the respective Surgeons General, were interviewed and the interviews were analyzed using content analysis.
  
  
  RESULTS
  The data showed that all Nordic countries cooperate in the field of military medical training to some extent. The models of recruitment and employment of health professionals differed as well as the degree of political support. These differences affected the ability for health professionals to gain actual experience from the military environment. To improve the quality of medical education and training, attempts were made to recruit physicians. The recruitment of physicians was considered a challenge which had resulted in disruptions of courses, training programs and maintenance of accreditation. The Nordic countries were described as having commonalities in the military medical systems and common needs for international collaboration within training, but differing in the range of education and training. Gaps were identified in methods for transferring outcomes from education into practice, as well as regarding evaluation and feedback of outcomes to military medicine. The educational tradition was described as oriented towards practical skills training without requirements on pedagogical education of educators. The results confirmed previous studies showing that e-learning was underutilized. Contextual understanding and experience of healthcare were seen as crucial factors for successful e-learning development.
  
  
  CONCLUSIONS
  Extended Nordic cooperation on military medical education and training are needed because of the limited volumes of advanced trauma cases. A key issue to the success of e-learning and blended learning is combining educational competence with contextual understanding into a strategy, of how to use digital educational methods.
authors.affiliation: Department of Learning, Informatics, Management and Ethics (LIME), Karolinska institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. linda.sonesson@ki.se.|Swedish Armed Forces Centre for Defence Medicine, Götaälvsgatan 20, 426 76, Västra Frölunda, Sweden. linda.sonesson@ki.se.
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0002-8132-4175
authors.initials: L
authors.lastname: Sonesson
authors.affiliation: Department of Surgery, Milpark Hospital Academic Trauma Centre, University of the Witwatersrand, Johannesburg, South Africa, Guild Road, Parktown ZA, Johannesburg, 2193, South Africa.|Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Boffard
authors.affiliation: Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.|Swedish Armed Forces Centre for Defence Medicine, Götaälvsgatan 20, 426 76, Västra Frölunda, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundberg
authors.affiliation: Mednet, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 7B, 405 30, Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Rydmark
authors.affiliation: Department of Learning, Informatics, Management and Ethics (LIME), Karolinska institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
authors.forename: Klas
authors.initials: K
authors.lastname: Karlgren
mesh_terms: D003194:Computer-Assisted Instruction / Q000592:standards*; D004501:Education, Medical / Q000379:methods / Q000592:standards*; D004517:Education, Professional / Q000379:methods / Q000592:standards*; D006801:Humans; D007858:Learning; D008887:Military Medicine / Q000193:education*; D009726:Nurses; D010820:Physicians; D012537:Scandinavian and Nordic Countries
keywords: Blended learning; Distance learning; E-learning; Medical education; Military medicine; Technology-enhanced learning; Web based learning