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Beyond HOSPEX: what is the additional training value of military hospital exercises (HOSPEX)?
  1. Madelaine Gimzewska1,2,
  2. K Hunter1,3,
  3. S Al Azzawi1 and
  4. A Boreham1
  1. 1 256 (City of London) Field Hospital, London, UK
  2. 2 Department of Academic Vascular Surgery, Imperial College London, London, UK
  3. 3 St George's School of Anasesthesia, London, UK
  1. Correspondence to Madelaine Gimzewska, Imperial College London, London SW7 2BU, UK; m.gimzewska{at}


Background The use of simulation in clinical environments is a frequently used adjunct to training individuals and teams. The military uses clinical simulation to train large numbers of personnel, standardise patient pathways and sustain specific skills to ensure medical personnel are prepared to deploy in their clinical roles.

Methods As part of a North Atlantic Treaty Organization (NATO) exercise, 256 Field Hospital (Reserves) deployed a team of clinicians to simulate a role 2 basic field hospital. This hospital exercise (HOSPEX) involved training, and a 4-day real-time exercise with casualty simulation. A retrospective survey of all clinical personnel was conducted to analyse the utility of the exercise on their understanding of their job role, the workings of the field hospital and their confidence in deploying on operations.

Results 39 personnel were surveyed, with questions graded on a modified Likert scale. 41% had previous operational experience in their current job role. A significantly higher proportion of respondents graded their understanding of their job role, and the field hospital overall, as good or excellent having completed the exercise (p<0.01), and 90% felt more confident in fulfilling their operational role postexercise. 90% of respondents had previous experience of simulation, and 94% of these rated the military simulation as being more beneficial than civilian equivalents.

Discussion With a shift towards simulation in medical training, opportunities have arisen within HOSPEX to develop additional skills for teams and individuals. Simulation is especially important in personnel who have not had previous operational experience, who may deploy on first time operations in senior clinical and leadership roles.

Conclusion HOSPEXs are perceived as being extremely useful by clinical personnel preparing for future operational deployment. HOSPEX simulation has prepared the military for varied operations since its inception, and the paradigm has potential for extension into civilian training for high intensity medical responses.

  • education & training (see medical education & training)
  • medical education & training
  • qualitative research

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  • Contributors The idea for this survey was formed by MG and SAA, and the survey conducted by MG and KH. MG, KH, SAA and AB wrote the manuscript, with overall supervision provided by AB.

  • Funding Captain Gimzewska is an Academic Clinical Fellow at Imperial College London funded by NIHR and Imperial BRC.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.