Why Wilderness Medicine Skills Matter in Clinical Practice

A patient needs your help, but the information is incomplete, resources are stretched, and your team is looking for a clear plan.

This could describe so many scenarios. A remote mountain rescue might come to mind, but you may also recognise it from your own clinical practice, perhaps even from a shift you worked recently.

Wilderness medicine brings these challenges into focus. Working away from immediate investigations, specialist support and familiar equipment means thinking carefully about priorities, communicating decisions and recognising when a plan needs to change. There may be a long wait for help, and the conditions around you can become part of the clinical problem.

You don’t need to be a wilderness medic to find value in learning how to work through this. These are skills you call on wherever you practise, even if your next patient is considerably closer to a hospital than a mountainside.

Exploring them somewhere unfamiliar can also help you notice things about your practice that are harder to see when you’re surrounded by your usual routines.

Making decisions with incomplete information

In clinical practice, decisions often come before certainty.

You may be waiting for results, working with a limited history or assessing someone whose condition is changing. You still need to decide what matters now, what can wait, and what would prompt you to take a different approach.

Remote medicine makes that process particularly visible. When investigations and specialist advice are some distance away, clinical assessment, repeated observation and clear reasoning become central to the plan. You have to work with the information available while remaining aware of what you don’t yet know.

That creates an opportunity to examine how you reached a decision in the first place.

Have we become attached to our first explanation?
Are we giving enough weight to new information?
Does everyone in the team understand why we’ve chosen this approach?

These can be uncomfortable questions, particularly when you’ve already committed time and effort to a plan. Changing direction may feel harder when the team is busy or when you were the person who suggested the original approach.

Practising that reassessment matters. An initial decision can be reasonable and still need to change as new information emerges.

A small pilot study using backcountry decision-making in medical education explored this connection. Participants reported a greater understanding of how cognitive biases could influence clinical decisions. The findings were exploratory, with limited participation, but they suggest outdoor learning can provide a useful setting for examining habits of thought that also affect patient care.

You’ll find this study and the other sources discussed below in the further reading section!

For clinicians, the potential value is in having time to recognise uncertainty, explain a decision and practise reconsidering it. That includes being able to say, “This was our working assumption, but something has changed.”

What happens when everyone is waiting for a plan?

Leadership can sound a little abstract until a team needs to assess a casualty and agree how to get someone to safety.

At that point, it becomes practical, with someone needing to establish priorities, make sure tasks are understood and keep track of what is happening beyond their own immediate role.

The questions that should be asked are often quite simple:

Who is coordinating the response?
Does everyone know their role?
Has someone noticed a risk that the rest of the team has missed?

You’ll probably recognise these from everyday healthcare, too.

The Agency for Healthcare Research and Quality’s TeamSTEPPS framework highlights the importance of sharing care plans, clarifying responsibilities and bringing teams together to review progress when circumstances change.

In practice, this might mean taking a moment to explain what you’re most concerned about and what you need each person to do. It might mean checking that a request was understood, or asking a quieter colleague whether they have noticed anything the team should consider.

There is also judgement involved in knowing when to step forward and when someone else is better placed to lead. A colleague may have more relevant experience, a clearer view of the situation or information you haven’t heard yet.

An unfamiliar training environment gives you an opportunity to pay attention to these behaviours.

How clearly do you communicate when you’re under pressure?
Do you make space for questions?
If you’re concentrating on a clinical task, who is keeping an eye on the wider plan?

You don’t need a leadership title to find those questions useful.

Being resourceful includes knowing your limits

Limited resources encourage you to think carefully about what an intervention needs to achieve.

When the equipment you would usually reach for isn’t available, you have to consider the options in front of you and whether they are appropriate for the patient and the situation.

What are we trying to achieve?
What can we safely do with the resources available?
What are the risks?
When do we need additional support?

Practical exercises involving casualty movement or fracture management can make this process tangible. You’re considering the patient’s needs alongside the equipment, people and conditions around you. A plan has to be workable for the team delivering it, as well as appropriate for the casualty.

The connection to everyday practice is in that assessment and planning. You might be caring for someone while awaiting a transfer, responding before the full team has arrived or working somewhere less familiar.

In each case, you need to understand what can be achieved safely now and what requires further resources or expertise. Any adaptation has to account for your competence, local guidance and the clinical risks involved.

Resourcefulness also starts well before an emergency. Checking equipment, understanding its limitations and anticipating what might be needed can give you more options when circumstances become difficult.

Wilderness medicine provides a setting in which to examine those decisions closely, because the consequences of preparation, or a gap in preparation, can become apparent very quickly.

The patient, the team and everything happening around them

It’s easy to become absorbed in the task immediately in front of you, especially when it requires concentration.

Meanwhile… Other things are changing.

In a remote setting, the weather may be deteriorating, daylight may be fading or a team member may be becoming too tired to contribute safely. An evacuation that looked straightforward an hour ago may need to be reconsidered.

In a clinical setting, the wider picture might include rising workload, access to equipment, delays elsewhere in the service or a colleague becoming overwhelmed.

These circumstances affect what the team can deliver, even when the patient’s immediate clinical needs remain the same.

AHRQ’s guidance on situation monitoring encourages teams to pay attention to the patient, their colleagues, the environment and progress towards their goal. It’s a useful reminder that awareness extends beyond the person carrying out a particular task.

This is where another pair of eyes can make a difference. Someone who is less occupied with the immediate intervention may be able to notice a change, identify a problem or ask whether the current plan is still realistic.

Learning to welcome that input is part of working effectively as a team, so is feeling able to offer it.

Having time to understand what happened

After a difficult situation, you may remember exactly what you did without having had much opportunity to explore why you did it.

Perhaps communication became confused, maybe two people took on the same task while something else was missed.

Alternatively the team worked particularly well, and there is something worth understanding and repeating.

During a busy shift, finding time for those conversations can be difficult, we get it.

Scenario-based learning creates space to examine them. Participants can work through a problem, receive feedback and discuss how their decisions and communication affected the exercise.

That discussion can reveal a gap between what someone intended and what others understood. You may have thought a request was clear; a colleague may have heard something different. You may have assumed everyone knew the plan because no one asked a question.

Those are useful things to discover in training.

A UK study of a wilderness medicine teaching programme found improved self-reported confidence among participating medical students. That is encouraging, although increased confidence does not, by itself, demonstrate improved clinical performance or patient outcomes.

The opportunity to reflect is an important part of the learning. TeamSTEPPS recommends structured debriefing to explore what worked, what could improve and how a team might adapt its approach in future.

A good discussion should leave you with something specific to take forward, that might be explaining your priorities earlier, checking that roles are understood or being more deliberate about inviting concerns.

Looking at what you want from your next learning experience

If this is something you’re interested in exploring, a course curriculum can tell you a lot about the opportunities you’ll have to practise.

Alongside the clinical topics, look at how the training approaches human factors, decision-making and working with other people. Consider whether you’ll have opportunities to apply those skills together, particularly when a situation develops beyond the initial assessment.

For example, our Expedition and Wilderness Medicine curriculum includes human factors, crew resource management, risk management and patient assessment alongside practical clinical skills. It concludes with a search and rescue scenario in which participants work together to locate, assess, treat and evacuate a simulated casualty, this also includes a debrief where you can discuss what went well and what can be improved. Plus feedback from the casualty themselves to understand the patient’s point of view.

An exercise like that brings several demands together.

The team needs a clinical plan, but it also needs to communicate, organise its resources and respond as circumstances change.

You may be curious about expedition work or looking for professional development that gives you a different perspective on your current role. Either way, it’s worth considering which parts of your practice you would welcome more time to explore.

Perhaps you want more experience coordinating a team. Perhaps you’d like to examine how you make decisions under pressure, or feel more prepared when the resources around you are limited.

If those questions sound familiar, you can take a closer look at the Expedition and Wilderness Medicine course curriculum to see how they are approached in training.

Why Wilderness Medicine Skills Matter in Your Clinical Practice