With the caveat that I haven't done any such training myself, I'm reminded of my wilderness EMT training. Rather than simply showing us how to splint a fractured femur and have us practice, our instructors created deliberately stressful situations to make us deal with all the other things that could happen: panicking patients, interfering bystanders, rain, snow, hail. You're not fixing a broken car, you're dealing with other human beings and their reaction to the situation, and your ability to manage the human part of it will greatly influence the outcome of the "broken car" part of it. It was very hard training, but very effective, as I found when I had to use my training for real. How you measure it? I have no idea.
Mary, funny you mention WEMT. I am currently doing WEMT training right now!
Thanks for the example. Scenario based training is a very good thing to do, and done right I think you can add stress by hitting all modalities as you mention. Martial Training can be done in the same way. However, I think scenario training only really works well if you have narrowed your parameters and conditions to more specific things.
For example, WEMT is a subset of specificity of EMT. The protocols and scenarios are driven by the Wilderness environment. We can't cover every single conceivable event, but there are patterns and "high percentage" things that can be addressed.
And in the process, we don't simply ignore certain aspects of EMT training simply because we deem them less important or we have a bend in a certain direction...or we really don't like head injuries.
How do you measure it? I think once you have defined your desired endstates, protocols, flows or branches and sequels in the decision cycles that you what your students to complete it becomes rather easy to measure how they perform to those standards given the stressful conditions or "loads" you place them under.
But it all started with a class on how to treat fractures. Then you conducted performance measures in a classroom environment, and finally you performed them under stress in a scenario. You didn't necessarily get to choose what aspects of that you wanted to deal with.
And yes, as you point out, you have to deal with bystanders, upset family members, violent patience...and those critical human interaction skills are necessary to do the physical thing you are trained to do...which is treat your patient and get him to the next level of care. However, all those things are implicit task and were meaningless if you did not have the tacit skills of patient care to actually treat your patient.
I think martial arts is the same way, albeit the analogy maybe a little off...sure de-escalation is a part of it, but I believe that it needs to be backed up with the capacity to physically mitigate it. Otherwise, you really are not in charge of the outcome, just "getting lucky" really if your opponent chooses to not escalate. It is always his choice. Yes, you may influence it by not pissing him off, or maybe you are able to reason with him. But in my mind, capacity to do something about it is paramount. Anything other than that...how much control do you really have over what he does or doesn't do? who knows for sure!
Thanks for the example...It is a good one!