This is an excellent practical question! Since students remember the skills and information they use on a regular basis, skill retention is shared by the wilderness medicine provider, their employer(s), and the graduate.

1. Wilderness medicine providers are responsible for:

• delivering the course material in a practical hands-on manner with as many skill labs and simulations as possible so students are able to grasp the required concepts and skills.
• providing on-going case studies and updates via blogs, newsletters, and other media to aid a graduate's knowledge retention.
• providing a field handbook and/or app that gives graduates access to assessment and treatment data.
• providing training and training options to a graduate's employers so they can run effective simulations and training sessions for their staff on a regular basis.

   
2. Employers of wilderness medicine graduates are responsible for:

• taking advantage of the training opportunities and strategies offered by the wilderness medicine providers.
• providing on-going simulation training, case study review, and discussion of possible problems—including their assessment and treatment—that their trips may encounter to their employees.

   
3. Graduates are responsible for:

• taking advantage of the opportunities offered by the wilderness medicine providers and their employers.
• taking a recertification course when they think their skills are becoming inadequate even if the course is before their certification expires.

Follow-up questions include (and will be addressed in later blog articles):

1. What are the most effective delivery strategies for providers?
2. What are the most effective strategies for employers to use to maintain their employees' assessment and treatment skills?
3. What kind of medical training do outdoor program administrators and directors need so they can make preemptive program design changes and on-going training decisions for their programs? This is especially true when it comes to preparing staff to deal with environmental problems. For example, program directors need to understand heat acclimatization in order to design training sessions and protocols for trips where the heat challenge may suddenly increase. They need to understand the physics behind lightning to train staff how to manage a rapid descent from an exposed ridge when an unexpected lightning storm approaches. Etc.
   

Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.

​Outdoor kitchens are fraught with potential danger (really). Typically not life-threatening danger but definitely trip ending danger from cuts, burns, and diarrheal illnesses (gastroenteritis). Aside from sunburn, most burns on outdoor trips happen in or near the kitchen with the vast majority of those due to hot water; the rest tend to involve alcohol and camp fires. Deep cuts occur on a hand when someone holds a bagel or cheese in one hand and wields a knife with the other. Poor hygiene leads to diarrhea.

When you think about it, it's pretty silly to have to leave a trip because of a cut, burn, or an intestinal illness that requires advanced care, especially with a little forethought and planning these type of injuries can be easily avoided. What follows is a summary of good management techniques for outdoor and camp kitchens that focuses on avoidance.

Introduction
Spending time outside for work or play is part of human history, both past and present. Interest in the outdoors is constantly growing with new human-powered and motorized activities/sports emerging on a regular basis. The development of more sophisticated equipment allows access to more challenging terrain and environments...and greater risk. Use permits, once unheard of, are now the rule—and are increasingly difficult to procure for both individuals and organizations. Wilderness ethics are changing as use increases and "leave no trace" has become a mantra for many. In short, the outdoors has become a thriving industry.

Introduction
Since 1962 when Outward Bound first introduced wilderness adventure programing to United States and the world in the mountains of Colorado, the field has grown exponentially. It is now commonplace to find successful wilderness recreation programs in K-12 schools, summer camps, military bases, and city and state parks. The use of outdoor adventure programs for therapeutic reasons has become it's own industry. And, enrollment in undergraduate and graduate degrees programs in outdoor recreation, education, and therapy is on the upswing.

Within the college/university systems there are three types of outdoor programs:

1. Recreation programs typically housed under student life.
2. Academic degree programs ± immersion semester(s).
3. Cocurricular programs ± immersion semester(s).

Training outdoor leaders within a college/university setting requires a multidisciplinary approach that does not fit well into a standard quarter/semester format due to the type of terrain and time required teach outdoor skills. The purpose of this article is to briefly discuss the design of each program type, list their pros and cons, and provide a conceptual template for those training students to staff some of their programs.