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Military general practice requires wider knowledge and more diverse skillset than that defined by the Royal College of General Practitioners curriculum. Following completion of specialty training, military general practitioners (GPs) were returning from mostly civilian training environments feeling deskilled and ill-prepared for their military role. The Academic Department of Military General Practice defined the training gap and used co-creative curriculum development to incorporate military topics throughout the GP specialty training programme. Simulation was identified as a key teaching method employed throughout undergraduate and postgraduate health professional education, which could be used to improve the trainee’s learning. The resulting operational preparedness training week used layered teaching methods and feedback to build trainees’ knowledge and skills before a final major immersive simulation exercise. This article describes the educational design process in terms of the ‘10 goal conditions’ described by Issenberg for high-fidelity medical simulations leading to effective learning.

Background Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. Objective The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. Methods We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. Results The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. Conclusions The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. Trial Registration ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034 International Registered Report Identifier (IRRID) PRR1-10.2196/49918

BACKGROUND Consumption of alcohol is synonymous with military populations and studies have shown that serving personnel drink more than age and sex matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of interventions in military populations. The DrinksRation smartphone application was designed to have a basis in Behaviour Change Technique theory, and focuses on providing behavioural prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. OBJECTIVE The primary purpose of the Military DrinksRation Randomised Controlled Trial (RCT) study is to determine whether it is similarly effective in a serving military population. METHODS Military DrinksRation study is a two-arm, single blinded, 1:1 randomised controlled trial of the UK Armed Forces population comparing the effectiveness of the DrinksRation smartphone application with treatment as usual for personnel identified at risk of alcohol related harm. It is hypothesised that the DrinksRation application will be more efficacious at reducing alcohol consumption compared to treatment as usual. RESULTS Recruitment to the study is expected to open from June 2023 and aims to enrol 728 participants into the study to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. CONCLUSIONS The UK Armed Forces have a relationship with alcohol that is different to the civilian population and so the MDR study aims to show whether the DrinksRation app is effective at changing the alcohol behaviour use in serving personnel. This could therefore potentially provide the UK Defence Medical Services with an evidence based tool to use as part of an alcohol management clinical pathway, and better support military personnel at risk of harm from alcohol drinking. CLINICALTRIAL International Standard Randomised Controlled Trial (ISRCT) Number registry (submission number: 42646)