A community nurse removes a dressing from a leg ulcer that has not healed in months. She has to decide, in a few minutes, whether it is venous or arterial, whether it is infected, whether compression is safe and which dressing goes on next. The account manager who visited her practice last month was supposed to help with exactly those decisions. Whether they could depends on something the company had never measured: what its field force actually knew about wounds. The program in this case ran from June to August 2026.
That was the starting point for this program. A global MedTech company in wound care, with a field force across 25 countries and three very different channels, had a clinically demanding portfolio and no map of its team's knowledge. In June 2026 we ran one battle per channel over four days, followed by nine weeks of reinforcement. Of 787 people invited to this annual readiness initiative, 93% took part, and 57% of the 15,758 knowledge gaps found at first attempt were verified closed within the assessment. The gaps that remained, concentrated in compression therapy and selling method, need an owner now, and they also shape next year's edition.
Wound care is clinical selling, in three different rooms
Wound care looks like a consumables business from the outside. From the inside, it is one of the most clinical conversations in MedTech. The customer is often a nurse, a tissue viability specialist or a podiatrist, and they judge the rep by one thing: does this person understand wounds?
The content reflected that. The questions mapped to 33 curriculum modules from the company's own material, and about two thirds were clinical: wound assessment and pathology (pressure ulcers, diabetic foot, venous and arterial leg ulcers, acute wounds, infection, skin and scar), treatment protocols (debridement, exudate management, negative pressure wound therapy), and compression therapy. The rest covered the dressing and fixation portfolio and the company's commercial method.
The complication was the three channels, each with a different customer:
- Rx and Home Care, where the conversation is with prescribers and community nurses managing chronic wounds at home.
- Hospital and Nursing, where it is with ward nurses, wound care specialists and procurement.
- Pharmacy, where it is with pharmacists and counter staff recommending for acute wounds and minor injuries.
A single program for all three would have been either too clinical for pharmacy or too shallow for hospital. So each channel got its own question bank, built around what its customer needs: 178 questions for Rx and Home Care, 185 for Hospital and Nursing, 92 for Pharmacy. The banks drew on the same curriculum modules, but they were not identical, and the records we used for this case do not say how many questions all three shared. That matters for how the results can be compared, and we come back to it below.
We designed one week of battles and nine weeks of reinforcement
The structure was simple and deliberately time-boxed.
In mid-June, three battles ran in the same four-day window, one per channel. Players took one-minute challenges (five questions in 60 seconds) against real colleagues in their own channel, organised into 73 teams. Running all three in the same week gave the company something it had never had: a reading of knowledge across channels and countries, taken at the same moment and against the same curriculum.
Then came nine weeks of reinforcement, to the end of August. Three waves targeted what stayed open, supported by 12 micro-contents. Gap Fixing sent each person the fix for their own mistakes, not a generic refresher.
We made three design choices on purpose.
First, the battle was the business moment. It was the annual readiness check for the whole field force, an expected part of the year rather than optional training, which is also why participation was high. Across the 100 programs in our case library, the 16 tied to a business moment (a launch, a kickoff, a certification, a congress) closed 55% of their gaps, against 41% for the other 84. That is an observed association, not proof that the framing causes the difference, but it is why we treat the moment as part of the design rather than decoration.
Second, the channels competed separately. A pharmacy rep competing against hospital specialists on compression pressures would learn only that the program was not for them. Competing within the channel kept the questions relevant and the leaderboards fair.
Third, while the battle itself was part of the annual requirement, the last reinforcement wave was opt-in. We wanted to see who would come back without being told, and what they would fix. Voluntary return is a better signal of engagement than any completion rate, and it tells a training team who might help carry the next edition in their teams.
A fair objection is that a four-day battle is too short to say anything about clinical competence. It is. A battle does not certify a clinician, and it was never meant to. None of the results below say anything about practical clinical competence, which would take observation in a real setting. What a battle does is find, person by person, which clinical facts and distinctions have not landed, in a week, across 25 countries. That is the input a training team needs to spend the rest of the year on the right things.
The first map of what a field force knows is rarely flattering. It is always useful.
57% closed, clinical content ahead, compression behind
Across the program, we identified 15,758 knowledge gaps at first attempt. A gap is one person wrong on one question at their first try, closed only when that same person gets it right later, verified in the platform. 9,044 closed, which is 57%. The remaining 6,714 were flagged for follow-up coaching. For context, across the 100-program library, 43% of identified gaps were verified closed, with a range from 18% to 80%.
Block by block, the picture was uneven in an informative way:
- Wound assessment and pathology, the largest block, produced 6,688 gaps and closed at 62%.
- The dressing and fixation portfolio produced 2,310 gaps and closed at 62%.
- Treatment protocols and therapy produced 2,109 gaps and closed at 57%.
- Commercial method produced 2,920 gaps and closed at 53%.
- Remaining modules produced 767 gaps and closed at 44%.
- Compression therapy produced 964 gaps and closed at only 42%.
The reinforcement mattered at the margin, too. In the final, opt-in wave, 124 participants took part and 471 gaps were verified closed; they are included in the 9,044 total. That is a small number next to the total, but it came from people who came back of their own accord.
Three clinical questions show the range
We describe these rather than quote them.
Where venous leg ulcers appear closed almost completely. Asked where venous leg ulcers are most characteristically located, 82 people were wrong at first attempt, and 76 of them picked a location more typical of other ulcer types. Repetition fixed 75 of the 82. Only 7 were still wrong at the end. This looks like a fact that simply had not landed, and it responded to repetition, although one later right answer does not rule out a lucky guess.
What causes arterial ulcers only half closed. Asked for the cause of an arterial leg ulcer, 92 people were wrong at first. Most of them (82) chose an explanation rooted in the venous system. That is the classic confusion between the two main types of leg ulcer, and it matters, because the treatment logic differs sharply between them. Repetition fixed 41 of the 92. Fifty-one were still wrong at close.
How compression works stayed open. Asked about the role of compression bandages in treating venous leg ulcers, 102 people were wrong at first attempt. Only 16 fixed it through repetition; 86 were still wrong at the end. People who cannot explain why compression works will struggle to recommend it with confidence, and will struggle even more with a nurse who is worried about applying it.
That third question is the one we would put in front of the training team. Across our case library, in one in five of the example questions we tracked, fewer than 20% of the people who were wrong corrected it; some of those were never retested, so not all are proven misconceptions. Here, with 16 of 102 corrected, compression mechanism looks like one of that group, and likely a misconception rather than a memory lapse. It needs a clinical specialist explaining the physiology, ideally with a bandage in their hands.
Five lessons from the first map of a wound care field force
- Measure all channels in the same week. A reading across channels and countries at one moment was the single most valuable output. Because the channel banks differed, it is not a like-for-like comparison between channels; it is best read within each channel, and across countries within a channel. To compare channels directly, include a shared core of questions in every bank.
- Split the question sets by customer, not by product. Each channel got what its customer asks about, which kept the questions relevant across very different roles. The 93% participation mostly reflects that this was the annual readiness requirement.
- Expect clinical facts to close faster than knowledge of clinical mechanisms. Where an ulcer appears closed for over 90% of those who were wrong. Why compression works barely moved. Plan different fixes for the two.
- Commercial method deserves its own line. At 53%, the selling method block closed below the clinical blocks. If it had been folded into an overall score, nobody would have seen it.
- The open gaps need an owner now, not only next year. The 6,714 open gaps, grouped by module and channel, shape the 2027 edition. But the critical ones, like compression mechanism and the venous and arterial confusion, belong to a named manager or clinical specialist this autumn, with a retest date.
What we would do next
The obvious next step is to act on the compression finding before the next edition. We would run a short clinical session per region on compression physiology, led by clinical specialists rather than trainers, followed a few weeks later by a focused challenge on the same questions. The retest will show whether the session moved the misconception or not. Each regional session needs a named owner and a date this autumn, not a slot in next year's plan.
We would also send the open gaps to first-line managers by name. A manager planning a ride-along with an account manager who still has arterial and venous ulcers confused has a much better agenda than one working from last quarter's call numbers.
And we would give the field a way to ask between editions. An assistant based on approved clinical and product content would help a rep in front of a nurse who asks a hard question about exudate or compression. Just as usefully, the questions it receives would show the training team which topics the field is unsure about in real conversations, feeding straight into the next battle.
The question to take into your next readiness planning
If you run a MedTech field force with clinical customers, ask yourself: could you say today, by channel and country, which clinical distinctions your team gets wrong? Not which modules they completed, but which facts and which reasoning.
Most organisations cannot, and that is not a failure. It is simply a measurement nobody has taken. At Atrivity we took it for this wound care team in one June week, and spent the summer closing what we found. The first map is rarely flattering. It is the only way to know where next year's training should go.