ERichard A. “Doc” Clinchy, PhD, EMT-P
By way of introduction and background, I will be renewing my paramedic license in Florida once again this year. By the time this renewal expires, I will have held an EMS license or certification of some sort for fifty years. Teaching of prehospital care started back in 1971…and first aid before that. If you are an EMS educator your value to quality prehospital care can never be over-estimated. If you are responsible for education of prehospital care personnel, those who are educators working for you cannot ever be under-valued. When running programs in South Florida over thirty years ago, I was very excited when I signed my first of book contract. I was proud of that accomplishment because I’d be “leaving something behind.” A friend and one of my instructors, a wise paramedic with Miami-Dade Fire Rescue, asked me, “How many EMTs have you educated?” My response was I wasn’t sure but over 1,000. He went on to ask, “How many paramedics?” My response was that in whole or in part over 500 and thousands who had participated in my conference presentations. His reply was something to the effect those students were my real legacy…not a book in a library. I share that only because that’s what teaching is all about…the legacy of the delivery of quality patient care.
If you ask any EMS educator what they are being paid, most will simply tell you their hourly rate or salary. When you look at the true cost of teaching a classroom full of aspiring EMTs or paramedics, it’s well beyond that: Instructor’s salary; students’ compensation by their department for each hour they sit in the classroom…sometimes involving overtime; the cost to the department or service to cover the student’s shifts, student’s paid-time off to attend classes, etc. It’s even more compensation per hour for the instructor if it’s a conference educational session where travel, lodging, honorarium, and per diem come into play. Good education is not cheap!
Let’s first address two terms…” Training” and “Education”. Taxonomy of learning theory talks about training focusing on skills…the “protocol paramedic” v. the paramedic who knows exactly why s/he is doing what s/he is doing. Education, on the other hand is comprehensive. It is achieved by a complex approach to learning and an understanding of the reasons behind what prehospital care providers should or should not do. It also embodies teaching students’ an understanding of the pathophysiology of a patient’s condition versus just making decisions based on what’s shown on a monitor or memorized from a protocol manual, e.g., see this then do this but never really understanding why.
What’s contained in this brief article began as an all-day workshop for EMS Educators at the Wisconsin EMS conference many years ago.
Nothing an educator does is unimportant…the teacher is on stage each and every time he/she is in front of a class. How you sound, how you look, my favorite…clothes on the outside reflect the mood on the inside. The true educator can never ever be over-prepared. Preparation reduces nervousness, usually resulting from lack of preparation. Being thoroughly prepared puts the educator in a mind-set where s/he is relaxed and in command.
Sitting while teaching is disrespectful of your students…stand-up, walk around, make eye contact with every student you are teaching…they will be far more engaged and will learn more.
The Chevy Vega did not last too long in the marketplace but the mnemonic VEGA is an important one for educators…V-oice, E-ye Contact, G-estures, A-ttitude. Get all those wrapped up in a teacher-package and there is an effective educator.
Arena preparation is critical to effective teaching…not arenas in which gladiators battle. The teacher’s classroom is the arena in which s/he fights to help students learn and learn well. What’s the seating arrangement? Can everyone see? Are they situated in a way that the teacher can get up close and personal? Traditional classroom set-ups prevent close interaction. So, why not rearrange a classroom in a U- or modified U-shape. What’s the lighting like? Can they see their own notes? Away from this article, look up Knowles’ Model of Human Learning. Adults essentially teach themselves and will learn based on need and intrinsic factors. The teacher is merely the catalyst. If you do it right, they will learn.
Adult learners almost inherently have test anxiety and many have been away from formal education for a very long time. Tell students what they’re expected to know. Do not create testing situations or questions to trick students. Teachers who produce students achieving high test results are not “easy graders” and will not “look bad.” Instead these teachers are truly educating if all their students become confident and competent.
Little things will push an adult learner off the rails and rarely do we consider these little things. Don’t mark “-20%” on a test score. Mark it “80%! Well done”. As kids, when we did badly in school, there were red marks everywhere on our test papers. Throw away the red pencils and mark everything in black or blue instead.
As an educator, how well do you know your students? Do you know their names and remember them? If not, get them to wear name tags that you can read and have a tent card in front of them with their name in big letters till the day you can look every student in the eye and address them by name. What do you know about them? At the beginning of a class, have each student introduce him/herself and tell everyone a bit about them…more than just “why are you here?” Learn their backgrounds and take notes. At my age, I have many life-long friends who are former students. They are running EMS systems, Chief officers at Fire Departments, one is a State EMS Director, many are now physicians, and they all remember those who were their real teachers.
Almost all EMS education is geared to a standard curriculum of some sort but it need not be canned. If you truly know your students, you’ll know what they need to be taught and, in fact, they can tell you and, in so doing, modify the curriculum. If you negotiate student-directed lesson plans the students will remain more engaged.
In the adult learning setting, have students practice using information immediately. Be creative using skills demonstrations, role playing, simulations, games…adults learn by doing. Adult learners who are not actively involved in learning will be lost. Start entry-level EMS students with “Mega-Codes”. Not the nail biting, tear inducing, terror situations of ACLS in the 70s and 80s but situations where students become cognizant of the “patient” and develop “situational awareness” of what things look, feel, and smell like. Have students practice skills in a darkened room and see how much better they become.
When you are preparing to teach students pediatrics, invite all of the students with children to bring their kids to school with them. First, the children will enjoy the adventure. Second, those who are parents, will find it easier to explain to their kids what they are learning and what their profession is all about. Finally, for those students who have no children of their own, they will begin to interact with children of all ages and sexes and not have to encounter their first pediatric patient “on the street.”
When it comes to evaluating performances, let the students do evaluations of themselves and their peers before you, the teacher, renders judgment. If you have been involved in full scale exercises, you are familiar with the concept of the hot wash. Do hot washes with your students. It will let you know how you are doing because you’ll better understand how they are doing.
There is no avoiding death by PowerPoint but no one is forcing an educator to use every PowerPoint slide invented by man. Thin them out, supplement slides by having equipment that students can gets “hands on”. Educators need to learn to draw or find supplemental resources. For example, you can show paramedic students a series of rhythm strip examples and hope rote memorization and recollection will enable them to recognize dysrhythmias in the real world. Or, the really well-prepared educator might have handouts that show the rhythm strip AND a diagram of the heart showing where conduction problems or ectopic foci might be occurring AND also listing what sort of signs and symptoms a patient might be experiencing. If the teacher starts the students’ learning in the classroom with a solid grounding of anatomy and physiology, it is amazing how logical many patient presentations will become to them.
Do the lights need to be turned down to show PowerPoint images? If so, get new PowerPoint images or, better yet, make your own. The brain’s reticular activating system is what triggers our wake and sleep states. When the lights go down, the sleep state is triggered. Never, never, never read PowerPoint slides… they are an educational adjunct…the teacher is the educator, not an inanimate screen.
As a retired SCUBA Instructor, we used to say, “SCUBA skills can’t be learned on the deck of the boat.” Similarly, EMS skills cannot be taught by lecture. Skills require hands-on activities and that requires a lot more thought and preparation by the teacher but it is well worth it.
Adults learn by using all of their senses and those who pursue EMS, Law Enforcement, and Fire Service professions…Public Safety as a whole… are typically more action oriented individuals. Teachers of these students need to be very creative to be effective. Keep them active. Go beyond the minimums. Have them do research away from the class that cannot be found in whatever textbook they have been given.
When teaching EMS students, get them to learn mnemonics to help them quickly recall complex lists of things they need to be cognizant of such as S-A-M-P-L-E, A-V-P-U, S-O-A-P, AEIOUTIPS, MUDPIES, SLUDGE… and many more. These will be stored in their “mental rolodex” and will become second nature to the students once “on the street”. With this knowledge always at hand, it will instill both calm and complete control of medical situations without missing any important aspect of the assessment and documentation process.
If you’re teaching IV drip rates and medication administration, simplify the learning process by converting concentration drip rates to the face of a clock. 60 minutes in an hour…60 drops per ml in a minidrip IV administration set.
Compare the Rule of 9s to the Pillsbury Doughboy.
Add humor now and then…it breaks up what can become very tedious material and when it becomes tedious, retention deteriorates.
I have tried to jam many hours of discussion, examples and concepts into a very brief article. However, if I can be of any assistance to you with building your quality EMS education programs, feel free to contact me at firstname.lastname@example.org . I’ll be delighted to lend a hand. As I implied at the opening, our legacy as EMS educators is to inspire outstanding prehospital care professionals who will consistently delivery nothing but superior patient care.