Teaching the curriculum? Teaching what is needed? How can we get to "both"?

For the last 30 years, EMS instructors/trainers/educators have followed national standard curricula, and now we're moving to national education guidelines.

My observation has been that these national MINIMUMS have turned in to the local MAXIMUMS - that local programs rarely go beyond what is recommended or required in those documents. And...heaven forbid...those documents are usually not completely on target.

How many folks go through EMT and/or paramedic school and never learn much about long term care? Or alcohol/substance abuse/detox? Or mental health problems and crises? Or how to save yourself if attacked by a patient, a family, or bystanders - or better yet, how to avoid such a situation? Or how to drive a 16-20,000 lb vehicle, which is required on every call?

We talk a lot about recruitment and retention in EMS. One of the major reasons cited that people leave their jobs that their "expectations" of the job don't match the reality. Do we contribute to that by teaching a curriculum that is heavily oriented toward didactic medical knowledge, and emergency interventional procedures, that are not very often used, and by overlooking the palliative, compassionate care needs of the elderly, the impoverished, etc? Do we set our young up for failure by preparing them for lights, sirens, resuscitation and then sending them out to do safety-net medical social work and transportation for which they have not been prepared?

I observe, from my perspective as a service chief, a disconnect between what is taught and what I think needs to be taught. I'd be interested in hearing how our educator community feels about these questions?

Thanks....Skip

Replies to This Discussion

Permalink Reply by Jeff on February 22, 2009 at 4:57pm

I think you are absolutely right that the NSC has become a maximum instead of a minimum. That seems like a standard theme in EMS all around not just in EMS education. The new standards are written to be much more flexible than the NSC. Hopefully this will lead to better programs that meet the needs of the student and the employer.

I think one problem we have on both sides of this issue is that we wait for someone else to fix the problem. Educating paramedics is a local issue. National organizations are important but the higher an issue is pushed up the food chain, the harder it is to get any change to happen. I think that it is up to the local EMS employers to define what kind of medic they need and then the schools should provide them. We have got to work together on these issues.

EMS services need to be vocal representatives on the program advisory committees. EMS program instructors need to be involved in the services FTO programs. I'm sure there are other ways to integrate educators and providers, we just need to find them.

I like all of the specific topics you brought up except driving. EMS agencies already have trucks and insurance in addition to the specific way that want their vehicles driven. Pushing that to the schools would mean a lot of extra expense where the tuition only covers a third of the cost of the program as it is.

Permalink Reply by Skip Kirkwood on February 22, 2009 at 5:04pm

Thanks, Jeff. All of that can work if you have the right persons in the right places.

What I often hear is "We know we need to teach more, but the administration will only give us the time necessary to teach the minimum." Is that true in most academic institutions? What about excellence?

Yes, we have trucks, but we do not necessarily have teachers to go with them - nor can we afford the additional time that will require, given the rest of the stuff we have to "remediate" in new graduates. The average EMS training officer is no better equipped to train emergency vehicle operators than is the average pre-service educator. And how can a school claim to offer a pre-service education program that does not teach THE SINGLE most frequently used skill to its graduates? ANd how can we have a credible licensure - certification exam that doesn't test the most commonly used skill? The police academies seem to find a way to do this - why is EMS so difficult? Ye old "head in the sand" approach to difficult problems......

Permalink Reply by Jeff on February 22, 2009 at 6:02pm

Having the right people in the right place can fix almost anything. My HR training tells me that is also one of the hardest things for any organization to accomplish.

Speaking of the right people, I have to brag on my Dean a bit. She would take the opposite approach from the administrators you describe. If the services in our area wanted more from us, she would make it happen with or without the current faculty. She has been very proactive when it comes to our program. She expects us to have produce good medics that pass registry the first time. Even though our numbers have gotten really low because everyone and their dog is putting on in-house classes to avoid sending their people to college, she is standing behind us.

Another factor to the time issue is the college accreditation. Clock hours have to translate into credit hours and associate degrees can only have so many credits. I am still learning about all of the ins and outs associated with this.

Police may be trained differently in your area so this may not apply. Here police officers are trained at internal academies. Even if a police candidate has a criminal justice degree they still go through the police academy after they get hired. They don't learn to drive police cars until the academy. I know nothing about the POST exam. Does it cover driving?

This might be admitting a lack of competence but I have never had any formal driving training and would not be comfortable teaching it.

Permalink Reply by Skip Kirkwood on February 22, 2009 at 6:18pm

In NC (and in lots of other states, particularly south and west with lots of small departments) basic LEO training is done by the community colleges, which are (like EMS programs are blessed by state offices) accredited by the state Criminal Justice Training Commission (or POST, or whatever).

Of course you wouldn't teach it yourself (neither would I) but the cops bring in accredited driving instructors from outside. We just had to borrow some of them to "teach" our advanced practice paramedics how to drive their EMS patrol cars.....

Skip

Permalink Reply by Jeff on February 22, 2009 at 7:26pm

Interesting points, I am going study this issue further.

Speaking of your Chargers, Dr. Meyer's presentation at Gathering of Eagles about your APP program was very well received. There were alot of us talking about it afterwards. I got to speak to him for a few minutes, he is an impressive guy.

Permalink Reply by Greg Friese on February 24, 2009 at 11:45pm

Skip,

Thanks for this thread. I really appreciated your time and additional thoughts on these questions during our recording tonight of the EMSEduCast podcast. The link to the conversation will be posted soon at www.emsgarage.com.

Permalink Reply by Skip Kirkwood on February 25, 2009 at 7:14am

It was a good Educast. Thanks for the great discussion!

Y'all be safe out there!

Permalink Reply by Duncan Hitchcock on February 26, 2009 at 6:33am

Skip, I agree that the trend is obvious in teaching the minimum as if it were the maximum. And as been discussed in other posts, this goes to the heart of the basic issue. As has been said in many fourms, the core curriculum needs to expand as the expectations of core performance increases.

The matter of vehicle operations is a prime example. We are seeing more applicants that have gone from EMT training to firefighter training to paramedic training without working in the field at any level along the way. In Florida, having the certificates for completion of these three basic training programs has become the entrance ticket for employment in anything other than a private agency. When we hire them, not only do we have to teach them how to drive an emergency vehicle, we have to teach them how to check the oil, tire pressure and which fluid goes into which hole.

An interesting example of the lack of real life experience and a flawed assumption on our part: Our vendor for repairs of gas powered tools reported that they were seeing a lot of our two-cycle tools being repaired because we were running pure gas in them. Sure each fire engine and station has two distinctively label gas cans; one straight gas, the other oil/gas mix for the two-cycle tools. After digging into the issue, we discovered the obvious....some of our newer folks just didn't understand the difference. So now our Training Bureau has added to their lesson plans the topic of the special fuel needs of the two-cycle tool.

For years in Florida, EMT and Paramedic programs were offered primarily at community colleges and community vo-tech schools, both under the umbrella of the state educational system. In the last 5 years there has been a growth in "colleges" and training centers that offer excelerated EMT and Paramedic programs. Their growth was in response to the demand for more Paramedics but quicker from third service EMS agencies, private agencies and EMS based fire departments. The minimum curriculum appears to have become the maximum in the goal of producing Paramedics. Please forgive me if I chose my words carefully here, because one of the larger training centers has threatened suits against folks that criticize their programs. This has included a site inspector from the state BEMS and the BEMS.

In the last year we have received calls from several such "colleges" and training centers wanting to use our agency for clinical-ride time as mandated by Florida Administrative Codes for Paramedic Training Centers. But we have no space. Where their students end up is a mystery to me.

This is a problem with the concept of supply and demand when applied to health care professions. Quantity does not equate to quality. Teaching the book does not prepare the EMT or Paramedic for the real world and the real demands of the job. There is a shortage of respiratory therapists, nurses and general practice doctors. While there are bridge programs that create a means for Paramedics to become RNs, the fundamental basic educational and clinical times are maintained. Yet, when there is a need for trained Paramedics the philosophy of minimum is maximum prevails. The end product equals the time and care devoted to its method and means of production.

Permalink Reply by Jeff on February 26, 2009 at 7:40am

Yes, we have trucks, but we do not necessarily have teachers to go with them - nor can we afford the additional time that will require, given the rest of the stuff we have to "remediate" in new graduates.

Skip (or anyone else), does your agency have a set of standards that you remediate your new hires to? How do ya'll decide that a new employee is ready to work without an FTO?

Permalink Reply by Skip Kirkwood on February 26, 2009 at 10:26am

We have a year long Field Training and Evaluation Program (FTEP) that involves a minimum of 30 days as a "3rd person."

The motto of the program used to be "Turning Paramedics in to Wake County Paramedics." Now, with new graduates, we seen to spend as much time turning new employees in to paramedics as we do on the former.

As part of the FTEP, we have a a "phase guide" that describes what skills should be mastered when, and daily observation reports that rate 30+ areas each shift. When the phase guide is complete, medical credentialing is complete, and the DORs reflect acceptable performance in all areas, the employee has completed the FTEP.

Skip

Permalink Reply by Jeff on February 26, 2009 at 5:25pm

Can I get a copy of the materials you use for your FTEP program?

Permalink Reply by Skip Kirkwood on February 26, 2009 at 5:41pm

Contact me directly at skip.kirkwood@co.wake.nc.us

Jeff said: