Monday, March 28, 2011

Narcissism and the Modern Student

I willingly (key word, here) read research studies related to educational psychology and educational topics in general. Several recent studies related to our current student body's most prevelant age group--those born between 1982 and 2003--have caught my attention.

Known as the "millennials",or "generation me", people; they are the product of a deliberate effort to build-up peoples' self-esteem. "Little Johnny can be anything he sets his mind to" and "Little Sally can be the first female quarterback in the NFL if she works hard!" EVERYONE recieves a participation medal just for showing up with a pulse!! The fact is, this is dillusional thinking.

I know I've ranted about this before, but it is really important that EMS educators understand how to deal with millennials.

I remember when I took the DOT instructor course. My instructor, Dr. Dennis Izzro, PhD., North Dakota State University, Fargo, ND; made it clear that the people we were teaching were on the tail end of the baby-boomer generation. This group had the need to be heard and understood. They were willing to put forth effort to understand but they wanted things compared to their world, not the instructors. Baby boomers were more reserved and often shy when it came to doing EMT skills in front of the class. They resented the unknown. They read the syllabus from front to back and they were quick to point out the times when you deviated from the schedule. They paid for the class with their own money and sometimes they were reimbursed by their employers or volunteer ambualnce service. They chose to take the EMT class not for financial gain, but for the knowledge and respect it earned them. They wanted to give back to their communities like their parents had done during World War II. Indeed, they were committed to helping others.

The millennials are committed to helping others as long as they get their needs taken care of first. The millennials want it fast, abbreviated, and they wand minimal disruption in their lives as they learn about EMS. They are not scared or reserved. They share every part of their lives on the internet via Facebook, MySpace, Twitter, LinkedIn and YouTube. It is as if they are constantly searching for their 15 minutes of fame. They have no problems, usually, performing in front of the whole class with their thong-underwear showing or their exotic piercings unapologetically dangling in front of everyone's face. They want to be EMTs and paramedics, but they don't want to "pay any dues" by working for free as a volunteer.

The level of narcissism should concern everyone. A narcissist lacks the ability to be emotionally invested in others. They lack compassion or even the capacity to care in extreme cases. They see people as tools to to get them what they need, not as equals. They want everyone to know that they are important. The world revovles around the narcissist.

Does this sound like any of your students?

To be sure, not all millennials are self-centered. To cover them all with this broad brush is unfair and unproductive. The key is to recognize the behaviors of a narcissist regardless of their generational alignment. Millennials don't have a claim to all the narcissists on the planet.

When you have a narcissist in your classroom, be prepared to explain to him or her why they are failing their paramedic class. Millinneals have been told from the day they were born that, as long as they try their hardest, they will be given what they want. What happens when Little Johnny isn't very intelligent, or more importantly, motivated?

Recently, the parents of a student who was failing his EMT class visited our training center to find out why he was underperforming. To their surprise, they found that he hadn't been taking his quizes. They proclaimed multiple times that their son was a "straight-A student in high school." They felt that is must be the instructor's fault...somehow....right?

I leave you with this rhetorical question to ponder: When did it become a bad thing to find out you aren't great at everything you do?

Tuesday, March 15, 2011

Training the Trainers.....

Do doctors make the worst patients? How about EMT's? Nurses?

I think there may be some truth to this. Somehow, once we have been indoctrinated into a culture, we feel we have the right of a dictator. We don't have to listen or comply with those who may actually know more than us; for they are beneath us.

Don't succumb to this temptation.

I'm tired of the anti-intellectual movement in EMS. Especially in our great state of North Dakota.

I have been busy putting together an EMS Instructor / Coordinator course. I want to help up-and-coming EMS educators; but guess what I've found? They don't really want my help. (I'm shocked....)

They want the course to be easy, cheap and un-challenging.

They don't want online; they don't want face-to-face. They don't want the class to interrupt their lives in any way.

Sorry folks, that ain't gonna happen. I have something to teach you and you will learn whether you like it or not. (Look out, Sherm's threatening to teach us something, again!!)

For those of you who've not already taken the DOT EMS Instructor Initial course and are ready to admit you don't know EVERYTHING...... Send me an e-mail for information about the upcoming course scheduled for May 22, 2011. You won't regret it.

Don't send me anything if you're not serious. Don't ask for my help if you already know everything about EMS education; I obviously can't help you.

--This was written with a significant amount of sarcasm intended. I'm not really all that cynical. Just ask Ron Lawler, Jodi Holston, Kelly Wanzek, Steve Siedschlag, Denise Vetter, Bob Klein, Kristi Engelstad or any of the other top-notch full-time, dedicated EMS educators I work with every day.

There are average EMS educators; and then there are those who take it to the realm of excellence and choose to learn from each-other.

Pick which group you want to hang with. It's really up to you, that's the cool part.


Wednesday, March 9, 2011

They're on to us......

They're on to us. Students have called out "B.S." when it comes to practical testing. And, I agree with them.

Practical testing has been a mainstay in EMS since the first curriculum was established more than 40 years ago. It is time for practical testing to die; at least in its current format.

I've always felt a bit insulted when I had to send my EMT and paramedic students to a state sponsored practical test site administered by emergency medical technicians that barely had more experience than my students; some, I believe, actually had LESS experience than my students.

Practical tests for EMS have but one purpose: HOOP JUMPING.

If a student is ready, they're ready. The instructor should be able to determine this without the interference of a test site that requires a student to state, "BSI, is the scene safe?".

Monday, January 10, 2011

Do your students trust you?

Trust is a wonderful, powerful, and sometimes dangerous, thing. When people trust you, they give you room to make errors. They'll allow you to change them; indeed, they'll probably help you change them. When people trust you, they become open to the possibility that you should be believed.

The more trust that you have in someone, the stronger your relationship with that person becomes. The more times your mechanic fixes your car correctly on the first visit, the more you trust him. When the treatment you receive from your doctor is helpful, you gain confidence in her ability to treat your illnesses. But if your doctor seems confused by your signs and symptoms, your trust in her wanes.

Think about the times throughout history that world leaders have asked their people--either implied or explicitly stated--to trust them. Presidents, prime ministers and dictators alike have called for sacrifice based on the notion that we should trust them. Men have fought and died because they were asked to believe in something a leader told them. Sadly, the Nazis trusted Adolf Hitler's twisted vision which led to the deaths of millions of people. In 1978, 918 people died in Guyana because they trusted Jim Jones. On the other hand, the British trusted Winston Churchill and it led to the downfall of Hitler.

My question to you is this: Do your students trust you?

EMT and Paramedic students will trust you on the first day of class because that's what they've been "trained" to do based on their past experiences. There is a general understanding that the pupil respects his or her teacher. But this level of trust is not stable. What you do during that first encounter and each subsequent encounter will tip the scale either positively or negatively. Most of us can likely list our favorite teachers and mentors. People who've affected our lives in a positive way required us--at some point in time--to trust them.

Students trust you when:

1. You are honest.
2. You are consistent.
3. You hold them responsible.
4. You listen.
5. You follow through.
6. You believe in them.
7. Your actions match your words.
8. You admit your mistakes.

Tuesday, October 5, 2010

Become a Paramedic in Two Weeks!!!

Those of you that know me probably consider me a bit of a skeptic. I am not prone to falling for every claim someone makes related to EMS training. Some of the advertising I've seen over the years touting new courses or methods of training has been down right misleading.

Yesterday I fielded a call from a 4-year degreed RN. The nature of her call was inquisitory. She wanted to find the fastest way to complete both her EMT-Basic training and her EMT-Paramedic training. She had found a two week class out-of-state for RN's looking for a fast-track to becoming a paramedic. The goal in this case is speed; not experience in the field, not experience intubating a variety of patients in a variety of settings, not a high level of competence based upon experiences over a period of time. No, this person wanted it fast and they wanted it with little interruption to their schedule.

I can't blame her. She already has much of the knowledge that a paramedic would need to pass the test. Sitting through hundreds of hours of didactic lectures and hundreds more of clinical rotations would be worthless, right?

I'm not certain that I have an answer to that question. Every learner is different. What takes one person 50 hours to master takes another 150 hours. These days, entry-level competency is the buzz-word de jur and there is plenty of evidence and support for this stance. I, personally, am a huge fan of competency-based evaluations that identify who is and who is not ready to face the real world as a paramedic. But there is one caveat that has been identified by many instructors as well as the National Registry of EMT's. The caveat is this: How do we measure this nebulous thing called competency?

Here's a few ways that it can be done now, before the NREMT identifies the best practices.

1. Perform internal testing for your team members. Just because they passed the NREMT practical and written exams, doesn't mean they actually meet your organizational standards. I can tell you from experience that many EMT's and paramedics that we hire can not pass our entrance exam. Others are unable to successfully complete our field training which results in their dismissal. These people are not entry-level competent based on our standards. So, set your standards and stick to them.

2. Get input from field providers and peers of the person in question. EMS is a small community. Whether it is a student or an EMT from another area of the country that your looking to hire; I assure you that you can find out who is, and who isn't, competent if you just pick up a phone or send an e-mail. Sometimes an employer will not want to divulge this information, but it can be discovered with a little work. Also, if the person has proven themselves a great medic or EMT, their prior employers will brag them up. A "no comment" answer from a former employer or supervisor usually means there were problems with the person.

3. Observe their real-life activities and actions. Entry level competency is too often based on what the person did in the classroom and what they know (test performance). But, what about how they act? If a person is a complete jerk, it doesn't matter how competent they are; you'll just recognize that you've hired a competent jerk. At the end of the day, jerks cause you problems and waste your time.

Faster isn't always better; but slower isn't real appealing either. Find the balance.


Sunday, July 4, 2010

A few random thoughts to consider before you start training EMS personnel

Here's some of the things you should consider BEFORE you start an EMS course.

1. Your experience. Some instructors have virtually no street experience but they can make up for this in teaching technique and by admitting up-front that they lack this attribute. For these instructors, it is critical to use outside experts to teach certain aspects of the course. Bring in a OB nurse to teach OB, for example. The other point I would like to make here is that more experience = better teacher. In fact, in my 20+ years of EMS, I've seen many "experienced" paramedics and EMT's fail at the front of the classroom. It can be quite spectacular and the people who suffer are the students.

2. Respect for time. If you say class starts at 7 PM, it should start at 7 PM. Respect your students' time. Those who show up late are disruptive and distrespectful to everyone. Put the hammer down on this one.

3. Be a coach. Allowing an underperformer to still play the game will bring the whole group down. I know this sounds harsh, but if someone on the team doesn't put forth the effort to improve, why waste your time? More importantly, what message does this send to the people who are trying to improve?

4. Make yourself available. When a learner approaches you for help, find a way to help. If you are too busy to make time, you should not be an instructor. I mean this sincerely. If you are volunteering your time and you think that that means class time only, your not really volunteering.

5. Know the material. This is critical. I dont' care if you've been an EMT for 60 years. You need to read what your students are reading. It is the only way to be up-to-speed on the concepts they need to know. If your students seem to know more than you do about the current standards, turn the class over to someone else.

6. Write down your expectations. Your class should know what the rules are before they jump in fully with two feet. Present the rules on the first night of class and go over them in detail. Then, have the students sign off on a form acknowledging that they'll follow the rules or they'll be asked to leave.

7. Talk to your "sponsor". If your teaching for a volunteer ambulance service whose board members or leadership personnel expect a 100% pass rate, have a heart-to-heart conversation with them. Attrition rates of EMT students in volunteer squads is very high. If the students are not committed to learning, they will not pass. You might be the best instructor in the world, but in the end it is the individual that needs to open the book on their own.


Friday, June 4, 2010

Hire Slow, Fire Fast

I'm not sure where I first read or heard the words, "Hire slow, fire fast." I like the concept. It translates quite well to the students and fellow instructors we associated with in the EMS classroom. Allow me to elaborate.


Of course we don't actually hire students. They hire us. But choosing students for your classes in rural communities involves a pseudo-hiring process. Most rural volunteer EMS personnel are recruited to fill seats in EMS education classrooms for free. Maybe you have even taught some of these students. It is not uncommon to start at class of 10 students and end up with less than half that amount completing the training. Here's some free advice for you and your EMS team if you are considering training a few local people for your volunteer ambulance service, rescue squad or fire department.

1. Charge something. People don't value things that are free or percieved to be free. Freebies are easy to throw away (think of the bottle opener, pen, stylus, lobster-bib combo with the star of life logo on it that you got for free at the last EMS conference you attended).

2. Recruit motivated people. If you had to beg them to take the class, they won't finish. A large number of people who successfully complete the course never take the NREMT test. What does your squad gain if they don't test? The answer: Nothing.

3. Make sure they can read before they start. This sounds like a no-brainer. But if you can, have them write a paragraph about why they wish to become an EMS provider. If they turn nothing in to you, they are either illiterate or unmotivated (see #2 above).

4. If all else fails, fire them. Kick out those people who are not performing. Hold them accountable. Once the dead-weight is gone, you can focus on the people who truly want to learn. Think about this: Is it better to have everyone finish the class "successfully" only to have 20% of them pass the NREMT testing process, or would you rather have a few top performers break away from the pack? Personally, I'd rather end up with three superstars than ten duds.


EMS Educators are a dime a dozen in North Dakota, South Dakota and Minnesota. In fact, I recently learned that Minnesota has more EMS Instructors than any other state and South Dakota is not far behind per capita. Why? Because they only have two rules about being an instructor. First, instructors must be trained to the level that they will be teaching (or above); and second, they must completed the outdated DOT instructor course. After they have met both of these criteria, they're "good-to-go" forever. No refreshers, no aptitude test, no pulse check to see if they're even among the living. Ladies and gentlemen, the pool is large....but extremely shallow.

Again, applying the "Hire Slow, Fire Fast" doctrine to EMS instructors, here's my recommendations / opinions:

1. Don't teach what you don't know. Instructors should start out slow. Try BLS before jumping to ALS. I can't tell you how many first year paramedics I turn away from our ACLS and PALS instructor courses. They are not ready. And what do they do when I turn them away, they find someone who will rubber-stamp them an instructor card in whatever discipline they desire. Greed is alive and well and the most novice EMT or paramedic can find someone who'll bless them with instructor certifications for a price. Is this good for patient care or is it just a budget move (we can teach it ourselves for less money and don't have to hire experience)?

2. Fire bad instructors. If you oversee EMS instructors you need to observe them teaching, look at class evaluations, audit their pass rates and educate them. If all fails, get rid of them before they hurt your organization.

3. Never make someone become an instructor. Many instructors teach because no one else on their squad will do it. Does it seem like a good idea to force someone to teach others just because they have the time to do it or they can be pressured into doing it? If you have a choice between buying a new squad jacket or paying for training from an expert; go with the training. It may save you money in the long run. Being competent in the EMS skills is a way to avoid litigation headaches.

4. Experience does not always lead to good instruction. Just because someone has been an EMT for 29 years doesn't mean they will be good teachers. Some people are just not cut out to be teachers. Unfortunately, they permeate our society. Did you ever have a teacher in high school that was really bad? Think about the classes where you've learned the most. Now think about the instructor. Was there a correllation between what the instructor did and how you performed? Good or bad, there usually is.

One final note: We will never improve EMS instruction until we hold EMS educators accountable. Recent rules changes in ND and MN have raised the bar a bit by addressing pass rates. This is only a first step, however, and more needs to be done to elevate the profession. Check out the national trends towards this effort at the National Association of EMS Educators website at

Those who can, do. Those who can do more, teach.