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.

Students

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.

Instructors

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 naemse.org.


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

--Sherm

Let's Have Lunch.

Recently, I was on the North Dakota State College of Science (NDSCS) campus in Wahpeton, North Dakota, with a coworker, Ron Lawler. After a business meeting our hosts graciously escorted us on a tour of their campus which concluded at the school cafeteria for lunch. Now, I know what you might be thinking: Cafeteria food? That must have been terrible? To the contrary, the food was fantastic, I found the staff friendly and polite, and the atmosphere was very enjoyable. Possibly the most intriguing observation I made was the seating arrangement.

At NDSCS, everyone eats together. The faculty is immersed among their customers (students). And although they have their own table, college staff and students are definitely in close proximity to one another (they could share the salt and pepper shakers, if necessary) and the atmosphere is that of one large family dining together (without the food fights). This is the culture of NDSCS; and it is a small part of what makes them successful.

Making appropriate connections with students should be the goal of every instructor. When bonds of mutual respect are formed, learning becomes a shared experience. I think most EMS educators would agree that the students who care the most tend to learn the most.

I'm not suggesting taking your students out individually for a candlelight dinner for two or hosting a keg party for them. What I'm suggesting is that you be present in the moment, engaged in your vocation and in touch with your students' learning progress.

What does your classroom and workplace culture tell your students?

This can't be as simple as having lunch together in the same room. Or can it?

--Sherm

Questions without answers.

Why doesn't everyone just admit that we need one unifying national EMS standard?

Why can't they make an ambulance that provides a comfortable ride?

Why aren't more people passing the National Registry cognitive exam on the first try?

Why do some people think that we still need practical testing?

Why do some EMS educators refuse to base their instruction on empirical evidence?

More to follow in the future.......


-Sherm

Ya Gotta Love It!

I just returned home from coaching an 11-12 year old baseball team. One of things I've noticed about kids this age is that they love to learn about a topic that interests them. In this case, baseball. If they were to put the energy they show for baseball into their homework, they'd finish college before they'd hit puberty.

Any EMS instructor who's done more than one class can tell you that motivation plays a huge role in learning. I dare say that you can't really "force" anyone to learn if they aren't interested in doing so. I've seen smart people with weak motivation fail miserably in an EMT and paramedic classes. Have you ever said, "He/she's really smart, but _________ (insert any commentary about laziness or lack of accountability the student demonstrated over and over again until they failed that you'd like).

The great news is that I've also seen people with documented learning disabilities overcome them with motivation and hard work. I've seen those with physical challenges rise to the top beacuse they wanted to prove to others that limitations are usually within one's own mind. I've seen "average" students excel at EMS because they wanted to succeed and there wasn't anyone or anything that was going to stop them. It is these students that should motivate you; if they don't, check your pulse.

--Sherm

Free Critical Thinking Class!

Educational psychology researchers have debated for decades on the topic of critical thinking. One of the unanswered questions is this: Should critical thinking skills be taught in the general sense or specific to a topic (such as EMS, for example)?

My support goes to the idea that critical thinking within context (specific to a topic) is the better bang for the buck. When students sign up for an EMT class or paramedic training they--unknowingly--are also signing up for critical thinking training. Maybe these researchers could learn something by taking an EMS course? EMT's are expected to take in the information provided to them by the patient, the scene and bystanders and then form a field impression, deliver safe treatment, and safely transport the patient to the appropriate facility. Critical thinking is clearly something EMT's must do in order to be considered "competent".

Because critical thinking isn't explicitly addressed in primary or secondary education (do you remember taking a critical thinking class, ever?); EMT students find themselves struggling through scenario-based test questions that arguably require critical thinking skills.

My advice to any EMS instructor is this: You need to introduce critical thinking activities (scenarios, problem-solving, essay questions with more than one right answer) into your EMT and paramedic classes early and often. It could mean the difference between success and failure on the National Registry exam.

By the way,the next time you're advertising an EMT class do the following: Critical Thinking Class offered at local ambulance service! Sign up now and recieve EMT training for free!

--Sherm

Are You Making Your Students Hoop Jump?

Telling a student to do something by a certain date and within certain parameters will surely result in a piece of work that meets the objectives but is likely uninspired. This is really just busy-work or as I like to call it: Hoop Jumping.

Instead of telling them to do this: "Write a report on Diabetes using three sources." "This is due in three days."; try asking them to do this: "Interview a person with Diabetes and describe for the class what you've found." "Compare and contrast this information to what you've read about the disease and create a made-up, but medically accurate, scenario based on the person you interviewed for your fellow classmates to review."

Which assignment seems more useful?

-Sherm

Competency

What makes an EMT or paramedic student "entry-level competent"? In the interest of full disclosure, I must admit that I've never looked up the definition of competency. I think it means that someone is able to perform to a certain standard that is acceptable to those who might define the standard. The problem that I've seen over my 20+ years in EMS is that this concept of competency differs from EMT program to EMT program and paramedic school to paramedic shool. Individual instructors also differ in their interpretations of the concept.

So how can we know competent when we see it? What if your definition connflicts with mine?

I don't know the exact answers to this complex question. But let me pose this to all the EMS educators out there:

Would you let me (or any other outside EMS educator) into your classrooms or into the back of your ambulances and allow me to observe and judge your students--the ones you feel are ready to take the National Registry cognitive exam--as to whether or not they are competent? If you're not scared of that, you probably don't have a problem identifying who is or isn't competent.

-Sherm