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.
-Sherm
Tuesday, October 5, 2010
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.
--Sherm
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.
--Sherm
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.
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
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
Thursday, May 27, 2010
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
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
Wednesday, May 19, 2010
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
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
Monday, May 17, 2010
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
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
Saturday, May 15, 2010
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
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
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