Going directly from EMT to EMT-P

[Veneficus]

Originally Posted by MedicBrew

Wow! Didn’t mean to ruffle any feathers. Just expressing my opinion.…

I am not ruffled in the least. Just sharing my perspective and information.

I just think the idea that being an EMT for a while always helps needs to be qualified and quantified.

I think Corky has a good observation. It depends on what your experience as an EMT is. Satisfying the qualitative requirement.

Just in my observation, it doesn't reflect in the type of service you work for, but in the culture of the service. Whether 911 or IFT, when you are taught skills matter over knowledge, you are being set up for a fail.

One of the most common things I hear out of failing students is: "This doesn't matter in the field."

When I hear it, I make every effort to sell/convince the value of the theory to them, but I am not always successful.

Originally Posted by MedicBrew

That being said, is the majority of EMT, especially upper level EMT training not made up of “Experienced providers”? That alone would influence the statistical data. If it’s not in your locale, then OK I can accept that statement at face value.

Over the years (9 now) I have seen a transition in the make-up of paramedic class. In the earlier years almost all of the medic students had been EMTs for a while.

About 6 years ago, because local agencies decided medic was a prereq for hire because they didn't want to send people to medic class on their dime, there was a population shift to most medic students being fresh out of EMT school without experience. Both the class sizes and pass rates increased.

The last couple of years most of the students were adults changing careers and younger currently enrolled college students with no field experience. Both pass rates and averages increased.

For about the last 5 years the all but 2 failures were "experienced" EMTs actively working in fire and or EMS, all except one was male (edited from reminder by collegue, there was 1 female in this group), and all without any college.

The other 2 was a lady who got pregnant and was forced to withdraw for childcare reasons after the withdraw with no grade date, and one man for family reasons that required his time, and he missed too many classes. (both were passing at the time)

Originally Posted by MedicBrew

In my area that happens to be the case and the numbers support my above statement. I see no real correlation to “age, sex, race or religion” as a factor in failing the training. I was relating personal experiences and experiences that have been expressed to me during my career..…

We have discovered by 6 years of data:

Men fail more than women when adjusted for percentage of class population. (there are always considerably more men so this has to be adjusted)

Women average higher scores in classroom

Men have better clinical reviews on the ambulances but worse than women from the hospitals.

Everyone with at least 1 year of college recieve higher scores than those without.

Nobody with 1 or more years of college failed in the 6 years of data.

Entrance exam scores very accurately predict the student's average class score.

Students who have live in children often have lower class averages than those without.

Older students report more hours studying compared to younger. It does not reliably translate to higher scores.

Students with full time employment usually have lower class averages than those that don't but receive better clinical reviews.

Students who work as EMTs while in class usually have better scores in trauma and cardiology than those who don't, but have lower averages in every other topic compared to classmates who are not actively employed in EMS.

Originally Posted by MedicBrew

Now I could have better stated this I admit. JUST because you can study and regurgitate information on a written test and perform a particular skills set in a controlled setting, DOES NOT relate how you will perform in an uncontrolled setting acting as lead under stress.

I had the pleasure of attending my paramedic training with very intelligent individuals that simply could not, or rather would not function at a productive level in the field. Placing both their patient and themselves in jeopardy.

Medicine is medicine I agree, but a rubber stamp education alone does not prepare an individual to apply any theory without at least some experience. And I don’t think 6 months setting in class and 96 whole hrs riding with a preceptor prepares everyone for that responsibility. Speaking generically of course, there are exceptions.

Again, this is just my opinion…

Fair enough.

[Maine iac]

I agree with what V said. His points seem to correlate with what I experienced in my class.


I took my EMT then one month later was in the P class. I passed everything, was in the top % of my class, and passed NR first go.

I also have a university degree, did not work during class time, and had FANTASTIC instructors.

[alphatrauma]

There is no definitive answer for all situations, as success is highly dependent on the aptitude of the individual and the quality of the instruction.

That being said... I have not read any significant research/study that would support the argument of compulsory field experience as an EMT before progressing to Paramedic.

My opinion: The archaic notion that EMT experience is directly proportionate to being a proficient Paramedic... benefits egos more than anything else.

[MedicBrew]

I would agree that an individual’s aptitude and quality of instruction bears on one’s ability to function, we’ll say adequately vs. exceptional, fresh out of school.

As far as research / studies regarding compulsory experience, nor have I. Are we talking about course completion or field performance? I am also unaware of any research / studies that refute it.

Now, Veneficus cited above (excellent data by the way V.) that inexperienced students fair better in the course of their studies and has the statistical data to back it up.

Upon reading, it makes perfect sense. What I get out of the data is that, a young professional student with fewer responsibilities will navigate the course more proficiently than a working, experienced, married, male with pre-established biases and bad habits and family responsibilities or a pregnant woman with medical and childcare needs.

Kind of seen that one coming.

I’m in the unique position (Quality Management) of seeing most all aspects of paramedic performance in our system, as well as working the ambulance myself. Now the reason I’ve drawn the conclusion I state above is there is a significant bell curve regarding the performance of inexperienced paramedics (by that I mean no prior experience working on an ambulance as a crew member, not a student). The learning curve as far as field / differential diagnosis, treatment modalities, rhythm interpretation, med errors, proper documentation, etc, is somewhat exaggerated in this population universe with a confidence interval of >60% compared to the experienced population.

As I attempted to say (poorly) in my initial response, which was my opinion, that experienced medics seem to perform (insert SLIGHTLY) better right out of the chute. Within six months of being released, the data relatively aligns. But there again, it’s with experience.

I not knocking anyone who went straight through, on the contrary, we have some excellent folks that did just that. I’m saying, with a little experience the transition may be a little smoother. I feel that anyone would be hard pressed to quantify this with any mathematical certainty either way, so were basically expressing our opinions.

Originally Posted by alphatrauma

My opinion: The archaic notion that EMT experience is directly proportionate to being a proficient Paramedic... benefits egos more than anything else.

Paramedics have egos?

[epipusher]

I took a break from being a preceptor/FTO solely due to having to teach the paramedic students how to be a basic first. The biggest advantage I have noticed to working as a basic first is just basic assessment skills. Too many of my students had no idea how to even generally assess their patients. Its unfortunate our local hospitals anu educational institutions are putting money before and sort of experience requirements.

[Robb]

Most MDs don't have pt care experience prior to graduating med school...then again I met a resident the other day that had the bedside manner of a dresser drawer.

I went EMT to medic without any actual ambulance experience and haven't had a problem. I got my job as an intermediate about half way through the first semester of medic school.

I've learned a TON through my time as an Intermediate but I think I could have gone straight to medic without experience and been just fine. I also have had the advantage of having partners that have all been very good about talking with me, asking me what I'm thinking, including me in pt care and assessment, giving me "homework" type stuff sometimes (I think some of this might be because they don't know the answer but you never know lol). It would have been tough but I definitely could have made it work starting work in the field with no EMT experience.