freezing up and choking during skill drills

[ellexruth]

So I started EMT-B school in mid-January. My teacher is really great. Works with us individually and everything. We're kind of just starting to move into skills training (opposed to the first two weeks with lectures around safety, professionalism, importance of documenting, how radios work, communicating with dispatch, etc. -- then anatomy / physiology / pathology). When we spend time doing skills (and it only started this past week with the most basic of basics -- airway management) I just CHOKE in front of the other students. Ugghdklsa. I do have social anxiety disorder (and ADD / OCPD / bipolar II). When I'm practicing after class with the manneqins and the mechanical airways / suproglottic airways I'm just a freaking ninja. So fluid and good at it. And on a knowledge level like I understand all the how they work / why the work / when to consider using certain ones. But like I said, I mean I just CHOKE during drills in front of everybody else. I'm so frustrated. My instructor will be like, "wtf you absolutely had this down the other day after class one-on-one". I'm so frustrated. Anybody else?

 

[mgr22]

I'm no expert, but I'd guess the medical history you described -- particularly the social anxiety disorder -- could have something to do with your performance issues. You and your physician(s) would be the best ones to decide if any changes in treatment might help.

Plain old shyness can also make it hard to act out scenarios in front of other students. Perhaps drilling more in front of others would help.

 

[CCCSD]

Yep. If you can’t do it in front of others, you are not going to be able to do it when it counts.

 

[NomadicMedic]

I always hear students say stuff like this, "I can do the skills, I just can't do it in front of other people"

My reply? You better learn how.

I'll work with you and put you in lower stress scenarios to start as you build confidence, but you do need to learn how to perform in front of others. EMS isn't a solo sport, and I don't care if you know how an iGel works if you can't put one in during a cardiac arrest when I need it done now.

The people in your EMT class should be allies and help you work through your anxiety issues. Confide in a class friend and explain your problems. Having a friendly face in the scenario with you can help you get through it.

But work on it. It won't go away on its own.

 

[E tank]

Big difference between performing in a contrived scenario for the purposes of evaluation and it being just you and the patient somewhere. Totally different cognitive pathways...Understand and anticipate your difficulty in the evaluation setting and do what you have to do to get by.

Every single hack that made it to the ambulance passed these evaluations and they don't guarantee anything. You're real learning and training starts when you step onto the rig...

 

[Tigger]

Big difference between performing in a contrived scenario for the purposes of evaluation and it being just you and the patient somewhere. Totally different cognitive pathways...Understand and anticipate your difficulty in the evaluation setting and do what you have to do to get by.

Every single hack that made it to the ambulance passed these evaluations and they don't guarantee anything. You're real learning and training starts when you step onto the rig...

But the folks that cannot perform skills in a classroom environment can rarely just make it happen on the street. If you "choke" on the skill in the classroom, you are missing the opportunity to learn to do something with a bit of added stress, the sort of stress that doesn't really approach what a real, sick patient looks like.

 

[NomadicMedic]

Agreed. An astute instructor knows how to add stress to skill scenarios. I add in stressors until the students are able to function while dealing with hysterical bystanders, loud noises and a sick patient all at once.

 

[Carlos Danger]

But the folks that cannot perform skills in a classroom environment can rarely just make it happen on the street. If you "choke" on the skill in the classroom, you are missing the opportunity to learn to do something with a bit of added stress, the sort of stress that doesn't really approach what a real, sick patient looks like.

That isn't really true though. They are very different types of stress, especially to someone with social anxiety issues.

Classroom and real life are very different, no matter how much you try to make the former resemble the latter. Performing a skill in front of a group of instructors and peers who you know are studying and judging every minute aspect of every movement you make is a very different stressor than performing a skill in the real world, when it counts, in a way that might not be perfectly textbook but is perfectly adequate.

 

[NomadicMedic]

That isn't really true though. They are very different types of stress, especially to someone with social anxiety issues.

Classroom and real life are very different, no matter how much you try to make the former resemble the latter. Performing a skill in front of a group of instructors and peers who you know are studying and judging every minute aspect of every movement you make is a very different stressor than performing a skill in the real world, when it counts, in a way that might not be perfectly textbook but is perfectly adequate.

I'd be interested in seeing some research on this. The last study I saw (I'm looking for the citation) showed that increasing stress levels in training scenarios directly impacted real world performance. That's why realistic simulation is so valuable in building competency.

 

[Carlos Danger]

I'd be interested in seeing some research on this. The last study I saw (I'm looking for the citation) showed that increasing stress levels in training scenarios directly impacted real world performance. That's why realistic simulation is so valuable in building competency.

With all due respect to the educators out there, I think that is complete bunk. I don't think there's any such thing as "realistic simulation" of an EMS call. No matter what you do, as long as you are in a classroom, it's not even close to realistic. Any stress you induce is going to be a very different type of stress than what is experienced out in the real world. I think the best thing you can do in the classroom is make sure the students memorize the stuff they need to memorize, learn the hands-on skills they need to learn, and then leave it to the field experience to bring it all together.

Also, we aren't talking about normal learners here. For someone with social anxiety issues, the stressors can be very specific. They may not be able to handle certain situations (performing in a classroom under close examination of peers and instructors) well at all, but perform just fine in the situations that most people think if as being more stressful.

OP, I can identify somewhat. I doubt I'd qualify for any type of social anxiety diagnosis, but I am not a people person in the least. I hate small talk and am not a good communicator in social situations with people that I don't know well. I come off as aloof and arrogant and uninterested in others, even though that's not the case at all. The more I try to assuage this, the more awkward things get, and the whole thing is a bit anxiety-inducing for me. It caused real challenges for me in my anesthesia training when I was constantly rotating through different sites and having to meet and impress new people all the time and constantly be under close scrutiny. I just don't do well like that. It did back in my paramedic training too; in fact I almost got dropped from the program because of it.

However, I do perfectly fine in any type of "official" communication, such as a job interview or doing a patient assessment or a pre-anesthesia eval. I get along with co-workers and bosses just fine. I have no problem talking to family members or nurses or environmental staff or the checkout lady in the cafeteria. I actually excelled very much as a paramedic, and am not doing too shabby as a CRNA, either.

Point is, a person can have a hard time in the classroom settings and still do just fine in the field. The two do not equate.

 

[NomadicMedic]

There is a difference between doing effective simulation with proper cues and a debriefing session versus just throwing a manikin on a table.

EMS Simulator | Healthcare Simulation | HealthySimulation.com

An EMS Simulator is a medical simulation tool or device used to depict emergency scenarios for education and training purposes. By using an EMS Simulator, trainees and learners alike can practice procedures and treatments that may be involved under high-stress emergency circumstances. Below are...

www.healthysimulation.com

 

[Carlos Danger]

There is a difference between doing effective simulation with proper cues and a debriefing session versus just throwing a manikin on a table.

EMS Simulator | Healthcare Simulation | HealthySimulation.com

An EMS Simulator is a medical simulation tool or device used to depict emergency scenarios for education and training purposes. By using an EMS Simulator, trainees and learners alike can practice procedures and treatments that may be involved under high-stress emergency circumstances. Below are...

www.healthysimulation.com

Sure. “Simulation” can be useful. Especially for practicing rarely used skills. But simulator skills is very different from simulating stress in a realistic way.

 

[CCCSD]

Try doing skills when someone is yelling at you and putting rounds into the dirt next to you. Good way to see where you are on doing things...

 

[Peak]

How do you simulate a known gang member who threatens to kill you if you don't save their kid?

 

[Tigger]

How do you simulate a known gang member who threatens to kill you if you don't save their kid?

You don't. There is no reason to even try to simulate a situation that will rarely, if ever happen to most providers. A good program tries to prepare its students for their primary responsibilities. A certain amount of both critical thinking and experiential learning is still needed to take what was hopefully dialed in during class and to extrapolate it to more infrequent situations. Can't cover everything right?

I hope more courses are moving away from the stereotypical MCI of hemophilic nuns on a bus and trying to emphasize core competencies instead. We certainly see a difference locally with the students, obviously that isn't something easily proved.

 

[DrParasite]

Point is, a person can have a hard time in the classroom settings and still do just fine in the field. The two do not equate.

I think that's more the exception than the rule. If you can't do it in a controlled environment (classroom), the chances if you being able to do it in a much more uncontrolled environment (the field, whether it's an ambulance, fire truck, special event, hospital, etc) is slim. Sorry if the truth hurts, but it is what it is.

Try doing skills when someone is yelling at you and putting rounds into the dirt next to you. Good way to see where you are on doing things...

What the heck would you do this? I have 20 years in, and if someone was putting rounds in the dirt next to me, I am pretty sure I would need a clean pair of undies after this call. I'm positive I would not perform to the best of my abilities. If an EMS instructor was evaluating me, I'd likely fail. If this happened in real life, I'd probably tell me I'm going home after this call, and to take me off for the next few shifts on PTSI..... I might even put in my 2 weeks notice, and I enjoy working in urban ghettos; but when bullets start flying that close to me, than it's time to reconsider.

@ellexruth, your personal psych history aside, this job requires you to be able to perform in front of an audience. when you go on a call at a SNF, you will likely have staffing looking at you. if you go to a pvt residence, you will likely have family looking at you. if you go to an MVA, every rubber necker will be looking at you. and if you work EMS at a football game, you might have hundreds of spectators looking at you. And that doesn't include your fellow emergency responders, public safety professionals, or (if you get really unlucky) the local news reporter. That all being said, you're still in class, and it's unfair to expect you to be able to be as comfortable as a 20 year veteran.

I taught an EMT class this past Saturday, and one of the students asked me how long did it take me to get comfortable with EMS, and doing all the skills, patient assessments and talking to people. I gave them an honest answer: I started at 16, got my EMT at 17, got my first paid EMS job at 19, and was working for a hospital based system in an urban city at 23. Are there calls where I draw a blank on how to handle? sure, but I would say it took me about 5 years of part time work to be comfortable with EMS. And the more I did it, the more comfortable I became. But it takes time, and experience, two things that you don't have yet.

You will make mistakes, but remember, every ambulance driver before you had to complete the EMT class too, and they still make mistakes. You need to work on it, but being able to perform with an audience is a pretty important thing in EMS

 

[CCCSD]

Since you’ve never served OCONUS, or worked in other countries, I’ll not bother to explain things to you as you’d just argue. If you had, you’d KNOW.

 

[Carlos Danger]

I think that's more the exception than the rule. If you can't do it in a controlled environment (classroom), the chances if you being able to do it in a much more uncontrolled environment (the field, whether it's an ambulance, fire truck, special event, hospital, etc) is slim.

Sorry if the truth hurts, but it is what it is.

Lol. Ultracrepidarianism and Dunning-Kruger are flipping a coin for who gets to make you their poster boy.

Do yourself a favor and don't ever confuse an opinion on something that you know nothing about with "the truth".

 

[DrParasite]

Lol. Ultracrepidarianism and Dunning-Kruger are flipping a coin for who gets to make you their poster boy.

wait a second.... so in all of your years of EMS, you found that the majority of those who couldn't do the skills in class, were phenomenal providers? I just want to make sure your point is crystal clear. I know there are exceptions, but they are exceptions, not the norm. But of course, after all of your years in EMS, and in education, you must know more than me.

Do yourself a favor and don't ever confuse an opinion on something that you know nothing about with "the truth".

you mean what you do on a regular basis? thank you for your contribution.

Since you’ve never served OCONUS, or worked in other countries, I’ll not bother to explain things to you as you’d just argue. If you had, you’d KNOW.

thank you for your service.

 

[E tank]

There are mass casualty drills and there are patient simulations. Categorically different. What is true is that neither approximates the real thing to any meaningful degree. They do "break out" the material resources from storage...they demonstrate available assets, but not much more.

Patient scenario simulations are something you do when real, meaningful training is not available. They are indicators of a training program's short comings.

How do you train trauma surgeons? In trauma rooms with real trauma. Do those guys do patient simulations? Not in any credible residency/fellowship. Because they're BS...

Challenging, thorough didactic preparation followed by expertly supervised and mentored field experience is what works...anything less is just stalling for time because of a lack of somewhere to put a trainee or to soak them for more tuition....