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[Veneficus]

Alphabet soup courses.

From time to time this topic comes up and I think it has been a while since we have talked about.

These classes serve 2 purposes, and make no mistake, the main purpose is to make money.

The more insignificant purpose is to provide minimal "training" in order to declare you have basic information on the topic.

The classes range over just about any medical topic you can think of. But I will share with you some insight.

Like most AHA instructors, I used to think I was teaching people how to resuscitate people. I complained about the 2005 guidlines and video driven courses. (which I now actively support) I complained that they did not go into enough depth or focus on what is absolutely important to successful resuscitation. (which I still believe)

Recently I was at an AHA conference where instructors spent a lot of time complaining about the same things.

I offered this perspective when fielding a question about ACLS.

It is impossible to teach or learn intensive medicine in 16 hours. Every person in the room has dedicated their entire career to it. If all it took was a 16 hour class, then we are the most retarded experts in the business.

These classses are not designed to make people experts. They are designed to teach a few steps that hopefully in a crisis a nonexpert, who hardly ever deals with this stuff will remember.

Now I was speaking specifically about ACLS but it applies to all of these alphabet soup courses.

If you never deal with disasters, disaster life support (if there really even is a such thing, which I seriously doubt) it is resolved by logistics, usually overseen by the expert cavalry that you call to save you.

The same with burns, tacmed, PALS, trauma, critical care, and all the other highly marketed and popular courses.

The reason agencies require these classes, is so they can document you possess the most minimum of knowledge and skill and recieve ongoing "training" in it.

If you really want to be "an expert" in any given discipline, these classes might be a good place to start. If the agency you work for or wish to apply to requires them, it would definately be a good idea to take whatever one(s) they expect.

But if you are really interested in the topic, it will require much more, and you may have to travel quite a distance and pay quite a price to gain such expertise.

Look beyond marketing.

Anything worth having is generally very difficult to come into possesion of.

 

[VFlutter]

I never felt that ACLS was designed to make someone an expert at resuscitation, despite popular believe to the contrary, but rather provide a basic understanding of resuscitation and prepare a person to begin advanced treatments which will hopefully buy enough time for an expert to arrive.

ACLS/PALS/XYZ courses are designed to create treatment algorithms that adequately treat a broad range of situations but not perfect for any one situation. For an expert to treat every cardiac arrest with the same treatment plan is just foolish.

I find it humorous that our physicians are required to take ACLS. Do they expect a electrophysiologist to run a picture perfect ACLS code on their patient during an EP study? Or an anesthesiologist to follow ACLS during an intraoperative arrest.

I also find it amusing when less qualified providers question the expertise of others because "they do not follow ACLS". They don't know what they don't know...

 

[Veneficus]

I think classes like ACLS for physicians who are not experts in resuscitation has the same benefit for them as for nonresuscitation healthcare providers in other fields.

It is what to do until an expert can help.

I also think it is beneficial for expert resuscitation providers to know what others are doing and where they are coming from.

As hospitals are required to provide ongoing emergency training by multiple accrediting agencies, "canned" courses like ACLS becomes the cheapest and easiest way to meet that requirement. The path of least resistance.

Whether or not any benefit can be had is really dependant on the level of the course and the instructor. For example an EP course can be of great benefit to experts. A discipline specific instructor can even present information beneficial in area specific application of video driven courses.

But it is unlikely when that instructor is providing a course related to their area of expertise to "students" whos expertise or environment is completely different.

 

[Summit]

These classses are not designed to make people experts. They are designed to teach a few steps that hopefully in a crisis a nonexpert, who hardly ever deals with this stuff will remember.

...

The reason agencies require these classes, is so they can document you possess the most minimum of knowledge and skill and recieve ongoing "training" in it.

These two statements are the bottom line.

I remember asking the ICU Nurse Educator whether I needed to have ACLS when I applied for the job. The answer was something like, "I really don't care. We'll give you a 2 day ACLS class because you are required to have that piece of paper just like a tele floor nurse. Then we'll spend two to three weeks actually learning what, how, and why we do what we actually do. But that won't be enough time, so you'll have lots of homework and you will be evaluated. When you are 'done,' then you'll just be at a minimal starting point for an ICU nurse, but we'll have to move on to other subjects." I liked the answer.

-Summit CPR PHTLS ICS QPR IV EKG WTF NobodyCares(tm)

 

[ExpatMedic0]

I have been into some pretty crappy EMS managers and educators office's who mount there PHTLS certificate and others similar certs in a huge expensive wall mounted frame like its a freaking Harvard sheap skin.

 

[Ecgg]

If you really want to make the argument of "If you really want to be "an expert"" pertaining to the field of medicine everyone then should enroll into medical school and become a doctor.

Alphabet soup classes are not designed to foster expertise. One to disregard them and state "it's waste of money and it's all marketing" does not really take into account the reasons people pursue these classes.

Is the only reason people attend these classes is to have a merit badge and consider oneself an expert?

Could one attend these classes to perhaps further their education in the subject? Perhaps it's a form of continued medical education. Not all alphabet courses suck, some are led by very experienced physicians and it's certainly beats medic CME check your ABC and drive faster.

An investment in knowledge always pays the best interest. (Some one said that once)

 

[Veneficus]

Could one attend these classes to perhaps further their education in the subject? Perhaps it's a form of continued medical education. Not all alphabet courses suck, some are led by very experienced physicians and it's certainly beats medic CME check your ABC and drive faster.

An investment in knowledge always pays the best interest. (Some one said that once)

So what?

It doesn't matter who it is led by, it boils down to simplified bullet points.

There is no way anyone can impart upon you the amount of background and ongoing information in a few days.

 

[Ecgg]

So what?

It doesn't matter who it is led by, it boils down to simplified bullet points.

There is no way anyone can impart upon you the amount of background and ongoing information in a few days.

I am not arguing that these courses impart expertise or some grandiose background information is a few days that makes one an expert. Nor do I believe that these classes even claim such.

You are missing the point here. Anyone who talks absolutes in one direction or the other (i.e. all 2 day classes are junk and its all marketing and waste of money VS 2 days are the greatest thing since sliced bread and I am an expert let me put them on my wall) is missing the point.

I am simply stating that reading the books and looking at the literature (not just bullet points) then attending a class, asking questions and clarifications and perhaps practicing in a conducive environment with others which fosters learning, perhaps is not the devil as some make it out to be.

Just because you have certain expectations of what ones education should entail does not automatically make things that don't subscribe to your mantra obsolete.

Usually with most things the truth is somewhere in the middle.

 

[Veneficus]

I am not arguing that these courses impart expertise or some grandiose background information is a few days that makes one an expert. Nor do I believe that these classes even claim such.

They most certainly do.

"advanced" X life support implies expertise. Otherwise, wouldn't it just be basic?

As was pointed out above, people come out of these classes believing they are expert to the point where they critisize true experts for not following the scripture they learned.

You are missing the point here. Anyone who talks absolutes in one direction or the other (i.e. all 2 day classes are junk and its all marketing and waste of money VS 2 days are the greatest thing since sliced bread and I am an expert let me put them on my wall) is missing the point.

I guess I will not make a very good jedi.

But I do have some insight on this.

These courses are designed with the goal the nonexpert will remember some basics principles under stress. Similar to military style drilling.

You cannot impart critical thinking or advanced knowledge into this format. It must be a simplistic trained reaction.

There was a period in history where understanding of medicne was so limited that this was all there was for any provider. If you ask many of the older ACLS providers and instructors they will recount tales of how hard it was to pass the class and how you were "truly expert" because that is all anyone knew.

Many of these courses have directly mirrored this AHA style of
delivery, but with lesser success, often because they tried to oversimplify much broader topics, like trauma.

I am simply stating that reading the books and looking at the literature (not just bullet points) then attending a class, asking questions and clarifications and perhaps practicing in a conducive environment with others which fosters learning, perhaps is not the devil as some make it out to be..

Perhaps if that was actually happening. But the reality is people don't read the books, don't spend enough time looking at literature, and come to class expecting to learn everything they need for the test in the class. I teach a fair few of these classes myself and I can tell you in minutes who read the books and who didn't.

I am not an outside agitator throwing stones, I am the squeaky wheel in the machine. My opinions are often introspective based on what I am actually doing. I am pretty good at figuring out when I am making money for nothing and wasting time.

Just because you have certain expectations of what ones education should entail does not automatically make things that don't subscribe to your mantra obsolete..

Again, introspection, I have spent a lot of time both as a student and an educator. While there are different learning styles, I have a pretty good handle on the difference between knowledge and information and their value.

Information is of lesser value than knowledge, it also degrades faster.

These classes provide information that you could look up on your iphone in the moment of need with equal or greater effectiveness and not waste time or money on them.

In terms of practicing, you cannot practice knowledge, you can memorize information, you can practice skills and in the environment you are likely to use them in.

But as I often tell my students in these classes, you can recite this information like a prayer, but you will find that nomatter how often you recite it, it doesn't bring you any closer to the truth.

 

[Trashtruck]

I have been into some pretty crappy EMS managers and educators office's who mount there PHTLS certificate and others similar certs in a huge expensive wall mounted frame like its a freaking Harvard sheap skin.

What's wrong with that? I carry my EVOC certificate, folded up nicely, behind my drivers license so that when I get pulled over I can show the police how I'm a skilled operator, certified to drive under duress and in extreme conditions!

Hilarious!!! A 'Paul Blart' of EMS?!

I recertify my ACLS and PALS for one reason: Employers require you to have it. I can't say I've gained any more knowledge sitting in the one day refresher classes every two years. I remember one refresher went like this: 'Do you guys just wanna take the test now and get out of here, or do you want to look over some stuff?' In and out in like an hour.

It's a total money maker.

 

[sir.shocksalot]

I recertify my ACLS and PALS for one reason: Employers require you to have it.

Anyone thinks that there is any other reason to hold these cards is kidding themselves. I have 3 pages worth of certifications I have "earned", their only purpose is to market myself to employers. In my experience, most people reading applications are not clinical people. To those people all these fancy "advanced _____ life support" look fancy and put you ahead of many other applicants.
These certs will be peddled and bought by many. Regardless of what we think of them or if they have any true worth (which they really don't).
So long as the people who do the hiring and management in EMS stay the way they are (knowing EMS we tend to promote more of the same) these alphabet classes will stay around.

 

[Ecgg]

But as I often tell my students in these classes, you can recite this information like a prayer, but you will find that nomatter how often you recite it, it doesn't bring you any closer to the truth.

Fair enough, I see your stance. In the original post you stated

"But if you are really interested in the topic, it will require much more, and you may have to travel quite a distance and pay quite a price to gain such expertise.

Look beyond marketing.

Anything worth having is generally very difficult to come into possesion of."

What in your opinion qualifies for traveling the distance and paying quite a price to gain the expertise?

 

[Bullets]

I recently took the Advanced Stoke Life Support class taught by maybe the best neurologist in the state

Do i think i am an expert in Strokes? Absolutely not. However i do feel as if i learned something in this class. Being able to determine the type of stroke, while practically useless for my job is educationally interesting. Learning about and implementing the MEND exam will help me give a better report and hopefully get my patient better care

I see these classes as a way to impart a basic knowledge standard upon everyone. This way when the experts show up they know whats going on. Should a person code in CT, i dont expect that the radiologists will run a perfect code but will provide decent care until the Emergency team arrives to take over.

I dont think taking a class makes you an expert, but going to the Eagles conference cant be a bad experience.

 

[DrParasite]

I recently took the Advanced Stoke Life Support class taught by maybe the best neurologist in the state

really? I'm guessing you took it at Capital Health, but the best Neurologist in the state works out of JFK and Overlook (or so I am told). Either way, it was suggested by someone to take the class and I will probably take it one of these days.

Many of these classes are a resume padder, no question about it. However, I do think there are some pretty good two day classes. Advance Burn Life Support was pretty interesting, PHTLS was decent (well, the first time, the refreshers not so much), AMLS was interesting (although it made me scared of some of the ALS providers who were struggling through the scenarios), PEPP was interesting, and CPR was totally awesome.

But I do think you are missing the point: none of these classes will make you an expert. Just like attending one of the national conventions and attending some classes won't make you an expert either, but they will give you some more information that you can use.

It's a starting off point. Hopefully your own experience and motivation will take it further.

So since you don't like alphabet classes, what do you propose be done instead? How should we teach others stuff that isn't in the paramedic ciriculum? Complain all you want about the system, but if you don't propose a solution you are just complaining.

 

[Veneficus]

So since you don't like alphabet classes, what do you propose be done instead? How should we teach others stuff that isn't in the paramedic ciriculum? Complain all you want about the system, but if you don't propose a solution you are just complaining.

Actually, everything in those classes is supposed to be in the paramedic curriculum.

 

[Veneficus]

What in your opinion qualifies for traveling the distance and paying quite a price to gain the expertise?

You will probably have to attend multiples avenues of education, from university to Coned Classes, seminars, conferences, etc. Generally all of these are not offered in a specifc place.

It will also require experience and patient contact. Not everyone lives next door to an academic healthcare facility.

The price is paid in money with the paying of tuition, entrance fees, books, periodicals, etc as well as in blood, time spent and the required sacrifices this brings.

How much? That is a good question. A lot.

 

[Bullets]

really? I'm guessing you took it at Capital Health, but the best Neurologist in the state works out of JFK and Overlook (or so I am told). Either way, it was suggested by someone to take the class and I will probably take it one of these days.

Yeah it was one of the first time they ran the class after they got the national accreditation. Id say it probably a toss up between Capitol and JFK. If you have a chance to take the class, Dr. Vez is awesome. Id hardly consider myself a stroke expert, but the lecture hall was filled with people from probably a dozen hospitals and EMS services. Definitely a course to consider

If alphabet soup courses are useless, how do you handle continuing education? Do you not think CE is needed?

 

[Veneficus]

If alphabet soup courses are useless, how do you handle continuing education? Do you not think CE is needed?

How do I get continuing education or how would I set up a system of continuing education?

 

[Clipper1]

Actually, everything in those classes is supposed to be in the paramedic curriculum.

This way of thinking is one reason why EMS is still way behind. You seem to think nothing should change and everything you were taught is still up to date. That's the way you were taught 20 years ago and it should still be good enough today.

You also seem to confuse a certificate of attendance with a certificate course which trains you for a profession such as EMT or Paramedic. You can take a weekend course in basketball for a certificate of attendance but you should know it won't make you just like Michael Jordan back in the day but it might improve your game at the station during down time.

ACLS gives you a certificate of attendance. In the book it emphasizes it does not entitle you to perform ACLS skills. In hospitals and EMS agencies (and Paramedic school) they will or should go over extensively the information and skills needed to perform ACLS to their needs and protocols.

You might think that a stroke is the same now as it was 20 years ago when you took an EMT or Paramedic class. The disease process might be but there have been a few new things learned in recent years and the treatment protocols have changed.

An advanced airway course might have some of the things learned in a Paramedic course but it also might give you some practice along with some tips or a critique of how you could improve.

Any certificate of attendance course which could offer more information to open up communication within your own organization for new ways of doing things or new equipment which might improve patient care and comfort should be worth it.

There is nothing wrong with resume padding. It shows the employer you have at least been introduced to the course. Any FTO with half a brain should know you will still need to be evaluated and trained or educated beyond a pass/fail course. By attending the recert classes for PALS and ACLS, you at least should have been introduced to the changes and your agency can move on from there with introducing the new protocols.

National seminars are also not a waste of time since you might see how others are improving their service or network with others for a future opportunity even within your own organization.

But, to never take an opportunity to review or learn something new is a waste. Even the experts in their fields take day courses or CEs to learn new equipment or techniques. Doctors know medicine and technology changes. It is time for some in EMS to realize this also. Stay current and don't just rely on your Paramedic certificate from way back when to be all there is to know.

 

[Ecgg]

You will probably have to attend multiples avenues of education, from university to Coned Classes, seminars, conferences, etc. Generally all of these are not offered in a specifc place.

It will also require experience and patient contact. Not everyone lives next door to an academic healthcare facility.

The price is paid in money with the paying of tuition, entrance fees, books, periodicals, etc as well as in blood, time spent and the required sacrifices this brings.

How much? That is a good question. A lot.

These are unrealistic expectations. You literary want PA's (Physician Assistant) staffing ambulances. This will never happen as you losing focus what the intent of a "Paramedic" was.

From: Emergency Care in the Streets 6th ed., Nancy Caroline et. al. (2008) (p. xIv)

If one has such dedication and willingness to devote time to college and pay tuition out of his pocket (EMS agencies rarely cover tuition) and actually attain such standards, what will keep said person in his current EMS position?

Truth be told those who attain such standards usually move on to MD, DO, PA RN fields.

Fact is these are qualifications to work as a Paramedic for 99% of EMS agencies out there

High School Diploma or GED
State Drivers License
Paramedic Certification
AHA Cards
# Years on the job