Ready for an unpopular idea?

[kev]

You make a valid point. Having not been in the field I have yet to see how the things we do in class translate into real life events.

 

[TheLocalMedic]

There are a lot of old guys who cut corners...

What may be perceived as "cutting corners" may actually represent the fact that they have seen that particular call so many times before that they immediately cut to the chase and don't ask a lot of extra questions. Experience = the ability to trim the fat and not do a lot of extra work. Also, work in the field long enough and you'll start to recognize when you should or shouldn't be doing/saying certain things.

I had a partner a few weeks ago that was concerned about why I wasn't backboarding people involved in traffic collisions. They even asked if I was "just lazy or what?" So I explained my rationale and how mechanism alone was not enough to justify c-spine, and that backboarding wouldn't do anything to stabilize a lumbar injury. I wasn't lazy or cutting corners, but rather applying my experience.

Their training was a lot different than ours was...

Yes, training was different, but just because we went to school long before you doesn't me we could stop learning. Medications change, protocols change, equipment changes, and treatment modalities change. We all keep learning and going to courses to keep up with the changing pace of medicine.

But I will take a fully educated paramedic vs an EMT who has been doing the job for 20 years and is still doing things this way "just because we have always done it this way" and no one has died yet.

I don't believe that you'll find many people out there who have the attitude of "just because we have always done it this way". Those experienced EMTs are often as sharp as their medic partners, and I've had my butt saved by good EMTs many times. I'd almost prefer the opposite of what you stated; I'd rather have a super experienced EMT who has proven themselves over 20 years than a wet-behind-the-ears medic.

 

[Masenko]

Still haven't figured out how to quote, the quoted stuff is bolded

@ TheLocalMedic: I'm getting some mixed messages from you, do you mind clarifying?

Today's EMT and paramedicine courses have in many respects been dumbed down to accommodate the demand for and influx of new practitioners and students. The first paramedics were taught by physicians and were often expect to have physician level knowledge. EMT courses are essentially advanced first aid, and aren't too different from what is taught in the Boy Scouts.

vs
Learn from the old dogs. They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS. Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.


I'm pretty sure the first paramedics were not expected to have physician level knowledge. Sure they were mostly military medics with unique skills and experiences, but even with that going for them they are far removed from what modern EMS and health science has evolved to. Physician skills yes, but knowledge? I thought this is the type of thought train we view as dangerous here. I get training by physicians too, but that doesn't mean I come close to their knowledge. Moreover, do you think our training is dumbed down boyscout first-aid or is our training up to par with the old dogs? If it isn't harder or easier than the old dogs' then don't the old dogs have boy scout training as well?

We WANT people who strive to be the best they can be, and we deride those who accept mediocrity.


If you really mean that, then why would you say this?

I'd almost prefer the opposite of what you stated; I'd rather have a super experienced EMT who has proven themselves over 20 years than a wet-behind-the-ears medic.

So you would rather have a guy who has accepted mediocrity for 20 years, and the knowledge consisting of A+B= hopefully patient gets better, than someone who has taken the time and effort to try and understand the science behind a situation? Than someone who cares enough to learn more? I understand what you mean in terms of dealing with the new student and his/her effect on day to day operations, but the good thing about experience is that it is something that literally happens by itself. The new guy can ride with you AND the 20yr EMT vet if you want! I bet the new guy will quit on his own if he can't deal with blood! I also bet he will be a loyal, trustworthy, experienced, overall stronger asset than the 20 yr EMT if he gets some guidance.

I like what Firetender is saying. Maybe some people aren't prepared for EMS, but why does this forum have to be the medium? I understand that constantly encouraging people to overcome the obstacles over and over again can get annoying, but maybe it's that repetition that's getting to people, not the actual obstacle or the "whiners".
And sure there are some people who do not belong. I have yet to find that out about myself. How long do they really last, with or without coddling?

I love this forum; I've been lurking here much longer than I've been a poster. People's posts here have inspired me to try and become the best emergency clinician I can be. Negativity and discouragement is prevalent enough in the real world. Constructive criticism is one thing. But c'mon, telling someone they can't do something based off of what they post ( a very small window of what is actually taking place) is a little disproportionate.
This is the internet. I can say with confidence that reading someone tell me to quit trying, anonymously, on an internet forum isn't going to sway my decision at all. It might make me feel a little bad... I might hyperventilate at the computer screen for a bit, but I definitely will not quit. Likewise, you will not find me asking for help to pass a state exam -_-...but that is besides the point.
Why not try to help those who want to better themselves? Obviously they care enough to come complain on a forum about it. If impatience is this out of control, don't say anything! Shooting someone down is not guidance, and it's not going to make them leave EMS. None of us are qualified to say what one person can and can not do (over the internet)! This is looking a little bit like what my text book calls "burnout", only of a different nature.

I know it might not look like it, but standards in EMS and healthcare are going up. Aren't we moving towards the AEMT? Aren't certificate programs on the way out? The GPA average and MCAT score for med schools sure aren't going down. And the average GPA requirement for nursing school is no joke either.
Those who will not make it will figure it out themselves, especially with rising standards. Some of us have made it clear that it's annoying that young folk are complaining about passing tests, about classwork... maybe we should be happy people are having a hard time with it. And for the ones who can handle the books, but not the real...they aren't exactly going to feel in place anyway. Push for better paramedic education and training, but don't push away those who give enough of a sh*t to come here.

 

[unleashedfury]

Its not just the student who struggles to pass the exam, its also the fact that schools need to better prepare students for expectations to perform. Standards should be much more stringent for students entering the EMT or paramedic program vs. well if the check clears you start on this date.

Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest.

Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test.

Improving the standard means raising the bar. stricter entry requirements including a written and psychomotor exam to be passed to a minimum standard. interviewing students to see what kind of education they have and the background they have. Why they want to do this as a career? I remember part of my entry process they were aiming more for people who already had college credit. I have a technical degree in automotive technology. So that set me to the top of the list because I have a degree. Does it apply to the medical field no. But the running joke where I work is I can drive the buggy, ride in the buggy and fix the buggy.

I'm in a program now. and it was pretty much yeah you meet the requriements they didn't even check to see if my EMT was valid until the council required it. So a student could attend the program and not even be a EMT and find out at the end that EMT was a requirement go figure.

 

[Biggs]

Class doesn’t translate to real life,

 

[NomadicMedic]

Class doesn’t translate to real life,

Explain...

 

[unleashedfury]

Class doesn’t translate to real life,

Well, I'm sure riding on the box with a medic preceptor while you do your field shifts. is the same as real life the only difference is when you get the certification after your FTO time. Your on your own, vs having a preceptor.

 

[DrParasite]

Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest.

Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test

These two paragraphs are probably the two biggest reasons why people don't get dropped from paramedic school. As well as why no one fails various continuing education classes, despite not retaining enough information to pass the class an use what they learned in their career.

 

[grind time medic]

i agree with what DEmedic said completely

i understand that being nurturing to a child when they are growing up is important! But what is more important for me is making sure children understand there boundaries, i read an article on the art of manliness about the paralyzing effects of the words "you can be what ever you want" does to a persons life.

 

[DesertMedic66]

Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest.

Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test.

I would be a little careful saying these as a general statement. Not every college or technical program boast a high pass rate from the class. There are some that focus solely on NREMT pass rates. The college I attended for EMT has about a 65%-70% pass rate for the class and a 93%-96% pass rate for the NREMT.

If the students are not meeting the requirements they will be dropped from the course regardless of how much money they paid for the course.

 

[unleashedfury]

I would be a little careful saying these as a general statement. Not every college or technical program boast a high pass rate from the class. There are some that focus solely on NREMT pass rates. The college I attended for EMT has about a 65%-70% pass rate for the class and a 93%-96% pass rate for the NREMT.

If the students are not meeting the requirements they will be dropped from the course regardless of how much money they paid for the course.

I can't speak for the entire US and all colleges. but the few that I've been around have a high pass rate for the program. Low pass rate for the NREMT.

However I know of a local hospital program that has a low program pass rate avg. 68%. and of that 96% of those who complete the program pass the NREMT congnitive and psychomotor on the first attempt.

 

[grind time medic]

i know one thing that some programs do is they will allow anyone to enter the program but then if they can tell that the person is not gonna pass they will talk them into withdrawing from the class or bounce them out for some infraction. to keep there % #'s high.

 

[Masenko]

Well that's one way to "up the standards"

 

[PRiel]

Follow Your Heart

I think there's a responsibility to research the job carefully before spending time and energy on the processing of education and qualifying for a position. That said, I definitely believe you should follow your heart. If you don't qualify, or you're not cut out for it...the answer will come to you sooner or later.

 

[Jon]

Its my belief that will and interest may not always equal job suitability. No matter what they tell you in paramedic school.

So.... I just found this thread.

This is a genius thread. How do we fix this?

 

[STXmedic]

This should be a sticky in the NREMT section.

Quoted for truth.

 

[UnkiEMT]

This is a genius thread. How do we fix this?

You, I like.

So, I have a tendency to wind up working for training houses, not really by design, but perhaps by temperament. We hire them out of school, they work for us for 6 months or so, and either go on to better pay or decide that this isn't the field for them and try something new. This perhaps gives me a different perspective on the question than most, or perhaps not.

From my observation, short of the absolute inability to learn the material, there's very little way to tell from how someone does in school whether or not they'll do well in the field.

As far as I'm concerned, these are the traits that make for a credit to the profession (though in all honesty, to varying degrees you don't need to have all of these traits to do okay in this field, just to be the best, which is what I want every last people with a star of life on their shoulder to be):

1) You've got to love it for what it actually is, not for what Johnny and Roy told you it would be. Considered dispassionately, this is a bad job, if you don't love it, you can do better elsewhere.

2) You do have to know your book-larnin', you don't have to absolutely master it, but you have to know it well enough to serve as a foundation for what you're going to learn in the field. As someone said, though, this stuff isn't exactly rocket science, most anyone who wants to can learn it, and if someone meets all the other requirements (notably the next one), I'll hold their hand through it.

2a) You've got to keep learning. I learn all the time, I learn from articles and studies, I learn from other EMTs (And not just 'medics, I've learned from basics, too), I learn from following up with pts I've dropped off, and I've learned from reading the charts of pts I'm doing IFTs on.

3) You've got to care about your pts in just the right amount. While they're in your truck, they've got to be your best friend, and once you walk away from their bed, you've got to walk away from them, too. I've seen otherwise promising EMTs destroyed because they couldn't get over the code they couldn't bring back.

4) You've got to stay calm when the fecal matter hits the rotary impeller. This one there's a little bit of wash on, to an extent, this can change, they freak out the first couple of scenes they're on then settle down, but some people are just constitutionally incapable of it, and you can usually tell the difference. (There is, by the way, a huge difference between panicking on a scene and panicking on a test. Some people just have test anxiety, and that's why I'll encourage someone who I know knows the material when they fail the test, I'll even work with them on the material, not so much to teach them, but rather to give them the confidence to pass the test.)

None of that can really be taught (aside from the basic grasp of the didactic stuff.), and largely it can't be tested for, the only way to see it is to put them in the field.

I can tell, with about a 95% accuracy, whether someone will make it in this field after I ride a single shift with them.

The ones who won't make it, unless they are dangerous, I'll lead to the conclusion that this isn't right for them, rather than actively getting rid of them. If I don't, then I'm just cursing them on a different service and community.

The ones who will make it, I take over where their school left off, and give them the knowledge and tools they need to be great.

It's not an ideal system, I wish there was some way to wash them out before they ever go near a patient, but I've yet to figure it out.

 

[neoclassicaljazz]

Agreed. And props for the ultimate frisbee shout out

 

[PRiel]

Hi there,
In Ontario Canada, about 10 years ago the Government began allowing private schools to offer paramedic training and developed criteria to certify the schools to do so. This raised strong objections and the subject captured in this thread is one of the concerns. Insisting that a school disclose their program success rates AND their certifying exam success rates as well is critical. In addition, the profession has responded by refusing to hire private school grads (or consider them at all) unless the school was accredited by our Canadian Medical Association. This has been very positive for EMS and has dramatically changed the education landscape. Now it is just a matter of the student choosing the best school.

 

[mycrofft]

Hi there,
In Ontario Canada, about 10 years ago the Government began allowing private schools to offer paramedic training and developed criteria to certify the schools to do so. This raised strong objections and the subject captured in this thread is one of the concerns. Insisting that a school disclose their program success rates AND their certifying exam success rates as well is critical. In addition, the profession has responded by refusing to hire private school grads (or consider them at all) unless the school was accredited by our Canadian Medical Association. This has been very positive for EMS and has dramatically changed the education landscape. Now it is just a matter of the student choosing the best school.

This could be the basis for a new thread…"stamp out certificate mills".
One of the first steps to becoming a real profession. Not necessarily going anywhere (no independent body of knowledge), but a win-win for patients and practitioners….if the system remains uncorrupted.
============================
Back on the OP thread. I know I have learned things I neither used per se nor as a means of making money but which broadened my perspective and provided a basis for wider associations with interesting people. On that basis, why not teach anyone who wants it?

On the other hand, spare bodies soak up class slots and drive up costs, and trained but not employed trainees without adequate discipline (or propelled by a sense of ethical duty) pose a danger for victims of illness or accident. They also drive down wages, in one respect.

This is bypassing the whole issue of triaging applicants due to temperament to spare them or their potential employers the psychic injury of failing at the cost of human suffering and death. I've seen young people snap-to when they take and pass such a course, and screening is going to eliminate some people who really COULD do it and need that job.

I say: screen your TRAINERS, use multiple trainers to backstop each other, and use their input after a long class with lots of practicum to help screen for the obvious "bad apples".
And make the certificate holders do practicums with trainers for part of refresher, not just click on a web page. The best apple will eventually become brown and spotty.