Regarding EMT-B schooling and it’s relation to real world medicine

Virgil

Forum Crew Member
94
16
8
I’ve been thinking about this ever since I got hired, and I want to ask what you all think.

During EMT school I learned things , and didn’t learn things, that were vastly different than what I encountered while on shift. I had to practically relearn and unlearn information during FTO.

With this, how can EMT schools better prepare students for real world scenarios and information? Is it just due to antiquated standards? Perhaps more ride alongs would help the student have a better grasp on practical application of the information learned? And do you believe there is an issue with how these schools are teaching this curriculum?

I’m not bashing on any school in particular, but this sentiment appears common among my peers and others I’ve encountered.
 

NPO

Forum Deputy Chief
1,831
897
113
There are a causes behind what you're explaining.

The most common reason for "The book says this, but do that" is instructors who were taught one thing but now the education teaches something different. It can be hard for instructors to stay updated, and even harder for them to change their own practice as evidence changes. In reality there are very few examples of learn this but do that If the material is well understood and taught in a good fashion.

Another complication that sometimes leads to this, is the fact that every EMS system is different but they are all working off of the same national standard. That national standard very rarely meets the needs of every system. For example in my local system we have three large providers which all operate very differently with very different clinical standards. The agency I works at is very off the board as far as clinical operations when compared to what the national registry teaches.

Usually if things are taught as a concept rather than a task students have a better idea of how to critically apply what they are learning and small adaptations to differences are easy to overcome.
 
OP
OP
Virgil

Virgil

Forum Crew Member
94
16
8
There are a causes behind what you're explaining.

The most common reason for "The book says this, but do that" is instructors who were taught one thing but now the education teaches something different. It can be hard for instructors to stay updated, and even harder for them to change their own practice as evidence changes. In reality there are very few examples of learn this but do that If the material is well understood and taught in a good fashion.

Another complication that sometimes leads to this, is the fact that every EMS system is different but they are all working off of the same national standard. That national standard very rarely meets the needs of every system. For example in my local system we have three large providers which all operate very differently with very different clinical standards. The agency I works at is very off the board as far as clinical operations when compared to what the national registry teaches.

Usually if things are taught as a concept rather than a task students have a better idea of how to critically apply what they are learning and small adaptations to differences are easy to overcome.

That makes a ton of sense, I never really considered the issue of National standards vs individual State, County, and Agency needs. I wonder where this is education will go in the next 5, 10, or 20 years. I’m sure there are plans for streamlining this, but I can definitely understand the struggle of keeping updated on the ever changing pre-hospital standards and compliance.

I’ve also heard of some EMT schools also conducting clinical rotations? Which is interesting, and I wonder the types of benefits those students are seeing from that.
 

NPO

Forum Deputy Chief
1,831
897
113
Did your school not do clinical rotations?

Typically EMT schools will include 24 or 48 hours in the ER and more or less the same amount of time on an ambulance.
 

CCCSD

Forum Deputy Chief
1,756
1,081
113
I did my first EMT school in 1979. There isn’t much reason todo more, since you can’t do anything in the ER, beyond VS.
 

akflightmedic

Forum Deputy Chief
3,891
2,564
113
I did my first EMT school in 1979. There isn’t much reason todo more, since you can’t do anything in the ER, beyond VS.

Do you even realize how wrong you are?

Your comments and dated thinking lend credence to the earlier post about instructors not staying current or getting locked into one perspective.
 

ffemt8978

Forum Vice-Principal
Community Leader
11,024
1,472
113
Usually if things are taught as a concept rather than a task students have a better idea of how to critically apply what they are learning and small adaptations to differences are easy to overcome.
Education is learning the rules, experience is learning the exceptions. Trainers are teaching from experience, but schools are teaching from the standards. Most schools basically end up teaching the bare minimum for their students to pass the test because it is easier, faster and more profitable to do it that way.
 

Tigger

Dodges Pucks
Community Leader
7,844
2,794
113
I did my first EMT school in 1979. There isn’t much reason todo more, since you can’t do anything in the ER, beyond VS.
Splinting, wound care, history gathering, physical assessments, CPR, BVM use, oxygen application, EKG acquisition, and IV equipment setup are EMT skills done in the ED. But yea, just vitals.
 

FiremanMike

Just a dude
1,129
696
113
The problem with clinicals (field and hospital) is quality, not quantity. There is so much variation in experience based on who you get as your preceptor.

Modern hospital clinicals have the added problem of so many students and so little acuity. EMT students, medic students, RN students, NP/PA students, medical students, residents, and on and on.. All fighting for the chance to perform XXX skill on the small number of actual sick/injured patients that come through the ED..
 

E tank

Caution: Paralyzing Agent
1,572
1,422
113
EMT school is just an orientation to the actual training which is on the job after certification.
 

DrParasite

The fire extinguisher is not just for show
6,196
2,052
113
Splinting, wound care, history gathering, physical assessments, CPR, BVM use, oxygen application, EKG acquisition, and IV equipment setup are EMT skills done in the ED. But yea, just vitals.
I did my "clinical time" in an ER as well, but in 1999 it was either 16 or 24 hours, and I can honestly say it was the biggest waste of my time. I didn't do any of those things. maybe my ER was just too slow, or my preceptor wasn't interested. to be honest, I don't remember much of it, but I did get a lot of reading done during those 12 hours. medic clinicals were better because I could do more skills, but even that wasn't super realistic, because the nurse preceptor I was assigned to asked different questions that weren't asked in EMS.

As for the original questions, much of the EMT class revolves around getting the student to pass the NREMT or state final exam. independent and critical thinking isn't stressed. complicated patient presentations are rarely used. and the clinical standards used in class don't always match up to the local agency's clinical standards. And this doesn't even factor in instructors who have an EMT card, a HS diploma, and an instructor certification, and only cover what is in the books. Not only that but if an instructor has too many students who fail, they will often get fired, because their employers want high graduation numbers because it brings in more money. Kinda kills the motivation to do more and teach above the minimum standards...

Although, I will say that there is often a disconnect between classroom learning and "the real world." this is evident in fire academies and a probie's first year, an EMS academy and the new hires FTO time, as well as in LEO academy and their FTO time. Part of the issue is FTOs are operating off of experience, not off what is taught in class, FTOs don't know what was taught in class and as such, they are just doing their own thing, and every FTO has a different way of doing things. I know this might shock everyone here, but just because something is done in the field, doesn't mean it is the clinically correct way to do something, especially if they had to explain their actions to their agency director, the media, or a jury.

The last thing I will say is many EMT programs don't prepare students for the roles they will be performing. In many parts of the country, an EMT is simply a paramedic assistant, while the EMT program is supposed to prepare them to be a provider in charge of a crew. So you take an EMT student, who has been preparing to be in charge of a crew, be able to make treatment decisions, perform assessments and patient care decisions based on what they have studied (and yes, the clinical education is lacking, we won't disagree), and you put them on an ALS truck, where they mostly do what the paramedic says, drives the truck, and lets the paramedic do most of the thinking for them... well you see where the conflict can occur. I'm a horrible paramedic assistant. but I'm a decent provider; which is why I prefer to be on the BRT, where my captain lets me take the lead and make decisions, vs always waiting to see what the ambulance paramedic wants to do.
 

Peak

ED/Prehospital Registered Nurse
1,023
604
113
One of the challenges of clinical is that you really cannot evaluate a student and make a good clinical education plan during just a few clinical hours/days or when they are put with a different preceptor every time. Instead what you end up with is 1-2 days of essentially shadowing and maybe practicing a small number of skills.

Specifically in regards to hospital based clinical it is very challenging to set up a good learning experience. Most ED EMTs and Medics are used for tasking and the student isn’t going to get a real idea of the clinical picture. Alternatively if they are placed with a nurse then they are often learning more about prioritizing an ED patient load rather than EMS assessments. When possible we try to place these students with nurses who have prior EMS experience, but often for us these nurses are assigned the most critical patients so while students will get to see a sick patient, they are also seeing care that is not very reflective of the prehospital environment.
 

NomadicMedic

I know a guy who knows a guy.
12,097
6,845
113
My full-time job is as an EMS educator and I teach a recruit style EMT academy several times a year. We no longer require any hospital clinical time. As many others have said, it’s a total waste of time for the students.

Our program is unique, as it’s totally designed to build EMTs that will function in our system. We teach them the national curriculum, But customize the educational process for our agency. My recruits learn exactly how we chart. How we process patient refusals. How we expect crewmembers to function on calls. The exact location of our equipment. It really gets them ready to function well, and we can usually clear them through the orientation program in 6 to 10 shifts.

I understand that not everyone is able to teach this type of program, but having a recruit every day allows you to quickly build upon yesterday’s lessons It’s amazing to watch students who in their first week couldn’t take a blood pressure, managing complex scenarios in the last week of recruit school.

The biggest disappointment for me is being forced to teach the national registry skill sheets for patient assessment and the like. I feel that the linear process that we teach in EMT programs does a disservice to students until they’ve gathered enough experience to make the connection that assessments are done holistically rather than in a stepwise fashion.
 

Trauma Cop

Forum Probie
29
6
3
Having racially went through EMT school, I would have to say I totally agree with you. I learned more in my 30 hours ride time than I did 4 months in a classroom. This was no fault of the instructor. I think anytime you're learning curriculum out of a book, you are failing to take into account a lot of the real world problems that you will encounter. As my username applies, I was a cop for a long time and I think that the police academy does a better job than an EMT course does when it comes to preparing students for the real world. EMT was a lot of practicing certain skills without a lot of explanation behind when these skills were needed. We were simply practicing them because we would be tested on them.There was not a lot of scenario-based training in the EMT course and as a result, I think a lot of students were left knowing how to do certain skills and knowing different numbers such as suction times, breath rates etc. However, they were not sure how to apply these under stress or with variables added. It's very sad too because with a classroom full of students, you have a number of patients at your disposal that you can practice scenarios with. However, we did that very little in the course that I attended.
 
Top