Trial By Fire-- Medical students doing EMT school

[Shishkabob]

http://healthland.time.com/2011/07/22/trial-by-fire-training-medical-school-grads-as-emts/

UCSF's Dr. Cooke notes that working as an EMT far outstrips passive shadowing of doctors, which can be not only boring, but fairly useless. "The student is actually providing a service. Patients being attended to by EMTs by definition need help and, while EMTs cannot provide more than limited medical interventions, in the settings in which they work, they actually are more capable than physicians, as any honest doctor who has stopped at an accident scene will tell you," says Cooke.

Long story short, medical students at this school are being required to get certified as an EMT, and do multiple ride-outs on ambulances in the first 2 years.

 

[Pneumothorax]

I think that's great. Perhaps as MD's they will be more compassionate to their EMS counterparts.
=]

 

[silver]

Thats pretty cool. Its interesting to see how all these newer medical schools are trying non-traditional methods.

There was a NY Times article about what they call MMI, multiple mini interviews. same idea about having people skills, but entirely different approach.

http://www.nytimes.com/2011/07/11/h...0374847-1WYtn Ju4/ax/xMxGo Skw&pagewanted=all

 

[Sasha]

I think thats ridiculous.

Sent from LuLu using Tapatalk

 

[JPINFV]

Waste of time, especially for all of the medical students who don't want to go into EM, and a gimmick for their stated purpose.

 

[medicdan]

I think if nothing else it's interesting exposure to the problems of the healthcare system-- and a great primer on Medicare and Medicaid...

 

[JPINFV]

I think if nothing else it's interesting exposure to the problems of the healthcare system-- and a great primer on Medicare and Medicaid...

Past Physician Declarations of Necessities, what does the -average- EMT know about Medicade and Medicare? Additionally, how much time are they actually going to work in a month once they are licensed, and given that this is NJ and that they will probably be working for a volunteer service, exactly how large do you think their call volume is going to be?



""Our students will be taught the cellular basis, how they develop thrombi or acute plaque within the coronary vessels, as opposed to just learning the terms,"

Umm, shouldn't you be doing that anyways in the entire "medical school" portion of your EMT/MD program?

 

[MrBrown]

Waste of time, Brown thinks a PGY1 House Officer is required to do ONE 12 hour shift with Ambulance here

 

[DrParasite]

Additionally, how much time are they actually going to work in a month once they are licensed, and given that this is NJ and that they will probably be working for a volunteer service, exactly how large do you think their call volume is going to be?

#1, it's NYC and Long Island not NJ. #2. in NJ, in an 8 hours shift, you can do as many as 6 calls in 8 hours, depending on which volunteer agency you are with. The busiest paid city agency in NJ I am aware of goes between 12 and 20 jobs during a 12 hour shift per unit. Pretty busy if you ask me. but NY is not as busy (per ambulance and per agency) as NJ.

and as for the overall concept, I think it's a GREAT IDEA. Having a newly graduated MD have to go through the EMT program will show them exactly how limited the education of EMTs are. Putting said newly certified MD and EMT on an ambulance will force them to experience what it's like to operate out of a hospital, with limited diagnostic equipment, with limited light, space and/or manpower. EM docs would probably gain the most, but even other MDs will get to experience some of the issues that occur in the prehospital environment, and what little you can do with limited resources.

 

[JPINFV]

#1, it's NYC and Long Island not NJ. #2. in NJ, in an 8 hours shift, you can do as many as 6 calls in 8 hours, depending on which volunteer agency you are with. The busiest paid city agency in NJ I am aware of goes between 12 and 20 jobs during a 12 hour shift per unit. Pretty busy if you ask me. but NY is not as busy (per ambulance and per agency) as NJ.

Opps.. NY. My bad. However, do you really think that they are going to be put on with a paid service? How much is the school going to be willing to pay the ambulance company to put up with the headaches of a third rider.

and as for the overall concept, I think it's a GREAT IDEA. Having a newly graduated MD have to go through the EMT program will show them exactly how limited the education of EMTs are. Putting said newly certified MD and EMT on an ambulance will force them to experience what it's like to operate out of a hospital, with limited diagnostic equipment, with limited light, space and/or manpower. EM docs would probably gain the most, but even other MDs will get to experience some of the issues that occur in the prehospital environment, and what little you can do with limited resources.

...except we aren't talking about putting new grads on an ambulance. We're talking about putting 1st and 2nd year (presumably) students on an ambulance. More importantly, if I'm going into, say, radiology, why should I care what takes place on an ambulance? Only a tiny fraction of a percent of my patients are going to need an ambulance for anything more than a horizontal taxi ride, and even that percent the limited diagnostic equipment is relatively irrelevant because my overall expectation would be for you to deliver my patient to an emergency department. Why should I care about the limited diagnostic capabilities if I'm looking for transport? Furthermore, outside of either idiots who refuse to move their patient to a larger room (you [generic "you"] really don't need to run a code in a narrow hallway, sometimes a small delay in compressions is less important than the efficiency gained) or things like trench rescues, there ultimately is little difference between prehospital space and hospital space. In the end, there's only so much space around a gurney.

 

[Shishkabob]

More importantly, if I'm going into, say, radiology, why should I care what takes place on an ambulance?

Ummm...


Why should a Paramedic care what goes on in a cath lab?
Why should a nurse that's going to work in Ob/Gyn care what happens in radioactive medicine?
Why should a Doctor that wants to do family medicine ever step foot in anything but a family clinic?

How is this any different than requiring clinical time in different parts of a hospital to get exposure and see how things are done, so you can better understand medicine in general?




For someone who always advocates further education and experiences, I'm surprised you're against this. It's not like they hide it from their students.



A huge part of contention in medicine is one part not knowing / understanding what another part does. Nurses and medics, nurses and RTs, nursing home and ER, etc etc.

 

[silver]

Opps.. NY. My bad. However, do you really think that they are going to be put on with a paid service? How much is the school going to be willing to pay the ambulance company to put up with the headaches of a third rider.

In NY many large academic centers have their own ambulance services. North Shore-LIJ, their university hospital, has a pretty large one.

 

[JPINFV]

Ummm...


Why should a Paramedic care what goes on in a cath lab?

MIs, just as the emergency physician should care what goes on in a cath lab. How many paramedics rotate through physical therapy and work with a PM&R doc?

Why should a nurse that's going to work in Ob/Gyn care what happens in radioactive medicine?

Teratogenicity...

Why should a Doctor that wants to do family medicine ever step foot in anything but a family clinic?

Things like post op, etc. A family physician, much like emergency physicians are going to treat a little bit of everything. Are we comparing the range of what a physician is expected to treat to a paramedic? Continuity of care from the provider standpoint is an issue prehospital providers generally do not have to deal with.

How is this any different than requiring clinical time in different parts of a hospital to get exposure and see how things are done, so you can better understand medicine in general?

For someone who always advocates further education and experiences, I'm surprised you're against this. It's not like they hide it from their students.[/quote]

First, this isn't being argued as an important piece of clinical exposure, but what is essentially a team building exercise. As an exercise in team building, how is this anything other than a gimmick?

Second, many emergency medicine clerkships require ambulance ride time anyways.

Third, how is training someone to be a physician, then limiting what they can do with that knowledge to the level of an EMT supposed to be educational. "Yes, all of those things about reactive oxygen species and the like we taught you in biochem? Yea, ignore that, give a NRB to everyone since that's the standard you're going to be held to as an EMT. Yea, we just taught you about decompressing chests for tension pneumos, but you can't do that either because you can't operate as a physician while on the ambulance." How is that educational again?

A huge part of contention in medicine is one part not knowing / understanding what another part does. Nurses and medics, nurses and RTs, nursing home and ER, etc etc.

...yet if we forced physicians to rotate through every specialty we'd have to add on another year to the curriculum, at least.

 

[Shishkabob]

MIs, just as the emergency physician should care what goes on in a cath lab.

So a doctor shouldn't care what is done in an ambulance BEFORE they touch a patient, but Paramedics should care what happens in a cath lab AFTER the release the patient?


(PS, I loved my time in the cath lab)

 

[medicdan]

Past Physician Declarations of Necessities, what does the -average- EMT know about Medicade and Medicare?

I think seeing the scope of medication and therapy non-compliance in the wild, or incompetence of SNFs, or what a patient looks like when they're not on a clean, variable height bed.

 

[JPINFV]

So a doctor shouldn't care what is done in an ambulance BEFORE they touch a patient, but Paramedics should care what happens in a cath lab AFTER the release the patient?


(PS, I loved my time in the cath lab)

Outside of ambulances going to emergency departments and critical care transports, how much care is actually provided on ambulances? Most physicians are not going to be on the receiving end of an emergency ambulance transport.

 

[Aprz]

I may be extrapolating too much, but I hope this program will help EMS. It would be lovely if an EMT program could mimic the same educational standards e.g. talk about it at the molecular level. I am doubtful though.

I agree with JPINFV, if they are taught to perform algorithms that EMTs are typically taught then this will be a waste of their time.

In the caption of image, it says they'll be doing it with North Shore Ambulance in New York. The students will be discounted at the school for their time spent on the ambulance.

As an added perk for being guinea pigs, students in the inaugural class (who range in age from 21 to 36 years old) will receive a $20,000 discount on the estimated $69,494 cost of attendance each year.

 

[JPINFV]

I think seeing the scope of medication and therapy non-compliance in the wild, or incompetence of SNFs, or what a patient looks like when they're not on a clean, variable height bed.

...because non-compliance doesn't make it's way to clinics, or do they magically become compliant when they do go and see a physician? Similarly, do you not think that physicians are exposed to SNFs, especially physicians involved with primary care? Finally, does it really make that big of deal if a physician who only sees patients on clean, variable height beds knows what a patient looks like when they are not on a clean, variable height bed? Sorry, but that last one feels like sour grapes more than anything else (I'm waiting for the "and take a blood pressure while going 80 mph down a side street with the lights and sirens on and being thrown into the wall of the ambulance").

Actually, let's take that one further. We should require all medical students to rotate through combat units in Iraq and Afghanistan so that they know what it's like to take care of a patient on the dirty with bullets whizzing by their head!

 

[Shishkabob]

Actually, let's take that one further. We should require all medical students to rotate through combat units in Iraq and Afghanistan so that they know what it's like to take care of a patient on the dirty with bullets whizzing by their head!

No need, just send them to DC or Detroit.

 

[JPINFV]

I may be extrapolating too much, but I hope this program will help EMS. It would be lovely if an EMT program could mimic the same educational standards e.g. talk about it at the molecular level. I am doubtful though.

Something else to consider. If they are placed on ambulances with a non-standard EMS education are they going to be led to suspect that that is what normal EMS education is held to IN ADDITION TO holding their partner to that level? Think it's bad enough when physicians don't know what the education standards are like, imagine what it's going to be like when they have a legitimate claim to believe that the education standards are far more stringent than they actually are.