Why??

[armywifeemt]

So.. I've been thinking a lot lately. Dangerous, right?

I think I've figured out what separates a good instructor in this field from a poor one - at least as far as I am concerned.

I've seen a lot of mentions on this forum about cookbook EMS. I despise cookbook EMS. You sit down in a class and an instructor gives you a list of symptoms and how you treat them. You drill it into your head, memorize those steps, and then you get out into the field and every situation is different..

I've been to a few seminars.. I've taken one refresher EMT class at this point.. I've been to drills, and discussed things with people in the various departments I volunteer for/have volunteered for. No, I am not an expert.. not even close. I have far less experience in this field than many.

Despite this, I am firmly grounded in logic, and I think I am pretty good at reasoning things out. I think the answer to the question, "Why?" is the key to all of it.

I've seen the cookbook problem/solution method of instruction. It leaves me wanting. It is harder to memorize than it is to learn. It is more of a pain to try to recall what an instructor said verbatim than it is to recall cause and effect.

When an instructor explains why the symptoms present themselves the way they do, it is easier to remember. When you get the, "Why?" it is fascinating... the body is amazing.. the way it adjusts and compensates for trauma and illness is nothing short of miraculous at times.

I think we would see a lot of progress in EMS if more instructors focused on why the body does the things it does. I've been lucky enough to have a lot of classes in which this was commonplace. I think it has made me more capable... I'd just like to see more of it.

Thoughts, folks?

 

[NomadicMedic]

If you're an EMT, you're simply a victim of how the Basic program and curriculum was designed. It was never meant to teach you the "why", it was simply created to teach you "how" to fix problems. (Apparently, the new standards will be teaching a bit more of the patho/phys but don't expect anything more than an 8th grade anatomy lesson.)

Now, if you're frustrated, and want to learn why things in the body happen the way they do, you'll need a solid science background. At very minimum, you'll need to start with Bio, Chemistry and then a college level A&P series. The Bio and the Chem classes will provide a foundation to build upon when you take that A&P series.

When you move to the Paramedic level, you'll find that Pathophysiology plays a huge role in developing your treatment plan. Cause and effect coupled with knowledge of risk vs. benefit will drive your medicine.

 

[mgr22]

The problem, I think, is that most EMS instructors went through the same curriculum as the rest of us and, therefore, don't know the "whys." You'd probably learn more by looking-up the information you seek, or finding a doc who doesn't mind answering questions.

 

[Veneficus]

Now Grasshopper you are ready...

Just to echo what was said earlier. Most instructors are simply regurgitating to you what they were taught. They memorized it so well they can now spout it flawlessly.

Sometimes you encounter a truly dangerous one who saw or heard something or understands a small part and thinks it is globally applicable. We have a discussion here not long ago about an instructor teaching people how to acutely reverse beta blockers and suggestng its use as an adjunct or alternative for conditions other than an overdose.

Perhaps 90% of the instructors I know would love to teach why, and they actually know. But there are constraints like the time devoted to the curriculum. Even worse, the more you learn why, the more foolish the cookbook looks. Since a student must pass the test based on the cookbook, if you teach too much why, you must constantly remind them what to answer on the test. It is very frustrating both as a instructor and student. "know this for real life, know this for the test." It can quickly turn into information overload and students mix it all together and then get a lot of nothing.

Even when you go to a medic mill, the curriculum is based on a sophmore level college class. So without a strong science background in Biology, General chemistry, and A&P many students cannot connect the dots of the brief outlines of the topics in the text like PH, cell biology, etc.

But the political powers that be (not for discussion here) have lobbied long and hard to make sure those subjects were not required prerequisites. So it is up to the student to do it on their own. Before is better than after.

The whole system works because you are taught to take a standardized test. In 9 months I could teach an immigrant janitor with English as a second language to take the USMLE, but I could not teach him about medicine. In 6 weeks, you can be taught to take the National Registry of EMT paramedic test. in only 120 hours the EMT B test. But you are none the wiser about why either.

I hope you will take this newfound insight, and pursue some education on your own. But no matter what, never ever stop asking "why." I know in EMS that is easier said than done, people resist challenges and change.

 

[MrBrown]

If nothing else the "hows" and "whys" are the most important part; you take somebody with a good understanding of anatomy, physiology and pharmacology give them a little dexterious skill proficency and they turn into me!

You can teach anybody to be a "Technician" but you are not teaching them to be a "Clinician" as the two are totally different. I am not interested in teaching people to become "Ambulance Technicians", have somebody else show them how to nebulise some salbutamol, I want to create "Ambulance Clinicians" by pulling out the whiteboard and discuss respiratory physiology, gas exchange and asthma.

A good sound working knowledge of A&P and pharmacology is the best tool in your magic box. I have gone to jobs and been told "oh I have this" or about what the doctor said lil' Johnny had and although I may not understand it to the same level as the physician in my mind the blocks are all being joined up; I can mentally go "ah ha!" and it is really like being through the looking glass.

Up until 2007 New Zealand had a base qualification called the National Certificate in Ambulance which was at what you would call junior year of college level. It covered a good dose of A&P and patho although not in great detail it was still fairly comprehensive.

An Officer on National Certificate was expected to do six months of pre-class assignments around A&P and patho (cells, tissues, organ structure, cardiovascular, respiratory, nervous etc) then do 20 days in class to gain more knowledge plus competence at the practical skills at the "Ambulance Officer" level which included GTN, IM Glucagon, salbutamol and the laryngeal mask airway.

Moving above this level to the "Paramedic" (IV/Cardiac) scope you again had a large number of assignments around fluid homeostasis, cardiac anatomy and physiology, renin angiotension aldosterone, cardiac medications eg beta blockers, diabetes etc. I have some of the old 2008 and 2009 assignments for the Paramedic course and am really impressed with the level of knowledge required.

Unfortunately since 2007 there have been significant changes to the National Certificate program which from what I understand have largely come about to "dumb it down" to a level that volunteer officers can achieve. I should point out that there have been a number of positive improvements such as the algamation of four different courses into one qualification and a new focus on simulation and understanding research.

This new qualification entitled the "National Diploma in Ambulance Practice" is a misreprentation of the word "Practice" and the title of Officers achieve it has since been altered from "Ambulance Officer" to "Ambulance Technician".

Unlike the old National Certificate with the new Diploma there is no six months doing pre class assignments around cells, tissues and organs instead cells, tissues and body structure (atoms, cells, tissues, organs and so on) has been removed and what knowledge is left is all intergrated into the coursework. While there is still a level of knowledge that is being taught it is heavily slated towards cardiac and respiratory. Some of the knowledge is quite good (such as cardiac and respiratory) while other information is glossed over or simply not present.

Don't bother asking a Diploma-only Ambulance Technician about how renin and angiotensin work because they won't know. Don't ask them how glucagon works because they are taught it reverses hypoglycaemia and not a lot else.

The National Certificate was hard[er] and it often took people a year to complete all the assignments and class work. Now you can be a "Technician" in sixteen weeks part-time.

It seems New Zealand is creating a disparity between it's bottom level (Technician) and the two other levels (Paramedic and Intensive Care Paramedic) who go to University full time and learn the proper micro-level sciences and pharmacology and end up with at least a Bachelors Degree.

But it is OK because that the information that is lost in that disparity is "not relevant when crewing an ambulance". Or so they say.

 

[adamjh3]

That's one of the things I really like about my school, all of the instructors (for the Basic curicculum) are full time medics, working in the field, and all but one of them has their stuff absolutely dialed.

They're always there before class, and are always more than willing to stay late to work with you.

That is one of the things that's been bugging me in the Basic role, not being taught the why behind the how. For example, when we went over CHF, 20 second lecture "Fluid backs up in the legs if the right side isn't working right, and it backs up in the lungs if the left side isn't working right."

So the students are going to go out in the field, see someone with swollen legs and just straight off the bad say oh, it's CHF. When it could be DVT, Stasis Dermatitis, varicose veins, etc, etc.

I'm not exactly sure what point I was trying to make with this, other than I think basics are going into the field completely under-prepared.

 

[MrBrown]

That's also something I really dislike this whole "ambo's teaching ambos" thing.

If you want to teach you should at least have a Masters or higher so you are not doing the "see, do, teach" act.

 

[Veneficus]

That's one of the things I really like about my school, all of the instructors (for the Basic curicculum) are full time medics, working in the field,.

So what? Do you think because I am not a full time medic that I am somehow lesser qualified?

Do you think full time educators are lesser qualified?

One of the biggest things that hold EMS back is the laborer mentality. It should be removed by inqusition.

Do they have any formal education in adult education?

and all but one of them has their stuff absolutely dialed.

How do you know? Have you sat in other programs to compare?

Last summer we hired a full time medic who stood in front of the class and said the other instructors were wrong, that an MI requires O2 by non rebreaather always. (I should add he is no longer employed by the institution) Perhaps many of his coworkers think he is really dialed in? He clearly thought we were dialed out enough to make a point to directly contradict what he felt we were teaching wrong in front of the whole class.

Some of the best teachers I have had I didn't recognize at the time. I thought they were way out in left field when I in their class, but they have been absolutely paramount to my continued success.

 

[adamjh3]

So what? Do you think because I am not a full time medic that I am somehow lesser qualified?

Do you think full time educators are lesser qualified?

One of the biggest things that hold EMS back is the laborer mentality. It should be removed by inqusition.

Do they have any formal education in adult education?





How do you know? Have you sat in other programs to compare?

Last summer we hired a full time medic who stood in front of the class and said the other instructors were wrong, that an MI requires O2 by non rebreaather always. (I should add he is no longer employed by the institution) Perhaps many of his coworkers think he is really dialed in? He clearly thought we were dialed out enough to make a point to directly contradict what he felt we were teaching wrong in front of the whole class.

Some of the best teachers I have had I didn't recognize at the time. I thought they were way out in left field when I in their class, but they have been absolutely paramount to my continued success.

No, no, sir, I do not believe you or any other instructor who is not active in the field is any less qualified. I would like to retract my statement regarding that matter. I didn't think that one through. I apologize.

I know two of them have taught at community colleges, I would assume to work there you would have to have training in adult education. I do not know for sure, though.

And yes, I did sit in with one of my buddies at one of the local community college's Basic course. The instructor was bland, spoke in monotone, and didn't do much for class involvement. But again, that was one class, it could have been an off day for him, and it is inappropriate for me to render judgement.

 

[xgpt]

So.. I've been thinking a lot lately. Dangerous, right?

Just don't hurt yourself, and please sit down if you think you're getting a little woozy!

If you're an EMT, you're simply a victim of how the Basic program and curriculum was designed. It was never meant to teach you the "why", it was simply created to teach you "how" to fix problems. (Apparently, the new standards will be teaching a bit more of the patho/phys but don't expect anything more than an 8th grade anatomy lesson.)

I don't even know if it teaches you the how to fix problems. EMT-B is so simplistic it's just getting them to the hospital without killing them. No fixing, just not-killing.

 

[armywifeemt]

just [/I]getting them to the hospital without killing them. No fixing, just not-killing.

Eh, it's more like first aid on steroids with (most of the time) better equipment.

An EMT can do a little bit of fixing. Traction splinting sure seems like fixing to the patients. People die really fast when they have large amounts of uncontrolled bleeding, too. I think it's something about blood carrying all the things that are necessary to sustain life...

As a side note, I have taken a couple of college level science classes - physics and chemistry - so perhaps that is why I feel like EMS education leaves me wanting.

 

[Veneficus]

Eh, it's more like first aid on steroids with (most of the time) better equipment.

An EMT can do a little bit of fixing. Traction splinting sure seems like fixing to the patients. People die really fast when they have large amounts of uncontrolled bleeding, too. I think it's something about blood carrying all the things that are necessary to sustain life...

As a side note, I have taken a couple of college level science classes - physics and chemistry - so perhaps that is why I feel like EMS education leaves me wanting.

With 2 physical science classes, you are well on your way to a more advanced healthcare degree. Now just do Biology, organic chemistry, and apply to med school.

 

[armywifeemt]

Ha! If I wanted to be a doctor, I'd be in med school right now.

It was always my dream as a little girl... but then I grew up and realized there were other things I could do that would make me much happier, and require a much smaller investment of time and money. My mom always wanted me to become a doctor or a lawyer, but personally I don't think I'm nearly enough of a workaholic for either of those careers.

 

[Veneficus]

Ha! If I wanted to be a doctor, I'd be in med school right now.

It was always my dream as a little girl... but then I grew up and realized there were other things I could do that would make me much happier, and require a much smaller investment of time and money. My mom always wanted me to become a doctor or a lawyer, but personally I don't think I'm nearly enough of a workaholic for either of those careers.

Strangely enough, I never said I wanted to be a doctor. But here I am in med school.

I started out wanting to be a fireman. But I achieved that so quickly I guess I have just been steadily moving on in pursuit of doing more for patients today than yesterday. I really loved rescue and truckie work. Couldn't stand hose jockying.