# Medics: Do you ever feel... under-educated?



## Genaio (Oct 1, 2012)

So I've been lurking on these forums for a while, but haven't posted much, so I guess this is my first real post. 

This is more directed towards Paramedics, but I'm sure some EMT-I's might have some insights as well. 

I've been a medic for about a year and a half and lately I've been getting this strange feeling like I'm horribly under-educated WRT understanding why we do what we do.  Do any of you feel that your education as a Medic was sub-par?  I mean I know the medic material pretty well, I passed the NREMT exam and practical with no problems and I'm confident in my skills for the most part, but I can't help but feel that I don't know as much as I should about advanced medical concepts (pathophys, bio, the _science_ behind it all).  I do work in the ER of a L1 trauma center, and I'm constantly surrounded by doctors, residents and CCRNs, so that may alter my perceptions of what I think I should know, but I do feel uneasy about it.  :unsure:

Anyone else feel like this?  Is this something that goes away with more experience?  Any non-US medics have anything to say about it? 

Thanks to anyone who answers.


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## shfd739 (Oct 1, 2012)

I think youre correct.

Most medic training is skills oriented- see this then do this. Hence the technician part.


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## Veneficus (Oct 1, 2012)

Genaio said:


> I've been a medic for about a year and a half and lately I've been getting this strange feeling like I'm horribly under-educated WRT understanding why we do what we do.  Do any of you feel that your education as a Medic was sub-par?  I mean I know the medic material pretty well, I passed the NREMT exam and practical with no problems and I'm confident in my skills for the most part, but I can't help but feel that I don't know as much as I should about advanced medical concepts (pathophys, bio, the _science_ behind it all).  I do work in the ER of a L1 trauma center, and I'm constantly surrounded by doctors, residents and CCRNs, so that may alter my perceptions of what I think I should know, but I do feel uneasy about it.  :unsure:
> 
> Anyone else feel like this?  Is this something that goes away with more experience?  Any non-US medics have anything to say about it?
> 
> Thanks to anyone who answers.



I think you have discovered the obviousness of the truth.

Medics are not properly educated in the US. It is done this way by design. 

It was and is meant to be a tech level position that basically uses If:then statements in order to provide emergent intervention.

Many people, including myself attempt to elevate medics out of this level, but unfortunately there is a lot of resistance to bettering the medic into a profession. 

I have spent more hours in gross anatomy than entire hours in my home state's paramedic program. 

I have more than doubled the hours of those same programs studying 3 or 4 specific diseases.

More than triple those hours on the disease process that is the focus of my attention. 

Most motivated medics when they discover this and desire more move on to nursing, medicine, etc.

From the nature of your post, I suspect you will be looking into that shortly.


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## NYMedic828 (Oct 1, 2012)

Every day.

But I don't feel I am undereducated, I know I am. As such, I will be moving on to nursing or PA in the coming years. There is no hope for me here.


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## NomadicMedic (Oct 1, 2012)

Yes. Everyday, but I take steps to increase my knowledge every day. 

When you stop learning is when you stop growing.


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## TransportJockey (Oct 1, 2012)

n7lxi said:


> Yes. Everyday, but I take steps to increase my knowledge every day.
> 
> When you stop learning is when you stop growing.



This. You can never stop learning


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## fast65 (Oct 1, 2012)

As others have said, I know I am under educated...it's not a great feeling in all honesty. 

That being said, the only reason I've considered nursing, is because I want to further my knowledge, and I seem to have a problem furthering my knowledge on my own in an organized fashion. However, that hasn't stopped me from trying.


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## 7887firemedic (Oct 1, 2012)

All the time! To be honest I study twice as much since becoming a Medic then I did during Medic school


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## Veneficus (Oct 1, 2012)

7887firemedic said:


> All the time! To be honest I study twice as much since becoming a Medic then I did during Medic school



Then you should probably enroll in some classes and get some formal credit for your efforts.


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## ParamedicCharlie (Oct 1, 2012)

Understand that we all start somewhere, an your urn for knowledge will take you far. I as many of my peers an colleagues have and will continue to further educate themselves. Don't ever stop, don't stop for anything or anyone, as others have posted, you will meet resistance from others who so not wish to further stimulate there medical practice. 

You are on the right path never give up never stop learning. 

A mental tool, mantra,  I use is "every patent is family". And if you were providing care to your family, wouldn't you want to know every single aspect of there care. From start to finish. 

You are doing great... All of you! (I mean look at you all, on a EMS forum on your off time) 

Thanks 
Charlie
"Every patient is family"


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## 7887firemedic (Oct 1, 2012)

Veneficus said:


> Then you should probably enroll in some classes and get some formal credit for your efforts.



Not much in my area in terms of formal ed and that cost$ to which I am not blessed. I am looking for pals,nals,phtls, and ccemtp that are close to me and affordable.


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## VFlutter (Oct 1, 2012)

7887firemedic said:


> Not much in my area in terms of formal ed and that cost$ to which I am not blessed. I am looking for pals,nals,phtls, and ccemtp that are close to me and affordable.




And that is the problem with paramedic eduction. Cookbook certification classes are in no way an alternative for actual college level education.


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## 7887firemedic (Oct 1, 2012)

ChaseZ33 said:


> And that is the problem with paramedic eduction. Cookbook certification classes are in no way an alternative for actual college level education.



I agree 100% I would love to be able to take formal ed in EMS disciplines i.e. cardiology, pathophysiology, etc.. Yes those topics were in my medic study but limited. For example 12 leads were 3 pages in cardiology, whereas I had taken it upon myself to dive deeper than st elavation and depression i.e. axis deviations, hyperacute t waves, nutrient and mineral balances etc... Knowledge is power and thats what helps me, help my patients. I will continue studying and learning until they pry my cold dead hands from my lifepak and drug bag lol


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## NYMedic828 (Oct 1, 2012)

7887firemedic said:


> I agree 100% I would love to be able to take formal ed in EMS disciplines i.e. cardiology, pathophysiology, etc.. Yes those topics were in my medic study but limited. For example 12 leads were 3 pages in cardiology, whereas I had taken it upon myself to dive deeper than st elavation and depression i.e. axis deviations, hyperacute t waves, nutrient and mineral balances etc... Knowledge is power and thats what helps me, help my patients. I will continue studying and learning until they pry my cold dead hands from my lifepak and drug bag lol



Vene and Chase weren't referring to education in EMS disciplines. They were referring to higher respected titles with better wages and future for you and your family.

Certain things can't be learned on your own and quite honestly it is a waste of time at some point in EMS. You can get all the certifications in the world but you won't be any more desirable than the other guy who is willing to work for $1/hour less than you are. It's all for nothing. In every other profession in healthcare, going the extra mile can be beneficial but not in EMS.

I self educate because it makes me feel good and leads me down a different path in my quest for knowledge and prepares me for my return to school in a different discipline altogether. But that effort won't take me anywhere in EMS.


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## 7887firemedic (Oct 1, 2012)

NYMedic828 said:


> Vene and Chase weren't referring to education in EMS disciplines. They were referring to higher respected titles with better wages and future for you and your family.



Gotcha, in that case I am a Medic to Rn student however I feel its a shame that EMS has not evolved. EMS should be a career not just a stepping stone as it often is. I have no ambition to be stuck in a Hospital all shift, my desire is to be in the field be it ground or air. Here in lies the fork in the road, stay in ems and struggle or move into the hospital settings (monetarily speaking)


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## NYMedic828 (Oct 1, 2012)

7887firemedic said:


> Gotcha, in that case I am a Medic to Rn student however I feel its a shame that EMS has not evolved. EMS should be a career not just a stepping stone as it often is. I have no ambition to be stuck in a Hospital all shift, my desire is to be in the field be it ground or air. Here in lies the fork in the road, stay in ems and struggle or move into the hospital settings (monetarily speaking)



The sad reality is the that EMS is not going to change. History has proven that EMS is not willing to evolve to meet the needs of modern healthcare.

In the last 20 years medicine has grown more rapidly than ever expected possible in the past. EMS has hardly changed one bit aside from a few tools in the box. (That we aren't properly trained to use) 

The truth is unfortunate and we all wish it different but you can't let it hold you back from succeeding in life and making something more of yourself. People who expect to wait around in EMS hoping for change are going to be heavily disappointed when reality sets in.


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## Jambi (Oct 2, 2012)

7887firemedic said:


> Gotcha, in that case I am a Medic to Rn student however I feel its a shame that EMS has not evolved. EMS should be a career not just a stepping stone as it often is. I have no ambition to be stuck in a Hospital all shift, my desire is to be in the field be it ground or air. Here in lies the fork in the road, stay in ems and struggle or move into the hospital settings (monetarily speaking)



This is like this for all the reasons Vene and others have, and it will not change so long as those that realize this keep leaving the profession for those with better pay and recognition.  The catch is why should such people stay when the situation is what it currently is and the resistance to change is as strong as it is.    Change can happen, will eventually happen (I like to think), but it will not be fast, nor easy.  It's going to be real rough for those that decide they want to be first...


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## NYMedic828 (Oct 2, 2012)

Jambi said:


> This is like this for all the reasons Vene and others have, and it will not change so long as those that realize this keep leaving the profession for those with better pay and recognition.  The catch is why should such people stay when the situation is what it currently is and the resistance to change is as strong as it is.    Change can happen, will eventually happen (I like to think), but it will not be fast, nor easy.  It's going to be real rough for those that decide they want to be first...



Even if I wanted to stick around and wait and pray for change, I couldn't.

60,000 a year in NYC is not a livable wage.

How long can people be expected to sit around and wait for what may never come when it ultimately is effecting their immediate future and that of their some day family. I for one am not goin to essentially waste my time when I know it could effect the quality of life my children have down the line.


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## Jambi (Oct 2, 2012)

NYMedic828 said:


> Even if I wanted to stick around and wait and pray for change, I couldn't.
> 
> 60,000 a year in NYC is not a livable wage.
> 
> How long can people be expected to sit around and wait for what may never come when it ultimately is effecting their immediate future and that of their some day family. I for one am not goin to essentially waste my time when I know it could effect the quality of life my children have down the line.



The average medic out here in Cali makes about 30k before OT. It sucks

Your conclusion is essentially the same one I've come to, and why I've done classes to get into RN or PA school.


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## Veneficus (Oct 2, 2012)

Jambi said:


> This is like this for all the reasons Vene and others have, and it will not change so long as those that realize this keep leaving the profession for those with better pay and recognition.  The catch is why should such people stay when the situation is what it currently is and the resistance to change is as strong as it is.    Change can happen, will eventually happen (I like to think), but it will not be fast, nor easy.  It's going to be real rough for those that decide they want to be first...



I think that it is important to also consider in the US, the volunteer and fire/ems establishments have a monetary interest in making sure EMS does not move forward.

It is *not* just a problem of unmotivated providers. 

If the standards for EMS were raised to that of the rest of the civilized world, the price to employ dual role fire/medics would skyrocket. 

The cost to train volunteers as well as maintain certification would likely become insurmountable for those agencies.

This quickly becomes a political nightmare. As EMS providers will be accused of:

a. taking away care from rural/poor communities for their own financial gain.

b. causing an increase in tax requirements for municipalties/reducing desired services again for their own financial gain. (the IAFF IAFC and affiliates will use the exact same PR arguments they have to convert to fire/ems because they work.)

Whether anyone admits it or likes it, the FD has spent considerable money and effort over the years on PR. They do PR probably better than anyone. This money comes from their members and through department funded initiatives.

In order to overcome that, a non-fire professional organization that excluded firefighters (consequently dual role providers) wouldhave to solicit members to pay money as well as private EMS/IFT institutions to help fund a massive research and PR campaign. 

This is where trade mags such as JEMS with their "strategic partnership" with the IAFF and NAEMT (with IAFF members in officer positions which have an obvious conflict of interest) fall way short. 

Realistically, if this organization were to actually kick off, it would immediately come under PR attack. 

I do not think it is possible to start a "grass roots" EMS movement which could tak on the already organizaed and established opposition. 

I ca see a few potentail strategies, but they will take a long time and considerable sacrifice on the part of individual providers.

A perfect example of PR, every year the US sees firefighters "fill the boot" for the MDA. 

WHat do we see EMS providers do?


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## Jambi (Oct 2, 2012)

I agree with everything you've said, including the systematic oppression of the profession for political gains and reasons.

The only way I can see something like this happening would be to partner with a major medial association that can bring to bear a level of authority (validity that people listen to) that can compete with the PR machine.

Some unbiased research produced by an organization not beholden to any group that has a stake at keeping costs/training low.

It's not wonder people abscond into other professions.


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## Veneficus (Oct 2, 2012)

Jambi said:


> The only way I can see something like this happening would be to partner with a major medial association that can bring to bear a level of authority (validity that people listen to) that can compete with the PR machine



The only organization that I can think of that could do this is the nursing association.


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## blachatch (Oct 2, 2012)

Veneficus said:


> The only organization that I can think of that could do this is the nursing association.



Do you teach in the Cleveland area?


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## Veneficus (Oct 2, 2012)

blachatch said:


> Do you teach in the Cleveland area?



Yes, but I am currently not in the area.


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## NYMedic828 (Oct 2, 2012)

Veneficus said:


> Yes, but I am currently not in the area.



Just a few miles away


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## Veneficus (Oct 2, 2012)

NYMedic828 said:


> Just a few miles away



I am a global player, there are many demands on my time.

I can't afford to pay well, but I really need a personal assistant and a secretary.


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## NYMedic828 (Oct 2, 2012)

Veneficus said:


> I am a global player, there are many demands on my time.
> 
> I can't afford to pay well, but I really need a personal assistant and a secretary.



I'm sure you can outpay the standard EMS salary.

$7.25 an hour isn't that much for you.


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## Jambi (Oct 2, 2012)

NYMedic828 said:


> I'm sure you can outpay the standard EMS salary.
> 
> $7.25 an hour isn't that much for you.



Throw a free patch and all you can use trauma shears and he'd have people beating down his door for a job.

:rofl:


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## Veneficus (Oct 2, 2012)

Jambi said:


> Throw a free patch and all you can use trauma shears and he'd have people beating down his door for a job.
> 
> :rofl:



I probably shouldn't make this joke, but here it is:

You could call yourself a "physician's assistant" on your resume, but there will be no clinical duties.


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## Jambi (Oct 2, 2012)

Veneficus said:


> I probably shouldn't make this joke, but here it is:
> 
> You could call yourself a "physician's assistant" on your resume, but there will be no clinical duties.



I just spit water out of my nose.  I managed to keep it off the key board though :rofl:


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## silver (Oct 2, 2012)

Veneficus said:


> The only organization that I can think of that *could do this* is the nursing association.



yep could is the key word. We all know politics plays way too much of a role in health care education.

I'm going to stay optimistic. I think the system will drastically change, but it will likely come in 20 years. Health care outcomes have demonstrated the value in preventive and community based practice, but has faced many political/financial obstacles. I think once we start seeing a greater change there, we will see a change in starting in EMS like 5 years later.


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## Trashtruck (Oct 2, 2012)

Yes. Very under educated. My paramedic program was a joke(it really, really was.) It doesn't even exist anymore. I am type-A and take it upon myself to stay abreast on EMS topics, education, etc. I'm only required to have a valid CPR card and my state EMT-P card for employment, but I maintain my NREMT-P, ACLS, PALS, and PHTLS for my own edification.

And as far as working in the field, well, it's been my experience that after you get your 'fill' of the guts and gore and 'cool' stuff, you'll become bored because there really is only so much to do. It becomes monotonous. You'll dig deeper into what is going on and why to stay stimulated.

If you want to know the how's and why's behind what you're doing, you'll leave the field, or educate yourself on your own volition. I look shiz up all the time because I want to know.

I let out a big YAAAAAAWN and roll my eyes enroute to yet another(fill in any of the automatic drop-down options dispatch decides to put in)


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## errey (Oct 7, 2012)

I have a question for you all, I haven't been a medic all that long (less than 1 year)  and I do a lot of self study on my spare time to broaden my knowledge behind my skills.  For all of you who do the same how do you treat pts without stepping outside your scope of practice? And by that I mean if a pt is asking you about a condition and you have answers but are answers you learned on your own and not by a formal study program how do you, or how would you proceed?  would you step over that line or no.  I guess I'm asking would you use information and knowledge you have learned on your own in your practice? Is that considered outside our scope?  (training dependent of course)


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## errey (Oct 7, 2012)

errey said:


> I have a question for you all, I haven't been a medic all that long (less than 1 year)  and I do a lot of self study on my spare time to broaden my knowledge behind my skills.  For all of you who do the same how do you treat pts without stepping outside your scope of practice? And by that I mean if a pt is asking you about a condition and you have answers but are answers you learned on your own and not by a formal study program how do you, or how would you proceed?  would you step over that line or no.  I guess I'm asking would you use information and knowledge you have learned on your own in your practice? Is that considered outside our scope?  (training dependent of course)



And i don't mean performing procedures if your not trained to do so just general knowledge


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## JPINFV (Oct 7, 2012)

errey said:


> I have a question for you all, I haven't been a medic all that long (less than 1 year)  and I do a lot of self study on my spare time to broaden my knowledge behind my skills.  For all of you who do the same how do you treat pts without stepping outside your scope of practice? And by that I mean if a pt is asking you about a condition and you have answers but are answers you learned on your own and not by a formal study program how do you, or how would you proceed?  would you step over that line or no.  I guess I'm asking would you use information and knowledge you have learned on your own in your practice? Is that considered outside our scope?  (training dependent of course)




1. Medicine is defined, in part, by life long learning. Not everything outside a class is always wrong, not everything inside a class is always right.

2. There is no scope of practice when it comes to knowledge.


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## Medic Tim (Oct 8, 2012)

errey said:


> I have a question for you all, I haven't been a medic all that long (less than 1 year)  and I do a lot of self study on my spare time to broaden my knowledge behind my skills.  For all of you who do the same how do you treat pts without stepping outside your scope of practice? And by that I mean if a pt is asking you about a condition and you have answers but are answers you learned on your own and not by a formal study program how do you, or how would you proceed?  would you step over that line or no.  I guess I'm asking would you use information and knowledge you have learned on your own in your practice? Is that considered outside our scope?  (training dependent of course)



I am constantly reading, taking courses, picking the brain of every doc I can, and anything really that I find interesting and pertains to what I do. If you only use your training/education from school and feel it is sufficient you have no business imo of being in charge of pt care. we are in an ever evolving field where you are always a student.Time permitting I always ask my pts if they have any questions about anything. I am constantly explaining what each of their medications do, how certain disease processes progress, what will probably happen at the er, why they had the test they just had, etc. I don't always have the answers but I do my best to explain what I do know . It also gives you something to talk about for those long transports.


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## firetender (Oct 9, 2012)

errey said:


> I have a question for you all, I haven't been a medic all that long (less than 1 year) and I do a lot of self study on my spare time to broaden my knowledge behind my skills. For all of you who do the same how do you treat pts without stepping outside your scope of practice? And by that I mean if a pt is asking you about a condition and you have answers but are answers you learned on your own and not by a formal study program how do you, or how would you proceed? would you step over that line or no. I guess I'm asking would you use information and knowledge you have learned on your own in your practice? Is that considered outside our scope? (training dependent of course)


 
You're basically talking about offering medical advice. I go along with continuing to educate yourself but, in the patient situation you have to be really really carefull about how you advise and what you suggest. 

If, for example it's on a call where the patient refuses treatment and you say something like "From what I've read you don't have anything to worry about." then that could come back to bite you in the butt.

I say don't act OR advise above your training.


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## JPINFV (Oct 9, 2012)

firetender said:


> I say don't act OR advise above your training.



However, who sets your training? Does training have to only be in a formal classroom setting? Does only the initial training count? How many tips and tricks do you use to treat patients that you picked up through informal routes?


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