# Oh Boy, here we go. Education Vs Skills



## MidwestFF (May 31, 2010)

I though that I would start another thread so "What did you have to do to get into Paramedic school?" isn't led so far off topic that it is either closed or the individuals hijacking the thread are dealt with by the Admin teamh34r:.

As the discussion in the other thread is comparing Education vs Skills I am going to state that I think the education needs far outweigh the so called "skills". One could physically have the skill to do something but much more importantly they need to know the when and the why when dealing with another persons life or limb.

For example I took my 11yo son (he has more the stature and size of a 9yo) with me on a couple of occasions to our labs as there were others in the class that wanted to work on pediatric/ child assessment 's, as they are hard to get with nervous parents in a clinical setting. 

During the first one of these trips our EMT class was also doing Combitube / Dual Lumen airway checkoffs in class as well. In under 30 minutes he learned how to appropriately place, secure, and bag unassisted through the skill to the point that after the third time through he scored a 100% on the check sheet unassisted and was able to spout off the indications and contra-indications. On a subsequent trip to the lab over a week later he was able to go through the entire process again scoring 100% unassisted the first time. 

My point being that this profession should be much more than a set of skills that a child could master (have you seen the control combination for a recently produced video game?). I feel that education is the key. Yes that's great I know how to go through the motions of performing this intervention but is it clinically appropriate and more importantly should it even be considered over some other therapy, IE: risk vs benefit.

My point being that as a Medical Provider Paramedic or otherwise we should have the education and knowledge to look at all of the clinical data that the patient presents with and be able to identify and apply appropriate interventions without having to get out the protocol cards to see if this patient meets up with one exactly. 

We have all heard "Treat the patient not the equipment" how about "Treat the patient not the protocols"

Let the mud flinging begin!


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## Shishkabob (May 31, 2010)

Why can't education match skills?


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## jjesusfreak01 (May 31, 2010)

Maybe no mud flinging here. I don't think we disagree on the importance of education and the ability of a medic to understand a patients condition and diagnose. I can think of situations in which a provider would be more beneficial to the patient due to their hands on skills (someone needing CPR and an advanced airway placement, maybe an IV placed) and other situations where the knowledge and experience comes into play (a complicated cardiac emergency that requires proper analysis of a 12 lead, correct medication, and a helpful diagnosis to the hospital/surgery team before arrival). A good medic should have both the skills and the knowledge to use them appropriately. (Read: Education should match skills)

The argument on the other thread was never comparing a medic to a basic or an intermediate, it was comparing a medic with significant field experience at the basic/intermediate level to a medic who had only their clinical hours from medic school (which they both had). This is more argument for the sake of argument, but my point was that the hands on and the diagnostic skills that the EMT gained while working in the field are immensely valuable. I also believe (and I may very well have to reassess this later) that basics paired with paramedics should be able to learn a great deal by watching their care on scene and reviewing their reports with the medics after the call. I am not going to have the, "I'm just an EMT-Basic" mentality. I want to be the basic that is observing and learning how to do skills that I am not yet qualified for, so that when I get to the point where I have that shiny new patch and I'm the one in charge I can look at the scene, take in all in, and know what I am supposed to do not just do to my training, but also from experience.


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## MidwestFF (May 31, 2010)

My point is that the education must meet or exceed the skills, it should not only be how to do something but an in depth understanding of the why. There are so many that want to have nothing to do with the education side and just learn cool skills. I have seen this both here in the virtual world, and first hand in person.

Ok so maybe I'm an idealist but I'm ok with it. The basis of the classroom education should not be how to pass the test, it should be in in depth understandings of the hows and whys in the pre-hospital environment. I want the knowledge and background to recognize and understand what's going on with my patient and why. While the proper execution of "skills" are important I feel that this comes in as a far distant second to knowing and understanding the clinical presentation of the patient to be able to know when the "skill" should be used. 

When presented with a patient I would like to be able to treat based on an educational background not just because the protocol said that's what we had to do. If this knowledge is not learned in the classroom where else are the providers supposed to learn it; in the field on real patients using trial and error as learning tools?


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## rescue99 (May 31, 2010)

MidwestFF said:


> I though that I would start another thread so "What did you have to do to get into Paramedic school?" isn't led so far off topic that it is either closed or the individuals hijacking the thread are dealt with by the Admin teamh34r:.
> 
> As the discussion in the other thread is comparing Education vs Skills I am going to state that I think the education needs far outweigh the so called "skills". One could physically have the skill to do something but much more importantly they need to know the when and the why when dealing with another persons life or limb.
> 
> ...



I have seen an almost 5 year old do a spot on trauma assessment, but it has nothing to do whith whether she knew what she was doing. She simply memorized a series of physical actions with no meaning. You taught an 11 year old only half a skill IMHO. The other half was left in the wind. 

Too many folks assume skills are simply the mechanics of something. When one teaches a "skill" he/she must also teach why a skill is being used or not used. It's nothing more than a pointless series of actions otherwise. Parroting indications and contraindications and complications is completely moot if the kid has no idea why he stuck a plastic thingie in rubber dummy head. Now teach him acid base and we'll all be impressed :>)


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## MidwestFF (May 31, 2010)

To delve back to one of my other posts



> Hmm, lets see
> 
> Just to be considered for the program:
> 
> ...



and your reply



> Originally Posted by *jjesusfreak01*
> Thats absolutely ridiculous. Those qualifications would get you into med school. If I end up doing medic training, it will be con-ed classes at a local community college. You can take an EMT-I class and then a 3 semester Medic course. Less than $1000 total, or free if you are affiliated with a rescue organization.



Obviously the program is trying to address deficiencies that they have seen in former students. Lets look at the educational prerequisites for my program.

2 Semesters of English
*Can you function at a college level, the reports you write are legal   documents, I'm sure there isn't an attorney out there that wouldn't litigate against a document/ contract/ PCR written at the 8th grade level.*

Interpersonal Communication
*We are dealing with people here with a multitude of cultures and beliefs and we need to quickly gain some sort of trust and working relationship with them. My point being we must at least have an idea how to communicate on at least a competent if not  professional level.*

General Psychology
*Normally when we are called people are the there worst and most vulnerable in a considerable number of cases there is more psychological distress than there is physical.*

Developmental or Abnormal Psychology
*Take your pick, both are going to present their own challenges to patient care.*

Algebra
*Critical thinking skills, plus students wont have to be taught how to properly work with ratios for drug calculations.*

Anatomy & Physiology 1 & 2
*This I wont even justify with an explanation.*


Now is this ridiculous?


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## MidwestFF (May 31, 2010)

rescue99 said:


> I have seen an almost 5 year old do a spot on trauma assessment, but it has nothing to do whith whether she knew what she was doing. She simply memorized a series of physical actions with no meaning. You taught an 11 year old only half a skill IMHO. The other half was left in the wind.
> 
> Too many folks assume skills are simply the mechanics of something. When one teaches a "skill" he/she must also teach why a skill is being used or not used. It's nothing more than a pointless series of actions otherwise. Parroting indications and contraindications and complications is completely moot if the kid has no idea why he stuck a plastic thingie in rubber dummy head. Now teach him acid base and we'll all be impressed :>)



You are 100% correct in that my son only learned the how and not the why. This is *exactly* the point I am trying to make. There are many students/ providers/ instructors that would argue that we as providers don't need the why as we will just be following protocols. What is there for those of us that want to know the why even if only for our own personal enrichment?

What kind of provider would you like to have work on you or even better yet one of your children?


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## jjesusfreak01 (May 31, 2010)

MidwestFF said:


> Obviously the program is trying to address deficiencies that they have seen in former students. Lets look at the educational prerequisites for my program.
> 
> 2 Semesters of English
> *Can you function at a college level, the reports you write are legal   documents, I'm sure there isn't an attorney out there that wouldn't litigate against a document/ contract/ PCR written at the 8th grade level.*
> ...


Maybe we are misunderstanding each other a little here. I definitely agree that all of these classes and skills are necessary for a paramedic. What I thought was somewhat ridiculous is 1, the GPA needed to get into medic school there, and 2, the expectation that you would have taken all of these classes before medic school.

As a pre-medical student (with a BS in Biology), I would still have to take interpersonal communication, another psych class, and another anatomy class to meet those qualifications. Are these actually requirements to get into the program, or just classes you have to take sometime before you graduate?

Again, I can see the application of each one of those courses, I am merely questioning those as standards for entrance into the program.


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## akflightmedic (May 31, 2010)

Think about this.

By raising the standards to that level several things are going to take place.

1. Obviously a well rounded and better educated paramedic will emerge...one might say a professional.

2. You weed out all the hero wanna bes, the we don't need to learn that people, and people who are looking for an "easy and exciting job". In return you get focused, career oriented licensed professionals.

3. You will see more autonomy within the scope of practice.

4. You will see a decrease in cook book paramedics being pumped out every 6 months.

5. You will see demand for these quality paramedics increase.

6. With increased demand and quality due to stringent entry requirements, pay will increase.

7. No longer will EMS systems be absorbed into departments for reasons such as "we can do that, its just an IV or just a tube plus we can bill for it" mentality.

8. Paramedicine will become a stand alone and admirable career choice.


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## reaper (May 31, 2010)

I agree that all those classes should be prerequisites to paramedic schools. You have to have that knowledge, long before you are trying to learn more. A good medic school will be a long year of being busy. between class, studying and clinicals, there would be no time to finish 5 other classes, while going through it.


So yes, one day that will be the prerequisites for all medic schools! (we can only hope)


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## MidwestFF (May 31, 2010)

All of these classes are required prior to admission. 

The reason the GPA is currently so high is the number of otherwise qualiffied applicants. From what I understand it is normally between 3.0 and 3.5. This cycle there where well over 100 applicants for 15 seats. I know selection is based on some sort of point system as well but I don't know what how it works.

I am actually having to re-take the A&P series as my classes were over 10 years old. I just finished A&P 1 again with the highest grade in the school. I will be doing A & P 2 in the fall in addition to staring medic. They want my knowlege to be more current but still accepted the old courses for entry requirements.


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## rescue99 (May 31, 2010)

MidwestFF said:


> You are 100% correct in that my son only learned the how and not the why. This is *exactly* the point I am trying to make. There are many students/ providers/ instructors that would argue that we as providers don't need the why as we will just be following protocols. What is there for those of us that want to know the why even if only for our own personal enrichment?
> 
> What kind of provider would you like to have work on you or even better yet one of your children?



Not to sound disrespectful but I still don't see the example this sets for education unless it is to point out that educators are failing to teach. Lazy educators (including internship mentors) have to step up to the plate and take a more active role. It can't all be up the student to learn on his own, lest ya get a rubber dummy with a thingie in its mouth! What I see is a bright young boy who learned half a skill. Half a skill taught equates to half an educator, not half an EMT.


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## MidwestFF (May 31, 2010)

rescue99

I think we are both on the same page, lets not forget there are students that are failing to learn what they should. As I said before there are too many that just want to teach/learn the absolute minimum to pass the test and get their card. There are problem individuals on both sides student / provider and educator. There are also many on the opposite end of the spectrum that can and want to learn more. 

My rant was triggered by the "ridiculous" entry requirements to the program I will be starting in the fall. There are educators and students both who will just defer to well its in the protocols who cares as to the why, just not in my program. I do care about the why and I think that all professionals should.


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## medic417 (May 31, 2010)

rescue99 said:


> Not to sound disrespectful but I still don't see the example this sets for education unless it is to point out that educators are failing to teach. Lazy educators (including internship mentors) have to step up to the plate and take a more active role. It can't all be up the student to learn on his own, lest ya get a rubber dummy with a thingie in its mouth! What I see is a bright young boy who learned half a skill. Half a skill taught equates to half an educator, not half an EMT.



What Midwest is saying is that anyone can learn how to do the skill.  He is also saying in different words the same thing you are though that that is less than half the skill.  He says you must see the education of the how, when why and even the possible complications and how to correct them.

His kid was not taught the skill, he observed and imitated it.  Sadly many in EMS were shown the skill but never received the education.  I see many students that refuse to study.  They refuse to read the text, and god help us all if they are asked to do research.  Many trying to enter this field sadly have that attitude so no matter how good the instructor/professor is all the student takes in is the how to put in the item but none of the rest.  Hopefully the student fails out so they do not harm patients.  Then you have the mills turning out skill users with test taking knowledge only.  They can not practice medicine because they never learned medicine.  They learned to imitate just like the kid did.


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## MidwestFF (May 31, 2010)

Thanks medic417 you hit the nail smack dab on the head. Sometimes it is difficult to convey what you would like in this environment. 

All I have learned so far is is I like what I am studying and I want to know much, much more!


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## Ridryder911 (May 31, 2010)

Part of the problem lies is that most of those providing the training and education do not understand the differences of training and education. As in other allied health areas, there are jobs and areas that skills are more important than having the knowledge of the procedure that is being performed.... i.e. nursing assistants performing vital signs. Yes, it's important that they be able to perform these with great accuracy but we do not expect them to interpret and be able to go in-depth of the physiology of the ...."how's and why's"... It is above their level of function and responsibility, as to only report and emphasize them to a higher level professional. 

Hence; part of the problem within in EMS, there is not always someone to oversee and ensure that priorities and care are properly performed. 

Most are not aware, skills performed at the EMT level are rated very simplistic. Hence; why they are allowed. With repetitious rehearsing and practice one should be able to master them without difficulty. This is even taught within the NHTSA EMT Instructor Course that the skills are easily mastered due to the simplicity of them. As well, most of the allowed skills have very little harmful side effects if performed improper. Sure, if one performs negligent anything can be harmful... but; seriously how hard is it to place a patient on a spine board, attach an oxygen mask to a oxygen cylinder and adjust to proper settings? 
We teach non-medical personal daily on how to obtain vital signs.... again; the understanding of why, the interpretation of findings, possible dangers, and outcomes is the difference of knowledge and being able to just perform "skills". 

Appendectomy surgery is really a non-complex surgery. Most could really learn how to perform this within a few hours and after a few surgeries could be able to perform it flawlessly.... does this mean one should be able to perform it ? No. The same as medical procedures within EMS. Knowledge is essential even though the procedure maybe very simplistic.... skills should be the action associated with the knowledge.

R/r 911


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## jjesusfreak01 (May 31, 2010)

Ridryder911 said:


> Appendectomy surgery is really a non-complex surgery. Most could really learn how to perform this within a few hours and after a few surgeries could be able to perform it flawlessly.... does this mean one should be able to perform it ? No. The same as medical procedures within EMS. Knowledge is essential even though the procedure maybe very simplistic.... skills should be the action associated with the knowledge.
> 
> R/r 911



It's funny you mention that, because I know a few college students that have been allowed to do those on medical mission trips in third world countries. They are taught the skill, and then allowed to do it. I'll make no assessment of whether that should be allowed or not, although I would jump at the opportunity if given it.


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## themooingdawg (Jun 2, 2010)

Education and skills should go hand in hand with what you are doing. Especially with the responsibility given to a paramedic, there should be no discrepancies between the two. There is a reason why paramedics are given extensive training in clinicals, prehospital, and a thorough didactic. To be a good paramedic, you have to be able to understand the whys and hows to performing certain actions.


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## Melclin (Jun 2, 2010)

MidwestFF said:


> 2 Semesters of English
> *Can you function at a college level, the reports you write are legal   documents, I'm sure there isn't an attorney out there that wouldn't litigate against a document/ contract/ PCR written at the 8th grade level.*



You don't need to interpret poetry and literature at a university level to be able to competently fill out a document. Your final year of highschool exit scores/course application/work history should be plenty to know whether or not a person is completely without ability in that area.



MidwestFF said:


> Interpersonal Communication
> *We are dealing with people here with a multitude of cultures and beliefs and we need to quickly gain some sort of trust and working relationship with them. My point being we must at least have an idea how to communicate on at least a competent if not  professional level.*



I don't disagree in theory, but those "interpersonal communication" courses are predominantly useless. Abstract academic models of communication do not help a person if they have poor people skills and they are useless if you already have good people skills. 

Our degree now has a communication subject that involves learning about how to actually talk to patients. Challenges in communicating with CALD patients (culturally and linguistically diverse...its the new buzz term here :wacko and practicing these techniques. Convincing a person who wants to wait for their daughter that they need to go to hospital now...understanding their fears..indentifying barriers..recruiting people your pt trusts, etc. They may use standard patients like the med students and their attempts at communication are videoed so that they may watch themselves and identify weaknesses. Their scenarios don't involve having to spout off memorised fact sheets and sticking tubes in dummies, they are graded on the rapport they build, and the ease with which they can manage a person, not an illness. 

Sounds great to me, I wish they had the subject when I was in first year. It was developed directly in response to the fact that these "interpersonal communication" subjects taught by other faculties are supremely useless for anyone, let alone us, and are most often taught by some of the worlds most useless academics.  



MidwestFF said:


> Algebra
> *Critical thinking skills, plus students wont have to be taught how to properly work with ratios for drug calculations.*



Algebra? What the hell kind of university teaches "algebra"? I did algebra in the 6th grade. University mathematics is ridiculously far beyond the level we need. If you did so poorly during the 6 years of your secondary education that your were unable to learn enough to do drug calcs etc...then I do not want you treating me, with or without a semester of "algebra". 






akflightmedic said:


> 2. You weed out all the hero wanna bes, the we don't need to learn that people, and people who are looking for an "easy and exciting job". In return you get focused, career oriented licensed professionals.



We still have plenty of problems with immaturity in both young and old paramedics. A university degree doesn't solve that problem entirely, but it does improve it immeasurably. I look around at some of the volunteers in the  our volly first aid organisation who have about the same training and entry requirements as an EMT-B and I really feel for you guys because those people that here are a harmless annoyance are actually riding on ambulances and treating real pts over there. 



jjesusfreak01 said:


> It's funny you mention that, because I know a few college students that have been allowed to do those on medical mission trips in third world countries. They are taught the skill, and then allowed to do it. I'll make no assessment of whether that should be allowed or not, although I would jump at the opportunity if given it.



I'm quite sure you wouldn't want them operating on YOU would you?


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## jjesusfreak01 (Jun 2, 2010)

I generally consider myself to be invincible (until proven otherwise), and I plan to never get appendicitis.

That said, so long as their technique (hands on skills) were good, I wouldn't have a huge problem with it. They do have surgeons very nearby and they aren't generally allowed to do the surgeries alone until they have proved the skills.


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## MidwestFF (Jun 2, 2010)

Melcin,

The English courses in question, or at least the ones that are required are more on the order of writing and research papers. Unfortunately high school English that I went through almost 20 years ago would have been sufficient what they are teaching now or the lack there of is the current problem.

The Interpersonal Communications Course was taught by a department head and intended for a professional audience police, fire, ems, and etc. I went in VERY skeptical but I did learn several strategies that have made my life easier in other pursuits.

As to the Algebra this is not what we learned in primary school. This was much more in depth and included mathematical modeling, and analytical geometry. I will have to admit that I did take this course; as I said previously it had been almost 20 years since I had been in a classroom. I had remembered what I had used but I had several gaps in memory due to non-use. Could I still properly work with volume based ratios, yes with no problems. Do I think this particular class was way overkill, yes, was it required, yes. I could be wrong but I don't think too many paramedics in the field will be modeling and graphing for a particular med based on all possible patient weights with recommended ongoing titration and dosing rates based on drug half-life's.

I will be the first to admit I personally think the primary and secondary schools here in the US absolutely suck 	:censored:	:censored:	:censored: at teaching; at least all of what I have seen in the last 8 to 10 years, but that is a conversation in and of itself.


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## rescue99 (Jun 2, 2010)

MidwestFF said:


> All of these classes are required prior to admission.
> 
> The reason the GPA is currently so high is the number of otherwise qualiffied applicants. From what I understand it is normally between 3.0 and 3.5. This cycle there where well over 100 applicants for 15 seats. I know selection is based on some sort of point system as well but I don't know what how it works.
> 
> I am actually having to re-take the A&P series as my classes were over 10 years old. I just finished A&P 1 again with the highest grade in the school. I will be doing A & P 2 in the fall in addition to staring medic. They want my knowlege to be more current but still accepted the old courses for entry requirements.



A/P changed? Evolution is pretty quick :>)


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## MidwestFF (Jun 2, 2010)

rescue99 said:


> A/P changed? Evolution is pretty quick :>)



I questioned it too. I was just figuring the school wanted more $$$$, after attending the first couple of classes I honestly wanted to ask the A & P instructor to what extent had brain volume and mass had fallen in the last 20 or so years in our nations young people, with further inquiry as to the suspected causes of the even more dramatic reduction in frontal lobe capacity and function.


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## rescue99 (Jun 2, 2010)

MidwestFF said:


> I questioned it too. I was just figuring the school wanted more $$$$, after attending the first couple of classes I honestly wanted to ask the A & P instructor to what extent had brain volume and mass had fallen in the last 20 or so years in our nations young people, with further inquiry as to the suspected causes of the even more dramatic reduction in frontal lobe capacity and function.



Ha...Funny :>) 

So many of my students will ask, " Mrs. D, I want a better grade...is there any extra credit I can do to bring my grade up?" Responses I've either used or would like to include, but not be limited to using: 

1. Umm, yeah, do the work you are assigned before asking about extra credit. 
2. Come into class pre-read and prepared.
3. PPT's are meant to facilitate..ya actually have to read the book.
4. Assume the same is true with lectures. 
5. If I assign something, it isn't an option. Please look up the difference. 
6. Manditory classes aren't optional but sleeping in class is...ya snooze, ya lose.
7. Please understand this is a college.... The feel good academy is next door. 
8. I'm more than happy to tutor but, you have to be present for me to do it. 
9. What do you mean you didn't know what to study for today? It's called an outline....did you refer to it?  

I've used most of these at one time or another...in the right context of course.


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## rescue99 (Jun 2, 2010)

Spell check is also optional but it should be "mandatory."  :blush:


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