Differential Diagnosis skill development?

[FuManChu]

I am yet to get my first EMT job, however I was just curious as to how all of you developed into more refined EMTs and Paramedics?

What I mean by this is, how did your differential diagnosis skills get stronger and stronger? Is it just through experience and constant exposure to certain things in the field? or is there more to it than that? I know you obviously have to know your stuff, study, and constantly stay up to date with things.

I am asking because when I did my ride-alongs for EMT school I felt so dumb. Whenever we ran a call, the EMT and Paramedic I was with would ask me what I thought was going on with the Pt. after the call. Almost every time they asked I just felt so clueless :wacko: Watching them work, they came up with different possible diagnoses on the fly, and I was sitting there trying to put the pieces together. I did great in my EMT class, passed every test with great scores, passed the NREMT, did great on my skills, but on my ride-along I just felt like I blanked out.

I guess it could be because it was my first exposure to working in the field and lack of experience. I just wanna really refine my knowledge and skill.

Any advice? encouragement?

 

[tacitblue]

What you are feeling is completely normal. You just went through an EMT class, which is at most 150 hours of education concentrating on only the very common life threatening medical problems (paramedic programs in Cal are 1100 hours, as a comparison. Still not enough). EMT training simply does not give you the tools to approach a complaint and formulate a good differential. Instead, you were taught how to do as little harm as possible and get people to the ER.

There have been good posts of this forum before describing how you might obtain a good education to practice good prehospital medicine. 150 hours doesn't cut it. Not even close. It will take you many years of instruction and experience to get there. This has been said a million times before, but to practice well you need to understand normal function of the body (A&P classes), altered function (pathology class), and how to use medication to correct function (pharmacology). These subjects require at least a basic understanding of atoms, molecules, and reactions (chemistry) and cells, tissues, and organs (biology). Then, you need clinical training in applying this knowledge. Its all about seeing actual patients, recognizing their disease process, and filing these encounters in your head as resources to draw on with later patients.

 

[Akulahawk]

I am yet to get my first EMT job, however I was just curious as to how all of you developed into more refined EMTs and Paramedics?

What I mean by this is, how did your differential diagnosis skills get stronger and stronger? Is it just through experience and constant exposure to certain things in the field? or is there more to it than that? I know you obviously have to know your stuff, study, and constantly stay up to date with things.

I am asking because when I did my ride-alongs for EMT school I felt so dumb. Whenever we ran a call, the EMT and Paramedic I was with would ask me what I thought was going on with the Pt. after the call. Almost every time they asked I just felt so clueless :wacko: Watching them work, they came up with different possible diagnoses on the fly, and I was sitting there trying to put the pieces together. I did great in my EMT class, passed every test with great scores, passed the NREMT, did great on my skills, but on my ride-along I just felt like I blanked out.

I guess it could be because it was my first exposure to working in the field and lack of experience. I just wanna really refine my knowledge and skill.

Any advice? encouragement?

Your feelings are very, very normal. The education you've received barely scratch the surface of medical knowledge. I suspect that the reason they're asking you those questions is to stimulate you to think. They have the advantage of having spent time in the field and seeing quite a few different cases along the way. Paramedic education is quite a bit longer than EMT, as has been said. Some Paramedics and EMTs attend A&P classes, classes in pharmacology, chemistry, and so on.

A place to start is, believe it or not, your protocol manual. Look up the conditions you find there and actually dig into the "why" that stuff happens. Then try to figure out why those particular therapies outlined in the manual are there. As you see more and more patients, try to correlate how they present to you with their known problems. And do more research. Eventually your brain will start to connect the dots and you'll start seeing multiple possible problems and you'll put names to those problems and... you'll be essentially doing your own differentials.

And then you'll start seeing how limited your care is, followed by seeking out additional education to better care for your patients. Your brain will no longer be just EMpTy, it'll be educated. As a side result, your peers will notice that you're very, very good, and at times, Yoda-like, from their perspective. Other healthcare professionals will eventually take note as well and realize that you know what you're doing and then some and trust you.

Yes, the stuff in the above paragraph happened to me. It's also happened to probably everyone on this forum that's been around the block a few times and has become educated about things. It's why we sometimes disagree with each other. We all were beginners, just like you and we all felt similar things that you did. You're not alone. We want you to become the best provider you can be. It is, however, up to you to want to keep doing better. Whether you end up as an EMT, Paramedic, RN, PA, NP, MD, DO, or dump truck driver, it's all your choice!

 

[FuManChu]

Thanks Tacitblue and Akulahawk.
I do plan on furthering my education, and I am really looking forward to learn from experience and exposure to a bunch of different complaints.

During my ride alongs I just felt like I should be up to par with the crews I was working with I know that is unrealistic without the experience and education, but I just wanted to "get in there" and share what I thought and help out.
I guess it will come with time.

 

[jefftherealmccoy]

I am a very green medic and something I do is browse this forum for the scenarios people go on. What would I do in this situation? Is there something about this call I don't understand (i.e disease process, physiologic response, ect)? If so, I study it. Another thing I do is when I come across a patient that presents a problem that is new/interesting to me, I write it down. I have a call journal filled with interesting calls and what I learned from each of them. It helps a lot to remember them and pull from those situations when I experience anything similar.

 

[FuManChu]

I am a very green medic and something I do is browse this forum for the scenarios people go on. What would I do in this situation? Is there something about this call I don't understand (i.e disease process, physiologic response, ect)? If so, I study it. Another thing I do is when I come across a patient that presents a problem that is new/interesting to me, I write it down. I have a call journal filled with interesting calls and what I learned from each of them. It helps a lot to remember them and pull from those situations when I experience anything similar.

I like the "call journal" idea. I do come on this forum a lot and read the scenarios, and study new things I don't quite understand. This site has really helped me learn a lot, I love when someone posts a new scenario. Just like you said, whenever I have heard or come across something new I look it up and try to understand what it is.

 

[mycrofft]

Went to school for four more years and got my BSN.:rofl:

 

[Akulahawk]

Went to school for four more years and got my BSN.:rofl:

Yeah, well, you're just different. :rofl:

Actually he's well educated and knows of what he speaks. There are some things that he needed to know when he was doing some other gigs, and like a good Nurse, he sought the education he needed.

We all should remember to do this, and continue to do this, and not just because we are required to do continuing ed for maintaining our certs/licenses.

 

[Wes]

I'm not normally a big fan of "card courses," but the Advanced Medical Life Support class is an excellent introduction to in-depth patient assessment and differential diagnosis, although it's a bit more geared to paramedic level providers.

Even if you can't find the course, the book itself is an excellent resource.

 

[Akulahawk]

I'm not normally a big fan of "card courses," but the Advanced Medical Life Support class is an excellent introduction to in-depth patient assessment and differential diagnosis, although it's a bit more geared to paramedic level providers.

Even if you can't find the course, the book itself is an excellent resource.

The best part about AMLS is that it's an introductory "what else could be wrong" course. I've not been able to take the course itself, but I have read the book, and have used it as a learning resource. Just using the book has been incredibly useful. One day, I will eventually take AMLS formally. I'm sure I'll get a LOT more out of it than just reading the book.

 

[medicdan]

I'm not normally a big fan of "card courses," but the Advanced Medical Life Support class is an excellent introduction to in-depth patient assessment and differential diagnosis, although it's a bit more geared to paramedic level providers.

Even if you can't find the course, the book itself is an excellent resource.

Agreed!! A great introduction, and way to develop DDx skills...

 

[PlatapusSupper]

Be careful to go into the advanced classes with as much relevant information as possible. I have seen people come through ACLS or PALS that had no idea what was going on and weren't able to get much from the classes

 

[Akulahawk]

Be careful to go into the advanced classes with as much relevant information as possible. I have seen people come through ACLS or PALS that had no idea what was going on and weren't able to get much from the classes

I just took ACLS. It was definitely a merit badge course... Of course, that impression wasn't helped by the simplification of the algorithms. I would fully expect to get a better (non-merit badge) education from AMLS. There's just too much in there that has to be covered to water it down to a merit badge course.

 

[STXmedic]

Be careful to go into the advanced classes with as much relevant information as possible. I have seen people come through ACLS or PALS that had no idea what was going on and weren't able to get much from the classes

Are you saying that ACLS was over their heads, or not enough/too watered down?

 

[Carlos Danger]

Are you saying that ACLS was over their heads, or not enough/too watered down?

Yes.

 

[STXmedic]

Yes.

I see... :blink:

:lol: