freezing up and choking during skill drills

Tigger

Dodges Pucks
Community Leader
7,251
2,203
113
There are mass casualty drills and there are patient simulations. Categorically different. What is true is that neither approximates the real thing to any meaningful degree. They do "break out" the material resources from storage...they demonstrate available assets, but not much more.

Patient scenario simulations are something you do when real, meaningful training is not available. They are indicators of a training program's short comings.

How do you train trauma surgeons? In trauma rooms with real trauma. Do those guys do patient simulations? Not in any credible residency/fellowship. Because they're BS...

Challenging, thorough didactic preparation followed by expertly supervised and mentored field experience is what works...anything less is just stalling for time because of a lack of somewhere to put a trainee or to soak them for more tuition....
I wasn't aware that the whole medical model of education included taking folks straight from medical school and into the trauma bay. Must be a wild first day.

Even if that was happening, it wouldn't make sense for EMS with its regrettably low contact hours. Maybe see one, do one, teach one is out but at a certainly point we have to actually give people practice and feedback before they are in even a supervised patient care realm. To do otherwise would completely waste most clinical time.

This is about augmenting not replacing actual supervised experiences with simulation.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,110
2,811
113
I wasn't aware that the whole medical model of education included taking folks straight from medical school and into the trauma bay. Must be a wild first day.
No one said that first day surgical residents were dropped in in the trauma OR unsupervised. The point is that there is no reliance to speak of on simulation.

Simulation is fine for practice of motor skills when no other options exist. Practicing a cric on a manikin is inferior to practicing them on cadavers or living, bleeding humans, but is better than not practicing them at all. Similarly, working through scenarios verbally or in a skills lab is not nearly as good experience as experiencing that scenario in real life with a real patient, but I don't doubt that it prepares one to deal with that scenario much better than if it was never considered or practiced at all.

The OP's question wasn't about simulation at all, though. Didn't even mention simulation. It was about how anxiety affects his or her performance in front of classmates. It's a typical presentation of social anxiety and is poorly indicative of how this person will perform in a different setting.
 

Tigger

Dodges Pucks
Community Leader
7,251
2,203
113
No one said that first day surgical residents were dropped in in the trauma OR unsupervised. The point is that there is no reliance to speak of on simulation.

Simulation is fine for practice of motor skills when no other options exist. Practicing a cric on a manikin is inferior to practicing them on cadavers or living, bleeding humans, but is better than not practicing them at all. Similarly, working through scenarios verbally or in a skills lab is not nearly as good experience as experiencing that scenario in real life with a real patient, but I don't doubt that it prepares one to deal with that scenario much better than if it was never considered or practiced at all.

The OP's question wasn't about simulation at all, though. Didn't even mention simulation. It was about how anxiety affects his or her performance in front of classmates. It's a typical presentation of social anxiety and is poorly indicative of how this person will perform in a different setting.
I was responding to another post regarding the fact that trauma surgeons do not do simulations, which is patently untrue.

Also if one’s anxiety prevents performance in front of a group of people, couldn’t that also hold true for I dunno, FTOs, other responders, and families? Are these folks not watching with a critical eye as well?
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,110
2,811
113
I was responding to another post regarding the fact that trauma surgeons do not do simulations, which is patently untrue.
I knew what you were responding to. I think you'll find very few examples of medical education using simulation the way it is used in EMS education. And I can guarantee that you'll find minimal if any reliance at all on EMS-style simulation in a trauma fellowship.

Also if one’s anxiety prevents performance in front of a group of people, couldn’t that also hold true for I dunno, FTOs, other responders, and families?
It could hold true, sure. But it often does not. Once again, all I'm saying is that one should not assume that just because an individual finds one setting challenging, that they'll necessarily be unable to perform in a very different setting, especially once gaining more experience and confidence.

I'm not sure why this group is so bent on that being a foregone conclusion.

Are these folks not watching with a critical eye as well?
I've never seen a responder nitpick a paramedic who is managing an airway over meaningless minutiae like the way they are holding the tongue blade or the exact wording they use when they ask questions, and then have all the family members who are closely watching roll their eyes like the paramedic is a dunce. That's the kind of stress that folks with social anxiety issues tend to have trouble with, and it's much less of an issue in the field or one-on-one with an instructor than it is in a group setting.

Edit: My own educational experience notwithstanding (which I reviewed a few posts up), I cannot even begin to recount all the paramedic students, practicing paramedics, RRT students, practicing RRT's, PA students who were former paramedics, ED physicians, and others - more than a few of whom assured me that they were an absolute rockstar with airway management - fumble, sweat, and in many cases absolutely choke when doing easy intubations in the OR. I do not doubt that most of these folks generally do a fine job in their own element, but if they were to be judged by how they perform in an unfamiliar environment when being watched like a hawk by a room full of folks who are used to seeing this done by true experts who practice in that environment every single day, you'd think there's no hope for them ever being able to manage an airway on their own.
 
Last edited:
OP
ellexruth

ellexruth

whatever it takes
17
3
1
I always hear students say stuff like this, "I can do the skills, I just can't do it in front of other people"

My reply? You better learn how.

I'll work with you and put you in lower stress scenarios to start as you build confidence, but you do need to learn how to perform in front of others. EMS isn't a solo sport, and I don't care if you know how an iGel works if you can't put one in during a cardiac arrest when I need it done now.

The people in your EMT class should be allies and help you work through your anxiety issues. Confide in a class friend and explain your problems. Having a friendly face in the scenario with you can help you get through it.

But work on it. It won't go away on its own.
I actually talked to my instructor about my anxiousness about 2 weeks ago and he stayed after class with me and did drills with me and really helped me work through being choked up. it helped a LOT. I was very grateful. I just made the cut into the 2nd part of the program :)
 
OP
ellexruth

ellexruth

whatever it takes
17
3
1
I appreciate everybody's responses. A lot of them were very eye opening and helpful to me. Can't remember who exactly said what, but I got the gist about if your classroom performance is sh* then you're screwed. I really felt that way actually. I worked with my teacher about this issue and he really helped me out. Now I am able to do these drills without tripping out. I just try to remove myself from the anxiousness mentally and just be aware of my surroundings, what my partner(s) is/are doing / what needs to be done and prioritizing. I made the cut into the 2nd part of the program, which consists of more intense drills / scenarios, clinical ride alongs and a mock NREMT in Baton Rouge. I honestly don't feel discouraged any more. I'm actually really excited about it actually.
 
OP
ellexruth

ellexruth

whatever it takes
17
3
1

Top