Pre-meds in EMS

[bstone]

You need to get yourself and your MSIII friend in check, now. You do not know more than a medic. You are learning very general pathology and biochemistry. Medical school does not prepare you to provide emergency prehospital care. It prepares you for a residency and step I and II of the USMLE. If your MS-III friend tries to overstep his bounds, he can be fired and lose his cert. He is an EMT, not a doctor.

As I am on the "pre-med" track right now, I may have a little more basic science classes than some of my co-workers. That means nothing to them, myself, my company, and nothing to the patient or the ant crawling on the floor.

The MS-III has already taken Step 1 (and passed) and is in the middle of clinical training. They likely have done rotations in internal med, surgery, peds and family med. Their knowledge of A&P, biochem, microbio, path and others has been more than extremely well tested- they've passed a HUGE licensing exam. So, I take issue with your statement that an MS-III learns "very general pathology and biochemistry". It's just incorrect.

 

[usafmedic45]

The MS-III has already taken Step 1 (and passed) and is in the middle of clinical training. They likely have done rotations in internal med, surgery, peds and family med. Their knowledge of A&P, biochem, microbio, path and others has been more than extremely well tested- they've passed a HUGE licensing exam. So, I take issue with your statement that an MS-III learns "very general pathology and biochemistry". It's just incorrect.

The problem is that for the most part they don't have much experience applying it. You know that old expression "A little bit of knowledge is a very dangerous thing", this is a perfect example of that in a lot of cases. There's a very good reason why complications spike at teaching hospitals around June and July when the new crop of med students and residents show up each year.

 

[JPINFV]

The problem is that for the most part they don't have much experience applying it. You know that old expression "A little bit of knowledge is a very dangerous thing", this is a perfect example of that in a lot of cases. There's a very good reason why complications spike at teaching hospitals around June and July when the new crop of med students and residents show up each year.

I'll bet money that complications increase at ambulance services that do internships for paramedic students every time a new batch of paramedics start their internships...

 

[usafmedic45]

I'll bet money that complications increase at ambulance services that do internships for paramedic students every time a new batch of paramedics start their internships...

Without a doubt and I was not trying to state differently. Actually that very point about EMS training cycles and complication rates would make for a heck of a research project if you could figure out a way to carry it out.

I was simply making the point that relying on skills that are as yet unrefined and untested is a very dangerous practice. This is why we keep our students- be they EMT, paramedic, RT, RN, or medical in nature- on a very short leash until such times as their education is complete. There probably isn't a training program out there where the accident/complication rate does not spike when you get a new batch of students.

What I was disagreeing with was this misguided belief that somehow an MSIII who has minimal clinical experience as a medical student is somehow automatically better able to assess a patient than an experienced EMS provider as result of their medical school experience. Perhaps at or near the end of third year once they've had a year of experience they might be comparable, but it is ultimately the experience that makes them superior and not what they were taught in terms of the underpinning science like some have implied. That may play a small role, but it is the feedback loop of being told "You see X? That's a sign of Y" firsthand that makes one a competent and skilled clinician, regardless of field, who can see somethings others overlook and go "Bingo, here's what's going on!". You need that experience, that hands-on teaching to tie it all together or most people are going to continue to function at a marginal level.

It's one thing to read about an obscure sign or symptom, it's a completely different one to be able to elucidate and properly identify it in the field if you've never been shown how. We've all met people who are extremely book smart but can't apply it clinically. That's the predicament a lot of medical students find themselves in: they have tons of knowledge and little idea how to apply it independently to patient care (through no fault of their own in most cases). It's just a function of the way medical education is practiced in the United States and other first world nations with which I am familiar.

 

[wyoskibum]

So I've read a few posts now discussing premeds in EMS and the few that I've read there is generally a negative connotation towards us.

Some of the best ER docs I know were in EMS before med school and they have a better understanding of what we face.

I think some of the negativity is those take an EMT class because it going to look good on their med school application. Some people would prefer to provide EMS training to someone who would use it as more than a stepping stone.

 

[ericg533]

The problem is that for the most part they don't have much experience applying it. You know that old expression "A little bit of knowledge is a very dangerous thing", this is a perfect example of that in a lot of cases. There's a very good reason why complications spike at teaching hospitals around June and July when the new crop of med students and residents show up each year.

Good call. We shouldn't let anyone with no experience apply any of their knowledge. Only people with experience should be able to do things.

 

[bstone]

There's a very good reason why complications spike at teaching hospitals around June and July when the new crop of med students and residents show up each year.

Citation needed.

 

[SeeNoMore]

"Some of the best ER docs I know were in EMS before med school and they have a better understanding of what we face. "

That is what I have heard. I am actually considering getting a BA in anatomy after I become a Paramedic. And then going to Medical school to become an ER doctor, but I would never stop working in EMS in some capacity.

Though not being an MD till 35 seems a little unrealistic. But the point is that the idea of ER docs with an invested interest in Prehospital medicine can only do good for our profession.

 

[JPINFV]

Citation needed.

http://www.allacademic.com/meta/p_mla_apa_research_citation/0/9/0/9/4/p90940_index.html

http://www.jstor.org/pss/3765766

Search for "July Phenomenon." Out of the first three I've found, 2 (links provided) supported it and a third looked at a specific neurosurgical procedure and didn't find a statistically significant number, but couldn't discount a few of the complications seen.

 

[bstone]

http://www.allacademic.com/meta/p_mla_apa_research_citation/0/9/0/9/4/p90940_index.html

http://www.jstor.org/pss/3765766

Search for "July Phenomenon." Out of the first three I've found, 2 (links provided) supported it and a third looked at a specific neurosurgical procedure and didn't find a statistically significant number, but couldn't discount a few of the complications seen.

Correlation is not causation. What was the P value?

 

[JPINFV]

More importantly, what is the relative risk. (P value as a significance test is worthless anyways)

 

[bstone]

More importantly, what is the relative risk. (P value as a significance test is worthless anyways)

Riiiight. Tell that to the Harvard biostats guy.

 

[JPINFV]

...and preach about the P value to the Tufts Epidemology guy. The simple fact is that it is extremely easy to manipulate the P value through simple things like sample size. Furthermore, the fact that a strict interpretation says that a P value of 0.06 makes something insignificant is rather stupid. Additionally, unlike a P value, the relative risk or risk ratio also tells you how much of an impact something has whereas a relative risk value does.

 

[bstone]

...and preach about the P value to the Tufts Epidemology guy. The simple fact is that it is extremely easy to manipulate the P value through simple things like sample size. Furthermore, the fact that a strict interpretation says that a P value of 0.06 makes something insignificant is rather stupid. Additionally, unlike a P value, the relative risk or risk ratio also tells you how much of an impact something has whereas a relative risk value does.

If you knew anything about the P value then you'd know it's 0.05, not 0.06. Seriously? My guy wrote the "Biostats" book and is the lead instructor of biostats at Harvard Med School. Yours?

 

[usafmedic45]

...and preach about the P value to the Tufts Epidemology guy. The simple fact is that it is extremely easy to manipulate the P value through simple things like sample size. Furthermore, the fact that a strict interpretation says that a P value of 0.06 makes something insignificant is rather stupid. Additionally, unlike a P value, the relative risk or risk ratio also tells you how much of an impact something has whereas a relative risk value does.

Nicely done JP. I could not have said it better myself (probably because I don't have an epidemiology degree (yet)).

Tell that to the Harvard biostats guy

Since I'm in no mood to walk into middle of the Massachusetts genitalia measuring contest I see about to begin here, I'll simply share a quote from one of my injury prevention colleagues who did his MD/PhD at Harvard: "Just because someone is trained at an Ivy League does not mean they are any less of a moron than they would have been otherwise. Anyone who tries to use the fact that they were as a way to end disagreement against their stance is probably grandstanding and should be treated accordingly."

Good call. We shouldn't let anyone with no experience apply any of their knowledge. Only people with experience should be able to do things.

Good call to be hyperbolic and take my statement completely out of context. If there is no point behind requiring experience and all that matters is the knowledge we gain from the classroom part of our education, then why does EMS and every other clinical career field insist upon clinical experience before allowing someone to practice independently?

 

[JPINFV]

Did you read what I said? I said that it's stupid to think that a P value of 0.06 is insignificant. As in not significant. Furthermore, there's going to be a major difference in content between an undergraduate biostats course and a graduate level epidemology course. Now are you seriously going to claim that something with a P value of 0.06 has absolutely no effect just because of convention? Furthermore, have you even heard about a relative risk ratio before today?

As far as the professor, my epidemology course was taught by a professor and researcher at Tufts Medical school.

 

[WuLabsWuTecH]

No.

When the heck did that become a BLS skill in Missouri?

Ohio. The Medic does the ACLS and manual defib, the basic does intubation, and a third FR (LEO, FF) or nursing home LPN does the compressions. It kind of makes sense. Otherwise the medic would have to do the drugs, the defib, AND the intubation while the basic is only good for thumping. In any case, most arrests here in the city get a dispatch that consists of 5-9 paramedics showing up on scene so the basic will most likely be standing 5 feet from the patient just watching unless the other units are really slow and the basic is really fast at intubating.

Some of the best ER docs I know were in EMS before med school and they have a better understanding of what we face.

I think some of the negativity is those take an EMT class because it going to look good on their med school application. Some people would prefer to provide EMS training to someone who would use it as more than a stepping stone.

I've heard that ER Docs who were medics/EMTs first do a lot better in learning initial atient assessment and with their experience can tell teh severity of a situation 2 seconds after entering the room and can start to suspect what is wrong much quicker than other docs of similar schooling but who have less street time (and by less I mean none!).

 

[usafmedic45]

Ohio. The Medic does the ACLS and manual defib, the basic does intubation, and a third FR (LEO, FF) or nursing home LPN does the compressions. It kind of makes sense.

Ah....OK....I still don't think basics should be intubating. In fact, given that the endotracheal route has been all but done away with for medication administration in arrest, one becomes hard pressed to argue for visualized airways in the field at all given the existence of so many good non-visualized options.

 

[daedalus]

bstone, lately I have been continually disappointed in your posts. Are you seriously going to whip out the names of Ivy league institutions to make an argument?

The MS-III has already taken Step 1 (and passed) and is in the middle of clinical training.

And this somehow prepares the medical student to work in the field how?

"Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine" -USMLE.org

No mention of testing student competence in preforming advanced out of hospital medicine.

So, I take issue with your statement that an MS-III learns "very general pathology and biochemistry". *(I did not say that an MS-III learns very general bio chem and path. I said that up until than, that is all they have learned.)* It's just incorrect.

Ok. So than every brochure that I have gotten from medical schools including USC, UCLA, Loma Linda, and others, lied to me. The first two pre-clinical years at these schools include instruction on basic science; biochem, gross anatomy, pathology, neuroscience, etc. This can be found on the description of years one and two on most medical school's websites.