Real learning vs spoon feeding

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jwk

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ERdoc said
Life doesn't spoon feed you the answers and neither will I. I will be more than happy to debate but you need to do your research and come prepared. The thing about emergency medicine is you will always come up against things that you have never seen and never learned about. You will need to be able to make decisions about something that you know nothing about. You don't need to know the answer but you need to know how to find it. By giving you the answer I am taking away from your learning, therefore doing a disservice to you and your future patients.
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This thread got closed a little quick, but this response is one I wanted to address. Some of you think this attitude is, well, a little snotty perhaps. It's not.

I had a professor in anesthesia school that had crazy hard tests. Fortunately he graded on the curve - the high score for his first test was about 28%. He was perfectly up front about his rationale - "I'm not going to test you on what you know - that would be stupid. I know what you know. I want you to take what you know, and see if you can apply that knowledge so solve a problem you've never seen before".

This is the essence of real learning - and it's not just in emergency medicine. It can apply to any field. We thought this professor was crazy (or worse) while we took our test. But the next day as we reviewed our abysmal tests, he walked us through each problem, showing us how to take what we knew and use that knowledge to answer the question. None of the questions were particularly difficult, and after every one we had a collective "aaaaaaaaaahhhhhhhhhhhhhh". For people that are used to answering true/false or multiple choice questions, or simply working through a math equation, this was quite a radical concept. But we quickly figured out that it made perfect sense.

For EMS folks - this is the difference between relying solely on protocols (which is quite necessary for some) and being able to actually understand and treat an issue. (which can be a big jump for many).
 
This is the way I was taught in several of my classes. It's the only way to grow as a learner.
 
Amen! I attribute it to a new generation of millennials who want everything handed to them, most don't want to put the effort into anything, do their time, etc. I see it more and more teaching, training new hires, and just in society in general. Solely my opinion though.
 
The posts hit a little close to home for me. I have a kid in college and we constantly hear how everything is everyone else's fault. "The professor didn't give us a study guide." "The professor didn't tell us what to study." "The professor didn't tell us we needed to bring pencils to the exam and the professor didn't bring any extra." Once you are out in the real world, people are not going to hand things to you. You have to know how to do things on your own.
 
Unfortunately, the mentality that manifested here is more common than it should be. Hell, even the fact that someone bothered to venture on to an EMS forum and ask "why" is becoming more and more rare.

Some people don't care why, and don't even ask. They take the entry-level training they receive (and this applies to ALL levels of prehospital providers), and run with it. If they have enough to get through a shift without killing someone or coming up on a QA, they're happy.

I'll use my own experience here: when I was sent to Afghanistan, in a remote outpost to care for all of coalition members and locals (during, and between an intense tempo of six day a week missions), my role as a provider shifted to an entirely different dimension. There was no multidisciplinary team at my side. There were no assets beyond what an urgent care would typically have (aside from chest tubes, a portable ultrasound, and a crash cart).

I was told in the prior months that I wouldn't work on kids. 40% of my casualties were burned, shot, and otherwise injured and Ill children. I was told that ACLS was irrelevant in theatre. Yeah, no. Sitting on a critically injured casualty for 6-8 hours can lead to some nasty arrythmias. Overdoses. Malaria. Sepsis. Meningitis. Dental work. Wound repair. Sometimes, things would be so dire that we would cross type bystanders and transfuse whole blood using Chinook transfusion kits just to buy time. And it worked.

Every night, every moment I wasn't on a mission, cleaning weapons , working out or other miscellaneous busy work, I had my nose in one of these:

Tintinalli
Current diagnosis and treatment 2009
Harriet lane handbook
Sanford guide

I was terrified that I would fall short in some regard. And I tell ya what, despite my compulsive efforts to stay sharp, I used every little bit of knowledge that I sought after. The hospitals would write us back on the SIPR and commend us for sending them afebrile, stable patients after hours and hours worth of delays due to weather and enemy presence. It felt real good.

Then, I came back home. I got out of the Army. I started re-integrating with conventional, (read: non-witch doctor) providers. Some were awesome, and some were content to barely maintain what the school house lazily made them retain to pass tests. It makes me sad. Really sad.

You can't teach motivation. And unfortunately a good chunk of people who take care of people should really be doing something else. But the bottom line is, they need warm bodies to fill spots. It's like that everywhere. I used to try to "convert" people who didn't care, but now, like ERdoc did, I just move on to the next person that's motivated to teach, and learn.
 
This is really the essence of simulation based training. Its not about getting that IV in 10 times out of 10. Its about dealing with things you'll deal with on a regular basis that can't be taught (like how to deal with a family member of a deceased patient...or even your team member who's losing it). Its about knowing when you're in over your head and how to deal with it so you'll return tomorrow. Its about looking at yourself in a mirror and saying, "I can DO this...feed me".

My best exam was about a completely pneumatically driven ventilator (this was many years ago people) and the scenario was about taking a patient into a hyperbaric chamber...how would all the settings be affected (flows, volumes, rates, etc). You were forced to think about how everything worked adn whether things went up, down or stayed the same.

And excellent sim runs give you the Kobayashi Maru on a regular basis just because that's what life gives you, especially when you break it down as a group and deconstruct it afterwards. Its not about failing the question, its about (as mentioned above), learning the most logical approach to do your best with what you have under those conditions.

Just my 2 cents. Stay safe and have a great holiday.
 
You have to walk before you run. Spoon feed first and then ask them to take the next steps, while being prepared to help/motivate/nudge at every stage. That's what Bloom's Taxonomy is all about and goes through painstaking length to explain. You cannot simply expect your students to go from no knowledge to Bloom's Level 5 or 6 (unless they happen to be a super genius).

fx_Bloom_New.jpg


More on Bloom's Taxonomy here.
 
Yeah, except you were asking about carrying a "clot buster" without demonstrating knowledge of the body systems they work on. YOU were trying to skip your little rhetorical pyramid.

No one has the time, or desire to try to explain the intrinsic and extrinsic clotting pathways to someone over an Internet forum, when they're too lazy to at least help look it up.

I tell people all the time. Teaching is like having sex. If one person is doing all the work, no one's having fun.
 
GloriousGabe said:
You have to walk before you run. Spoon feed first and then ask them to take the next steps, while being prepared to help/motivate/nudge at every stage. That's what Bloom's Taxonomy is all about and goes through painstaking length to explain. You cannot simply expect your students to go from no knowledge to Bloom's Level 5 or 6 (unless they happen to be a super genius).
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While many of us here are students, not many of us are students with no knowledge. Most of us have some kind of basic knowledge here, many here have a much more in depth knowledge base and skill/experience to back it.
 
Doczilla said:
Yeah, except you were asking about carrying a "clot buster" without demonstrating knowledge of the body systems they work on. YOU were trying to skip your little rhetorical pyramid.

No one has the time, or desire to try to explain the intrinsic and extrinsic clotting pathways to someone over an Internet forum, when they're too lazy to at least help look it up.

I tell people all the time. Teaching is like having sex. If one person is doing all the work, no one's having fun.
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I'm talking about education and knowledge in general, not me specifically. Can we stick to that?
 
GloriousGabe said:
I'm talking about education and knowledge in general, not me specifically. Can we stick to that?
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But the whole point of creating this thread was to address the attitude that you brought up in the previous thread. This was further propagated when you posted your whole triangle scheme and presumably made reference to your own situation about needing to "walk before run".
 
MonkeyArrow said:
But the whole point of creating this thread was to address the attitude that you brought up in the previous thread.
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Let's just stick to the broad concept. Please?

This was further propagated when you posted your whole triangle scheme and presumably made reference to your own situation about needing to "walk before run".
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It's not mine, it's Bloom's Taxonomy.
 
I'm going to humor you once, and since you're a grown man, I'll give you the benifit of the doubt instead of calling you a massive troll.

You're arguing that "crawling" entails someone giving you some answer that you're likely going to forget despite the fact that a) it isn't relevant to you in the slightest, and b) it was handed to you in a big Mac wrapper instead of going out to seek it on your own.

We get it. You don't know jack about the previous topic. That's okay. But what's not okay is throwing a tantrum when you get called out on your behavior.
 
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The thing is this, someone who is involved with EMS is presumed to be an adult. At this point in their life they should already know how to crawl and walk. That is what elementary school is about and should be further refined through junior high and high school. An adult (ie someone who has finished high school) should be expected to be able to run without the spoonfeeding. In the age of the internet there is no reason any half-functioning adult shouldn't be able to find the answers to the questions they ask. Google scholar may not always be right but it is a reasonable place to start. Also, as an adult, someone shouldn't get offended if they are asked to find some information on their own.
 
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Keep the thread on topic and civil or it will be closed as well.
 
I personally feel that the biggest downside to real learning in most things is that there is not a perceptible end-state difference in how we are treated in comparison to the half-assers.
 
Yeah, that's an issue, but in a vacuum (aside from toxic leadership) growing as a provider should be motivation enough.
 
And from the perspective of a student and a paramedic....often we fall into the trap of assuming that all students, members of a cohort, educational products, etc. Are equal and similar in their motivation, effort and yield of their work. We see it here with the Millenial-bashing. As educators, we need to remember that everyone does bring individual approaches to our classes and we need to keep our classes on-target for the roles we are training for. This is often mistaken for spoon-feeding.
 
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