The more you know, the less you know

ghost02

ghost02

CA Flight Paramedic
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So I just got my FP-C after a long while of studying and such and after all of that, I've realized that the more I learned the less I really knew. It is one thing to have the certification and another thing entirely to be fully comfortable with it. I only have 2 years as a Medic so before I start trying to get on a Helicopter in another year I think it's time to get to the learning!

So I was thinking, "Hmm, CCT would take quite a few ICU patients, so maybe I should start there". So I bought The ICU Book. Started reading it, then realized that I needed much more pharmacological knowledge than I have, so I started looking at Pharm books only to see that I needed better Pathophysiology knowledge to understand how the medications worked. In order to understand Patho, I need anatomy and physiology. So I then took an online anatomy and physiology class. Now I feel like I'm at a good starting point.

That said, how does this course of study sound? Pathophysiology with Robbins and Cotran, then Pharmcology with Goodman, then the ICU book. After getting the certification I realized just how little I knew, if anyone has any recommendations I am all ears. Perhaps trying to do ground CCT work?
 
I was and still am in the same boat as you. Thought I knew a decent amount at 2 years as a medic until I started to study for the FP-C. Started flying as soon as I hit 3 years and really realized how much I do not know. Study one topic just enough to realize I don’t know enough about another topic to really understand the first topic. It is a non-stop learning cycle.
 
Learn the autonomic nervous system if you want to understand atropine, pressors, inotropes, inopressors and inodilators. Basically most of the drugs you're interested in. Paralyzing agents will make more sense too.
 
DesertMedic66 said:
I was and still am in the same boat as you. Thought I knew a decent amount at 2 years as a medic until I started to study for the FP-C. Started flying as soon as I hit 3 years and really realized how much I do not know. Study one topic just enough to realize I don’t know enough about another topic to really understand the first topic. It is a non-stop learning cycle.
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I think I am in that boat as well. Colorado paramedics are pretty fortunate to have a broad scope of practice and for the most part my interactions with the helicopter are "here's the patient, they're ready for transport to X hospital." And that's it. Patient goes on their monitor and vent if need be and they're out. When they beat us on calls they do the same sort of care we'd do and get going.

So I sit here and think, that looks pretty fun. I should look into this.

I did a lot of transfers out of a critical access hospital. They almost never called for flight. Hmmm, am I doing critical care transport? I am transporting critically ill patients. Then I start reading about actual critical care transport and boy, I do not know nearly what I thought I did. It's a never ending dive.

I want to get my FP-C but having switched jobs to a cush single role medic at a suburban FD means that I'm doing 95% 911 calls on 25 minute transport times and I am not sure that I can actually put such education to good use. I want a job where sick patients are the norm but the thought of giving up fire pay and bennies is a non-starter. I'm not sure you can get good at critical care doing it part time either. 🤷‍♂️
 
The truth is, the “critical care” patients you will be subjected to in the HEMS world are truly subjective.

Advanced certs are kewl and all, but once you enter this side of the field you realize, it too, has its limitations.
 
VentMonkey said:
Advanced certs are kewl and all, but once you enter this side of the field you realize, it too, has its limitations.
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What do you mean? Limitations on what you can do or is the field itself limited?

I was using the FP-C more as a launching point to try and sus out what I don't know more than an end goal in and of itself. I'll take a good look at the creighton course, I need to save my pennies for that.

Thank you guys for the responses, I appreciate it.
 
The moment you begin to believe that you know enough in this field is the moment you become dangerous to your patients and should get out before you kill someone.
 
ghost02 said:
What do you mean? Limitations on what you can do or is the field itself limited?
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Both. It’s still considered the prehospital arena to in-hospital folks. And many of them are unaware of what it is we too provide, or can offer, aside from rapid transport.

Am I insinuating that the learning stops? No. The Creighton link I posted is a course, that yes while expensive, will be more in depth than a review course or book. It’s drawn out over several weeks and cover topics that not only come up in these exams, but some you’ll never have heard of. Worth the money.

And yes, it can be a launching point for self-motivated folks such as yourself, but it also shows you just (generalizing) need a P card and ambition to pass. And no, that’s not a personal knock.
 
ghost02 said:
So I just got my FP-C after a long while of studying and such and after all of that, I've realized that the more I learned the less I really knew. It is one thing to have the certification and another thing entirely to be fully comfortable with it. I only have 2 years as a Medic so before I start trying to get on a Helicopter in another year I think it's time to get to the learning!

So I was thinking, "Hmm, CCT would take quite a few ICU patients, so maybe I should start there". So I bought The ICU Book. Started reading it, then realized that I needed much more pharmacological knowledge than I have, so I started looking at Pharm books only to see that I needed better Pathophysiology knowledge to understand how the medications worked. In order to understand Patho, I need anatomy and physiology. So I then took an online anatomy and physiology class. Now I feel like I'm at a good starting point.

That said, how does this course of study sound? Pathophysiology with Robbins and Cotran, then Pharmcology with Goodman, then the ICU book. After getting the certification I realized just how little I knew, if anyone has any recommendations I am all ears. Perhaps trying to do ground CCT work?
Click to expand...

These are broad and in-depth topics that most of us find much easier to learn from a good instructor teaching a clinically oriented course in a structured academic setting. If you have any inclination to eventually continue your formal education in a clinical direction (nursing, PA, etc.), go ahead and enroll in 2-semester A&P course (with lab) at your local community college. Also do pharm and pathophys. Do some research and pick the classes being taught by the instructors with the best reviews - it can make a big difference.

If you don't plan to go back to school or can't do college courses right now, you can certainly gain a good grasp on this stuff yourself. There are tons of quality, free resources out there on the web, including some good YouTube channels, and there are more textbooks on phys and pharm than you can count. Goodman is a great text but honestly, I'd start with books that are written for laypeople, like the For Dummys series. These books are meant to be easy to understand and digest and who wants to make this harder than it has to be? Let's face it, the more academic and in-depth a text is, the more effort it's going to take to read and understand. And because you can only retain a certain percentage of what you learn, the more clinically irrelevant minutiae you learn, the smaller the amount of useful information that will stick in your brain. So really, keep it simple and focus on the basics.

As far as the specific topics, I agree with E tank that a through review of the ANS is a good place to start, and I would add the renal system and acid-base balance and pharmacology. Then some respiratory phy, cardiac phys, and finally hemodynamics. A solid grasp of the basics of those topics and you'll know more than you ever need to know to be a very solid clinician.

So spend a few bucks on some easy to read, "intro to" books, supplement those with YouTube videos and web searches, and then if you want to, move on to something more in depth.

The ICU book is very good, as is the FCCS text. Nothing wrong with looking at the same time you are studying the science, but in general, critical care is much easier to learn when you are actually doing it rather than just reading about it.
 
My personal favorite basic pharm text is Lippincott's Pharmacology Review. Basic & Clinical Pharmacology by Katzung is excellent too, though not quite as easy to read and digest as Lippincott's, IMO.

For phys, I strongly recommend Medical Physiology - Principles for Clinical Medicine by Rhoades. Ganong's Review of Medical Physiology is very good, too. Human Physiology - An Integrated Approach by Silverthorn is also good as well, but not as clinically oriented as the first two. Guyton & Hall's Textbook of Medical Physiology is very popular but personally I find it dry.
 
Anyone taking the time to check out these resources, expand their knowledge, and has the fire to do so is truly the cream of the crop of paramedics.

Likely as such a motivated individual, you will probably desire to move upward at some point. For some this realization happens quickly and for others over time. This knowledge and experience will help when that time comes.

Others find a great gig as a medic where they can treat patients at the top of their training for a salary that is worthwhile (like KCMO, ATCEMS, etc), and they love it. Perhaps they are the outliers in the wide and varying world of prehospital medicine.

My hat goes off to all of you thinkers.
 
I think I have a better course of study now, thank you Remi for the suggestions on books. I'll take a look more at the ANS E tank, thanks.

VentMonkey said:
And yes, it can be a launching point for self-motivated folks such as yourself, but it also shows you just (generalizing) need a P card and ambition to pass. And no, that’s not a personal knock.
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Not taken as a knock at all!
 
I just want to say congratulations on making this discovery early in your career while also being able to state it publicly. KUDOS! And never, ever lose that mode of thinking.

You don't know what you don't know...and once you start the journey, you quickly realize (as you have). Too many people never start the journey and just press on with the attitude of they know what they need to know and assume that is all there is to know about what they think they know. :)
 
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