Trouble with class/instructors

[EMTBWannabe]

It's not weird.

There is a difference (and it is a big difference) between the modality of treatment and the knowledge required to treat.

Guidelines, protocols or standing orders whatever you work to or from are fairly generic and cross jurisdictionally nonspecific. A seizure is a seizure and will respond to midazolam the same down the street or on the other side of world just like if you zap somebody in VF the effect of cardioversion is no different wherever you are.

Legislatory and regulatory frameworks differ from one jurisdiction to another; California is quite tightly legislated and each EMSA has thier own standing orders whereas in the UK the Joint Royal Colleges Ambulance Liason Committee has establishes the guidelines UK Paramedics work from. There is also disagreement between medical directors as to the objectivity and validity of evidence and as such you get variation between protocol, guideline or standing order.

The modality of treatment is very narrow requiring little knowledge and a high degree of dexterious skill e.g. draw up midazolam and administer, how to size a hard collar while the cognitive knowledge required to make good functional linkages and use the modalities of treatment is somewhat more substantive.

A good example is chest pain and GTN; sure you can be a protocol monkey and give everybody with chest pain some sublingual GTN but if you have are a thinking and well educated Paramedic you know to check for signs of a right ventricular infarct first.

The National Registry is attemtping to ensure that people have the knowledge to be proficent, thinking, clinically sound Paramedics and not just protocol monkeys.

If you have the right knowledge the specifics of a modality of treatment is really fairly benign and should not be an issue if your guideline changes because you moved from jurisdiction A to jurisdiction B.

agreed on your point concerning modality and knowledge to treat. but when you're a student and a complete novice you'd want some consistency in reading materials while also presenting the material in some logical sense.

an example in my class would be the following - we're learning pt assessment currently- so you have your scene size up, initial assessment, rapid/focused assessment, baseline, sample, ongoing -

we have the orange book and some sheets full of acronyms (presumably from the NYS protocols) - the steps are somewhat different in sequence.

i asked the instructor do we have to follow the pt assessment step by step - he said yes and no - you have to following the main points.. that is in ABC, the B need needs to fall in between A and C - but within B you can perform OIPASS or IPASSO doesn't matter as long as you get it performed.

specific example on the recent test for ongoing assessment.. what should you do first for ongoing assessment? repeat vitals or repeat initial assessment.

i asked the instructor that's an unfair question because he said if it was within that framework the steps doesn't really matter as long as it gets done.

in ongoing assessment you have to repeat initial and vitals so according to him it doesn't matter what i do first.. but the test specifically asks what should be done first in the ongoing assessment.

that's the consistency i'm looking for. sure, nothing goes textbook but as a student i need the consistency first.

 

[Shishkabob]

Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.

Vitals aren't part if the primary survey, initial assessment or what ever you call it.

 

[Veneficus]

you can perform OIPASS or IPASSO doesn't matter as long as you get it performed.

Can somebody tell me what that even means?


Afterword, might I suggest not trying to dumb medicine down to a series of acronyms and memory aids without learning the why behind it or at the very least what you are using memory aids for?

Otherwise you get idiots looking for DCAPBTLS but have no idea what the significance of any of it is.

 

[EMTBWannabe]

Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.

Vitals aren't part if the primary survey, initial assessment or what ever you call it.

funny you should say that... after the exam the instructor said he would have picked repeat vitals before repeating initial.. however i did choose repeat initial.

it's a fair question if he said we must adhere to the steps not as long as we perform it within that frame.

i'm gonna fail now... cuz he's probably monitoring this forum. haha.

 

[EMTBWannabe]

Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.

Vitals aren't part if the primary survey, initial assessment or what ever you call it.

no it's part of the ongoing assessment. my question was based on ongoing not initial...

 

[EMTBWannabe]

Can somebody tell me what that even means?


Afterword, might I suggest not trying to dumb medicine down to a series of acronyms and memory aids without learning the why behind it or at the very least what you are using memory aids for?

Otherwise you get idiots looking for DCAPBTLS but have no idea what the significance of any of it is.

i need to memorize it in the "B" section - IPASSO = inspect, palpate, auscultate, seal, stablize, Oxygen (administration) - sorry.. i'm a NOOBIE.

 

[EMTBWannabe]

Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.

Vitals aren't part if the primary survey, initial assessment or what ever you call it.

here's another thing why do we have to call initial assessment by a few different names.. initial assessment aka primary assessment aka primary survey... ah well i guess there's always going to be multiple names for the same thing.

 

[JPINFV]

There is a National Registry of EMTs isn't there? That's one specific set of standard of knowledge for those who decide to take the national registry. the national registry isn't studying all 50 states protocols - it's a non-state non-regional set of standards.

don't you think?

each state, even down to the city level has their own set of protocols. i think it's weird.

Your confusing curriculum with standards. There's only 1 US Medical Licensing Exam (USMLE) and only 1 Comprehensive Osteopathic Medical Licensing Exam, but there's currently 130 ways to make an MD and 28 ways to make a DO since there is no set curriculum for teaching medical students.

Should EMS have a set standard for what each EMT and paramedic needs to know? Yes.

Should anyone be dictating how a school takes a student and makes them meet that standard? No.

 

[MrBrown]

Should EMS have a set standard for what each EMT and paramedic needs to know? Yes.

Should anyone be dictating how a school takes a student and makes them meet that standard? No.

That is what the National EMS Education Standards go aways to fixing since they are replacing the National Standard Cirricula

 

[John E]

Getting back to your original question...

you, and the rest of the class apparently, failed to differentiate between a condition that "occurs" and a "threat" if the test question was worded the way you relayed it.

Menopause isn't a threat to anyone other than the people living with the woman undergoing it. It's part of the natural path of life.

Cancer on the other hand, is a disease which kills people, it's a threat.

What would have been even more interesting would have been having heart disease in the list of potential threats, it kills more women than men but there are more forms of cancer and the odds of contracting one or more of them is higher than the odds of contracting heart disease.

If you think about what the test question is really asking you, you'll usually find that the correct answer will jump off the page. Don't get tied up with facts not in evidence or thinking beyond the scope of the questions asked.

Now back to modalities...

John E

 

[joeshmoe]

emtwannabe....I think you should spend time thinking logically about WHY you do certain things and WHY you should do them in a certain order, instead of just robotically memorizing x comes before y.

For instance take the ongoing assessment. Think of WHY it makes sense to repeat the initial assessment before retaking vitals...rechecking a pt's mental status, airway, breathing and circulation is something that can be done quickly and as you have learned by now, the ABC's, especially airway, take priority. So it makes sense to do that BEFORE, say, rechecking someones BP and temp.

You cant reduce everything to some cookbook recipe, there has to be some critical thinking and decision making involved which requires some understanding of what is happening and why. This can take some time and thought to develope. You may not learn everything you need to know in class, reading and studying on your own is required.

 

[EMTBWannabe]

emtwannabe....I think you should spend time thinking logically about WHY you do certain things and WHY you should do them in a certain order, instead of just robotically memorizing x comes before y.

For instance take the ongoing assessment. Think of WHY it makes sense to repeat the initial assessment before retaking vitals...rechecking a pt's mental status, airway, breathing and circulation is something that can be done quickly and as you have learned by now, the ABC's, especially airway, take priority. So it makes sense to do that BEFORE, say, rechecking someones BP and temp.

You cant reduce everything to some cookbook recipe, there has to be some critical thinking and decision making involved which requires some understanding of what is happening and why. This can take some time and thought to develope. You may not learn everything you need to know in class, reading and studying on your own is required.

i agree with you 100%.

 

[Veneficus]

i need to memorize it in the "B" section - IPASSO = inspect, palpate, auscultate, seal, stablize, Oxygen (administration) - sorry.. i'm a NOOBIE.

Whoever came up with that should be beaten prior to being permanently barred from EMS or any educational undertaking.

 

[wannabeemtb]

Apologies for not checking the thread in some time, for some reason it stopped emailing me replies.

I've got things more or less worked out at this point, I was mostly stressed over my scores because I believed (at the time) that they had a direct correlation to the level of patient care I would be able to provide. I've since spoken to a half dozen Basic's and Paramedic's who assure me this is not the case. Passing is passing, and that's good enough for me, I don't really even look at my score on the tests anymore.

I completed my first mandatory rideout earlier this week, and scheduled another in a couple weeks just to get more field experience. Class is over in a month or so.

Thanks for all the replies, they were a big help.

 

[Fox]

Whoever came up with that should be beaten prior to being permanently barred from EMS or any educational undertaking.

I have to agree with this.

Sounds like this instructor is just teaching memorization to me. Making up acronyms to assist with memorization.

 

[Cohn]

Hi all, I'm a first time poster, so if this in the wrong place, I'm sorry. Also, if this question has been answered elsewhere, sorry for the double post, I searched, I really did.

My names Ben, I'm 30 years old, and I recently started an EMT-B class.

I'm having a problem with the class/instructors. We're studying Prehospital Emergency Care, Ninth Edition by Mistovich/Karren published by Pearson. We've got the main book, a workbook, and access to a website with practice tests and games. We're taking a test at the end of each module. We're told that 70% is a passing grade, that we can take a test again if we fail the first time, but if we fail twice, we're dropped from the class, and that these are DOT standards. We're also told that we must pass one module before being allowed to continue on with the next module. We're usually given a 10% bonus for correctly labeling a diagram, so far of the heart, skeleton, etc...

My issue is that text seems to bear little relation to the test. The rules seem to be against giving specific examples in this forum, so I'll refrain. I've taken 3 module tests so far, and passed all three. The first I got a 94 (104 with bonus), the second 78 (88 with bonus), and the most recent 76 (most likely 86 with bonus).

I study for a minimum of eight hours before every test. I'm present for every class. I fill out my workbook. I take the practice test online multiple times. I've spoken with two instructors so far about my performance on the test. I've voiced my concern that the text bears little relation to the test. I've been told their's nothing they can do, it's just the way that it is. When I asked for additional resources to study to improve my grade, I was referred to Barnes and Noble to read guides they had there.

I'm very frustrated with this advice from my instructors. Being told that's just the way it is doesn't offer any sort of actionable information that I can glean, perhaps it's just some inside EMS code that I've not been taught yet? The Barnes and Noble advice, while actionable, is a dead end. The study guides are designed for the entire test, and I'd really need something that was targeted toward the module test I was taking.

My question to any of you who've read this far is what would you do in my situation? I want to be an EMT. I want to pass my module test. I'm willing to whatever work is required to do that, I just have no idea where to start. I don't know what I don't know.

Thanks for reading all this, felt good just to get it out there if nothing else.

you got it good buddy... 80% and lower is a fail when I went to school.

 

[mycrofft]

NOTHING personal to the OP, but...

...generically, when I read these posts, I get this question in the back of my mind as to whether they are just trainees complaining due to their not cutting it, or not understanding the process, or are these factual events of stupid, crazy or macho instructors?
Maybe a FAQ needs to be drawn up. Same issues time and again.

My stock answer: you paid for it, if it sucks get your money back or stop payment on your credit card and get another class. If enough people do that the trainers will go out of business or figure it out and straighten up.

 

[Focallength]

70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.

I have a question why would you think menopause is a threat as opposed to cancer? Cancer is a disease, menopause is something every woman of a certain age goes through, its a biological function. You cant die from menopause

 

[Fox]

70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.

we had to have an 84 or higher on everything.

 

[rescue99]

70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.

Yeah, they all say how amazing their pass rates are. What you will never see is any school proving it. I can hardly wait until the day NR and my state starts showing those amazing pass rates on line!

I have a question why would you think menopause is a threat as opposed to cancer? Cancer is a disease, menopause is something every woman of a certain age goes through, its a biological function. You cant die from menopause

Many cancers are fueled by hormones, male and female alike. Take away the fuel and cancer may be curable or put into remission. And, while one may not die from menopause, the negative hormone state increases disease potential. Same goes for men.