So during a break I was thinking...
A few years ago one of my coworkers, who was a medic for easily 2 decades longer than me, had to take a state test in order to get his EMS instructor certificate. Being very knowledgable, he did pass on the first try. But he admitted it was close.
That 2000 curriculum change had caught him rather off balance. He complained that a medic didn't need to know what medication to treat hyper K+ with or what the most likely symptom of an Fe overdose was.
A decade on, we have just instituted another major change. But this one is not only creating headaches for students, many instructors are finding themselves no longer up to the task of teaching the curriculum. (which was forseen)
During a teaching staff meeting late last year, one of the major issues was that EMT-B instructors who were not medics did not know acid/base balance themselves but were now expected to teach it. How were we going to schedule medic instructors to cover that material when the classes ran simultaneously?
For the last 2 years, the topic of "metabolic pathways" was witheld on the schedule to make sure I was available to teach it. I am the only medic instructor at the institution that understands it. The attempt to use a publisher made powerpoint on the topic had failed terribly.
Now it seems every EMS publisher has caught on to the need to create bullet point presentations to memorize on the new additions of basic science.
Except science doesn't work like that.
You cannot make it an order of operation to perform or a list to be memorized.
As such, many students are suffering because of the lack of instructor knowledge all over the US.
Simply having experience working in the field is no longer sufficent to teach.
I can't help but wonder if the rash of students needing to retake registry multiple times is because instructors are trying to cram in as many disconjoined medical facts as possible into students and hoping it will have the same positive outcome on a test as drilling psychomotor skills in lab for practical tests.
Now consider the disproportionate time spent with skills comparitively. 4 clock hours of metabolic pathways lecture (which is really 3 because there is a 15 minute break per hour) and then 4 hours on lab skills.
One of the first skill taught in medic class is how to start an IV. With one maybe 2 days spent on it before releasing people to the street/hospial to do it.
But look at the hours upon hours of intubation practice. On a grand scale, considering how little it is used, how little time it makes a difference when it is, and how only the finest agencies spend the resources to maintain proficency of providers, and best of all, when it can no longer hurt, even a basic is allowed to try to put in a tube.
Moving on, it seems almost blasphemy not to spend a solid 2 weeks on cardio. Plus an EKG workbook so you can identify any basic rhythm you see in less than a second before you rattle off a cookbook treatment without even considering an underlying pathology that would render such treatment moot.
How long does your class spend learning the national registry acceptable way to put on a KED or a traction splint? Does this match how often those devices are used in the field?
I think not.
But you drill, and can perform.
Med math
Megacode
trauma assessment
You can run through the skill sheets blindfolded.
But it doesn't translate to the field the way you practice (drill) it.
Then your agency requires "training" which you think needs to be kept "interesting" to maintain your ability to triage a teddy bear with a piece of paper on it or intubate and bag a patient in the dark, under the bed, with your off hand, using an adult bag on an infant doll. (just in case)
You learn it so well, you don't know that you cannot stabilze a perfectly in an extrication like you can your classmate sitting in a chair.
You can't even tell who needs medicine, who needs an ED, and who doesn't because you are trained for patients that rarely exist anymore. Whether it is the massive trauma patient or the crushing substernal chest pain radiating to the arm and jaw. Patients rarely present in those ways.
So you are given a few caviats to help. Like remember to run a 12 lead on a 95 y/o female who has abd pain and diabetis.
Maybe you are told not to give nitro to a right-sided MI.
But it all comes down to the point.
Whether you have a degree or not, EMS has and is changing. It is not a set of helpful skills to be provided by a techincally educated tradesman.
No matter how good your skills, if you cannot apply biochemistry on your medic test or explain Poiseuilles's Law as it relates to vascular dynamics, you will not be a paramedic. Not because I said so, but because you'll never pass the test with your knowledge of when and how to apply a few skills.
So if you have trouble with math and chemistry and all those other "book learnings" like physiology and pathophysiology, you may want to start taking a few classes before medic or consider another career.
Your ability to intubate Fred the head, hold c-spine, start an IV, and put on a KED aren't going to get you by and if there is a deficency in the knowledge of your instructor, all of the war stories, what they think really matters in the field, and what they say you can forget after class is over won't get you by anymore either.
Degree or not, there is a shift from skills to education in EMS.
Maybe that is why they took the "EMT" off the front of paramedic
Just something to think about the next time you drill or go to skills lab.
A few years ago one of my coworkers, who was a medic for easily 2 decades longer than me, had to take a state test in order to get his EMS instructor certificate. Being very knowledgable, he did pass on the first try. But he admitted it was close.
That 2000 curriculum change had caught him rather off balance. He complained that a medic didn't need to know what medication to treat hyper K+ with or what the most likely symptom of an Fe overdose was.
A decade on, we have just instituted another major change. But this one is not only creating headaches for students, many instructors are finding themselves no longer up to the task of teaching the curriculum. (which was forseen)
During a teaching staff meeting late last year, one of the major issues was that EMT-B instructors who were not medics did not know acid/base balance themselves but were now expected to teach it. How were we going to schedule medic instructors to cover that material when the classes ran simultaneously?
For the last 2 years, the topic of "metabolic pathways" was witheld on the schedule to make sure I was available to teach it. I am the only medic instructor at the institution that understands it. The attempt to use a publisher made powerpoint on the topic had failed terribly.
Now it seems every EMS publisher has caught on to the need to create bullet point presentations to memorize on the new additions of basic science.
Except science doesn't work like that.
You cannot make it an order of operation to perform or a list to be memorized.
As such, many students are suffering because of the lack of instructor knowledge all over the US.
Simply having experience working in the field is no longer sufficent to teach.
I can't help but wonder if the rash of students needing to retake registry multiple times is because instructors are trying to cram in as many disconjoined medical facts as possible into students and hoping it will have the same positive outcome on a test as drilling psychomotor skills in lab for practical tests.
Now consider the disproportionate time spent with skills comparitively. 4 clock hours of metabolic pathways lecture (which is really 3 because there is a 15 minute break per hour) and then 4 hours on lab skills.
One of the first skill taught in medic class is how to start an IV. With one maybe 2 days spent on it before releasing people to the street/hospial to do it.
But look at the hours upon hours of intubation practice. On a grand scale, considering how little it is used, how little time it makes a difference when it is, and how only the finest agencies spend the resources to maintain proficency of providers, and best of all, when it can no longer hurt, even a basic is allowed to try to put in a tube.
Moving on, it seems almost blasphemy not to spend a solid 2 weeks on cardio. Plus an EKG workbook so you can identify any basic rhythm you see in less than a second before you rattle off a cookbook treatment without even considering an underlying pathology that would render such treatment moot.
How long does your class spend learning the national registry acceptable way to put on a KED or a traction splint? Does this match how often those devices are used in the field?
I think not.
But you drill, and can perform.
Med math
Megacode
trauma assessment
You can run through the skill sheets blindfolded.
But it doesn't translate to the field the way you practice (drill) it.
Then your agency requires "training" which you think needs to be kept "interesting" to maintain your ability to triage a teddy bear with a piece of paper on it or intubate and bag a patient in the dark, under the bed, with your off hand, using an adult bag on an infant doll. (just in case)
You learn it so well, you don't know that you cannot stabilze a perfectly in an extrication like you can your classmate sitting in a chair.
You can't even tell who needs medicine, who needs an ED, and who doesn't because you are trained for patients that rarely exist anymore. Whether it is the massive trauma patient or the crushing substernal chest pain radiating to the arm and jaw. Patients rarely present in those ways.
So you are given a few caviats to help. Like remember to run a 12 lead on a 95 y/o female who has abd pain and diabetis.
Maybe you are told not to give nitro to a right-sided MI.
But it all comes down to the point.
Whether you have a degree or not, EMS has and is changing. It is not a set of helpful skills to be provided by a techincally educated tradesman.
No matter how good your skills, if you cannot apply biochemistry on your medic test or explain Poiseuilles's Law as it relates to vascular dynamics, you will not be a paramedic. Not because I said so, but because you'll never pass the test with your knowledge of when and how to apply a few skills.
So if you have trouble with math and chemistry and all those other "book learnings" like physiology and pathophysiology, you may want to start taking a few classes before medic or consider another career.
Your ability to intubate Fred the head, hold c-spine, start an IV, and put on a KED aren't going to get you by and if there is a deficency in the knowledge of your instructor, all of the war stories, what they think really matters in the field, and what they say you can forget after class is over won't get you by anymore either.
Degree or not, there is a shift from skills to education in EMS.
Maybe that is why they took the "EMT" off the front of paramedic
Just something to think about the next time you drill or go to skills lab.
