Hidden Crisis: Ethics Breakdown in Massachusetts
What have we learned from the great recertification scandal?
We have allowed a system to survive that encourages these problems. The major problems noted in the program centered on refresher courses and timing.
Anyone in EMS for more than four years has probably learned to look upon refreshers with trepidation and angst. They can be rote and incredibly boring. Instructors who attempt to add variety and updated material are told by their superiors to “stay with the program.” Indeed, many instructors themselves abhor teaching refreshers.
We need to rid ourselves of the word and concept of refresher and substitute what the public really expects: a recertification. We need to prove to the public that we are current, not “refreshed.” Other professional organizations recertify their members and in doing so evaluate their competencies and current knowledge in their specialty areas.
Another option is tailored refreshers/recertifications. In this model, students take an extensive exam before a class begins. The class is then tailored to what the exam shows the students’ needs are. Areas the students master are not reviewed; areas where they score poorly are emphasized. In this way, the class focuses only on areas of actual need, and instructors have time for updating and new material—those things EMS providers attend continuing education programs to receive.
The downsides of this concept are:
• Class sizes must be kept small. This is the only way in which individual needs can be appropriately addressed.
• Instructors must be flexible and adaptable to meet students’ needs.
A final system failure is the two-year recertification model. Refreshing this often is costly and unnecessary. Continuing education is necessary to maintain knowledge and proper to require of all professional EMS personnel, and may be able to bridge longer intervals between recerts. Indeed, many providers would seek out and attend CE courses even if they were not required. One of the involved individuals stated, “Double my continuing education, but don’t make me take a refresher!”
If an EMT or paramedic were to join a new class of graduates and take a complete certification exam (reboarding, in other medical specialties), they could be comfortably certified for 4–6 years, having proven they have the core abilities to be recognized in EMS.
Ethics Training
A recent article by Craig Klugman, PhD, argued for an updated and appropriate set of ethics for EMS.3 Klugman cited a 1992 study that found that 14.4% of all EMS responses involved ethical conflicts.4 Now, almost 20 years later, we need to address these issues. We need to provide real ethics training for those involved in patient care that addresses conflicts we face in our day-to-day work—real situations that need to be viewed in realistic terms. This cannot be just a quick mention during the “roles and responsibilities” section of our initial training. It needs to be organized and appropriate for our day-to-day needs.
The implications of 18% of our cumulative control group admitting to claiming they attended classes they didn’t are enormous. In one of those classes, a paramedic refresher with both new and old individuals from mixed backgrounds (fire, public, private and third-service), 42% of the individuals did not check Not applicable, has never happened.
So just how deep does this problem run, and how long has it been running? The author remembers attending one of his first CE classes after being certified and being asked by a coworker, “Would you sign me in? Here is my EMT number.” That was 30 years ago.
Cheating is not new, nor is it limited to these individuals. There have been scandals involving EMS ethical missteps across the country. This case just happened to be especially large and well publicized.
Managers, regulatory agencies and individual providers in their own capacities need to examine this problem and find answers now. To wait is to ignore another ticking time bomb.
