EMS Revisited: Advancing the EMS Education Process

EMS Revisited is an exclusive column that offers reprints of various columns and articles from our archives that are not currently available in electronic format. This article originally appeared in the April 2003 issue of EMS Magazine (now EMS World Magazine).

In EMS as elsewhere, some EMS students learn faster and with greater ease than others. Why, then, are most EMS education programs equal in length for all students (based upon the number of hours spent in the classroom)? A student who falls behind classmates may be required to spend additional time reviewing material, but the opposite--moving students forward as they demonstrate mastery of the material--is relatively uncommon. Requirements for hours spent in the classroom, while meeting national guidelines, do not truly reflect the students' capabilities or patients' expectations. An hour spent in the classroom does not automatically equal improved performance.

Creative Solutions to Tough Times

In an era where increasing demands are being placed upon the shrinking resources of healthcare, it seems reasonable to take a fresh approach to the concept of educational efficiency. One way to do this is to examine the possibility that learners should stay in programs only as long as it takes them to meet or exceed the educational goals of EMS training. Training to meet or exceed standards is a part of most EMS programs, but the measurement of success is typically the number of students who meet the minimum standard: passing a state test.

Of course there must be some method of ensuring competency in those who are fast-tracked. One way of advancing high-scoring students, if your program's testing standards are sufficiently reliable, is to identify them first using a short version of the test, thus saving time, sweat and tears for both students and faculty. Only students who don't do extremely well on the initial short version require more extensive training and testing, which establishes their performance level with greater accuracy and confidence.

It also seems logical to define increasing levels of competence we want EMS students to achieve at the various stages of their education. Measure and validate their progress frequently against these criteria, then send them on their way to the next level of training once they meet each standard, not waiting for some pre-defined period of time to pass.

Validating Performance

EMS students learn from studying and classwork, but most of all from taking care of patients. The competence of EMS clinicians grows with time and increased patient contacts. Yet EMS training programs focus primarily on classroom hours, test scores and psychomotor testing. Exams simply may not measure many of the more important elements that make up clinical competence in the field: experience, judgment and patient empathy. Indeed, over-reliance on simple, easy-to-implement testing methods may account for much of the observed decline in EMS clinicians' performance over time. We all know the minimum passing score prior to taking a test; how many of us can get extra credit for expanded knowledge?

Pacing students according to performance and not hours spent in the classroom would pose daunting logistical problems. How could an EMS educational program plan--hire faculty, line up field experiences, schedule classes and lab time and put together "coverage" for clinical services--if planners were never certain how many students would be arriving, how long they would be staying or when they would be leaving?

The reality of training to competence would be the need to determine what level of competence students would have to achieve before moving on to the next training segment. A system in which they needed only to perform at a "lowest common denominator" (LCD) level, consistent with safety but nothing more, would be neither practical nor credible. It would lead to mediocrity and a downward spiral of declining goals, and students at the higher end of performance would lose the opportunity to improve.