Last month we discussed the concept of commitment to excellence. We looked at several aspects of EMS and how this concept applied to our practice. A commitment to excellence is about always striving to improve and the personal choices we make to do the best we can. This month we examine a related behavior: commitment to scholarship. Our series guide, Dr. Herbert Swick, observed that "physicians exhibit a commitment to scholarship and to advancing the field."1 Such a commitment, being bound emotionally and intellectually to a course of action, is a part of professional behavior.
Scholarship is "knowledge resulting from study and research in a particular field,"2 "learning; knowledge acquired by study,"3 or "creative intellectual work that is validated by peers and communicated broadly."4 How is a commitment to scholarship important to EMS practice?
Scholarship in EMS
Emergency medical services is a relatively new discipline. It began in 1966, when the National Academy of Sciences Committee on Trauma and Committee on Shock released a 37-page document entitled Accidental Death and Disability: the Neglected Disease of Modern Society. This publication, often referred to as the EMS "white paper," was one of the initial triggers for the development of EMS in America. Counting from that beginning in 1966, EMS is now all of 44 years old. As a very young discipline, we have only a small volume of solid scientific studies directed at answering the questions we need answered to move our practice forward.
The impact of our youth is compounded by other factors. EMS is not actually a single discipline but many, often conflicting, areas of practice and endeavor. This is both an opportunity and a curse. There is opportunity for research in many areas. There are innumerable questions we can ask and seek answers to concerning the aspects of practice that make up EMS. The downside is that we are competing for resources, and many of us do not have the education, skill or knowledge to complete the research required to answer the questions. I would argue that we often don't even know the right questions to ask.
As with medicine in general, progress in EMS is fostered by research and scholarship. We must acquire the knowledge, skills, abilities and attitudes that will allow us to identify the most important questions. EMS needs practitioners who are committed to scholarship to identify root problems, to ask the right questions, and to do the work to find the answers.
How many of you have heard the term evidence-based practice? Evidence-based practice is "the practice of healthcare in which the practitioner systematically finds, appraises and uses the most current and valid research findings as the basis for clinical decisions. The term is sometimes used to denote evidence-based medicine specifically but can also include other specialties, such as evidence-based nursing, pharmacy and dentistry."5 The important part is "the most current and valid research findings." For there to be evidence-based EMS practice, there must be EMS research. It seems we need "EMS scientists": educated individuals with the support of academic institutions and the resources, time and money to spend on the research process.
If we argue that EMS professionals should, like physicians, exhibit a commitment to scholarship and advancing their field, it follows that we all should in some way participate in research. We all can become EMS scientists on some level.
The first step is learning how to find, read and evaluate scientific literature that applies to EMS. Where can we find that? There are several scientific journals that include peer-reviewed articles applicable to our practice. These include Prehospital Emergency Care, Prehospital and Disaster Medicine, Journal of the American Medical Association, Emergency Medicine, The Journal of Emergency Medicine and Annals of Emergency Medicine. There are also trade journals like EMS Magazine. Although trade journals do not generally include peer-reviewed articles reporting on original scientific research, they are excellent resources. They include valuable information, and reading them should be a part of your scholarly EMS pursuits.