Remaking the Recert

     I renew my paramedic certification every three years and my National Registry every two. In four out of every six years, I must complete some form of recertification process, and over a 35-year career, I will do that 23 times. The process and refresher course content have not substantially changed since the beginning.

     How can my recertification/reregistration be more efficient, challenging and customized to what I need? How can it better prepare me to do my job and help raise my standard of care without simply increasing classroom hours? And why do I have to complete it away from home or work, on someone else's schedule? The computer may answer all these concerns, and perhaps allow educators to achieve greater levels of objective, competency-based education.

     THE PROBLEM, THE SOLUTION

     To ensure EMS providers are minimally competent, certification bodies like the NREMT and state EMS offices are forced into the current continuing education design. That design must be reasonable for attendees and cost-effective for course sponsors. Hour and curriculum requirements are based on the minimum time and content it takes to bring the poorest practitioners to competency. The rest of us are along for the ride. The resulting traditional recertification regimen condemns us to attend, en masse, regurgitations of the most basic material to simply assure we leave with minimum required knowledge and skills. This occurs regardless of our assessment, medical emergency, trauma and special-patient knowledge. Certification and registration bodies have lacked other ways to assure the public that refresher graduates have the knowledge they require-those minimum competencies.

     A better solution may be found at your keyboard. The computer has tremendous energy to work for us, at our convenience. The power of computer-enhanced education was best described 25 years ago by educator B.F. Skinner when he predicted, "Classrooms seen to be filled with computers which would act as infinitely patient tutors, scrupulous examiners, and tireless schedulers of instruction." They go relentlessly about assigned tasks with unfailing patience and uncompromising adherence to defined standards. And they are available for individual use whenever and, for the most part, wherever they're needed.

     COMPUTER-ENHANCED EDUCATION

     Computer-enhanced education (CEE) uses computers' computer-enhanced educations to improve the educational experience. The most basic of these computer-enhanced educations are computer-based evaluation, enhanced electronic textbooks and computer-based patient care simulation. Integrated into learning systems, these components can change the face of recertification. An example of this computer-based recertification might measure your initial knowledge and identify your strengths and weaknesses. With this information, it constructs and presents an educational program to address your specific needs, both absolute (not meeting a competency) and relative (competent but weaker performance). CEE then rehearses your knowledge and judgment on simulated patients. Finally, it remeasures your competencies and, if indicated, remediates and retests you. In the time you'd spend before an instructor (with 20 other refresher students), you receive an individual educational experience that assures you acquire the knowledge necessary to provide good emergency care.

     COMPUTER-BASED EVALUATION

     You sit at your laptop, open your refresher program and begin with a test. The computer asks you questions regarding the essentials of emergency care. As you answer correctly, you advance to the finer points of prehospital practice. Your answers define where you demonstrate mastery, where you demonstrate competency but not strength, and where you just don't know all you should. After you move through the elements of EMS content-the EMS system, anatomy and physiology, assessment, medical emergencies, trauma emergencies, special patients and EMS operations-the computer analyzes your responses and formulates an educational experience for you. That program ensures you meet all the competencies of an EMS provider (and those established by your certification/registration body). It also provides information to address your weaknesses and may provide elective enhancements to help you grow professionally or investigate areas of interest.