Tailoring Learning to the Learner
There is a growing concern about the state of EMS refresher and recertification education. Many worry it’s too basic, inadequately meets the needs of professionals across diverse work environments, and discourages our people from pursuing education opportunities beyond minimum requirements.
A greater tailoring of EMS education to individual needs can address these concerns. We can achieve this through individual paramedic learning plans based on three central pillars.
Pillar #1: Data-Driven Education
EMS agencies now collect an enormous amount of dispatch and patient care data in sophisticated programs that can intelligently analyze it for patient care trends, protocol adherence and community events. I envision automated analysis based on specific biological events or patient outcome measures.
For example, many EMS agencies provide annual training about influenza and droplet precautions. Because we don’t know exactly when influenza will arrive, we usually deliver the training in early fall, well before it’s actually needed. By the time influenza arrives, if at all, the training is forgotten or poorly remembered.
In a data-driven education system, an automated analysis of CAD and PCR data would recognize the arrival of influenza based on patient complaints, symptoms reported and provider diagnoses. That surveillance marker, when triggered, would automatically assign an influenza training program to all system paramedics. That program would be immediately relevant and useful, and could be completed before the peak of influenza patients.
Other potential uses for data-driven education include:
Protocol adherence—EtCO2 monitoring is the standard for any intubated patient, but we know it is often not used. Rapid analysis of PCR data could immediately check for intubations performed and EtCO2 monitoring. If capnography was not performed, a series of automated actions might include a template e-mail from the medical director with a link to a form asking the paramedic to explain why EtCO2 was not used and how airway placement was confirmed. The same e-mail could include a link to a PDF of the airway management protocol, an instructional video of adding EtCO2 monitoring to the airway circuit, and an assignment to complete an online CE module on interpreting capnography waveforms.
Skills competency—We’ve all heard complaints that certain providers seems to always magically have patients with blood pressures of 120/80—regardless of the patient’s age, condition or medical history. An automated analysis of PCR data could search for documentation anomalies by analyzing the last 100 blood pressures measured by each provider and then alert a QI manager of providers who have 90% of documented systolic blood pressures between 115–125 mmHg. Suspicion and time-consuming investigation are removed from the process because the data is always being analyzed for every provider.
Correct diagnosis and treatment—Correctly assessed heart failure treated with CPAP and nitroglycerin is known to reduce the need for intubation, length of hospitalization and risk of hospital-acquired infections. Ongoing data analysis could always be looking for the proper assessment and treatment steps for heart failure. If, on the last five heart failure encounters, a paramedic only applied CPAP two times, that could be a trigger for automatic assignment of a CE module on heart failure, an invitation to skills lab to practice assembling the CPAP device, and an appointment at the simulator lab to practice and be checked off on assessment and treatment of heart failure.
Conversely, if a paramedic has correctly assessed and treated all their recent heart failure patients, continuing education on heart failure, at least at the same level as the underperformer, is not only unnecessary but a waste of time and resources. Instead, use other data-driven education, as well as pillar #2, to help high performers continue to broaden and deepen their knowledge of heart failure and other problems.
Low-frequency encounters—Depending on your service area, there is likely a known subset of low-frequency encounters. In a heavily geriatric community, for instance, a paramedic could go months without encountering a pediatric patient. A simple automated analysis of CAD data could determine which paramedics have not had pediatric patient encounters and then assign appropriate continuing education modules, case reviews and observation opportunities. Similarly, if a paramedic has gone a certain time period, such as 24 months, without encountering a patient in active labor, they could be scheduled for a practice delivery in the simulation lab or live birth observation/assistance at the local hospital.
Pillar #2: Development of Niche Expertise
I believe paramedics are most effective when they develop niche expertise or specialization within the broader field of paramedicine. Part of individual learning plans would be annually or semiannually outlining self-study plans based on individual interests and career goals. Each paramedic would present this plan to their training director to receive affirmation and support of their goals, as well as to create accountability.
There are plenty of opportunities for specialization within paramedicine, a field where we generally know a little about a lot. For example, a paramedic could outline a plan to learn more about 12-lead ECG interpretation, airway management, environmental emergency assessment, pediatric trauma pathophysiology or any number of clinical topics through activities like seminars, online training programs, books, expert interviews and preparing training programs.
We also know there is a need for paramedics to develop nonclinical skills and competencies to prepare them to advance into EMS leadership positions. Training directors could serve the succession needs of their organizations as well as the profession by supporting employee plans to grow in areas like leadership, finance, education, risk management, information technology, marketing, software development, community outreach and injury prevention.
This pillar would be a logical place to support coursework that puts a paramedic on the path toward completion of an associate or bachelor’s degree, or even beginning the process of pursuing a graduate degree. Imagine if every year one of your organization’s paramedics was publishing an MS research thesis on a topic relevant and beneficial to your organization.
Pillar #3: Training Officer-Assigned Education
There will always be a need for education assigned by a training officer to all paramedics across an organization or groups of paramedics within an organization. Courses in this pillar would include compliance topics (e.g., bloodborne pathogens and respiratory protection) to meet regulatory requirements and service-specific training on topics like documentation, customer service and vehicle operations. It is essential these courses be relevant and specific to the EMS workplace to be valued by the workforce and actually applied.
The number of courses within this pillar will likely be determined by the training officer’s trust in the efficacy and effectiveness of pillars #1 and #2. I imagine that initially this pillar will make up a majority of paramedics’ education and could be potentially crowded with the tiresome refresher courses that already reteach initial education. As paramedics transition to self-directed learning and data-driven course assignments, the amount of time in this pillar should decrease significantly.
Another option to reduce time spent on training director-assigned education is to use competency-based education. Assess competency with written, oral and skill exam stations. Paramedics who pass the test don’t need instruction on the learning objectives tested and can complete additional pillar #1 and #2 training. Paramedics who fail need time for competency practice and instruction.
What is your take on the idea of individual paramedic learning plans and the pillars described above? What would you add or change? What are the barriers to implementing something like this, and how can we overcome them?
We know we need something better. We will only find it if we start trying something different. I look forward to hearing your experience and ideas.
Greg Friese, MS, NREMT-P, is the director of education for CentreLearn Solutions, LLC. Greg is a conference speaker, published author and marathon runner. Connect with him at firstname.lastname@example.org.