EMS Revisited: 20 Pearls of Great EMS Instruction
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 first appeared in the July 2001 issue of EMS Magazine.
You enter to find that the coffee is gone, the copier is down again and the dry-erase markers are dried out. The first words you hear are, "What time are we getting out of here today?" So begins the day of the EMS educator.
EMS educators are a special breed. They are called upon to teach to a diverse group of adult learners. Some of these learners are young adults aspiring to new careers in EMS or the fire service. Some are current EMS providers elevating their levels of certification. Finally, there is the "captive" audience of seasoned providers assembled to meet their continuing-education requirements.
This last group is perhaps the most challenging for an EMS educator--it is difficult to face a roomful of veterans who are there because they have to be. Collectively, this group poses the question (sometimes silently, sometimes aloud): "What can you tell me that I haven't heard before?"
After spending a few years as both a student and an educator, I have come to believe that there are certain truths about great EMS instruction. Some people call them "pearls" because they are hard to find, and even one is worth a fortune. In this article, you will read this educator's opinion on the top 20 pearls of great EMS instruction.
1) The Best Way to Teach a Great Class Is to Teach a Lot of Classes. Babe Ruth is remembered for his home runs, not his strikeouts. He had a lot of both. Get in the game. Make every teaching opportunity a learning experience. Experiment with something different and see how it works. Start by captivating your audience. Suppose you're asked to present to a group of experienced EMS providers who are there only because they have to be. If you attempt to baffle them with BS, they will eat you alive. Although they may be skeptical that you have anything new to offer, they will usually give you a fair shot at it before attacking. Show them that you have something worth hearing and do it early. If you can hook them in the beginning, they will listen and learn. They might even thank you. It could happen!
2) Recognize the Unique Characteristics of Adult Learners. Adults learn differently. They are different from other learners and even each other. They bring life experience to the classroom and use it to measure the truth and value of what you say. Adults are generally eager to share their experience. Recognize and respect the collective learning and experience of your audience. Together, a roomful of adult students has almost certainly outlived, outlearned and outearned their instructor. Use this experience to enrich the class.
3) Be a Content Expert. You must have a thorough knowledge of your content area. This is perhaps even more important when working with inexperienced students. Inexperienced students tend to believe what you tell them. They don't have the benefit of experience to evaluate an instructor's merit. If you try to fake it in front of the veterans, they will probably humiliate you for wasting their time.
4) Competence Breeds Confidence. If you teach your students well, they will develop the confidence needed to survive in a tough profession. Let them know mistakes are expected in class; that's how learning takes place. Try letting your students evaluate you on the next skill you will test them on. Students have a tremendous respect for instructors who are willing to risk making mistakes in front of them. Remember, they do it in front of you all the time.
5) Set Expectations High. This applies to both you and your students. Students tend to live up (or down) to your expectations. If you're giving students your best effort, why would you ask for anything less from them? You should be the first one there and the last one gone. The students shouldn't be turning the lights on and getting the coffee started for you. Walk in prepared every day. Demonstrate your ability to adapt to unforeseen circumstances. These are the very things you expect from them, right?
6) CPR. Yes, CPR! These are foundation skills for EMS providers of all levels. CPR is usually a student's first introduction to assessment, medical/legal considerations and death. CPR is also one of the few procedures we perform in front of the public that they probably know something about. Sloppy CPR is not likely to escape the notice of bystanders. Your willingness to accept marginal CPR skills (or your demand for excellence) sets the tone for everything that follows.
7) Implicit Simplicity. Great instructors have an ability to make things simple for their students. Our job is to keep simple things simple and make complicated things as simple as possible. It is rarely appropriate to try to teach your audience to the fullest depth of your knowledge. Focus on what they need to know at this time in their education. Recognize that you will, at some point, encounter a student whose knowledge is greater than yours in a given area. Respect this, and use it for the good of the class.
8) Model for Your Students. Lecturing helps your students understand, not perform. You've got to show them how it's done, not just tell them. They will start by simply trying to mimic your performance. As their confidence grows, they will try some ideas of their own. Whether these ideas work or not, they indicate growth and learning. This is usually when the dreaded "what if" questions start. Once, a student asked me, "Can I use jumper cables to defibrillate someone?" Admittedly, this indicates something other than growth and learning.
9) Guide Your Students To Success. When you ask for volunteers to help you demonstrate a skill to the rest of the class, do you get any? If so, you probably recognize the importance of guiding your students to success, not failure. This is especially important when students are learning new skills. Letting students make a series of mistakes and then picking them apart afterward will ensure two things: First, you will demoralize and embarrass your volunteer; and second, you won't likely get another one. When students are practicing new skills, take corrective action immediately. You want them to practice doing it correctly, not incorrectly. This way, students are assured of completing the skills successfully. Their confidence will improve as they require less and less corrective action from you.
10) Establish Lifelong Learning. Are you enabling your students to continue their development once they leave you? The preceptors who inherit your students will tell you that the education doesn't end when they graduate. Have you introduced them to the trade journals of their profession? Do they know that there are countless EMS websites for them to visit? Have they been introduced to the various distance-learning opportunities, such as continuing-education articles? Tell them about the wonderful conference opportunities that allow them to mingle with their colleagues from around the country. Avail your students of technology. EMS education has entered the technology era. There are excellent websites, software and enhanced multimedia texts available to students and educators. Consider asking your students to assemble a list of sources they have found useful. Have them cite each source and briefly describe what it offers. You can assemble a master list and distribute it to students. After a few semesters, you will have an impressive bibliography of resources.
11) Make Your Exams a Learning Tool. A professor once told me, "I don't like tests, but it's my last chance to make you think about something I consider important." It's our job as educators to let students know what we expect and help them achieve it. Ultimately, students will choose what they want to learn. Study guides can be helpful in focusing students' learning objectives. Using the learning objectives to guide the development of a study guide is appropriate and beneficial to students. Developing a study guide to match the test is unethical and a disservice to students. Following a test, determine which questions were frequently missed. Perhaps they're bad questions, or the material was not covered satisfactorily. Questions that are never missed are probably too easy. Review the test with students whenever possible. Their perspective of a question can be enlightening to you, and your insight will be valuable to them. Be prepared to concede a bad question. It will happen!
12) Serve Multiple Learning Styles. Some adults need to hear information through lecture and discussion (audio learners). Others need to see concepts and ideas on the board, in a handout or through slides, overheads, etc. (visual learners). Still others need a more hands-on approach (tactile learners). If they're not careful, educators can unconsciously favor their own learning style while teaching. Make an effort to diversify your approach. There are some simple methods of determining what learning styles dominate a particular class. This may help you tailor your approach to your audience.
13) Firm, Fair and Consistent Behavior. All you can ask is that the referee calls it the same on both sides, right? In the classroom, you are the coach and the referee. You must teach students how to perform, and then evaluate whether they have or not. Make sure the rules apply to your star pupil just as they do to the student who gives you a rash.
14) Practice Saying "I Don't Know." Beware of the student (or instructor) who is often in error, but never in doubt. If you are not capable of admitting you don't know something, stop teaching now. You probably already know that some students live to hear you say those three words. "What do I do if I have a victim stuck on a 20-foot flagpole and I only have a 10-foot ladder?" I don't know! "How many feet of small intestine are there in the human body?" I don't know! If the question is relevant to the content, then let them know you will try to find out. A student asked me once what was the No. 1 cause of nontraumatic hypotension in children. God bless paramedic students. I think it is gastroenteritis with dehydration, but I don't know!
15) Offer Them a Sandwich. The sandwich technique is an effective way to critique a student. Start off with something genuinely positive, then identify areas needing improvement, and conclude on a positive note. Example: "Your assessment started off strong when you verbalized BSI precautions. Things really went badly after that, but I enjoyed your conclusion." Perhaps I need a sandwich myself.
16) Put It on Paper. I was once compelled to give a student a retest on his final exam because my syllabus didn't specify that there were no retests on the final. I argued that the syllabus didn't specify that cheating was against the rules either, because that was generally understood by adults. Didn't work. Your grade book, syllabus, course schedule and disclosure forms should be clear, complete and comprehensive. Distribute them, discuss them and stick to them. This is what your administrators will look for when you ask them to back you up.
17) Get Your Own Report Card. Ask your students how you're doing. Consider allowing your students to give you anonymous evaluations. Do this after your students have gotten a chance to know you, but in time to make changes, if necessary. You know how hard you work for your students, but hearing it from them is as good as payday. Criticism may be harder to accept, but it's just as valuable.
18) Critical Thinking. Encourage your students to be critical thinkers. Teach them the value of sound research. Let your students know you will challenge them to tell you the "why," not just the "how." Challenge them to explain and support their decisions. They will certainly have to do so in the field. Don't let that be a surprise. Let them know it's OK for them to ask the same of you. At a recent conference, a fellow educator asked if anyone else had trouble with students arguing test questions. I thought, "Yes, my problem is that not enough students will argue their points of view with me." My favorite part of a test is when I return it and wait to see who wants to go at it over a question. They're hoping to gain a point, and I'm hoping to make one.
19) Paramedic, Heal Thyself. EMS providers are the most dedicated, compassionate and committed professionals I've ever known. The only people we don't take good care of are ourselves. I don't want to offend a group of people I am proud to be a part of, but we need to better emphasize our own well-being. I was at a conference recently, and believe me when I say it was the largest collection of EMS providers I've ever seen. Three of us on the elevator, and we were close to the weight capacity. I don't believe this was an anecdotal observation; I believe it is the "body of EMS" today. Our own physical and mental wellness is just beginning to become a priority in the classroom. The emphasis needs to begin during entry-level programs and continue throughout our careers.
20) Continue to Learn. Adult educators are content experts. Most have had little formal education on how to teach fellow adults. Your experience and expertise qualifies you to be an EMS educator. Make the same commitment to grow as an educator as you do to being a provider. The best instructors are those who don't forget what it's like to be the student. Take a class, attend a conference or just watch someone else teach. There's no copyright on good instruction, so when you find a good idea, use it.
In the years I've been teaching, I've made countless mistakes. The one thing that has never been in doubt is my passion and commitment to what I do for students in the classroom. As an educator, your attitude is infectious throughout the class. There will be times when it seems like the only thing on your side. It is enough.
Dr. Chris Coughlin is the EMS program director for the Public Safety Sciences Dept. at Glendale Community College in Glendale, AZ. He has been an EMS educator since 1994 and has been an NREMT paramedic since 1991. You can contact Dr. Coughlin at firstname.lastname@example.org.