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.
Continue Your Education
We can also demonstrate our commitment to scholarship by attending local, state, regional and national conferences. There are many benefits to this. You can accrue continuing education toward maintaining certification. You can learn new ideas, methodologies and processes to become a better, more well-rounded EMS practitioner. You can meet your peers and network with other practitioners who understand what EMS is all about. You can expand your thinking and your perspectives. You can also experience new places. I know it is difficult in these times to find the money and take time away from family and work, but it is worth the investment.
Finding and enrolling in an educational degree program at the associate, bachelor, master or doctoral level is another. With the explosion of online degree programs, we now have enormous opportunity for formal education in pursuit of a degree. You can do your coursework on your own schedule, at home, even while working full time. It's not easy, but you can do it if you're committed, motivated and choose to succeed.
In his discussion of commitment to scholarship, Swick said it is "the desire to share one's knowledge for the benefit of others." Perhaps you will choose to demonstrate your commitment through writing. If you are already in an educational program, you know one aspect of formal education is developing writing skills. The more you write, the better you get. Although I'm not suggesting your term papers would be accepted for publication, if you choose to, you can work toward that end. Publication is an important component of scholarship.
As you learn and develop deeper understanding of EMS and its various facets, you may choose to share what you've learned by presenting at a CE session or conference. Start local and work your way up. It takes scholarship, determination discipline and desire.
You can also share what you've learned and know by becoming an instructor. I've made lots of mistakes throughout my career. One of the things I like to think I have accomplished, by becoming a preceptor and later an instructor and educator, is helping others learn from my mistakes. In an earlier article, we briefly mentioned peer review. When I first became a paramedic, the system I worked in held monthly peer review sessions. Attending at least half of these sessions was a condition of maintaining medical command. During these sessions the paramedics shared their interesting and challenging calls and the lessons learned from them. Sometimes we discussed cases that were hard to figure out. Together we worked out various approaches and eventually determined a best course of action. This process prepared us for similar cases. We also shared our mistakes in a safe setting with the goal of preventing others from repeating them. One of my favorite conference presenters, Gordon Graham, often says, "Predictable is preventable." If you become a preceptor or instructor or participate in peer review, you are sharing your knowledge and lessons you learned the hard way. This may help others learn some lessons the easy way.
All of these activities we've discussed contribute to improving our field. If you're not already doing one or more of these things, which will you choose? Each of these activities represents a process that demonstrates your commitment to scholarship and advancing EMS. Remember, the ultimate point of this is to provide the best care for the people we serve. Are you ready?
1. Swick H. Toward a normative definition of medical professionalism. Acad Med 75(6): 612-616, June 2000.
Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. Contact him at email@example.com.
Writing for Publication
Here are some tips to maximize your chances of getting published:
Consider what you can contribute that's unique or meets a need. Do you have expertise that can benefit others?
Contact editors and ask about their needs. Many offer author guidelines with submission instructions. Who's a good match for what you're writing?
Articles must generally be submitted to one publication at a time.
MS Word is always a safe format for submissions.
The lead--your first few sentences--is essential to hooking readers. Make it compelling.
Edit yourself. Never use 10 words to say what you can say in three.
Fact-check to a fault. The fewer errors you make editors catch, the better your odds of producing an accurate work.
Don't be insulted when you're edited. No one's stuff is untouchable.
Many outlets welcome photographs and illustrations to accompany submissions. These can enhance an article's impact and value.