Ross LJ, Jennings PA, Gosling CM, Williams B. Experiential education enhancing paramedic perspective and interpersonal communication with older patients: a controlled study. BMC Medical Education, 2018; 18: 239.
Our population is aging. According to the World Health Organization, the percentage of people 60 and older will increase from 12% to 22% of the total global population by 2050. Comparable growth is expected in the United States, along with increasing ethnic diversity, economic disparities, and complexity of geriatric patients’ healthcare needs.
Healthcare providers are directed to use a biopsychosocial approach to the care of the elderly, which considers environment, social networks, and mental health status in addition to the patient’s physical well-being. This approach demands we change the way we educate healthcare practitioners, including EMS students.
Previous research suggests an experiential model of education can improve healthcare provider awareness and understanding of their patients and holds potential for improving health outcomes. Paramedic students in one study demonstrated limited knowledge and slightly positive attitudes toward geriatric patients; however, no studies have explored the relationship between increasing knowledge, expanding awareness, changing paramedic behaviors, and improving clinical practice.
In a recent study researchers in Australia examined the effect of an experiential education program on paramedic student knowledge, attitudes, and behavior regarding the geriatric patient population. This was a controlled, single-institution before-and-after study that used a two-phased educational intervention. Second-year paramedic students at Monash University in Melbourne were consented and then allocated into either a control group or an intervention group for a four-month period during which the control group participated in pediatric education modules while the intervention group participated in geriatric modules. The programs in each case involved small group interactive workshops about the biopsychosocial aspects of patient care, followed by face-to-face interactions with patients in a series of unstructured home visits. Students were aware of their allocation and the purpose of the study, but the research team that evaluated outcomes was blinded to the allocation. The primary outcome was interpersonal communication with older patients according to scores on a validated communication scale, the Kalamazoo Communication Skills Assessment (KCSA). Factual knowledge and provider attitudes were also assessed before and after the educational programs using the Facts on Aging Quiz (FAQ2) and the aging semantic differential (ASD).
Surprisingly, this study showed little impact on knowledge and attitudes about geriatrics before and after the education programs for both the control and intervention groups. Knowledge scores remained relatively poor, and attitudes remained slightly positive about geriatric patients. The main impact was noted in the area of behavior, specifically in the area of interpersonal communication with older persons, but this positive effect was noted in both the control (pediatric) and intervention (geriatric) groups! Statistically significant improvement in “understands patient perspective” was noted in the geriatric (intervention) group for both self-assessment and evaluator assessment of interpersonal communications. This could indicate that a targeted home visit could increase empathy, an affective competency already shown to have positive effects on clinical competence and patient satisfaction.
This study raises questions about educational design and underscores the potential benefits of experiential learning throughout an EMS education program. It also provides us with tools for measuring and researching specific affective competencies and their potential effect on clinical care in the field.
Megan Corry, EdD, EMT-P, is the program director and full-time faculty for the City College of San Francisco paramedic program and on the board of advisors of the UCLA Prehospital Care Research Forum.