Most EMS educators did not set out for teaching to be their career goal, said Gary Heigel, BA, paramedic and division chair at Rogue Community College, Grants Pass, Ore., during Part 1 of the annual EMS Educators' Huddle during EMS World Expo Sept. 14. People enter EMS to be providers, not teachers.
As a result, many educators simply develop their teaching approach by replicating what they see around them, rather than refining their own system based on evidence-based educational theory. But just like clinicians can learn and practice new clinical skills, educators can adopt new approaches as well, Heigel said.
Heigel was joined by Ginger Locke, BA, NRP, of Austin Community College; Maia Dorsett, MD, PhD, FAEMS, of the University of Rochester Medical Center; and Christopher Kroboth, MS, NRP, CCEMT-P, of Fairfax County Fire and Rescue, to discuss current trends in EMS education.
Part 2 of the Educators’ Huddle will take place Sept. 15, 2020 from 1–3 p.m. Eastern. Register at www.emsworldexpo.com
Heigel shared consistent patterns of learning across disciplines to begin his talk. A period of “knowing everything” early in a student's course of learning is typically followed by a “trough” or "valley of despair" in which students can feel lost and that “everyone gets it but me!” It's beneficial to share this pattern with your students, said Heigel—reassure them you’ve seen this before and that they will begin to understand and succeed if they stick with it.
Heigel then introduced the concept of “instructional scaffolding” to teach a new skill, whether it's intubation or documentation. The foundational steps to this method include:
Teach basic knowledge of the skill: indications, complications, and steps;
Independent practice with self-evaluation and reflection;
Peer evaluation; and
Application in realistic contexts.
A related method to instructional scaffolding is “spaced repetition," which capitalizes on “the power of (almost) forgetting.” Rather than fully drilling one concept, method, intervention, or topic for a short time and then moving on, leverage long-term memory pathways by revisiting previously covered skills, advised Heigel. Relating the concept to teaching mathematics: Rather than teaching and testing addition, then subtraction, multiplication, and division in separate and discrete skills, intersperse and interweave these subjects. Teach one for a short time, move on to another, then revisit the first.
Team-based learning is another educational theory ideally suited for EMS, Heigel said. Stop using assessments that force students to demonstrate skills by themselves. “EMS is a team sport," he said. "Our students need to train the way they're going to work,” Teamwork, communication, delegation, and collaboration won’t be developed by practicing and testing alone in a room, he said.
Finally, create desirable difficulties and appropriate challenges that match the level of the student. Don’t design overly complex clinical scenarios based on a call you remember from the field. Designing scenarios for people to fail, and attempting to teach through humiliation, is not effective, said Heigel.
In concluding, Heigel recommended periodic pauses in the course of an educational program to evaluate where students are and identify where adjustments are needed. Learning is not the result of experience—it’s the result of reflecting on that experience, Heigel said.
As an example, while debriefing after a simulated call, rather than identifying specific mistakes along the way, ask the student open-ended questions such as, “Can you walk me through your reasoning for what you did?” This will help the student retain knowledge and apply what they’ve learned to a wide range of applications in the future, rather than shutting down and despairing over their mistakes.
“I care less about what they did to that patient than what their thought process was,” Heigel said.