Learning Styles and the Paramedic Student

You will spend the rest of your life...

STUDYING!!!

I had a recent discussion with a soon to be finished paramedic student about what sort of time requirements were necessary to be successful in paramedic school. The vast majority of folks I come across speak of spending a lot of time studying. I think that stems from people's uncertainty about what type of learner they are.

I think a great disservice that is done to the vast majority of learners out there is not establishing a preferred learning style early on. I'll try to explain this better, so maybe this will help.

DISCLAIMER: This is a somewhat controversial model, but its the only one I have learned, in multiple fields. I guess maybe that is why it isn't widespread in the regular education system...

Wikipedia calls it Fleming's VAK/VARK Model. The idea is that everyone has a preferred method of disseminating information.

There are three methods:

• Auditory
• Visual
• Kinesthetic

Auditory learners typically learn best by hearing things ("Can you explain that to me?"). They typically don't need to watch a speaker, and are easily distracted by background noise. Visual learners do best by seeing things. Kinesthetic learners do best by doing. Exercises, homework and practice is key for them.

A good teacher will incorporate every style into the lesson, but that doesn't help what a learner does on their own time. 

Here is a quiz from AES education planner.Org for testing learning styles.

I think that if paramedic students are aware of their specific learning style, then it will be much easier for them to focus on how they should study, instead of wasting time.

While taking National Ski Patrol Instructor Development course I found out that the vast majority of Ski Patrollers are kinesthetic learners, and the majority of NSP's curriculum is geared towards that. I wouldn't be surprised to find that Emergency Medical Professionals are much the same way.

If that was the case, it would make sense for Paramedic Education to be difficult, because a lot of Medic school is....academic, for lack of a better word, and that kind of thing is definitely hard to teach kinesthetically. That would also explain why EMTs need to be taught that being a Medic is not about the skillz.

The Application Process - Documentation

There is a lot of documentation involved with applying to a paramedic education program. No more or less really than any other college program, but definitely more than someone who expects to just walk in.

A Current Resume
How much does a resume matter in the scope of things when it comes to a job? It definitely says a lot when you don't have one. One ambulance service that I applied to twice (first time-no resume, second time-sent one) only called me back for an interview on the second instance, and they were even hiring. Resume skills are important in life in general. There is no standard about what makes a good resume, but for entry level positions, I'd say it is good to keep it to one page.

EMS Credentials
Kind of a given I guess.

Proof of Health Insurance
I was kind of suprised by this one, but luckily for where I live, health insurance is avaliable to everyone.

A Letter of Recommendation from the Head of my EMS service
They spelled my name wrong, I was definitely annoyed by this. I went to pick it up right before my interview, so I guess I can take the blame, but in the end, I guess it didn't matter. 

Documentation of 50 calls as the primary responder over the past 12 months.
I guess this is a given as well, but if I was working as a volunteer for a a rural service one day a week, it might be a stretch.

A copy of my High School Diploma and College Transcripts(where applicable)
A lot of people aren't really "academic" which is okay, but to get through paramedic training, I think you need to have at least a basic level of academic proficiency and study habits, I will provide a post about learning styles this saturday.

This was a list of things that I was required to bring to the interview. But there was more...

A letter of recommendation from Medical Director of EMS service
I think that this was kind of meaningless, being that I have never met or seen the Med. Director of my service, but my program wanted this letter to state at least that there were no clinical issues that would keep me from finishing. Since my Medical Director isn't my PCP, I don't know how he/she would know this.

A Health Evaluation form
This had to be filled out by my PCP.

Proof of Childhood MMR immunizations
Also a given, working in Healthcare setting

Proof of Hep. B immunizations
Like I told the nurse at my PCP, I don't want some crackhead spitting blood in my face.

PPD test for TB
Another obvious one, I think its required by OSHA.

This was quite a list of things to compile, but if someone is working in Emergency Medicine already, it wouldn't be too bad.

Uncovering Paramedic Clinicals

It is getting to be the countdown to the start of this show, and I was just looking around for some information about clinicals, and I came across this article:

Uncovering Paramedic Clinicals

It seems like it has some pretty good information.

The Application Process - The Interview

The Interview and Skills Test

A few days after I had initially applied on line, I received an email with a specific date and time for my interview where the program was going to be held. Also attached was a list of the documentation that I needed to bring with me to the interview, as well as just a run down of what was going to happen.

The day of, I arrived fairly early, and the first step was the administrator of the program went over some of my documentation with me, and talked about the costs of the program, and how payment was expected up front, but they wouldn't mind making a payment plan as well, were they would charge a card monthly over the course of the program, which I thought was really great, because they didn't charge interest.

The program's refund policy is that they will pro-rate you a refund for however much of the class is left, if you can't finish it for whatever reason. So I'm sure as long as the student was "in the black" on their payments they wouldn't mind stretching things out a bit, which is really great, because the program costs $9000 before materials.

After I had a short discussion over costs, I was given a multiple choice test of EMT-B knowledge and a basic math/arithmetic test.

I wish I had gone over stuff a little bit before I took those tests, but I guess it doesn't matter now.

The math was all pretty straightforward, but I hadn't done any for a few years really, so I definitely spent some time cleaning out the cob-webs.


Afterwards, I had a discussion with the manager of the school. He talked about the school, and the hospital which is affiliated with it. He talked about the instructor I was going to have, he asked about any paramedics I knew, and what I liked about them. We went over the paperwork that I brought in. Any specific questions he asked me ("College? Anatomy and Physiology? Experience?") he had a check list for and he marked the answers, so I am guessing that part of the acceptance process is how many "points" you have on that sheet, I don't know if there is a minimum threshold or what, but I guess I did good enough.

We also took a tour of the facility. There were a few classrooms and some smaller skill labs. There was plenty of equipment to get familiar with, as well as a closet full of the drugs I would be learning about (except narcs). It was nice to see that the school had all the resources needed, right there, and there wasn't a need to "borrow" them from any hospital or fire department or whatever. I guess that is the kind of program I was looking for.

He also mentioned how many spots were open for the course, and I was surprised at how many applicants they had, but not really, being that there isn't a lot of options, like I said, in this area.

I made sure to show up with everything they had asked me to, and I was definitely dressed for an interview. I'm sure both of those things made a different, because talking to both staff members lead me to believe that a lot of folks don't really take the program's gravity seriously, and don't make it.

Why the Jump?

also titled...

Why didn't I become an EMT-I before going into Paramedic School?

Lets look at some education guidelines...


For an EMT-B the education requirements are as follows....

"In addition to the required 110 hours of instruction, this course requires that the student have patient interactions in a clinical setting."

that is per EMS.gov National Standards Cirricula
 
For an I-85(the intermediate level in New Hampshire)....



Okay...I searched and searched, and I can't get a straight answer out of anywhere about the hours of education and clinicals. The number of hours I typically saw was somewhere in the range of 200 or so for classroom time and clinicals, as well as a certain amount of IV sticks and intubations(where applicable). I guess in the range of 10 or so each. Please correct me if I'm wrong.

For my paramedic program...



So, let's visualize this...

Finally, I found an interesting passage on pages 18-19 the DOT national standard curriculum for Paramedics(pdf file!) in regards to being a basic as a pre-requisite for Paramedic Education:

EMT-Basic
It has been a long held tradition to use EMT-Basic certification as a prerequisite for more advanced EMS education, and this curriculum continues that tradition. It is important to note that some educators have questioned the practice of using EMT-Basic as a required certification prior to enrollment in Paramedic education. In fact, no studies have been able to verify EMT-Basic certification or experience as a predictor of success in paramedic education. Of course, paramedics are required to be competent in all of the skills and knowledge of and EMT-Basic, and this knowledge base and skills competence should be verified during paramedic education.

 Although this curriculum identifies EMT-Basic as a prerequisite, we have done so in the absence of empirical data suggesting that this is appropriate. We encourage flexibility in approaching the issue of EMT-Basic as a prerequisite to paramedic education. We also recognize that it may be possible to incorporate all of the material of an EMT-Basic class into a paramedic program, eliminating the need for it as a prerequisite. Clearly, more research is needed.

I guess I have confidence in my abilities and knowledge to complete the program and I thought going through with becoming an Intermediate first would just be a waste of my time and money. i feel like Paramedic Education goes so far above and beyond the intermediate level that any advantage would be overshadowed fairly quickly. Please comment if you agree or disagree.

The Application Process - The Beginning

Since I still have a few weeks before things get started, I figure I can talk about what the application process was like for the Paramedic Program I am enrolled in.


How did I pick my program?

I didn't have many choices living where I do, but I knew I didn't want to get involved with a Community College based program, because years ago I took an EMT-B class as a CC, and wasn't very happen with the outcomes, I never took the National Registry test then, because I was out of the country at the time, and I really don't think I had the maturity level to be working in healthcare at the time (I know right?). I also already have an Associate's and a Bachelor's degree, so I was really only interested in getting my paramedic education. I didn't need any more pieces of paper.

Scheduling was also an issue, my program meets one day a week, and I can schedule clinicals around my work schedule. The school is also a 2.5 hour drive, so only making that once a week is definitely better for me.

I also took my EMT-B at a place that was specifically in the business of EMS training, and I was happy with the outcomes of the program, it was definitely more expensive, but the instructors were full-time instructors, and we were able to take the National Registry test at the school, using the equipment that we were familiar and practicing with.


Once I chose what program I was going to do, there was quite a list of things that I had to do, and I will go over them one by one.

• Preliminary Application
• Interview/Testing
• Documentation

Preliminary Application

This application was quick and easy, my national registry number and basic information (address, phone, etc). I think it was a $75 application fee

This was done all on line, through the Program's website.

I will post about the Interview process, as well as all the documentation I needed later.

Wilderness Medicine....

is where I started.

I began my journey in Emergency Medicine by taking a Wilderness First Responder Course taught by by Stonehearth Open Learning Opportunities.

My definition of Wilderness Medicine is:

The assessment and treatment of patients in situations where transportation to definitive care is not readily accessible

Just consider any instance where "the golden hour" is definitely not going to be an option.

It has definitely affected my attitudes and beliefs towards patient care.

It has helped me understand that Emergency Medicine is all about looking for trends and treating problems before they become problems. Emergency Medicine is about understand what's really important (AIRWAY! AIRWAY! AIRWAY!!) and understanding how seemingly secondary injury may exacerbate what we really should be paying attention to.

In the urban world, sometimes when talking to colleagues I refer to "hot potato-ing" a patient. Typically this is in jest, but I am a firm believer that in most instances there is nothing I can really do to make a patient better, and my job as a basic rescuer involves trying to keep the patient from getting worst before I can "hot potato" them to the next level of definitive care.

This attitude really doesn't work so well for Paramedics.

If a patient goes into cardiac arrest, there really isn't anything a hospital can do for them that a paramedic can't (as far as I know). And I think that this is where much of the difficulty of that mindset swap may throw some wannabe-student-paramedics off, because if they spent their entire previous work history constantly hot potato-ing patients off, then actually dealing with a stressful situation may be difficult, if not impossible.

Wilderness Medicine is the exact opposite.

From minute one, you are taught that this situation is going to be long, and no way is this patient going to be going anywhere soon.



So we will see how things go I guess.

Med Math...er...Arithmetic..

I got an email from my instructor a few days ago, included was a few practice problems that we were expected to be comfortable with.

I looked at them, and immediately I thought about all the upper levels of Calculus and Discrete Mathematics I had encountered completing my Computer Science degree.

My ego scoffed at how easy it was, and that it wasn't math, but simple arithmetic...


I started working on the problems, and luckily, I was able to find instructions for long division on the internet.



I think that I will have to be careful, because sometimes I have the tendency to trivialize things that I had exposure to in the past, without actually assessing my competency in them. I guess that might not be right, because I was in the process of assessing when I realized that I completely forgot how to do long division.

But luckily, when it got to the scary looking stuff, I did alright...I think. The units I ended up with were an actual measurement, so that's pretty exciting.

At least I think I did...if anyone solves these problems, feel free to leave your answer in the comments, I'll share what I got too.

Weigh the consequences....

Is it bad to over-react in Emergency Medicine?

---

I came on the scene, the patient was lying prone in firm snow, on a fairly steep bank on the uphill side of a trail. His right ski was still on his foot, and his left boot was externally rotated to what appeared to be opposite of the bend in the knee. Neither of his ski boots were buckled correctly, and consequence of such, were very loose. He was relatively calm, probably about 10 years old. I asked him what happened...

He said that he had fallen and twisted his ankle, and now it felt "weird". He said he couldn't walk on it. He used words like tingling, burning, electricity, numbness. The patient denied other injuries and there was no spinal point tenderness on palpation. The position he was in, plus the possibility of an in-boot spiral tib/fib were my main concerns. I tried to palpate for deformity/open wounds in his boot. After a slight scare that turned into melted snow, I ruled out any bleeding, but I couldn't tell on deformities one way or the other.


I called for a backboard and a set of hands because the patient was in relative comfort in the position found, and I didn't want to have to flip him, and end up have him screaming as his leg flopped around, or both of us go sliding down the hill and cause more significant injury to his leg.

When help arrived, we managed to log roll the patient onto the backboard, which caused no discomfort at all, the patients injured foot was stable, and didn't rotate to either direction. After more assessment I finally asked the right question...

"Have you ever hurt yourself before?"

"Yeah, but I've never broken anything, just bruises"

"How much does your ankle hurt compared to that?"

"Less..."

We took him off the board, he sat up, and we got him down, he walked just fine.

---

If I just went on the level of discomfort this patient was in, I could have figured he just twisted his ankle. But I had been in a similar situation; the EMTs were certain I didn't break my femur because I wasn't screaming enough. I'm sure they had learned in the back room of some fire house that femur injuries hurt like hell and the patient will be screaming their bloody cords out. There are so many subjective measures in what we do, the only thing that we can do is what we think is best for the patient at the time.

On scene, for a moment, I was slightly worried about overreacting, for a split second I was concerned what folks would say for me calling for a backboard for a patient with a twisted ankle, but I am glad that I immediately thought about what would happen to this patient did have a fracture, and if I did try to flip them on my own and take care of the situation without help. There would be a chance that we would have slipped a few dozen feet down the slope.


As I read over this post, and think about this situation I guess if I had asked the patient if they could flip on to their back or sit up, he would have, and been fine, but I assumed that no one would lie face down in the snow unless that WAS the most comfortable position, but I guess the way his leg was presenting put that out of my mind right away. I guess you can call that defensive assumptions.

One thing I know for certain is that I can only do what I think is best for the patient at that moment in time. It is easier to justify our actions for the worst case scenario than to say "I didn't think it was that bad"

As I read over this post, and think about this situation I guess if I had asked the patient if they could flip on to their back or sit up, he would have, and been fine, but I assumed that no one would lie face down in the snow unless that WAS the most comfortable position, but I guess the way his leg was presenting put that out of my mind right away