Bringing the Streets to the Classroom

Do you remember the days of sitting in classrooms watching slide after slide of boring PowerPoint presentations, or listening to EMS lectures on the same material you spent hours reading the night before? What about the frustration of watching a piece of equipment demonstrated, but never getting the opportunity to practice with it hands on? Those days are over in our Motlow College EMS training programs. In an era of progressive medicine, we have chosen to be aggressive in our treatment and to teach progressive, evidence-based medicine to our students.

In 1996, at the National Teaching & Learning Forum, professors Joan Middendorf and Alan Kalish from Indiana University described the effect of lengthy lectures on the retention of material.¹ They stated that most adults only retain information from the first 15 minutes of lecture. Additionally, a study published in the Proceedings of National Academy of Sciences of the United States of America showed a 55% higher probability of failing a class during traditional lecture vs. active learning.² With that information, why do we continue to lecture for hours on end? Are we slaves to tradition? Or are we simply resistant to change? Either way, our methods and styles of teaching need to evolve.

It’s About Timing

There are many styles and methods of presenting material other than the traditional lecture. There are new methods of “flipping” the classroom, using scenarios, employing case studies, relying upon student interaction and creating situational simulation. At Motlow, we rely heavily on simulation, not only during scenarios, but also in everyday teaching. A paramedic’s timing is vitally important to treating patients and managing a call. If our scenarios and simulation only take 10 minutes, but calls take 40 minutes, how can a student perfect timing of treatment and continued assessment? When a student is supposed to wait 3–5 minutes to administer a drug, what do they do with the time between doses? In the past, many educational facilities just verbalized the actions rather than perform them. Without this practice, how can students develop timing and their internal clock?

We stress focusing on the small things. When a student wants to treat a patient with medication, she or he has to draw the simulated medication into a vial and go through the “six rights.” If they want to give a specific dose of medication, they have to perform the skill. They can’t simply verbalize that they administer it. Our paramedic coordinator, Justus Smith, says simulation works because students say how amazing it is to see the length of time it takes to draw medications properly, and how important timing is. That student confirmation, making them do this, is all the research I need to know to correctly simulate patient care. They understand that in the back of the ambulance, timing is everything.

Along with having to draw the medications, each paramedic student has a sealed simulated narcotics box. They have to verify what drug they want to administer, and then break the seal to get access to the drug. This is that extra step that adds time to the process, which very closely simulates the realities experienced in the back of the truck. The students operate out of jump bags with code boxes, narcotic boxes, drug boxes and real oxygen. The students even have nebulized saline to simulate nebulizer treatments. That process has been successful because the nebulizer treatment takes 4–6 minutes to administer. If the student doesn’t simulate using the nebulizer, his or her timing will be off.

An additional method of realism we use is to hand them a “bag of bottles” with popular prescription drug names (both trade and generic), requiring them to determine the medical history of the patient based only on the medications. This strengthens both assessment and pharmacology skills. Each of these processes is vital to the growth of the student as he or she works through the requirements for becoming a paramedic.

Different Kind of Labs

A lab located at the Tennessee Fire and Codes Academy facilitates additional simulated training. This location offers 330 acres of simulation space and includes a real fire station, a six-story burn tower, a simulated house, a hotel, an education building and our full operational ambulance. This location allows us to run “real” simulated calls. We create scenarios and have students “respond” and assess not only the patient, but also the entire scene. Moreover, our program, along with the fire recruit classes, holds simulation days where we work together on large scenes. This allows for exposure by both fire and EMS students to communication and understanding of each other’s job requirements. Students learn how to rescue, treat and transport patients to the simulated hospital. They are even required to give radio reports and hand-off reports to the receiving facility.      

Each spring, the college holds its overnight experience with the AEMT (Advanced EMT) classes. At that point in their curriculum, these students have never experienced the effects of having to perform paramedic work on little sleep, much less having to function as an actual AEMT. This class gives insight into handling a full shift. Students arrive at 8:30 a.m. for their regularly scheduled class time and participate in class until 4:30 p.m. At that point, they get ready for the overnight experience. The students get their bedrooms ready and ambulances checked off. The paramedic students create the scenarios and become the patients for the AEMTs. We have several ambulances that respond to the student calls. During the night, the AEMT students respond to 26 emergencies ranging from canceled calls to situations involving nursing home patients and multipatient accidents. The students are allowed to sleep and are awakened when their truck needs to respond. The night is capped off with a mass-casualty event requiring the students to identify properly the triage colors of 10–12 patients.

Paramedic students have several training days to accomplish before being released to clinicals. They are required to have a “high stress, low light airway day” prior to being allowed in the operating room or intubating on the ambulance. Students are placed in a room with little to no light. They are assigned a patient who is in a hard-to-reach location and are told to manage the airway. The room has red strobe lights, the instructor plays loud music, and at times the student’s equipment is removed or is deemed not operational. This forces the student to think creatively in order to achieve the desired outcome. For example, to manage the problem, the student may have to utilize a supraglottic airway rather than intubate. However, the students don’t always receive straightforward scenarios. This training creates students with the ability to treat outside of algorithms. They also must accomplish check-offs for obstetrics, pediatrics and competencies prior to the field internship, including a final check-off at the end of entire program.

Keeping Focus

We use several uncommon techniques in the classroom, including whiteboard challenges, case studies, games, video projects, research projects and student-led classes. Students are required to avoid opinions and base their decisions on research and data.

Our students respond well to the methods and come to class each day looking for ways to improve. Looking at new techniques and styles, we review each of our current techniques for improvement. Our goal is to have students ready to respond to calls the first day they step foot on the ambulance, a goal made possible through the use of realistic simulation.

References

Middendorf J, Kalish A. The "change-up" in lectures. NTLF, 1996 Jan; 5(2).

Freeman, S, Eady S, McDonough M, Smith M, Okoroafor N, Jordt H, Wenderoth M. Active learning increases student performance in science, engineering, and mathematics. Proceedings of National Academy of Sciences, 2013 Oct.

Drew Hooker is the program director at Motlow College in Lynchburg, TN. He has experience in both collegiate and service-based EMS systems administration. He has over 13 years of EMS experience with a dedication to helping move forward progressive evidence-based medicine.