EMS World Expo Recap: Implementing Evidence-Based Learning in Prehospital Care

Given UCLA’s large volume of paramedic students—approximately 140 a year—the instructors feel an obligation to contribute to the literature any chance they can. They often do this by sharing results from their own program through the Prehospital Research Forum.

Two such changes were presented by Baxter Larmon, Heather Davis and David Page at the 2016 EMS World Expo to a packed house of providers and educators. During the session they described the portfolio and scenario-based learning system used at UCLA, as well as over 100 other EMS education programs, as a way of flipping the standard EMS classroom model such that the ultimate beneficiaries are future EMS clinicians and their patients.

Rather than requiring instructors to keep track of which students have completed which skills, portfolio-based learning forces the student to take ownership and track which skills they have practiced and how often. At UCLA, this simple change in accountability of the student resulted in an immediate increase in their first pass rate from 72% to 85%.

A more complex change happening at UCLA is the use of scenario-based learning from the first day of class. As Davis explained in her introduction, the instructors recognize that while educators may teach skills in a discrete fashion, students rarely need to use them as such, either on exams and in real-life situations. By expecting students to practice discretely we, as an industry, are doing a disservice to future generations of clinicians.

Scenario-based learning increases the stress and cognitive load students face, which as Davis explained, results in a catecholamine dump that causes students to forget much of what they have recently learned. When students debrief after the scenario they are able to evaluate what they missed and store it in their memory in a more permanent manner, something that practicing a skill discretely can never achieve.

With each iteration of a new scenario, students are forced to access their memory for all necessary information, further cementing freshly learned information into their long-term memory. Although it seems hard to fathom, effective teaching within a scenario-based environment requires the instructors to talk less.

As an example of the above, Page asked how many instructors lectured on the need to check equipment and then asked the same group if anyone thought creating a scenario in which the equipment wasn’t checked, leading to faulty patient care, would be more or less effective. Everyone in the room agreed the scenario would stick with the students past the classroom setting.

The UCLA team has taken over eight years to develop and implement this education model. They recognize that it must be continuously evaluated and improved. Page recommends that anyone trying to make improvements to their education system needs to ensure they measure any changes, seeking information from outside sources via outlets such as podcasts or a journal club, and share any success they have seen with others such that the science of teaching can continue to improve.

For information on next year’s EMS World Expo, scheduled for November 16–20 in Las Vegas, NV, visit EMSWorldExpo.com.

Catherine R. Counts is a doctoral candidate in the department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine where she also previously earned her Master of Health Administration. Counts has research interests in domestic health care policy, quality and patient safety, organizational culture and prehospital emergency medicine. Follow her on Twitter at @CatherineCounts.