PCRF Research Alert: EMT Training in Medical School
Each month the Prehospital Care Research Forum combs the literature to identify recent studies relevant to EMS education practices. In this segment PCRF board member Megan Corry reviews the “hidden curriculum” benefits of EMT training for med-school students.
Russ-Sellers R, Blackwell TH. Emergency Medical Technician Training During Medical School: Benefits for the Hidden Curriculum. Acad Med, 2017 Jul; 92(7): 958–60.
It’s been several decades since medical colleges first realized the need to integrate clinical experience into the first years of medical school. Since then several models have been implemented. One such model includes the integration of Emergency Medical Technician (EMT) training into the early curriculum. Educational researchers at the University of South Carolina School of Medicine Greenville (USCSOMG) launched a first-semester medical school curriculum that included an EMT program, which initially ran as a six-week boot camp and was subsequently adjusted based on early feedback to better integrate EMT with biomedical sciences.
The two-year experience showed equal success rates on the state EMT exam for students in the first year who completed the six-week curriculum compared to students from the subsequent year who completed an extended integrated course. Medical students were required to maintain EMT certification for the first two years and also complete at least one shift a month on an ambulance in the local EMS system, all while continuing their medical school curriculum.
In this follow-up innovation report, the researchers evaluated student learning by analyzing written critical reflections each student was required to submit twice each semester on a topic of their choosing. Authors first looked at the frequency of EMT-related reflections and then examined their thematic elements. Self-assessments typically included an evaluation of the learning process and identification of gaps and weaknesses.
Faculty review of these evaluations provided a glimpse of what the authors refer to as the “hidden curriculum,” which includes elements of medical practice that go beyond clinical skills and recognize the social determinants of health, appreciation of working with an interprofessional team, and the value of longitudinal learning in the medical profession. Frequency evaluation showed that 81% from the first group (n=53) and 98% from the second group (n=54) referenced their EMT experience in at least 1 of 4 reflections. Of all 216 reflections, 29% and 38% were primarily related to EMT experiences.
Thematic stratification provided an opportunity to evaluate the “hidden curriculum” in these reflections. Four common themes included patient care, professionalism, systems-based practice and interpersonal communication skills. Medical students wrote about cultural and language differences and resulting communication barriers, domestic violence and grief support, and reflected on behaviors that either exemplified or deviated from professional practice.
Although these reflections may not surprise EMS providers who do this for a living, this shouldn’t take away from the relevance of experience and self-reflection in a developing medical professional and in the potential impact on longitudinal learning in any EMS education program. These researchers show that tracking competency is more than just counting skills, patient contacts and hours completed or assigning numerical values from a rubric or skills sheet. Longitudinal tracking of competency-based reflections can inform a curriculum, whether it’s EMT, paramedic or medical school, and identify persistent weaknesses in the learning system. This feedback can also pinpoint areas for faculty professional development and identify a need for test redesigns based on student learning and patient-centered experiences. The authors hope these early EMT-related reflections will create a lifelong impression and impact on longitudinal practice.
Megan Corry, EMT-P, EdD, 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.
