EMS Professionals are Fed Up with CE and What to Do About It
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Slides from 2012 EMS Today Presentation by Greg Friese about EMS Continuing Education.
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EMS Professionals are Fed Up with CE and What to Do About It
- 1. EMS Professionals are Fed up with CE Greg Friese, MS, NREMT-P
- 2. EMS Professionals are Fed up with CE (and what to do about it) Greg Friese, MS, NREMT-P
- 3. Greg Friese, MS, NREMT-P
- 4. Audience Response Pads Special thanks to C3Softworks.com and VisualBroccoli.com
- 5. Free Food, Donuts and Coffee
- 6. Free Food, Come On!
- 7. Session Description EMS professionals are fed up with the continuing education they endure to meet certification and licensure requirements. The current one size fits all model of continuing education delivers a broad reach of content with little depth. Continuing education rarely accounts for previous experience or individual performance data. It does not challenge or incentivize EMS professionals to learn more than what they have already been taught. After briefly reviewing the current state of continuing education the presentation will describe a conceptual model of an independent learning plan for EMS professionals. The presentation will include specific strategies to implement the pillars of the learning plan to meet regulatory requirements while also delivering continuing education that honors an EMS professional’s experience, knowledge, and time.
- 8. Session Objectives • Discuss state of continuing education • Explain pillars of independent learning plan • Describe specific strategies to implement
- 9. State of EMS Continuing Education Objective 1
- 10. EMS CE is Ground Hog Day
- 11. EMS CE is Generalized
- 12. EMS CE is Shallow
- 13. EMS CE is Repetitive Peds / OB Med CPR Trauma
- 14. EMS CE is Poorly Timed
- 15. EMS CE Chases Topics
- 16. EMS CE Instructor Variability
- 17. 2012: My Recert Year
- 18. I Don’t Have Time Preparatory OB/Peds Medical Trauma Airway CE Course
- 19. Education Hours Teaching Ride time Conference Articles Videos
- 20. Registration Time + + - - Hours Minutes
- 21. Seat Time + + 00 00 60 50 40 30 20 10 - - Hours Minutes
- 22. Reading Time
- 23. Reading Time Test A VAD is a mechanical device that’s surgically implanted into the patient’s chest to augment cardiac output, or the ability to pump blood. VADs can be used as a “bridge to transplant” or as “destination therapy.” The compact size and portability of VADs affords patients the opportunity to be discharged from the hospital and have an improved survival and quality of life. VADs are used as a bridge to transplant in patients who meet the qualifications for cardiac transplantation but need temporary support to survive their condition until a suitable heart donor becomes available. VADs are also used as destination therapy for patients with advanced heart failure who are symptomatic despite optimal medical therapy and who don’t meet the qualifications for cardiac transplantation.2 The goal of destination therapy is to minimize heart failure symptoms and improve quality of life. Destination therapy means that the patient will live with the device for the rest of their life. It’s used not as a temporary solution, but as a permanent therapy to improve quality of life. There’s no expectation or plan to progress to heart transplant. Mean = 1
- 24. Reading Time Variability WPM WPM College 8th grader 250 Student (low) 340 College 11th grader 350 student (average) 450 Average College adult 300 student (high) 800
- 25. Quiz Duration + - Minutes
- 26. Activity, Not Quality 12 Lead Instruction Who is teaching?
- 27. Paramedic Degree
- 28. Time Passes … 2 years later
- 29. Time Passes … 4 years later
- 30. Time Passes … 6 years later
- 31. Time Passes … 10 years later
- 32. Time Passes … 20 years later
- 33. CE and Degree Completion AA/AS BS/BA MS RN/BSN MPH PA MBA MD ED/PhD JD
- 34. College Credit Hour 1 Contact Hour + 3 hours studying x 15 weeks = 45 hours
- 35. CE Visualization Exercise Close your eyes
- 36. Pillars of an Independent Learning Plan Objective 2
- 37. Marathon Training Plan Data Time Goal Coach
- 40. Actual Conversation “I need more airway courses.” “What kind of airway courses?” “Airway” “Airway courses of what type?” “It needs to be an airway course” “Exactly, a course about airway. I need to know more about what you need.”
- 41. Similar Conversation “I need more spice.” “What kind of spice?” “Spice” “Spice of what type?” “It needs to be a spice” “Exactly, a spice. I need to know more about what you need.”
- 42. EMS Training Plan Experience Competency Goal Training Officer
- 43. Individual Learning Plan A D S S A E S T L I A F N G E D
- 44. Pillar I: Data ePCR CAD Bio- Surveillance
- 45. Data from Bio-Surveillance Best time for training?
- 46. Train When Slope Changes Training No Training Longer Needed Needed Now
- 47. Available Bio-Surveillance Data What events could you monitor for with existing data sources?
- 48. Adherence to Protocol Data 50 40 30 20 10 0
- 49. Protocol Driven Training Failure to use EtCO2 triggers: 1. Email from medical director 2. Google Doc form to explain not using 3. Link to PDF protocol 4. Assignment of online lecture 5. Competency check at simulator lab
- 51. Skill Proficiency 001 116/80 013 116/80 025 116/80 037 116/80 002 118/80 014 118/80 026 118/80 038 118/80 003 122/82 015 122/82 027 122/82 039 122/82 004 120/82 016 120/82 028 120/82 040 120/82 005 120/78 017 120/78 029 120/78 041 120/78 006 122/70 018 122/70 030 122/70 042 122/70 007 120/80 019 120/80 031 120/80 043 120/80 008 122/86 020 122/86 032 122/86 044 122/86 009 124/78 021 124/78 033 124/78 045 124/78 010 122/80 022 122/80 034 122/80 046 122/80 011 120/78 023 120/78 035 120/78 047 120/78 012 122/84 024 122/84 036 122/84 048 122/84
- 52. Pillar II: Self-Directed Paramedic Knowledge Paramedic Knowledge Niche Expert Goes Deep Broad and Shallow 12-Lead ECG Pediatrics
- 53. EMS Professional Chooses! Seminars Online Courses Classes Classroom Courses Books Expert Interviews Articles Simulation Site Visits Discussions Testing Case Review
- 54. Learning Plan Self Assessment 1. What are you really good at? 2. How do you know you are really good at those things? 3. What do you want to get better at? 4. What do you need from the organization to get better at those things?
- 56. Learning Plan Accountability Training Me Officer Co-Workers Social Networks
- 57. EMS Career Paths FTO/ Customer Human Information Leadership Marketing Finance Education Billing Preceptor Resources Service Technology Paramedic
- 58. Pathway to Degree Completion Paramedic Bachelors Degree Masters Degree ?
- 60. Assigned by Training Officer Training Need Deliver to All Competent? Complete
- 61. Assigned by Training Officer Training Need Competent? No Yes Training Complete
- 62. Distribution of Training Hours 100% Training Training Training Officer Officer Training Officer Officer Self Training Officer Self 50% Self Self Data Data Self Data Data Data 0
- 63. Implementation Strategy Objective 3
- 64. Healthy Training
- 65. Begin with End in Mind
- 66. Assess Knowledge
- 68. Learning Plan Components Goals Tasks and Activities Timeline t0 Complete Coaching Peer Review Self-Assessment Documentation
- 70. Data Filtering
- 71. Road to Change
- 72. Try Something Different 100% Today? Training Officer Training Self Officer 50% Next Self Year? Data Data 0
- 73. Session Summary Have a Goal Individualize Training Focus on Competency Use Available Data Take Action!
- 74. Questions Search
- 75. Connections EMS Today During After greg@centrelearn.com 717-227-4655 (office) CentreLearn 715-204-9874 (mobile) Booth #3122 Facebook.com/gfriese Twitter.com/gfriese Blog.CentreLearn.com
Editor's Notes
- Room in banquet set-up, chairs around tables. Sit so you can best see … upcoming presentation on capnography.
- 90 minutes
- Me and what I doMy primary role is director of education for CLSHave been involved and engaged in online education development, production, and use since 2004.Variety of online education involvement:Continuing education coursesPodcasts hostBlog authorWeb videos Microblogging
- I can only offer you virtual donuts and coffeeDoes that impact your willingness to be here, would you learn more if I had donuts and coffee, would you think higher of me if offered coffee and donuts?
- Should we have a higher bar for our time and interest? Time is our most valuable commodity. We can’t get any more of it. Is your time really worth nothing more than a few dollars of food? On the list of top life regrets I don’t think you are going to find “I wish I had traded more of my time for free food and mediocre CE” If time is limited and CE accomplishment is measured in hours seek out the CE that most closely matches what your time is worth.
- This is what I told JEMS/EMS Today what I would present….
- And these are the objectives …
- We’re not sure.Then discussion of CE
- Kelly Grayson Article, Great points and great analogy, http://www.ems1.com/ems-education/articles/1235005-How-Id-change-EMS-continuing-education/
- This is what I believe about EMS CEGeneralized to the lowest common denominator. Not actually designed to meet the needs of all users just to meet the needs of the poorest performers. Made for everyone. Often tilted towards the lowest performers or people with the least knowledge, least experience, least motivation,
- Problem with most EMS education, wading pool. No depth. Learn a little about a lotCE often repeats the same little we know about a little.Above and beyond is pretty tough because of the low performers.
- Repeat same topics over and over, often for reasons that are not entirely clear … at least to the participantIs it because of bad care or bad field performance or simply the fact we already have the content ready. Warning I might sing this out in a low and ominous tone. Part of the repetitionCard course required to maintain certificationHow much above and beyond information do you get in a card course like PHTLS, ITLS, EPC, GEMS, AMLS???
- No relation of time of course work to actual need of knowledge Retention of lecture content is often poor and gap of time between presentation and actual usage. Searches for phrase “drug overdose” Do you know why this spiked? Do current events news impact incidence of cases other places? If I were a training officer I would be figuring out how to offer training on EMS response to active shooters or school shootings. CE Mash-up idea.
- Topics can skew towards flash in the pan problems – Bath Salts, Suicide types, Synthetic Marijuana – Just make sure the actual threat and the perceived threat align. Training depth and frequency should match the likliehood of occurrence and severity of occurrence. Focus on the excitement of the problem rather than underlying pathophysiology or even the general principles of treatment.
- [Instructor teaching a course]Of all the variables of a course – content, students – the one that can vary the most is the instructor. Part of the reason we see emphasis on pre-packaged training content (DVD) or curriculum with set objectives or set slide sets (ie PHTLS or WMA courses). Standardize as much as possible so “anyone can teach”Under emphasis on instructor selection, training, and development
- [Image of my expiring cards … NREMT, WI, BLS, ACLS]Some of my experiences from recertifying … Mix of people in course – full time medics and nurses in hospital setting, full time medics in EMS agencies and fire departments, part time medics, new grads (2 years ago) still job searching or finishing AS degree. Waited until last minuteReceive exact same content as practicing nurses and paramedicsAbility to access information (Google) and write responses might be what is actually being assessed rather than my skills and knowledgeA great match for what I am personally seeking – path of least resistance to retain an important professional credential without undue hardship or stress since I don’t intend to practice Missing an intake form or pre-assessment to determine my goals as well as KSA’s I am coming into the course with.
- CL user complaining they don’t have time to complete training, 8 windows open to watch 8 videos at the same time. Complain that system isn’t recording completion of those videos
- Need something to measureWhat is easiest to measure … attendance and or completionMeasuring pre-course competence, skills, experience is very difficult. It can be done but not easily done. CE awards hours for these different activities. How are these things equal???TeachingRide TimeConferencesArticle
- May be awarded time for registering/preparing for course.
- The actual time you spend sitting listening/watching/viewingThe instruction quality and presentation quality play a big factor here but if it is mostly lecture based your retention is going to be dreadfully low.
- How quickly can you read? [Excerpt an article from JEMS Online on screen with a stop watch. 18 point font?] 183 words on screen. 3000 words in a CE article – read in less than 15 minutes. 250-300 words per minute, http://en.wikipedia.org/wiki/Words_per_minuteHuge variability3rd grade students 150 wpm4th Grade Students1708th Grade Students25011th Grade Students 350Average Adults300Low Scoring College Students 340Average College Students450High Scoring College Students 800Mid Level Executives340High Level Executives575College Professors680High School Dropouts240http://www.free-speed-reading.com/articles/what-is-the-average-reading-speed-of-americans
- How quickly can you read? [Excerpt an article from JEMS Online on screen with a stop watch. 18 point font?]3000 words in a CE article – read in less than 15 minutes. 250-300 words per minute, http://en.wikipedia.org/wiki/Words_per_minuteJEMS VAD article – all words, sidebars, references, etc ~3500 wordsHuge variability8th Grade Students 250 wpm (about the same as a high school drop out)11th Grade Students 350Average Adults300Low Scoring College Students 340Average College Students450High Scoring College Students 800http://www.free-speed-reading.com/articles/what-is-the-average-reading-speed-of-americans
- 1 minute per quiz question Poll question … Multiple choice questions should take about how long to completed30 seconds60 seconds90 seconds 120 seconds
- 12 lead program Presented by Dr. MarriotPresented by Dr. WesleyPresented by Tom, Tim, Bob, etalPresented by some guyAll get me an hour – regardless of presenter knowledge, skill, experience.
- EMS Meme – started by Sean EddyCourse work that gets you back where you started[Animation, start as a paramedic and … end as a paramedic]Refresher course based on national standard curriculumLike groundhog day you are back where you started.
- [groundhog phenomenon Kelly described]
- …
- …
- …
- …
- Over a 20 year EMS career is it reasonable to expect that someone should be able to go from paramedic certificate, or AA/AS to one of these?I think it is.
- http://en.wikipedia.org/wiki/Course_creditI am going to do some math1 Credit hour equals 1 contact hour per week over a 15 week semesterExpectation of 3 hours of studying per week. Paramedic refresher course24 hours face to face24 hours online workUndetermined amount of time Should I get 3 college credit hours for doing this? If I tool 3 credit A and P instead should that count as an alternative to Paramedic refresher?What about biochemistry, organic chemistry, genetics, anatomy lab, research methods, statistics, accounting?
- When I say continuing education is planned for Wednesday evenings at the hospital you think ….
- Marathon running training plans. Driven by three pillars – data, individual goals, and coach prescription16-20 weeks to run and work-out four to six days a weekDriven by:Current level fitnessTime available for trainingDesired effort of exertionFinishing goal Training plan adapts to experience, environmental conditions, injury/illness, schedule, and actual results. Adapted to the Individual
- NREMT recertification hours. Current paramedic learning plan in the US:
- Homogenous mandatory training plan for all providers. One size fits all. Rehash of previous training programs.Broad, but shallow … no depth.
- So broad we are overwhelmed with choices. Or we don’t have tools or language to focus our choices. “I need more airway courses?”“What should those courses be on?”“Airway”“What kind of airway courses?”“They need to be about airway”“Exactly, a course about airway. I need to know more about what you need.”Replace the word airway with salad dressing, jam, toilet paper.No relation to DATA from field experience, community served, clinical competency,
- Replace the word airway with salad dressing, jam, toilet paper, or spice.
- Needs to be related to and guided by DATA from field experience, community served, clinical competency,
- Data driven competency evaluation and provider self-assessment to create unique training plans3 pillarsDataSelf-directedTraining officer assigned
- Plentiful data sources, challenge is filtering the data sourcesCan use these sources independently or in combination
- Field surveillance (slope for influenza cases changes)[Google Flu trends]2007-2008 – flu cases spike in February. When should you schedule training for following years? 2009-2010 –flu cases spike in September
- Question to the audience: What events could monitor for with existing data sources.
- What does this waveform tell you about the endotracheal tube? After intubation if capnography is not used to confirm tube placement … as documented in the PCR and from monitor data … what happens next.
- Protocol Adherence - EtCO2 monitoring is the standard for any intubated patient, but we know it is often not used. Rapid analysis of the PCR data could immediately check for intubation performed and EtCO2 monitoring. If capnography was not performed a series of automated actions might include a template email from the medical director with a link to a form asking the paramedic to explain why EtCO2 was not used and how airway placement was confirmed. The same email could also include a link to a PDF of the airway management protocol, an instructional video of adding EtCO2 monitoring to the airway circuit, and an assignment to complete an online CE module on interpreting capnography waveforms.
- Low Frequency Encounters – depending on your service area there is likely a known sub-set of low frequency encounters. In a heavily geriatric community a paramedic could go months without encountering a pediatric patient. A simple automated analysis of CAD data could determine which paramedics have not had pediatric patient encounters and then assign appropriate continuing education modules, case reviews, and observation opportunities. Similarly, if a paramedic has gone a certain time period, such as 24 months, without encountering a patient in active labor the paramedic could be scheduled for a practice delivery in the simulation lab or live birth observation/assistance at the local hospital.
- Blood pressure assessments [scroll of systolic and diastolic pressures, 95% are between 115 and 125 mm Hg]
- Self-Assessment that leads to niche expertise. Examples:Tom Bouthillet – 12 leadKyle Bates – EMS instruction, pedi-u, first few moments. Dan Limmer – test prepStephen Rahm – test questions[interesting connection between entrepreneurship, self-promotion, and self directed learning to obtain niche expertise. Also share a huge amount for free]
- Choice! Steps towards attaining niche expertise. Gain depth. Annual or bi-annual learning plan:SeminarsClassesBooksArticlesDiverse assignmentsOnline courseClassroom courseOne to one meetingSelf directed learningSimulationGroup discussionCase reviewTesting Not just consumption but also application of knowledge
- Self Assessment should answer these questions:What are you really good at?How do you know you are really good at those things? DATA!What do you want to get better at?What do you need from the organization to get better at those things?
- Individual learning plan is validated by and accountable to a training officerSome connection to social networks and key opinion leaders to influence and validate those learning plansInfluenced and validated by Social CirclesTraining officerCoworkersSocial networksKey opinion leaders
- Individual learning plan is validated by and accountable to a training officerSome connection to social networks and key opinion leaders to influence and validate those learning plansInfluenced and validated by Social CirclesTraining officerCoworkersSocial networksKey opinion leaders
- [graphic … field provider and paths to these different careers with EMS]Prepares for different advancement paths … LeadershipFinanceBillingMarketingCustomer serviceEducationFTO/Preceptor Human resourcesIT infrastructure
- Link to associates and undergraduate degree completionPathway towards advance degree attainment
- There will always be a need for training assigned by a training officer to fulfill regulatory requirements. Top priorities of training officers:Completion of a certain amount of timeMeets requirementsEveryone is presented the same information Maybe some throwaway words like “good” “useful” or “interesting” or “informative”
- Training officer assigned content as it exists now. A need is identified. It is deliveredTraining completed.Where in this process does competent fit?Does it even matter to the training officer that just wants to know
- If you are going to assign training at least give people the opportunity to “test out” by completing a knowledge or competency assessment. Credit (or at least a free pass) for stuff you already knowCreate pathways depending on results of competency assessment.
- EqualNowWhat could be? Different for different people or different years?
- Great CE is like a bowl of fruit. There is something for everyone and it is all good for you.What does GREAT CE Feel Like?What is the outcome of GREAT CE?
- http://www.articulate.com/rapid-elearning/how-to-create-a-learning-journal-to-go-with-your-e-learning-courses/Or a learning journal GoalsTasks and ActivitiesTimelineCoachingPeer ReviewSelf-AssessmentDocumentation
- Build coalitions
- We don’t lack dataWe lack the proper filters of dataOcean, crab pot, crab dinner!
- This is, unfortunately, what the road to change looks like in many organizations
- Make small changes
- Action you are going to take to improve your own continuing education