Next slide. Next slide. Next slide.
Wait, what was that video about?
Previous slide. Previous slide.
Third time’s a charm.
Oh come on! A knowledge check?
New tab: Google.
We’ve all been there. Slogging through slides of material in order to assure our paramedic service that they have indeed educated us. At least we have our one-day, eight-hour classroom session where we can re-learn this and actually get to practice it. Although, not many working medics look forward to that either. Sitting in a classroom for lengthy slideshow presentations isn’t how most would choose to spend their day off, especially those of us who have grown to love our exciting, dynamic and engaging work environment.
We all know that continuing medical education (CME) is necessary, and we’ve come to expect the traditional formats. Classroom and digital training are proven and efficient methods of disseminating information to large groups of paramedics. Education departments can meet their compliance needs by creating one-size-fits-all learning material and delivering this en masse to entire paramedic services.
But have we lost sight of paramedic engagement as an important facet of learning?
Although grossly underutilized in paramedic continuing education, many “alternative” learning styles exist to promote learner engagement. Examples such as gamified learning and virtual reality are increasingly being recognized to have positive benefits on learning outcomes – the American Heart Association (AHA) now recommends considering both of these methods for basic and advanced life support training.1 Even within our own unique profession, examples exist of alternative learning methods being used to foster increased paramedic engagement. Let’s shed some light on this topic by presenting a few successful cases that we’ve found and discussing their value, implementation and barriers.
One idea that should not come as a surprise is moving where education actually happens. Taking education out of a classroom setting is in fact the entire basis for online learning. However, the strength in this idea does not come from a scenery change behind your presentation screen. The entire learning environment can be shifted by moving educators into the field, promoting casual learning in a group or club environment, or providing opportunities for needs-based education.
Tommy LeBlanc is an expert in paramedic education in Ontario. After working as an advanced care paramedic and operations superintendent, he moved into education specialist and training supervisor roles, eventually becoming the academic chair of a leading college. When speaking with Tommy on October 11, 2020, he told us about his part in developing a mobile simulation program during his time with Frontenac Paramedic Services.
The mobile sim lab was a self-sufficient high-fidelity simulation lab built inside an oversized ambulance. At the time, the simulation program was designed in a way that allowed paramedics to participate in short but structured learning opportunities while on shift without impacting system operations. These sessions were adaptable based on needs and were trackable. If designed properly, these types of training programs can be both effective and efficient.
Moving education into a scenario ambulance makes sense, but learning environments do not need to be limited to the workplace or even other healthcare settings. What about a farm… or a brewery?
PHARMers, a paramedic group based in southwest Ontario, has led small group learning sessions in both of these environments. The group has been immensely successful, receiving CME accreditation from Southwest Ontario Regional Base Hospital Program. We learned more about PHARMers by interviewing one of their members, Chris Slabon, on October 5, 2020.
The organization hosts collaborative learning events featuring interactive components, guest speakers, panel talks, demonstrations and scenarios. The events are open for all levels of paramedics and students. Even physicians and allied agency workers have been in attendance. Working paramedics choose and teach the content. Unique local needs are taken into consideration, such as when they ended up at a working farm to recreate rural accidents that were increasing in frequency.
PHARMers drives engagement and fills events by creating a casual, non-ego driven environment (hence the occasional brewery setting). When asking Chris about the success of his organization and why paramedics seem to love this learning style, he stated “there’s no pressure on anybody… there’re the people who contribute and the people who sit back and watch… it’s very casual”. What stops this sort of medic-led learning from happening in other areas? Chris believes it’s a combination of logistics, gathering a passionate team and finding just the right ideas to teach.
We’ve seen that we can shift physical environments to promote learner engagement. How about content? Instead of creating learning material from scratch, can we increase efficiency by tracking the ample learning opportunities that present themselves to paramedics every shift? Paramedics naturally crave the need to learn from their own practice. Some agencies promote this through providing feedback in medical call audits or patient outcome reports. Others have taken it a step further by reviewing the case in a clinical or operational debriefing, or even directly with the physicians who took over care.
Dr. Martin McNamara currently practices as an emergency physician at Georgian Bay General Hospital. He had several years of paramedic experience before transitioning to his role as a medical doctor. We spoke to Dr. McNamara on October 11, 2020. He told us of his previous work in an emergency department in Hamilton, ON where he and several other physicians started doing rounds with paramedics. The rounds consisted of a physician on duty meeting with available crews and discussing interesting calls from the shift before. The paramedics who attended the call would present the details and differential diagnosis to the other paramedics and physicians. Students would also often get involved and offer opinions on a possible diagnosis. The physicians would then present the diagnosis and the paramedics would be able to review patient labs if pertinent. Relevant research topics could be assigned when needed. The sessions would last up to an hour and happen once a week. He continued this practice in another region, but it became difficult when that paramedic service moved to a larger, regional model.
Having both the paramedic and physician perspective while attending these rounds, Dr. McNamara described to us a list of positive outcomes. “The other doctors and I would get to know the medic skill set and understand differential diagnosis. There was value in the direct communication between doctors and medics… closing the loop of treatment… and building confidence in clinical judgement.” He believes the success of the program came from reflection on field experiences, stating that “learning begins on the road and there is more to be learned on a case by case basis.”
Dr. McNamara’s view on learning from field experience is shared by Tommy Leblanc, who thinks this may also hold the key to future training efficiency. Tommy told us (October 2020) that:
In my opinion, the future of paramedic continuing education depends on the ability of education teams to do two things. First, create smaller but more frequent learning opportunities that can be evaluated and tracked over time. Second, find ways to capture and measure the less formal but perhaps more valuable learning that occurs on duty while facing real life cases. This is in contrast to the large annual endeavour of creating and delivering an entire day of learning for all paramedics.
Experience-based, dynamic education is already occurring on a daily basis throughout the paramedic community. Given proper systems, these ample learning opportunities could be enhanced, measured and tracked, leading to increased efficiency and learner engagement. So why are most education departments still adhering to large scale classroom or online training? Tommy believes the hesitancy stems from the need to show consistent, measurable outcomes. “Training resources and budgets continue to get cut because education departments struggle to demonstrate the value they add to their organization. They have an overwhelming focus on compliance… completion and satisfaction, rather than learning and performance”
Continuing medical education is essential to our profession. Educating and engaging a large group of autonomous, independent-minded adults can be a daunting task. However, numerous examples show that it is possible to achieve a high level of learner engagement while still maintaining the efficiency that modern agencies demand. Moving the setting of paramedic education into high fidelity “real world” environments such as breweries, farms and ambulances has the potential to create engaging content that can be as dynamic as the profession itself. Our continuous supply of unique patients allows the opportunity to learn from our own practice, promoting “continuing” learning as the CME phrase entails. The largest barrier? The hesitancy for change. Are we continuing to educate the way we do because it’s the most effective, or is it because it’s how we’ve always done it?
Effective educators also recognize that adults often learn collectively from each other. The optimal role of the adult learner in the learning situation is that of a self-directed, self-motivated manager of personal learning who collaborates as an active participant in the learning process and who takes responsibility for learning.2
Jannette Collins, MD, MEd
- American Heart Association. Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. Heart and Stroke Foundation of Canada Edition. Ottawa: Heart and Stroke Foundation of Canada; 2020. 32 p.
- Collins J. Education techniques for lifelong learning: Principles of adult learning. Radiographics. 2004;24(5):1483–9. Available from: https://doi.org/10.1148/rg.245045020