Not a week goes by that doesn’t include a discussion with someone, somewhere, about the topics of professional development, leadership development and continuing education in EMS. Recently, the discussion has branched a bit into ethical issues and the scandals associated with “refresher training” that have cropped up in some corners of the U.S.
Historically, the EMS community has adopted a very narrow view of continuing education. Since the earliest days, EMS personnel have had a rigid, rigorous approach to continuing education that seems to have been designed for folks who didn’t actually do patient care very often (perhaps back in the “lots of volunteers” era), before the evolution of career EMS personnel and agencies. The national standard refresher course and many of the state continuing education schemes appear to have been designed by people who didn’t think much of EMS folk, and thought an every two years back to the very basics model would be a good thing for someone.
I’ve always wondered why paramedics had to get more continuing education hours than any other regulated “profession” that I can find, and why those hours have been refined in such restrictive, great and painful detail. Personally, I always do loads of continuing education—most of which doesn’t “count” for re-certification, re-licensure or re-registration. Like everybody else, I do the annual exercise of trying to fit the hours that I’ve done into the matrix that defines what must be done to meet the requirements of whatever authority issues the card.
At the same time, the EMS community has huge needs for education. But encumbered by these structured requirements, and with limited time and budgets, those areas aren’t addressed, or they’re given such minimal attention as the EMS agency is forced to give. Many of these areas are important: improving and advancing clinical care, but also developing field training officers and first-line supervisors, use of computers and technology, how to develop and manage a simulation program, physical personal protection skills (probably should be in pre-service education, but alarmingly is not) and a host of others.
Recently, I started poring over the websites from community colleges, law enforcement training organizations and fire service training organizations, as well as their related EMS programs. After a dozen or so stops, I started to see an interesting pattern.
Throughout most of the U.S., law enforcement officers can enroll in literally dozens of continuing education opportunities, offered either by community colleges or regional law enforcement academies. Courses range from investigating ____ crimes (pick your flavor from an even dozen), to first line supervision, to field training officer to managing complex drug investigations.
Similarly, those same schools offer a bevy of programs for the fire service: advanced ladder company operations; building construction for the fire service; fire officer 1, 2, 3, 4; confined space rescue techniques; and others.
But when I look at the EMS offerings, they’re scant to non-existent. Oh, there’s occasionally a “refresher course” offered, but again it’s back to the basics—entry-level clinical information required for re-licensure, no more, no less—with no connection to the current clinical needs and issues of the local EMS system.
What is it about EMS that there seems to be no market for courses beyond the minimum required to maintain the license? Where’s the means for EMS personnel to grow themselves, to develop into subject-matter experts, first-line supervisors or organizational leaders? Could it be that our “concept of self” is so limited to today’s (or even yesterday’s) EMS organizations that we’re stuck in a box where an “EMS agency” is a couple of trucks with one person in charge, where there are no thoughts of growing, diversifying, expanding the depth, breadth and service level of our organizations?
We’ve had a long history of two-day merit badge courses that re-packaged current clinical material and offered a credential—material that in every case should have been core course material in paramedic school. After 30 years, we have evolved a culture in which any course longer than two days is seen as too much—not for any reason, but just because.
It isn’t so. Two days is barely enough to review the basics. OK then, let’s use those courses for what they can do and understand that you can’t develop proficiency in anything with the limited number of repetitions that can occur in a 16-hour course. Some courses are just going to take more than that. Get used to it. Courses need to require as many hours as is required to develop the competencies related to the subject matter of the course, whether that’s 12, 24, 40, 80 or more. There’s no guarantee of a “two-day miracle.”
With this column, I’d like to put a challenge to our nation’s EMS leaders, local, state and national; public and private; operational and regulatory. Let’s take a look at EMS beyond the borders of the national standard refresher course and what the National Registry requires for re- registration. How about allowing EMS agencies, or perhaps EMS regions, to design their own minimum credentialing requirements?
What if those requirements must be based on documented clinical performance issues within the local or regional EMS system? A substantial portion of our nation’s EMS encounters are well-documented in electronic patient care reporting systems. We ought to use that data, in 2011 and beyond, to figure out what our clinical needs are.
And to our trainers and educators, I’ll also put a challenge. Let’s think beyond the box of state and national re-credentialing. Let’s look at meeting the current and future needs of EMS systems and design programs to meet those needs. Every EMS system I know of needs someone trained to do deployment and operational analysis. Most EMS agencies need trained first-line supervisors and middle managers. Every agency needs people who know how to do a proper pre-plan for community events, and every EMS agency needs people who know how to properly plan to provide medical support to special community events.
Let’s start seeing training for those functions developed in to sound educational curricula, and let’s start seeing them on the continuing education websites. There’s lots of expertise out there. Let’s start putting it to use and spreading it around.
It’s not 1978 anymore. Let’s take a fresh look at how we approach continuing education and professional development in EMS.