Continuous positive airway pressure (CPAP) has been in use for several decades as an adjunct to ventilator-dependant patients, treatment for sleep apnea, and in patients with congestive heart failure (CHF), obstructive pulmonary diseases and premature birth. Most recently, it has found its way onto EMS vehicles for treatment of exacerbated CHF. Its use in the emergency setting has been shown to decrease the need for intubation.
Thus, CPAP is becoming a mainstay treatment of CHF in the field and is being taught across the country in classrooms and skill labs. But the concepts behind its use may be difficult for some to grasp. Let's look at different learning styles and how to help providers learn to use CPAP in the correct circumstances and in the correct manner.
Well-known educational theorist D. A. Kolb identified four specific learning styles—accommodating, diverging, assimilating and converging. As educators, it's important to make sure we can speak to all types of learners as we teach. A learner who's forced to learn in a manner they're not comfortable with may produce less-than-satisfactory results. Some learners may not retain the information and may become frustrated. It's also important to know your own learning style. We typically teach as we like to learn, but we must be able to adapt our style to reach all learners.
Learner preference has two components: how the learner perceives new information and how the learner processes the information. In the first component, learners will either analytically break down a new idea or skill and consider its value (thinkers) or they'll consider the new idea or task as a whole and evaluate how they "feel" about the new concept (feelers).
The processing component induces the learner to learn by doing (doers) or to learn by watching someone else a couple of times to see how it's done (watchers). We all apply some of each style in our learning processes, but everyone has a perception preference and a processing preference that together create their learning style.
Accommodating: The accommodating student is a "doer" and a "feeler." This student likes to jump right in and learn by trying. They'll run through the new task on intuition: how they think it should be done. This student may not appreciate the skill sheet they were given when learning a new skill. They just want to try it out and see how it works. These students can get the job done; it just may not be in the way it was presented. They may say things like, "I think it would work better like this." When you ask them why, they may tell you it just seems like a good way. Instructors should allow these students time to work through the process. They tend to be good team players and are willing to share their thoughts with their classmates.
Diverging: The diverging student is another good team player, but they would rather watch their team members or the instructor do something a couple of times before they try. They're "watchers" and "feelers," and can view situations from many different points of view and generate a wide range of ideas. As they watch what's being done or listen to what's being said, they'll evaluate the overall process, not the individual steps. Like their accommodating cohort, they'll work off of intuition and gut instinct. This student may say, "That doesn't seem correct to me." When asked to give it a try, they'll commonly ask to have it demonstrated one more time. Allow these students time to watch, but at some point they need to actually do the skill, which may take coaching on your part.
Assimilating: The assimilating student loves the classroom. They're "watchers" and "thinkers." They like to watch, listen and evaluate things step by step. They're more focused on the concepts than the people involved. They need clear step-by-step directions and explanations, and they prefer sound theory over practical use. These are the students who will memorize the skill sheet you give them. They'll want to watch others do the skill several times before they make an attempt, and they'll be quick to ask about a missed step. This student may be the wallflower in the back of the class or corner of the skill room. They may not say much, so watch for a confused look if the process isn't explained clearly.
Converging: The converging student is the other "doer." The difference from the accommodating student is that the converging student needs to know the technical reasons behind what they're doing and why it works. They're "thinkers" as well, so this student will want to jump in and participate immediately. They learn by doing and will evaluate the process step by step as it's being performed. This will be the student who tells you the skill sheet is out of order because the steps don't make sense.
Remember that all students exhibit characteristics of all of the learning styles, but most will have a strong preference toward one style. To make learning effective, instructors must strive to facilitate all learning styles. Let's use CPAP to model this process.
Teaching CPAP should include discussion of when the device is indicated, how it works, and the side effects and contraindications. You should also provide time in a skill lab for students to work with the equipment and learn how to physically apply the device.
When talking about indications and describing CPAP to the accommodating and diverging students (the feelers), you'll see that they're content to know that the application of CPAP decreases the work of breathing in patients with cardiogenic pulmonary edema. They'll also like to hear that CPAP decreases the need for intubation. A brief explanation of how CPAP provides pressure in the airways to keep the air passages from collapsing on exhalation will make perfect sense. To these two types of learners, CPAP will sound like a good tool and they will feel it's a beneficial procedure.
In the same classroom, listening to the same explanation of CPAP, the assimilating and converging students (the thinkers) will start to become restless if they sense they're missing some information. Their hands will shoot into the air with the resounding questions of "why" and "how." These students need to understand the specifics of how this device works to ease the work of breathing in CHF. Their learning styles will require you to explain pressure gradients and review CHF pathophysiology. To these learners, it needs to make logical sense. They won't be content simply knowing that patients feel better; they want to know why it makes them feel better.
Once the procedure has been described and explained and you move into the skill setting for practice, the group dynamics will change. In the skill lab, the accommodating and converging students (the doers) will want to look at the device, hold it and maybe start applying it before you even have a chance to demonstrate the procedure. On the other hand, the diverging and assimilating students (the watchers) will stand in the corner and observe everything that's happening.
Remember that as you explain the skill, the converging and assimilating students will need step-by-step instructions of how the device is applied. The assimilating student will be taking notes, and the converging student will be doing the skill while the steps are being described. An instructor could almost tell the accommodating student to do the skill without any demonstration, and the student would figure out how to apply the device, whereas the diverging student will watch and take it all in.
So, when presenting a topic to a diverse group of students, try to satisfy all of the learning styles. Begin the topic of discussion with an overall description of the process. Share relevant statistics about the process. Then, offer a detailed explanation of why it happens or how it works. Be prepared for questions. Answer most of the questions in class. Some students (typically assimilating) may ask questions beyond the "need to know" scope of your audience. Encourage these students to meet with you outside of class or help them research their own questions. Also, students with different learning preferences in the same group will help each other learn.
When introducing a new skill, provide one perfect demonstration first. Some institutions have created videos of perfect performance of individual skills for consistency. This approach also allows students who like to watch before demonstrating the chance to see the skill done repetitively.
Then, describe the overall process and list the steps of the procedure in order. Skill sheets can help students see the steps. Skill sheets are wonderful to help students remember the process, but all students must actually demonstrate the skill. It's fine to allow students to watch several times, but they still must eventually perform the skill.
Teaching to a wide range of learning styles is exciting and challenging. The key to reaching all students is a dynamic presentation style. Instructors should be aware of how they like to learn because that's typically how they'll teach, which may hinder the exchange of information with some students. Be sensitive to other's learning styles even if you don't fully understand their thought process. Allow enough skill time for students to practice, remembering some students need to watch several times before performing. And have a great class! JEMS
Dennis Edgerly, EMT-P, has been active in EMS for more than 20 years and has been involved with EMS education for more than 15 years, teaching primary and continuing education at all levels. He's the paramedic education coordinator at HealthONE EMS in Englewood, Colo., and a JEMS.com columnist. Contact him at Dennis.Edgerly@Healthonecares.com.
Masip J, Roque M, Sanchez B, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: Systematic review and meta-analysis. JAMA. 2005;294:3124–3130.
Kolb DA. Experiential Learning: Experience as the source of learning and development. Prentice Hall, 1984.
Read Dennis' Back to Basics column at www.jems.com/edgerly.