Columns, Patient Care, Training

Study Describes Simulation Use, or Lack Thereof, in EMS Education

Issue 6 and Volume 40.

SUPER Study

McKenna KD, Carhart E, Bercher D, et al. Simulation use in paramedic education research (SUPER): A descriptive study. Prehosp Emerg Care. Feb. 9, 2015. [Epub ahead of print.]

Think back to the roots of your EMS education. No matter when it was, there were probably manikins. From a simple CPR trainer to today’s high-fidelity manikins, the face of EMS education is evolving to include a focus on simulation because it provides consistency and creates clinical opportunities to assess and treat patients who students may not see during their clinical rotations.

Despite this great potential, it’s important to characterize the current use of simulation in EMS education before our profession can move forward in studying and developing best practices for the use of simulation. Researchers from the National Association of EMS Educators (NAEMSE) have filled this void through an effort to help the stakeholders of EMS education target educational initiatives and resources.

Background: Study authors, including Research Review contributor Elliot Carhart, sent surveys to 638 paramedic programs that were accredited or in the process of becoming accredited by the Commission on Accreditation of Allied Health Education. The survey consisted of 56 items, primarily multiple-choice questions along with a limited number of open-ended responses for clarification purposes. The questions asked respondents if they had–or had access to–and if they used various types of manikins and other simulation equipment. The survey also captured information about other methods of simulation, such as standardized patients, computer-based scenarios and games, and virtual reality simulation. They also asked about training and the program’s personnel resources. Additional questions focused on how each program used simulation (e.g., teaching, testing, etc.), with other questions designed to capture the respondents’ perspective on the use of simulation in EMS education.

A total of 389 surveys (61% response rate) were returned to the investigators from programs all across the United States. This provided an excellent cross-section of the country from a demographical perspective. The vast majority of respondents came from publically funded programs (80%), with post-secondary institutions (75%) being the most common type of program sponsor and 77% of those post-secondary institutions being two-year colleges.

It comes as no surprise that 100% of respondents had or had access to task trainers, such as IV arms and intubation heads. Every program also had or had access to simple manikins (e.g., CPR trainers), but only 92% of programs reported they were used for training paramedic students. It was a similar story for intermediate manikins (e.g., IV, intubation, and ECG), which were only used by 94% of programs even though 99% of programs had them. Computer-based simulation, a relatively new foray in EMS education, was surprisingly available to 71% of paramedic programs but only used by 31%.

When it came to advanced manikins (i.e., those with similar task features to intermediate manikins, but that are fully programmable), 91% of programs responded as having or having access to them, but only 71% responded as having used them during their last paramedic class. Upon further analysis, the authors found that respondents who “had” an advanced manikin were significantly more likely to actively use it when compared to those who only “had access to” an advanced manikin.

A deeper look into the findings of unused equipment revealed that 31% of respondents admitted to having simulation equipment that sits unused, with the most frequently reported reason being inadequate training (26%). Less than half of the programs (48%) felt faculty training was adequate. Most respondents (79%) indicated they would like to use more simulation in their education, but over half of all programs (56%) reported they had no personnel support available to their staff for the maintenance, upkeep and use of simulation techniques.

Discussion: The results of this study suggest that a large portion of the EMS education community is experiencing similar problems with the use of simulation as a training modality. The findings regarding inadequate personnel resources aren’t surprising, as EMS educators must often wear many hats when incorporating simulation into their practical scenarios (e.g., operating equipment while facilitating a simulation). Trying to do too much with too little is likely to lead to frustrated educators, idle equipment and missed opportunities for learning.

Because of the wide variability in the types of patients seen during clinical rotations, and the challenges of maintaining adequate field and clinical slots for EMS students, EMS educators may need to lean on simulation in order to create environments that will prepare students for patients they simply may not encounter during their paramedic education. That means that educators need to have the most effective simulation equipment and methods, along with the proper training and the resources to use them effectively. This study provides an important first step toward the development of evidence-based best practices for the use of simulation in EMS education.

Bottom Line:

What we already know: Simulation joins didactic education and clinical/field experience as part of the toolbox needed for EMS education.

What this study adds: Although certain simulation methods are widely available to EMS educators, inadequate personnel resources and a lack of training might deter their use.