Incorporating subtle, unexpected clues during assessment simulations can help students stray from their assessment blueprint and trust their intuition. Photos courtesy Carolyn Gates
We’ve all had it: that aha moment during patient assessment when it all comes together. It might be a physical exam finding, an out-of-whack vital sign or something found on scene that causes it to all make sense. How do you teach new EMTs and paramedics this intuition?
STRAYING FROM THE BLUEPRINT
I teach students the “five parts of the run.” Coupled with memorization of drugs, protocols and policies, it’s a formula that should get them through any type of call. I tell them they don’t need to have completed the entire exam before coming to an educated guess as to the cause. But it’s hard for them to stray from the blueprint. So I’ve come up with a way to jump-start students’ critical thinking skills to help them zero in on that one clue—the clue a seasoned EMT or medic would spot immediately.
I use an assessment-based management game designed to help students develop good situational awareness and quickly disseminate their assessment findings. By incorporating unexpected elements, I’m able to help students develop the gut feeling that seasoned medics have. Here’s how it works.
I come up with the same number of chief complaints as the number of students. Each student gets a chief complaint on a slip of paper and a number from 1 up to the number of students.
They also get a second slip of paper with just a number—the second number can’t match the one on their complaint. They are told not to share their chief complaint or number with any of their peers.
Each student gets 15–20 minutes to come up with a simulation for their complaint. I impress upon them the need for an accurate prop (e.g., coffee ground emesis, heroin needles, discolored sputum, etc.), some proper out-of-range vital signs or physical finding to present a realistic patient.
When it comes time to start presenting, I take the students outside the classroom—we’re in San Diego so luckily that usually means outdoors. I take the first student aside, confirm what their complaint is and review how they plan to present it. I add anything I think is pertinent and we return to the group. I position myself to be whoever they need on scene: wife, bystander, police officer, etc.
The number written on their complaint is called out and the student with the corresponding number on their number-only slip then steps up and runs the simulation. No one knows who’s going to be called on to run their simulation, so each one is a learning experience for everyone. I give them the setting and they begin to assess their patient. The other students watch silently and soon realize it’s harder to be the one running the call and catching all the clues. The student running the simulation has to let me know what they think the etiology of the complaint is as soon as they have solid evidence and can back up their determination.
TEACHING THE AHA MOMENT
One of the patient complaints is a skin rash—an obvious allergic reaction but I want the student to figure out the cause. I assist in the scenario as the patient’s girlfriend, and here’s the curveball: I’m eating peanuts throughout the entire call.
It might appear to be obvious, but students (including the armchair quarterbacks) tend o get tunnel vision focusing only on the patient. I love to see the aha moments on their faces when it all comes together.
Although I also urge students to not close their mind to alternate or multiple causes for the patient’s complaint, the drill serves as a reminder that a welldeveloped gut feeling is seldom wrong.