The Just-in-Time Format 

Areas that are highly impacted by COVID-19 are seeing disruptions in mass gatherings and places where many people congregate. Many colleges across the country have suspended live classes and are moving to online platforms to finish out the semester. These same factors may affect many EMS educational programs at all levels in the near future. Delivering EMS education at a distance can be complex dependent upon the instructors familiarity with the delivery platform as well as what platform may be available.

Things to be considered if you program has to move out of the traditional classroom

What didactic method will we use
Lab experience
Hospital clinical time
Field internship time

There are three ways that EMS education can be delivered effectively to our students.

Traditional Classroom

The traditional classroom setting is what most instructors are used to. In this format, the instructor interacts, delivers content, asks questions and can guide students. Quizzes and exams are given in the classroom and lab stations are conducted.

Asynchronous Online Learning

These asynchronous classes are commonplace across college campuses. As the name entails, this is didactic information that is presented in an online format students can access remotely at any time. Many EMS program use a Learning Management System (LMS) to disseminate information to students in this way.

Online education is far more than just PowerPoints with voiceovers. While there may be some presentation in this format, short video recordings of subject matter experts talking on the topic imposed within the PowerPoint is commonplace. Student-directed assignments are used to push the student to research a topic outside of the presentation.

Chat rooms monitored by the instructor are a commonly used tool with required participation posts by each student. Quizzes and exams are usually conducted on the LMS, but careful preparation is essential to prevent students from sharing information. Building a shell (course) on an LMS takes time and technical expertise. If you and your program have an LMS in place and you possess the technological knowledge this may be the best way to deliver your educational content.

Synchronous Distance Learning

Synchronous distance learning is much like a teleconference and has been used for many years in rural areas of the United States to reach students. In the early days, student would need to travel to a location that had sufficient bandwidth to support two-way video conferencing. Today, most people can do that from their phones.

Many college-based LMS systems have an integrated conferencing platform built in. However, there are many cost efficient free-standing platforms that meet the educational need. Zoom and GoToMeetings are examples of good cost-efficient platforms that can be paid for monthly on an as-needed basis.

These platforms allow for the students to see the instructor live and for the instructor to see the students (up to 49 of them) live. Students can ask questions with the embedded microphone on their device or in a chat room. The instructor can show their screen to show PowerPoint presentations and video. There is a white board available on most platforms as well.

For most of these platforms, all the technology need is right there on a laptop or PC as long as there is a camera present. Instructors and students will need a broadband connection that is capable of steaming video. That is not a problem for most of us.

Student will need some type of device to view that presentation on. A laptop or desktop PC or Mac works best; iPad and tablets work equally well for most functions.  Android and iPhones have apps for these platforms, but the screen size may make viewing any PowerPoints difficult. All of the platforms have a dial-in option, but the students would not be able to see the screen.  Traditional exams and quizzes would need to be delivered remotely via some type of LMS which may not be available to many instructors. In these situations, alternative forms to measure knowledge should be implemented. Writing a paper on the proper splinting techniques could substitute for quiz or exam on the topic. While this form of education at a distance requires some technical expertise, it is not nearly as complicated as developing a shell for an asynchronous online class.

The instructors will use all of their currently prepared information and lectures to the students, just as if they were sitting in front of them. Class times would remain the same, as would attendance and participation by the students. There is a slight learning curve involved when asking questions and waiting for replies. Usually, there is a slight time lag due to the transmission of the video that requires some getting used to. However, after 15 minutes everyone has adjusted and things move forward seamlessly. 

One of the authors preparing a synchronous presentation.

Comparison of distance education delivery type

Asynchronous Synchronous
Didactic
Lab experience
Clinical

The lab experience is difficult to simply replace online. Some colleges in the Pacific Northwest that have suspended live classes have made exceptions for lab experience with some modifications. Most campuses have moved classes to a remote format to prevent gathering of people in one location. Faculty can come and go from campus as needed and some have allowed students to come to campus to take part in lab experiences.

The campuses that allow the lab experience to take place are limiting the number of students that can be in the lab at one time. Other programs have simply revised their schedules by pushing off the lab experience until after the crisis has eased.

Hospital Clinical and Field Internship

Hospital systems across the country have limited the visiting policy for their facilities. Most had a policy in place since we are in the midst of flu season and may have further limited those who can visit. Many have instituted screening process for all visitors, and some have instituted a travel restriction policy for employees.

A few hospitals have implemented a policy restricting students from the hospital clinical environment. Programs should have a plan in place if this situation arises in their local area. These plans might include deferring hospital time to later in the program and front loading some field experience ride time.

CoAEMSP send out guidance letter to program directors recently. It should be noted while field experience can take place at any point in the program, team leads can only take place after didactic is completed. Program directors faced with these situation should consult the CoAEMSP and their State OEMS offices directly.

Barriers to Education at a Distance

While most students would have the needed technology evaluable to connect to both a synchronous and asynchronous format, there are some students that may not. Proper implementation requires planning ahead for student equity. Survey the class to see if they have the necessary hardware – computer, phone and tablet – and more importantly high-speed broadband internet.

Some students may struggle financially and rely on the computer labs on campus to complete current assignments. Some students in more rural areas may not have an internet connection at all. While these situation can be overcome, early awareness of the barriers and timely solutions can make it easier transition to conducting the program from a distance.

While our younger students usually excel at technology use, some older adult learners may struggle. One-on-one coaching in how to log into the learning platform or conferencing website prior to the implementation is of utmost importance to this group of learners.

Barriers to learning at a distance

• Needed hardware (computers, tablets, phones)
• Broadband internet access
• Early understanding of how to login/logon to the platform
• Assuring student equity

It is obvious that COVID-19 will spread and have an effect on most EMS educational programs in some way. Preplanning for the potential of a change in delivery systems and sequencing of the program should take place sooner rather than later.

If your program utilizes an LMS for delivery of some content, it may be an easy transition to place all of the didactic classes online. For programs that do not have experience in LMS based distance learning the synchronous two-way delivery methods may be the easiest and most cost effective format for short-term use.

Be transparent with your students. Let them know that they will know what you know when you know it. Include them in the process, especially if rescheduling is needed  Most will need lead time to schedule work and home commitments.