Note: Abstracts may be downloaded as a single PDF using the link below.
Hide or Go Seek: Do More Pediatric Encounters Make Better Paramedics?
Author: Tom Brazelton, MD, MPH
Associate Authors: Sandi S. Wewerka, MPH, CCRC, Aaron Burnett, MD, Elliot Carhart, EdD, RRT, NRP, Levi Danielson, BS, Patricia Tritt, RN,MA, Gordy Kokx, PhD, NREMT-P, Genghis Philip, MA, Kate Hanson, BA, Luke Stanke, BS, Jon Studnek, PhD, NREMT-P
Introduction
The 1998 Department of Transportation National Standard Curriculum recommends 30 pediatric patient encounters of various age groups [annually?] to maintain skills. The average U.S. paramedic student will encounter an about 33 pediatric patients in their clinical and field experiences. The majority of the patients (66%) are school-aged and adolescents. The National EMS Education Standards require “competency” in caring for pediatric patients of all ages but the current measures of competency are limited to testing metrics. No research exists examining the number of pediatric field encounters and performance of paramedic students on the pediatric section of the Fisdap Blue Paramedic Exam. .
Methods
A retrospective review of prospectively identified data from the Fisdap, an EMS student data collection system, was performed. Paramedic graduates consented to their anonymous data being prospectively gathered and used for research. Data verification was audited and validated by instructors and designated “good” if it was accurate and complete.Performance was defined by paramedic students on test items with a logit score model where the average item difficulty logit score centered at 0. The logit score becomes a reflection of the student’s ability to answer the question compared to the average question in that exam.
Results
For the Fisdap Blue Paramedic exam’s pediatric-specific questions, the average student logit score was 2.1 ± 0.9, meaning students were likely to get the answer correct 88% of the time. Paramedic students saw an average of 24.6 ± 16.6 pediatric patients in their clinical rotations and 5.6 ± 4.6 pediatric encounters in the field internship.
Field encounters contribute more to the logit score than clinical encounters. With about 33 pediatric patient encounters, the overall effect would be an additional 6.6% to 13.2% improvement in paramedic student scoring on the pediatric-specific test questions .
The effect of nonwhite background was strongly but negatively associated with paramedic student success answering pediatric-specific test questions on the Paramedic BLUE exam, prior to that student ever having any pediatric patient encounters.
Conclusion
Pediatric test questions are relatively easy for paramedic students and might not adequately assess cognitive competency. Field encounters contribute more to success than clinical encounters. Ethnic differences should be investigated further.
Do Preceptors Associate Professional Behavior With Team Leadership During the Field Internship?
Author: Marilee Vosper, BS, Paramedic
Associate Authors: Dennis Baier, BSN, RN, Paramedic, Antonio Garcia Merino, MS, RN, Stephen Asche, MA, Tia Radant, MS, NREMT-P, John Cook, MBA, NREMT-P, Mike Bowen, NREMT-P, Benjamin W. Drummer, Logan Smestad, BA, NREMT-B
Introduction
The National Highway Traffic Safety Administration has established professionalism to be a necessary skill of paramedics. Anecdotal evidence suggests that leadership requires professionalism. This study analyzes the correlation between professional behavior and team leadership in the paramedic student field internship.
Hypothesis
Paramedic preceptor’s scoring of a student’s professional behavior is associated with the scoring of the student’s team leadership.
Methods
Paramedic student field internship experiences were prospectively reported in Fisdap, an EMS student data collection system, and retrospectively reviewed. In all, 10,294 runs occurring from more than 500 students at 45 paramedic programs from 2012 to 2013 were included using these criteria: 1) had a paramedic student account; 2) student provided consent for research; 3) run evaluations available with both professional behavior and team leader score by the preceptor; 4) runs available with scores of 0, 1, or 2 on professional behavior and team leadership. A score of “0” defines unsuccessful, “1” marginal and “2” successful for professional behavior and team leader. To test the association between professional behavior and team leadership the researchers used contingency tables and Pearson Chi-square test.
Results
There was a significant positive association between the rating of team leadership and professional behavior (p<.0001). When scoring a student’s professional behavior on a run as successful (10,088 or 98% of total runs), 76.7% (7,738) of runs were scored successful, 21.1% (2,129) marginal, and 2.2% (221) unsuccessful as team leader. When scoring a student’s professional behavior on a run as unsuccessful/marginal (205 or 2% of total runs), 12.2% (25) of runs were scored successful, 66.5% (136) marginal, and 21.2% (44) unsuccessful as team leader.
Conclusion
A paramedic preceptor’s scoring of a student’s professional behavior is positively associated with the scoring of the student’s team leadership. Furthermore, the data suggest that preceptors are considering professional behavior in evaluating successful team leadership. This study supports the anecdotal evidence that leadership requires professionalism. Additional studies are necessary to better define the association between these variables.
Babies Breath and Teen Angst: Distribution of Paramedic Student Primary Impression By Age
Author: Aaron Burnett M.D.
Associate Authors: Sandi S. Wewerka, MPH, Tom Brazelton, MD, MPH, Elliot Carhart, EdD, RRT, NRP, Patricia Tritt, RN, MA, Genghis Philip, MA, Christopher Anderson, MPH, Levi Danielson, BS, Sam Tape, BA, Jon Studnek, PhD, NREMT-P
Introduction
EMS educators have divided the pediatric population into age groups to assist in targeting clinical and didactic curricula. Emphasizing paramedic student exposure to pediatric patients based entirely on age might not adequately prepare students for later clinical practice.
Hypothesis
There are unique clusterings of pathologies, represented by paramedic student primary impressions, in different age groups.
Methods
The study retrospectively reviewed data documented by paramedic students in the Fisdap, an EMS student data collection system, in 2011and 2012. For the purposes of this study pediatric patients were defined as between 0 and 16 years of age. All paramedic student primary impressions recorded in Fisdap for patient’s aged 0 to16 years during 2011 and 2012 were abstracted. Primary impression by age was calculated and graphed. The frequency of primary impression was then assessed for significance of trend by age with an alpha <0.05 considered significant.
Results
The paramedic students’ primary impressions showed clinically significant variability in prevalence among different pediatric age groups: Respiratory Distress, Medical-Other, Abdominal Pain, Seizure, Overdose/Poisoning, Behavioral, Cardiac. In patients less than 13 years old, Respiratory and Medical-Other were the most common primary impressions and both decreased with age. Cardiac was most common in patients aged 0 to1 year and Overdose/Poisoning was most common in patients older than 12. In patients aged 5 to16, the prevalence of Respiratory and Medical-Other decreased and Abdominal Pain and Behavioral increased.
Conclusion
There are statistically significant variations in the frequency of paramedic student primary impressions as a function of age in the pediatric population.
Specialized Clinical Rotations and Their Effect on Paramedic Student Performance
Author: Jesse Davis, MEd, NREMT-P, I/C
Associate Authors: Melisa Martin, MHS, EMT-P, Chris Anderson, MPH, Daniel Atwood, BS, Rob Gurliacci, BPS, EMT-P, Amy Hammond, BS, Greg LaMay, NREMT-P, Andy Lovell, NJ-MICP, Michael Mayne, BA
Introduction
Paramedic education includes clinical rotations that provide students with a structured environment in which to apply their knowledge. Some paramedic programs use specialty rotations such as pediatrics and obstetrics. Although it is assumed these specialized rotations enhance knowledge acquisition within those subject areas, there are no data to support this claim. The purpose of this study was to determine the influence of specialized rotations in pediatrics and obstetrics regarding knowledge within those subject areas.
Hypothesis
Paramedic students who have completed at least one clinical rotation in obstetrics and/or pediatrics have appreciable improvement in cognitive performance on the obstetrics/pediatrics subsection of the Fisdap Blue Paramedic Exam compared with students who do not complete these rotations.
Methods
Data were collected retrospectively from December 2006 to January 2013 from paramedic students participating in Fisdap, an EMS student data collection system,. Inclusion criteria was paramedic students who used the Fisdap skills tracker option and completed the Fisdap Blue Paramedic Exam. Students were categorized based on whether they completed at least one clinical rotation in either obstetrics or pediatrics. The primary outcome measure was the average number of correctly answered questions within the obstetric/pediatric subsections of the exam, which was analyzed using an unpaired t– test.
Results
The obstetrics/pediatrics subsection of the Fisdap Blue Paramedic Exam consisted of 33 questions (11 obstetric and 22 pediatric). A total of 2,552 exam attempts were evaluated, of which 342 (13.4%) completed obstetric rotations only and 369 (14.5%) completed pediatric only; 1,411 (55.3%) completed both rotations; and 430 (16.8%) completed neither. Students who completed a rotation in a specialized obstetric department on average answered a greater number of questions correctly compared to those who did not complete the rotation (7.88±1.63 vs. 7.62±1.67, p<0.01). Similarly, students who completed a rotation in a specialized pediatric department correctly answered 18.03(±2.17) questions compared to 17.55(±2.38) among those not completing the pediatric rotation (p<0.01).
Conclusion
While students who completed specialty rotations scored statistically higher on the obstetrics/pediatrics section of the cognitive exam, the practical significance of this difference is not clear. Rotations in these specialty departments should be further evaluated to determine their true impact on student outcomes.
Student Self-Evaluation: Learning to “Know Thyself”
Author: James Dinsch, MS, NREMT-P
Associate Authors: Greg Cliburn, MA, NRP, William Gaskill, Liz Mrak, BS, NREMT-P, Adam R. Parker, AAS, NREMT-P, FP-C, Sara Richter, MS, EMT-B, Dana Snuggerud, BAS, Rachel Wasilewski, BS
Introduction
The ability to evaluate one’s own performance is an important professional quality and a goal of paramedic affective education. Paramedic students are often required to evaluate their own performance, but how well they self-evaluate, how they learn to improve their self-evaluation skills, and the effect of these skills on their overall academic performance have not been studied. The purpose of this study was to determine whether the accuracy of student self-evaluation improves over time and whether that has an effect on academic performance.
Hypotheses
By the completion of the field experience, paramedic student self-evaluation aligns with preceptor evaluation of the student.
Students who are accurate self-evaluators of their field experience perform better on a summative cognitive examination.
Methods
Three paramedic programs were identified as having participated in the National Registry of Emergency Medical Technician’s Paramedic Psychomotor Competency Portfolio Package Project and used Fisdap, an EMS student data collection system. Field experience and comprehensive paramedic exam performance data were abstracted for students who had “good” data and consented to have their data used for research. Student and preceptor evaluations were compared for seven categories (Communication, Field Impression, Interview, Physical Examination, Professional Behavior, Skills Performed, and Team Leadership) using Cohen’s weighted kappa coefficient. Evaluation agreement over time was evaluated using a Chi-square and relationship to exam pass/fail status examined with the Mann-Whitney-Wilcoxon test.
Results
The dataset included 34,570 evaluated field patient encounters for 267 students. The percent of encounters in which both preceptor and student completed the evaluation was high (76.25% to 82.11%) as was overall agreement in all seven categories. Student awareness of when to rate and preceptor-student agreement across all categories increased with increased experiences (p<0.0001). Higher agreement relative to exam passing was only significant for Professional Behavior (p=0.0076).
Conclusion
Student awareness of when to rate and agreement with preceptors’ ratings were high overall, but increased exposure did increase the level of agreement. While agreement relative to exam passing status was significant for Professional Behavior, overall high agreement in both pass and fail groups across all categories offers no practical importance.
Preceptor Bias? EMS Student Perceptions of Preceptor Interactions Based on Age, Gender, and Ethnicity
Author: David I. Page, MS, NREMT-P
Associate Authors: Melisa Martin, EMT-P, MHS, Michael W. Hubble, PhD, MBA, NREMTP, Jesse Mortenson, BA
Introduction
Previous research in allied health clinical education indicates that preceptor relationships play a key role in student success. EMS program accreditation requires students to evaluate their preceptors. Anecdotal reports indicate EMS preceptors might not be as welcoming of minority and female students as their Caucasian male counterparts.
Hypothesis
Student perceptions of preceptor interactions vary based on gender, age and ethnicity.
Methods
Between September 2007 to January 2013 EMS students participating in Fisdap, an EMS student data collection system, prospectively completed a Preceptor Evaluation survey. The survey consisted of 14 items adapted from the Committee on Accreditation of EMS Programs Resource Survey (Part C). Using a 5-point Likert scale students rated their preceptors on each of the following dimensions: Communication of expectations, welcoming and orientation of the student, facilitating student involvement in patient care, allowing interaction with patients and family, providing useful feedback and fair evaluations, demonstrating an enthusiasm for teaching, and the degree of comfort working with the same preceptor during a future rotation. All completed surveys were retrospectively reviewed and aggregated for analysis based on gender, age and ethnicity usingt-test, Pearson correlation, and ANOVA procedures. Statistical significance was established at p<0.05.
Results
A total of 1,666 students participated representing 16,075 clinical shifts. Compared to males, females rated their preceptors significantly lower in the dimensions of welcoming behavior, communication of expectations, orientation, allowing patient interaction and fair evaluation (p<0.05). Similarly, compared to their Caucasian counterparts, minorities reported lower levels of satisfaction with their preceptors on all of these dimensions plus enthusiasm for teaching and comfort level for future rotations (p<0.05). In addition, increasing age was negatively correlated with all of the above dimensions of student-preceptor interaction (p<0.05).
Conclusion
Minority, female and older EMS students reported significantly lower preceptor performance ratings on most dimensions compared to their Caucasian male counterparts. The causes, practical significance and effect on student success of these differences warrant further investigation.
Lights! Siren! Learning? Paramedic Student Exposure to Prehospital Emergency Patient Contacts Improves Summative Exam Scores
Author: David I. Page, MS, NREMT-P
Associate Authors: Melisa Martin, EMT-P, MHS, Michael W. Hubble, PhD, MBA, NREMTP, Jesse Mortenson, BA
Introduction
Field internships during paramedic student clinical rotations have been linked to improved critical thinking and improved overall performance on cognitive exams. Anecdotally, EMS programs encourage students to obtain contacts during emergency responses over nonemergent or transfer responses. Little is known, however, about the value of emergent vs. nonemergent patient contacts and their effect on student cognitive performance.
Hypothesis
Students who are exposed to increased prehospital emergency patient contacts during field clinical experiences will perform better on cognitive examinations.
Methods
Electronic records and cognitive exam results from paramedic students participating in Fisdap, an EMS student data collection system, were retrospectively reviewed. All students completing the Fisdap Paramedic Blue Exam were included. The 200 item exam consisted of seven sections: Airway, Cardiology, ECG, Medical, Obstetrics, and Trauma. Overall scores as well as a cognitive level results for: knowledge (43 questions), application (111 questions), and problem solving (46 possible) were considered. Prehospital patient contacts were reported as either transfer, ASAP, or emergency. Analysis was completed using normalized data and the Pearson correlation procedure. Statistical significance was established at p<0.05.
Results
A total of 1,335 students completed the exam from June 2005 to December 2010. Patient contacts during transfers were negatively correlated with student overall score (p=0.022) as well as their application score (p=0.014). Contacts during ASAP responses were positively correlated with student knowledge scores (p=0.00). In addition, emergency patient contacts were positively correlated to all score types; overall (p=0.00), knowledge score (p=0.00), application score (p=0.00), and problem solving scores (p=0.00).
Conclusion
Students with increased prehospital emergency patient contacts performed better on all levels of a summative examination. Student participation in transfer responses was associated with lower application level scores and lower overall scores. Further investigation is warranted to clarify the effect emergent and non-emergent runs in EMS programs.
Are the Current CoAEMSP Airway Requirements Obtainable?
Author: Sahaj Khalsa, AS, NREMT-P
Associate Authors: Michael Buldra, MEd, NREMT-P, Michael Voss, MAEd, NREMT-P, Dana Voss, MBA, LSSMBB, EMT-B, Kathy Wells, NREMT-P, Rodney Ray, AS, NREMT-P, Jesse Davis, MEd, NREMT-P, Nikk A Oquendo, EMT-P
Introduction
In August 2012 the Committee on Accreditation of Emergency Medical Services Programs (CoAEMSP) released new interpretations of the airway standards for accredited paramedic programs. The standards state: “The paramedic student should have no fewer than 50 attempts at airway management across all age levels, with a 90% success rate utilizing endotracheal intubation models in their last 10 attempts. The paramedic student needs to be 100% successful in the management of their last 20 attempts at airway management.” This study examines whether paramedic students are able to achieve 50 attempts at airway management during the clinical/field portion of their program.
Hypothesis
During a student’s typical clinical and field experience, he or she will obtain the requirement of 50 attempts at airway management.
Methods
Data were collected from Fisdap, an EMS student data collection system, from 2001 to 2011 and were retrospectively reviewed for field and clinical hours, and field and clinical airway attempts. The data were analyzed using process capability analysis and a lower specification limit of 50 for airway management attempts.
Results
The data (n = 9,265) show a mean of 11.5 recorded airway management attempts per student, a significant difference from the 50 attempts mandated in the standard. According to the data, if field hours are 1,001 to 1,500 and clinical hours are 600 to 800, the standard is achievable. However, data also show that the mean number of hours spent in the field is 430 and 202.5 in the clinical setting. Based on the capability analysis performed, 98% of the student numbers of airway attempts fell below 50.
Conclusion
Data show that the CoAEMSP standard is not achievable in the typical internship/clinical timeframe. Based on these results, to meet the CoAEMSP standard of 50 airway management attempts, paramedic programs must build in at least 40 lab airway management experiences for students.
Faculty Perceptions of Barriers to Conducting Research in Accredited EMS Education Programs
Author: Elliot Carhart, EdD, RRT, NRP
Introduction
In 2001, the National EMS Research Agenda identified the problem of inadequate production of EMS research, as well as a lack of translation between EMS education and clinical practice. This suggested a need for education-focused EMS research. At the same time, there also appeared to be a lack of educational institutions committed to EMS research. It does not appear much has changed in the passing decade and it remains unknown as to which barriers are impeding progress.
The purpose of this study is to characterize the perceived barriers to conducting research in accredited EMS education programs. Identification of such barriers might invite discussion among EMS stakeholders aimed at promoting EMS-related research efforts.
Methods
This descriptive survey study used a convenience sample of EMS educators throughout the nation. A recruitment e-mail was sent to the directors of 342 accredited EMS education programs requesting their participation with secondary distribution to their faculty members. The survey instrument contained 22 questions on participant and institution demographics, as well as the participant’s perceptions regarding barriers to conducting research.
Results
A total of 226 responses were received from all regions of the country. Five incomplete responses were excluded (N=221). The majority of participants (88.2%, n=195) were faculty members at degree granting institutions (associate or higher), with a small portion of those institutions awarding graduate degrees (15.8%, n=35). While most participants believe EMS educators should conduct research (80.5%, n=178), the majority of participants have never conducted EMS-related research (57.9%, n=128). Even fewer have conducted EMS-related research at their current institution (21.7%, n=48). The majority of participants did not believe their institution has the resources necessary to conduct EMS research (59.7%, n=132), with only half of all participants (48.9%, n=108) indicating they have access to an Institutional Review Board. A significant number of participants responded their teaching load does not afford time for research (77.8%, n=172) and many believe a lack of funding prevents them from conducting research (66.1%, n=146).
Conclusion
This descriptive study has yielded an insight into faculty perceptions regarding research. However, further effort to investigate these reported barriers is warranted.
Entrance Exam Prediction on Paramedic Student Performance
Author: David I. Page, MS, NREMT-P
Associate Authors: Michael Bowen, NREMT-P, Luke Stanke, BS
Introduction
Paramedic education can be costly and time consuming. Previous allied health entrance screening tools have been shown to have little predictive value to overall paramedic student success. Employers, students and educators could benefit from accurate pre-paramedic program assessment tools to guide admission and remediation of key abilities.
Hypothesis
Paramedic entrance exams scores can positively predict performance during key unit exams.
Method
Paramedic programs using Fisdap, an EMS student data collection system that measures paramedic student progress and summative competency, administered a Fisdap Entrance Exam to new paramedic students at the beginning of their courses. The exam is designed to measure cognitive ability with breakdowns in Math, Reading, Inference/Analysis, Anatomy, Physiology and EMT-level critical thinking. The exam also measures personality traits associated with highly reliable employees. The Rasch model (Rasch, 1960) Fisdap Entrance Exam (n=861), Airway Exam (n=937), and Cardiology Exam (n=821) was fit to the data to obtain true score estimates for each of the examinees. A correlational analysis of the true scores was then compared across examinees between the Entrance Exam, and the Airway and Cardiology subject tests.
Results
A total of 125 examinees completed both the Entrance and Airway exams., and 144 examinees completed both the Entrance and Cardiology exams. The correlation between the Entrance Exam and the subjects’ tests was statistically significant (Airway Exam: r=.59; Cardiology Exam: r=.63).
Conclusion
It is possible to use the Fisdap Entrance Exam to predict successful performance on the Airway and Cardiology exams. More research is needed to determine the practical value and accuracy of the Entrance Exam in predicting overall success.
Personality Traits of Paramedic Students and The Effect on Cognitive Ability
Author: David I. Page, MS, NREMT-P
Associate Author: Michael Bowen, NREMT-P, Luke Stanke, BS, James, Billy J, PhD, LP
Introduction
Extensive research has been performed to describe personality characteristics of high functioning employees and ideal profiles for law enforcement candidates. The M5-50 (McCord, 2002), NEO Personality Inventory (P. T. Costa, Jr., & R. R. McRae, 1992) and International Personality Item Pools (Goldberg, 1999) are a validated, reliable and published or commercially available personality inventories used for these purposes. The elements of Agreeableness, Conscientiousness and Neuroticism, also described as Emotional Stability, appear to be useful in the identification of ideal paramedic students. Conscientiousness may also have utility in predicting elements of caring or empathetic behaviors.
Methods
Consenting paramedic students beginning their educational program and enrolled in programs using Fisdap, an EMS student data collection system, completed the new Fisdap Entrance Exam (reliability = .89). Thirty relevant affective domain elements from the M5-50 were embedded into the 126 item exam. The exam is designed to measure cognitive ability with breakdowns in Math, Reading, Inference/Analysis, Anatomy, Physiology, and EMT level critical thinking. Logit scores for the exam and the cognitive traits were scaled using the Rasch model (Rasch, 1960) and converted to true scores. A multiple regression was then completed using the estimated true scores obtained from the Rasch models to determine the proportion of variance accounted for by the traits on the exam. The regression was fit is as follows: Entrance Exam = B0 (Cognitive Ability) + B1(Agreeableness) + B2(Conscientiousness) + B3(Neuroticism).
Results
Two personality traits, Conscientiousness and Emotional Stability were statistically significant in predicting cognitive ability, accounting for 6% of total variance. While these two traits significantly predicted cognitive ability scores, agreeableness did not. On average, examinees with higher levels of conscientiousness obtained higher overall cognitive ability scores (B2 = 0.86, p=.004), while examinees with higher neuroticism scores obtained lower cognitive ability scores (B3 = -0.71, p=.01).
Conclusion
Conscientiousness and Emotional Stability appear to be measurable personality traits that are desirable in paramedic students. Future research is needed to correlate and predict how affective traits and cognitive ability are associated with student success.
