Are You Ready for Change?

The theme of change has been central throughout of the history of the U.S. and has been most visible around election time. Most educators would agree that change is their mission every day. However, although we agree our goal is to transform students into providers, understanding our role in helping to change knowledge, skills and attitudes is our biggest challenge.

What is Change?
Change is more than a six-letter word. As defined by the educational theorists, change is a process that requires knowledge, careful planning and precise execution to achieve. To enact the change that enables someone to perform a new task, to impart some new information or to reframe their viewpoint may take just a few minutes — or it may evolve over many years.

Experienced EMS instructors and managers recognize the difficulty of their task, and they carefully plan training to accomplish it in the most effective manner. Doing this to enact a complex change requires careful evaluation of the factors needed to most effectively foster that transformation. That change process is often accomplished with lesson planning or curriculum design. Although many types of design processes are available, all require an analysis of some essential components. And all require leadership. The Institute of Medicine’s 2003 Health Professions Education report concludes that, with regard to curricula, “leadership is the pivotal element in success, as leaders control or substantially influence all of the other factors.” (1) And just like any team effort, the process of planning change involves recognizing and managing power struggles among the groups involved in the change.

How to Enact the Change
It’s critical to delineate goals and develop measurable objectives early in the planning process. This will clearly define the vision for change. It’s also critical to understand that teaching a single planned program may not result in the permanent change outlined in the program goals and objectives. It’s one thing to get an EMT or paramedic to pass the quiz and perform the skill correctly at the end of a training session. It’s quite another for them to integrate that new knowledge or skill into their everyday practice. The end goal for each training program is “adoption of the new mission as an internalized and habitually used concept.” However, as educational theorist Cyril O. Houle points out, that’s never easy — “particularly if it requires a complete reorientation of practice.” (2)

Before you introduce something to the practice of paramedicine that changes the entire way in which a task is performed, consider that it will be difficult for some to make the transition. A good example is when an alternative reporting format, such as computerized documentation, is introduced. Because this activity is performed on every call, it’s automatic and ingrained within the practice of EMS personnel. Because of this, it may be hard for some to transition smoothly to a new procedure.

Effective curriculum design should include provisions for follow-up to monitor performance and to reeducate those are having difficulty with the new procedure. In the above example, this would include those who either felt no need for a narrative (leaving large gaps in patient reporting) and those who continued to write a lengthy narrative duplicating their other documentation. The bottom line is to be prepared to teach the how, the why and the when of knowledge and tasks, but also identify ways to help learners transfer those skills and facts to the real world.

Evaluating Our Effectiveness
Planning for change also requires careful evaluation of how it will affect others. When you introduce new equipment, do you account for the training mutual aid companies or the hospital will need to successfully adapt their patient care? Do you analyze how the other processes within your department may need to be altered to support the modifications you’ve made? If your answer is no, you may be making it more difficult for even the most eager learners to make the desired change.

An essential element of any program plan is to evaluate whether your learners have achieved the desired goals and objectives. Of course, the evaluation methods will be as diverse as the types of change you may be striving to make. They can include competency testing of skills and knowledge; quality improvement activities, learner reflections and self-evaluation. To be meaningful, the evaluation plan should be linked to your initial objectives for change and to the subsequent learning activities.

Change always requires energy, so it’s natural for most of us resist it. But consider where EMS would be today without the constant evolution that change brings. So, regardless of the version of change you choose to vote for in the next election, listen to — and believe — Sheryl Crow when she sings, “change will do you good.”


  1. Greiner AC, E Knebel: “Health Professions Education: A Bridge to Quality.” National Academies Press: Washington, D.C. 2003.
  2. Langenbach M: “Curriculum Models in Adult Education.” p. 112. Krieger Publishing Company: Malabar, Fla. 1993.

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