PCRF 2014 Educational Abstracts

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2014 Educational Abstracts (PDF) 239.34 KB

Use of a Preparatory Course as a Reductive Intervention of EMT Course Attrition
Author: Ginny Renkiewicz MHS, EMT-P
Associate Authors:  Michael Hubble, W. PhD, NREMT-P

Introduction
A growing concern in EMS education is student attrition. Perchance, there is a population of non-matriculated students (i.e., enrollees in non-credit courses) that may not possess the prerequisite academic skills or are otherwise ill-prepared for the unique requirements of the EMS profession. Consequently, addressing these issues could promote academic and occupational preparedness, thereby reducing attrition and promoting course completion.

Objective
To measure the impact of a preparatory course designed to address academic and psychosocial skills that may affect EMT course completion.

Methods
We conducted a retrospective analysis of a 24 hour prerequisite preparatory course using a before-and-after non-experimental design. The course included the EMT preparatory curriculum, program orientation, workforce-preparedness skills, and culminated with an academic skills assessment. All students enrolled in an EMT course at a single study site between July 2008 and December 2011 were included. Chi-square analysis was performed on attrition categories defined by CoAEMSP (Academic, Disciplinary, Attendance, Health, Financial, Personal, or Never Attended). A logistic regression model calculated the odds ratio (OR) of course completion as a function of completing the preparatory course while controlling for demography.

Results
The historical control group consisted of 117 (58.5%) students enrolled prior to implementation of the preparatory course, while the remaining 83 (41.5%) students in the intervention group completed the preparatory course. Overall attrition was 109 (54.5%) students with lower rates observed in the intervention group (13.0% vs 32.5%, p < 0.01). Significant differences were observed for intervention versus control groups in the attrition categories of Academic (9.1% vs. 90.9%, p<0.01) and Never Attended (5.6% vs. 94.4%, p<0.01). After controlling for age, gender, race, and educational background, students who took the preparatory course were more likely to achieve course completion (OR = 5.17, p<0.01).

Conclusions
We found that students who participated in an EMS preparatory course were 5 times more likely to achieve course completion and reduced the proportion that enrolled but never attended an EMT course. In contrast to prior studies, we did not observe a paradoxical increase in other attrition categories after addressing academic preparedness. These findings may prove useful for EMS educators tasked with program planning.

Skeletons in the Closet: Paramedic Program Simulation Equipment That Sits Idle or Unused
Author: Kim McKenna, MEd RN EMT-P
Associate Author: Elliot Carhart, EdD RRT NRP NCEE, Danny Bercher, PhD NRP, Andrew Spain, MA EMT-P NCEE, John Todaro, BA RN NRP NCEE, Joann Freel, BS CMP

Introduction
Simulation is an important strategy used in paramedic education. It is not known if paramedic programs have simulation resources that sit idle and unused.

Objective/Hypothesis
The objectives of this study were to describe simulation resources that accredited paramedic programs have, and which of those resources they use.

Methods
The National Association of EMS Educators conducted a census survey of all paramedic programs in the U.S. that were accredited, or had a letter of review from the CoAEMSP as of November 2013 to characterize the use of simulation in initial paramedic programs in order to target educational initiatives and resources. Respondents were asked if they had simulation equipment that sits idle or unused (never used or never used as intended).

Results
There were 638 paramedic programs that received the survey. Of those, 389 responded (61%). Respondents from 118 programs (31%) indicated they have simulation equipment that sits idle. The unused simulation equipment included advanced (fully programmable) manikins, intermediate manikins, synthetic cadavers, a driving simulator, a simulation lab and a simulated ambulance. Respondents cited several reasons for the idle equipment.

Pearson Chi-square analysis indicated a relationship between idle equipment and reported adequacy of faculty education resources à·2 (1, N = 377) = 50.112, p<0001 and with adequacy of personnel resources à·2 (1, N = 374) = 24.388, p<0001.

Conclusion
Over one third of paramedic programs have valuable simulation resources that sit idle. Respondents reported personnel training and resources as the top issues influencing this lack of use.

Pain is Inevitable, Suffering is Optional: an Analysis of Paramedic Student Treatment of Extremity Traumas
Author: Laurie Hill, AAS NRP
Associate Authors: Lewis, Catherine BA, Jason Hums, MPH, Avis Thomas, MS,  Sandi Wewerka, EMT-B, MPH, Mark Malonzo, MA, NRP, Rachel Walberg, BA, Abigail Zagar, BS, Nick Skenderian, BA, EMT-B, Nathan Ross, BS, NRP, MS, Mike Burbank, EMT-B

Background
Evidence-based standards in pain management indicate all patients should have pain assessed continually utilizing age-appropriate pain scales. Additionally, all patients with moderate or greater pain should be considered candidates for analgesia regardless of transport intervals.

Hypothesis
Paramedic students are not administering narcotic medication for pain management uniformly across age groups.

Methods
A retrospective review of data was collected using Fisdapâ„¢, an internship skills tracking system for EMS students. Inclusion criteria included: Field data inputted by paramedic students in contexts between 01-01-2009 and 12-31-2013; patients coded as “alert and oriented”; patients with a primary impression of “trauma — extremity”. Age groups were defined as pediatric (0-8 years), adolescent (9-17), adult (18-69) & geriatric (70+). Patient care was analyzed based on administration of narcotic pain management medication (morphine, fentanyl, hydromorphone & meperidine). Data was analyzed using descriptive statistics and P-values were calculated for two-way interactions between categorical variables using Chi Square statistics. Most differences were statistically significant due to large sample size.

Results
A total of 190,449 patient encounters by 33,997 paramedic students were included for analysis. In a comparison between age groups, results indicated patients in the pediatric age group received narcotic medication significantly less frequently than patients in other age groups.

Conclusion
In examining the paramedic students’ treatment of extremity trauma between 2009 and 2013, a trend appeared that administration of narcotic medication to pediatric patients was approximately one third the rate given to other age groups. Future research needs to be done to determine the reasons for this discrepancy.

Increased Neuroticism is Associated with poor professional behavior during paramedic students field internships
Author: David Page, MS, NREMT-P
Associate Authors: Michael L. Bowen, NREMT-P, Luke Stanke, PhDc

Introduction
Previously validated personality inventories have linked emotional stability to high functioning law enforcement officers (M5-50 (McCord 2002), NEO Personality Inventory (NEO PI-R; P. T. Costa, Jr., & R. R. McRae, 1992)). Paramedics work under similarly stressful conditions and must also demonstrate acceptable professional behavior (PB). Use of these inventories to measure neuroticism in paramedic students (PS) may help predict and avert poor affective performance in the field.

Hypothesis
Increased neuroticism in paramedic students is associated with poor professional behavior during field internships.

Methods
All paramedic students consenting to research and participating in both the National Registry of EMTs (NREMT) Psychomotor Competency Portfolio Project (PCPP) and the FISDAP(R) Entrance Exam (EE) were included in this study. Preceptors evaluated student’s PB using the NREMT-PCPP form. Affective domain scores from the EE were then compared the PCPP rating, a dichotomous preceptor rating, acceptable or unacceptable, that evaluated their professional behavior after each patient encounter using a generalized linear multilevel model (GLMM). The GLMM included random effects for student and preceptor and fixed effects for the square root of the total number of patient encounters completed prior to the rating and affective domain scores.

Results
A total of 75 student met the inclusion criteria and received rating by 323 preceptors. The mean logit score for neuroticism was -1.53 (SD 1.21; Range -5.11 to 1.70).

The results from the model fitting suggested a statistically significant relationship between neuroticism logit scores and professionalism behavior rating received by preceptors (p=.01).

The results produced an odds ratio suggesting that for every 1 logit increase in neuroticism, a student was 2.4 times more likely to obtain a negative rating on professional behaviors from a preceptor, controlling for student ability, preceptor rating harshness, and total number of encounters prior to the rating. These ratings were scaled using the Partial Credit Model(Masters,1982).

Conclusion
Increased neuroticism levels of entering paramedic students are associated with poor professional behavior during field internships. Future research is needed to determine if educational interventions can decrease neuroticism and improve emotional stability and professionalism in the field.

Developing a Model of Continuous Professional Competence (CPC)/Continuous Medical Education for Irish EMTs, Paramedics and Advanced Paramedics.
Author: Shane Knox, Hdip (EMS), MSc.
Associate Authors: Colum Dunne, Professor, BSc. (Hons), PhD, MBA, Cullen, Walter, Professor BAO, MD, MRCGP

Background
Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the imminent introduction of a CPC framework for emergency medical technicians (EMTs), paramedics and advanced paramedics (APs) in Ireland, our research aimed to identify attitudes towards CPC and factors that might influence this CPC framework.

Methods
All EMTs (n=925) paramedics and APs (n=1816) registered in Ireland were invited by email to complete an anonymous on-line survey. The study instrument was designed based on CPD questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed.

Results
The overall response rate was: EMTs 43% (n=399), APs and Paramedics 43% (n=789), with 82% of APs and 38% of paramedics participating. The majority of all groups agreed that registration was of personal importance and that evidence of CPC should be maintained; 39% of paramedics/APs and 78% of EMTS believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, in access of 88% of all respondents indicated practical training scenarios, cardiac re-certification, e-learning supplemented by related practice and training with simulation manikins were most relevant. However e-learning alone (Paramedic/AP 36%; EMT 35%), project work (Paramedic/AP 27%; EMT 48%) and appraisal of journal articles (Paramedic/AP 24%; EMT 39%) were least relevant.

Conclusion
Irish EMTs, Paramedics and Advanced Paramedics are supportive of CPC and favor a “˜mixed’ model approach which includes: Blended learning, practical skills, simulation, practical/team-based exercises, e-learning combined with practical skills, and evidence of patient contact.

Clinical Compliance of Paramedic Students Acquiring Prehospital 12-lead ECGs 
Author: Dean Meenach,  BSN, RN, CEN, CCRN, CPEN, EMT-P
Associate Authors: Thomas Dobrzynski, BS, NRP, Joanne Ruck, API, RN, BPS BN, Mark Cromer, MS, MBA, NRP, James D. Dinsch, MS, NREMT-P, Elizabeth C. Landry, BS, NREMTP, Alyssa R. Morris, BS, Sara Richter, MS, EMT-B, Michael Bowen, NREMT-P, Jesse Mortenson, BA

Introduction
Obtaining prehospital 12-lead ECGs on selected patients has been an AHA Class I recommendation since 20001. Emphasis of prehospital 12-lead ECG acquisition has been of increasing academic and clinical importance since the publication of the National EMS Education Standards2 and 2010 AHA Guidelines3 leading to prehospital 12-lead acquisition protocols worldwide. The purpose of the study is to evaluate if paramedic students acquire 12-lead ECGs as part of their differential diagnosis.

Hypothesis
Paramedic students acquire prehospital 12-lead ECGs on all adult patients meeting clinical criteria.

Methods
Data on prehospital 12-lead ECG acquisition from 2010-2012 for patients age ≥18 complaining of chest pain, dizziness, AMS, syncope, change in responsiveness, headache, blurred vision, malaise, abdominal pain, breathing problems, nausea/vomiting, or palpitations were abstracted from FISDAP®, an Internet-based administrative database, for students with “good” data and research consents. Patients classified as trauma, childbirth, allergic reactions, cardiac arrest, and death were excluded. Descriptive summaries were generated and differences by gender were analyzed by chi-square tests.

Results
Of the 89,507 patients meeting inclusion criteria, 33.2% received a 12-lead ECG. Percent of 12-lead ECG application differs by complaint and patient gender, see Table 1.

Table 1. Percent of Patients Receiving 12-Lead by Complaint

Complaint n Overall Female Male p-value

Chest Pain 22,348 58.3 57.5 59.1 0.0145

Palpitations 82 61.0 57.1 65.0 0.4660

Altered Mental Status 24,257 26.0 26.4 25.6 0.1193

Abdominal Pain 16,590 24.5 23.2 26.6 < 0.0001

Breathing Problem 27,662 39.4 37.6 41.6 < 0.0001

Change in Responsiveness 12,066 36.3 34.4 38.4 < 0.0001

Dizziness 21,016 36.8 34.8 39.3 < 0.0001

Headache, Blurred Vision 11,511 31.1 29.8 32.9 0.0004

Malaise 192 39.6 45.8 29.7 0.0270

Nausea/Vomiting 421 39.7 43.1 34.3 0.0713

Weakness 38,663 33.1 31.7 34.7 < 0.0001

Overall 89,507 33.2 31.9 34.8 < 0.0001

Discussion
Prehospital 12-lead acquisition is an important component of differential diagnosis. Paramedic students demonstrate subclinical frequency regarding 12-lead ECGs for all identified complaints. Limitations include the self-reported nature of the data. It is important to note that the data does not account for potential limited access to 12-lead ECGs and preceptor bias. Further studies should focus on controlling for these limitations and identifying additional obstacles to obtaining 100% clinical compliance.

Sharing Simulation Resources is Associated with Less Frequent Use of Simulation in Accredited Paramedic Programs.
Author: Kim McKenna, MEd RN EMT-P
Associate Authors: Elliot Carhart, EdD RRT NRP NCEE, Danny Bercher, PhD NRP, Andrew Spain, MA EMT-P NCEE, John Todaro, BA RN NRP NCEE, Joann Freel, BS CMP

Background
Simulation is an important strategy used in initial paramedic education, but there is no published data showing what simulation resources paramedic programs have and use.

Purpose
The purpose of this study was to characterize the use of simulation in initial paramedic education programs in order to target educational initiatives and resources.

Methods
The National Association of EMS Educators conducted a census survey of all paramedic programs in the U.S. that were accredited, or had a letter of review from the CoAEMSP as of November 2013. Types of simulation resources programs have or have access to versus those they use were analyzed to determine their relationship.

Results
The survey was sent to representatives from 638 paramedic programs. We received 389 responses (61%). Nearly all programs reported that they have task trainers (100%), simple manikins (98%), and intermediate manikins (95%). Fewer programs reported having advanced manikins (76%), standardized patients (58%), computer-based simulation (45%), and virtual reality (8%). However, some programs that did not have these resources indicated that they do have access to: advanced manikins (15%), standardized patients (25%), computer-based simulation (26%), and virtual reality (11%). A series of Pearson Chi-square analyses showed that programs that reported “having access to” a given simulation resource use that resource less frequently than programs that reported “having” the same resource (Figure 1)

Conclusion
Initial paramedic programs that share or borrow simulation resources use them less frequently than dedicated resources. These findings have significant practical implications and highlight a major limitation of sharing simulation resources.

How Training Affects Use of Advanced (Fully Programmable) Simulation Manikins in Paramedic Programs
Author: Kim McKenna, MEd RN EMT-P
Associate Authors: Elliot Carhart, EdD RRT NRP NCEE, Danny Bercher, PhD NRP, Andrew Spain, MA EMT-P NCEE, John Todaro, BA RN NRP NCEE, Joann Freel, BS CMP

Introduction
Simulation is an important strategy used in paramedic education. It was not known how paramedic faculty members were trained on the use of advanced simulation manikins, or if there was a relationship between their training and manikin use.

Purpose
The purpose of this study was to characterize the use of simulation in initial paramedic education programs in order to target educational initiatives and resources.

Methods
The National Association of EMS Educators conducted a census survey of all paramedic programs in the U.S. that were accredited, or had a letter of review from the CoAEMSP as of November 2013. Programs indicating they had or had access to advanced (fully programmable) manikins were asked if their faculty had any training on their use. Programs whose faculty had training were asked about the specific types of training. Pearson Chi-square was used to examine the relationship between training and use of advanced manikins.

Results
The survey was sent to 638 paramedic programs. We received 389 responses (61%). Programs whose core faculty were trained on the use of advanced manikins were more likely to use them X2 (1, N=278) = 17.397, p<0.001. Training reported in simulation methods varied, although only training in technical trouble-shooting was significantly related to use of advanced manikins X2 (3, N=224) = 9.037, p=0.29 (Table 1).

Conclusion
Faculty trained to use advanced manikins are more likely to use them. Programs planning to purchase advanced manikins should budget appropriate funds for training.

Agreeableness is linked to improved communication during paramedic student internships
Author: David Page, MS, NREMT-P
Associate Authors: Michael L Bowen, NREMT-P, Luke Stanke, PhDc

Introduction
Teamwork and cooperation are core paramedic competencies that depend on good communication.

No studies exist linking affective personality traits to paramedic field performance. The FISDAP® (Saint Paul, MN) Entrance Exam (EE) contains a portion of the previously validated M5-50(McCord 2002). Among other measurements, the EE assesses affective traits of conscientiousness, agreeableness, and neuroticism.

Hypothesis
Increased agreeableness scores in paramedic students result in improved communication ratings during field internships.

Methods
All paramedic students consenting to research and participating in both the National Registry of EMTs (NREMT) Psychomotor Competency Portfolio Project (PCPP) and the FISDAP(R) Entrance Exam (EE) were included in this study. Preceptors evaluated student’s ability to communicate using the NREMT-PCPP form. Communication was defined as the ability of the student to effectively communicate with the team, provide an adequate verbal report and thorough written patient narrative. Agreeableness scores from the EE were then compared the PCPP rating, a dichotomous preceptor rating, acceptable or unacceptable, that evaluated their communication skills after each patient encounter using a generalized linear multilevel model (GLMM). The GLMM included random effects for student and preceptor, and fixed effects for the square root of the total number of patient encounters completed prior to the rating and affective domain scores.

Results
A total of 75 students met the inclusion criteria and received rating by 323 preceptors. The mean logit score for agreeableness was 1.33 (SD 1.03; Range -1.33 to 5.25).

The results from the model fitting suggested a statistically significant relationship between agreeableness logit scores and ability to communicate ratings received from preceptors (p=.02). The results produced an odds ratio suggesting that for every 1 logit increase in agreeableness, a student was 1.6 times more likely to obtain a positive rating on communication from a preceptor, controlling for student ability, preceptor rating harshness, and total number of encounters prior to the rating.

Conclusion
A positive relationship exists between preceptor ratings of communication skills and a student’s level of agreeableness. More research is needed to determine if agreeableness and improved communication can be increased with targeted interventions during paramedic education.

Educating Premedical Students about the Importance of Cultural Competency
Author: Nika Carrillo, B.S.
Associate Authors: Karla G. Castillo, B.S., Afghani Behnoosh, M.D.

Hypothesis
With an ever-changing and progressively heterogeneous patient population, current healthcare systems require culturally competent physicians that are prepared to manage linguistic and social challenges. Through the UC Irvine School of Medicine, faculty, medical and undergraduate students established the annual Summer PreMed Program, a pioneering enrichment program designed to bolster the interest of a diverse body of premedical students in pursuing a healthcare career. The objective of our study was to investigate the effectiveness of the health disparities and cultural diversity module, a course where students learn how to interact and communicate with various patient populations as a physician. The workshop was based on a series of speaker presentations that included PowerPoint lectures, video passages and various collaborative activities. After the course, students were given an evaluation addressing the relevance and effectiveness of the module.

Methods
Within a three-year period, feedback from a total of 311 students were collected and analyzed. The students were asked to rate topic relevance, provide any suggestions for improvement and comments about how the workshop has educationally enlightened them.

Results
Among the 311 evaluations, 258 (83%) of the students reported an overall increase in awareness and relevance in cultural competency and approximately 90% of the students noted an overall increase in their interest to pursue a career in healthcare. The main themes that were identified from the answers to the open-ended question, “How has this workshop helped you?”, included a) better understanding of the relevance of cultural diversity in the healthcare profession, 2) better knowledge of various beliefs among different cultures, and 3) promoted interest towards healthcare careers. Additionally, using a scale from 1-5 (1= no relevance, 5 = extremely relevant), the average score for topic relevance obtained from all evaluations was 4.54.

Conclusions
Overall, the health disparities and cultural diversity module proved to be a pivotal component of the Summer PreMed Program with regards to increasing cultural competency as a healthcare practitioner and garnering the interest of underrepresented individuals to pursue a career in the medical field.

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