I spent most of Saturday morning doing skills testing at Rice University in Houston for their Advanced EMT students. For those of you who don't know, Rice is a private university in Houston that routinely competes with the Ivy League. It also has its own student-run EMS first responder organization.
I was tasked with testing the students on the medical assessment skills station. I'll respect the NREMT process and rules and omit describing the scenario other than to say that it was a medical patient with the potential to "crash." You know -- the kind where you can use some clinical judgment on how to treat the patient.
Here's my problem. There were 48 possible points available to be awarded for completing the skills station. There's a point awarded for considering spinal immobilization. Points awarded two different times for checking AVPU. Points for each question in the SAMPLE and OPQRST mnemonics. But only ONE, YES ONE, f--king point for verbalizing a treatment plan and calling for appropriate interventions.
And I'd say that 90% of these very smart young people thought that the solution was to use the patient's prescribed medication and that alone. I think only 2 or 3 mentioned a couple of other medications that an Advanced EMT can use in this particular emergency. Yet all of them did mention high-flow oxygen via non-rebreather mask. Not one mentioned capnography. It was obvious to me that none of them understood the pathophysiology or pharmacology involved with this medical emergency.
EMS education and the National Registry process in particular have turned some of America's brightest youth into mindless automatons parroting the mantras of "BSI and scene safe."
The saddest part is that some of these young people may end up as physicians and medical directors. I will not be surprised when these aspiring doctors push a "monkey see, monkey do" set of protocols on their medics. What disgusted me is that NREMT doesn't even seem to care if you properly treat your patient or even know what you're assessing so long as you parrot BSI, scene safety, consider c-spine immobilization, and run down the OPQRST and SAMPLE
questions. Memorization counts and understanding is irrelevant.
None of these kids failed the skills station, but National Registry sure failed these kids and ultimately, their patients.
Having gone through this testing and evaluation process, I am now not surprised that the "best EMS service in Texas" walked my mother to the ambulance after trying to push a refusal on her.
Sorry, I'm just disgusted.
:-). Nothing else needs to be said.
As usual…have to agree with you Wes.
I think an important thing to remember is that the purpose of NREMT is to provide a starting point and to assess their very entry level status in the profession. No amount of initial education will replace years of experience and continuing education. Try not to get too upset at the state of affairs with our newest cohorts. It’s our job to continuously mentor them and get them ready to serve our patients.
I did similar testing a few weeks back for a paramedic class testing the Oral station. I was saddened that only 2-3 passed my skill station. The scenerio was written to fail students.
Please do not judge all EMS students or all schools by this small study group.
Actually, I didn’t see where he did anything but complement a group of very bright students that were being forced down a path well below their abilities against their will.
Typo and unable to edit “scenario”
So what is your solution? Until someone provides a better method of ensuring entry-level competency, complaining aboit Registry is just a bunch of noise making.
And Registry has NOTHIBG to do with walking your family member to the ambulance
The solution, at least to me, is that NREMT get out of the skills testing business. Skills testing done in a vacuum only ensures that students can repeat a process from memory. Skills testing should be done prior to certification and should be scenario based. As for my family being walked to the ambulance, I said that in regards to the lack of critical thinking and decision making tested by Registry. So many EMS management types look upon NREMT certification as a stamp of approval rather than what it really is – an assurance of minimal competence.
Complaining doesn’t help. But complaining, while also describing exactly what one sees as the weaknesses in the system is the start of education, debate, and future change.
Criticizing those that recognize a problem without also presenting a complete solution in text that shows an inability to spell and/or proof read….that is just noise.
Before anyone else comments, please read the post and try to understand the context. It was not a detriment to the students, but the system as a whole. I agree whole hardily with the post. Our pre-hospital education is more than 5 years behind evidence based medicine. I have known the commentator of this post for many years and he does not judge people in general, but processes and implementation of evidence based medicine.
This is exactly how we get so many “Whatshisname”s.
The NREMT realizes that those “rote” skills should be tested during initial education and critical thinking/clinical decision making should be tested to obtain certification. They are piloting what has become known as the “portfolio” with plans to only test 3 things instead of 13 like they do now for medic. They will test 3 scenarios: medical, trauma & Pedi. Look @ NREMT for info on the Portfolio or I can email it to you. We are already using it with our current medic class. Cheers!
I’m starting to hear this. It will be a good thing. Imagine telling a prospective EMS provider (of any level) to manage an airway rather than telling them to intubation within X number of minutes. We’ll be progressing at that point.
A note of clarification. This is not meant to take away from the Rice students’ accomplishment. Rather, this is much more an indictment of a testing process (beyond the testers’ or students’ control) that ultimately short changes the students and our profession. The students did what was asked of them and they did it well.
Ultimately, my hope is that if there is a skills testing process outside of the initial education program that it test critical thinking rather that rote memorization of a checklist of flow chart. My sincerest apologies if anyone took it otherwise.
If you aim for “minimum competent” you develop minimum competence. If we always have the first tube fail on a Combitube, the students will skip the first tube in the real world. We don’t develop real “scene safety/BSI” skills, because regurgitating the mantra is all that matters.
I would like to see the skill sheets disappear, so the students aren’t learning “the Registry way”.
I would also like BLS CPR to incorporate compressions while waiting for the AED to charge, but that’s another story; something about saying 10 seconds between compressions is too long during ventilations, but ok during AED use seems to be a conflict.
I definitely agree that there can be improvements in the NREMT organization, but as we all know, change takes time. I believe NREMT is fairly aware of their faults, and are trying to make changes like the “Portfolio”. I’ve been invited to take part in writing some new test questions, and I’m interested to get a behind-the-scenes look at what goes on in NREMT. Until then, I do what I can to sharpen my own critical thinking and mentor those around me.