How Do You Teach Assessments?

[AnthonyM83]

Well, actually my problem guys is that it seems almost impossible to teach good assessments without having them memorize a flow chart, step by step. It gives them a framework (or perhaps railroad track) to go back to when they start getting lost to keep them on track. They need to know what they're deviating from before actually deviating from it. Then you start teaching them how to interview, how to pick the tools they need from the flow chart, and how to respond to information they find during their assessment.

[brentoli]

I failed.

Honestly the way I invision it, would be to throw the chart out, and teach from the body out. But thats a college degree, I think its call a BSN.

I think we would agree that teaching the test sets up canidates for failure however.

I envision looking at the assessment as a whole, opposed to breaking it down in to it's seperate parts.

Why do we care about the ABC's? Are the answers just yes yes yes? What do we need to examine with all of these parts, and how do they fit into the "care plan" we develop in the back of the ambulance.

A nurse has time to look over a whole series of charts, potentially talk with an associate, and has the freedom, tools, and time to do a full body assessment of anything you can imagine. Then they develop a plan to take care of the paitent considering all of their needs.

In the back of the `bolance we (usually) have a short time and focus on the immediate problems.

Somewhere between the assesment a nurse learns, and the NREMT practical sheets, is a happy medium.

This is why I am not an instructor yet. I haven't found it.

Sorry for the hijack, I guess.

[Ridryder 911]

Everyone attempts to blame the NREMT for the failure of teaching EMT's. Remember the sheet is ONLY a reference that one has to be sure that all the critical areas are performed properly.

If we had educators instead of instructors, then possibly the "sheet" could be done away with, but until then we have to comply to make sure that the drones are able to follow a step by step process.

I don't think NREMT is all happy about the sheets as well, from what I understood. Unfortunately, would you trust many of those finishing the programs without it? Look around and observe. Yes, I agree its a horrible method and I hope we can abolish skills stations someday* but until then we know at least know that at one day, during a specific time period, they were able to recite and perform those required skills.

* In the future, if one completes and graduates from an CoEMSP accredited Paramedic program; one will not have to perform all skills station(s) at the NREMT Paramedic exam. Watch for more up-dates from the NREMT.

[emt~ff~82]

the nremt is actually a great program but in adult ed it alsp depends on the students. I have been around this field my entire life. So there for i helped family and friends pass. I read it like i am gonna teach it so i learn every detail. you have to have conviction for this field. Not the look at me i'm cool i'm an emt/ff

[AnthonyM83]

I read it like i am gonna teach it so i learn every detail. you have to have conviction for this field. Not the look at me i'm cool i'm an emt/ff

Uh...not sure what that has to do with it . . .

But yeah, remember assessment is a SKILL. It's not book knowledge. So you can have smart students, smart instructors who can tell them and demonstrate everything they'll need for a good assessment, but when you put them in front of a real patient, they're still going to be all over the place. They're going to forget to ask stuff. They're going to get freaked out about one finding and forget another important one. The flow chart keeps you grounded. Practice of the skill is what makes you good as actual assessments.

[Dustdevil]

I read it like i am gonna teach it so i learn every detail.

Learning every detail doesn't do squat. That's how you train monkeys, not educate medical professionals. Sure, you may pass the checklist for NREMT, but it won't teach you a thing about real medical assessment. There is no point in going through all those steps if you lack the medical education to interpret the results.

Assessment is THE most important skill in EMS, without exception. Yet it is the skill that most EMS providers are most inadequate at. Obviously someone -- including the NREMT -- is seriously screwing something up. So I sure wouldn't look to them for any shining example of how things should be done. In fact, even they will tell you that this is not what they are there for.

Screw your pass rates. It means nothing. Nada. Zero. Zilch. The competent medical practice of your graduates is the only measure that means anything. And if all you are doing is prepping people to pass a five minute exam station, you FAIL.

[mstovall]

This is the way I was taught and I think that the teacher did a great job of blending the theory of the skill sheets with practical knowledge. The teacher first started each class going over the skill sheets. We did this for a couple of weeks. Then the teacher would through things in. I will never forget killing my patient. I gave my nitro for the chest pain prior to examining his chest. When he opened his shirt, viola, a moulaged chest wound from a fight the night before in a bar, representing an alleged cardiac tamponade. Next week someone gave him AS for a CAP and then found out he was allergic to aspirin. He did a good job of doing different things, going unconscious when you didn't get a SAMPLE on a medical, multiple symptoms, etc. He always built upon what was being taught that night. This made you want to read more, apply what you knew so you weren't the one who killed him that night, and the routine drove home how to pass the practical test. The scenarios he used were from runs out of our local service. Hope this is the type of answer you were looking for.

Michael

[mobey]

One of my instructors would give us a single symptom, from that we had to list as many DD as possible, then we had to start ruling them out based on assessment and history. This would go on for hours, I guess it was more for critical thinking, but it helped with assessment as well.

All this was done on the white board, and it really kept the classroom alive, I suggest it for all schools.

I am interested to know how you would teach it Dust?

[Dustdevil]

One of my instructors would give us a single symptom, from that we had to list as many DD as possible, then we had to start ruling them out based on assessment and history. This would go on for hours, I guess it was more for critical thinking, but it helped with assessment as well.

All this was done on the white board, and it really kept the classroom alive, I suggest it for all schools.

I like it. It is imperative that the pathophysiological theory be well understood before moving forward with the mechanics. This is the problem with EMT school, as well as the patch-factory medic schools. They teach only the mechanics of doing an assessment. And their students do a great job of going through the motions, and even writing/reporting their findings. But all too often, they lack the ability to put it all together into a concise and accurate differential diagnosis. They'll tell you all these signs they found, but when you ask them what they mean, they don't have a clue.

Before we start working on assessments, my students already know what they are looking for and why, not just the monkey steps of the exam. And when you know what you are looking for and why, the actual exam becomes a lot easier to understand and learn.

Education is not training. Education is an intelligent process that relies upon establishing a theoretical foundation before beginning to build skills. Attempting to reverse the order retards the process, if not completely derailing it altogether.

[AnthonyM83]

Good ideas there, guys.

The problem ends up being having enough time to teach this stuff. You need sound pathophysiology, then a lot of time for group work (which ALWAYS ends up taking longer, especially if we make sure everyone is included in discussions). It's hard enough getting enough practice time for manual skills like traction splint, KED, rapid trauma assessments, and proper assessment of ABCs.