How much is too much?

[chbare]

I was given the unique opportunity to basically have free reign to design a series of lectures that were integrated into a paramedic programme. The lectures were given at the beginning of a pathophysiology course for paramedic students. It is a 14 month course and the student receive college credit with the option of an AAS if they have completed enough general coursework.

The lectures I developed were chemistry based;

The first was a basic overview of the history that led to our current understanding of the atom. Basically, I explained black body radiation and the contributions of Max Planck and the beginning of quantum mechanics, the photoelectric effect and the contribution of Einstein, the contributions of Neils Bohr and the Bohr atomic model and emission line spectra as it relates to the quantized electrons, the contributions of Heisenberg and the uncertainty principle, de Broglie, Schrodinger and the wave function and the Contributions of Pauli and the exclusion principle. The quantum numbers were briefly covered and related to the arrangement of the periodic table.

The second lecture was an overview of basic chemistry where we covered the components of the atom, the periodic table, atomic numbers, number of energy levels, valence electrons and the octet rule and the basics of ions, ionic bonds and covalent chemistry. I also discussed the concept of the mole, then related it to basic lab values and even electrolytes in a litre of 0.9% sodium chloride.

I hope to refine and possibly add additional concepts such as reactions and acid/base chemistry.

However, the process has galvanized me into thinking about the education of new paramedics. What level should we consider adequate? How in depth should we go and what should we consider as good endpoints in the fundamental educational concepts of paramedic education?

Take care,

chbare.

[Just Plain Ruff]

When you ever decide to write a paramedic book as well as design your paramedic class, I'd like to be the first to sign up and take it from you.

You could be the next Bryan Bledsoe or Nancy Caroline.

Any chance you need a reviewer for your class notes?

[spenac]

But the publishers will require him to dumb it down just like they did Dr Bledsoe.

[chbare]

I think it's tough to some extent. We basically have to "dumb" everything down to an extent. For example, I know about some of the quantum mechanical concepts and that numbers obtained from the calculations explain certain types of behaviour accurately; however, I do not have enough understanding to properly calculate most of these concepts. I only know in a basic sense what the numbers from the calculations represent. Clearly, I have learned a very dumbed down version of these concepts.

I am trying to get a feel for how much detail should be required for prospective paramedics. I would love to require a dedicated chemistry course; however, that goal is highly ambitious at this point in time. So, I am trying to work within my limitations and still provide an improved educational experience. I think, I can successfully integrate some fundamental concepts that are "dumbed down" but still ensure a good overall educational experience IMHO.

It seems what I have done has at least helped the students study and understand some of the other concepts that they have encountered. Many of the students had read about ions and stated that they understood the concept of an ion much better. Simply explaining the octet rule and how metals loose electrons and non-metals gain electrons and the change in electrical charge that occurs did seem to help the class understand the ion concept. I often find we tell people an ion is a "charged" particle but leave them hanging on how these charged particles are created or the meaning of charge, let alone how they interact. Unfortunately, it seems these concepts are not being taught or are so glossed over in high school, people start college in a tabula rasa state.

Clearly, I focused on one example, but I am still trying to get a feel for what I can include and what I should not with respect to the education of a competent entry level paramedic. I am not sure about any book writing as I am not a physician, nor do I have an advanced degree in anything at this point. However, I would love to be involved in the process if given the opportunity.

Take care,

chbare.

[spenac]

Hopefully you will peak the interests of your students so they will take it upon themselves to continue their education. I see no problem with touching on the basics of these more in depth areas to get your students to see how much more they need. The class I recently taught though I got lots of that's not in the book or that's not going to be on the NR exam so why are you wasting our time? No matter how hard I tried to get them to understand I was not teaching the test I was teaching them to be medical professionals some still fought it the whole time. What is funny the ones that listened and applied what I said passed NR no problems as it was easy compared to what I provided. In fact I had students from other programs that would come sit in on my classes and I have had several tell me that my going more in depth made their class seem easy and the NR seem easy.

[HERBIE1]

The first question I would have is where you want to go with the program? Depending on how in depth you go with the background sciences, you could be pushing towards a more comprehensive, 4 year degree program. I would put together your proposed more advanced curriculum and pitch it to the higher ups.

The problem with something like this(trying to elevate the education standards) is that in order to be successful beyond your classroom, you need a buy in from the powers that be, other instructors in the area, as well as medical control. You need to have the preceptors and FTO's to be on board and their training equivalent to what you are teaching didactic-wise.

I would suggest making a pitch and putting out a plan- showing how and more importantly WHY- you feel the standards need to be elevated.

I was asked by the dean of a public safety program to develop a new class for their fire science program- EMS Administration. I- along with 2 others- developed the curriculum, wrote the class, picked the text, etc. Luckily we were essentially given free reign because the dean was familiar with us from being in his Masters program.

At first, we also received resistance when we began delving deeper into the leadership/management aspects, but at the end, we have received mostly positive reviews.

As long as you lay out your plan, abide by any requirements/goals set forth by those in charge, and justify and demonstrate how your plan will achieve those goals, I think you will be in good shape.

Good luck.

[Just Plain Ruff]

What is really sad is that you have to dumb it down at all to fit the needs of the students.

Who's fault is it that you have to do that?

The students themselves who have been fed education that only teaches to the test

The education system itself

The instructors who don't stand up to the dumbing down crowd and just acquiesce because in order to get their books published or even to teach have to follow the rules of the above two groups

I had an instructor in college who taught what he wanted to teach and gave tests that required students to read his additional reading assignments which were in addition to the textbook for the class. His tests were some of the hardest tests I've ever taken, exams routinely lasted 2-4 hours. Midterms were set for 4 hours. Finals were minimally 4 hours. We were in his class for 6 hours a week.

There is more to this incredible instructor and his ways that I'd explain but don't have time to do so. When I was finished with his class, my understanding of the course was nearly graduate level in nature.

I've had other instructors which would tell the students "This is going ot be on the test" "Remember this, it's on the test" They taught to the test only. NO additional info given, just what was on the test. These instructors were the EMS instructors.

Funny thing, I went to a court reporter school website and saw that their program length was 2 years minimum. My medic course was 10 months.

To be a translator for the court system(federal) I have a friend who has been studying and taking her translator courses to translate for the federal court system for 3 years now. She has a year to go. She needs that additional year to also translate for the FBI During their investigatory wiretaps. She is in training with another person for another year and then she gets to go out on her own to do the wiretap translation.

So my education pales in comparison to these two careers.

So why dumb it down? Teach what you teach and see your students blossom and learn things that they didn't expect.

[chbare]

I appreciate the replies. At this time, a four year programme is not on the table as this is a community college. An AAS is offered and encouraged. There is a push to mandate an AAS degree for every graduating paramedic; however, the option for a graduation certificate is currently offered (essentially, you are short some general education credits).

Again, I believe that we have to simplify some concepts regardless of how high of a quality programme we have. It would be counterproductive and unnecessary to teach the finer points of quantum mechanics and associated chemistry concepts to paramedic students.However, having a fundamental appreciation of chemistry and at least a basic conceptual grasp of the concepts that define chemistry will be helpful IMHO. I actually spent much self study time developing a basic understanding and even spent one on one time with an organic chemistry professor working on wrapping my head around the concepts and subsequently breaking them down into easier to digest chunks.

I have received additional feed back and it appears most of the students found the chemistry lecture very helpful. The reviews have been mixed regarding the quantum concepts. From what I gather it was difficult for the students to grasp the concept of probability and the fact that we cannot know location accurately if we know momentum. However, most of the students did acknowledge that it was nice for someone to discuss some of the "why" behind the chemistry. Again, this was a conceptual lecture with minimal math. Last year, I did not teach the quantum lecture and ended up having several students ask me why electrons lived in defined areas of energy and other related questions. So, my goal is to answer some of the "why's" without overwhelming the students to the point of counter-productivity. This quantum lecture series is supplemental to the curriculum and the students will not be tested on it; however, we will be testing them on the chemistry concepts.

Take care,

chbare.

[bbledsoe]

Ah...the conundrum of EMS textbooks. We pushed Brady to let us push the envelope with our 5-volume paramedic texts--and we did. Then, we started to lose some business to the one-volume Mosby text--so we developed the Essentials book. I pushed hard to modify Ric Martini's college A&P book for EMS. It worked and has sold well but we continually get requests for a lower level A&P book in addition to Anatomy and Physiology for Emergency Care, Second Edition. The lower level book will be out later this year. We are finishing a pathophysiology book and I am again trying to push the envelope. It seems we push forward with content only to have a segment of the EMS community push back. I wish I had a nickel for every time I've heard. "Just give us a book that will get us through the test." Interestingly, I've never heard that phrase in the world of medicine. My congratulations to you for attempting to push the educational envelope. I've about given up. I've been often asked, "Which comes first? Improved EMS pay or improved education?" While it is a "chicken or the egg" argument, I would say that education has to come first. It is hard to believe that some oppose accreditation of paramedic programs. What's the deal?

BEB

Bryan E. Bledsoe, DO, FACEP, FAAEM

Clinical Professor of Emergency Medicine

University of Nevada School of Medicine

Department of Emergency Medicine

University Medical Center of Southern Nevada

Medical Director, MedicWest Ambulance

Las Vegas, Nevada

[firetender]

From what I gather it was difficult for the students to grasp the concept of probability and the fact that we cannot know location accurately if we know momentum.

I have to chime in with a contrary view that is also supportive. Emergency Medical Services is a highly specific series of actions that are taken, according to the illness or injury, to intervene and prevent further injury and death.

As much as I agree that in order to further the profession we must expand our education, I still hold to let's stick to the basics. Personally, I would snooze through your presentation (no offense meant) primarily because it's going to take you an awful long time to build all all the theories it took in chemistry to get to the point where it was decided that administering Glucose to a diabetic can make an unconscious patient conscious.

My experience in the field was that rather than getting deeper with theory, I got much more focused on action. The less time I spent in my head, the more room I had for my patient. Rather than Chemistry being emphasized, I would prefer connection, because that's what 80% of our patients need most.

If you want to include Quantum Theory, then, since it shows in essence (if you want to take it deep enough) that we create our own reality, then the intervention of the medic would be holding your patient's hand and saying, "Don't think that!" Funny how that goes right back to connection, isn't it?

AND I think that the work you do can be pivotal in prompting a lot of medics to go deeper into medicine. Understanding the processes of which you and your patient are a part is important and can help you to reduce future pain and suffering for the patient. But action always comes first.