Do educational scenarios as currently structured do students a disservice?

[usalsfyre]

Everyone knows how the typical educational scenario is structured. Intervene correctly and the patient gets better, don't and the patien gets worse. Let's face it though, patients rarely follow this game, especially I'm surgical cases. Are we creating unrealistic expectations in our students? Should we have some scenarios where the patient deteriorates and dies no matter what the student does?

[paramedicmike]

When I'm teaching ACLS more "patients" die than survive even if the student does everything right. When I'm working with EMT or paramedic students the balance evens out a bit but there's still a good mix of "patient's" who die versus patients who survive.

It's funny, too. They really get bent out of shape when their classroom patient dies. The explanation they get is that sometimes, even when you do everything right and the stars are aligned, your patient is still going to die. They don't like it at the time. But I've talked to several (former) students who remembered the lesson at some point down the road when they did everything right for a patient who decided to die anyway. The might not have liked the classroom ending but the appreciated the drill when it came to real life.

[crotchitymedic1986]

Yes you should. The difference between bad medics and super medics is "Critical Thinking Skills". The crazy scenarios that will probably never happen exercises your brain so that you can treat patients properly.

[Just Plain Ruff]

Yes you should. The difference between bad medics and super medics is "Critical Thinking Skills". The crazy scenarios that will probably never happen exercises your brain so that you can treat patients properly.

The best instructor who I know of that epitomizes the crazy scenarios is Bob Page from Springfield Mo. Most will know him from his 12 lead courses.

I had a guy with some obscure electrolyte imbalance that only a infusion of calcium and glucose would fix. Needless to say, the guy died because well, patient's just sometimes die.

[AnthonyM83]

The scenarios our students get all depend on how well their specific class is doing (though some are working to change this and just have them standardized).

At the beginning, straight scenarios with a juicy mystery diagnosis can pull the students in and interest them. This gives them motivation to practice their assessment skills.

Toward the end of class, I present only real life scenarios with a real life mix of classic signs and symptoms and extras that patients throw in. The chest pain with dementia, the legitimate medical emergency with a panic attack (so they don't answer your questions directly), the head injury with projectile vomiting that develops signs of herniation to see if they recognize it and hyperventilate (per their text), and whenever I can, I'll act as the patient recreating the chilling anxiety in my voice of someone who knows their going to die and pleading not to, some will be just combinations of signs/symptoms from a call where I never figured out what was going wrong.

It all depends on what the students can handle, though. There's only limited time in the class, and while I could literally do life-like and critical thinking scenarios for 8 hours straight (my favorite thing), I would be doing them a disservice by not letting them get their simple assessments down first.