Summer 2014 - Educator Update

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Don’t miss our live demonstrations at the19th Annual Educator Symposium and Tradeshow!

students fail the EMT exam on the 1st attempt.*

Feel The Pressure In 2012, the national average first-time pass rate of the EMT exam was 72%. Across the country, pass rates varied from 59% to 84% suggesting the need for instructional consistency in every state. Simulation can help achieve quality education through standardized learning, and ultimately improve pass rates.

NAEMSE endorsed EMT Medical & Trauma Scenarios Now Available!

Does your training include simulation?

Visit us at to learn more about how simulation-based education can support emergency medical training. *National Registry of Emergency Medical Technicians 2012 Annual Report. Š2014 Laerdal Medical. All rights reserved. Printed in USA. #14-14306



National Association of EMS Educators 250 Mount Lebanon Boulevard Suite 209 Pittsburgh, PA 15234 Phone: 412-343-4775 Fax: 412-343-4770


2013-2014 Board of Directors Scott Bourn, PhD, RN, NREMT-P President Michael Nemeth, AEMCS(f), EMT-P, ICP, MA(c) Vice President Connie Mattera, MS, RN, EMT-P Treasurer Richard Beebe, MS, RN, NREMT-P Secretary John Creech, MEd, LP Kim McKenna, M.Ed, RN, CEN, EMT-P


Michael Miller, BS, MS, EMS, RN, NREMT-P Nerina Stepanovsky, PhD, MSN, RN, PM

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Donna Tidwell, MS, RN, EMT-P

2014 FISDAP Research Summit: A Look Back

Bill Young, M.S., NREMT-P

John Todaro, NREMT-P, RN, TNS, NCEE Rebecca Valentine, B.S., EMT-P, EMT I/C, NCEE

by William Robertson, MS, NRP, CCEMT-P

National Office Staff Joann Freel, BS, CMP Executive Director, Editor

Let Them Play the Game

Stephen Perdziola, BS Business Manager

by Sarah Demers

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Six Questions That Will Bring Your Teaching Philosophy Into Focus

Nora Davidson, BA Membership Coordinator Brandon Ciampaglia, AS Communications Coordinator Laurie Davin, AS Education Coordinator Larissa Kocelko, BA Administrative Assistant

by Neil Haave, PhD

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Clinical and Field Internship Sites

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Thought Experiment

William Raynovich, MPH, NREMT-P, Ed.D Editor, Domain3

Reprinting Information

Interested in reprinting one of the articles you find in this publication? If so, please contact Brandon Ciampaglia via e-mail at or by phone at (412)343-4775 ext. 29

by Patricia L. Tritt, RN, MA

Submission Guidelines

by Colleen Flaherty | Educator Update |

Unsolicited submissions are welcomed. Members of the NAEMSE Publications Committee review Domain3 manuscripts. Acceptance of a manuscript for publication is contingent upon completion of the editing process.


Manuscripts should be e-mailed to submissions@ Submit a cover letter with each manuscript indicating: Author name, credentials, title, and affiliation. A title letter should also be included disclosing any commercial associations that could post a conflict of interest. If you have an idea brewing that you’d like to submit, please contact us. We would be happy to discuss it. New authors are welcome and encouraged.



Name: Shelly McLaughlin Hometown: Wheat Ridge, CO Current Employer/s: Emergency Medical Services Academy at the University of New Mexico’s Health Sciences Center, School of Medicine Job Title/s:

Director for the Bachelor Degree in EMS, Rural Programs, and Distance Education. Hardest Job Aspect: As the lead EMS training agency for the state of New Mexico, we are constantly challenged with delivering affordable education to all rural areas of the state. New Mexico is rural and the population is very sparse with many limited resources in the areas. These are very critical areas with a need for medically trained personnel. We rely heavily on volunteers who are willing to travel and provide care during very lengthy transports to the closest medical facility. As a result, we have to be able to deliver economical and top quality EMS education in a range of delivery methods throughout the state. Most Rewarding Job Aspect: EMS is definitely my extended family. I have met so many people who have influenced me to become a better person every day. I am honored to work with so many humble and well educated instructors who are ultimately responsible for providing excellent patient care. Why I Joined NAEMSE: Is peer pressure acceptable here? Although I have worked for the EMS Academy for many years, it was not until 7 years ago that I joined NAEMSE as I took a larger role in EMS Education. NAEMSE has so many opportunities for all educators to continue to grow (though I never quite peaked over 5’ 1”), share techniques, and to continue to strengthen and build our future providers and educators. Activities: I stacked my beds to make bunk beds so I would have so much room for activities... (a ‘Step Brothers’ reference if you missed that one). I am currently active on three NAEMSE committees. The Membership Committee, in particular, is obviously an area that I feel I can lend the most value given my very outgoing personality.

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“ I love being a part of the student’s

growth in EMS, in both our Bachelor Degree in EMS and all of our certificate programs.” I am an active part of the New Mexico Heart Start Program, Faculty Mentor to our Students of EMS Organization, and a mentor in the “Mentor 2.0 Big brother Big Sister” Program. Personal Hobbies: I recently claimed to take up golf, although I have only been to the range twice. I actively work out and regularly engage in powerlifting in my garage (pink weightlifting shoes are a must). I definitely enjoy hiking the gorgeous mountains in New Mexico with my family and engaging in anything that involves the great outdoors. I recently got caught wearing kid size waders to fly fish (picking up that fish for the infamous pose is another story). Actually, all of this exercise just encourages my great love for cooking. The joke around my house is that I am very resourceful in making elaborate meals out of whatever I find in the house at that particular time. It basically means that you will never have the same meal twice. Who Would Play Me in a Movie: Sandra Bullock without a doubt! Charismatic personality aside, I am pretty sure I have experienced many of Bullock’s movie roles in real life already. ‘Miss Congeniality’ might have been written just for me. What My Refrigerator is Never Without: SRIRACHA ALL THE WAY!

| Educator Update |

INSTRUCTOR COURSE DATES NAEMSE continues to bring its heralded EMS instructor course to all corners of the country. If you have never attended, you can reserve your spot online. If you’re an instructor, spread the good news to your colleagues in the EMS community. The following is a sampling of our upcoming Summer courses: INSTRUCTOR COURSE I

Springfield, IL: July 18-20, 2014 Held in partnership with Medics First Brooklyn: NY: July 25-27, 2014 Held in partnership with Kingsborough Community College Houston, TX: August 8-10, 2014 Held in partnership with San Jacinto College Manheim, PA: August 22-24, 2014 Held in partnership with Clyde E. Brown Training Institute

INSTRUCTOR COURSE II Mount Gay, WV: July 11-12, 2014 Held in partnership with Dunlow Fire & EMS Greenville, SC: August 15-16, 2014 Held in partnership with Greenville Tech. College

WEBINARS A New Look at CPR: BLS Training Tailored to You Presented by

July 10, 2014 @ 12PM (EST)

For more information, please visit



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Technology Classroom Management Hot Topics Simulation CoAEMSP Accreditation Administration

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| Educator Update | | Educator Update |



2014 FISDAP Research Summit: A Look Back By: William Robertson, MS, NRP, CCEMT-P

There comes a point in time for every medical discipline, in which self-governance and progress must be determined by its own authority; not on the merit of past practices, but by questioning current ones. In the field of emergency medical services (EMS), many believe that time is now. As a veteran clinical provider and an evolving clinical educator, I believe this to be an exciting time for growth in the realm of out-of-hospital care. That being said, growth comes with challenges and the success of those challenges depends on professionals who not only have an understanding of where our profession has been, but what it needs to evolve into. Over the years, as I transitioned from a full-time provider to a full-time educator, I have learned how much of my role (as an educator) includes being an advocate for progressive change. But how do I best facilitate that change? Today, pre-hospital professionals are advanced trained medical clinicians, providing a complex arrangement of diagnostics and care. EMS is still in its infancy, however, when compared to many allied health professions. Its inception and development have been driven primarily on anecdotal evidence of success. Is there value in trial and error? Most would say yes, but in order for our profession to be brought to a level of deference we know it deserves, our time tested techniques need to be put through a process of formal evaluation to prove their worthiness… and ours. Due to EMS’s traditionally considered status as a technical field, the idea of empirical inquiry has not been well adopted. In fact, it has only been in recent years that evidence-based medicine has been universally introduced in EMS.

EducatorUpdate Update| | 5 56 | |Educator

As a result of the lacking amount of graduate degrees in EMS, especially from those strong in the practice of research, the following question is often posed: “Do we have the ‘credentials’ to determine our own direction?” After all, much of the evidence that steers our profession continues to be produced, not by EMS providers, but by physicians. Although physicians do play an important role in EMS, some feel they often lack the exposure to the important characteristics that make our profession unique. To that end, the next question would be, “Besides physicians, who is qualified to facilitate the necessary progression within the field of EMS?” Thanks to the vision of the NAEMSE Board of Directors, I was sponsored as a representative of the Research Committee to attend the 2014 Fisdap Research Summit in Minneapolis. Although I went to the summit expecting to collaborate with those in academia, it was the others in attendance that defined my future mission. As expected, the summit was attended by some of the most well-known instructors and professors in our industry; many of whom I have known through publications and indirect associations. There were also statisticians, epidemiologists, street medics, and even medic students; all like-minded, and all excited about research. It served as a reminder that research isn’t about who has the medical degree, or any degree for that matter. It’s about who is asking the tough questions based on the shortfalls we see as providers. And why do we question? Because scrutiny is at the heart of what drives progress. As educators we know that instruction goes far beyond simply “teaching to” students; rather, we are facilitators of the transfer of knowledge. We have that knowledge not because we are educators, but because we were providers. It is because we are educators that we can facilitate research in our field. Similar to clinical knowledge, our objective should not be to just do research but to provide the tools with which the next generation(s) will know how to answer their own questions, instead of waiting for those outside of our field to answer them however they see fit. Many health professions have long ago implemented research methodologies into their educational programs. In fact, undergraduate research is becoming a required component in many educational programs outside of medicine. With leadership by individuals who have both the dedication and formal education grounded in the concepts of empirical inquiry, we too can stand on equal ground as an internally motivated and evidence-based driven clinical profession.


Let Them Play the Game By: Sarah Demers My children and parents were in bed before 10 p.m. one night over the holidays. I sat at the dinner table with my brothers and our spouses. Quick glances around revealed that we all, miraculously, had enough energy for a game of cards. I knew a game that was the perfect balance of fun and simple. In the time it took me to push back my chair and stand up I’d fully morphed into professor mode. I launched into a mini-lecture to teach them how to play. As an assistant professor in the physics department at Yale University, I am in my groove when I’m giving a lecture. Physics is a gorgeous subject, and shockingly counterintuitive even at the introductory level. You start students with the big picture. Armed with mathematics, you land on specific examples that shatter the framework they, maybe unwittingly, had developed for the natural world in their 18-plus years of walking around and paying attention. What do you mean an object in motion stays in motion without an external force? How can it be that a ball you drop and a ball you throw horizontally will reach the ground in the same time? Doesn’t that thrown object have additional oomph that translates into more time aloft? And this is well before we get into 20th-century physics. You can’t outpace the constant speed of light even if you let that flashlight beam loose from the front of a charging train. And the realm of the microscopic, with destiny governed by probability in the calculations of quantum mechanics, calmly tosses determinism out the window. When your excitement for something you love is contagious, heads nod and questions fly. And the fact that the lesson can so easily turn catastrophic, with an extra minus sign or a botched explanation, kicks up the stakes. The students who sleep or text provide immediate feedback that you have failed to engage everyone. The even balance between the times I leave class victorious and the times I’m ready to crawl under a table reminds me that teaching is one of those activities that will forever label me, “needs to improve.” That’s fine. I like to improve. But this mini-lecture over the holidays wasn’t one of those obvious catastrophes.

I’d started with the foundation, telling them the big-picture goals of the game. Only when heads were nodding did I move to details, being sure to come back around to specific examples and the “here’s how you win” take-home. It was so smooth and we were so together in it that I mentally noted, “this is what it feels like to give a good physics lecture.” That perceived connection makes what follows particularly humiliating. I’d barely hit my seat when my older brother piped up with, “I have no idea how to play the game.” I was shocked. I immediately turned to my husband. He knew the game well and isn’t afraid to give me honest feedback, but he justified my confusion by stating, “That was a beautiful explanation!” Someone who knows the material is best placed to recognize a well-crafted presentation, but not necessarily an effective one. I turned back to my brother and asked, “Why were you nodding your head if I wasn’t making sense?” He replied, “You were making sense. Everything you said made sense as you said it. But now that you’re finished, I don’t know how to play the game.” By now my brothers were between giggling and guffawing at my consternation. My younger brother gently suggested, “Maybe if we just start playing the game we can learn as we go?” And it dawned on me that this had been quite close to a typical physics lecture indeed. We all know that we can learn by doing. Many of us realize that we learn best by teaching. The act of gathering together the loose ends and tying them up into our own explanation, what I’ve learned to call “constructing my own knowledge” thanks to education research, is the surest way to adjust our existing framework. Constructing our own knowledge isn’t about getting us through the next test, but is about fundamentally adjusting how we view the world. A set of well-tested interventions that can improve learning in traditional lecture courses are collectively known as “active learning.” These activities seem most effective when carried out in small groups. To make the group work less awkward, instead of sitting in rows in a lecture hall and staring at me, my students in introductory physics sit around tables and stare at each other. | Educator Update |


LET THEM PLAY THE GAME It can still be awkward. Reminders that this is not just about having fun or being educationally trendy, but is instead about using our time effectively, are a necessary part of my routine.

Their mini-experiments, surprise, five minutes of discussion, and a two-minute classroom-wide conversation resulted in learning that the theory alone didn’t deliver.

When I handed out sheets of aluminum foil a few weeks ago in the middle of class I felt as if I were balancing on a high wire. Any hint that I am wasting their time sends students reaching for laptops to check email. The slightest sense that I am treating them more like my six-year-old than as budding scholars sends them to Facebook or to an assignment for another course.

There is a place for lectures in education. They can introduce, motivate and contextualize material. However, we often want classroom time to go beyond equipping students to learn and into actual learning. My failed attempt to teach the card game is serving as a parable.

I gave instructions for the students to wrap one of their phones in aluminum foil and to call it. The wrapped phones didn’t ring. Their mission was to come up with an explanation. I had told them weeks before that there are no electric fields inside conductors and tried to motivate why. I’d also derived the behavior of electromagnetic radiation from fundamental equations, revealing it to be electric and magnetic fields traveling at the speed of light. The signal to their phones (electromagnetic radiation) did not pass into the enclosure of aluminum foil (a conductor.)

It warns me away from the false security of a lecture that feels good and might be admired by my colleagues but accomplishes little with the students. If we want them to learn we need to cede time to them to struggle with loose ends. We need to let them play the game. Reprinted from INSIDE HIGHER ED April 23, 2014 with the permission of Inside Higher Ed, copyright 2014. Inside Higher Ed is the free daily news Web site for people who work in higher education. Breaking news, lively commentary and thousands of job postings bring more than 800,000 people to the site each month. Read more:

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| Educator Update |


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Providing a Voice for EMS Educators

Official Publication of the National Association of EMS Educators


9 Five Things the EMS Educator Needs to Know

About Flipping the Classroom

by Bill Young, M.S., NREMT-P

13 Hard Times for Soft Skills


by Rommie Duckworth, LP


15 Situated Learning Applied to EMS Simulation

by Greg Vis, B.S., EMT-B

Editorial Review Board William Raynovich Les R.Becker Bruce Butterfras Todd Cage Lynne Dees Kim McKenna Mike G. Miller

Maddie O’Donnell Michael D. Pante Richard A. Walker David Blevins Greg LeMay Beth Ann McNeill Fred W. Wurster

NAEMSE MISSION: To inspire and promote excellence in EMS education and lifelong learning within the global community. | Educator Update | 8 | Educator Update | A


To inspire and promote excellence in EMS education and lifelong learning within the global community

Five Things the EMS Educator Needs to Know About Flipping The Classroom By: Bill Young, M.S., NREMT-P

For a number of years now, the concept of “flip-

ping the classroom” has been the buzz in public and private education. This consists of recording the lectures and making them available to the student to view outside of class. When the students return, the time is then used for practical application and higher level critical thinking activities. Educators had been experimenting with what was then called “reverse learning” as early as 2001 (Lage, Platt and Treglia 2000). The primary proponents of flipped learning appear to be Jon Bergman and Aaron Sams, two chemistry teachers in Woodland Park, Colorado. Their concerns were that their students were in a rural district and missed many days of class due to outside, legitimate school activities such as sports. They felt that there needed to be a method for these students to stay current in their studies. Sams read an article about how one could superimpose audio over a PowerPoint slideshow and the light bulb went on! Using rudimentary screen capture software, that was just beginning to emerge in 2007, they began recording the lectures for their students to view when absent from class (Bergman 2012). There seems to be an interesting dichotomy in EMS practice and EMS education. For those who have been involved in EMS for 15 years or longer, the changes that have come about have been drastic. The change from tiny LifePak 5 monitors to those that, though not much larger than the Five, can acquire and transmit 12 lead ECGs as well as monitor end tidal CO2 values all the way to the burgeoning use of pre-hospital ultrasound. Field providers, for the most part, seem eager to learn about and begin to implement the latest in evidence based medical practice. Educators, on the other hand, have not been as enthusiastic about adopting corresponding technology in their classroom environments. For many, the last technological adaptation that was made in their teaching practice was the implementation of what has been affectionately known as “Death by PowerPoint”.

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Educator Update |

Canned slides and the accompanying pre-written lectures from publishers, although a great starting point, has, unfortunately, become the mainstay of many educators. For those who still teach the same way in which they did five years ago, I would encourage you to ask yourself these two questions: “Why?” “Would I be guilty of malpractice if I still practiced EMS the same way I did five years ago?” The fear of embracing technology seems to be one of the largest deterrents to its use in classroom teaching (Li, 2007). Lam (2006) states, “The main reasons are related to the teacher’s personal belief in technology’s benefits, or lack thereof, rather than to a resistance to technology.” In other words, most educators fail to see the benefits that technology can add to their teaching. This is a mistake because when used correctly, staying current with both the hardware and software of educational technology will enhance the educational process by making it more relevant to and fun for your students. You may have wondered if the flipped classroom is just the latest in the trend of best practices that shine for a short time and then fizzle out. You might have also wondered how to go about beginning the process. Excellent! You are giving due diligence to evaluating an educational process before jumping on board. That is using evidence-based practice to guide your own classroom andragogy. The following are five things that you must know about flipping the classroom in order to be successful from the perspective of both you and your EMS students. 1. Flipping the classroom would never work for EMS classes. This could not be farther from the truth! The flipped classroom was designed for classes such as those that deal with pre-hospital emergency care. How would you answer the following question, “What is the biggest complaint from students about EMS based education?” If you are like most EMS educators, students complain most about “too much lecture and not enough hands on time.” By recording your lectures and expecting your students to view them outside of class, the educator now has freed up more time to implement more psychomotor practice in class, when instructor involvement is needed the most.


To inspire and promote excellence in EMS education and lifelong learning within the global community

In addition, by recording your lecture in small bite size bits of no more than 10-15 minutes in length, you enhance your student’s retention of the material through a process known as “chunking”. According to Bor, “Experiment after experiment has shown that, on average, the human brain can hold 4 different items in its working memory.” In other words, chunking allows us to go beyond the limits of the brain’s working memory by compressing bits of information into our long term memory that are easier to process than a long line of random bits and pieces of lecture. Recording your lecture and allowing your student to listen to bits and pieces of it fulfills the chunking mechanism perfectly. In addition, the student can re-listen - as many times as he or she cares to - to the areas that are particularly difficult for him or her. 2. You have to video yourself lecturing in order to flip your classroom. With the advent of Youtube, Teachertube and Khan Academy, it is possible for you to flip most of your lectures without you ever having to record a single word. Recording your own lectures can be a particularly effective method of reaching your students. However, this is not the only way to provide out-of-class lectures for your students. A recent search of Google found hundreds of videos that could be used in the place of face-to-face classroom lectures. However, a warning is appropriate here: The educator will have to wade through a lot of poorly recorded lectures that sometimes give outright wrong information in order to find the videos that will convey the correct information in a concise manner. Once most educators compare the amount of time it takes to search for this “needle in the online haystack” they find that it is quicker to make their own recordings. In addition, educators are using video as a medium to ask students questions, provide instructions in regards to psychomotor skills, help students who need remediation, and create lessons that can be used during a student’s absence. One of the greatest benefits of the flipped classroom is that the teacher can also encourage students to develop videos to share with the class, thus fulfilling the EMS wisdom maxim of “see one, do one, teach one.” 3. There is no evidence that it works.

This does not mean, however, that there is not some research that is currently taking place. According to Greg Green, principal of Clintondale High School in Detroit MI: “At Clintondale High School, we have been using this education model for the past 18 months. During this time, our attendance rate has increased, our discipline rate decreased, and, most importantly, our failure rate - the number of students failing each class - has gone down significantly. When we first implemented this model in the ninth grade, our student failure rate dropped by 33% in one year. In English, the failure rate went from 52% to 19%; in math, 44% to 13%; in science, 41% to 19%; and in social studies, 28% to 9%. In September of 2011, the entire school began using the flipped instruction model, and already the impact is significant. During the first semester of the year, the overall failure rate at the school dropped to 10%. We’ve also seen notable improvement on statewide test scores, proving that students’ understanding of the material is better under this model (2012).” 4. The flipped classroom will replace teachers. Technology will NEVER replace quality human educators. Those who learn to use technology “for good and not for evil” will be those educators who capitalize on all of the domains of learning for their students. It is the wise instructor who knows that each student learns at a different pace and seeks to meet each student, as far as possible, wherever they are. The use of the flipped classroom will assist in this greatly. One of the challenges facing educators of all disciplines and at all levels is that they are expected to produce more results with fewer results in less time. The effective flipping of the classroom by a human instructor allows for this to happen while maintaining the relationship needed in the classroom for effective learning. According to Peck and Dorricott (1994), “Some things only teachers can do. Teachers can build strong, productive relationships with students. Technologies can’t. Teachers can motivate students to love learning. Technologies can’t. Teachers can identify and meet students’ emotional needs. Technologies can’t. Technology-based solutions in education can, and must, free the teacher to do the important work that requires human interaction, continuous evaluation, and improvement of the learning environment.” A close corollary of this is the importance to understand that flipping the classroom does not make it an online class.

To a certain degree, this is true. However, the accuracy of this statement is due, in part, to the lack of completed, really good studies on this process. | Educator Update |



To inspire and promote excellence in EMS education and lifelong learning within the global community

Students and educators both need to realize that the same amount of face-to-face time will be required for this class. The difference is that the instructor is re-allocating valuable classroom time to intensive, one on one if necessary, critical thinking exercises.

About the Author: Bill Young is an assistant professor with Eastern Kentucky University and writes a blog on low and no cost education technology for EMS educators. It can be found at:

5. Students will not watch the videos.


This argument might have some validity as it is a challenge now to just get the students to take their textbook out of the shrink-wrap and put a crease in its binder just by opening the first page. Flipping the classroom doesn’t mean that the students will begin to learn in isolation and not have an instructor to ask questions of. On the contrary, most studies have shown that there is an increase in contact time between the educator and those students who might need more time than what they would receive with a traditional lecture format. Having an educator who has flipped the classroom will enable that person to ascertain (on a basis of daily interaction with the student) whether or not they have reviewed the material. Jon Bergman, who was referenced at the beginning of this article, actually has his students take notes in a standardized manner and turn them in with each class period so as to verify that the student has watched the take home videos.

Bergman, J. (2012, April 15). How the flipped classroom is radically transforming learning. Retrieved from how-the-flipped-classroom-is-radically-transforming-learning-536.php

Many times educators make this argument simply because they don’t have the desire to put forth the extra work needed on the front end to begin the flipping process.

Lage, M.J., Platt, G.J., & Treglia, M. (2000). Inverting the classroom: a gateway to creating an inclusive learning environment. The Journal of Economic Education, 31(1), Retrieved from

Summary Years ago, in the bad old days of television cigarette commercials, a particular tobacco producer targeted women smokers with the tag line, “You’ve come a long way, baby!” The same could be said for clinical practice in EMS and the educational component of EMS must stay current, as well. Fear keeps many of us from trying something new. However, at some point in your EMS career, you did not know how to read a 12 lead ECG, understand pharmacology or put on a spinal immobilization device. If you had an effective instructor, they encouraged you to try again when you made a mistake. Using technology in the classroom is no different. Step out of your comfort zone and try. You will fail at times, but that is where learning takes place. After all, isn’t that what we are asking our students to do?

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Educator Update |

Bergman, J., & Sams, A. (2012). The flipped classroom. Chicago, IL: International Society for Technology in Education. Bor, D. (2012). The ravenous brain: How the new science of consciousness explains our insatiable search for meaning . Philadelphia, PA: Basic Books. Green, G. (2012, January 18). Interview by Meade Robin. My view: Flipped classrooms give every student a chance to succeed., Retrieved from http://schoolsofthought.

Lam, Y. (2006). Technophilia vs. technophobia: A preliminary look at why second-language teachers do or do not use technology in their classrooms technophilia vs. technophobia. Canadian Modern Language Review/ La Revue canadienne des langues vivantes, 56(3), 389-420. Li, Q. (2007). Student and teacher views about technology: A tale of two cities?. Journal of Research on Technology in Education , 39(4), 377-397. Peck, K., & Dorricott, D. (1994). Why use technology?. Educational Leadership, 51(7), 11-14.


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To inspire and promote excellence in EMS education and lifelong learning within the global community

Hard Times for Soft Skills By: Rommie Duckworth, LP

Crucial to everyday human interaction, Soft Skills consist of personality traits, communication skills, and social abilities often closely associated with Emotional Intelligence and professionalism.

Rising to prominence in the early 1990s, Soft Skills were identified by the Secretary of Labor’s “Secretary’s Commission on Achieving Necessary Skills” (SCANS) as critical to workplace productivity. More recently, in 2008, a Job Outlook survey conducted by the National Association of Colleges and Employers (NACE) found that the top five characteristics looked for in new hires were soft skills: initiative, strong work ethic, interpersonal skills, ability to communicate, and perform as a team. Another poll conducted by the Society for Human Resource Management (SHRM) found that such soft skills as critical thinking, leadership, professionalism, teamwork, and adaptability were just as important for experienced professionals. While any employee must possess industry specific Hard Skills (such as the ability to splint, intubate or start an IV), soft skills are especially critical in industries where the worker is in direct, face-to-face contact with the customer, has to work independently in an unsupervised context or has to lead and coordinate coworkers. Scenarios such as these are clearly integral to EMS work, especially in time or task-critical situations. Despite the fact that soft skills play an important role in the success of many professions, the 2007 report “Every Promise, Every Child: Turning Failure Into Action” indicated that a large percentage of students preparing to enter the workforce over the next 20 years are significantly lacking in their ability to apply soft skills in the workplace. This then begs the question of all educators: Are we incorporating these critical skills as a core component of our educational programs or are we simply hoping that students pick it up as they go along? Evidence of the failure of our primary school system to teach and foster soft skills resulted in the development of the US Department of Labor document, Skills to Pay The Bills, a brand-new soft skills teaching curriculum that targets students aged 14 to 21.

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This program focuses on six specific soft skills: - communication - enthusiasm and attitude - teamwork - networking - problem solving and critical thinking - professionalism While this program is no doubt a good first step towards defining and teaching soft skills for a future workforce, it does not benefit today’s current EMS providers and students. Educators dealing with students who have limited prior experience with the development and application of soft skills may find a comparable list of soft skills first proposed by Archna Sharma to be more applicable to EMS. This list includes written and oral communication, critical thinking and problem solving, teamwork, lifelong learning and information management, entrepreneurship and motivation, ethics and professionalism, and leadership. The skills on this list are undeniably important to the field delivery of EMS; why then do they so often go by the wayside when it comes to EMS education? Six reasons come immediately to mind: • These skills are often presumed to be acquired by students before they begin class. • These skills are presumed to be somehow integrated into each lesson. • These skills are presumed to be the responsibility of the examining body to test for as a requirement for certification / licensure. • These skills are presumed to be the responsibility of the student’s employer to teach / test if they are valued. • Educators don’t know how to teach these skills. • Educators fear liability associated with evaluating what they believe to be subjective performance criteria. So what can be done to correct this problem? The good news is that healthcare educators need not reinvent the wheel. These skills can either be taught in stand alone soft skills specific programs, or they can be embedded into an existing curricula. Both methods have their pros and cons.


To inspire and promote excellence in EMS education and lifelong learning within the global community

While stand alone programs can offer clear and defined emphasis on written and oral communication; critical thinking and problem solving; teamwork; lifelong learning and information management; entrepreneurship and motivation; ethics and professionalism; and leadership, it can be difficult for educators to add additional educational modules for all of these skills into existing EMS programs. The logistics of embedding the teaching and evaluation of soft skills into existing curricula is often much easier than adding discrete soft skills modules and adds the benefit of contextual learning and integration of these skills into field EMS practices. The risk is that many educational programs place great emphasis on high risk/low-frequency emergency medical skills, while everyday skills (such as report writing, safe driving, and soft skills) can receive far less attention, class time, and practice. Whether an educator chooses the standalone or embedded format, developing learning outcomes for soft skills hinges - as it does with any skills - on identifying the appropriate topics (in this, case soft skills such as those in the list above) and identifying the desired performance criteria using SMART, ABCD or other objective setting formats. These then provide the outline for teaching and testing soft skills in either their own standalone lessons or integrated into other lessons, such as EMT, paramedic or any other EMS-specific program. Once the performance criteria have been set, any number of teaching techniques can be used to meet these objectives based on the skills and preferences of the educators. Examples include fostering written and oral communication by having students write and present to the class on a selected EMS topic, or, alternately, evaluating the student’s ability to give a written and/or oral report during a simulated patient transfer at the end of the patient care scenario.

The EMS Education Agenda for the Future says, “The public and employers demand that health care education produce graduates who are responsive to the needs of the patient, have excellent communication skills, and are able to adapt to changes in their responsibilities. They demand graduates who are technically competent, socially conscious, and culturally sensitive.” And, yet, what is commonly taught, practiced, and tested in the EMS Communication System section of the National EMS Education Standards are communication system procedures and technology rather than effective oral, written, and interpersonal communications. It has been argued that due to a lax communication and social skills, the need for the teaching of Soft Skills is greater with millennials than with any previous generation. Whether or not this argument is valid, it is clear that the proximate inclusion of soft skills in educational objectives and testing criteria is crucial for EMS providers’ ability to provide excellent patient care, succeed in leadership levels within their profession and advance emergency medical services (as a profession) to a level that stays on par with other healthcare providers. For this to happen, EMS educators must not allow soft skills - critical to all calls - to be pushed aside in favor of more easily tangible and “teachable” Hard Skills, which are only critical for some calls.

BIBLIOGRAPHY 1. Skills, U. S. D. O. L. S. C. O. A. N. Teaching the SCANS competencies. (1993). 2. Lazarus, A. Soften up: the importance of soft skills for job success. Physician Exec 39, 40–45 (2013). 3. Department of Labor. Skills to Pay the Bills. (2014). at <> 4. Sharma, A. Importance of Soft skills development in education. (2009). at <http://schoolofeducators. com/2009/02/importance-of-soft-skills-development-in-education/> 5. National Highway Traffic Safety Administration. EMS Agenda for the Future. (Washington, 1996). 6. American Academy of Pediatrics et al. Equipment for Ground Ambulances. Prehosp Emerg Care 18, 92–97 (2014). 7. Ray, J. D. & Overman, A. S. Hard facts about soft skills. Am J Nurs 114, 64–68 (2014).

Due to the difficulty in defining soft skills, educators must be careful to use clear criteria and to find a ranking system that enables them to provide students with the feedback they will need to develop and apply these skills effectively in their practice. An example of such a system may include using an even number of ranking levels (leaving no “middle-of-the-road” option) such as: Unsatisfactory, Moderate, Good, and Excellent. Of course, ranking students in such a manner is only effective as part of a larger feedback mechanism that will help guide the students to improve their application of soft skills in the patient scenarios that they are likely to encounter as part of their work in EMS. | Educator Update | | Educator Update |



To inspire and promote excellence in EMS education and lifelong learning within the global community

Situated Learning Applied to EMS Simulation By: Greg Vis, B.S., EMT-B he use of medical simulation has grown T rapidly in EMS education in recent years.

Simulation offers many benefits and can serve as a vital bridge between the didactic learning of the classroom and the rigors of field practice. Simulation can be used to teach a number of aspects of the EMS curriculum including psychomotor skills, teamwork, critical thinking and affective domain competencies. As a relatively new educational media, simulation has specific requirements regarding the efficient use of resources and personnel that must be carefully planned in order to maximize benefits and minimize costs. Educational theories assist in establishing frameworks with which to understand and guide the integration of simulation experiences into existing curricula. The Situated Learning theory developed by Lave and Wenger will be examined and compared with Issenberg’s review of effective simulation for the important lessons they provide in helping design and develop EMS simulations that lead to meaningful learning experiences in a cost-effective manner. Situated Learning In the early 1990s, Jean Lave and Etienne Wenger introduced the model of situated learning to describe the effects of the physical and social environment on learning. Central to the model is the learner’s participation in a “real world” environment with other learners including peers, more advanced learners, and experts, who together form a community of practice. In a community of practice, individuals participate in actual activities and have a range of levels of expertise in a discipline of common interest. Participation within a “real-world” environment expands learning beyond simply content knowledge to include tacit knowledge, such as a common language and expected behaviors of community members. When possible, real contexts, roles, and tools are used. When a student connects what is learned to an actual situation, the translation of content becomes clear. Learner participation in authentic tasks strengthens their integration within a community.

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Learners begin their experience through participation in tasks that are less vital to the community and then increase their level of responsibility to full participation in the central tasks of the community. Learners must also engage in assessments that reflect these opportunities and their participation. Medical Simulation Best Practices ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’ is the question asked by Issenberg in a landmark study. The answer includes 10 key features, which were found to contribute to effective simulation experiences. Key Features of Effective Medical Simulation

1. Feedback 2. Repetitive Practice 3. Range of Difficulty Levels 4. Individualized Learning 5. Curriculum Integration 6. Multiple learning strategies 7. Capture Clinical Variation 8. Controlled Environment 9. Defined Outcomes 10. Simulation Validity Comparison of Lave and Issenberg When we compare Issenberg’s findings with Lave’s Situated Learning theory we see several shared concepts explained in different terms. These concepts are compared in the table below. Three fundamental shared concepts for effective learning stand out: matching the teaching to the stage of the learner, practicing in a realistic environment and effective assessment and debriefing. Lave and Wegner Situated Learning


Peripheral to central activities within community

Range of difficulty levels

Real world context

Validity- Fidelity

Reflective Assessment


Discussion and Practical Applications From Periphery to Center: Range of Difficulty Levels EMS students are regularly immersed in a rich community of practice. EMS education has always placed a heavy emphasis on realistic training relying on a network of instructors and preceptors from the community.


To inspire and promote excellence in EMS education and lifelong learning within the global community

Spending time in actual clinical settings and in EMS agencies immerses learners in the culture. Most instructors will be active in EMS delivery as well as education and provide a valuable link to actual practice in their region. As learners progress from novice to experts in the discipline, they are guided along the way by the community of practice and move from its periphery to the center. Effective learning is enhanced when learners have opportunities to engage in practice of medical skills across a wide range of difficulty levels. Trainees begin at basic skill levels, demonstrate performance mastery against objective criteria and standards, and proceed to training at progressively higher difficulty levels. Each learner will have a different ‘learning curve’ in terms of shape and acceleration. It is the role of instructors and preceptors to judge the appropriateness of a certain skill or task and the student’s ability to perform. Repetitive tasks below a student’s ability level may lead to boredom. Similarly, tasks which are too advanced for a learner’s stage of development can lead to poor performance and motivation problems. The content matter of specific simulations should follow after the didactic presentation of the same topic in order to enhance the simulation experience. Careful planning and preparation is therefore essential by the educator and/or skills facilitator managing simulation. Realistic Environment: Validity & Fidelity Lave’s realistic environment concept and Issenberg’s validity concept describe the same phenomena. In both cases, learners will ideally see cues and consequences very much like those in the real environment. Trainees can be placed in complex situations and act as they would in the real environment. Validity is the degree of realism or fidelity the simulator provides as an approximation to complex clinical situations and tasks. A simulation is never completely identical with the ‘real thing’ for many reasons: cost, limits of technology, avoidance of danger and time constraints. From an intuitive viewpoint, it would appear that the higher the level of fidelity in medical simulation, the higher their validity would be for performance on tasks in real-world. We could deduce that the closer simulators can imitate the real world, the more efficiently they can train and aid in the transfer of learning to the actual real-world situations. Such a deduction could be misleading without considering the stage of the learner and it also does not take into account the realities of today’s tight budgets.

In the field of aviation, Alessi (1988) illustrated the role of fidelity at different learning stages. He hypothesized the existence of a marginal rate of return on learning and fidelity based upon the stage of the learner. The law of diminishing returns states that a point exists beyond which one additional unit of simulation fidelity results in a diminished rate of return on investment. Alessi also proposed that the degree of fidelity of a simulation experience should closely match the specific learning objectives and that higher levels of fidelity are most effective with expert learners and not always optimum for less experienced learners. Matching simulation equipment and environments to specific learning objectives, while also taking into consideration the stage of the learner, is thus of paramount importance. Looking at one application of these concepts in EMS, we know that IV skills are critical skills evaluated prior to completion of paramedic training. The skill is most often introduced in the lab setting using an IV arm task-trainer. Going from the lab setting to the back of a cramped ambulance can, however, be quite a leap for paramedic students. Approaching a disembodied body part on a table is quite different from positioning a patient’s arm in the back of an ambulance. A more effective bio-mechanical approach for simulating this skill is to have students positioned similarly to how they would be positioned in an ambulance. This can be achieved very simply and cheaply by placing a manikin on a cot and having the student sit on a bench or stool at the right height and distance from said manikin. While extremely inexpensive, the fidelity of this improvised setup for the psychomotor simulation is effective and possibly higher compared to an isolated task trainer or even a 3D virtual reality trainer where users interact with a screen. In teaching critical thinking and affective domain skills, the quality of the scenarios, debriefing, actors and instructors in recreating a realistic situation will have a much greater impact on the validity of the experience than the fidelity of the manikin used. Effective simulation need not be expensive; creativity can substitute for funding, but it must be well thought out.

(IV Training Positioning) | Educator Update |



To inspire and promote excellence in EMS education and lifelong learning within the global community

Reflective Assessment: Debriefing


Feedback was found by Issenberg and others to be the single most important feature of simulation-based medical education for effective learning. In order for task performance to contribute to learning, Lave’s model emphasizes the need for authentic assessment from the community of practice members. Educational feedback also appears to slow the decay of acquired skills and allows learners to self-assess, reflect and monitor their progress toward skill acquisition and maintenance.

With its focus on learning in real contexts and the social aspects of learning, the Situated Learning model provides a robust theoretical underpinning to guide the integration of simulation into EMS education. The primary tasks for educators using simulation are to carefully match the available resources to the learning objectives and stage of learning of the students in an optimum social environment. As simulation continues to grow in importance as a teaching method in EMS, our practice can be guided by the wealth of available research in both education and the interdisciplinary field of simulation itself.

Having a structured debriefing plan and methodology to encourage student reflection on actions is essential for all simulations. A number of formats exist for structured debriefing. The American Heart Association (AHA) now incorporates structured debriefing into ACLS and other courses. The AHA also offers an online course for educators on the principles of structured debriefing. Simulation evaluations must also measure the degree to which the simulation learning objectives are met during the learning activity. Video capture and playback can greatly enhance simulation debriefing. A number of high quality SD card HD camcorders on the market are available for under $150. The SD cards can be played back through most existing projection systems.

References Alessi, S. M. (1988). Fidelity in the design of instructional simulations. Journal of Computer-Based Instruction, 15(2), 40-47. Issenberg, B.S., Mcgaghie, W.C., Petrusa, E.R., Gordon, D.L., Scalese, R.J. (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher, Vol. 27(1) , 10-28 Lave, J. and Wenger, E. (1991). Situated Learning. Legitimate peripheral participation. Cambridge: University of Cambridge Press

2014 Call for Abstracts Now Accepting Research Abstracts for Presentation. Submit your abstract or learn more via online at: Category: Deadline: Presented at:

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For additional questions contact the Prehospital Care Research Forum at: Telephone: (310) 312-9315


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Six Questions That Will Bring Your Teaching Philosophy Into Focus

Perhaps what I need to consider is varying the teaching strategy I use (Venkatech et al 2013) taking into account the need to bridge post-secondary students’ transition from pedagogical to andragogical learning (Grow 1991).

By: Neil Haave, PhD in Philosophy of Teaching

What I particularly like in Grow’s article (1991) is his assertion that good teaching responds to the needs of the student — in his words, it is situational. My question then is, how do instructors make their teaching situational to an entire class? An entire class will contain a large continuum between students needing pedagogical vs. andragogical learning strategies. How do we respond to all of these different needs and the existing continuum in learning approaches (Knowles 1990)? How we learn informs how we teach I wonder if how we teach might be improved by considering how we ourselves learn (Weimer 2014). I sometimes find that, as an instructor, I forget what it was like to learn an idea or concept for the first time. I forget that much of how I view/interpret new ideas is informed by the experiences and ideas I have already encountered and that this may be relatively limited for students.

Earlier this year, a couple of contributions to The Teaching Professor (Haave 2014) and Faculty Focus (Weimer 2014) discussed the place of learning philosophies in our teaching. The online comments to Weimer’s blog post (2014) made me think more about how we as instructors need to be careful to bridge instructivist and constructivist teaching approaches for students not yet familiar with taking responsibility for their own learning (Venkatesh et al 2013). Students still seem to equate lectures with better learning/teaching as opposed to student-centered teaching strategies despite the preponderance of evidence to the contrary. This preference is confirmed for me when I review the end-of-term student evaluations for the courses in which I use team-based learning (TBL) – an active learning strategy if there ever was one. But what is really interesting is that there is a seeming sweet spot. For those courses in which I used TBL all of the time, student evaluations requested more lecturing. In contrast, in the one course in which I used TBL for only a couple of course sections, students indicated that a bit more TBL would be appreciated.

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One of the tasks I most enjoyed while serving as associate dean of teaching at the Augustana Campus of the University of Alberta was to help new instructors and teaching award nominees develop their teaching philosophy by helping them make the connection between personal learning experiences and the reasons for using a particular teaching approach. What I have come to realize is that how we learn can inform how we teach and perhaps help us to bridge the development of students from a young to adult learning approach. One strategy I used to help initiate the process was to have colleagues link their teaching philosophy to concrete experiences they had as a student and how that manifests itself now in their own teaching. A common approach I employed was to ask fellow instructors to describe an exemplary learning experience from their past and to explain what made it particularly significant for them. I would then ask them to consider how that learning experience informed their own teaching and if it had not, why not? Subsequently I would have them consider an exemplary teaching experience they had with their students and ask how that informed their teaching philosophy. Should it? Why or why not? How does the teaching philosophy manifest itself in the teaching strategies that you use?

SIX QUESTIONS THAT WILL BRING YOUR TEACHING PHILOSOPHY INTO FOCUS Both exemplary and deeply unsatisfying learning/ teaching experiences can be used to develop learning and teaching philosophies because each will say something about how we prefer to learn and what teaching practices we and our students have found to be successful. The learning experience that I always return to for myself is the introductory biochemistry lecture I attended in the second year of my undergraduate degree in which my instructor explained the responsiveness of hemoglobin to the oxygen and pH environment of our tissues and lungs, and how the protein’s shape changed and thereby impacted its affinity for oxygen. At that moment, it became clear to me that our breathing process is mirrored by the protein’s conformational changes as it bound and then released oxygen in response to the acidity of the environment (it’s more complicated than that, but this will suffice for this example). It then dawned on me that the protein, in a sense, breathes and is by no means a static structure as was depicted in textbooks (this was in the early 1980s).

It was then that I knew I wanted to study biochemistry, because it had become a dynamic process worthy of investigation and understanding. How has that impacted my teaching philosophy? As a teacher, I want to create learning environments that are fertile ground for those sorts of “aha!” moments for my students. I want to create the conditions in my classroom that will enable students to come to their own realization that molecular cell biology, biochemistry, and histology are dynamic engaging processes that inspire fascination and curiosity. I want them to become the type of students whose reasons for learning go beyond the desire for a passing grade. Thus my guiding principle, which has led me to try and master team-based learning, is to consider how to create a learning environment inside my classroom that will entice students to be eager to learn on their own and to always be asking “How does this work?”. I try to find problems to set the table for learning. Or rather, I till the field and plant the seeds of interest waiting for the students to tend their garden in anticipation of what knowledge they will grow.

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SIX QUESTIONS THAT WILL BRING YOUR TEACHING PHILOSOPHY INTO FOCUS Examining our teaching philosophies Below is a set of questions that I have used in workshops on developing teaching philosophies. There are no correct answers, but there are answers that are better supported than others. The intent of the exercise is to build, articulate, and be explicit about our reasons for teaching the way we do, as advocated by Girash (2014). Eventually, our teaching philosophies need to be made manifest in our students’ learning outcomes and, it seems to me, mindful of individual students’ learning philosophies. We need to ask ourselves, ‘What is the evidence that how we teach is successful?’ These questions are best answered in conversation with a colleague or two. 1. Describe the best learning experience you have had as a student. (This helps to identify how we best learn and reminds us as instructors what it is like to be a student. Maryellen Weimer (2013) recently discussed this in the context of influencing the learning environment) 2. Describe the best teaching experience you have had as an instructor. Are there any similarities to the learning experience you described above? (This question attempts to link our learning to our teaching.) 3. What are you trying to achieve in your students with your teaching? (This is a big question and may be best initially answered by thinking about it in the context of what you feel is the course you teach with the most success.) 4. Why is this important to you? (This helped me to begin articulating my approach to my discipline in the context of teaching. For others I know it becomes larger than the discipline itself and may link to the personal growth of students and not only their intellectual growth.) 5. How do you achieve your objectives you wrote down for question #3 above? That is, what teaching strategies or approaches do you use in your classes that produce the learning environment or opportunities for your students to reach your teaching objectives? (Hopefully, this has been informed by your answers in questions #1 & 2 above. If there is no apparent connection between this question and your answers to #1 & 2, then this might be cause to pause and reflect why this is.)

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6. Why do you use these particular teaching strategies as opposed to others that are available to you? (This is where you start developing the argument or citing the evidence for the value or success of your approach to teaching. Hopefully, you are able to make links to your own learning philosophy.) These questions have helped me and others to develop our teaching philosophies. They can be strengthened with regular revision and grounding them in questions of philosophy (Beatty et al 2009). Considering our teaching philosophies in the context of our own and our students’ learning philosophies has the potential to help us, as instructors, aid our students’ development from dependent to independent learners. So, how does your learning philosophy inform your teaching philosophy? And how does that manifest in the teaching strategies that you have chosen to use in your classes? References: - Beatty, J.E., J.S.A. Leigh, & K.L. Dean. 2009. Philosophy rediscovered: Exploring the connections between teaching philosophies, educational philosophies, and philosophy. Journal of Management Education, 33(1): 99-114. - Girash, J. 2014. Metacognition and instruction. In V.A. Benassi, C.E. Overson, & C.M. Hakala (Eds.). Applying science of learning in education: Infusing psychological science into the curriculum. Retrieved from the Society for the Teaching of Psychology web site: ebooks/asle2014/index.php - Grow, G.O. 1991. Teaching learners to be self-directed. Adult Education Quarterly, 41 (3): 125-149. - Haave, N. 2014. Developing students’ learning philosophies. The Teaching Professor, 28(4): 1 & 4. the-teaching-professor/story/6910/ - Knowles, M.S. 1990. The Adult Learner: A Neglected Species, 4th edition. Houston (TX): Gulf Publishing Co. - Venkatesh, V., J. Jedwab, J. Rabah, T. Thomas, W. Varela, & K. Alexander. 2013. From disconnected to connected: Insights into the future of distance education and Web 2.0 tools in higher education. International Journal of Technologies in Higher Education, 10(3): 6-13. http://www. - Weimer, M. 2014. What’s your learning philosophy? Faculty Focus, March 26. whats-learning-philosophy/ - Weimer, M. 2013. Two activities that influence the climate for learning. Faculty Focus, November 13.

Dr. Neil Haave is an associate professor of biology at the University of Alberta, Augustana Campus. Article reprint courtesy of six-questions-will-bring-teaching-philosophy-focus/

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Clinical and Field Internship Sites by: Patricia L. Tritt, RN, MA High quality clinical and field internship sites are like rare minerals: sometimes hard to find, must be mined carefully, and should be guarded jealously. Obviously, all sites are not created equal. According to the Standards and Guidelines, through a combination of sites/experiences, the students shall “have access to adequate numbers of patients, proportionately distributed by illness, injury, gender, age, and common problems encountered in the delivery of emergency care…” One of the first things a new program must determine in a feasibility study is whether adequate clinical and field resources are available in the local area. For that matter, any program contemplating its continuing existence asks the same questions.

Additional training for preceptors is required by the Standards, beyond what is provided for hospital clinicals. What is your relationship with the agency? How does the program select an appropriate preceptor? How does the program determine competency? Have you abdicated all responsibility for assessing competency to a preceptor that you have never met?

The focus of the clinical experience is shifting from a specific location to include locations that can meet the rotation goals and objectives. The Standards and Guidelines identify seven locations for hospital/ clinical affiliations. Of course, the emergency department and labor and delivery will be standards. But, for example, pediatric patients may be encountered in an emergency department, a pediatric clinic, a pediatrician’s office, or other venue and not necessarily a rotation on a pediatric unit. Programs may be creative about where students get the experience but the program must insure that it is a quality experience. The controlled clinical settings offer ideal opportunities to: perform patient assessments; develop patient interviewing and communication skills; and practice isolated skills such as medication administration, intravenous insertion, and airway management. Experience in the clinical setting usually provides ‘pieces’ while the field An emerging trend for some programs is to send students internship provides the ‘whole’. out of the region, or even out of state, to satisfy these experiential requirements. Whatever your approach, there The field internship is a capstone experience. A are some questions to consider. How will your program capstone course offers the student nearing graduation orient key hospital and other clinical experience the opportunity to summarize, evaluate, and integrate personnel to: the purposes of the student rotation; their previous coursework. In addition, student work program evaluation tools; criteria for evaluating/grading; needs to be evaluated by faculty members responsible and contact information for the program? How will your for the program, not just the preceptor. The purpose faculty assess the quality of the clinical experience? How of the field internship in the paramedic program is will your faculty determine if the student has developed to provide the opportunity to assess and manage all the desired competencies? Are you only evaluating types of calls and develop experience team leading. numbers or are you evaluating the quality of the student In other words, to pull the knowledge obtained in experience? Documentation that all students meet the the classroom, skills lab, and clinical areas together required minimums set by the program for assessments to assess, manage, and treat all types of patients in of the various types of patient complaints and skill the prehospital setting. The obvious dilemma for a interventions is required. However, numbers alone do program, especially one with limited staffing/faculty, not determine competency. Also, if your students are is how to effectively provide the supervision and traveling, is your student licensed or certified in the sequencing that truly makes this a capstone out-of-state rotation to perform the skills required in the experience. At a minimum the following is required: program? And is there a medical director, with a license in that state, who is taking responsibility for this student? 1. Careful selection of field precepting agencies. Does your program worker’s compensation and liability insurance cover the student in this circumstance? 2. Careful matching of the preceptor and the student. Additional challenges present when students complete a field internship in an out-of-state location.

3. Adequate preceptor training. || Educator Educator Update Update ||

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CLINICAL AND FIELD INTERNSHIP SITES 4. Meaningful daily/shift evaluation by the preceptor with verbal and written feedback to the student. 5. Review of patient care reports by a faculty member with feedback to the student. 6. Milestone, summative evaluations by the preceptor: after a specified number of hours or shifts or patient encounters. This type of evaluation summarizes the student progress to date, based on where they are in the program, not just on a given shift. 7. Final summative evaluation of the student by the preceptor. 8. Periodic communication between a program faculty member and the preceptor. 9. Periodic meeting and progress review with a faculty member and the student.

Each of the four components of a paramedic program is vital to student success: the classroom or didactic portion, the skills laboratory, the clinical settings, and the field internship. And equal focus must be placed on content, delivery, and monitoring student progress in each of these areas.

* Disclaimer: Ms. Tritt is a member of the Board for the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and a long time accreditation site visitor. However, the views and advice expressed here are her own and should not be interpreted as CoAEMSP policy.

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Thought Experiment By: Colleen Flaherty WASHINGTON – Sharon Kaye was having trouble describing what she does for a living while at a party a few years ago. The professor of philosophy at John Carroll University, a small Roman Catholic university in Ohio, said the old “philosophy is the love of wisdom” line wasn’t cutting it. So she posed a philosophical hypothetical dilemma to illustrate the value of her discipline. The room was impressed. And it got Kaye thinking. “I said, wow, if I could get that kind of reaction in the classroom…” she said. Fast forward several years, and Kaye is knee deep into her new teaching style, which she presented here Friday at the annual conference of the American Association of University Professors. Kaye’s talk, called “Thought Experiment as an Interdisciplinary Pedagogy,” encouraged professors of all disciplines to incorporate into their teaching the philosophical concept of the “thought experiment.” Dating back to ancient Greece, thought experiments are imaginary scenarios explored to create new knowledge, Kaye said. Classic examples include those from the Roman philosopher Lucretius, to get at truths about the nature of time and space: Imagine throwing a spear at the edge of the universe. Will it keep going or hit a boundary? Here’s another example, posed by Socrates just before his death: “Do you really think you have the right to live in a country whose laws you regularly disobey?” Of course, Kaye’s students didn’t know Socrates was the inspiration for that thought experiment when she posed it to her students like this at the beginning of a class this semester: “You came to this room expecting a lecture, but this is a sting,” she said she told her students, all non-majors, introducing herself as “Agent” Sharon Kaye. She asked her students to hand over their wallets, cell phones and belts, and accused them of traffic violations (committed just about every time they drive), copyright violation (pirated movies and music), substance abuse (enough said) and more.

She asked students to turn themselves in to authorities, but many proclaimed their innocence. So Kaye asked the class to vote on their collective guilt, and watched them come up with sophisticated arguments for why they deserved to remain free citizens. In another, more modern experiment, created by the philosopher Judith Jarvis Thomson, Kaye tells her students that they’ve woken up in hospital room to find that a famous violinist is attached to them by various tubes. The violinist is completely dependent on the student, and in order for him to live, the student will have to remain with him in the hospital bed for nine months. The experiment is way of exploring the complex philosophical arguments surrounding abortion, Kaye said, and sometimes students who originally feel one way about the hospital scenario are surprised when they realize their views on abortion differ. Students also debate whether or not the scenario is an apt metaphor. “[They] have a lot to say about that, too,” Kaye said. The professor’s class meets three times per week, and each Friday is dedicated to a thought experiment. She lectures on Monday and assigns quizzes on Wednesday, but to make time for the thought experiments, she said she relies more heavily on students to do readings outside of class, in a kind of “flipped” classroom model. “Some of them won’t” do the readings, Kaye said, adding that the thought experiment model doesn’t please everyone. The professor said some students have written in course evaluations that they didn’t get their “money’s worth” out of a course because it didn’t feel like traditional instruction. But Kaye said she’s committed to the new teaching model – even when she doubts herself – for its results, mostly “indirect.” Kaye said it’s hard to tell just how the thought experiments are affecting student learning, but that students over all seem more engaged. And the quality of their writing has definitely increased, she said, attributing the shift to a deeper personal investment in course material. “If it’s a chore, it shows,” she said. || Educator Educator Update Update ||

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THOUGHT EXPERIMENT Kaye said she hoped those writing gains would translate to other courses with other instructors. The thought experiment session was well-attended, and audience members came from fields as diverse as biology, psychology, history and student development (but not philosophy). Kaye said the thought experiment, although the “sine qua non” of philosophy, was applicable to many different disciplines.




But Debu Misra, professor of geological engineering at the University of Alaska at Fairbanks, said he wondered how he could use thought experiment in his technical science classroom, where students need so much hard knowledge before attempting coursework. In response, Kaye advocated her “flipped” classroom model, in which students take greater responsibility for learning content outside of class themselves, and use classroom time to practice it. She said an engineering thought experiment might ask students to develop a plan for saving people in two buildings, one flooding and one on fire, at the same time with a given set of random items to use as tools and equipment. Another session attendee, Barbara Levy, who teaches ethical psychology within the Rutgers University system, said she’s been doing thought experiments with her students all along – but never knew to call them that. She said such critical thinking exercises, which have a more practical slant in her courses, given the subject matter, are more immediately applicable to certain disciplines than others. But she said higher education over all – no matter the field – needs more such “creative instruction.” “What we have in education today is a lack of [promotion] of critical thinking,” she said. “So it seems like anything we can do to strengthen that is a good idea.” Reprinted from INSIDE HIGHER ED January 10, 2014 with the permission of Inside Higher Ed, copyright 2014. Inside Higher Ed is the free daily news Web site for people who work in higher education. Breaking news, lively commentary and thousands of job postings bring more than 800,000 people to the site each month. Read more:

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