February 23, 2023 • 42 mins
This continuing education podcast looks in the mirror to talk about continuing education. No one better to have this conversation with than Jay Scott, Executive Director of CAPCE. We talk about the intent of CAPCE, how CE is delivered and reported, and some fascinating insights into the future of EMS CE. And you get CE!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Seven Things EMS Podcast, a continuing education offering of limer education.
(00:12):
Seven Things EMS Podcast is designed to give you what you need to succeed in EMS, it's
conversational, informational, and without the fluff.
Our Seven Things podcast now brings us a special guest, Jay Scott, the executive director of
(00:37):
Capsi.
A lot of people know Capsi by the continuing education and getting their state or their
national registry recertification done, but today we're going to take a little bit of
a deeper dive in this.
We're going to talk a little bit about CE and the man behind the CE.
I'm Dan Limmer from Limmer Education, we're just incredibly fortunate to be here today
(01:01):
with Jay Scott.
Jay Scott is, like I said, executive director of Capsi formally.
CISP means a board member there and the most common face that we know with that, but comes
from an EMS background, including even New York State or on Syracuse.
So we're not that far from our old stomping grounds and welcome Jay.
(01:21):
Dan, thank you for having me so much.
I'm honored to be here tonight.
Great to have you.
I think our motto is to get right into the Seven Things.
What I like about your Seven Things Jay is that you have a great cadence here.
Talk a little bit about CE and also I like the fact you talk about some of the vision
for CE.
I think people would like to know some of those things.
(01:42):
Let's just get started.
Number one, don't be fooled by CE that lets you skip the content and go right to the tests.
You're not really getting anything for your investment of money or time.
Jay, I got to tell you, there's people that love to complain that their CE has got no content
and it's boring and they love to complain that it's too hard and too much work.
(02:03):
Tell me about that.
Tell me what you would envision CE to be not going directly to the test.
Well, I think that there are some really, really good online and face-to-face continuing
education programs that are out there, but specifically the online stuff where I do a
self-study program.
If I pay a subscription fee and I log in and I have the opportunity to go directly to the
(02:28):
test and skip the educational component, I'm really not helping myself much.
I think that people that provide educational content in an online format spend an awful
lot of time and money developing their content and most of it is excellence.
I've never understood why somebody that spends that much time and investment in providing
(02:50):
an educational activity would allow the user to skip that activity and go directly to the
post-test and get a certificate, never having interacted with the activity at all.
Like I said, it is a little bit of a love-hate thing.
It's interesting that you said that there's a lot of quality CE out there.
(03:14):
I think people get in, they take their initial class, they get out there.
I think we go through phases.
I think we go out thinking, we know everything.
Sometimes we get shocked into learning what we don't know.
Then we hit the long haul.
I think the people that survive in EMS, the people that go out and do really good care
are the ones that take learning seriously, that understand that you don't know everything
(03:39):
and that's always important to do more.
I agree and I think the technology is at a point now that allows us to a lot of very
creative things with continuing education that the start of it was go online, read an
article, take a test and that was long before we had any real technological advances on
the internet and honestly, reading an article and taking a test is pretty boring stuff.
(04:05):
That in and itself, the market is kind of phased out.
People don't gravitate towards that kind of continuing education.
They want the interactive stuff.
They like the video-based case studies and they like to be able to do something with
the content, not just listen to the same old thing they've heard a dozen times, the same
(04:26):
old blood-borne pathogens lecture and they don't certainly don't want to just read something
and then have to take a quiz.
Those kinds of things you can tell are just not popular.
Well, I think EMS people are action-oriented.
They're people-people.
We don't always, I don't want to put everybody in pain.
I'm in a broad stroke.
I always have the longest attention spans.
(04:47):
I know I can speak for myself in that and we are a little driven by excitement.
I think it's pretty normal that people really do want to have CE that is engaging.
I think we're trying to get above that lowest common denominator of training like the articles.
(05:08):
It's really come a long way.
And the different levels of CE that we have from in-person to distributed to built to
the new technology categories, CE I think has progressed.
And actually we have a section a little bit on technology a little bit later.
But it's exciting stuff.
(05:30):
And I think COVID has really put us in a spot where we recognize that there's not only an
ability to offer good stuff online, sometimes we have a need.
Yeah, and it has to be portable as well.
I mean, I have to be able to do my CE while I'm on a shift.
I know a lot of people that work a full-time job, you know, four, 12-hour days on and on
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their four days off, they tend to work a second job just to make ends meet.
And asking that person to stay after for a lecture or, you know, attend a mandatory training
session sometimes is just very difficult because they don't have the time and they'd
like to spend it with their family.
So if we can do training in some kind of portable format that's driven by technology that they
(06:15):
can do while they work on their shift, I think that is more attractive to people than spending
time in their off time having to go through their mandated CE hours.
We certainly are a mobile society.
We go out and about in the number of people with pods and different things in their ears
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and listening to things certainly is the norm.
Well, if we were to take this, I think we, and this is what I'd like to bet your seven
things is we can just roll from one into the other.
Is number two is that CE is necessary.
I look at this as kind of a, you're going to give us a little bit of a big picture vision,
(06:57):
but you know, why does the executive director of CE's beams, you know, it's not your job
saying this.
It's not job security.
You're doing this because you believe it.
Why is CE necessary?
CE is necessary because EMS is the most rapidly evolving profession in the world.
It changes and morphs daily.
(07:17):
Practice standards change.
Equipment changes.
Our abilities to perform certain tasks in the field change.
Our abilities to analyze and assess and diagnose people change.
For example, the advent of ultrasound as an EMS skill is something that where the technology
is driven the profession to a certain point.
(07:40):
In order for us to keep up with the changes, we really need to do continuing education.
It's just necessary.
It's part of the job and it's part of the realm that we happen to work in.
If you, this, I told you I was going to throw a couple of questions at you as we go here.
What would the director of Capsi doing CE to maintain your license, what's your favorite
(08:06):
topic?
If you could list, oh, look, there's a whole big list of connet things on your screen and
your provider.
What would you love to listen to or watch?
I just did my favorite lecture last night for a paramedic original program.
I did a NASA base balance lecture.
A lot of people think I'm crazy that how could you enjoy acid-based balance?
(08:27):
Honestly, it's my favorite topic.
But if you present anything in a case-based format, for example, if you happen to have
access to a simulation lab or a virtual patient or a compilation of video-based cases where
you can group things together like simple, non-complicated chest pain, and the second
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case is a little more severe with a STEMI.
The third case is a full-blown cardiogenic shock and clumping those things together and
starting with, here's what we're going to tell you, here's the signs and symptoms you're
going to look for.
Then you do a case either in a simulated environment or in a video-based environment.
Then you move it up.
(09:09):
All right, so the next case is this.
These are the treatment things we're going to add to that patient.
The next one is even more severe.
Here are the things that patient needs.
Clumping cases together in a group that makes sense, that provides for a non-stressful learning
environment.
I think those are my favorite things.
(09:30):
My favorite topic is acid-based.
My favorite environment is being able to do case-based learning around a series of patient
scenarios.
All right, I'm not worthy because of that acid-based thing.
It's my least favorite, so I am very impressed with that.
It took me by surprise as probably most people listening to this.
(09:55):
I was recently at a presentation the National Registry did at an educator conference.
One of the things that they say that they're looking to test more as they work towards
phasing out psychomotor exams is judgment and thinking.
I think that that continues into what you're saying is that when you can learn to apply
and have some challenging cases and things that aren't the basics, that I think we benefit
(10:22):
from that and we grow, that CE can really help us grow.
I agree.
All right, that takes us, this is flying.
I mean, we're going through this really well.
CE, this is number three.
CE should not be a rehash of what you already know.
It should be about 60 to 70% new content.
(10:44):
I think that there's a lot of people, EMS came from a background of refresher classes.
I'm doing air quotes here where you got taught the same old thing again.
That's a lot of what we did.
Combining that with your prior statement about how things in EMS are changing certainly
does leave just wide open opportunities for really valuable CE.
(11:12):
Yeah.
I think that in a perfect world, we've all seen patients that we didn't quite understand.
I think there isn't any EMS practitioner in the world that says they can look at every
single patient and know exactly what's going on.
I've certainly seen patients in the last 40 years that I've looked at and said, I'm
(11:35):
really not sure what's happening to this person.
You get into the ER and you say, doc, what is this?
The doctor goes, I don't know.
We're going to have to do some tests.
I would really like it if the continuing education program were adaptive enough that if I saw
a specific thing that I didn't understand, if I could go back and study that thing, if
it was something new, for example, what if I had never ever encountered a patient that
(12:01):
suffered both COPD and CHF that now has difficulty breathing?
I have to discern the two.
Which is it tonight?
Is it the COPD or the CHF?
What kind of assessment things do I need to know?
What are the clues?
What's the right treatment path for me to go down?
You could certainly do things for one or the other.
It would be harmful if I misdiagnosed.
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I think I would like to learn about new things.
If I treat my first LVAD patient and I've never been exposed to an actual LVAD patient,
and I go see them and I'm really not sure what's going on.
I'm flying by the seat of my pants.
That's a very, very uncomfortable feeling.
We've all been there.
We've all had that patient that makes us pretty unnerved and gets to the hospital and there's
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a sense of relief and the staff at the hospital takes over.
I'd like if we could go back and study the things that maybe surprised us or go through
the things that we're not quite certain on.
Or say I haven't ever done a needle-crike in my career and I have, but if I'm that person
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that's never done it, shouldn't I spend time practicing up or learning about those things
that I'm going to really need to know sometime and it might be one time in my career.
When I use it, I really, really need to know it and I need to do it well.
So I think the continuing education program shouldn't be about what we already know.
It ought to be about those things that we want to really brush up on or about patients
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we're not quite certain on.
We want to learn more about.
We've been an EMS a similar amount of time and one thing that you said, I think really
rings true is that many people remember the ones that they didn't get more than the ones
they did get or save.
Right?
When we, when we knock it out of the park and know the right med together, choose the
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right protocol is one thing.
But the ones where you have to ask the doc, you go back and have to check and do that
in education.
We'd call that a teachable moment.
But for a motivated, you know, field provider, when you look at a career, whether it be over
the years or decades, many times we learn the most from the ones we don't know.
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And that should fuel our quest for continuing education.
Now, not everything comes with a set number of hours.
You can certainly research and do things on your own.
But getting CE, not being a rehash to watch and know, I think makes a lot of sense.
So let's roll into into number four.
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And this is where I think really we get into some of the vision for CE.
And I like that.
I think people have an interest and I'm going to keep my license.
What am I going to do?
What's going to be in some of this might be in the future, but you say CE should be replaced
by continuous learning.
(15:00):
That strikes me as a pretty high level kind of statement.
I'd love to hear more about that.
Yeah, I think I'll kind of harken back to my days working for emergency medicine and
upstate medical university in Syracuse and, you know, having emergency medicine residents
come into the SIM lab and every week there was a specific topic.
And every week you were you had a brief primer about so the topic today is this might be
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pulmonary embolism or some other topic.
And here's the sign of the symptoms.
Here's the things to look for.
And then that group goes into the SIM lab and they run that case.
And then when that case is done, everybody's got it.
You go back into the lecture area and we'll talk about the next thing, the next patient
that has the same thing, but is more complex, something that needs more treatment and more
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labs and more analysis.
And then you learn about that and you go back into the SIM lab.
So I think that instead of just kind of rushing at the end of your research cycle and try
and get your CE done and doing as much as you can within kind of the framework, I think
it would be better if we replace that system with, I want to say curriculum, but pretty
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much a curriculum that says here are the things over the course of the next year.
And here's the schedule and this is how we're going to lay it out.
And then this week we're going to talk about pulmonary embolism.
And next week we're going to talk about stroke or whatever.
But I think we can design a continuing education program that I think also could be custom
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tailored to the extent that I do a lot of electronic run documentation and whichever
company I happen to use for that has a certain record of the types of calls that I've been
on.
And if I'm really good at STEMI care and I treated a lot of patients with chest pain
and I've done well and haven't had any complaints or issues about my care, that's great.
(16:53):
Do I really need to take the cardiac section of the curriculum or should I be able to skip
that and maybe replace it with something I haven't seen in a long time?
Maybe if I haven't delivered a baby in eight years now, maybe I should brush up on that.
So I think the continuous learning model with flexibility built into what I've done and
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what I'm really good at, and this kind of leads a little bit into the continuing competency
argument instead of continuing education.
I think I would even call it continuous learning instead of continuous competency.
And the learning is a directed curriculum based on my call volume and things that I've
seen and things that I haven't seen.
Well, let's brush up on things that I haven't seen.
(17:39):
I think, excuse me, I'm going to roll into number five because you mentioned technology
and I think that's probably one of the biggest changes.
Like I said, you and I have got a similar amount of time in EMS and we weren't particularly
high tech.
And the things that are available out there, I had somebody call me and say, do you guys
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have eye stats?
It's like no, but what we can do and how we can direct care, how we can take our care
and make it more seamless within hospital care.
And some of these things I think are fascinating in the technology.
But you say technological advances are making CE evolve.
(18:24):
You can now do case studies that cover new content and patient care areas we need to
improve.
I think we've covered a certain amount of that.
But I just think that technology is, I think, where everyone's going.
And I just want to see if we can throw anything more about that.
Yeah, I think, and I don't think we have any choice, Dan, what I think that we learned
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that through COVID and the restrictions that the hospitals had to place on things like
going to the hospital to do some clinical time for the paramedic program.
Or we used to a long, long time ago, if we had somebody that wasn't particularly good
at intubation, we could get them into the OR and they could learn intubation with an
anesthesiologist and get some practice before they get back out in the field.
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And so on.
And those days are kind of done.
They're not completely done, but boy, they're in trouble.
So I think we learned through COVID that we could design virtual cases and virtual formats
that if there were a specific type of case, it doesn't ever really replace actually touching
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a patient.
But we could certainly learn about patient management for specific types of cases.
And even if you had a person who had a quality improvement issue that needed to brush up
on drug doses for asthma or anything, honestly, you could set up a series of cases within a
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virtual environment that are custom tailored to the needs of the individual, to the EMS
practitioner.
So they could interact with that patient on a regular basis until they really felt confident
and could sail through that patient care scenario and then get them ready to get back out on
the street and touch actual people.
So I think technology has given us a great advantage.
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And unfortunately, it's not quite developed enough where it's uniform.
It's not available to everybody yet.
And I'm looking forward to the day that it is.
Yeah, that certainly is.
Now, things have happened in your realm technologically.
I don't know how many years it is, but you've created a system where continuing education
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providers can feed you information now electronically, and then you can transmit it to the national
registry electronically relatively quickly.
As you say, people are always in March looking to get their stuff done at the last minute.
But tell us about that.
And I don't want you to spill any big beans or if there is anything else going on.
(21:06):
How has that technology changed things for you guys?
Is there anything that you would envision next?
Yes, yes, yes.
Yes, your question.
Yes, I like it.
So yeah, we, the board of directors of CAHPSI talking with the board of directors of the
national registry devised a plan by which we could share data.
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And for those people that were nationally registered, if their records exist in our
database on the courses they've completed within their own continuing education program,
that we could build a pretty simple data sharing API that the individual would manage and monitor.
And simply they would go into the national registry and there's a button within the transcripts
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part of the registry page.
And they hit the, and in that section, there's a button that says import CAHPSI records.
And they hit that button and anything that they have within the CAHPSI database that
they've completed moves into the recertification file within the national registry.
And it's dramatically changed the ability of the individual to process recertification.
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I don't have to create things manually anymore.
And I think the last time I had to recertify and I created things manually for my own recertification
of the national registry, it took me more than 24 hours.
I mean, it was a significant amount of time to put all those things in.
And I said, there really just has to be a better way.
And so talking with the national registry, we said, there is a better way.
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And let's just build it and let's make it free and available.
And it is, and it works and it's great.
And I've done it myself and we have people that call up all the time and say, what's
the best way to move my records to the registry?
We tell them, log in, hit that one button, tell us what happens.
And they go, oh, all my records are here.
This is awesome.
And so then the question is, really does, is that a benefit to the individual EMS practitioner?
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And the answer is very clearly yes.
And can we expand it?
Can we make it more beneficial to other people?
If people that are state licensed only and say, I work in Massachusetts and I'm not nationally
registered, but I've got a state license, could I use that same system or a similar system
to move my records either to the registry or the state office that I work under?
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And the answer is yes, we can build a similar means of doing that.
And would that help the individual?
Yes.
Is that something Capsu wants to do or be willing to do?
And the answer to that question is yes.
And we're working on it right now.
We're working on agreements with several states to allow us to transmit records to the state
office from our database.
And the best, the most important part of that is there's no cost to the individual
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practitioner.
We're just going to do it.
Wow.
That's really a great service for people.
People often lose track of the vision, the things that people actually do for them behind
the scene while they're counting their hours and doing all these things.
That's really great stuff going on.
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Now we talked about continuing competency.
Now number six says continuing competency and con-ed are two different things.
And that's something I think we also, in this really great conversation, talked about.
Is there anything different that would happen with Capsu as regard to that?
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Or are you saying that we want people to maintain continuing competency and that's a subset
of con-ed or con-ed is a subset of that?
Or what are we saying with number six?
Yeah.
So I think there's a line to be drawn between the two.
And being able to show that I'm competent in all things, that I'm a competent practitioner,
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that my medical director and the stadium office that I worked under or the national registry
views me as a competent individual and I'm capable of providing care in all care situations.
And the question really is how do we prove that?
What set of things do we go through?
Is that skill-based?
Is it educational-based?
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Are there things that I do from a practice standpoint and caring for people in the field
that prove that I'm competent?
And the answer is it's a combination of all the above.
And so the ability to complete case studies and case-based scenarios built around a certain
(25:46):
patient complaint and using that to show that I'm a competent paramedic or competent EMT
I think is a very, very valuable thing.
But there's still, there's got to be a certain level of flexibility within the state that
says I really want my people to know the following things.
For example, I lived in New York.
We have a very, very extensive hypothermia protocol and everybody was very well versed
(26:09):
in how to treat people with frozen limbs that were still alive and not yet in vitricular
fibrillation and I moved to Texas and there's no hypothermia protocol here in Texas, not
to that extent.
So based on the region that you're in and based on the local processes that are happening,
like the advent of bath salts that hit back a few years ago, it would take a while for
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the continuing competency process to catch up with that, to develop enough cases that
we could spread in a wide enough format that enough people could take part in it where
a continuing education program and putting together a lecture or a built program or a
podcast, certainly we can do that much quicker.
And if we need to reach the masses on something that's happened that requires acute attention
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like COVID, we needed to ramp up very, very quickly and I think the continuing education
model is more agile than the continuing competency model might be.
And I could be proven wrong and if Mark Terry is listening, Mark, I apologize and please
prove me wrong, right?
But I think that there are certain levels of things that we can put out through a specific
(27:23):
continuing education model that we're using now that maybe the continuing competency model
won't quite be agile enough.
And certainly at this phase, it's still in the phase of we're trying to conceive of what
it's going to look like and what all the parameters are going to be.
So we're not quite there yet, but I think at some level the two have to be separate.
(27:43):
Well, you know, I think that as in my role as an educator of initial courses where I
teach at Calvist and College again here in Texas and then my CE hat, you know, for a
limer education, what I've found over time is that I think in mature, I think that EMS
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is still growing and is still getting maturity and figuring out who is responsible for what.
You know, people that are looking for EMTs and medics now, which is everyone, want someone
to come out street ready.
You know, I put out entry level people.
I think there's responsibility for employers and agencies and volunteer agencies to help
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get their people up to the point where they're competent and confident on the street.
And then there's maintaining it.
And I think that process is something that as a profession, we certainly haven't gotten
together on it.
And I think we struggle with getting somebody out of medics school in your department that's
paid someone to be there and say, okay, you're a crew leader on Saturday that we struggle.
(28:53):
I'm going right through that competency and quite frankly, confidence is an issue.
I don't mean to get into much of a soapbox here, but I see what you're saying in that
continue education is something, but maintaining competent providers, even if you defined it
simply as the ones you would want to come to your house, that we do struggle with that
(29:18):
as a profession.
I think it's really interesting.
I'll give you one second.
I'll give you a second if you want to respond to that.
It's something I, as you can tell, I've struck with and how we get somebody out of school
when competent in the field.
Yeah, I think there's a, again, it's a bit off topic, but that's okay.
(29:39):
That's good.
It's healthy.
I think that, you know, programs struggle a bit with the desire to have a 100% pass
rate.
We want everybody to pass and everybody to be successful.
But I think we've all seen that one or two people in our careers that you wonder, is
(29:59):
this person really got what it takes to be a competent, long-practicing EMS practitioner?
And I think those are the people we kind of worry about and struggle with and does a simple,
you know, exam, a simple practical skills exam at the end of a course to find whether
(30:21):
or not somebody's competent.
And I think there's a difference between practice competence and emotional competence.
And I worry that some people now, when I see students that, you know, walk into the classroom
for their first time, and I'm in my basic, my first ever basic EMT class, and one of
the first things we have to teach them is how to interact with the human being.
(30:42):
Because they're so used to interacting with their phones or technology, sometimes we have
to teach them, all right, we're going to practice looking somebody straight in the eye or shaking
their hand or introducing yourself.
And some people have a hard time with that.
So I think there are multiple levels of competence and proving continuing competence is going
to be a difficult thing.
(31:03):
Not that it's not worthy, it certainly is.
And I think that's where the profession needs to go.
But I think there are a lot of moving parts and there's a lot of factors that we have
to consider before we're ready to make that jump.
Well, you saw my go slightly off topic and you raised me one.
I'm very impressed, bringing in the emotional components and the other things.
(31:26):
I think that we certainly have room to grow in that and make ourselves better.
So this brings us to number seven.
And this is another potential hot-pot topic when you bring up college, but you're throwing
a gauntlet down here and saying, number seven, I envision a CE system of the future where
(31:50):
you gain accredited college level credits for completing required learning.
Imagine gaining the degree everyone thinks you should have by doing your CE hours.
Yee-haw.
Tell us about it.
Yee-haw.
You know, that is my pie in the sky dream.
And I've kind of told myself before, I think I'm ready to retire, which I hope is years
(32:15):
off.
But before I'm ready to go, I want to see movement towards a process by which taking
my continuing education credits gains me college credits.
And everybody thinks I should have a bachelor's degree.
Well, you know, I'd love to have one if I could afford one if I had the time to do it,
which I think are primary constraints for EMS practitioners these days.
(32:38):
But wouldn't it be nice if, you know, our required continuing education programs were
centered around a college curriculum?
And if I complete that guided curriculum that we talked about back, I think it was point
number four, continuous learning.
And if we guided the continuous learning well enough and some of the accredited providers
were community colleges, we could then potentially design a curriculum by which if I complete
(33:05):
my continuing education hours, and it wouldn't all be medical, some of it might be finance,
some of it might be education, some of it might be economics, but I think all those
things are okay.
And the more we learn, the more we learn how to learn, right?
So if we had a program that my continuing education hours were part of a broader curriculum
(33:28):
and completion of hours over a predefined period of time got me enough college credits
that I could gain an associate's degree or I could work towards a bachelor's degree.
And I know that's pie in the sky and there's a lot of work to do to get to that point.
And there's some people right now that are shaking their heads, Jay is crazy, that's
never going to happen.
Is it really that far fetched?
(33:48):
And do you think we're that far off?
Or do you think we could put together a curriculum that would get people to point where continuing
education gains them college level credits?
For every person that says that'll never happen or my city is crazy, you know, as a
bonus, I'd never get college credit.
There's going to be one or two people listening to this saying, wow, we need to make that
(34:11):
happen.
You know, that we have the ability to get word out and do things like that.
Not only if you do, I mean, if you think about things that are required and things that we
do, you had mentioned, you know, finance, what about supervision?
What about lifespan development?
What about infectious disease and, you know, getting more into microbes and things that
(34:35):
what if we gave it to me, you know, there's a lot of people out there not going to mention
any names or organizations that are saying, you know, we're not ready for a degree yet
and EMS.
But what if we made it easier and easier to do that?
I think my answer to your question is, is that for every person or a couple of people
(34:56):
that say, yeah, yeah, yeah, there's going to be somebody listens to this and say, how
do we make that happen?
And I think that's how that's how progress happens.
If nobody dreams, if nobody stretches, we don't we don't get to that point.
And I think if I think it says that everything else we talked about earlier today, see can
be valid.
(35:17):
It can be, you know, good learning, it can be things that can make you thrive in EMS.
So why not take it to the point where we can make it part of an accredited program?
Exactly.
I'm in.
Yeah, I'm in.
I'm in.
And I think that, you know, one of the drawbacks and one of the things that people, you know,
(35:38):
one of the reasons why we have to work so much and I've got to work a second job and
I do oodles of overtime and I work a, you know, a 4896 shift, but in the middle of my
48 hours off, I grab another 24 hour shift, you're not recovering.
You can't.
There's no way you're rested enough for your next 48 hour shift.
You just can't be.
You can't you can't convince me that it's possible.
(36:02):
And part of the problem is we we're not supported.
I'm going to get myself in trouble here.
We're not supported financially enough as a profession to have the point, to have the
ability to just work regular hours and not have to work overtime to make ends meet.
Wouldn't it be nice if this program, if we could design a program that gets us college
(36:23):
credit and suddenly everybody in the professional or working towards a degree plan, wouldn't
that raise the bar?
Wouldn't that raise the pay scale?
It would have to.
And if we did that and people were drawn towards the profession more, there'd be more people
available to do care.
And I think there'd be greater respect amongst the rest of the medical community.
(36:43):
I think it's a step that we have to explore.
I think that any profession that feeds and waters itself, that takes care of itself and
tries to move forward, gets more respect.
Now you can go out to social media and people say, well, degrees don't earn money and degrees
don't do this.
I've been an advocate for them that the rounding that it gives, the fact that other health care
(37:10):
professions who have all gotten farther ahead have all been degree based.
But I do totally also agree with you in that we will get more respect simply for the fact
that we are, and the way I seem to describe it, as feeding and watering ourselves to make
ourselves grow and be better.
(37:32):
Yeah, I think that's a great way to put it.
And the greater investment we can make on our personnel, the better the profession is
going to be.
And unfortunately, I don't think we collectively, as a system across the country and across
the world, honestly, have the wherewithal to support the EMS practitioners to the extent
(37:52):
that they deserve and expect and want and need to support their own families and their
own lifestyles.
And I think that we need to do more to take care of them.
And if we can raise the bar, if we can get them something for the training that they
do, and here you got to do CE, it's mandated, right?
Or you've got to prove that you're competent and it's mandated.
(38:14):
But what if that mandated training got us something for it?
Wouldn't that be better?
I think it has to be.
So I like your thought about feeding and watering.
I think it's a perfect analogy.
I do these and every time I get to talk with someone interesting like you, the conversations
(38:35):
go in fascinating directions.
And we've gone through our seven things.
We say that we don't do a lot of other stuff or relatively talk about the weather and calls
and stuff.
I think that this was just a fascinating finish to this.
I'm very grateful.
Now, how I end all of these, and I sometimes put people in the spot a little bit, I ask
(38:59):
all my guests for a parting shot.
We have primacy and recency.
What do we hear first that we remember?
And what do we hear last?
What would your thing that you would say about anything we talked about today, anything from
your experience or vision as the Executive Director of Capsi, what's your parting shot?
(39:20):
What's the last thing you want people to hear in their headphones before we end this episode?
I think the thing that I believe the most and would be that there is no more rewarding
profession in the world than emergency medical services.
And I've been doing this for a long, long time and I continue to do it and I continue
(39:41):
to teach because I love it, because I think that the people that I work with are worth
it.
And that smile that you put on the face when you walk into a house and you find a truly
unstable person that's diaphoretic and cyanotic and really sick.
And by the time you get the patient to the hospital and the family sees them again for
the first time after you transport them and the patient is now sitting up and their skin
(40:04):
is dry and the colors come back and they're smiling and they're laughing and they feel
better.
That impression that you've made on the family members and on the patient and on the staff
of the hospital is worth more than anything else I could ever get.
So again, I think this is a very noble profession.
(40:25):
I think it's very rewarding and even though some of the things that happen are pretty
bad and we like to forget them and there are a lot of things that I wish I could forget
that I can't and that I never will, but I think there still is no more rewarding profession
in the world and I'm going to continue to devote my time and energies to making it better
for the EMS practitioner.
(40:46):
I think that for this hour of continuing education, I hope what people get from this
is that Capsi is a player.
It's not a repository that you've got a really nice vision and that you're part of a group
(41:08):
of national agencies that are looking to move EMS forward.
I really enjoyed the conversation.
I think some of the vision you have is really outstanding and I hope that we're able to
share that for a lot of people and challenge them to rise to the vision that you talked
about.
Well, thank you, Dan.
(41:29):
This is a lot of fun.
I really enjoyed this and this has been a great conversation and I hope you get a chance
to talk again about something else.
I just like the conversations that everybody goes out for a drink or dinner after the EMS
conference and we can solve the problems of the world out there.
We had a little bit of that in here today and Jay Scott, Executive Director of Capsi,
(41:52):
I have to say that you've given me some hope and vision for something that a lot of people
thought was kind of static and I look forward to hearing more and seeing more of what you
all do there at Capsi.
All right, Dan.
Thank you very much.
Welcome to the Seven Things EMS Podcast, a continuing education offering of limer education.
(00:12):
Seven Things EMS Podcast is designed to give you what you need to succeed in EMS, it's
conversational, informational, and without the fluff.
Our Seven Things podcast now brings us a special guest, Jay Scott, the executive director of
(00:37):
Capsi.
A lot of people know Capsi by the continuing education and getting their state or their
national registry recertification done, but today we're going to take a little bit of
a deeper dive in this.
We're going to talk a little bit about CE and the man behind the CE.
I'm Dan Limmer from Limmer Education, we're just incredibly fortunate to be here today
(01:01):
with Jay Scott.
Jay Scott is, like I said, executive director of Capsi formally.
CISP means a board member there and the most common face that we know with that, but comes
from an EMS background, including even New York State or on Syracuse.
So we're not that far from our old stomping grounds and welcome Jay.
(01:21):
Dan, thank you for having me so much.
I'm honored to be here tonight.
Great to have you.
I think our motto is to get right into the Seven Things.
What I like about your Seven Things Jay is that you have a great cadence here.
Talk a little bit about CE and also I like the fact you talk about some of the vision
for CE.
I think people would like to know some of those things.
(01:42):
Let's just get started.
Number one, don't be fooled by CE that lets you skip the content and go right to the tests.
You're not really getting anything for your investment of money or time.
Jay, I got to tell you, there's people that love to complain that their CE has got no content
and it's boring and they love to complain that it's too hard and too much work.
(02:03):
Tell me about that.
Tell me what you would envision CE to be not going directly to the test.
Well, I think that there are some really, really good online and face-to-face continuing
education programs that are out there, but specifically the online stuff where I do a
self-study program.
If I pay a subscription fee and I log in and I have the opportunity to go directly to the
(02:28):
test and skip the educational component, I'm really not helping myself much.
I think that people that provide educational content in an online format spend an awful
lot of time and money developing their content and most of it is excellence.
I've never understood why somebody that spends that much time and investment in providing
(02:50):
an educational activity would allow the user to skip that activity and go directly to the
post-test and get a certificate, never having interacted with the activity at all.
Like I said, it is a little bit of a love-hate thing.
It's interesting that you said that there's a lot of quality CE out there.
(03:14):
I think people get in, they take their initial class, they get out there.
I think we go through phases.
I think we go out thinking, we know everything.
Sometimes we get shocked into learning what we don't know.
Then we hit the long haul.
I think the people that survive in EMS, the people that go out and do really good care
are the ones that take learning seriously, that understand that you don't know everything
(03:39):
and that's always important to do more.
I agree and I think the technology is at a point now that allows us to a lot of very
creative things with continuing education that the start of it was go online, read an
article, take a test and that was long before we had any real technological advances on
the internet and honestly, reading an article and taking a test is pretty boring stuff.
(04:05):
That in and itself, the market is kind of phased out.
People don't gravitate towards that kind of continuing education.
They want the interactive stuff.
They like the video-based case studies and they like to be able to do something with
the content, not just listen to the same old thing they've heard a dozen times, the same
(04:26):
old blood-borne pathogens lecture and they don't certainly don't want to just read something
and then have to take a quiz.
Those kinds of things you can tell are just not popular.
Well, I think EMS people are action-oriented.
They're people-people.
We don't always, I don't want to put everybody in pain.
I'm in a broad stroke.
I always have the longest attention spans.
(04:47):
I know I can speak for myself in that and we are a little driven by excitement.
I think it's pretty normal that people really do want to have CE that is engaging.
I think we're trying to get above that lowest common denominator of training like the articles.
(05:08):
It's really come a long way.
And the different levels of CE that we have from in-person to distributed to built to
the new technology categories, CE I think has progressed.
And actually we have a section a little bit on technology a little bit later.
But it's exciting stuff.
(05:30):
And I think COVID has really put us in a spot where we recognize that there's not only an
ability to offer good stuff online, sometimes we have a need.
Yeah, and it has to be portable as well.
I mean, I have to be able to do my CE while I'm on a shift.
I know a lot of people that work a full-time job, you know, four, 12-hour days on and on
(05:51):
their four days off, they tend to work a second job just to make ends meet.
And asking that person to stay after for a lecture or, you know, attend a mandatory training
session sometimes is just very difficult because they don't have the time and they'd
like to spend it with their family.
So if we can do training in some kind of portable format that's driven by technology that they
(06:15):
can do while they work on their shift, I think that is more attractive to people than spending
time in their off time having to go through their mandated CE hours.
We certainly are a mobile society.
We go out and about in the number of people with pods and different things in their ears
(06:36):
and listening to things certainly is the norm.
Well, if we were to take this, I think we, and this is what I'd like to bet your seven
things is we can just roll from one into the other.
Is number two is that CE is necessary.
I look at this as kind of a, you're going to give us a little bit of a big picture vision,
(06:57):
but you know, why does the executive director of CE's beams, you know, it's not your job
saying this.
It's not job security.
You're doing this because you believe it.
Why is CE necessary?
CE is necessary because EMS is the most rapidly evolving profession in the world.
It changes and morphs daily.
(07:17):
Practice standards change.
Equipment changes.
Our abilities to perform certain tasks in the field change.
Our abilities to analyze and assess and diagnose people change.
For example, the advent of ultrasound as an EMS skill is something that where the technology
is driven the profession to a certain point.
(07:40):
In order for us to keep up with the changes, we really need to do continuing education.
It's just necessary.
It's part of the job and it's part of the realm that we happen to work in.
If you, this, I told you I was going to throw a couple of questions at you as we go here.
What would the director of Capsi doing CE to maintain your license, what's your favorite
(08:06):
topic?
If you could list, oh, look, there's a whole big list of connet things on your screen and
your provider.
What would you love to listen to or watch?
I just did my favorite lecture last night for a paramedic original program.
I did a NASA base balance lecture.
A lot of people think I'm crazy that how could you enjoy acid-based balance?
(08:27):
Honestly, it's my favorite topic.
But if you present anything in a case-based format, for example, if you happen to have
access to a simulation lab or a virtual patient or a compilation of video-based cases where
you can group things together like simple, non-complicated chest pain, and the second
(08:48):
case is a little more severe with a STEMI.
The third case is a full-blown cardiogenic shock and clumping those things together and
starting with, here's what we're going to tell you, here's the signs and symptoms you're
going to look for.
Then you do a case either in a simulated environment or in a video-based environment.
Then you move it up.
(09:09):
All right, so the next case is this.
These are the treatment things we're going to add to that patient.
The next one is even more severe.
Here are the things that patient needs.
Clumping cases together in a group that makes sense, that provides for a non-stressful learning
environment.
I think those are my favorite things.
(09:30):
My favorite topic is acid-based.
My favorite environment is being able to do case-based learning around a series of patient
scenarios.
All right, I'm not worthy because of that acid-based thing.
It's my least favorite, so I am very impressed with that.
It took me by surprise as probably most people listening to this.
(09:55):
I was recently at a presentation the National Registry did at an educator conference.
One of the things that they say that they're looking to test more as they work towards
phasing out psychomotor exams is judgment and thinking.
I think that that continues into what you're saying is that when you can learn to apply
and have some challenging cases and things that aren't the basics, that I think we benefit
(10:22):
from that and we grow, that CE can really help us grow.
I agree.
All right, that takes us, this is flying.
I mean, we're going through this really well.
CE, this is number three.
CE should not be a rehash of what you already know.
It should be about 60 to 70% new content.
(10:44):
I think that there's a lot of people, EMS came from a background of refresher classes.
I'm doing air quotes here where you got taught the same old thing again.
That's a lot of what we did.
Combining that with your prior statement about how things in EMS are changing certainly
does leave just wide open opportunities for really valuable CE.
(11:12):
Yeah.
I think that in a perfect world, we've all seen patients that we didn't quite understand.
I think there isn't any EMS practitioner in the world that says they can look at every
single patient and know exactly what's going on.
I've certainly seen patients in the last 40 years that I've looked at and said, I'm
(11:35):
really not sure what's happening to this person.
You get into the ER and you say, doc, what is this?
The doctor goes, I don't know.
We're going to have to do some tests.
I would really like it if the continuing education program were adaptive enough that if I saw
a specific thing that I didn't understand, if I could go back and study that thing, if
it was something new, for example, what if I had never ever encountered a patient that
(12:01):
suffered both COPD and CHF that now has difficulty breathing?
I have to discern the two.
Which is it tonight?
Is it the COPD or the CHF?
What kind of assessment things do I need to know?
What are the clues?
What's the right treatment path for me to go down?
You could certainly do things for one or the other.
It would be harmful if I misdiagnosed.
(12:24):
I think I would like to learn about new things.
If I treat my first LVAD patient and I've never been exposed to an actual LVAD patient,
and I go see them and I'm really not sure what's going on.
I'm flying by the seat of my pants.
That's a very, very uncomfortable feeling.
We've all been there.
We've all had that patient that makes us pretty unnerved and gets to the hospital and there's
(12:48):
a sense of relief and the staff at the hospital takes over.
I'd like if we could go back and study the things that maybe surprised us or go through
the things that we're not quite certain on.
Or say I haven't ever done a needle-crike in my career and I have, but if I'm that person
(13:10):
that's never done it, shouldn't I spend time practicing up or learning about those things
that I'm going to really need to know sometime and it might be one time in my career.
When I use it, I really, really need to know it and I need to do it well.
So I think the continuing education program shouldn't be about what we already know.
It ought to be about those things that we want to really brush up on or about patients
(13:34):
we're not quite certain on.
We want to learn more about.
We've been an EMS a similar amount of time and one thing that you said, I think really
rings true is that many people remember the ones that they didn't get more than the ones
they did get or save.
Right?
When we, when we knock it out of the park and know the right med together, choose the
(13:56):
right protocol is one thing.
But the ones where you have to ask the doc, you go back and have to check and do that
in education.
We'd call that a teachable moment.
But for a motivated, you know, field provider, when you look at a career, whether it be over
the years or decades, many times we learn the most from the ones we don't know.
(14:17):
And that should fuel our quest for continuing education.
Now, not everything comes with a set number of hours.
You can certainly research and do things on your own.
But getting CE, not being a rehash to watch and know, I think makes a lot of sense.
So let's roll into into number four.
(14:38):
And this is where I think really we get into some of the vision for CE.
And I like that.
I think people have an interest and I'm going to keep my license.
What am I going to do?
What's going to be in some of this might be in the future, but you say CE should be replaced
by continuous learning.
(15:00):
That strikes me as a pretty high level kind of statement.
I'd love to hear more about that.
Yeah, I think I'll kind of harken back to my days working for emergency medicine and
upstate medical university in Syracuse and, you know, having emergency medicine residents
come into the SIM lab and every week there was a specific topic.
And every week you were you had a brief primer about so the topic today is this might be
(15:23):
pulmonary embolism or some other topic.
And here's the sign of the symptoms.
Here's the things to look for.
And then that group goes into the SIM lab and they run that case.
And then when that case is done, everybody's got it.
You go back into the lecture area and we'll talk about the next thing, the next patient
that has the same thing, but is more complex, something that needs more treatment and more
(15:44):
labs and more analysis.
And then you learn about that and you go back into the SIM lab.
So I think that instead of just kind of rushing at the end of your research cycle and try
and get your CE done and doing as much as you can within kind of the framework, I think
it would be better if we replace that system with, I want to say curriculum, but pretty
(16:05):
much a curriculum that says here are the things over the course of the next year.
And here's the schedule and this is how we're going to lay it out.
And then this week we're going to talk about pulmonary embolism.
And next week we're going to talk about stroke or whatever.
But I think we can design a continuing education program that I think also could be custom
(16:29):
tailored to the extent that I do a lot of electronic run documentation and whichever
company I happen to use for that has a certain record of the types of calls that I've been
on.
And if I'm really good at STEMI care and I treated a lot of patients with chest pain
and I've done well and haven't had any complaints or issues about my care, that's great.
(16:53):
Do I really need to take the cardiac section of the curriculum or should I be able to skip
that and maybe replace it with something I haven't seen in a long time?
Maybe if I haven't delivered a baby in eight years now, maybe I should brush up on that.
So I think the continuous learning model with flexibility built into what I've done and
(17:15):
what I'm really good at, and this kind of leads a little bit into the continuing competency
argument instead of continuing education.
I think I would even call it continuous learning instead of continuous competency.
And the learning is a directed curriculum based on my call volume and things that I've
seen and things that I haven't seen.
Well, let's brush up on things that I haven't seen.
(17:39):
I think, excuse me, I'm going to roll into number five because you mentioned technology
and I think that's probably one of the biggest changes.
Like I said, you and I have got a similar amount of time in EMS and we weren't particularly
high tech.
And the things that are available out there, I had somebody call me and say, do you guys
(18:02):
have eye stats?
It's like no, but what we can do and how we can direct care, how we can take our care
and make it more seamless within hospital care.
And some of these things I think are fascinating in the technology.
But you say technological advances are making CE evolve.
(18:24):
You can now do case studies that cover new content and patient care areas we need to
improve.
I think we've covered a certain amount of that.
But I just think that technology is, I think, where everyone's going.
And I just want to see if we can throw anything more about that.
Yeah, I think, and I don't think we have any choice, Dan, what I think that we learned
(18:49):
that through COVID and the restrictions that the hospitals had to place on things like
going to the hospital to do some clinical time for the paramedic program.
Or we used to a long, long time ago, if we had somebody that wasn't particularly good
at intubation, we could get them into the OR and they could learn intubation with an
anesthesiologist and get some practice before they get back out in the field.
(19:13):
And so on.
And those days are kind of done.
They're not completely done, but boy, they're in trouble.
So I think we learned through COVID that we could design virtual cases and virtual formats
that if there were a specific type of case, it doesn't ever really replace actually touching
(19:34):
a patient.
But we could certainly learn about patient management for specific types of cases.
And even if you had a person who had a quality improvement issue that needed to brush up
on drug doses for asthma or anything, honestly, you could set up a series of cases within a
(19:55):
virtual environment that are custom tailored to the needs of the individual, to the EMS
practitioner.
So they could interact with that patient on a regular basis until they really felt confident
and could sail through that patient care scenario and then get them ready to get back out on
the street and touch actual people.
So I think technology has given us a great advantage.
(20:17):
And unfortunately, it's not quite developed enough where it's uniform.
It's not available to everybody yet.
And I'm looking forward to the day that it is.
Yeah, that certainly is.
Now, things have happened in your realm technologically.
I don't know how many years it is, but you've created a system where continuing education
(20:42):
providers can feed you information now electronically, and then you can transmit it to the national
registry electronically relatively quickly.
As you say, people are always in March looking to get their stuff done at the last minute.
But tell us about that.
And I don't want you to spill any big beans or if there is anything else going on.
(21:06):
How has that technology changed things for you guys?
Is there anything that you would envision next?
Yes, yes, yes.
Yes, your question.
Yes, I like it.
So yeah, we, the board of directors of CAHPSI talking with the board of directors of the
national registry devised a plan by which we could share data.
(21:33):
And for those people that were nationally registered, if their records exist in our
database on the courses they've completed within their own continuing education program,
that we could build a pretty simple data sharing API that the individual would manage and monitor.
And simply they would go into the national registry and there's a button within the transcripts
(21:56):
part of the registry page.
And they hit the, and in that section, there's a button that says import CAHPSI records.
And they hit that button and anything that they have within the CAHPSI database that
they've completed moves into the recertification file within the national registry.
And it's dramatically changed the ability of the individual to process recertification.
(22:20):
I don't have to create things manually anymore.
And I think the last time I had to recertify and I created things manually for my own recertification
of the national registry, it took me more than 24 hours.
I mean, it was a significant amount of time to put all those things in.
And I said, there really just has to be a better way.
And so talking with the national registry, we said, there is a better way.
(22:41):
And let's just build it and let's make it free and available.
And it is, and it works and it's great.
And I've done it myself and we have people that call up all the time and say, what's
the best way to move my records to the registry?
We tell them, log in, hit that one button, tell us what happens.
And they go, oh, all my records are here.
This is awesome.
And so then the question is, really does, is that a benefit to the individual EMS practitioner?
(23:08):
And the answer is very clearly yes.
And can we expand it?
Can we make it more beneficial to other people?
If people that are state licensed only and say, I work in Massachusetts and I'm not nationally
registered, but I've got a state license, could I use that same system or a similar system
to move my records either to the registry or the state office that I work under?
(23:30):
And the answer is yes, we can build a similar means of doing that.
And would that help the individual?
Yes.
Is that something Capsu wants to do or be willing to do?
And the answer to that question is yes.
And we're working on it right now.
We're working on agreements with several states to allow us to transmit records to the state
office from our database.
And the best, the most important part of that is there's no cost to the individual
(23:55):
practitioner.
We're just going to do it.
Wow.
That's really a great service for people.
People often lose track of the vision, the things that people actually do for them behind
the scene while they're counting their hours and doing all these things.
That's really great stuff going on.
(24:17):
Now we talked about continuing competency.
Now number six says continuing competency and con-ed are two different things.
And that's something I think we also, in this really great conversation, talked about.
Is there anything different that would happen with Capsu as regard to that?
(24:38):
Or are you saying that we want people to maintain continuing competency and that's a subset
of con-ed or con-ed is a subset of that?
Or what are we saying with number six?
Yeah.
So I think there's a line to be drawn between the two.
And being able to show that I'm competent in all things, that I'm a competent practitioner,
(25:01):
that my medical director and the stadium office that I worked under or the national registry
views me as a competent individual and I'm capable of providing care in all care situations.
And the question really is how do we prove that?
What set of things do we go through?
Is that skill-based?
Is it educational-based?
(25:23):
Are there things that I do from a practice standpoint and caring for people in the field
that prove that I'm competent?
And the answer is it's a combination of all the above.
And so the ability to complete case studies and case-based scenarios built around a certain
(25:46):
patient complaint and using that to show that I'm a competent paramedic or competent EMT
I think is a very, very valuable thing.
But there's still, there's got to be a certain level of flexibility within the state that
says I really want my people to know the following things.
For example, I lived in New York.
We have a very, very extensive hypothermia protocol and everybody was very well versed
(26:09):
in how to treat people with frozen limbs that were still alive and not yet in vitricular
fibrillation and I moved to Texas and there's no hypothermia protocol here in Texas, not
to that extent.
So based on the region that you're in and based on the local processes that are happening,
like the advent of bath salts that hit back a few years ago, it would take a while for
(26:34):
the continuing competency process to catch up with that, to develop enough cases that
we could spread in a wide enough format that enough people could take part in it where
a continuing education program and putting together a lecture or a built program or a
podcast, certainly we can do that much quicker.
And if we need to reach the masses on something that's happened that requires acute attention
(26:58):
like COVID, we needed to ramp up very, very quickly and I think the continuing education
model is more agile than the continuing competency model might be.
And I could be proven wrong and if Mark Terry is listening, Mark, I apologize and please
prove me wrong, right?
But I think that there are certain levels of things that we can put out through a specific
(27:23):
continuing education model that we're using now that maybe the continuing competency model
won't quite be agile enough.
And certainly at this phase, it's still in the phase of we're trying to conceive of what
it's going to look like and what all the parameters are going to be.
So we're not quite there yet, but I think at some level the two have to be separate.
(27:43):
Well, you know, I think that as in my role as an educator of initial courses where I
teach at Calvist and College again here in Texas and then my CE hat, you know, for a
limer education, what I've found over time is that I think in mature, I think that EMS
(28:04):
is still growing and is still getting maturity and figuring out who is responsible for what.
You know, people that are looking for EMTs and medics now, which is everyone, want someone
to come out street ready.
You know, I put out entry level people.
I think there's responsibility for employers and agencies and volunteer agencies to help
(28:28):
get their people up to the point where they're competent and confident on the street.
And then there's maintaining it.
And I think that process is something that as a profession, we certainly haven't gotten
together on it.
And I think we struggle with getting somebody out of medics school in your department that's
paid someone to be there and say, okay, you're a crew leader on Saturday that we struggle.
(28:53):
I'm going right through that competency and quite frankly, confidence is an issue.
I don't mean to get into much of a soapbox here, but I see what you're saying in that
continue education is something, but maintaining competent providers, even if you defined it
simply as the ones you would want to come to your house, that we do struggle with that
(29:18):
as a profession.
I think it's really interesting.
I'll give you one second.
I'll give you a second if you want to respond to that.
It's something I, as you can tell, I've struck with and how we get somebody out of school
when competent in the field.
Yeah, I think there's a, again, it's a bit off topic, but that's okay.
(29:39):
That's good.
It's healthy.
I think that, you know, programs struggle a bit with the desire to have a 100% pass
rate.
We want everybody to pass and everybody to be successful.
But I think we've all seen that one or two people in our careers that you wonder, is
(29:59):
this person really got what it takes to be a competent, long-practicing EMS practitioner?
And I think those are the people we kind of worry about and struggle with and does a simple,
you know, exam, a simple practical skills exam at the end of a course to find whether
(30:21):
or not somebody's competent.
And I think there's a difference between practice competence and emotional competence.
And I worry that some people now, when I see students that, you know, walk into the classroom
for their first time, and I'm in my basic, my first ever basic EMT class, and one of
the first things we have to teach them is how to interact with the human being.
(30:42):
Because they're so used to interacting with their phones or technology, sometimes we have
to teach them, all right, we're going to practice looking somebody straight in the eye or shaking
their hand or introducing yourself.
And some people have a hard time with that.
So I think there are multiple levels of competence and proving continuing competence is going
to be a difficult thing.
(31:03):
Not that it's not worthy, it certainly is.
And I think that's where the profession needs to go.
But I think there are a lot of moving parts and there's a lot of factors that we have
to consider before we're ready to make that jump.
Well, you saw my go slightly off topic and you raised me one.
I'm very impressed, bringing in the emotional components and the other things.
(31:26):
I think that we certainly have room to grow in that and make ourselves better.
So this brings us to number seven.
And this is another potential hot-pot topic when you bring up college, but you're throwing
a gauntlet down here and saying, number seven, I envision a CE system of the future where
(31:50):
you gain accredited college level credits for completing required learning.
Imagine gaining the degree everyone thinks you should have by doing your CE hours.
Yee-haw.
Tell us about it.
Yee-haw.
You know, that is my pie in the sky dream.
And I've kind of told myself before, I think I'm ready to retire, which I hope is years
(32:15):
off.
But before I'm ready to go, I want to see movement towards a process by which taking
my continuing education credits gains me college credits.
And everybody thinks I should have a bachelor's degree.
Well, you know, I'd love to have one if I could afford one if I had the time to do it,
which I think are primary constraints for EMS practitioners these days.
(32:38):
But wouldn't it be nice if, you know, our required continuing education programs were
centered around a college curriculum?
And if I complete that guided curriculum that we talked about back, I think it was point
number four, continuous learning.
And if we guided the continuous learning well enough and some of the accredited providers
were community colleges, we could then potentially design a curriculum by which if I complete
(33:05):
my continuing education hours, and it wouldn't all be medical, some of it might be finance,
some of it might be education, some of it might be economics, but I think all those
things are okay.
And the more we learn, the more we learn how to learn, right?
So if we had a program that my continuing education hours were part of a broader curriculum
(33:28):
and completion of hours over a predefined period of time got me enough college credits
that I could gain an associate's degree or I could work towards a bachelor's degree.
And I know that's pie in the sky and there's a lot of work to do to get to that point.
And there's some people right now that are shaking their heads, Jay is crazy, that's
never going to happen.
Is it really that far fetched?
(33:48):
And do you think we're that far off?
Or do you think we could put together a curriculum that would get people to point where continuing
education gains them college level credits?
For every person that says that'll never happen or my city is crazy, you know, as a
bonus, I'd never get college credit.
There's going to be one or two people listening to this saying, wow, we need to make that
(34:11):
happen.
You know, that we have the ability to get word out and do things like that.
Not only if you do, I mean, if you think about things that are required and things that we
do, you had mentioned, you know, finance, what about supervision?
What about lifespan development?
What about infectious disease and, you know, getting more into microbes and things that
(34:35):
what if we gave it to me, you know, there's a lot of people out there not going to mention
any names or organizations that are saying, you know, we're not ready for a degree yet
and EMS.
But what if we made it easier and easier to do that?
I think my answer to your question is, is that for every person or a couple of people
(34:56):
that say, yeah, yeah, yeah, there's going to be somebody listens to this and say, how
do we make that happen?
And I think that's how that's how progress happens.
If nobody dreams, if nobody stretches, we don't we don't get to that point.
And I think if I think it says that everything else we talked about earlier today, see can
be valid.
(35:17):
It can be, you know, good learning, it can be things that can make you thrive in EMS.
So why not take it to the point where we can make it part of an accredited program?
Exactly.
I'm in.
Yeah, I'm in.
I'm in.
And I think that, you know, one of the drawbacks and one of the things that people, you know,
(35:38):
one of the reasons why we have to work so much and I've got to work a second job and
I do oodles of overtime and I work a, you know, a 4896 shift, but in the middle of my
48 hours off, I grab another 24 hour shift, you're not recovering.
You can't.
There's no way you're rested enough for your next 48 hour shift.
You just can't be.
You can't you can't convince me that it's possible.
(36:02):
And part of the problem is we we're not supported.
I'm going to get myself in trouble here.
We're not supported financially enough as a profession to have the point, to have the
ability to just work regular hours and not have to work overtime to make ends meet.
Wouldn't it be nice if this program, if we could design a program that gets us college
(36:23):
credit and suddenly everybody in the professional or working towards a degree plan, wouldn't
that raise the bar?
Wouldn't that raise the pay scale?
It would have to.
And if we did that and people were drawn towards the profession more, there'd be more people
available to do care.
And I think there'd be greater respect amongst the rest of the medical community.
(36:43):
I think it's a step that we have to explore.
I think that any profession that feeds and waters itself, that takes care of itself and
tries to move forward, gets more respect.
Now you can go out to social media and people say, well, degrees don't earn money and degrees
don't do this.
I've been an advocate for them that the rounding that it gives, the fact that other health care
(37:10):
professions who have all gotten farther ahead have all been degree based.
But I do totally also agree with you in that we will get more respect simply for the fact
that we are, and the way I seem to describe it, as feeding and watering ourselves to make
ourselves grow and be better.
(37:32):
Yeah, I think that's a great way to put it.
And the greater investment we can make on our personnel, the better the profession is
going to be.
And unfortunately, I don't think we collectively, as a system across the country and across
the world, honestly, have the wherewithal to support the EMS practitioners to the extent
(37:52):
that they deserve and expect and want and need to support their own families and their
own lifestyles.
And I think that we need to do more to take care of them.
And if we can raise the bar, if we can get them something for the training that they
do, and here you got to do CE, it's mandated, right?
Or you've got to prove that you're competent and it's mandated.
(38:14):
But what if that mandated training got us something for it?
Wouldn't that be better?
I think it has to be.
So I like your thought about feeding and watering.
I think it's a perfect analogy.
I do these and every time I get to talk with someone interesting like you, the conversations
(38:35):
go in fascinating directions.
And we've gone through our seven things.
We say that we don't do a lot of other stuff or relatively talk about the weather and calls
and stuff.
I think that this was just a fascinating finish to this.
I'm very grateful.
Now, how I end all of these, and I sometimes put people in the spot a little bit, I ask
(38:59):
all my guests for a parting shot.
We have primacy and recency.
What do we hear first that we remember?
And what do we hear last?
What would your thing that you would say about anything we talked about today, anything from
your experience or vision as the Executive Director of Capsi, what's your parting shot?
(39:20):
What's the last thing you want people to hear in their headphones before we end this episode?
I think the thing that I believe the most and would be that there is no more rewarding
profession in the world than emergency medical services.
And I've been doing this for a long, long time and I continue to do it and I continue
(39:41):
to teach because I love it, because I think that the people that I work with are worth
it.
And that smile that you put on the face when you walk into a house and you find a truly
unstable person that's diaphoretic and cyanotic and really sick.
And by the time you get the patient to the hospital and the family sees them again for
the first time after you transport them and the patient is now sitting up and their skin
(40:04):
is dry and the colors come back and they're smiling and they're laughing and they feel
better.
That impression that you've made on the family members and on the patient and on the staff
of the hospital is worth more than anything else I could ever get.
So again, I think this is a very noble profession.
(40:25):
I think it's very rewarding and even though some of the things that happen are pretty
bad and we like to forget them and there are a lot of things that I wish I could forget
that I can't and that I never will, but I think there still is no more rewarding profession
in the world and I'm going to continue to devote my time and energies to making it better
for the EMS practitioner.
(40:46):
I think that for this hour of continuing education, I hope what people get from this
is that Capsi is a player.
It's not a repository that you've got a really nice vision and that you're part of a group
(41:08):
of national agencies that are looking to move EMS forward.
I really enjoyed the conversation.
I think some of the vision you have is really outstanding and I hope that we're able to
share that for a lot of people and challenge them to rise to the vision that you talked
about.
Well, thank you, Dan.
(41:29):
This is a lot of fun.
I really enjoyed this and this has been a great conversation and I hope you get a chance
to talk again about something else.
I just like the conversations that everybody goes out for a drink or dinner after the EMS
conference and we can solve the problems of the world out there.
We had a little bit of that in here today and Jay Scott, Executive Director of Capsi,
(41:52):
I have to say that you've given me some hope and vision for something that a lot of people
thought was kind of static and I look forward to hearing more and seeing more of what you
all do there at Capsi.
All right, Dan.
Thank you very much.
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