October 23, 2023 • 47 mins
Much has been written about the flipped classroom. In this podcast, Dan talks with Chuck Allias from Penn State Fayette about his experiences and insights from implanting a flipped format. Chuck includes practical tips on teaching and testing and even finds a way to bring Ted Lasso into the conversation. Get CE for listening! 1 hour CAPCE-approved F3 CE. Purchase here https://lc-ready.com/store/details/103-7_things_flipping_the_classroom
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Episode Transcript
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(00:00):
Welcome to Seven Things EMS, a continuing education offering from LEMUR Education.
(00:12):
Seven Things EMS is designed to give you what you need to succeed in EMS, it's conversational,
informational and without the fluff.
(00:32):
Alright and welcome to another episode of Seven Things EMS.
We're taking an education topic today and I'm very happy to introduce Alkalias.
Chuck is the program director of Penn State program in Pennsylvania.
We're going to talk about education, the traditional versus flipped, some experiences Chuck has had
(00:55):
and I'm excited about that.
My name is Dan LEMUR, I'm your host as usual and Seven Things cuts through the fluff.
That's what we do so we're going to cut through the fluff and we're going to start with these Seven Things.
Chuck, welcome.
Thank you Dan for having me.
Your first point here in our Seven Things, I almost said to you, maybe we should move that to the end.
(01:19):
It's really powerful.
I decided to keep it where it was because I like it so much and I'm going to let you take it.
But your first one is resist comfort.
Tell me about it.
Sure.
I'd like to pull the quote from Mike Tomlin, the head coach of the Pittsburgh Steelers.
He starts off by saying seeking comfort is a natural human condition.
(01:42):
We all seek comfort, we all want to be comfortable with things.
He also states that if you realize if you want something special or you want special outcomes,
you have to be comfortable being uncomfortable.
He said that he's trained himself over the years as a coach to resist comfort.
I thought, well, that applies really to us in education,
(02:05):
especially whenever we're looking at results.
Being happy with less than 100% pass rates is seeking comfort.
Also stating that a certain type of student didn't pass, blaming it on the student, is seeking comfort.
I think we as educators need to embrace our opportunities and take on challenges that really scare us.
(02:31):
If we look at even Brene Brown's work in this, she has a similar approach,
this is not without risk or exposing vulnerability.
Anytime we step out of our comfort zone, when we resist that comfort, we're putting ourselves out there, aren't we?
We are.
If we go ahead and we do the things that we feel comfortable with in doing,
(02:56):
and let's go with the traditional lecture style teaching, we know that it's not effective.
We look at the studies that are out there and it shows it's not effective.
But by taking this risk into implementing a flipped or hybrid style classroom or whatever buzzword you want to use,
I think you're jumping outside your comfort zone.
(03:17):
You have to accept responsibilities for your failing.
I mean, me as the program director for the programs,
I have to accept responsibility for EMR up through paramedic as to those that are teaching the classes.
If I can't get my points across as an educator to the other educators,
then we're failing the educators and we're also failing those students.
(03:37):
Arthur, and I think the flipped classroom probably is at the top of the list of takes away people's comfort.
Both educators and students are really comfortable when the instructor gets up and hands the student by slides,
all they need to know, and the student likes it because they feel like they're being taught.
(03:57):
And I think this really introduction into this concept,
because that might be the ultimate risk or vulnerability or step an instructor can take.
And those of us have been doing national registry testing and looking at results.
If you lecture to the students, if you're just presenting what's already given to them in the book,
(04:20):
we're using the publisher slides, we're really not preparing them in the past that exam.
I mean, you have a bunch of great products out there.
I've used your products. I've used some other products.
And those products and those questions do not correlate to it's on this page of the book.
It's the sky is what color, those types of questions.
(04:40):
And that's what we're expecting of our students and our students are going to fail this exam.
Yeah, when I teach educators, I ask them what keeps them from changing your classroom.
And I have several stock choices.
Is it the university or the program director? Is it money? Is it time? Is it creativity or whatever?
(05:03):
But most of the time, it's the time and creativity that keeps people from stepping out
of the box and doing those things.
And I think that probably really fits in well with your statement about resisting comfort.
It really requires a mental step out of the box.
It does. And this allows us to teach everyone.
(05:26):
It's easy to teach the students that we know that our college bound students that have been successful
in the past that know how to study.
And we know there's a group of students in the middle that the way we teach, the way we pass information on to the students will help them.
What about the lower end students that maybe they are taking an EMT class and their next logical step is to become a paramedic?
(05:52):
Well, paramedic level education is a 300 or 400 level college level course.
It's just not easy to take an EMT class and then think that just because I pass an EMT class, I can pass a paramedic class.
Well, we also see even going the step in between, a EMT has had dismal pass rates nationally.
(06:13):
And I think to some extent, and we can't generalize every program, it's really poor preparation at the EMT level that makes people suffer when they move up.
It is.
And I like to look at it as somebody needs to jump into the fire.
I'm resisting comfort. I'm putting my pride at risk.
(06:34):
And I want others to follow.
So if this means that I have to be the leader in our area or help you lead a nation wide as to pushing us forward as educators, then I won't do so.
Well, let's go on.
And we're in subsequent points you have in your seven things.
Getting into some more details.
(06:56):
But one of the things you mentioned, I think is really important, including a lot of input is to implement scenarios.
So let's talk about that.
We'll blend with resisting comfort and we'll talk about scenarios.
And some of this stuff, Dan, the quotes I've taken, I mean, I'm a big, huge Steeler fan.
(07:17):
I'm a huge Ted Lasso fan.
So again, be curious and not judgmental was a quote from one of his scenes and everything.
And it truly hits home as to when we're doing things.
Why are we doing things a certain way or why is somebody learning a certain way?
And if we provide that judgment at first without asking questions, then I think we're failing the students and we're failing ourselves as educators.
(07:47):
Implementing scenarios that can be as simple as case study scenarios, discussions with the students,
and then moving it into full blown scenarios where we're doing hands on learning with with the students.
So we need to start with that at first.
And then whenever we were not curious, I mean, that clip from Ted Lasso, the darts, the owner was trying to hustle him and then he ended up getting
(08:11):
hustled because he didn't ask questions.
I mean, I'm sure we do that all the time.
And what we do is learners as educators.
We need to we need to take out that judgment and start asking more questions.
And sometimes as educators, we need to step back, listen to the students.
And we don't always have to say something to be able to educate them.
(08:33):
I think that it would seem like a lot of people have seen Ted Lasso.
But Ted Lasso and only as an entertaining show really is almost like a leadership masterclass.
You know, it really is something that I found fascinating on so many levels.
How do you think implementing scenarios has benefited your students?
Do you have any any quick insights or out of that?
(08:54):
What do your students get from that?
I think by implementing scenarios, you're allowing these students to be able to think critically.
It's a critical aspect of education and learning is what's going to make these students excel
at the EMR, EMT, AMT and paramedic level.
This we want them to learn now than the lecturing later part has to be put off to the side.
(09:20):
We can't be comfortable as an educator just by standing in front of the classroom,
clicking the PowerPoints and expecting those students to do well.
I'm going to steal this from David Page is if the practice like you're going to fight,
make these scenarios as realistic as possible.
If you're pushing medications, you need to have some sort of IV pad on their arm and not just having a fake arm,
(09:44):
the third arm that we see that's out there.
Or when we're innovating, putting the innovation head on a table, bolting it to the table at the perfect height.
That's not how we see things in the field.
And again, it's like getting these students to do the scenarios, to do the practice and actually do the treatments and not voice
treat. I think the more we voice treat or we allow our students to voice treat, the less successful they are.
(10:12):
Yeah, I think that I look at this.
Your first one was resist comfort.
Our second one implements scenarios.
I would almost say we're also saying resist tradition.
Absolutely.
We have to change.
I think that's great.
You were in a presentation I did this week where I talked about something I tried with my high school students and they came in with a bunch of sugary snacks.
(10:35):
It's a pop heart.
And I said, don't eat that.
Let's check your blood glucose first and then check it.
So we checked the blood glucose and again in 15 minutes and again in 15 minutes.
And then we got to predict.
We got to figure out what the variables would be.
Everybody checked blood glucose three times, about an hour, hour and 15 minutes.
(11:00):
But the thinking they got out of that, how they applied and the engagement, this engagement, that should be part of this as well.
It is.
The students, they're going to remember more by doing.
If we look at the Bloom's taxonomy in the past, we remember 10% of what's being talked to us about.
And we remember 90% of what we do and we can act it out.
(11:24):
And it's, it's that repetition.
It's building that muscle memory over time.
It's just not telling a student to do something once or saying it once.
It's what's going to build that lasting impulse or that lasting image in their synapses.
And I think that we look a lot at our endpoint as the national registry.
(11:48):
I believe that what you're talking about here will help students with the registry.
We talk about, you know, kind words about our products and the reputation and they're not specific.
And the registry isn't book specific.
I think that's beneficial when students apply and think that helps them with the registry.
But I would even go one step further and say, it's going to make them a better product.
(12:13):
We put out as educators.
Absolutely.
I mean, we get in the habit of the class has to be in a classroom.
Take the class outside, do your scenario outside, do it in a hallway, do it in a bathroom.
This is where you're going to be presented with your patients.
We also, we use a red card and yellow card concept, whether it's a flash card or whether it's on the back of a notebook that we hand out to the students.
(12:40):
A red card is a scenario, is a stoppage of the scenario if it's going to be harmful or someone's doing something that is wrong in a scenario.
We don't want to build that poor muscle memory.
A yellow is a pause in the scenario, a caution.
Whether I have a question, the other instructors have a question, as soon as the question will pause the scenario, ask the question to make sure that we're on the right track or make sure we're not going down the wrong pathway.
(13:04):
Those will also help with us as educators.
Wow, cool stuff.
Well, let's take, we often in these conversations, we sneak into other points inadvertently, but number three is teach and encourage students to think critically.
(13:24):
With this point in, it's, we're looking at evidence-based teaching, evidence-based practice.
These national registry style questions that the students are being tested on are critical thinking questions.
If you've taken the test, I've taken the test, I've looked at your products, I've looked at other people's products.
And those questions that are the harder questions for students, it's not a clear-cut answer.
(13:49):
It looks like it's in the gray.
And we tell these students, let's practice medicine in the gray area, but if we don't go ahead and prepare them to think into act accordingly, then how are they going to be successful in doing so?
And like we talked about before, PowerPoints were great to get things started, but I think how they've been used over time has been a crutch for the instructors.
(14:14):
Again, 10% of what we read, the students are going to remember.
90% of what is said and done is what's going to help them remember as we move forward.
We as instructors, whenever we're teaching students to think critically, we need to have a safe environment for them to learn.
This is something where they can feel comfortable with making mistakes in the classroom.
(14:36):
Make the mistakes, ask the questions, get them to practice this higher level of learning.
Allow this time to develop to foster critical thinking skills.
Promoting the dialogue, maybe as the instructor is more of the facilitator, we just ask a question to get the students to think a little bit more.
(14:56):
And then once we ask one question, we follow that up with another question instead of letting us talk, let the students talk, let them figure stuff out.
Sometimes we feel as educators that the silence is a horrible thing.
Sometimes it's good to have silence, let the students think, let them look something up.
(15:17):
They're asking us to give them the answers to be the gatekeepers of information that most of them have a smartphone, most of them have access to Wi-Fi.
And the internet, while we're doing something, says, go ahead and look up the question that you have.
Talk to each other, use the resources that's available here.
We also don't allow enough time for self-reflection after a scenario or a call.
(15:41):
What happened, what did you do, why did that happen?
That reflection should probably happen right after the scenario.
Let that reflection occur because if we're on a call, those less than our providers, we're going to talk with our partner directly after that call.
What went right, what went wrong, what could we do differently?
We're not going to do that 10, 15, 20 minutes after the call.
(16:01):
That's usually something we talk about as soon as we're done, transferring care at the hospital for the patient.
Yeah, some really good points here.
A couple of things come to mind.
We have another podcast we used.
We did an inquiry-based learning.
And starting your class by saying to the students, based on what you read, what do you want to know?
(16:29):
I tried that and I put all the questions on the board.
And then as we went through, I said, okay, we must solve it.
At the end, it's like, well, there's a couple of things.
They wondered, but I didn't know.
And the other thing, this is your thing, I don't want to take a lot of your time, is that I look at anaphylaxis as something that, when you can teach them to critically, it's so important.
(16:50):
We teach generally allergic reaction and anaphylaxis.
Right?
Most patients are confused.
And we're in the middle.
You know, we can have simple, we can have extreme, but I feel like I've got a lump in my throat.
I'm worried as well.
And students don't know what to do in that situation.
(17:10):
And there are guidelines out there that actually can help them in this decision making.
It is.
And I think what we give them, if we show them the evidence and the reasoning behind this
critical thinking and the support critical thinking, this will help them.
This will also help them think deeply and to make those relevant connections as you're talking about there.
(17:31):
That also then, as we just talked about, engages that reflective thinking.
All right, I did this or this is what happened in the scenario.
All right, what get asked the student, what are some two or three things that you did positive on the call?
What could you done differently on a call?
We don't have to tell them what they did wrong.
They're going to most likely know what they did wrong before we can even tell them what they did wrong.
(17:54):
Let them also seek better and new solutions.
Ask questions in clarity.
I mean, if we can provide the clarity for the students, then that's what we need to do.
Oh, I think that's outstanding.
I and as students get on in their class and get near the end, they can create scenarios.
They can put things together and things like that is just incredible.
(18:16):
So we are on number four and I love our conversation so far.
It's a great flow and great information you created.
Teach you and test progressively.
Testing is a big part of this.
Let's talk about it.
It is.
We need to make sure that when we're testing, we're testing and why are we testing,
(18:37):
but we also have to build them up before the testing.
So when we look at teaching and testing progressively, we need to start off with a formative.
We need to start building and doing the scaffolding for the students,
letting them understand we're learning for understanding.
Let's take away the need or for the risk for them to feel that they need to cheat.
(18:58):
Let's take that away and if we're going to give them interactive lectures or homework to do at home,
give them as many chances as they want to do that.
Give them the opportunities to do and research some things that it's going to be less
stressful for them, lower stakes so that again,
it don't create it at all or let them have the opportunities to redo that over and over again.
(19:22):
But whenever we need to put punishment down, we need to have zero tolerance for academic dishonesty
in EMS education.
There's so much that I've seen over the years where students aren't doing the right thing at times
and we need to hold them accountable for that.
We can't have those people in a profession that are going to make us look like we don't know what we're doing.
(19:44):
We want to raise this profession and to raise this profession, we have to be professionals ourselves.
I totally agree in that regard and I think we all have got stories in our teaching,
ultimately disappointment and seeing people otherwise we think very
strongly engaged in behavior that is dishonest.
(20:07):
I think that it is part of those educators are the affected domain and we have to create an atmosphere for that.
I'll also say one of the things you said that struck me that I like,
I'll have a different approach.
I'd like to give you a clarification a little bit more.
There are times in that staff approach that we give students an opportunity to succeed,
(20:29):
to learn from this, to be able to fix their work and go back and earn what they do.
I think ultimately not only are they getting a grade,
but they're getting an example of how to learn.
They're getting an opportunity to succeed.
In succeeding, we also need to encourage them that it's okay to do things wrong.
(20:51):
We're not going to do everything correctly.
So making a mistake, reading something and not understanding it or looking at a quiz question
or allowing that student to redo that quiz again, learning does take place whenever that happens.
We as the educator then need to provide timely feedback and also proper remediation.
(21:13):
But when we're looking at the summative and we're looking for confirmation of master of the knowledge,
whether that's at the end of a module exam,
that's when testing is occurring.
We're not doing remediation at that time.
We want to see what does the student know at that point in time
so that we can move on to the next lesson, the next module.
Joe Mistovich, a good friend and an occasional co-author in projects we work on,
(21:39):
said to me something that always stuck with me.
He said, if you test students superficially, they will learn superficially.
If you test them comprehensively, they will learn comprehensively.
Maybe a little bit of a shock in the beginning.
A test really do more than measure really does drive learning.
(22:01):
How does your scaffolding work and how do you get to that challenging test?
Well, I think we need to do in-flight course correction.
So we might plan a certain module, a certain project, a certain way,
and we need to gauge how are the students learning,
or they understanding the materials as we're moving forward.
It might be a stop, we'll continue with caution, we're going to correct, we're going to repeat.
(22:25):
It's just like the red card and yellow card concept we talked about a little while ago.
Give them positive reinforcement, let these students learn from their mistakes.
In a workshop I went to recently, there was a great concept that they said is,
don't give them any more than three corrective feedback suggestions at a time.
The students, the brain can't remember more than three.
(22:48):
If you give them four or five, they're going to remember the last three that we gave them.
So we, a lot of times we'll give them a laundry list of things that they did wrong.
Let's summarize that to two or three, give them the chance to make those corrections and to move on.
Interesting.
Well, let's go on to number five.
I think we're, like I said, we're going along at a good pace.
(23:09):
I'm loving this.
Teach through questions.
And I did talk a little bit about an inquiry based approach.
Tell us about that one.
Well, teaching through questions, I mean, we need EMS, we solve problems, right?
How often, again, that's rhetorical question, we solve questions to problems every day.
(23:32):
Nursing has used this over the years.
So again, we don't have to reinvent the wheel in what we're doing.
And when we're teaching through questions, we also need to have the students earning the right to be in class.
The big thing with the foot classroom and what people don't really understand with it is the pre-course work, the readings, the lectures,
we're now holding the student accountable for what they should be doing, whether it's giving them an assigned video to watch,
(23:59):
lectures to read, lectures to listen to.
And when we compare that to lecture style learning, that's low level recall.
And that goes back to point one, that false sense of comfort.
We should be prepared and prepare these students to be ready to function in the classroom just like they would whenever they are on the call.
(24:21):
And I've struggled with this over some times.
I'd have the students say, and I probably started flipping the classroom in 2016.
I know you and I had a talk shortly after I started doing it.
It was a little frustrating because the instructors were fighting it, the students were fighting it.
And then you hear students say, I'm teaching myself.
I never had a really good answer to give them.
(24:43):
I knew that wasn't what was happening.
And then I went to the NMC conference this August in Reno, and one of the presenters made the comment,
well, if you're teaching yourself and I can go on vacation and come back a week or month from now, and let's see how prepared you are and pass in the exam,
which is one good point.
And another good point, and another presenter made was, we're teaching you the students how to learn.
(25:08):
You're not teaching yourselves.
It's just a different way that we're teaching you how to learn.
I think the Reno conference this year was one of the better content-wise that I've seen in a long time.
Everybody really enjoyed that.
When I started doing this, I'm not risk averse at all.
(25:30):
I'll give anything a try.
And when I started doing this, I had scenario students were working in groups,
and I brought in medical, I had Harrison's, Tenton Alley, and all these resources and some papers printed out, some research.
And we got through and I said, okay, there'll be a test next Tuesday.
(25:53):
This is a Thursday, Tuesday, Thursday class.
And they raised their hand.
How can there be a test?
You didn't teach us anything.
I was like, no, no, you learned.
You know, that's what it's about.
And it does take a little bit.
And one of the things is, I think we can't let them see us sweat or doubt it.
Right?
We have to be sure that when we go in that we have a plan for this and that they're learning.
(26:19):
If they see us hesitant, they'll be even more hesitant.
They will.
And these students, they're going to be awkward.
They might feel embarrassed.
They might feel uncomfortable with doing these activities.
But we know that those that have flipped the classroom, those that have gone away from the lecture style learning,
we see how important and how much better the students are prepared in passing the class and passing the national registry exam.
(26:46):
The students will come across sometimes and say, you're wasting our time.
Because like you said, I think if they see us sweat or if the instructors aren't buying into that concept,
then that gives the students a reason to question what we're doing.
And can't we just go back to the other way?
I really, I really learned more from the lecture style learning.
(27:07):
And we know that's not the case.
These activities have to be multifactual.
We have to encourage the critical thinking as we talked about before.
And we must demand these students are be able to problem solve in the classroom and then taking care of our patients.
I think that there's a painful reality here.
You know, Chuck, for you as a program director.
(27:29):
Not everyone is going to be able to pull this off.
We may lose some educators as we go on in this.
And not just the older educators or stubborn educators.
I've seen people become almost profits in the flipped classroom, but I've seen others that have flat out refused.
I think that probably challenged you as a program director.
(27:53):
It is. I mean, in our area in Western Pennsylvania,
I don't see a lot of people willing to embrace this.
Even the classes that we we sponsor as the Ed Institute, they seem reluctant to change.
And I think it's part of it is they feel comfortable, comfortable with what they've done in the past.
(28:14):
But then when you ask them, or if we need to look at results, the results aren't where we need to be.
I mean, we want to have more providers out in the field.
If we can't get people to pass the exams, then we're not going to get more providers.
This idea that we as the educators are the gatekeepers of that information.
Why does a student have to say that Dan or Chuck is the only one that can tell me what I need to do to pass this exam?
(28:40):
We're not going to be there when they're taking care of a patient.
So we need to be able to to foster these providers, these clinicians to think critically so that when they're given a difficult situation
or difficult patient that doesn't follow the cookbook method here, that they can actually take care of the patient.
They understand why they're going to do a treatment for that patient.
(29:01):
I'm getting a little off topic here, but I've actually said several times that I don't know if someone really have just one paramedic instructor.
And they need influences from multiple people, the same person all the time.
Despite talent and passion and dedication, you basically become, if I taught the entire class, people say, well, I had a liver paramedic,
(29:23):
you know, or an alias paramedic.
I really want my students to have more when a lot of education wants people to have one source for consistency.
Those multiple sources that create how come this instructor said this and you said this, then you talk about it, then you learn and you develop a practice.
(29:46):
Absolutely. I mean, like you said before, too, these students are resistant to change.
If you have more than one person, now you have more people giving their expert opinion into what needs to be taught or what should be done.
And sometimes we don't always speak the same language.
So somebody has to, if you're the one running the class and you're the person in charge, then it's your job to talk to each instructor,
(30:14):
to bring them together and say, all right, these are the two concepts that maybe the miscommunication here.
This is really what we need to go in and allow the students to be able to realize what is correct or what maybe one instructor said a little bit differently than the other.
We need to stay the course with this.
Yeah, I think that's true. Let's go on because you've got one that's near and dear to my heart. Everything here has been good, but we're talking about depth and understanding.
(30:43):
I mean, as we go more and more towards advanced practice, all this stuff is really important to go out there and make decisions.
When we go to someone's home as an advanced practice paramedic, say, mobile integrated healthcare, we're making decisions, big decisions that affect patients.
That's all on us. I think that's really important.
(31:05):
And what is the basis for everything we do?
Year number six, pathophysiology must be taught at the cellular level.
We talked about the EMT level for this.
No, you took the words right out of my mouth, Dan. This has to start at the EMT level.
(31:26):
We hear directors of services, you don't need to, why are we teaching so in depth? You're teaching too much information.
The class doesn't need to be this long.
Well, we know that you have to understand pathophysiology at that cellular level.
And I wish I knew cellular physiology as well as Joe Misovic whenever he did that talk to you guys.
(31:48):
The seven minutes that you guys talked in the beginning was phenomenal, but it truly makes sense as to when we look at a patient, why is something happening?
When the students understand that, they truly will really understand what's going on.
So I want to throw this little bit of scenario out.
It's a little bit different than what Joe did, is you have a female patient presenting to you with generalized weakness and brain eucardic.
(32:13):
What's wrong with your patient?
And the students will say, well, there's not enough information. I need more information.
Based on that information, that patient's having a myocardial infarction, and we can prove it otherwise.
There are other differential diagnoses that we can go and say that this is what's wrong with the patient, but it's an MI because female patients present different than the male patients that are having a heart attack.
(32:40):
And having that heart rate of 50, now they have normal blood pressure, normal respirations.
So if we do a 12-week, we're going to make this to the paramedic level here.
We see ST segment elevations and leads one, I'm sorry, leads V1 and V2.
That's telling me that they're having a septal wall MI.
If we do this cookbook paramedic teaching to these students, brain eucardic patients are going to get atropine.
(33:04):
Well, if I give atropine to this patient, I'm going to kill this patient because I'm going to cause an increase in the heart rate.
I'm going to have that infarct increase in size because we know that atropine does not work above the, works above the AV junction.
And these impulses are having a problem getting through that AV junction.
The patient needs to go to the TATH lab.
(33:25):
So this patient would have atropine being contraindicated that infarct is happening in the septum.
We know that the LAD is our culprit vessel.
What do we know about that culprit vessel? It's a widowmaker.
Why is it the widowmaker?
It's because that's what causes people to have acute cardiac sudden death.
And it all depends on where that widowmaker lesion is.
If it's closer to our left coronary artery, then that person's likelihood of getting to the TATH lab and table and surviving is probably very low.
(33:53):
But if that has a distal occlusion, that gives them a greater chance of survivability.
And that's just one instance of how we can look at and understand cellular physiology and how we can teach the students to understand something that is a very in-depth concept, but can also save a patient's life.
(34:14):
We, you know, the basic path of physiology, even what you talk about, is recognizing the potential of cardiogenic shock and reduced cardiac output with the bradycardia.
Yes.
And how that comes together.
The other one that really comes to mind is that I think we're seeing, and I teach a lot at the EMT level, but certainly this applies at all levels, is if we're going to be using epnography and teaching about acidosis,
(34:46):
our students look at kusmal's breathing and don't recognize the role of acids and where that comes from, and that starts at the cell and it continues on from there.
And the more that we can bring an understanding, and that understanding is challenging.
It is.
(35:07):
It's difficult to teach, but I totally agree with you, which your experience with this EMT level or above anything as far as the path of physiology.
I think it's almost non-existent in the classes that I've seen over the years.
It's not a big emphasis.
I think the classes that there is more of an emphasis on those students tend to do better.
(35:31):
And the recording that you referenced with Joe Mstovich, we have a two-part pathophysiology and assessment podcast in this seven-thing series.
Joe is an amazing educator.
The way he teaches and makes things understandable.
The other thing about Joe is when he teaches, he teaches a lot.
So we had to break it into two parts.
We couldn't just do one session, but it's good listening.
(35:55):
And thank you for mentioning that as we go.
So the last part, and I think a very valuable part is the clinical judgment and decision making.
I think you're going to define that for us.
And then you've got some examples.
And I think the reason I like the order in these is I looked at your points on this one of our seven things.
(36:20):
I think it is valuable in itself and also gives us a choice to kind of wrap it up nicely.
It does.
This is something that National Registry is implementing at the AEMT level and the paramedic level July 1st of 2024.
The psychometric exam is going away and they're going to implement this testing.
And they're already implementing these questions as pilot questions for our students.
(36:43):
So we, as EMS professionals, are making decisions based on our level of knowledge.
And we're doing that through evidence theories and patterns of behavior.
And we're doing it at the pre-seen, the seen, and the post-seen areas.
In each of those areas, the students are going to have to recognize clues, analyze those clues, define the hypothesis,
(37:07):
generate solutions, take action, and evaluate.
It's a continuous loop.
And this is how we're going to ask questions.
We're National Registry going to ask questions for the students in each of those phases.
It might only be 13 or 15 questions. I know it's less than 20.
So if we don't prepare our students now for what to do and how to look at these areas here,
(37:28):
they're going to struggle with this part of the exam and they're going to fill that psychomotor portion of the exam
because we didn't prepare them as an educator.
Yeah, I think that I'm actually more excited than I am concerned about the new National Registry style questions.
(37:49):
Although I do think that the educators do have some catching up to do, I think, to prepare their students as well as they could.
The National Registry and the educators have been doing a series of courses about this.
They did one in Reno and then there are several scheduled around through 2024.
(38:10):
I think there's four or five around the country.
And I would encourage people to see those if there's one in their neighborhood.
And what we'll do is we'll link.
And there's an article in pre-hospital emergency care that explains this.
I think we'll leave that in our show notes for this.
(38:31):
But I think that as the registry phases out the psychomotor exam,
they're looking to put in things that you mentioned here, not only the scene,
seeing all the things that are done, but I think that we'll be able to test a student's sequence, predict.
(38:52):
Right? Is that how do you predict in a test if a student can identify someone who might crash later?
It turns out I think you can.
We definitely can.
I think we have to use the teaching methods that are available that we talked about earlier, scenarios, simulations, case studies, problem-based learning.
(39:13):
We as the educator need to ask the probing questions, how the students discuss, debate, and have discourse in the classroom.
Encourage them to explore it.
Don't just give the first answer that comes to mind. Ask them another question. Why?
And we as educators can't stop with the first question.
We need to follow up our question with another question, another question to get these students to think critically through this process here.
(39:40):
We also then have to allow these students to be able to deep breathe.
A good classroom is a noisy classroom.
Have the students think out loud.
I don't know what a student is thinking in their head unless I have them think out loud and tell me what are you thinking?
Why did you come up with this conclusion?
And we as educators need to be able to help them think and be able to think critically.
(40:04):
So asking those questions and think out loud.
And the case studies have them do it in two parts.
Clinical scenarios can be about a patient, a family member, or given situation that asks questions about that scenario.
The individual case can unfold.
We can get new data from what a student asks or from maybe what a partner may want to know.
(40:26):
And that can help us build upon that case study scenario leading into other decisions or other possible decision making and taking care of that patient.
It must be difficult as an educator.
I think I've felt it, perhaps you have as well, is that we want to be the one that presents the information.
It's different to put it out there and let the students do it.
(40:49):
And intuitively, I don't think anyone would say that it's not better.
It's better, but it's challenging for us to do that.
It is.
And we need to make sure that we're doing this, making these scenarios realistic.
Again, having these students have a higher level of thinking.
Have them focus on more than one problem.
Very the setting, like we talked about before, not only with taking the students outside or into a bathroom, maybe going through your local store, grocery store, hotel, and actually doing a scenario.
(41:20):
One of the educators at the Nancy conference said that they go to a hotel that's close to their university and they asked them before they clean the room.
Can we go ahead and run through students through a scenario in a hotel room?
Again, we're putting these students into a real life situation by allowing them to do these scenarios in those given situations.
Going into a used hotel room makes me think we need good PPE as well.
(41:45):
Absolutely.
Well, we have a bonus one here and we have a little bit of time.
So I want to put that in there.
Use cognitive retraining and I think this goes a little bit as a continuation of our teaching through questions.
Let's just take a couple of minutes as we wind down and just tell me about that.
(42:07):
Cognitive retraining.
When I first took over as a program director at my previous job, I had a group of students that were struggling in the past for an exam.
They've taken the class multiple times I was working with the students and looking at the questions answering questions.
And one of the students made a comment that I wouldn't do this in the field.
(42:30):
I'll do something differently.
And it was a light bulb clicking onto my head where I'm like, oh my gosh, the knowledge is there for these students.
They just don't understand how to answer the registry style question.
So we as educators need to teach them how to answer the registry style question.
You can do that many different ways.
I use the MS testing product.
(42:53):
There's a group testing aspect to it where we present a question in front of the classroom.
That's almost like Jeopardy style.
Each student logs in, they have their choices.
If it's not the multiple, multiple guests, they have an ABCD option.
We can do the same thing if we were bringing up your apps or other products that are out there.
(43:14):
And then we want to have the students break down the question.
I'll first start off and I'll read the question out loud and I'll look at the first sentence and say, I think this is what they're stating.
This is what I think is going on.
And then I'll have the students agree, disagree, and then we'll look at the next sentence.
Does that further enhance or negate what we looked at earlier?
(43:38):
We go through each of the sentences depending on how many sentences there are.
And then we look at the last sentence in the stem and that's going to tell us really what are they asking us in the question.
I want the students send a reread the question.
Come up with their answer and if that answer is in the choices, that's most likely the right answer.
(43:59):
But they also need to read through the other distractors.
Because the registry is great at telling us there is one right answer and there are three plausible answers.
The other ones are going to seem to be correct.
And if we don't know that information, they all look good.
They are all tasty distractors for these students.
And we need to show them sometimes in a question, why is this answer a good answer to choose, but it's a wrong answer.
(44:23):
And if we can point this out to the students, that will help them understand what to do better in taking that exam.
I'll close and saying I agree with everything you say.
I think that a lot of people say the national registry and the street are two different things.
But the truth is that when you get to start through information, some of it conflicting and you ultimately make decisions.
(44:50):
And that a national registry question does that.
It doesn't always give you the answer you want, but if you take and you interpret that information properly, you always have enough to make the choice.
But you can't do it slowly or casually.
And I think it's actually much more like the street and people admit that frustration over some sense sometimes.
(45:14):
But everything is there.
It comes down to weighing the information properly.
Your description of how to go through sentence by sentence is outstanding preparation for your students to go sit for the exam and modeling behavior to help them succeed.
Thank you.
I didn't come up with that on my own.
I've picked that up from listening to others, listening to yourself, listening to Dave Page and another great presenter to talk about good ways of helping students look at an analyzing question.
(45:42):
So I think we as educators need to be able to pass this information along to other educators as to what we need to do to make these students be successful.
I think there's times educators are intimidated by the questions, just like the students.
But again, if you don't put yourself out there, I like to have my instructors answer the questions along with the students.
(46:05):
And we keep score.
It shows which students got questions right.
How many they got right.
And also, it also shows what educators got questions right and wrong.
So if you want to talk about giving the students some motivation, put yourself out there, answer the questions with them.
And they're going to look to beat you without a doubt.
(46:26):
Hey, anybody is welcome to be smarter than me.
I'm more than happy to give you the stage and do that.
And you do get some pretty smart students and our class.
Absolutely.
We hit our time right on the mark.
This was a great conversation.
That's what we want this to be.
Want this to be going over things, keep a page going, pre MSP people's attention.
(46:51):
And have a good conversation.
Listen to listen to it.
I felt confident we did that.
I'm thrilled that you're here.
Chuck Elias, the program director for state fail.
So, it's really great stuff and sharing your experience.
I'm very grateful.
And thank you for being with us.
Thank you for having me.
And I appreciate it.
(47:12):
Thank you for listening to a seven things EMS podcast by limer education.
If you've listened to this podcast on a streaming service and you're interested in getting continuing education credit, please go to LC dash ready.com for more information.
Welcome to Seven Things EMS, a continuing education offering from LEMUR Education.
(00:12):
Seven Things EMS is designed to give you what you need to succeed in EMS, it's conversational,
informational and without the fluff.
(00:32):
Alright and welcome to another episode of Seven Things EMS.
We're taking an education topic today and I'm very happy to introduce Alkalias.
Chuck is the program director of Penn State program in Pennsylvania.
We're going to talk about education, the traditional versus flipped, some experiences Chuck has had
(00:55):
and I'm excited about that.
My name is Dan LEMUR, I'm your host as usual and Seven Things cuts through the fluff.
That's what we do so we're going to cut through the fluff and we're going to start with these Seven Things.
Chuck, welcome.
Thank you Dan for having me.
Your first point here in our Seven Things, I almost said to you, maybe we should move that to the end.
(01:19):
It's really powerful.
I decided to keep it where it was because I like it so much and I'm going to let you take it.
But your first one is resist comfort.
Tell me about it.
Sure.
I'd like to pull the quote from Mike Tomlin, the head coach of the Pittsburgh Steelers.
He starts off by saying seeking comfort is a natural human condition.
(01:42):
We all seek comfort, we all want to be comfortable with things.
He also states that if you realize if you want something special or you want special outcomes,
you have to be comfortable being uncomfortable.
He said that he's trained himself over the years as a coach to resist comfort.
I thought, well, that applies really to us in education,
(02:05):
especially whenever we're looking at results.
Being happy with less than 100% pass rates is seeking comfort.
Also stating that a certain type of student didn't pass, blaming it on the student, is seeking comfort.
I think we as educators need to embrace our opportunities and take on challenges that really scare us.
(02:31):
If we look at even Brene Brown's work in this, she has a similar approach,
this is not without risk or exposing vulnerability.
Anytime we step out of our comfort zone, when we resist that comfort, we're putting ourselves out there, aren't we?
We are.
If we go ahead and we do the things that we feel comfortable with in doing,
(02:56):
and let's go with the traditional lecture style teaching, we know that it's not effective.
We look at the studies that are out there and it shows it's not effective.
But by taking this risk into implementing a flipped or hybrid style classroom or whatever buzzword you want to use,
I think you're jumping outside your comfort zone.
(03:17):
You have to accept responsibilities for your failing.
I mean, me as the program director for the programs,
I have to accept responsibility for EMR up through paramedic as to those that are teaching the classes.
If I can't get my points across as an educator to the other educators,
then we're failing the educators and we're also failing those students.
(03:37):
Arthur, and I think the flipped classroom probably is at the top of the list of takes away people's comfort.
Both educators and students are really comfortable when the instructor gets up and hands the student by slides,
all they need to know, and the student likes it because they feel like they're being taught.
(03:57):
And I think this really introduction into this concept,
because that might be the ultimate risk or vulnerability or step an instructor can take.
And those of us have been doing national registry testing and looking at results.
If you lecture to the students, if you're just presenting what's already given to them in the book,
(04:20):
we're using the publisher slides, we're really not preparing them in the past that exam.
I mean, you have a bunch of great products out there.
I've used your products. I've used some other products.
And those products and those questions do not correlate to it's on this page of the book.
It's the sky is what color, those types of questions.
(04:40):
And that's what we're expecting of our students and our students are going to fail this exam.
Yeah, when I teach educators, I ask them what keeps them from changing your classroom.
And I have several stock choices.
Is it the university or the program director? Is it money? Is it time? Is it creativity or whatever?
(05:03):
But most of the time, it's the time and creativity that keeps people from stepping out
of the box and doing those things.
And I think that probably really fits in well with your statement about resisting comfort.
It really requires a mental step out of the box.
It does. And this allows us to teach everyone.
(05:26):
It's easy to teach the students that we know that our college bound students that have been successful
in the past that know how to study.
And we know there's a group of students in the middle that the way we teach, the way we pass information on to the students will help them.
What about the lower end students that maybe they are taking an EMT class and their next logical step is to become a paramedic?
(05:52):
Well, paramedic level education is a 300 or 400 level college level course.
It's just not easy to take an EMT class and then think that just because I pass an EMT class, I can pass a paramedic class.
Well, we also see even going the step in between, a EMT has had dismal pass rates nationally.
(06:13):
And I think to some extent, and we can't generalize every program, it's really poor preparation at the EMT level that makes people suffer when they move up.
It is.
And I like to look at it as somebody needs to jump into the fire.
I'm resisting comfort. I'm putting my pride at risk.
(06:34):
And I want others to follow.
So if this means that I have to be the leader in our area or help you lead a nation wide as to pushing us forward as educators, then I won't do so.
Well, let's go on.
And we're in subsequent points you have in your seven things.
Getting into some more details.
(06:56):
But one of the things you mentioned, I think is really important, including a lot of input is to implement scenarios.
So let's talk about that.
We'll blend with resisting comfort and we'll talk about scenarios.
And some of this stuff, Dan, the quotes I've taken, I mean, I'm a big, huge Steeler fan.
(07:17):
I'm a huge Ted Lasso fan.
So again, be curious and not judgmental was a quote from one of his scenes and everything.
And it truly hits home as to when we're doing things.
Why are we doing things a certain way or why is somebody learning a certain way?
And if we provide that judgment at first without asking questions, then I think we're failing the students and we're failing ourselves as educators.
(07:47):
Implementing scenarios that can be as simple as case study scenarios, discussions with the students,
and then moving it into full blown scenarios where we're doing hands on learning with with the students.
So we need to start with that at first.
And then whenever we were not curious, I mean, that clip from Ted Lasso, the darts, the owner was trying to hustle him and then he ended up getting
(08:11):
hustled because he didn't ask questions.
I mean, I'm sure we do that all the time.
And what we do is learners as educators.
We need to we need to take out that judgment and start asking more questions.
And sometimes as educators, we need to step back, listen to the students.
And we don't always have to say something to be able to educate them.
(08:33):
I think that it would seem like a lot of people have seen Ted Lasso.
But Ted Lasso and only as an entertaining show really is almost like a leadership masterclass.
You know, it really is something that I found fascinating on so many levels.
How do you think implementing scenarios has benefited your students?
Do you have any any quick insights or out of that?
(08:54):
What do your students get from that?
I think by implementing scenarios, you're allowing these students to be able to think critically.
It's a critical aspect of education and learning is what's going to make these students excel
at the EMR, EMT, AMT and paramedic level.
This we want them to learn now than the lecturing later part has to be put off to the side.
(09:20):
We can't be comfortable as an educator just by standing in front of the classroom,
clicking the PowerPoints and expecting those students to do well.
I'm going to steal this from David Page is if the practice like you're going to fight,
make these scenarios as realistic as possible.
If you're pushing medications, you need to have some sort of IV pad on their arm and not just having a fake arm,
(09:44):
the third arm that we see that's out there.
Or when we're innovating, putting the innovation head on a table, bolting it to the table at the perfect height.
That's not how we see things in the field.
And again, it's like getting these students to do the scenarios, to do the practice and actually do the treatments and not voice
treat. I think the more we voice treat or we allow our students to voice treat, the less successful they are.
(10:12):
Yeah, I think that I look at this.
Your first one was resist comfort.
Our second one implements scenarios.
I would almost say we're also saying resist tradition.
Absolutely.
We have to change.
I think that's great.
You were in a presentation I did this week where I talked about something I tried with my high school students and they came in with a bunch of sugary snacks.
(10:35):
It's a pop heart.
And I said, don't eat that.
Let's check your blood glucose first and then check it.
So we checked the blood glucose and again in 15 minutes and again in 15 minutes.
And then we got to predict.
We got to figure out what the variables would be.
Everybody checked blood glucose three times, about an hour, hour and 15 minutes.
(11:00):
But the thinking they got out of that, how they applied and the engagement, this engagement, that should be part of this as well.
It is.
The students, they're going to remember more by doing.
If we look at the Bloom's taxonomy in the past, we remember 10% of what's being talked to us about.
And we remember 90% of what we do and we can act it out.
(11:24):
And it's, it's that repetition.
It's building that muscle memory over time.
It's just not telling a student to do something once or saying it once.
It's what's going to build that lasting impulse or that lasting image in their synapses.
And I think that we look a lot at our endpoint as the national registry.
(11:48):
I believe that what you're talking about here will help students with the registry.
We talk about, you know, kind words about our products and the reputation and they're not specific.
And the registry isn't book specific.
I think that's beneficial when students apply and think that helps them with the registry.
But I would even go one step further and say, it's going to make them a better product.
(12:13):
We put out as educators.
Absolutely.
I mean, we get in the habit of the class has to be in a classroom.
Take the class outside, do your scenario outside, do it in a hallway, do it in a bathroom.
This is where you're going to be presented with your patients.
We also, we use a red card and yellow card concept, whether it's a flash card or whether it's on the back of a notebook that we hand out to the students.
(12:40):
A red card is a scenario, is a stoppage of the scenario if it's going to be harmful or someone's doing something that is wrong in a scenario.
We don't want to build that poor muscle memory.
A yellow is a pause in the scenario, a caution.
Whether I have a question, the other instructors have a question, as soon as the question will pause the scenario, ask the question to make sure that we're on the right track or make sure we're not going down the wrong pathway.
(13:04):
Those will also help with us as educators.
Wow, cool stuff.
Well, let's take, we often in these conversations, we sneak into other points inadvertently, but number three is teach and encourage students to think critically.
(13:24):
With this point in, it's, we're looking at evidence-based teaching, evidence-based practice.
These national registry style questions that the students are being tested on are critical thinking questions.
If you've taken the test, I've taken the test, I've looked at your products, I've looked at other people's products.
And those questions that are the harder questions for students, it's not a clear-cut answer.
(13:49):
It looks like it's in the gray.
And we tell these students, let's practice medicine in the gray area, but if we don't go ahead and prepare them to think into act accordingly, then how are they going to be successful in doing so?
And like we talked about before, PowerPoints were great to get things started, but I think how they've been used over time has been a crutch for the instructors.
(14:14):
Again, 10% of what we read, the students are going to remember.
90% of what is said and done is what's going to help them remember as we move forward.
We as instructors, whenever we're teaching students to think critically, we need to have a safe environment for them to learn.
This is something where they can feel comfortable with making mistakes in the classroom.
(14:36):
Make the mistakes, ask the questions, get them to practice this higher level of learning.
Allow this time to develop to foster critical thinking skills.
Promoting the dialogue, maybe as the instructor is more of the facilitator, we just ask a question to get the students to think a little bit more.
(14:56):
And then once we ask one question, we follow that up with another question instead of letting us talk, let the students talk, let them figure stuff out.
Sometimes we feel as educators that the silence is a horrible thing.
Sometimes it's good to have silence, let the students think, let them look something up.
(15:17):
They're asking us to give them the answers to be the gatekeepers of information that most of them have a smartphone, most of them have access to Wi-Fi.
And the internet, while we're doing something, says, go ahead and look up the question that you have.
Talk to each other, use the resources that's available here.
We also don't allow enough time for self-reflection after a scenario or a call.
(15:41):
What happened, what did you do, why did that happen?
That reflection should probably happen right after the scenario.
Let that reflection occur because if we're on a call, those less than our providers, we're going to talk with our partner directly after that call.
What went right, what went wrong, what could we do differently?
We're not going to do that 10, 15, 20 minutes after the call.
(16:01):
That's usually something we talk about as soon as we're done, transferring care at the hospital for the patient.
Yeah, some really good points here.
A couple of things come to mind.
We have another podcast we used.
We did an inquiry-based learning.
And starting your class by saying to the students, based on what you read, what do you want to know?
(16:29):
I tried that and I put all the questions on the board.
And then as we went through, I said, okay, we must solve it.
At the end, it's like, well, there's a couple of things.
They wondered, but I didn't know.
And the other thing, this is your thing, I don't want to take a lot of your time, is that I look at anaphylaxis as something that, when you can teach them to critically, it's so important.
(16:50):
We teach generally allergic reaction and anaphylaxis.
Right?
Most patients are confused.
And we're in the middle.
You know, we can have simple, we can have extreme, but I feel like I've got a lump in my throat.
I'm worried as well.
And students don't know what to do in that situation.
(17:10):
And there are guidelines out there that actually can help them in this decision making.
It is.
And I think what we give them, if we show them the evidence and the reasoning behind this
critical thinking and the support critical thinking, this will help them.
This will also help them think deeply and to make those relevant connections as you're talking about there.
(17:31):
That also then, as we just talked about, engages that reflective thinking.
All right, I did this or this is what happened in the scenario.
All right, what get asked the student, what are some two or three things that you did positive on the call?
What could you done differently on a call?
We don't have to tell them what they did wrong.
They're going to most likely know what they did wrong before we can even tell them what they did wrong.
(17:54):
Let them also seek better and new solutions.
Ask questions in clarity.
I mean, if we can provide the clarity for the students, then that's what we need to do.
Oh, I think that's outstanding.
I and as students get on in their class and get near the end, they can create scenarios.
They can put things together and things like that is just incredible.
(18:16):
So we are on number four and I love our conversation so far.
It's a great flow and great information you created.
Teach you and test progressively.
Testing is a big part of this.
Let's talk about it.
It is.
We need to make sure that when we're testing, we're testing and why are we testing,
(18:37):
but we also have to build them up before the testing.
So when we look at teaching and testing progressively, we need to start off with a formative.
We need to start building and doing the scaffolding for the students,
letting them understand we're learning for understanding.
Let's take away the need or for the risk for them to feel that they need to cheat.
(18:58):
Let's take that away and if we're going to give them interactive lectures or homework to do at home,
give them as many chances as they want to do that.
Give them the opportunities to do and research some things that it's going to be less
stressful for them, lower stakes so that again,
it don't create it at all or let them have the opportunities to redo that over and over again.
(19:22):
But whenever we need to put punishment down, we need to have zero tolerance for academic dishonesty
in EMS education.
There's so much that I've seen over the years where students aren't doing the right thing at times
and we need to hold them accountable for that.
We can't have those people in a profession that are going to make us look like we don't know what we're doing.
(19:44):
We want to raise this profession and to raise this profession, we have to be professionals ourselves.
I totally agree in that regard and I think we all have got stories in our teaching,
ultimately disappointment and seeing people otherwise we think very
strongly engaged in behavior that is dishonest.
(20:07):
I think that it is part of those educators are the affected domain and we have to create an atmosphere for that.
I'll also say one of the things you said that struck me that I like,
I'll have a different approach.
I'd like to give you a clarification a little bit more.
There are times in that staff approach that we give students an opportunity to succeed,
(20:29):
to learn from this, to be able to fix their work and go back and earn what they do.
I think ultimately not only are they getting a grade,
but they're getting an example of how to learn.
They're getting an opportunity to succeed.
In succeeding, we also need to encourage them that it's okay to do things wrong.
(20:51):
We're not going to do everything correctly.
So making a mistake, reading something and not understanding it or looking at a quiz question
or allowing that student to redo that quiz again, learning does take place whenever that happens.
We as the educator then need to provide timely feedback and also proper remediation.
(21:13):
But when we're looking at the summative and we're looking for confirmation of master of the knowledge,
whether that's at the end of a module exam,
that's when testing is occurring.
We're not doing remediation at that time.
We want to see what does the student know at that point in time
so that we can move on to the next lesson, the next module.
Joe Mistovich, a good friend and an occasional co-author in projects we work on,
(21:39):
said to me something that always stuck with me.
He said, if you test students superficially, they will learn superficially.
If you test them comprehensively, they will learn comprehensively.
Maybe a little bit of a shock in the beginning.
A test really do more than measure really does drive learning.
(22:01):
How does your scaffolding work and how do you get to that challenging test?
Well, I think we need to do in-flight course correction.
So we might plan a certain module, a certain project, a certain way,
and we need to gauge how are the students learning,
or they understanding the materials as we're moving forward.
It might be a stop, we'll continue with caution, we're going to correct, we're going to repeat.
(22:25):
It's just like the red card and yellow card concept we talked about a little while ago.
Give them positive reinforcement, let these students learn from their mistakes.
In a workshop I went to recently, there was a great concept that they said is,
don't give them any more than three corrective feedback suggestions at a time.
The students, the brain can't remember more than three.
(22:48):
If you give them four or five, they're going to remember the last three that we gave them.
So we, a lot of times we'll give them a laundry list of things that they did wrong.
Let's summarize that to two or three, give them the chance to make those corrections and to move on.
Interesting.
Well, let's go on to number five.
I think we're, like I said, we're going along at a good pace.
(23:09):
I'm loving this.
Teach through questions.
And I did talk a little bit about an inquiry based approach.
Tell us about that one.
Well, teaching through questions, I mean, we need EMS, we solve problems, right?
How often, again, that's rhetorical question, we solve questions to problems every day.
(23:32):
Nursing has used this over the years.
So again, we don't have to reinvent the wheel in what we're doing.
And when we're teaching through questions, we also need to have the students earning the right to be in class.
The big thing with the foot classroom and what people don't really understand with it is the pre-course work, the readings, the lectures,
we're now holding the student accountable for what they should be doing, whether it's giving them an assigned video to watch,
(23:59):
lectures to read, lectures to listen to.
And when we compare that to lecture style learning, that's low level recall.
And that goes back to point one, that false sense of comfort.
We should be prepared and prepare these students to be ready to function in the classroom just like they would whenever they are on the call.
(24:21):
And I've struggled with this over some times.
I'd have the students say, and I probably started flipping the classroom in 2016.
I know you and I had a talk shortly after I started doing it.
It was a little frustrating because the instructors were fighting it, the students were fighting it.
And then you hear students say, I'm teaching myself.
I never had a really good answer to give them.
(24:43):
I knew that wasn't what was happening.
And then I went to the NMC conference this August in Reno, and one of the presenters made the comment,
well, if you're teaching yourself and I can go on vacation and come back a week or month from now, and let's see how prepared you are and pass in the exam,
which is one good point.
And another good point, and another presenter made was, we're teaching you the students how to learn.
(25:08):
You're not teaching yourselves.
It's just a different way that we're teaching you how to learn.
I think the Reno conference this year was one of the better content-wise that I've seen in a long time.
Everybody really enjoyed that.
When I started doing this, I'm not risk averse at all.
(25:30):
I'll give anything a try.
And when I started doing this, I had scenario students were working in groups,
and I brought in medical, I had Harrison's, Tenton Alley, and all these resources and some papers printed out, some research.
And we got through and I said, okay, there'll be a test next Tuesday.
(25:53):
This is a Thursday, Tuesday, Thursday class.
And they raised their hand.
How can there be a test?
You didn't teach us anything.
I was like, no, no, you learned.
You know, that's what it's about.
And it does take a little bit.
And one of the things is, I think we can't let them see us sweat or doubt it.
Right?
We have to be sure that when we go in that we have a plan for this and that they're learning.
(26:19):
If they see us hesitant, they'll be even more hesitant.
They will.
And these students, they're going to be awkward.
They might feel embarrassed.
They might feel uncomfortable with doing these activities.
But we know that those that have flipped the classroom, those that have gone away from the lecture style learning,
we see how important and how much better the students are prepared in passing the class and passing the national registry exam.
(26:46):
The students will come across sometimes and say, you're wasting our time.
Because like you said, I think if they see us sweat or if the instructors aren't buying into that concept,
then that gives the students a reason to question what we're doing.
And can't we just go back to the other way?
I really, I really learned more from the lecture style learning.
(27:07):
And we know that's not the case.
These activities have to be multifactual.
We have to encourage the critical thinking as we talked about before.
And we must demand these students are be able to problem solve in the classroom and then taking care of our patients.
I think that there's a painful reality here.
You know, Chuck, for you as a program director.
(27:29):
Not everyone is going to be able to pull this off.
We may lose some educators as we go on in this.
And not just the older educators or stubborn educators.
I've seen people become almost profits in the flipped classroom, but I've seen others that have flat out refused.
I think that probably challenged you as a program director.
(27:53):
It is. I mean, in our area in Western Pennsylvania,
I don't see a lot of people willing to embrace this.
Even the classes that we we sponsor as the Ed Institute, they seem reluctant to change.
And I think it's part of it is they feel comfortable, comfortable with what they've done in the past.
(28:14):
But then when you ask them, or if we need to look at results, the results aren't where we need to be.
I mean, we want to have more providers out in the field.
If we can't get people to pass the exams, then we're not going to get more providers.
This idea that we as the educators are the gatekeepers of that information.
Why does a student have to say that Dan or Chuck is the only one that can tell me what I need to do to pass this exam?
(28:40):
We're not going to be there when they're taking care of a patient.
So we need to be able to to foster these providers, these clinicians to think critically so that when they're given a difficult situation
or difficult patient that doesn't follow the cookbook method here, that they can actually take care of the patient.
They understand why they're going to do a treatment for that patient.
(29:01):
I'm getting a little off topic here, but I've actually said several times that I don't know if someone really have just one paramedic instructor.
And they need influences from multiple people, the same person all the time.
Despite talent and passion and dedication, you basically become, if I taught the entire class, people say, well, I had a liver paramedic,
(29:23):
you know, or an alias paramedic.
I really want my students to have more when a lot of education wants people to have one source for consistency.
Those multiple sources that create how come this instructor said this and you said this, then you talk about it, then you learn and you develop a practice.
(29:46):
Absolutely. I mean, like you said before, too, these students are resistant to change.
If you have more than one person, now you have more people giving their expert opinion into what needs to be taught or what should be done.
And sometimes we don't always speak the same language.
So somebody has to, if you're the one running the class and you're the person in charge, then it's your job to talk to each instructor,
(30:14):
to bring them together and say, all right, these are the two concepts that maybe the miscommunication here.
This is really what we need to go in and allow the students to be able to realize what is correct or what maybe one instructor said a little bit differently than the other.
We need to stay the course with this.
Yeah, I think that's true. Let's go on because you've got one that's near and dear to my heart. Everything here has been good, but we're talking about depth and understanding.
(30:43):
I mean, as we go more and more towards advanced practice, all this stuff is really important to go out there and make decisions.
When we go to someone's home as an advanced practice paramedic, say, mobile integrated healthcare, we're making decisions, big decisions that affect patients.
That's all on us. I think that's really important.
(31:05):
And what is the basis for everything we do?
Year number six, pathophysiology must be taught at the cellular level.
We talked about the EMT level for this.
No, you took the words right out of my mouth, Dan. This has to start at the EMT level.
(31:26):
We hear directors of services, you don't need to, why are we teaching so in depth? You're teaching too much information.
The class doesn't need to be this long.
Well, we know that you have to understand pathophysiology at that cellular level.
And I wish I knew cellular physiology as well as Joe Misovic whenever he did that talk to you guys.
(31:48):
The seven minutes that you guys talked in the beginning was phenomenal, but it truly makes sense as to when we look at a patient, why is something happening?
When the students understand that, they truly will really understand what's going on.
So I want to throw this little bit of scenario out.
It's a little bit different than what Joe did, is you have a female patient presenting to you with generalized weakness and brain eucardic.
(32:13):
What's wrong with your patient?
And the students will say, well, there's not enough information. I need more information.
Based on that information, that patient's having a myocardial infarction, and we can prove it otherwise.
There are other differential diagnoses that we can go and say that this is what's wrong with the patient, but it's an MI because female patients present different than the male patients that are having a heart attack.
(32:40):
And having that heart rate of 50, now they have normal blood pressure, normal respirations.
So if we do a 12-week, we're going to make this to the paramedic level here.
We see ST segment elevations and leads one, I'm sorry, leads V1 and V2.
That's telling me that they're having a septal wall MI.
If we do this cookbook paramedic teaching to these students, brain eucardic patients are going to get atropine.
(33:04):
Well, if I give atropine to this patient, I'm going to kill this patient because I'm going to cause an increase in the heart rate.
I'm going to have that infarct increase in size because we know that atropine does not work above the, works above the AV junction.
And these impulses are having a problem getting through that AV junction.
The patient needs to go to the TATH lab.
(33:25):
So this patient would have atropine being contraindicated that infarct is happening in the septum.
We know that the LAD is our culprit vessel.
What do we know about that culprit vessel? It's a widowmaker.
Why is it the widowmaker?
It's because that's what causes people to have acute cardiac sudden death.
And it all depends on where that widowmaker lesion is.
If it's closer to our left coronary artery, then that person's likelihood of getting to the TATH lab and table and surviving is probably very low.
(33:53):
But if that has a distal occlusion, that gives them a greater chance of survivability.
And that's just one instance of how we can look at and understand cellular physiology and how we can teach the students to understand something that is a very in-depth concept, but can also save a patient's life.
(34:14):
We, you know, the basic path of physiology, even what you talk about, is recognizing the potential of cardiogenic shock and reduced cardiac output with the bradycardia.
Yes.
And how that comes together.
The other one that really comes to mind is that I think we're seeing, and I teach a lot at the EMT level, but certainly this applies at all levels, is if we're going to be using epnography and teaching about acidosis,
(34:46):
our students look at kusmal's breathing and don't recognize the role of acids and where that comes from, and that starts at the cell and it continues on from there.
And the more that we can bring an understanding, and that understanding is challenging.
It is.
(35:07):
It's difficult to teach, but I totally agree with you, which your experience with this EMT level or above anything as far as the path of physiology.
I think it's almost non-existent in the classes that I've seen over the years.
It's not a big emphasis.
I think the classes that there is more of an emphasis on those students tend to do better.
(35:31):
And the recording that you referenced with Joe Mstovich, we have a two-part pathophysiology and assessment podcast in this seven-thing series.
Joe is an amazing educator.
The way he teaches and makes things understandable.
The other thing about Joe is when he teaches, he teaches a lot.
So we had to break it into two parts.
We couldn't just do one session, but it's good listening.
(35:55):
And thank you for mentioning that as we go.
So the last part, and I think a very valuable part is the clinical judgment and decision making.
I think you're going to define that for us.
And then you've got some examples.
And I think the reason I like the order in these is I looked at your points on this one of our seven things.
(36:20):
I think it is valuable in itself and also gives us a choice to kind of wrap it up nicely.
It does.
This is something that National Registry is implementing at the AEMT level and the paramedic level July 1st of 2024.
The psychometric exam is going away and they're going to implement this testing.
And they're already implementing these questions as pilot questions for our students.
(36:43):
So we, as EMS professionals, are making decisions based on our level of knowledge.
And we're doing that through evidence theories and patterns of behavior.
And we're doing it at the pre-seen, the seen, and the post-seen areas.
In each of those areas, the students are going to have to recognize clues, analyze those clues, define the hypothesis,
(37:07):
generate solutions, take action, and evaluate.
It's a continuous loop.
And this is how we're going to ask questions.
We're National Registry going to ask questions for the students in each of those phases.
It might only be 13 or 15 questions. I know it's less than 20.
So if we don't prepare our students now for what to do and how to look at these areas here,
(37:28):
they're going to struggle with this part of the exam and they're going to fill that psychomotor portion of the exam
because we didn't prepare them as an educator.
Yeah, I think that I'm actually more excited than I am concerned about the new National Registry style questions.
(37:49):
Although I do think that the educators do have some catching up to do, I think, to prepare their students as well as they could.
The National Registry and the educators have been doing a series of courses about this.
They did one in Reno and then there are several scheduled around through 2024.
(38:10):
I think there's four or five around the country.
And I would encourage people to see those if there's one in their neighborhood.
And what we'll do is we'll link.
And there's an article in pre-hospital emergency care that explains this.
I think we'll leave that in our show notes for this.
(38:31):
But I think that as the registry phases out the psychomotor exam,
they're looking to put in things that you mentioned here, not only the scene,
seeing all the things that are done, but I think that we'll be able to test a student's sequence, predict.
(38:52):
Right? Is that how do you predict in a test if a student can identify someone who might crash later?
It turns out I think you can.
We definitely can.
I think we have to use the teaching methods that are available that we talked about earlier, scenarios, simulations, case studies, problem-based learning.
(39:13):
We as the educator need to ask the probing questions, how the students discuss, debate, and have discourse in the classroom.
Encourage them to explore it.
Don't just give the first answer that comes to mind. Ask them another question. Why?
And we as educators can't stop with the first question.
We need to follow up our question with another question, another question to get these students to think critically through this process here.
(39:40):
We also then have to allow these students to be able to deep breathe.
A good classroom is a noisy classroom.
Have the students think out loud.
I don't know what a student is thinking in their head unless I have them think out loud and tell me what are you thinking?
Why did you come up with this conclusion?
And we as educators need to be able to help them think and be able to think critically.
(40:04):
So asking those questions and think out loud.
And the case studies have them do it in two parts.
Clinical scenarios can be about a patient, a family member, or given situation that asks questions about that scenario.
The individual case can unfold.
We can get new data from what a student asks or from maybe what a partner may want to know.
(40:26):
And that can help us build upon that case study scenario leading into other decisions or other possible decision making and taking care of that patient.
It must be difficult as an educator.
I think I've felt it, perhaps you have as well, is that we want to be the one that presents the information.
It's different to put it out there and let the students do it.
(40:49):
And intuitively, I don't think anyone would say that it's not better.
It's better, but it's challenging for us to do that.
It is.
And we need to make sure that we're doing this, making these scenarios realistic.
Again, having these students have a higher level of thinking.
Have them focus on more than one problem.
Very the setting, like we talked about before, not only with taking the students outside or into a bathroom, maybe going through your local store, grocery store, hotel, and actually doing a scenario.
(41:20):
One of the educators at the Nancy conference said that they go to a hotel that's close to their university and they asked them before they clean the room.
Can we go ahead and run through students through a scenario in a hotel room?
Again, we're putting these students into a real life situation by allowing them to do these scenarios in those given situations.
Going into a used hotel room makes me think we need good PPE as well.
(41:45):
Absolutely.
Well, we have a bonus one here and we have a little bit of time.
So I want to put that in there.
Use cognitive retraining and I think this goes a little bit as a continuation of our teaching through questions.
Let's just take a couple of minutes as we wind down and just tell me about that.
(42:07):
Cognitive retraining.
When I first took over as a program director at my previous job, I had a group of students that were struggling in the past for an exam.
They've taken the class multiple times I was working with the students and looking at the questions answering questions.
And one of the students made a comment that I wouldn't do this in the field.
(42:30):
I'll do something differently.
And it was a light bulb clicking onto my head where I'm like, oh my gosh, the knowledge is there for these students.
They just don't understand how to answer the registry style question.
So we as educators need to teach them how to answer the registry style question.
You can do that many different ways.
I use the MS testing product.
(42:53):
There's a group testing aspect to it where we present a question in front of the classroom.
That's almost like Jeopardy style.
Each student logs in, they have their choices.
If it's not the multiple, multiple guests, they have an ABCD option.
We can do the same thing if we were bringing up your apps or other products that are out there.
(43:14):
And then we want to have the students break down the question.
I'll first start off and I'll read the question out loud and I'll look at the first sentence and say, I think this is what they're stating.
This is what I think is going on.
And then I'll have the students agree, disagree, and then we'll look at the next sentence.
Does that further enhance or negate what we looked at earlier?
(43:38):
We go through each of the sentences depending on how many sentences there are.
And then we look at the last sentence in the stem and that's going to tell us really what are they asking us in the question.
I want the students send a reread the question.
Come up with their answer and if that answer is in the choices, that's most likely the right answer.
(43:59):
But they also need to read through the other distractors.
Because the registry is great at telling us there is one right answer and there are three plausible answers.
The other ones are going to seem to be correct.
And if we don't know that information, they all look good.
They are all tasty distractors for these students.
And we need to show them sometimes in a question, why is this answer a good answer to choose, but it's a wrong answer.
(44:23):
And if we can point this out to the students, that will help them understand what to do better in taking that exam.
I'll close and saying I agree with everything you say.
I think that a lot of people say the national registry and the street are two different things.
But the truth is that when you get to start through information, some of it conflicting and you ultimately make decisions.
(44:50):
And that a national registry question does that.
It doesn't always give you the answer you want, but if you take and you interpret that information properly, you always have enough to make the choice.
But you can't do it slowly or casually.
And I think it's actually much more like the street and people admit that frustration over some sense sometimes.
(45:14):
But everything is there.
It comes down to weighing the information properly.
Your description of how to go through sentence by sentence is outstanding preparation for your students to go sit for the exam and modeling behavior to help them succeed.
Thank you.
I didn't come up with that on my own.
I've picked that up from listening to others, listening to yourself, listening to Dave Page and another great presenter to talk about good ways of helping students look at an analyzing question.
(45:42):
So I think we as educators need to be able to pass this information along to other educators as to what we need to do to make these students be successful.
I think there's times educators are intimidated by the questions, just like the students.
But again, if you don't put yourself out there, I like to have my instructors answer the questions along with the students.
(46:05):
And we keep score.
It shows which students got questions right.
How many they got right.
And also, it also shows what educators got questions right and wrong.
So if you want to talk about giving the students some motivation, put yourself out there, answer the questions with them.
And they're going to look to beat you without a doubt.
(46:26):
Hey, anybody is welcome to be smarter than me.
I'm more than happy to give you the stage and do that.
And you do get some pretty smart students and our class.
Absolutely.
We hit our time right on the mark.
This was a great conversation.
That's what we want this to be.
Want this to be going over things, keep a page going, pre MSP people's attention.
(46:51):
And have a good conversation.
Listen to listen to it.
I felt confident we did that.
I'm thrilled that you're here.
Chuck Elias, the program director for state fail.
So, it's really great stuff and sharing your experience.
I'm very grateful.
And thank you for being with us.
Thank you for having me.
And I appreciate it.
(47:12):
Thank you for listening to a seven things EMS podcast by limer education.
If you've listened to this podcast on a streaming service and you're interested in getting continuing education credit, please go to LC dash ready.com for more information.
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