Testing Stinks

Years ago, when discussing the precepting program at my division, somebody said, “I don’t know why we are taking so much time to evaluate these people.  They were able to pass the paramedic test that right there should tell us that they are ready for the field.”  What this person did not understand is that testing that takes place in the written and practical settings have very little to do with.  Our testing, which has evolved very little in the fifteen years that I have been a paramedic, has become so disconnected from what our profession actually does, and we need to start reevaluating it.

Granted, my frame of reference is about three years old, and I am otherwise going by what I have heard third hand from people, but I can say, without a shadow of a doubt, that the practical stations that I went through in 2012 for my National Registry certification almost matched the stations I participated in back in 2000 when I received my certification in Massachusetts, the exception being the two oral stations that NREMT has added to the testing.

I guess most of the credit for my performance in 2012 goes to the staff at Springfield College and the meticulous teaching of Gary Childs who was the head instructor back in 2000 who spent more than a year instilling on me the importance of things like memorizing the critical fail points of each station, ripping the tape before starting an IV, and making sure that I verbalize every single step as I do it in case an evaluator is not watching.

I did, however, have to break a number of bad habits to get myself ready for the 2012 test.  I found as I walked into each station that a number of steps that I was asked to do had little to do with how I perform as a paramedic.  For example, as I freely walked around a patient and worked from all angles to apply the KED to the volunteer who was my patient, I could not help to think about not only how impractical this was, but I also wondered how many items I would have to remove from under the bench seat of my ambulance to even access the KED, which I had used like this twice in the previous twelve years.

The biggest inconsistency for me comes into play right from the start of each station.  National Registry requires students to ask their instructor if the scene is safe, or indicate that they are checking for scene safety.  I’ve said it, Kyle David Bates has said it, and many people have said it, “scene safety stinks.”  In the real world, scenes evolve.  They change.  Testing like this, and more importantly, teaching such as this encourages tunnel vision in EMTs.  They take a look around, make sure that there are no threats, and then move on to the next mechanical step that they were instructed to do.  I have come up with two ideas that might help teach and test better situational awareness.

  1. Instead of asking a student to state “scene safety” from the start of the station, have them ask it multiple times throughout the testing station. Require a student on two or three different occasions, to ask the evaluator, “has anything changed in this scene that would make it potentially unsafe?” or something similar.  The answer quite obviously would most likely be “no, everything is still the same” but it would encourage students to pick their heads up and have a look around.
  2. Building on my first idea, give the evaluator a whiteboard and have them write a simple math problem on it. Hold it up, and require the student to notice it on their own, complete the problem (5+3=?) and then return to what they were doing.  Do this a couple of times through the station and record the time that it took the student to recognize that the problem as there, and the time that they took to complete the simple problem.  This would show the test taker’s ability to be aware of other things that are going on around them beyond the patient in front of them, and would show that they have the ability to mentally multitask while they continue to provide care.

What it comes down to is we should do more to evaluate a student’s ability to recognize an evolving situation and less regurgitation of mantras like “scene safety, universal precautions, number of patients 1” six or seven times in a day before moving on to the more important psychomotor skills that they are asked to display in each particular station.  We need to shift the culture in EMS education and try to prepare prospective EMT and paramedic students more for the environment that they will encounter once they get that card in their back pocket, and put less emphasis on the mantras that they will be asked to regurgitate to get that card.