Past and present: Changes in EMS education
By Robin Young
College Paramedic education in Ontario has changed drastically over the years. There have been major shifts in teaching methodologies, skill, equipment and medical responsibility at the PCP level. Today, there is a much higher level of educational responsibility and student sophistication.
History lessons
When I graduated from the Ambulance and Emergency Care program at Toronto’s Humber College in 1984, the education at the time was, by today’s standards, limited. Certainly, the program prepared us for the prehospital care field for the time, but it was a different time, with different social needs, technological availability and educational preparation. The program was one academic year and consisted of theory, skills, clinical and field placement. There was a limit to the skills that we were taught and eventually could provide to the public. We learned and practised first aid on each other and performed CPR on simplistic mannequins. We applied the Thomas and Hare traction splints and wooden board splints. We backboarded each other with short boards and long boards and used triangular bandages until we modernized to simple seatbelt straps. We mastered the use of the Flynn Oxygen Kit with oxygen driven suction units. We lifted on #30 stretchers and the weight standard to lift was 160 lbs. We had a basic first aid kit in a tool box. We wore grey slacks, light blue dress shirts and a clip-on tie...
The educational approach back then was sound. The instructors had a lot of independence in their teaching methodology and approached teaching on a personal level that resonated with the students. The classroom belonged to the instructor. Then, college level ambulance educators were designated “Teaching Masters” and came from ambulance backgrounds into the classrooms with an abundance of practical ambulance experience, knowledge and enthusiasm to teach and prepare us for the realities of the road. Many instructors had little or no post-secondary education and little, if any, teaching experience but were naturals in the academic arena. Many had graduated from the original Canadian Forces Base Borden Fundamentals of Casualty Care course, Ontario’s first organized prehospital care credential. Many personally met Dr. Norman McNally, the originator of the first formal training program for ambulance personnel in Ontario. Classroom technology consisted of chalk and blackboards, 16 mm movie projectors and overhead projectors. And lectures went on with few educational adjuncts. The instructor was the main deliverer of knowledge. There were few student expectations in educational delivery. They looked to the person in front of the classroom. They listened, wrote their notes, practised their skills and learned. With limited college budgets, EMS equipment in the classroom was just as much borrowed or gifted to the program from the services as it was purchased through formal college channels.
Field placement was considered, as it still is today, the real classroom, where we learned from the masters on the road. Crew attitudes on the road at the time reflected those from an older generation, with different values, different approaches and different expectations in training ambulance students. They were committed to train the next generation. There few formal contractual agreements between the college and the services. Crews that took on students did so out of tradition, favours to old friends and colleagues and the altruism of “giving back” to the colleges. Ambulance crews saw themselves in a position to make a difference to the students and pass along their skills and experience.
There was a sense that we were just beginning to shift away from being mere technicians. The concept of ambulance profession was still in its infancy, but getting stronger. We were taught college curriculum to become Emergency Medical Attendants (EMA), the designation for ambulance personnel in Ontario at the time. There was no Emergency Medical Services but Ambulance Services; no paramedics but EMAs. Advanced Life Support, the precursor to Advanced Care Paramedics, was still new.
Today
Educators, curriculum and approaches to EMS education have changed significantly from earlier generations. Student expectations have also changed. Paramedics are no longer coming right off the road as experts in their field to the front of the classrooms and labs. Having only road experience is not enough. There is increasing demand for those who apply to become full-time college level paramedic program educators to already have, or obtain upon hiring, higher university credentials, with most job descriptions requesting a Masters degree or higher. The colleges look for the above academic credentials along with strong vocational skills, proven leadership roles as well as significant adult teaching experience. The old “Teaching Master” designation for college instructors disappeared and the title of “Professor” was implemented, not to imply senior academic credentials or standing, as in the university setting, rather, to reflect academic integrity and the shift away from the obsolete and somewhat discriminatory colonial title.
The paramedic programs in Ontario colleges are now two full academic years to accommodate the large body of existing material, addition of new material and the shifting of education away from the provincial Ministry of Health and long term care and into the college curriculum. The advances in curriculum are many, with major changes to reflect what the paramedic can now do in the field, including specific advanced medical procedures such as the use of symptom relief medications, Semi-Automatic External Defibrillation, initiation of intravenous fluids and more advanced airway skills. There are increases in sophistication of paramedic language and terminology. As medical knowledge increases and older medical assumptions and practices are improved upon, the colleges have to reflect those changes and advancements in their content. Knowledge has to be consistent. Where, in the past, medical assumptions and traditional knowledge tended to be the mainstay, today, there is more and more challenges to that very information with increasing research findings and the acceptance of evidence based medicine. The colleges sometimes have to race to keep up.
Today, the educator is no longer the sole deliverer of knowledge, as it was in the 1980s. Technology as a vehicle for curriculum delivery is in the forefront of EMS education just as much as the human educator. Blackboards and chalk have gone. PowerPoint presentations, Smart Boards, High Fidelity Simulation Mannequins and modernized labs are the standard and expectation. Greatly increased budgets for programs allow for the purchase of modern EMS educational equipment for the paramedic classrooms and labs. Increases in technology translate into the need for increased instructor education and knowledge on how to use that technology as an effective educational tool. With simulation mannequins costing in the tens of thousands of dollars, there is a great expectation that once purchased they will be used effectively in the classrooms and labs. With the technology comes costly maintenance and repair. The danger is that if the faculty is not trained effectively, or the program does not “buy in” to the technology, very large amounts of money will have been wasted and educational opportunities lost. Along with this comes the risk to the integrity and appearance of the programs in relation to other colleges around the province.
There is an evolution in college paramedic education to involve other programs and vested professions. They learn about Paramedicine through intra-cooperative learning opportunities. Paramedic programs are involved with Pre-Fire Education programs, Law and Security and Police Foundation programs through shared lectures and field exercises (Conestoga College`s cooperative learning exercises and training days with Baden and Palmerston Fire Services is an excellent example of this). The opportunities to participate in cooperative exercises not only creates more realistic learning opportunities, but also creates a greater sense of fellowship among the various groups at the student level, prior to their entry into the professions, counteracting intra-professional stereotypes, attitudes and biases.
Student expectations of their paramedic education have changed drastically as well. There is an expectation of excellence at the paramedic educator, program and institutional levels. Students have become much more sophisticated in their knowledge and use of technology in their education. Students are generations ahead of some of the older professors who are still behind the digital learning curve. Some professors have to catch up to the students to meet their technological expectations. Students look towards an inclusive education, with seamless connections between theory, labs, clinical, field experience and technology.
Last words
This June will have another generation of young paramedics graduating from the Ontario college paramedic programs. Paramedic education has evolved along with the generations of students. The educational experience is inclusive. Technology has advanced. Medical science has changed. The college system integrates all aspects of the educational process to better prepare the student for their future paramedic employment. With the inclusion of intra-professional activities within the college community and within emergency services and general health care communities, the students, upon graduation, have received an education as close to “the real thing” as possible. The grads of 2011 will certainly be very different from those that graduated along with me in 1984.
