Supporting EMS Education and EMS Instructors in Michigan

Practical CE vs. Competency Verification of Practical Capabilities

<< First  < Prev   1   2   Next >  Last >> 
  • 24 Apr 2017 10:08 PM
    Message # 4777537
    Dena Smith (Administrator)

    The discussion began at the Traverse City conference this past March.  The purpose of this forum is to gather ideas we can take to the EMSCC for consideration on what direction we may be to take on this matter.  What are your thoughts--required practical CE or practical skill competency verification?  This forum is open to all for responses and will be moderated by Board Member, Bob Cesario, with the intention that your comments be taken to the EMSCC/Education sub-committee. 

    Last modified: 24 Apr 2017 10:11 PM | Dena Smith (Administrator)
  • 25 Apr 2017 9:13 AM
    Reply # 4778320 on 4777537

    This is a great opportunity to follow up on the discussion we had at the spring conference. I think the LSAs and MCAs are doing competencies already. The topic of eliminating the requirement came up at the strategic planning session held at Livingston County EMS. I look forward to reviewing our membership's thought's.    

  • 25 Apr 2017 9:24 AM
    Reply # 4778341 on 4777537

    It appears likely that the issue of practical credits may come to the table at the May 19 EMSCC meeting.  All members, please offer your thoughts and engage is the discussion, so Steve Myers and myself (our EMSCC reps) can accurately reflect our organization's desires if it comes to a vote.

  • 04 May 2017 11:36 AM
    Reply # 4814436 on 4778341
    Dena Smith (Administrator)
    Eric Smith wrote:

    It appears likely that the issue of practical credits may come to the table at the May 19 EMSCC meeting.  All members, please offer your thoughts and engage is the discussion, so Steve Myers and myself (our EMSCC reps) can accurately reflect our organization's desires if it comes to a vote.

    Is this an issue because it is sometimes difficult to obtain practical credits?  

    Or is there practice data that suggests that obtaining regular practical skill experience in an education setting validates providers' skills??  Or data/experience that it doesn't??

    Who should do competency evaluation??  Employers??  Do our licenses imply competence more than other licensed professions??  (I'm thinking not). 

    Just challenging us to produce a non-emotional argument to the EMSCC. 


  • 05 May 2017 2:31 PM
    Reply # 4816784 on 4777537

    My discussions with members have revealed a few thoughts. 


    1.  Practical was originally thought to equate competency.  It was widely thought that if someone attended a practical CEU session, they would be demonstrating competency in that category.  However, a provider could potentially sit at a table with an airway manikin and spend an hour cramming an OPA up the manikin's nose and get a practical credit.  In theory, we all agree this should never happen, but nothing prevents it.


    2.  Agencies and MCAs are charged with ensuring competency prior to letting someone practice.  That thought process discussed has been why look at a competency based CEU system, when agencies and MCAs have to do it already.  But that misses providers not practicing.


    3.  I  haven't heard of much difficulty in obtaining the practical CEUs.


    4.  The only opposition of eliminating practical CEUs I have heard of is from those who rely on providing practical CEUs for income. 


    5.  It is likely that the proposal to eliminate the practical CEUs will come with a limit to the number of online CEUs that providers can use to recertify.   Should this happen, even though the practical mandate is eliminated, it may mean that providers actually have to spend more face to face time to renew than currently with the practical mandates. 


    Just listing these random thoughts in random order. 

  • 05 May 2017 9:44 PM
    Reply # 4817371 on 4777537

    Eric - I agree with points 1-3. I think point 4 may be a misinterpreted concern. However, someone with true concern about this can speak to this, but anyone relying on providing practical CEU as part of their education business model can easily adjust what they provide to providing verification of competency for the employer or MCA for their personnel. Leading to your point in 5 and reflecting back to 2, that the MCA's and agencies already do this regularly. Suggesting we eliminate the practical CEU really should be to align it with the verification of competency as the NREMT does with this process. My personal opinion would be to have a system that mirrors how the NREMT requires validation of practical competencies.

  • 06 May 2017 10:14 AM
    Reply # 4818008 on 4777537

    Looking at this with my usual naivete (tiny rural corps), I wonder why anyone would WANT to eliminate the practical component.  Continuing education just isn't that difficult to achieve, even here in the sticks, and we have three years in which to do it.  What's the big deal about it?

    Any educator can cheat at any of this, whether it's an agency, an MCA, or a CE sponsor confirming competency.  Short of having a state inspector at every single class, there's no way to eliminate that sad possibility, and probably not even then.  Requiring or not requiring practical credits certainly won't change it.

    I've heard people say that they perform these skills all the time in the field, so why should they have to test out on them?  But why SHOULDN'T they have to?  If they're so wonderful at doing the skill, what's the big deal about demonstrating that to someone once every three years?

    I've also seen experienced, working paramedics at conferences using a BVM wrong, practically inflating a patient or not getting a good seal.  Just because someone is doing a skill in the field all the time doesn't mean they're doing it RIGHT.

    What am I missing here?  Why do people want to eliminate practical credits?


  • 07 May 2017 10:55 AM
    Reply # 4819040 on 4777537

    A couple of points:

    Eliminating practical CEs seem counter-intuitive to everything we learned during the research involved in the MI-MEDIC; where realistic hands-on training was significant in the student's improvements in medication administration.  

    Many organizations have moved to human patients simulator (HPS) for their training based on best practices and evidenced based studies.   

    Not every licensed EMS provider in Michigan functions under a MCA/LSA.  This trend is only increasing in recent years, especially paramedics and EMTs working in emergency departments.  Regardless all licensed EMS providers are required to obtain continuing education.  So having practicals in their CE requirement will help avoid providers from falling through the cracks.  

    Who doesn't function under a MCA or LSA: ED paramedics, in-hospital based paramedics (high-risk intra-hospital paramedics -UoM SWAT for example), paramedics who are not practicing as paramedics but still hold the EMS license (nurses in hospitals, ED techs, patient care techs, unemployed paramedics, or EMS educators who no longer practice EMS and teach for an educational institution that is not a LSA). 

    Additionally, for those fire department providers who are paramedics and work for LSA at the BLS level, how would you propose ALS competency verification at the MCA/LSA level for these providers if the CE practical requirements are removed?

    Would the MCA/LSA competency verification be a condition of re-licensure?  I would strongly urge caution due to a large number of providers who do not function under a MCA/LSA or who hold an ALS licensure and work for a BLS agency.  If you are going to require a competency verification as a condition of re-licensure it should allow for the flexibility to have it verified at a MCA,  LSA, or Michigan EMS CE based verification process level (Individual IC, EMS CE Sponsor, and Initial EMS Education Sponsor).

    Correctly done, practicals are great learning experiences for both the instructors and students.  I haven't had one practical CE were I didn't learn something as a student or as an instructor.  While practical CEs are harder to organize, more expensive and requires more work from the agencies, instructors, and students; in the end, practical CEs, are beneficial to the provider, their agencies, and our communities by having providers who regularly have hands-on training and practice.


    Dan Crots

    Last modified: 08 May 2017 10:17 PM | Daniel Crots
  • 11 May 2017 2:48 PM
    Reply # 4827515 on 4777537

    Practical CEs and Practical Competency Testing really are two different beasts, and I feel they should be addressed in very different conversations.

    First, practical CEs, in my opinion, are vital to continuing education.  We hear all the time about "those skills" that we rarely perform in the field.  Having an opportunity to refresh one's skills, hands-on, is a way to deal with that.  To refute the argument :"I do those skills all the time..." - practical CE's are a great way to make sure that those skills are being done correctly, and not falling prey to laziness, shortcuts, or the like.

    Second, Practical Competency Testing seems like it would be a win for everyone.  Sitting through a practical CEU provides instruction/refresher training, etc.  While there is typically some type of an assessment, they don't typically provide the stress levels that many feel when testing, especially when there's a lot riding on being successful. It seems that requiring a type of competency testing on an annual or even bi-annual schedule would just up the quality of care providers in MI.

  • 18 May 2017 8:01 PM
    Reply # 4840981 on 4777537

    I question Eric Smith's point #1 as to why practical credits were adopted.  Although there was some discussion of "competencies" the biggest issue, if I recall correctly, was establishing a mechanism so providers could not obtain all their CE's online.  

    Years ago, while as the Education Coordinator at AMR-West Mi, we applied for (and it was approved) to issue practical credits for documented field performance (the same thing that was done for "Advanced Airway") this included all categories of "required" practical credits.  The criteria required was a minimum of 10 successful performances of a skill, as documented on the PCR.  This worked for a higher volume EMS system but could be challenging for a low volume system .  This could be modified by using high and/or low fidelity simulation and have the skills performed and documented (not minimum or maximum "seat time")

    We have been told, under previous administrations, it is not the responsibility of the State to ensure competency but the responsibility of the MCA and/or the employer. It makes sense we expect/accept demonstration of competency over "seat time"  

    To Danial Crots observation regarding the Mi-Medic research, he has a valid point but given the current mandatory practical CEU's requirements it does not address the competency aspect.  50 minutes of "classroom skills perfomance" time does not equate to competence of performance of skill yet one could say someone could demonstrate competency of a skill (e.g. pediatric assessment) in less than 10 minutes. 

    Even the National Education Standards have eliminated the minimum hours and has gone to objective based outcomes.  It makes sense to adopt this principle in Michigan CEU's, especially since Michigan has adopted the National Education Standards.

    Keep in mind this response is in part historical and part opinion and coming from a Michigan IC who is not "practicing" in Michigan let alone living in the Mitten state.

    Good luck!


    Last modified: 18 May 2017 8:08 PM | David Maatman
<< First  < Prev   1   2   Next >  Last >> 

The Society of Michigan EMS Instructor Coordinators.  All rights reserved.
33365 Raphael Road
Frarmington Hills, MI 48336

email the SMEMSIC office: 

Powered by Wild Apricot Membership Software