Supporting EMS Education and EMS Instructors in Michigan

Practical CE vs. Competency Verification of Practical Capabilities

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  • 04 Aug 2017 3:44 PM
    Reply # 5012650 on 4777537

    Practical CEs are necessary and relevant.  People that do not have a chance to practice their skills in the field not only refresh but improve their hands on techniques.  It is also a way to introduce new methods and correct bad habits.

    Pushing this out to MCAs (we have 45 agencies) may not have the positive effect you are looking for either.  Although some PMDs are or have been more involved then others, it still remains a proven fact that practical examination is a stressful environment that requires the opportunity to practice prior to testing.  

    The lack of interest in EMS education with fewer ICs can make it harder to supply those practicals but it is well worth the effort once done.

    I believe we should keep them until we can come up with a suitable alternative.

  • 22 Aug 2017 8:07 PM
    Reply # 5042648 on 4777537
    While all of you make valid points on the practical CE's, I do not believe that the unavailability of practical credits is an issue. Our biggest problem is that we have no true grapevine that allows our EMS personnel to know when these classes are available. We need one source that advertises what our IC's are doing across the state. The Fire and Ambulance Services that only teach their own employees need to reach out and allow others to be a part of their instruction, especially with practical CE's. I have held several practical credits in Big Rapids, at MI EMS Education LLC and have received very small numbers for my efforts. I've advertised on radio, in newspapers, through emails and still I am not able to fill my classroom. I could sure use help in this area.

    Now why do practical CE's matter? Remember what drew many of us to learn in the EMS classrooms was the  hands on learning experience. A majority of our EMS and Fire personnel are applicatory learners and not so great with online courses and textbooks. I'm not saying that we're dumb, but I am saying that the practical learning experience enhances the meaning of why we do or do not use certain maneuvers, drugs, equipment, or techniques when handling patients and it's the practical classroom setting that teaches us this. It also give us the opportunity to learn new equipment like the CAT Tourniquet, new ways to obtain bleeding control, or any changes in our local or state protocols. As an NREMT examiner, I often ask my peers why we do not use the "Trendelenburg Technique," anymore, which works great for getting blood immediately to the brain where it is often needed. Very few of my peers have been able to answer this question. I know that the practical research behind it has proven that the horizontal position is equal to the Trendelenburg. Many of us old time Paramedics will disagree with this part of the research (just ask anyone who's quickly awakened a patient from a syncopal episode). The problem, also through research, tells us that the lifting of the legs sends the blood from the feet towards the heart. Prior to reaching its destination; however, it pushes up against the internal organs, which in turn push up against the diaphragm, causing an artificial breathing problem and that's why we don't use the Trendelenburg Technique. Through a practical setting, we can work with our classmates and mannequins to learn IV starts, medication administration, and any other techniques that would be difficult, at best, to learn through verbal instruction. Therefore, it is my humble opinion that we need practical CE's for a better understanding of lecture education material. 

  • 05 Oct 2017 2:19 PM
    Reply # 5297132 on 4819040
    Daniel Crots wrote:

    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

    Well said.

    I'd like to add that medical simulation wouldn't be taking off if there was no value found in 'hands on training'. Practical training isn't just for initial education and competency initiatives need to be strongly designed and refined before they can be valid/valuable.

    Last modified: 05 Oct 2017 2:38 PM | Maria Willoughby-Byrwa
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