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Becoming an Education Architect
Developing a high-caliber training program takes considerable planning. From assessing training needs to developing objectives, lesson plans and course materials, training officers continuously look at the structure of programs and fine-tune the processes. In 2004, Florida college professors Walter Dick, Lou Carey and James Carey developed a model for designing training programs called the Systematic Design of Instruction.1 A schematic adapting the approach is shown in Figure 1. This article discusses sections of the model and provides EMS educators with ideas to assist them in developing training programs for their EMS crews.
Training Needs
Before creating a new program, the EMS training officer must conduct a needs analysis and assessment, set goals for the training program, and determine for whom and where the training will be conducted.
Identifying the topics to be taught is referred to as conducting a needs analysis or needs assessment. While often used interchangeably, these two concepts are significantly different. According to training consultant Donald J. Ford, a needs assessment consists of identifying the knowledge, skills and attitudes (KSA) that are needed to perform the job.2 The needs assessment also seeks to identify gaps in those KSA that must be filled so employees are performing at the same or a standardized level. In contrast, a needs analysis determines if training or some other intervention can resolve performance problems or create a change in performance based upon the needs of the EMS system.
Needs Assessment
In EMS, the required KSA are set by the national standard EMT and paramedic curricula, as well as by state and local laws and rules.
A needs assessment will determine the KSA for a specific EMS provider. Thus, the training officer must identify the knowledge, skills and attitudes that all employees must have in order to perform at the entry level for that specific employer. When performance gaps are identified, training is often provided to eliminate the deficiencies.
In conducting a needs assessment, human-resources consultant Robert Rouda and professor Mitch Kusy suggest that the training officer evaluate the current state of KSA within the EMS provider by examining base-level requirements compared with the current performance level.3 They also suggest that the training officer look for problems or performance gaps, such as variations from benchmarks. For example, if the endotracheal intubation rate for the provider is low (<80% success rate), an in-depth assessment should be performed to identify causes of the deficiency and the need for remedial training. Impending change, new directions and mandated training are also part of the needs assessment. New guidelines for CPR and emergency cardiac care may require a training intervention just to bring all personnel up to date.
All essential knowledge, skills and attitudes must be listed and compared to current performance. Skills checklists may be useful in evaluating performance benchmarks of a given organization. Further, a brainstorming session involving management and field personnel can help identify KSA that are critical to the success of the EMS organization.
Needs Analysis
In contrast to a needs assessment, a training needs analysis looks at four areas of the organization. According to performance consultants James and Dana Robinson, the four areas of need in an organization include:4
- Business needs such as obtaining correct billing information or enhanced customer service
- Performance needs such as reducing reaction or response times
- Training needs that enhance job knowledge and, ultimately, patient care
- Work-environment needs such as equipment that will facilitate or enhance care.
Human-resources specialist Jeannette Swist offers five reasons for a needs analysis that include determining if training is relevant to the employee's actual job, determining if training will result in improved performance, evaluating the effect of training on patient care, separating training needs from management problems and linking between the EMS provider's goals and visions with job performance.5
- Is the training relevant?
Assume a request is made for training on CPAP (continuous positive airway pressure), yet the EMS provider does not currently carry CPAP equipment and does not anticipate purchasing the machines. The training in this situation is not relevant to the job and would not be cost-effective. - Will performance improve?
In evaluating proposed training, will it enhance the knowledge or skills, or have little or no impact on job performance? For example, if proposed training focuses on pediatrics, yet the primary response area is located in a retirement community, performance may not improve. - Will the training enhance patient care?
Training based upon the needs of the community can make a difference in overall patient care. For that crew stationed in a retirement area, training on geriatric emergencies can make a difference. - Is training separate from management problems?
Often, training is used to correct a behavioral problem or, in some cases, manage the employee out of the organization. The purpose of training is performance improvement, not to replace a management decision for a behavioral problem. - Is training linked to the goal, mission and vision statements of the EMS provider?
Typically, EMS training is linked to the department's goal, mission and vision statements. While training programs keep the strategic plan of the organization in mind, linking training to the organization's goals has less importance than the other four. Reed Training discusses the importance of aligning training with the goals and objectives of the department to ensure that any training will be specific to the organization and meet the needs of the business.6 Considering needs assessment and analysis, Reed Training proposes its Accelerate Model, composed of six stages. Figure 2 summarizes the first three stages of this model as it pertains to initial training program design.
Conducting a Needs Analysis
A training needs analysis consists of one or more techniques to get a clear picture of actual needs. Here are some examples of techniques that can be deployed:
- Direct observation
Direct observation can yield interesting results and is an excellent tool for identifying performance gaps. Unfortunately, it can be intimidating. The presence of a training officer evaluating patient care on scene can be unnerving to some EMTs and paramedics and may ultimately affect their performance. - Surveys
Surveys, especially those with in-depth questions, can help identify areas of needed or preferred training. Author Peggy Sleeth suggests that surveys query about training needs, who would receive the training (EMTs, paramedics, officers, clerical staff, etc.), the type of information being requested and where to find the information, including subject matter experts, library, Internet, etc.7
Training expert Denise Ruggieri suggests that a survey can include both closed- and open-ended questions, but warns about the limitations of each.8 Closed-ended questions make tabulating the data easy, but can limit the results or restrict ideas. In contrast, open-ended questions allow the introduction of concepts that may have been overlooked. Ruggieri also emphasizes keeping surveys short. The longer the survey, the less likely employees will take time to respond. - Consultations
Consulting with management or subject matter experts can offer training ideas. Interviewing employees, supervisors and subject matter experts can be beneficial; however, interview questions must be crafted beforehand. This is particularly true when a supervisor or chief wants the training officer to solve a perceived problem. Should this occur, the training officer needs to determine if a training intervention is really the answer, or if the solution to the problem lies somewhere else. Questions for the supervisor can include: Can you describe the problem? Specifically, what did you observe and why do you feel that it is a problem that requires training? Can you address what, where and how the observed performance deviated from expected performance? Has this problem occurred before, and how often? Has the employee been counseled about the problem after prior instances? What do you see as the desired outcome if training is provided? - Focus groups
Focus groups can gather input from a number of employees in a given setting and identify problems or training needs before they are recognized as such. Advantages of a focus group include high efficiency in collecting information over a short time and a degree of quality control and reliability of the information gathered. However, focus groups have disadvantages, including limiting the number of questions that can be covered and inadvertent diversions. - Written or skills evaluations
Training officers can administer written or skills evaluations to identify weaknesses or deficits in performance; however, limitations include the type of format, as well as subjectivity or objectivity of the examination. - Patient care reports
Finally, patient care reports offer a retrospective review of on-scene performance, provided the reports are properly documented. Patient care reports can reveal deficiencies in treatment or inappropriate treatment in given situations. Further, poor documentation may be evidence of a training need, especially if poor documentation is chronic. Review of patient care reports should be a continuous process, not one that takes place periodically. If patient care reports and tabulating statistics are not computerized, quarterly data collection can be tedious and subject to potential errors.
As the training needs assessment and analysis are being conducted, the overarching goal of the training session will become obvious. Once the goal has been established, the training officer can move to the nature of the learners and location of the training session.
Who Will Be Taught and Where?
Another key component in the early stages of instructional design involves identifying who will be taught and where the training will take place.
The approach to the adult learner in the classroom is considerably different than for children. These differences are important, since adult learners come to class with a different attitude toward learning. In his book Modern Practice of Adult Education, first published in 1970, Malcolm Knowles popularized the term andragogy to reflect teaching of adults.9,10 Various authors have argued the points that Knowles discussed, yet four basic assumptions of andragogy have persisted through the years:
- Adults want control of and responsibility for their learning.
- Adults bring various life experiences to the classroom.
- Adult learning is often problem-centered.
- Adults are motivated to learn from within--intrinsic motivation.
Based upon these general teaching premises, the training officer can develop a program to best suit the needs of his or her adult learners. It is also important to understand the different educational and experience levels of the group. Questions to consider include: How many learners are EMTs? How many learners are paramedics? How many learners have little or no EMS background (i.e., lay public)?
For example, when I taught a program for an ambulance service that advertised the program in the local newspaper, the audience consisted of EMTs, paramedics and the lay public. Being forewarned about the diversity of the group would have allowed for additional planning and preparation.
Where Will Training Be Held?
During the initial planning stages, the training officer needs to know the location of the class. Will the training session be located in a:
- Classroom
- Conference room
- Conference or classroom at the local hospital
- Field station for a small group
- Field station in a one-on-one setting?
The class location will give the training officer information regarding any limitations that may be imposed on the program. For example, some facilities easily accommodate audiovisual components, such as PowerPoint presentations, whereas other facilities, like a field station or on board an ambulance, may preclude their use. Other information gleaned from the type of facility includes the use of manikins, hands-on role-play activities and facilities that allow for breaks.
Summary
This article has discussed the concept of instructional design and the initial processes involved in creating high-quality, comprehensive training sessions that meet the needs of the EMS organization and its employees. Conducting a training needs assessment, as well as a training needs analysis, provides essential information about the types of training necessary to enhance overall performance. Additionally, knowing the audience and location for the training will afford insight into limitations on the program. This essential information leads to the creation of behavioral or performance objectives as the developing curriculum progresses.
References
Bibliography
Nixon RG. EMS Field Training Officer. Upper Saddle River, NJ: Brady/Pearson Education, 2004.
Rossett A. Knowledge Management Meets Analysis. Training and Development 53, pp. 62-68, 1999.
Robert G. Nixon, MBA, EMT-P, has been involved in EMS since 1971 and EMS education since 1974. He is currently manager of clinical and educational services for AMR in Connecticut and Western Massachusetts, and is president/owner of LifeCare Medical Training in Auburn, MA.
