ADVERTISEMENT
Teaching Affective Concepts in the EMS Classroom
As educators we have all heard about the cognitive, psychomotor and affective domains. Our old curricula were built around objectives in those categories. The curricula have gone away but the need to teach in all domains hasn’t. One of the most challenging things to teach is the affective domain. This is for many reasons. It may seem a bit amorphous to some—and it seems the cognitive and psychomotor take most of our time and attention. From the attributes of an EMT to dealing with the geriatric patient, affective concepts are part of what we do—and teach. I wrote this article some time ago—and I think I have embraced the concept of teaching the affective domain even more with experience.
When our students are asked, "Why do you want to be an EMT?" we often hear the reply "because I want to help people." The act of "helping people" is at the core of what affective objectives drive at: the feelings, emotions and attitudes involved in the delivery of patient care. These objectives are much more difficult to teach than cognitive knowledge or psychomotor skills, but they are vitally important.
Almost every EMS service has a bulletin board where letters are posted that compliment a crew on the care they gave. These letters talk of "taking care of me" or "being there for my mom when she fell." Rarely, if ever, do they comment on astute clinical care or decision-making under pressure. To patients, the time spent in your presence is an experience almost totally in the affective domain.
We know that patients freely recommend marginal clinical practitioners to their family and friends. And patients are less likely to bring a lawsuit against a clinical provider whom they believe cared or listened - even when a mistake is made.
So the affective domain has tremendous value to our students. Why, then, is it so difficult to teach these objectives or to have our students appreciate this important concept? There are obvious answers to some of these questions: Time is short. Students struggle with airway, assessment and traction splinting (to name a few). Affective objectives don't have great value when studying for the NREMT exam. It is also much cooler to practice skills—especially when using things with giant, important names like sphygmomanometer—than to talk about feelings. And many of our students have never seen a critically ill person. They have never been in the kitchen with a family member whose loved one is deceased in the bedroom.
In short, it doesn't always seem like a priority.
Do feelings have a place in clinical medicine? The clinical intuition we desire in our students and providers has a strong affective component. For a practitioner to let go of bulleted lists of signs and symptoms - or to combine or apply these on the fly to get an accurate, intuitive and rapid decision - involves the affective domain. No one will ever develop a gut feeling unless it is accepted that the concept of accurate feelings has a place.
Affective objectives are, in fact, interwoven throughout our clinical and interpersonal patient care roles. This column explores ways to not only teach, but to bring acceptance and validation to the affective domain.
Values
One component of the affective domain is values. We all intrinsically believe that a core set of values is necessary to be a caring and compassionate provider and team member, but what are those values and how do we bring them to our students' attention?
EMS educator Chris Le Baudour, working with an EMT class at the Santa Rosa Junior College in California, came up with an exercise to teach the values of values. The exercise involves students working with a set of 36 "values" that are provided to them on cards. Blank cards can be used to add values students wish to use. Ask your students to choose the five values that best represent them as individuals. Allow them to discuss this among themselves, if they choose. Remember, discussing and defending a point brings a higher level of learning.
Once the students have chosen five cards, invite them to share their choices with others. Don't force students to share if they are uncomfortable doing so. You will have enough volunteers. Discussing why some values were chosen over others is only the beginning. This exercise comes with a long-lasting message. The letters in the words "I CARE" actually stand for integrity, compassion, accountability, respect and empathy - core values identified by Le Baudour's students. One of the students in that class found a lapel-type pin with the message "I CARE." A teaching assistant, who was also a local businessperson, donated pins for the class. In each subsequent class, students were asked to tell a story of an act by another student or faculty member that met one of the core values. By the end of the class, all students had been pinned—and given a dynamic and lasting education on what values in EMS truly are.
Putting a Face on a Disease
We talk about signs and symptoms, assessment and treatment. We talk about the "COPDer" we had last night, but teach little about a disease's true effects on a patient. The following exercise is designed to put a human face on a disease.
Use a complaint you are teaching in class, like a respiratory or cardiac emergency. Anaphylaxis also works well, but is more of a challenge to find.
At the end of a class, send your students out with a homework assignment - for example, to find a person with a respiratory problem. It may be a friend with asthma or a parent/grandparent with COPD. Have your student respectfully ask the following questions to that person when he/she is free of symptoms:
- Can you tell me about your breathing problem, disease, etc.?
- What happens when your condition worsens?
- Do you take any medications for your condition?
- Do the medications help? How do you feel afterward?
- Is there anything you can't do because of your condition?
By doing this, your students have used an open-ended question (question 1), learned signs and symptoms (question 2), linked a medication to a problem (question 3), learned what happens when medications are taken (question 4) and learned about how the disease affects the patient's life (question 5).
In the next class session, ask some of your students to share their experiences. Take the opportunity to highlight some of the affective points, such as how the disease has affected the patient's life. Note that each interview was a person, not a disease. In this exercise, your students not only explored affective concepts, they also had the experience of practicing components of a medical history in a safe environment. This is good practice for a skill that causes serious anxiety and confusion in early practice.
These are two examples of ways to integrate true affective education into your classroom. There are many more excellent ideas out there.
