Stress, Emotion, and Learning: Considerations for the EMS Educator

Educators charged with teaching the next generation of EMS providers must prepare their students with an expansive repertoire of knowledge and skills and often must do so in a short period of time.
To further complicate this challenge, they must ensure their students are capable of proficiently functioning in a highly dynamic environment. They know these students will be frequently exposed to a multitude of stressors (e.g. loud noises, poor lighting, & chaotic events), and in the face of such stressful environments, they will be expected to quickly and competently make decisions affecting life or death. This presents a fairly unique challenge for EMS educators: How do we prepare individuals to function capably in such an environment when similar exposure during the educational process can compromise learning?
Neuroeducation and Learning
Educational best practices have previously relied on anecdotal observations. Luckily, the field of education is slowly being informed by the study of neuroeducation. Neuroeducation is one of several names referring to “an interdisciplinary field that combines neuroscience, psychology and education to create improved teaching methods and curricula.”1 When properly interpreted and applied, this newfound knowledge can provide educators with insight into the process of learning.
Neuroeducation shows us that learning is more than simple memorization; it is a process resulting in being able to make sense of things.2 Evidence from the field of neuroscience shows that learning is the result of chemical changes in our brain known as neural or synaptic plasticity.3 These changes involve the structuring and restructuring of connections between neurons (i.e., synapses). With repeated exposure, these connections are strengthened and learning occurs. Researchers have described how these connections are not permanent once established, but rather can strengthen (a.k.a. potentiation) or weaken (a.k.a. depression) over time.4
Stress & Emotion
From a conceptual perspective, stress has been described as an increased demand for mental or physical productivity; however, from a physiological perspective, stress refers to a heightened state of arousal.5 We refer to those factors that induce stress (i.e., challenges and conflicts) as stressors. Similarly, emotions are those feelings (e.g., fear, anger, sadness) that characterize our state of mind. Together, stress and emotion induce protective mechanisms within our bodies that are regulated by the nervous system. While these mechanisms help us avert perceived threats, they can also compromise higher-level cognition.6
The Stress-Emotion Connection
The reaction that an individual experiences in response to stressors is driven by the activation of our autonomic nervous system (ANS). Exposure to stress and emotion results in the release of stress hormones (cortisol, adrenaline and noradrenaline).5 These hormones are then responsible for the fight-or-flight response.7
While it might be tempting to focus singularly on stress or emotion as a factor affecting learning, such a task is complicated by the similar characteristics of stress and emotion. Emotions are often prompted by stressful events (e.g., fear or joy), yet the experience of a particular emotion can itself trigger a stress response.7 From this perspective we can see the shared properties between emotion and stressors: both have an identifiable source, involve an intense experience of short duration, and create physiologic changes in our bodies. Lupien et al. suggests this interconnected relationship as the reason most literature on stress, emotion, and learning fails to distinguish between the two.
Effects on Memory
A great deal of literature addresses the effects of emotion and stress on memory. Some sources report the detrimental effects of stress, while others suggest memory and learning can be enhanced by stress. Researchers have attributed such variations to the source of the stress (e.g., physical, cognitive or emotional), as well as the stage of learning at which the stress is introduced.5
It has been argued that stress could sabotage our high level cognition, thus blocking memory and subsequent comprehension.2 This is attributed to narrowed attention (i.e., tunnel vision). When faced with fear-related stress, our executive function is diminished and we resort to a low-level survival response. Such stress is often associated with taking tests and speaking in front of others.2
Other research reminds us that memory and learning are also dependent on attention.5 In the absence of all stressors, it is likely that students will not pay attention, thus they will not be able to recall the information presented to them.
In addition to the effects of various levels of stress on memory and learning, it appears the timing of such stress must also be considered. Stress that occurs prior to the intended learning (e.g., anticipation of stressful event) can impair memory formation, while stress that occurs during learning and in the context of what is being learned can enhance learning.5 Schmidt and Schwabe reiterated those findings and further described the need for such stress to be short-lived. They added that chronic or repetitive stress, even if short-lived, would not result in enhancement of learning.4
Through careful consideration of the effects of stress and emotion on learning, there appears to be a few ways in which we can improve the effectiveness of our instructional efforts. These efforts should be focused around establishing an appropriate balance of stress in the classroom, appropriate use of emotional hooks, improving stress tolerance, and repetition of psychomotor skills.
Balance in the Classroom
It is important to recognize that many students come to us with the preexisting self-identity of a poor learner.3 These individuals often possess negative memories associated with past learning experiences, which alone can trigger detrimental classroom stress. Researchers suggest this can be reduced over time through a process of mentoring, but we must also provide a safe learning environment so that new experiences can challenge existing knowledge.3
In order to provide a safe learning environment for all students, EMS educators should encourage small-group work. This can help students gain confidence and avoid feelings of judgment they might associate with working in larger groups. It is also important to avoid singling students out in front of their peers and to avoid classroom tactics (e.g., the absence of routine) that can lead to anticipatory stress.
Conversely, educators must be careful not to completely eliminate stress from the classroom environment.
Repetition
We have all heard the expression that “practice makes perfect.” With this consideration, it is reasonable to believe that students who are well drilled in psychomotor skills will fall back on that subconscious knowledge when an acute stress reaction reduces them to lower levels of cognition. This becomes even more important for rarely encountered skills.
The downside of repetition is that students can easily become bored. To overcome this, it is helpful to make a game out of it. Challenge students to see who can correctly perform a particular skill in the shortest time or who can correctly perform the skill the most times in a row without making an error. Given the personalities that we typically find in our profession, your students will likely lose sight of the “boring practice” and focus on winning the contest.
Stress Tolerance
Some educators might resist the notion of minimizing stress in the learning environment with the belief that they would be doing a disservice to future EMS professionals. I once shared this perspective and believed that training under stress equated to better performance under stress. There is no evidence to support this notion; however, we have seen evidence to the contrary.
Much of the performance detriment associated with an acute stress response can be attributed to feelings of loss of control.8 Individuals who feel like they are in control are less affected by stress. They suggest that since we cannot remove the stressors from the environment we must instead focus on improving stress tolerance. Improvement of stress tolerance is not accomplished through chronic exposure to stress, which has an opposite effect, but rather through self-evaluation and enhancement of emotional intelligence. EMS educators should therefore see a greater understanding of the concepts underlying emotional intelligence and seek ways to incorporate those concepts into their curriculum. This combined with repetition of skills performance will best prepare our students to function effectively in a stressful environment while avoiding the application of such stress in the classroom.
Conclusion
It is important for educators to avoid the inappropriate application and induction of stress and emotion. It is not necessary to train students under stress in order to prepare them to work in a stressful environment. Rather, by providing our students with an emotionally stable learning environment, we will be able to capture their attention and successfully provide them with the knowledge necessary to function as an EMS professional.
References
1. Mehta A. Neuroeducation emerges as insights into brain development, learning abilities grow. The Dana Foundation. www.dana.org/news/brainwork/detail.aspx?id=22372.
2. Caine G, Caine RN. Meaningful learning and the executive functions of the brain. New Directions in Adult & Continuing Education, 2006, 110, 53–61.
3. Cozolino L, Sprokay S. Neuroscience and adult learning. New Directions in Adult & Continuing Education, 2006, 110, 11–19.
4. Schmidt MV, Schwabe L. Splintered by stress. Scientific American Mind, 2011, 22(4), 22–29.
5. Lindau M, Almkvist O, Mohammed AH. Effects of stress on learning and memory. 2007, 571–577.
6. Willis J. The current impact of neuroscience on teaching and learning. In Sousa DA, (Ed.). Mind, Brain, & Education: Neuroscience Implications for the Classroom. Bloomington, IN: Solution Tree Press, 2010.
7. Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE. The effects of stress and stress hormones on human cognition: Implications for the field of brain cognition. Brain and Cognition, 2007, 65, 209–237.
8. Delahaij R, Gaillard AW, Soeters JM. Stress training and the new military environment. In the proceedings of: Human Dimensions in Military Operations–Military Leaders’ Strategies for Addressing Stress and Psychological Support, 2006
bibliography
Carter R, Aldridge S, Page M, Parker S. The Human Brain Book. New York: DK Publishing, 2009.
Davidson PS, McFarland CP, Glisky EL. Effects of emotion on item and source memory in young and older adults. Cognitive, Affective, & Behavioral Neuroscience, 2006, 6(4), 306–322.
Draganski B, Glaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: Changes in grey matter induced by training. Nature, 2004, 427(22), 311–312.
Gordon D. (Ed). Cerebrum 2010: Emerging Ideas in Brain Science. Washington, DC: Dana Press.
Kuhlmann S, Piel M, Wolf OT. Impaired memory retrieval after psychosocial stress in healthy young men. Journal of Neuroscience, 2005, 25(11), 2977–2982.
Olsson A, Nearing KI, Phelps EA. Learning fears by observing others: The neural systems of social fear transmission. SCAN, 2007, 2, 3–11.
Volkow ND. Challenges and opportunities in drug addiction research. www.dana.org/news/cerebrum/detail.aspx?id=25802.
Vook. Neurology: The Guick Guide. Vook, Inc., 2011.
Zull JE. Key aspects of how the brain learns. New Directions in Adult & Continuing Education, 2006, 110, 3–9.
Elliot D. Carhart, MHS, RRT, EMT-P, EMT-T, is an assistant professor of emergency services at Jefferson College of Health Sciences in Roanoke, VA. He is currently an EdD candidate at Nova Southeastern University, where his studies have focused on healthcare education. He is a former firefighter/paramedic, registered respiratory therapist, and has experience in tactical EMS and technical rescue. Contact him at carhart.elliot@gmail.com.