Best Practices in CE

Juan March and Jay Scott are featured speakers at EMS World Expo, Sept. 15–19 in Las Vegas. Visit EMSWorldExpo.com.

The Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) was founded in 1992 under the vision and guidance of Janet Head, then president of the National Association of Emergency Medical Technicians (NAEMT).

Janet recognized that not all EMS continuing education (CE) was of a level or quality she would expect for practicing EMS providers. Thus she sought support from the leadership of other EMS leadership organizations such as the National Association of EMS Educators (NAEMSE), National Registry of EMTs (NREMT), American College of Emergency Physicians (ACEP) and National Association of EMS Physicians (NAEMSP). Together these organizations provided representation to the CECBEMS Board of Directors. Their collective goal became to raise the bar of EMS CE by setting standards and requirements and providing an accreditation service for EMS-based CE.

Among continuing education providers, a broad spectrum of CE delivery and educational methodology exists. Some CE providers (CEP)—i.e., services that offer CE activities to EMS providers (EMSP)—offer CE in the form of live lectures EMSP can sign up for and attend. Others provide distributed learning (DL) in the form of written-word-only documents tied to short post-tests. Some providers administer CE through online written-word activities, PowerPoint activities, short videos and video-based case studies.

While CECBEMS’ goal is to standardize EMS CE, consumers are free to pick and choose which format they would like to use for CE hours. Unfortunately, the culture of “faster and easier” permeates EMS CE to a degree, and the EMS industry as a whole will need to reject this philosophy as we look forward to creating a more professional profession.

Evolving Educational Technologies

In recent months, the CECBEMS Board of Directors has witnessed a technological evolution of DL activities available to EMSP. Some truly innovative DL designs have led to a shift in consumer/marketplace loyalty toward the innovation and away from the more traditional education formats.

Clearly, this new generation of EMS providers has greater access to technology that provides instant information at their fingertips, and they are not as interested in traditional education. Instead, they yearn for innovation, for “flash” and activities they can accomplish on the go without being tethered to a teacher or a classroom.¹

Accredited providers and CECBEMS accreditation applicants must commit significant resources to the production and delivery of the activities listed in their catalogs. High-quality CE activities are not inexpensive to produce regardless of the type of presentation. As [continuing education expert Chuck] Karayan stated, the quality of the presentation must meet or exceed the investment the student makes to view and participate in the activity.² It is in this light that the CECBEMS Board of Directors would like to highlight best-practice models in EMS CE accreditation, particularly where innovation is driving evolution in continuing education.

New CE Models

Virtual instructor lead training (VILT)

VILT is a new distributed learning technology that allows an instructor to present information by means of a lecture when students are only present in a virtual classroom. Students log in to the classroom and are able to view and hear the presentation. They interact with the instructor either by voice and webcam video or by typing questions in a fashion similar to a chat room. All pieces of the activity occur simultaneously. Students are typically assigned textbook chapter reading before the event. At the end of the session, the students are given a unique code that grants them access to a post-test.

Video-based training with supporting documents

This is a DL format in which the students watch video narration and case presentations. They are given supplemental reading and creative handouts to complete. After each step in the process, they are allowed to take a post-test for CE credit.

Integrated testing

Integrated testing ensures students complete the content requirements by writing the post-test into the content. In other words, a student progresses through an interactive video training program. At key points in the video the student is given a question or short series of questions that must be completed before the student may progress to the next section. Failure to correctly respond to the questions returns the student to the relevant section in the video so the content can be reviewed. The question is then presented again. This is a great way to ensure student participation.

Virtual graphics training with integrated testing

In this case, the DL provider offers a smartphone/tablet application that allows the student to interact with the presentation and practice skills. The student uses his/her fingers to interact in a case scenario that may require them to move equipment, prepare equipment, prepare a patient for a procedure, perform a procedure and evaluate a patient before and after each procedure is completed. This format also provides integrated testing such that each question reinforces the procedure or skill the student is practicing.

This educational format is very expensive and difficult to prepare, but the interactive nature of the presentation is portable and dynamic for the student. The area of virtual graphics training has great potential in the near future as technology advances and educators are able to integrate more sensitivity and complexity into the software.

Best Practices of CECBEMS-Accredited Applications

The involvement of a qualified medical doctor (MD) is integral to the success of any EMS education program. CECBEMS requires that an MD sit on the program committee and expects that the MD will review each and every activity before the CECBEMS application is complete and before it is made available to the EMS community. The MD must ensure accuracy and relevance of each activity delivered.

Aggregate needs assessments can be carried out that review the nature and breadth of an EMS service or EMS service area to determine the educational needs of a large group of EMS providers. Needs assessments can be produced by survey of what EMS providers feel they need; review of EMS call data; review of quality improvement data; review of patient outcomes; and review of population demographics. Needs assessments can also be carried out on an individual level. In these cases, the criteria listed above are reviewed and applied to an individual EMS provider and a custom-tailored CE program is identified, defined and initiated.

Accreditation Delivery

CECBEMS, by its charter, maintains the standards for the delivery of EMS CE. Those standards include requirements for active medical direction, valid post-tests, quality infrastructure, sound educational design including delivery methodology, marketing, fees, evaluation, student record-keeping and data reporting.

CECBEMS accreditation exists so that EMS providers have access to high-quality standard-driven continuing education activities and are awarded credit for participating in such activities. One of the greatest challenges of delivery of CECBEMS accreditation is ensuring that CE providers accurately report the names, certification numbers, certification state, activity numbers and CEH hours earned by subscribers (EMS providers). It is of the utmost importance that CE providers accurately report data to the CECBEMS data management center so each and every EMS provider gets credit for the CE they complete. CECBEMS depends on the quality of the data it receives. EMTs and paramedics depend on CECBEMS to provide accredited programs that are less likely to be subject to audit by the National Registry of EMTs or individual state EMS offices.

Much work is being done to make the assignment of CEH objective and accurate but the subjectivity variable will always be present to some degree. CECBEMS expects that all continuing education content is:

• Relevant for the intended audience;
• Medically accurate;
• Properly referenced;
• Original work that is correctly cited;
• Grammatically correct with accurate spelling;
• Not misleading.

CECBEMS also requires the following:

• Providers will cite and reference recent peer-reviewed journals as much as possible;
• Content areas cannot be skipped and post-tests cannot be completed until the content has been viewed;
• CE hours will be correctly applied. For example, a provider will not award 2 CEH for a 20-minute activity;
• Student activities and interactions will be recorded, tracked, analyzed and reported to the CECBEMS data management system;
• Students will be required to evaluate the program on completion of the lesson;
• The program committee will analyze the evaluations to make decisions on how they need to improve their activities;
• Needs assessments are performed and their results are applied to future educational content.

This article is taken from CECBEMS’ Best Practices in Continuing  Education document available for download at https://cecbems.org.

References
1. Aran Levasseur. Teaching Innovation Is About More Than iPads in the Classroom. Media Shift, www.pbs.org/mediashift/2012/07/teaching-innovation-is-about-more-than-ipads-in-the-classroom198/.
2. Chuck Karayan. The Problem with Continuing Education. American Surveyor, www.amerisurv.com/PDF/TheAmericanSurveyor_KarayanTheProblemWithContinuingEducation_May2005.pdf.

The CECBEMS Board of Directors includes Juan A. March, MD, FACEP, chair; Robert A. Loftus, BS, NREMT-B, vice chair; Sean Trask, MPA, EMT-P, secretary-treasurer; Richard Beebe, MS, RN, NREMT-P; Stephanie Davis, DO, FACEP; Andy Gienapp, MS, NREMT-P; Joe Holley, MD, FACEP; Gabriel Romero, MBA, NREMT-P; Robert Wales, BS, CCEMT-P, NREMT-P; Elizabeth Sibley, former executive director; and Jay M. Scott, BS, NREMT-P, executive director. Contact CECBEMS at 972/247-4442;  jscott@cecbems.org; https://cecbems.org.