Ten Key Steps for EMS Education

Evidence-based medicine helps clinicians deliver the treatments most likely to improve patient outcomes. Evidence-based education methods work in virtually the same way, helping improve student performance through initial training, continuing education, and quick in-service updates.

A pioneer in this field was Robert M. Gagné, an educational psychologist who worked with the Army Air Corps during World War II. Gagné needed to take new recruits without prior job experience and quickly train them to do more than just fly planes. Students needed to be full-fledged combat pilots with skills superior to the enemy out of the gate. It has been argued that Gagné’s ability to test and refine education techniques was a vital component of the allies winning the war.

EMS educators can benefit greatly from understanding Gagné’s steps for effective practical education. Gagné designed these “events of instruction” to help ensure lessons produced effective performance outcomes. Whether teaching a scripted part of a long-format class or a quick, informal update, educators can use this list to make sure their lesson gives students everything they need to apply what they learn in the real world.

1. Get their attention—Students must be receptive before learning can begin. The first step has to make students personally interested in what you’re about to teach. This must be more than simply stating, “This is important” or “You need to know this for the exam.” Begin the lesson with a thought-provoking question, a shocking statistic, an emotional story, or anything that will draw your students away from all the other things competing for their attention. Like respect, an adult learner’s attention must be given. It cannot be demanded.
2. Set a clear goal—Make the goal of the lesson clear to both the students and the educator. This is not “Get though the cardiac chapter” or “Review the new airway setup.” The goal is what the students can accomplish when they finish the lesson that they could not do before. This is more than stating an objective from a book or a checklist. In this step, clarify and convey to students the difference they will be able to make in a patient’s life when the lesson is complete.
3. Prompt recall—This is not the repetition of information that’s already been covered or things the student knew before coming to class. All of us have plenty of knowledge, skills, and proper attitudes tucked away. This step helps students unlock and build on them. Accomplish it by asking students about their personal experiences with the topics to be covered. Have students recall not just facts and information but their own observations and perspectives on the material they will need to complete the lesson you’re about to teach. As an educator this will give you an idea of the gaps to be filled in, misinformation to be corrected, and information the students already know.
4. Present to consume—The new content is presented to the students in short, digestible sections. Don’t power through a ton of information. Students will not be able to digest it. Be realistic about the objectives students can achieve given the time and resources for the lesson. Don’t set students up for failure by overloading them with information or skipping events listed here. Present new material in chunks the students will be able to assimilate and give them a chance to use it.
5. Provide guidance—This can include presenting examples, case studies, algorithms, or mnemonics to help students put information together in a way they’ll be able to use.
6. Practice—Whenever possible have students practice application of their new knowledge, skills, or attitudes in a real way and with the real tools they’ll need in real-world situations. While full-scale and high-fidelity simulation is not always possible, practical simulations and verbal scenarios should focus on eliciting as real a response as possible.
7. Offer feedback—For students to refine their skills as they practice, instructors must observe student performance and provide specific and actionable feedback and guidance. Feedback should be clear on what was done well, opportunities to improve, and critical failure points that occurred and how to avoid them in the future.
8. Assess performance—Ultimately students must be able to perform without prompts, guidance, or feedback. Assess this as clearly and objectively as possible and based directly on the goal. While it may be appropriate for students to receive feedback based on these assessments, it is always important for educators to analyze the results to refine their teaching practices.
9. Ensure retention and transfer—The final step is to ensure students can take their newly acquired knowledge, skills, and attitudes and apply them in a variety of real-world circumstances in a dynamically changing environment. This can be accomplished by providing additional situations and scenarios for students to use for practice or explaining how their performance can be modified to work under a variety of circumstances.
10. Next steps—While not one of Gagné’s steps, an extension of retention and transfer applicable for emergency services is to let the students know how what they’ve learned can be applied in other, sometimes more advanced contexts. This should encourage lifelong learning and give students a target for their next lesson. Helping students understand their next steps is not just about telling them about higher-level provider abilities. It is about helping them appreciate other perspectives on EMS beyond what you discuss in this individual lesson.

This does not have to be an elaborate and time-consuming process. These steps do not always have to be used in exactly this order, and for some lessons not every step may apply. The take-home point for EMS educators is to make sure, whatever you are teaching, that you’ve considered how you will include these crucial events of instruction in your lesson.

Evidence-based education techniques like this, which helped win a war, can also help make your students battle-ready.

References

Butler AC. Repeated testing produces superior transfer of learning relative to repeated studying. J Exp Psychol Learn Mem Cogn, 2010 Sep; 36(5): 1,118–33.

Corry M. Gagne’s Theory of Instruction. George Washington University, https://home.gwu.edu/~mcorry/corry1.htm.

Gagné R. The Conditions of Learning and the Theory of Instruction, 4th ed. New York: Holt, Rinehart, and Winston, 1985.

Good T, Brophy J. Educational Psychology: A Realistic Approach. New York: Holt, Rinehart, and Winston, 1990.

Karpicke JD, Blunt JR. Retrieval Practice Produces More Learning Than Elaborative Studying With Concept Mapping. Science, 2011 Feb 11; 331(6,018): 772–5.

Zipperer E, Klein G, Fitzgerald R, Kinnison H, Graham E. Training and Training Technology Issues for the Objective Force Warrior. U.S. Army Research Institute for the Behavioral and Social Sciences: Research Report 1809.

Rommie L. Duckworth, LP, is a dedicated emergency responder and award-winning educator with more than 25 years working in career and volunteer fire departments, hospital healthcare systems, and public and private emergency medical services. He is currently a career fire captain and paramedic EMS coordinator.