Duckworth on Education: Teach With Your Hands Behind Your Back

A fundamental principle of effective communication is “show, don’t tell.” The EMS education corollary is “Telling isn’t teaching.” This doesn’t mean you shouldn’t speak; it means that for students to be able to perform as emergency medical providers, they must be able to make their own connections with the course material.

Making personal connections doesn’t mean becoming best buddies with the textbook. A personal connection is when you’re doing more than just memorizing and nodding your head as someone tells you something. It is when that knowledge “clicks” and true understanding occurs—the kind of understanding that allows you to apply this knowledge in a variety of circumstances different than the ones you were originally taught. These personal connections are crucial to understanding and applying the information as well as building the confidence to perform under field conditions. 

One of the methods I use to accomplish this during breakout and practical sessions is to have instructors literally teach with their hands behind their backs. Instructors can still prompt students and give advice, but once the background information has been taught and students have seen a demonstration, they just have to do it themselves, even if they fumble at first. This is how connections are made.

Because this can initially make students uncomfortable—they may be expecting more reviews, demonstrations, and hand-holding—it is important to make it clear that this is a walk-through, not a test, and that you’re there to help them move the knowledge from their brains to their hands, not walk them through the exercise. It must be clear to both instructors and students that students are not being thrown to the wolves. This step can only occur after the students are otherwise set up for success, even if we don’t expect them to perform perfectly in the first go-around.

Often instructors in charge of breakout sessions turn them into mini-lectures. Sessions begin with, “Let’s just review once more before we start.” The instructors’ intention is to help students prepare, but consider it from the students’ perspective: What they hear is, “Now that you’ve finished reading and watching videos and listening to lectures, you finally get your hands on the skill you’ve been training for, but first let me explain it all over again.” If students and educators have worked properly to try this skill for the first time, then let them get to it, see where they struggle, and assist where needed. If the students still aren’t prepared, then a quick review before shoving equipment into their hands is likely to bore the prepared students and not be enough to help the unprepared ones.

All human beings tend to overestimate their ability to perform. This is why EMS students tend not to pay as much attention during breakout sessions. They often expect these sessions to be passive rather than active experiences. Be sure to reward those who are first to jump in and give it a try; as peer leaders they are demonstrating positive behavior as well as showing other students how to perform, even if you need to provide corrective feedback. Students tend to be much more attentive when watching other students take an assessment or perform a practice they will have to do next. This is much better active learning then watching an instructor repeat a demonstration.

Students focus better when they understand no one is going to do it for them. Even if you’re in the early phases of skills practice and providing feedback as students go, teaching with your hands behind your back tells students you are there for support, but they must do it themselves. This helps build one of the most important soft skills of any EMS provider: self-reliance.

As students continue to practice, educators can leverage the “power of the pause.” As students work through a skill or simulation, hold not only your hands behind your back but your mouth closed until the very end. This may initially result in a long, awkward pause while they wait for you to tell them how they messed up or the right way to do it. Once they understand you are there to give feedback only at the end and they must troubleshoot their own obstacles, the pause will be shorter, and the learning will be stronger.

As they continue to practice, students become confident they can do it under dynamic conditions. They learn to identify their own prompts and decision points. As you interject less as an educator, students will have the opportunity to identify important clues and cues that should prompt them to take action or decide the best course for the patient.

As an EMS educator, you are already a success. Now it is the students’ turn. By teaching with your hands behind your back, you help your students learn what success looks like, but also what success feels like.

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.