The Trip Report: Paramedic Learning Styles

Reviewed This Month

Paramedic Learning Style Preferences and Continuing Medical Education Activities: A Cross-Sectional Survey Study.

Authors: Staple L, Carter A, Jensen JL, Walker M. 

Published in: Journal of Allied Health, 2018 Spring; 47(1): 51–7. 

This month we discuss an interesting study that examines the learning styles of EMS providers and evaluates the continuing medical education (CME) activities they complete. Previous studies have evaluated the learning styles of paramedic students; however, little research has looked at those currently working in the field.

As the authors note in their introduction, research among nurses has shown that learning styles for students and professionals differ. This could also be true for EMS providers, so the authors developed this study to find out. 

The study objective was to “determine the learning style of ground ambulance paramedics, describe the CME programs they attend, and determine if the CME activities paramedics attend match their learning style.”

You will notice from the objective that the authors only mention paramedics. This is because the study was conducted in Canada, where all EMS providers are called paramedics.

Despite the terminology, there are differences in skill levels similar to those in the United States. Luckily the authors dichotomized the study participants into ALS and BLS providers based on their scope of practice. 

The authors also included their hypothesis. They hypothesized there would be more than one learning style among the providers in their study and that the CME activities paramedics elected to attend would not match their preferred learning styles. It is important that authors tell you what they believe their results will show prior to completing their research. Even so, hypothesis statements are sometimes omitted from manuscripts. 

Learning Styles

To meet the study objective and test their hypothesis, the authors sent a survey to all EMS providers in a Canadian provincial ground ambulance service.

The survey included demographic questions about age, gender, level of certification, level of education, employment status, and years of service. They used the Kolb learning style inventory (LSI), an industry assessment standard, to evaluate learning styles.

An interesting note is that the authors had to obtain permission from the owners of the LSI to use it in their survey. One of the conditions to using the LSI was that they couldn’t reproduce the questions publicly, so we don’t know exactly what was asked, but the authors give a summary of how the LSI works and the types of questions. Most important for readers is that the LSI categorizes learning styles into four groups: diverging, assimilating, converging, and accommodating. 

The following is taken directly from the manuscript and describes the four learning styles defined by the LSI: 

• Diverging style—Those practitioners with a diverging learning style benefit from group learning exercises, receiving personalized feedback, and creative challenges. Activities that best serve this learning style include journal clubs, roundtable discussions, small-group learning, personalized assessments, and peer evaluations.
• Assimilating style—Those with an assimilating learning style benefit from attending lectures that 1) focus on underlying theories and ideas and 2) offer an opportunity for private reflection. Activities that best serve this learning style include conferences, online lectures, podcasts, distributed reading material, textbooks, and journal articles.
• Converging style—Those students with a converging learning style benefit from participating in simulations, formal testing, and exercises that encourage decision-making. Activities that best serve this learning style include scenarios, computer simulations, lab simulations, written tests, performance evaluations, formal certification courses, and case studies.
• Accommodating style—Those with an accommodating learning style benefit from participating in hands-on learning, engaging in new and challenging experiences, and in-field training. Activities that best serve this learning style include field training, labs, skill practice, patient contact, learning stations, teaching, and presenting.

Finally the survey asked 12 questions about the CME activities chosen by the EMS providers. Each CME question was associated with one of the LSI learning styles. The questions were asked using a five-point Likert scale. 

A Likert scale is simply a range of agreement (you’ll read about Likert scales a lot as you read more survey research). In other words, rather than just asking whether you agree or disagree with a statement, Likert scale response options might be: disagree, somewhat disagree, neither agree nor disagree, somewhat agree, agree.

For this study the response options that were given to respondents ranged from never to very frequently when participants were asked how often they attended particular CME activities. 

A Note About Research

Before we dive into the results, I want to mention one thing to all you budding researchers: The authors here made comparisons based on ALS vs. BLS providers, education level, and whether the EMS provider had 10 or fewer vs. more than 10 years of service.

The data analysis was conducted completely in Microsoft Excel. You don’t always need a fancy statistical program to complete meaningful research. 

Results

The survey was sent to 1,036 EMS providers and had an overall response rate of 25.1%. The respondents were mostly ALS providers (54%). Overall the learning styles were pretty evenly distributed, at 27.7% assimilator, 25.4% diverger, 23.8% converger, and 23.1% accommodator.

There was a difference when comparing ALS and BLS: More ALS providers had a learning style of assimilator compared to BLS providers (35.9% vs. 19.8%), and fewer ALS providers had a learning style of diverger compared to BLS providers (20.6% vs. 29.7%). 

When comparing education levels, those with a college education more often preferred accommodator learning styles (28.8%), and those with a university education most often preferred assimilator learning styles (31.9%).

(This was a Canadian study; colleges and universities there are distinct institutions. Colleges tend to be more career-oriented and offer part- and full-time diploma and certificate programs and sometimes bachelor’s degrees, while universities grant undergraduate and sometimes graduate degrees as well.) 

When evaluating learning styles by years of service, those with 10 or fewer years least preferred diverger (17.8%), while those with more than 10 years of service most preferred it (33%). EMS providers aged 40 and younger most preferred accommodator (28%), while those older than 40 most preferred assimilator (35%).

Finally, full-time EMS providers most preferred the assimilator style (29%), while part-time providers most preferred converger (30.4%). 

When evaluating CME activities the authors also found a relatively even split among the learning styles or classes completed. The section inquiring about CME activities was completed by 244 respondents.

Of those who responded to this section, 23.7% completed accommodator, 25.2% completed converger, 25.6% completed diverger, and 25.5% completed assimilator. This suggests EMS educators are well aware that EMS providers have varying learning styles and try to offer a variety of options (especially because the authors found that reasons for attending CME courses were largely based on convenience). 

The authors also note in their discussion section that the reregistration process may have influenced these results, since EMS providers are required to participate in self, group, and interactive learning activities. The authors suggest that this requirement encourages EMS providers to develop as flexible learners. 

Conclusion

These authors of this study did a good job describing their limitations, which include only using a single EMS system. There also may have been some response bias—in other words, those who didn’t reply to the survey may have had different learning styles than those who did. 

This was a well-done study that adds important information to the available literature. I hope all of you can read the manuscript; the authors do a great job explaining the learning styles and putting their results into context with other studies.

It would be great to see this study replicated in the U.S. to see if there are differences. 

Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North Carolina–Chapel Hill. He has been a nationally certified paramedic since 2005 and completed the EMS Research Fellowship at the National Registry of Emergency Medical Technicians.