A Three-Sided Model for Continuing Education

It can be said there are two kinds of students in a class: those who want to be there and those who have to be. It’s not uncommon to find recertifying EMTs and paramedics in the “have to be” group. They’re not really concerned with learning anything; they’re just meeting their requirement, checking a box.

This is obviously not the best use of providers’ time. Further, it's not the best use of the instructor’s time and talents, nor is it the most effective use of leave hours, stipends, or overtime pay. 

Continuing education generally refers to the process of periodically refreshing knowledge, skills, abilities, and current practices, and multiple fields require it. The CE process should be an opportunity to review seldom-used knowledge and skills and become updated on new information, techniques, and equipment. It should not just be a hoop to jump through. 

The NCCP Model

Continuing education requirements are often described in numbers of hours, required subject matter, or measures such as CEUs (continuing education units). Where continuing education is mandated, there is generally some requirement that addresses the content and/or number of hours.

The National Registry of Emergency Medical Technicians (NREMT) has begun using the National Continued Competency Program (NCCP) model. This requires a set number of total hours (40 for EMTs, 60 for paramedics), which is then divided into three components: a national component, a local or state component, and an individual component. 

Topic areas under the national component are updated and published every four years. State and local components are either specified by a state EMS office or agency or developed by local EMS entities. If there are no state or local requirements, then these hours are considered flexible content, and any state-approved or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) course can be used. Individual component hours are also considered flexible content. 

Using the NCCP model, we now have an outline, or road map for the direction we must travel. However, we must still choose specific topics, and since developing or attending instruction is an investment in both time and money, we must ensure everyone is getting the most from this commitment. So how does one choose? How does a provider decide what type of coursework to attend, and how does an instructor or administrator decide what to offer?

Based on what we’ve discussed thus far, the following model is offered as a guide for selecting the content for continuing education. This model is meant to serve as a simplified visual representation of the concept and structure of continuing education. Its objective is to aid in the decision-making process by providing focus and direction. It was conceived mainly from an EMS perspective but could be applied to any field that requires continuing education. 

Sides of the Triangle

The first side of the con-ed triangle (CET) is new material and addresses subject matter being introduced for the first time. It covers information, skills, and equipment that have emerged recently or could be used in the future. Topics that could currently fall into this category include prehospital ultrasound, video laryngoscopy, an update of opioid overdoses or emerging infectious diseases, or equipment for moving patients (keep in mind that this side of the triangle will be fluid and continually change). 

This side of the triangle could be the most challenging. It requires instructors to stay informed and monitor publications and current events to keep up on emerging topics. This side of the triangle is important because effective surveillance of new activities and other changing information in a field helps keep a program on the cutting edge.

Next is the review side of the CET. There is a great deal of literature that deals with learning, memory, and forgetting. There are two concepts that demonstrate the importance of the review side. One theory is termed fading, the other decay. The fading theory holds that information is engraved, or inscribed into our brains, much like a path made in the woods as people walk along the same route. If people stop taking that path, it eventually becomes overgrown until it disappears. In the same way, facts and skills we learned in EMT or paramedic class can be forgotten if we don’t use or review them. 

Decay theory was conceived by Edward Thorndike in his 1913 book The Psychology of Learning.3 His premise was that memory fades simply due to the passage of time (this contradicted an earlier hypothesis, known as interference theory, which basically suggested new information and memories inhibit retrieval of old ones). So if a person does not access their memory and use the stored information, the information will wear away, or decay, over time. These two concepts demonstrate the importance of reviewing the knowledge, skills, and abilities used less often.

Finally, the you side of the CET refers to topics that are specific to an agency, department, or individual. Topics on this side of the triangle depend on local data and should be closely tied to quality assurance or improvement (QA/QI) efforts.

Remember, QA/QI is not meant to be punitive but should focus on maintaining a desired level of quality and be a way of preventing mistakes and avoiding problems. Thus, continuing education specific to an agency’s needs is essential. For example, if data shows that driving accidents or mistakes in PCRs have increased or the success of IVs or IOs has decreased, these areas need addressing in the next recertification program. 

The NCCP national requirements are fairly detailed, providing broad topics, then subtopics with specific lessons. Local content requirements are decided by the state, regional, or local agency, and within the individual requirement providers are free to complete any EMS-related coursework. The con-ed triangle thus becomes especially useful at the local and individual levels.

It is fair to say that continuing education is the shared responsibility of both the healthcare provider and the administration. Whether career or volunteer, providers are expected to maintain their competence, but they are also expected to evolve and continually improve their performance and capabilities.

Employers have the responsibility to develop their personnel and increase their potential to perform new, different, or more difficult tasks. Thus another use of the CET could be in agencies that conduct other professional development that’s not part of a recertification process. If a fire or EMS agency begins using different CPAP equipment, if a police department begins carrying tourniquets, or if a hospital changes bed manufacturers, the CET can be useful to help steer the needed training. 

Similarly, the CET can be used on a personal level. Providers who want to take a class but are unsure about the area they want to pursue can use the triangle for guidance.

For example, a provider could choose a class on pharmacology (review), which could directly enhance his job performance; complete a course on writing (new) to enhance her documentation skills; or attend a class on public speaking or any other area in which they feel weak (you). 

Making CE Worthwhile

The con-ed triangle is a model that can help simplify and organize the educational process for administrators, instructors, and students choosing a program. It promotes a bottom-up approach, focusing on the needs of field providers, and helps guide decision-making at all levels. The triangle will help turn CE days from something one has to complete to days all parties look forward to.  

References

1. National Registry of Emergency Medical Technicians. National Continued Competency Program, https://www.nremt.org/rwd/public/document/nccp.

2. Commission on Accreditation for Pre-Hospital Continuing Education. About CAPCE, https://www.capce.org/About.aspx.

3. Thorndike EL. The Psychology of Learning. New York: Teachers College, 1914, p. 4.

John Alexander, MS, NRP, is a retired fire captain and currently a volunteer in Baltimore County, Md. He has been a paramedic for 30 years and involved in education for approximately 20 years.