Two Views: Rinse and Repeat

Two Views is a new column from veteran EMS technologist and critic Jonathon Feit that examines current industry issues from the perspectives of both frontline personnel and leadership/management. In this column he considers the role of education for providers.

I considered calling this column “The Altered Universe of Mobile Medicine’s Future.” I reconsidered only because it would sound too much like a prelude to Doctor Strange in the Multiverse of Madness. Yet the characterization fits: Some days an apt description for the mobile medical profession is The Twilight Zone—or an experience Einstein might call insanity (“Do the same thing, expect a different result”). 

The Crew View

Consider the debate around education as a requirement to serve or advance. It’s difficult for anyone to identify a downside to education (aside from possibly cost), and in the classical view education was seen as an end unto itself. There was a sense that an informed citizen was a better citizen. But does our profession reward education—a way of tearing down the status quo by way of approaches like the Socratic and scientific methods—or does it prefer something better identified as “training,” where repetition and obedience are prioritized over innovation? 

When turned to the nature of the education to require, the argument tends to devolve into a list of degree categories. It rarely goes as far as it needs to in terms of deciding what degree(s) should be mandated—but that’s an essential question. Are we talking about core “hard” subjects and even hybrids like fire science or the traditional premed curriculum? Or are we talking about the subjects that will make one a more engaged and personable clinician, like the social sciences (psychology, sociology, anthropology, economics), or subjects like theology and art that help clinicians connect with children and adults who need to believe it will all be OK? 

Unfortunately the answer remains open because in our profession education is being used as a proxy for something more deep-seated: a misplaced sense of inferiority to other areas of medicine. The goal is to join health care’s table of the future, but a degree isn’t a proof of purchase that buys a seat. What does is a more robust commitment to scholarship, strong publishable research, and healthy debate—even the power to make change—without fear of reprisal. 

Moreover, coopting education as part of a deep-rooted desire for parity and position requires a willingness to ignore contravening data that might suggest education isn’t an effective key to getting that bump. For example, according to Brookings, as of 2016:¹  

“How much upward lift does a bachelor’s degree really give to earnings? The answer turns out to vary by family background… It turns out that the proportional increase for those who grew up poor is much less than for those who did not… Bachelor’s degree holders from low-income backgrounds start their careers earning about two-thirds as much as those from higher-income backgrounds, but this ratio declines to one-half by mid-career.” 

The data-supported answer to positioning formal higher education as key to pay raises across our ecosystem is, simply, “It depends.” 

Management Memo

Then there are the politics. In our profession relationships govern a great deal—too much, even. In an article for another industry publication, my colleagues Ron Nichols and Britt Lineberger asked, “Does mobile medicine still qualify as science if our ‘gold standards’ and ‘best practices’ emerge from single-sample studies that ‘seem OK to me,’ because retests are expensive and risk offending whoever has been disproven?” 

Once upon a time to have one’s findings challenged by other bright minds was aspirational. Now to question the veracity of a new protocol, device, or technology is taken as denigrating those involved in creating it. What if it turns out that the edge case is actually correct—that the “kook” saw what others missed? It may not happen often, but it does from time to time. 

Are we sufficiently educating our profession’s leaders—from the practice of mobile medicine to analytics and quality control—to think critically, question respectfully, and relate to those who need care? Or are we teaching them to rinse and repeat? The proliferation of social media and our profession’s hiring crisis may have forced a decision: Do we want to be rank-oriented and imbued with tradition? Or are we scientific and committed only to the pursuit of answers? I would argue we are a bit of both—but our economic doldrums come from not adhering closely enough to either.  

References

1. Hershbein B. A college degree is worth less if you are raised poor. Brookings. Published February 19, 2016. www.brookings.edu/blog/social-mobility-memos/2016/02/19/a-college-degree-is-worth-less-if-you-are-raised-poor/

Jonathon S. Feit, MBA, MA, is cofounder and CEO at Beyond Lucid Technologies and a frequent contributor to multiple EMS platforms. Visit www.beyondlucid.com.