Continuing Medical Education – Keeping EMS Rooted in the Past

Frozen in Time. This pic is of an ambulance in our fleet that stopped at our HQ station for supplies during an ice storm in Seattle in early 2012.

Are you jumping on board with the EMS freight train paving the way to move EMS from a vocational to academic industry?

The EMS Education Agenda for the Future has a vision and it is a bright one.  If you’re an educator, manager or EMS industry leader, I’m sure you’ve read the EMS Education Agenda, reviewed the National Core Content, and the EMS Education Standards that fell gloriously from the sky into our anticipatory laps earlier this year.  But where were the changes/improvements in CME requirements?

The new EMS standards increase the depth and breadth of information required for EMS providers.  After working over 18 years in EMS I can clearly see where our industry has significantly increased in complexity.  From BP cuffs, stethoscopes, EOA’s and monophasic machines to biphasic 12 Lead EKG, capnography, Easy IO, bio-markers, and auto ventilators, our equipment, diagnostic tools, medications, and procedures have increased our access to tools that may allow us to provide better care in the field.

As the level of complexity increases, so does the level of knowledge required and thus the need for CME to dust off the old, introduce the new and shiny and bridge the gaps during changes.  But, in my opinion, CME requirements in EMS are one of the paradoxes that I think keeps EMS from progressing into the future and instead leads to stagnation, complacency and apathy in EMS professionals.   I see a variety of interrelated factors for this paradox.

1.  The EMS professional’s attitude towards education and training – I generally see two types of EMS attitudes towards continuing education.  The obligatory bored provider and the provider who just doesn’t do it until their certification /livelihood is threatened.  Both of these attitudes eventually lead to liability.

2.  The instructors ability to engage the audience, deliver content with effective instructor methodologies, and the instructors ability to build upon existing knowledge (continuing education) vs. just refreshing knowledge (re-certification classes).

3.  The CME requirements of the regulating agencies.

  • Our state law sets the EMS provider up to receive refresher type information instead of requiring the provider to increase and expand their knowledge base by requiring CME programs follow the National Core Content and EMS Instructional Guidelines.  I think this is excellent for initial education and I believe a certain amount of review is necessary.  However, for example, when an EMT takes an ACLS course or a college anatomy / physiology course that increases the breadth and depth of knowledge and contributes to professional development, the provider is not given credit for CME obtained outside of what’s defined in their scope of practice and core content for their level of care.  This creates an environment of decreasing extrinsic motivation for an audience that clearly thrives on extrinsic motivators, and decreases professional development opportunities.
  • The number of card classes required for providers is excessive and expensive.  ACLS, PALS, PHTLS, ITLS, AMLS, EPC, PEPP, GEMS, CPR, NRP, STABLE, and I could go on and on.  I have yet to see any convincing evidence that mandating (if your agency does this) all of these courses as often as we do actually improves the quality of care.  I do not see a paramedic of 20 years who has had to attend PHTLS course 5 times provide better trauma care than a paramedic who has attended it 2 times.
  • The CME requirements between most States and NREMT is inconsistent leading to providers having more requirements in CME than what may really be necessary.

4.  The quality of EMS instruction needs to improve and should with mandatory accreditation of EMS programs.  EMS instructors need to be able to teach well.  Taking a 40 hour DOT instructor course barely prepares you to instruct a group of students effectively and move them through the four levels of understanding.

I want to approach CME requirements from the same perspective that we should be approaching the new equipment and techniques we are using in EMS today.  Driven by data and CQI programs.  Evidence based medicine.

What if an EMS Professional’s CME was determined by the following;

  1. a minimum number of hours/competencies to be completed based on their performance as a practitioner during their certification period.
  2. a minimum number of hours/competencies to be completed based on their performance on re-certification or ongoing education and training tests.
  3. a minimum number of hours/competencies to be completed in new industry standards, technology, etc.

We’ve “improved” our initial education standards, and the complexity of our para-medicine, but we have yet to address the best way to maintain the best practices, encourage professional development by increasing the breadth and depth of knowledge over time and motivating students to achieve more.

In my opinion, our EMS CME requirements are keeping us rooted in the past.