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Home > List Archives

stress(semi-long)

Terry Dinerman trauma-list@trauma.org
Wed, 5 Jun 2002 10:23:33 -0700


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Dear Ms. Ricky-

What do you do with the students who just don't have the stamina to make =
the cut?  If, when you have tried your entire bag of tricks and still =
cannot get that person over the hump?

I define myself and my teaching by the product I turn out, and turn =
LOOSE on society, with the proverbial "License to Kill".

I am going to have some tough standards, and they are quite simple: I =
expect my graduates to be competent ENTRY-LEVEL Paramedics, ready for =
entry into the graduate school of emergency medicine known as AN =
AMBULANCE.  I do not expect my grads to be Dr. Debakey (or Dr. Maddox). =
Just be a competent member of a team.

If a Student cannot come up to my (an my institutions) expectations, if =
I wouldn't want a particular student treating my Mother, how can I =
justify NOT sending that student for evaluation and remediation?=20

And if remediation fails, how can I justify NOT FAILING such a student?

I don't build in any extraneous stress, I too am considered a Maverick =
in my testing philosophy, which reduces test anxiety to the minimum, but =
I am teaching "soon to graduate" paramedic students who are going to be =
expected to participate in emergent treatment of life-threatening =
illness and injury.=20

My job is to teach these folks critical thinking skills under as =
life-like a set of conditions as I can re-create, so they are prepared =
to act competently at that 3 car pile-up at 3 am.=20

How do you set standards for this?  My students can kill the mannequins =
as many times as it takes to get their skills up to par, but they have =
to be ready to work on flesh and blood when I am done with them. =20

My Mom and yours are counting on me to do my job well.

And it seems that the tougher I get on my students, the better they rate =
me on my evaluations.  At least the ones who last do.......sort of like =
your favorite instructor.....

"Cruel But Fair"

Regards-

Terry Dinerman EMTP EMSI FF EIEIO
  ----- Original Message -----=20
  From: KPCRP@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Tuesday, June 04, 2002 7:06 AM
  Subject: Re: stress(semi-long)


  In a message dated 6/4/2002 5:37:13 AM Eastern Standard Time, =
Panorama71@aol.com writes:



    <<people doing their best work and I'll do what's necessary to get =
my students to achieve. That's what I get the big bucks for. If that =
means being a b*****d I'll do it. If it means easing off a bit, then =
I'll do that too. A 'one size fits all' approach=20
    to training doesn't work.

    I do agree with the Mattox Maxim - quality in, quality out, =
discipline in,=20
    discipline out. However, that doesn't mean disregarding people's =
varying=20
    responses to the same stimulus.>>


  Gordon, since you specifically named me, I will respond this way and =
beg the Lists' indulgence for diverging from pure trauma issues for one =
post (though I believe the subject relates directly to how we respond to =
trauma<G>):

  I am a member of the "PTSD - Post Traumatic Stress Disorder" =
fraternity and would NEVER dismiss true psychological issues in a =
student.  In fact, I think having those issues myself, I am quite a bit =
more sensitive to the signs in my students. =20

  Additionally,  I don't think you will find any other Instructor or =
student who I have ever worked with who will tell you I have a "one size =
fits all" approach to teaching.  If anything, I have bucked the trend =
for years with my approach to teaching....the same one other people are =
getting rich off of now because they have the degrees (but that's =
another subject<G>).  I have been teaching people (and myself) to "think =
outside the box" for over 20 years.  If anything, I get hassled by other =
Instructors because they say the effort I put into teaching and our =
students, makes them look "bad".

  I was the victim of test anxiety many times in years past, but I =
finally figured out why.  Few of my Educators ever took the time to help =
me or my classmates feel confident in our knowledge and skills PRIOR to =
the test or hospital/field clinicals.  They handed us books and lectured =
fom them word for word OR said "Memorize this, there will be a test =
tommorow".  They handed us lists and then tested our memorization skills =
and called it "learning".  No exchange of thought process, no =
explanation of "why", just memorize, test and move on. =20

  The result was little to no retention, as we did weekly brain dumps in =
order to make room for the stuff coming next.  Even worse, there was =
little to NO understanding of why we were studying what we were studying =
and how it would be important later on.  They never painted the big =
picture.  We mangled our way through it and survived - but at what cost =
to our attitude about learning?  What cost to our patients?  (Working in =
the clinical setting is a learning curve in and of itself, but it is =
much less intimidating if one has a solid base from which to start.)

  I then got lucky and tripped over an Educator who not only used =
alternative methods to teach, but helped us BE confident, so test =
anxiety disappeared.  It's funny....I hated him for a while, but over =
time I realized what he had done for all of us.  He turned babies into =
adults, and wannabees into practitioners.  I walked out of his classroom =
in tears of frustration more time than I can count, but I was never =
afraid of failure, only challenged to do more and do it better.  What he =
did made me stronger and ultimately (I believe), a better medical =
practitioner. =20

  The one thing he NEVER did, however, was to make us afraid of failing =
in the classroom and he taught us to use those failures as a learning =
tool.  Consultation with my Paramedic classmates of so long ago has =
illustrated over and over again it is a lesson which we have never =
forgotten.  (So, David T. - and I know you are out there - for whatever =
you might think *I* think of you, you have my gratitiude.) =20

  Students who suffer from test anxiety, IMNSHO, are the product of =
Instructors who are inadequately prepared, use fear as a teaching tool =
and wouldn't understand the phrase "Teachers teach, Instructors =
pontificate."  I believe the major part of our job as teachers is =
motivation and instilling a desire in the students to WANT to learn and =
understand what they are learning.  When an educator sets goals based =
upon failure, rather than success, the students learn to fear and look =
at the "What do I need to do  to pass the test" bar, rather than the =
"Hey!  I blew it this time, but next time it will be better and next =
time it will be better...." , until "it" becomes second nature. =20

  Classrooms are where students need to feel SAFE failing and taking =
risks.  Sometimes the greatest learning takes place in the presence of  =
a failure turned into a critical thinking exercise and then done over =
again until the lightbulb comes on and they get "it".  Practicing skills =
in a vacuum is not enough....perfect practice makes perfect practice =
only after those practical skills are coupled with scenarios that DO =
induce stress and help students use critical thinking skills to do their =
very best for themselves and their patients.  So, I believe students who =
WHINE about that stress, and use it as an excuse to continually fail =
(read: never learn), rather than use it as motiviation to succeed, do =
NOT belong in Emergency Medicine, and I am not shy about telling them =
so.

  Once students are able to make the transition from following the =
algorithm sheet or check sheet to THINKING, stress becomes secondary and =
"test anxiety" should no longer be an issue.  This symbiotic skill does =
not come without a little anxiety along the way and no two patients =
present the same, but students who learn the "box" cold, can think =
outside that "box", on their feet, real-time and without stressing to =
the point they *can't* function or think. =20

  Unfortunately, it is this kind of currently practicing medical =
professional/"student" I run into constantly in Refreshers, and alphabet =
courses like ACLS and PHTLS, which were the original subject (we were =
not talking about newbies just starting out, remember....we were talking =
about people already practicing in Medicine taking their "alphabit =
courses").  I blame their teachers for most of their attitude and =
anxiety. =20
  If they cop a defensive, anxiety-based attitude in MY class, they =
either get their act together (sometimes Mommy/Teacher even has to =
supply the hugs and kleenex) or they don't get the signature. =20

  Ever fail the head of a Cardiology Department in ACLS?  I did.....and =
I won the complaint action against me.  More importantly I won his =
respect for making him DO his job for real, rather than as a martinet =
standing in the corner looking over his fiefdom.  I had no idea who or =
what he was until it was all over....all I knew was I had a student who =
refused to participate either verbally or hands on because he thought he =
knew it all already.  He didn't.  He is now one of the toughest ACLS =
Instructors I know!  LOL!

  Helping people get to that place is my job as a teacher.  Anything =
less means *I* have failed them, thereby perpetuating the wheel we now =
see in EMS education, as well as secondary/post secondary education.  =
The students will fail themselves, "stress" over those failures and fail =
to learn, if we, as teachers, fail to do *our* job.    More importantly =
(and sadly) they will fail their patients.

  Of course, all of the above is my opinion, so take it for what you =
feel it's worth, especially after I tell you that Patch Adams, MD, is =
one of my heroes......

  Respectfully,

  Katharine P Rickey
  NREMT-P: EMS I/C
  and other alphabits
  NH/USA
  "I have a method to my madness, people.  Roll with it, and watch what =
happens!"=20

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<BODY bgColor=3D#ffffff>
<DIV><FONT face=3D"Comic Sans MS">Dear Ms. Ricky-</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">What do you do with the students who =
just don't=20
have the stamina to make the cut?&nbsp; If, when you have tried your =
entire bag=20
of tricks and still cannot get that person over the hump?</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">I define myself and my teaching by the =
product I=20
turn out, and turn LOOSE on society, with the proverbial "License to=20
Kill".</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">I am going to have some tough =
standards, and=20
they are quite simple: I expect my graduates to be competent =
<U>ENTRY-LEVEL</U>=20
Paramedics, ready for entry into the graduate school of emergency =
medicine known=20
as <U>AN AMBULANCE</U>.&nbsp; I do not expect my grads to be Dr. Debakey =
(or Dr.=20
Maddox). Just be a competent member of a team.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">If a Student cannot come up to my (an =
my=20
institutions) expectations, if I wouldn't want a particular student =
treating my=20
Mother, how can I justify NOT sending that student for evaluation and=20
remediation?&nbsp;</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">And if remediation fails, how can I =
justify NOT=20
FAILING such a student?</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">I don't build in any extraneous =
stress, I too am=20
considered a Maverick in my testing philosophy, which reduces test =
anxiety to=20
the minimum, but I am teaching "soon to graduate" paramedic students who =
are=20
going to be expected to participate in emergent treatment of =
life-threatening=20
illness and injury.&nbsp;</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">My job is to teach these folks =
critical thinking=20
skills under as life-like a set of conditions as I can re-create, so =
they are=20
prepared to act competently&nbsp;at that 3 car pile-up at 3 am. =
</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">How do you set standards for =
this?&nbsp; My=20
students can kill the mannequins as many times as it takes to get their =
skills=20
up to par, but they have to be ready to work on flesh and blood when I =
am done=20
with them.&nbsp; </FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">My Mom and yours are counting on me to =
do my job=20
well.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">And it seems that the tougher I get on =
my=20
students, the better they rate me on my evaluations.&nbsp; At least the =
ones who=20
last do.......sort of like your favorite instructor.....</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">"Cruel But Fair"</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Regards-</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS"></FONT>&nbsp;</DIV>
<DIV><FONT face=3D"Comic Sans MS">Terry Dinerman EMTP EMSI FF =
EIEIO</FONT></DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3DKPCRP@aol.com =
href=3D"mailto:KPCRP@aol.com">KPCRP@aol.com</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Tuesday, June 04, 2002 =
7:06=20
AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: =
stress(semi-long)</DIV>
  <DIV><BR></DIV><FONT face=3Darial,helvetica><FONT size=3D2>In a =
message dated=20
  6/4/2002 5:37:13 AM Eastern Standard Time, <A=20
  href=3D"mailto:Panorama71@aol.com">Panorama71@aol.com</A> =
writes:<BR><BR><BR>
  <BLOCKQUOTE=20
  style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #0000ff 2px =
solid; MARGIN-RIGHT: 0px"=20
  TYPE=3D"CITE">&lt;&lt;people doing their best work and I'll do what's=20
    necessary to get my students to achieve. That's what I get the big =
bucks=20
    for. If that means being a b*****d I'll do it. If it means easing =
off a bit,=20
    then I'll do that too. A 'one size fits all' approach <BR>to =
training=20
    doesn't work.<BR><BR>I do agree with the Mattox Maxim - quality in, =
quality=20
    out, discipline in, <BR>discipline out. However, that doesn't mean=20
    disregarding people's varying <BR>responses to the same=20
  stimulus.&gt;&gt;<BR></BLOCKQUOTE><BR>Gordon, since you specifically =
named me,=20
  I will respond this way and beg the Lists' indulgence for diverging =
from pure=20
  trauma issues for one post (though I believe the subject relates =
directly to=20
  how we respond to trauma&lt;G&gt;):<BR><BR>I am a member of the "PTSD =
- Post=20
  Traumatic Stress Disorder" fraternity and would NEVER dismiss true=20
  psychological issues in a student.&nbsp; In fact, I think having those =
issues=20
  myself, I am quite a bit more sensitive to the signs in my =
students.&nbsp;=20
  <BR><BR>Additionally,&nbsp; I don't think you will find any other =
Instructor=20
  or student who I have ever worked with who will tell you I have a "one =
size=20
  fits all" approach to teaching.&nbsp; If anything, I have bucked the =
trend for=20
  years with my approach to teaching....the same one other people are =
getting=20
  rich off of now because they have the degrees (but that's another=20
  subject&lt;G&gt;).&nbsp; I have been teaching people (and myself) to =
"think=20
  outside the box" for over 20 years.&nbsp; If anything, I get hassled =
by other=20
  Instructors because they say the effort I put into teaching and our =
students,=20
  makes them look "bad".<BR><BR>I was the victim of test anxiety many =
times in=20
  years past, but I finally figured out why.&nbsp; Few of my Educators =
ever took=20
  the time to help me or my classmates feel confident in our knowledge =
and=20
  skills PRIOR to the test or hospital/field clinicals.&nbsp; They =
handed us=20
  books and lectured fom them word for word OR said "Memorize this, =
there will=20
  be a test tommorow".&nbsp; They handed us lists and then tested our=20
  memorization skills and called it "learning".&nbsp; No exchange of =
thought=20
  process, no explanation of "why", just memorize, test and move =
on.&nbsp;=20
  <BR><BR>The result was little to no retention, as we did weekly brain =
dumps in=20
  order to make room for the stuff coming next.&nbsp; Even worse, there =
was=20
  little to NO understanding of why we were studying what we were =
studying and=20
  how it would be important later on.&nbsp; They never painted the big=20
  picture.&nbsp; We mangled our way through it and survived - but at =
what cost=20
  to our attitude about learning?&nbsp; What cost to our patients?&nbsp; =

  (Working in the clinical setting is a learning curve in and of itself, =
but it=20
  is much less intimidating if one has a solid base from which to=20
  start.)<BR><BR>I then got lucky and tripped over an Educator who not =
only used=20
  alternative methods to teach, but helped us BE confident, so test =
anxiety=20
  disappeared.&nbsp; It's funny....I hated him for a while, but over =
time I=20
  realized what he had done for all of us.&nbsp; He turned babies into =
adults,=20
  and wannabees into practitioners.&nbsp; I walked out of his classroom =
in tears=20
  of frustration more time than I can count, but I was never afraid of =
failure,=20
  only challenged to do more and do it better.&nbsp; What he did made me =

  stronger and ultimately (I believe), a better medical =
practitioner.&nbsp;=20
  <BR><BR>The one thing he NEVER did, however, was to make us afraid of =
failing=20
  in the classroom and he taught us to use those failures as a learning=20
  tool.&nbsp; Consultation with my Paramedic classmates of so long ago =
has=20
  illustrated over and over again it is a lesson which we have never=20
  forgotten.&nbsp; (So, David T. - and I know you are out there - for =
whatever=20
  you might think *I* think of you, you have my gratitiude.)&nbsp;=20
  <BR><BR>Students who suffer from test anxiety, IMNSHO, are the product =
of=20
  Instructors who are inadequately prepared, use fear as a teaching tool =
and=20
  wouldn't understand the phrase "Teachers teach, Instructors=20
  pontificate."&nbsp; I believe the major part of our job as teachers is =

  motivation and instilling a desire in the students to WANT to learn =
and=20
  understand what they are learning.&nbsp; When an educator sets goals =
based=20
  upon failure, rather than success, the students learn to fear and look =
at the=20
  "What do I need to do&nbsp; to pass the test" bar, rather than the =
"Hey!&nbsp;=20
  I blew it this time, but next time it will be better and next time it =
will be=20
  better...." , until "it" becomes second nature.&nbsp; =
<BR><BR>Classrooms are=20
  where students need to feel SAFE failing and taking risks.&nbsp; =
Sometimes the=20
  greatest learning takes place in the presence of&nbsp; a failure =
turned into a=20
  critical thinking exercise and then done over again until the =
lightbulb comes=20
  on and they get "it".&nbsp; Practicing skills in a vacuum is not=20
  enough....perfect practice makes perfect practice only after those =
practical=20
  skills are coupled with scenarios that DO induce stress and help =
students use=20
  critical thinking skills to do their very best for themselves and =
their=20
  patients.&nbsp; So, I believe students who WHINE about that stress, =
and use it=20
  as an excuse to continually fail (read: never learn), rather than use =
it as=20
  motiviation to succeed, do NOT belong in Emergency Medicine, and I am =
not shy=20
  about telling them so.<BR><BR>Once students are able to make the =
transition=20
  from following the algorithm sheet or check sheet to THINKING, stress =
becomes=20
  secondary and "test anxiety" should no longer be an issue.&nbsp; This=20
  symbiotic skill does not come without a little anxiety along the way =
and no=20
  two patients present the same, but students who learn the "box" cold, =
can=20
  think outside that "box", on their feet, real-time and without =
stressing to=20
  the point they *can't* function or think.&nbsp; <BR><BR>Unfortunately, =
it is=20
  this kind of currently practicing medical professional/"student" I run =
into=20
  constantly in Refreshers, and alphabet courses like ACLS and PHTLS, =
which were=20
  the original subject (we were not talking about newbies just starting =
out,=20
  remember....we were talking about people already practicing in =
Medicine taking=20
  their "alphabit courses").&nbsp; I blame their teachers for most of =
their=20
  attitude and anxiety.&nbsp; <BR>If they cop a defensive, anxiety-based =

  attitude in MY class, they either get their act together (sometimes=20
  Mommy/Teacher even has to supply the hugs and kleenex) or they don't =
get the=20
  signature.&nbsp; <BR><BR>Ever fail the head of a Cardiology Department =
in=20
  ACLS?&nbsp; I did.....and I won the complaint action against me.&nbsp; =
More=20
  importantly I won his respect for making him DO his job for real, =
rather than=20
  as a martinet standing in the corner looking over his fiefdom.&nbsp; I =
had no=20
  idea who or what he was until it was all over....all I knew was I had =
a=20
  student who refused to participate either verbally or hands on because =
he=20
  thought he knew it all already.&nbsp; He didn't.&nbsp; He is now one =
of the=20
  toughest ACLS Instructors I know!&nbsp; LOL!<BR><BR>Helping people get =
to that=20
  place is my job as a teacher.&nbsp; Anything less means *I* have =
failed them,=20
  thereby perpetuating the wheel we now see in EMS education, as well as =

  secondary/post secondary education.&nbsp; The students will fail =
themselves,=20
  "stress" over those failures and fail to learn, if we, as teachers, =
fail to do=20
  *our* job.&nbsp;&nbsp;&nbsp; More importantly (and sadly) they will =
fail their=20
  patients.<BR><BR>Of course, all of the above is my opinion, so take it =
for=20
  what you feel it's worth, especially after I tell you that Patch =
Adams, MD, is=20
  one of my heroes......<BR><BR>Respectfully,<BR><BR>Katharine P=20
  Rickey<BR>NREMT-P: EMS I/C<BR>and other alphabits<BR>NH/USA<BR>"I have =
a=20
  method to my madness, people.&nbsp; Roll with it, and watch what=20
  happens!"</FONT> </FONT></BLOCKQUOTE></BODY></HTML>

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