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Fri Jun 12 22:27:53 BST 2009

Dr. McSwain,

I completely agree. I have been making this point for years. Hardly as
long as you have, but those in a position to influence decisions have
not been receptive to the idea of education to the point of
understanding. Memorization is as far as they are willing to go. As long
as the National Registry keeps saying that their tests are validated,
people will buy what they are selling.

Passing a multiple choice test is a joke, but the National Registry is
much more concerned with the appearance of the possibility of
discrimination on the part of any of their examiners, that they are dead
set against any evaluation of understanding. And dead is the right word.

How can you develop understanding, when understanding is not part of the
goal. The educational institutions just want the students to pass/not
pass, but with a high enough pass rate.

This is one of the reasons I stopped teaching paramedic school. Teaching
magical chants is not my cup of tea. Mnemonics can be very helpful in
memorizing material. There will always be material to memorize. That
does not mean that memorization and parrot phrases should be the goal.

Tim Noonan.

On Fri, 12 Jun 2009 06:02 -0500, "McSwain, Norman E Jr."
<nmcswai at tulane.edu> wrote:
> Tim, Tim and others
> 
> You are right, but for the wrong reasons.
> As you know I have been teaching prehospital providers at multiple
> levels since then early 1970's. In the mid 70's Mary Beth Skelton and I
> analyzed providers at the EMT-P level that we had trained and were
> training. For many years this paper was one of the very few published
> looking at skill and knowledge loss in prehospital personnel. We found
> that it was the basic skills that were lost first and that bad habit in
> their use was the problem. Knowledge loss was not as bad. Even at 6
> month intervals up to 3 years
> At that time no one was teaching 'parrot phrases' and blind memorization
> for learning but teaching the understanding of the subject matter was
> critical. If one understands, loss of substance is minimal. The current
> methods of teaching especially in the prehospital field is memorization
> and protocols. In fact one of the major prehospital trauma educational
> programs teaches 'parrot phrases' and protocols. PHTLS does not. We
> teach that 'judgment is based on knowledge and understanding'
> 
> The outcome of the testing reported is to be expected. If you teach
> memorization and not understanding this is quickly lost.
> 
> I'm not sure who said it but it is true:
> "Tell me and I will forget.
> Show me and I will remember
> Involvement and I will understand"
> 
> Our educational programs today do not take the time nor  the extra
> effort to assure that the students understand. They are only taught how
> to pass the tests. This is bad for patient care
> 
> Norman
> 
> Norman McSwain MD
> Professor - Tulane Univ. SOM
> Trauma Director - Charity Hospital
> 504 988 5111
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy
> Hardcastle
> Sent: Friday, June 12, 2009 3:59 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Ironic timing DCFEMS article Washington Times
> 
> Does this really surprise anyone
> 
> as "evidenced based practitioners we know that the 90 day retention of
> all
> knowledge is only around 60% for all emergency skills even with active
> providers - this is proven in a number of publications. CEU/CPD systems
> are meant to address these issues, but the uptake of EBM in prehospital
> care is poor at best!
> 
> Tim
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer University of KwaZulu-Natal Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban - South Africa
> 
> > While I am not suggesting that multiple choice tests are an effective
> > means of evaluating knowledge, this is surprising.
> >
> > "On the written tests, only THREE paramedics scored 70 percent or
> above;
> > a passing grade for an entry-level paramedic on the national registry
> > exam is 75."
> >
> > "The written tests - equivalent to the National  Registry of Emergency
> > Medical Technicians test for paramedics - were  performed last year at
> > the Maryland> Fire and Rescue Institute (MFRI) and  taken by about 175
> > of the city's 250 advanced life-support providers."
> >
> > 3/175 scored over 70.
> >
> > 70 isn't even passing. 75 is passing.
> >
> > Is the test worded that badly?
> >
> > Are the paramedics that bad?
> >
> > Is it a combination of the two?
> >
> > 175 of the 250 active medics took the test, not new graduates. Part of
> > the problem is that National Registry almost requires that the
> students
> > be trained for their particular memorization test. These medics, not
> > being in the artificial "no paramedic left behind" "memorize these
> > parrot phrases for the test" setting, may be unprepared for a test
> that
> > is not relevant to patient care.
> >
> > However, scoring that poorly on any test, even remotely related to
> EMS,
> > is not a good sign.
> >
> > Tim Noonan.
> >
> >
> > On Thu, 11 Jun 2009 16:19 -0400, LNMolino at aol.com wrote:
> >> Tuesday, June 9, 2009
> >>
> >>
> >> Some D.C. paramedics to be  retrained
> 
> 
> 
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Ironic timing DCFEMS article Washington Times