Blokes With Bandages 2 – Training

There are two important parts of training, that of the initial training that you have to do and the other being the continual development, refreshment and assessment of our skills that should be constant through our career.

Initial Training

The LAS is a place where you never quite know the skill level of the person that you find yourself at the scene of an accident with. In part this is due to the varied training programmes that you have in order to be employed by the service.

For instance, I was trained in sixteen weeks. I was sat down in front of a Powerpoint presentation while a trainer read out what was on the screen. We also had to practice some physical skills – the use of a carry chair and CPR were just two of those skills.

There was very much a 'systems' approach to my EMT education. 'This is the heart, this is what goes wrong with it and this is what we do with these patients, this is the brain, this is what goes wrong with it, this is what we do to patients who have this problem.' There was little teaching of the underlying reasons, causes and biology behind the diseases.

As an example – I was taught that diabetics with high blood sugars will continue to eat because their 'cake gland' goes into overdrive and this is why they eat lots and get fat.

Other parts of the course seemed to have floated in from elsewhere – for en example we had to know what 'astroglia' were.

The course was full of 'Need to know' – i.e – a patient having a heart attack is given oxygen. Then there was the 'Nice to know' – i.e. the reason why we give oxygen to these patients.

In other words – you Need to know certain things to be an ambulance person, but if, just if, you have a bit of an interest in it, this is something that is Nice to know but not essential and as it isn't on your exams you shouldn't worry too much.

Of course, now you have the guidance that we shouldn't give people having heart attacks oxygen in most cases we don't have the theoretical background as to why this is a good idea – and so 'old hands' continue to give it because it's what they were taught.

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The other day I delivered a baby in the back of my ambulance. My maternity training consisted of one afternoon of a bored looking midwife telling us that basically it would be best if we just take everyone to hospital and try not to touch anything. Oh, and if you have an umbilical cord poking out, stick a damp dressing on it and transport the mother on her head.

I seem to remember spending a whole day on mental health problems. The majority of that was issues with violence and the legal requirements to get someone Sectioned.

I can't remember if we learned about alcoholism, I suspect that it was a half-day thing – way too short given the number of our patients that are alcoholic. Certainly no time was given over to the care of the binge drinker.

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But it's changing, I think.

I say that I think because reports from the new people we are getting coming out onto the road vary wildly.

The LAS is, rightly in my view, going down the route of having people study to degree level. This means that, hopefully, there is more to the course than powerpoint and playing with dummies. Hopefully they are learning some theory, some basics of reflective practice, some idea of how to critically read a research paper.

But then the LAS continue to do in service training. This isn't to a degree level, and yet the staff come out the same.

I have no idea what is going on, and if I work with a new member of staff I have no idea what they have learned.

My crewmate, one of the first Paramedic degree students knows very little about mental health problems. But she likes working with me because I teach her the knowledge that I've been taught as a nurse, or learnt on my own.

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Before I worked on the ambulances I was a nurse, and if there is one very important thing that my nursing diploma taught me it was that you need to keep learning, and it gave me that enthusiasm to keep learning.

I don't see that at the moment, either in the old-fashioned staff (how I was trained), or in the new degree level students.

—–

The problem with our initial training (and the majority of my colleagues went through the same training I did) is that it is very much rote learning, and rote learning by people who are often not teachers. The trainers are mostly people who have been through an internally run 'instructors course'.

Before joining the NHS I trained for four years to be a teacher of children.

Because of this rote teaching, there is little room to give students an enthusiasm to continue learning. There is no teaching of the skills of how to learn, how to read research, how to develop yourself – and as I will show you later, developing yourself is pretty much the only development that you can rely on having.

Because of this teaching – the bare basics, the lack of underlying theory and the rote – if 'A' then 'B' then 'C' and then take to hospital. There is created a staff body that sees itself as, not healthcare professionals, but as 'blokes with bandages'. There is no questioning of current practice, there is no provision of the skills needed for self directed learning and there is no desire or enthusiasm for further learning.

The Solution

We are partly towards a solution at the moment in that a lot of people are joining the service after a three year Paramedic Science degree course. What we need to do is work towards getting every member of staff that has road duties that same degree course on a part-time basis. No-one should lose their job because of trouble in passing this, but it should be compulsory that everyone should work towards it.

If not a degree, then the absolute minimum we should be aiming for is a diploma level education.

It is only with better training that we can properly have staff that are competent and feel secure in leaving some patients at home rather than clogging up the A&E departments, which is the future service that we are going to have to provide – if only to differentiate ourselves from the private ambulance firms that are itching to get NHS contracts.

We need proper EMS educators. The sadly true joke was that road staff became instructors because they wanted to shag as many students as possible. Hopefully this is changing, I've heard too many first hand accounts of trainers trying to get students into bed – and not just from the LAS…

We need educators that are smart, well-trained, and enthusiastic. Road skills and experience is certainly useful, but being good on the road doesn't necessarily make you a good teacher.

A well educated work-force is a happy work-force. Raise the morale of the staff and performance will raise, and education is just one way to raise the morale of the workforce.

We cannot continue to turn out people who have learnt by rote and who are uninterested in further learning, we cannot continue to turn out people who see themselves as semi-skilled workers.

Not unless all you want from your workforce is bums on seats to hit that eight minute target.

UPDATE – I meant to put this link in about a Service being forced to halt it's training because it isn't up to standard…

12 thoughts on “Blokes With Bandages 2 – Training”

  1. the people who come out with the BSc have the training to become ECPs if they choose this is what the BSc course at the university of plymouth offers im not sure if any of the other BSc course allow this.

  2. Giving substantive training brings on the ability to think creatively. It's one thing to be taught to the level of 'Blokes with bandages' but what happens when it all goes wrong and they're faced with a situation that is out of their knowledge circle? That's the difference between being taught to follow instuctions and being thouroughly trained. How can anyone trained in a myriad of medical emergencies be fully competent after only 16 weeks? It's after training that you really learn.

  3. ok first of all sorry if this sounds like im ranting but i feel like i should stick up for my side….Us newbies are fully trained, i did not chose to do the degree because i always know that if i want to i can go back and do it. at the end of the day the 3rd year degree bit is a couple of essays and a dissertation and a bit more knowledge… do we not get the knowledge on a day to day. as u keep saying “u learn something new everyday” or “you get a new challenge everyday” and i couldnt agree more.

    You seem to slate us newbies the whole way through tht and i understand if u didnt mean to. but we are good at our jobs and we find it hard to work with u 'old timers' because some of u look down on us and think were cocky… were cocky cause we are sooo scared!!! we have all this knowledge and then because of these day to day challenges everything form a text book goes out of the window we look up to u 'old timers' for support and advice.. u give it… but then u go home and blog about how crap we are unless we have a degree.

    At the end of the day we ALL do a bloody good job and I feel that everyperson i work with is at the standard for the situation we are in. if something crops up and none of us know about it then we work together and get the answer together; newbies and 'old timers' united!

    So sorry that, that sounded like a rant but i felt like it needed saying

  4. What the article failed to mention was that the part of the course that was suspended was the module that is essentially the 8 week IHCD para course which had nothing to do with the uni as it was being run by the service. The course had 1 week left to run when it was suspended.It seems that the lack of mentoring criticism is because there aren't enough people to hold our hand and give us a hug when we (eventually) qualify…

  5. Do I feel 'fully trained' with 16 weeks of sitting in a classroom? No.If we are to be seen as healthcare professionals, rather than as 'blokes with bandages' then we need good, diploma level at a minimum training.

    If anything I'm 'slagging off' *my* training – 16 weeks and I'm expected to leave sick people at home where a nurse with 3 years training isn't allowed to discharge patients.

    If I'm 'slagging you off' because you don't have a degree then I'm also slagging myself off.

    This isn't an attack, this is a post about how we should train our people better if you want a happier and more productive workforce.

    Might I also suggest that, posting a comment about how you aren't stupid using 'txtspeak' and confusing grammar isn't the best way to get your point across.

  6. Isn't part of the problem the fact that, until relatively recently, part of the selection process was “do step-ups for 3 min holding 30kg in your hands”? The first bits were an assessment of brain power – for want of better words – but many bright people who would have made good paramedics were then excluded because of lack of brawn. The involvement of the Unis in the selection of degree candidates removed that and now there are some extremely intelligent and care-orientated entrants. There are some who did a degree course to aim to be clinical scientists but then came up against the total lack of training places available – even in London – their chosen field and have moved over into nursing or paramedic courses.The new part of the problem is that a foundation degree course seems to induce a certain arrogance in some (by no means all) people who then believe they are “qualified” and know it all, and because they have a degree are better than older EMTs who “only” have a diploma. It was much the same to start with the degree courses for nurses. This, in turn, leads to “older” members of staff often having a poor perception of the newbies. Both are right and both are wrong: the theory is important and so is the practice, and the practice will be learnt out on the road and the longer you are on the road, the more you will learn. But the desire to keep learning and updating your skills and knowledge is also essential and should be nurtured. I'm not saying that there isn't a need to improve the teaching though!

    Maybe it's a shame that the previous government decided all training should be designated as degrees – there was nothing wrong with the concept of the old ordinary and higher national certificate and diploma courses, done as thick or thin sandwich courses alongside working in post. You had a job, you learnt the theory and you learnt the practice – and as you worked your way through your apprenticeship you rose in your working world. How far you rose was, to a great extent, up to you and the opportunities available, more in some fields than others.

    I'm not speaking totally off the top of my head – I was a product of the old system and my are daughters of the new. There were/are flaws in both but I think the baby got thrown out with the bathwater. In London, of course, there seem to be other problems asociated with abuse of the emergency medicine provision by the use of it as primary care together with the “entitlement syndrome”. All the practitioners who blog from the SE seem overwhelmed with non-emergency situations but that isn't the case everywhere.

    Just a thought!

  7. I read your post as being very positive about new starters, and suspect the previous poster took it the wrong way.Alas, I think training is going the same way in nearly every field. The attitude seems to be “train them to a point where they can't get us sued, and stop them from doing anything outside their training”.

  8. Just out of interest what is the staff retention like among those who have entered with a degree?I'm just wondering because many students seem to be sold University with the idea of it paying off with a very well paying job at the end -not to mention that they may NEED a well paying job because of the student debt they have amounted.

    I haven't worked in the NHS, just in another part of the public sector (DWP) but one thing I do know is that the public sector is not known for the generosity of it's wages -or in many cases the thanks of a grateful public.

    I'm just wondering if the attitude is different from those that have come in from University? -will the 'I did three years and owe xx,000 for THIS???' kick in sooner on one too many bad nights in a row?

  9. Heard a rumour from a reasonably reliable source today that Uni Medics coming out with a FdSc or less are Band 5 same as any other, but those with a BSc do exactly the same job but get Band 6.

  10. One of the problems is that, for most of us, training has stopped.There is the occasional update for new kit but there is no developmental training. An EMT going for their bag is left to do all the studying on their own then sit a set of exams and, if you fail, you are thrown out of the process with nothing more than try again next time.The Student Paramedic route is denied to existing EMT's as is the degree route. We have a large number of very good EMT's who are disenfranchised and feel left behind by a management who (it appears) do not care.There is a wall between road staff and management. This wall is made out of bad feeling and fear. Ultimately road staff do not understand what management is doing because we are only getting instructions not information. If we can find a way for us to work together instead of against each other we could all move forward and let the service become what we all want it to be. History says that will never happen.I hope to be proven wrong.

  11. I thought you were very positive about staff in general and negative about the standards of trianing/eductation received by ambulance staff and rightly so. We get 2 training days a year where we cover BLS/ALS, manual handling and whatever is topic of the moment whether that is mental health, infection control etc. I have had very little continuation training over the 3 years since I qualified as a paramedic despite requesting sessions in general clinical care, maternity and 12 lead recognition.Our firm are giving us the opportunity to attend uni to do a diploma course at a rate of one module a year, 2 days of which are paid, any subsequent days (longest module is 4 days attendance plus a given amount of hours self study) are done in your own time. I have been on this course for 2 years and have completed one module, the teaching and content of which was appalling. The staff had no experience of prehospital care and were surprised by some of our responses.

    I know a great many staff who have no opted out of the courses due to lack of confidence in the scheme. How are you supposed to remain motivated when it would take 5 years to complete a diploma and a further 8 years to get the degree in something I am already registered to do while feeling like you are learning little of any relevance?

    As for the fitness test as part of the application process, I am a strong advocate for it and feel that tests should be repeated throughout the course of ones career. We have too many staff who, although clinically competant, are puffing and blowing before they reach the patient, let alone after they attempt to carry them down stairs. Knowledge and fitness are part and parcel of working on a frontline vehicle. The fitness tests are realistic to simulate what you would need to attend to a patient, if you know that is part of the application process then you should apply yourself accordingly. Our test was some step ups, step ups with weights (one 15kg carried between both hands and another set with 7kg in each hand bearing in mind a lifepak 12 weighs 12 kg) and a brief bout of CPR in the middle with your heart rate not going above a prescribed lmit. Not something you have to be an Olympian to pass but will give you a level of fitness required to do your job.

  12. Reynolds, I do remember your training course. And it was a case of dealing with people who had previous medical knowledge and those who didn't. Everyone had to be involved in the training, both theory and practicals. Some people were good at practicals and weaker on theory and others good at both. All types of learners had to be involved to get the best from the course. Hopefully you enjoyed it and got something worth while out of it. I do believe that you helped out on the mental health issues as you had previous knowledge in this topic. Don't forget the course was actually longer than 16 weeks. You did have operational training as well before you were let lose on the public.Ambulance training to me has lost the plot to doctors, academics and the HPC. Training is expensive. The initial training should be focused on the job role which you are going to do. Nothing wrong with the IHCD courses as the core training. Paramedics then used to have one day a year refresher with a yearly audit. A week long classroom based “requalification” was every three years where skills that were not used frequently were refreshed and updated as necessary. Then a week in hospital to have peer review practise. Technicians could do the same, with topics that they need to cover, but this never happened. I see nothing wrong with continuing with this method and then using the higher education modules as part of the continuing professional development for those that are already working on the road. Then a link between classroom theory and job role would be easier and help ambulance students understand why they are learning something.

    Higher education is a big stressor for anyone who has been out of education for a period of time. To expect people who have been away from an formal education to be able to write at the levels that are being asked for just shows that there is no consideration by the academics for the people who made up the core of the ambulance service. Those with life experience who joined the ambulance service not as their first job, but with work experience. They could problem solve and use their initiative. Skills that are core to working on your own or as a team. This group of people are now discriminated against because they do not have a piece of paper that says they have achieved an higher education qualification.

    A balance between the two training methods would be useful and a positive way forward, like a modern apprenticeship scheme. But alas the academics, doctors and HPC have taken over the ambulance service and it's education pathways for their own goals.

    Rod

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