Bridging the generational gap

[letmesleep]

A deep conversation in another thread was started about "old school" vs. "new school" medics (and EMTs), ok, actually it hijacked the thread. I was inspired by another member to start a sperate thread to continue the discussion on this topic. I will say right off the bat that this could get a little heated, so let me remind everybody of 2 things I think we should keep in the back of our heads:

1) We are all well educated in our own right, and should be as respectful as possible to each other

2) Be a professional when you answer

some questions:

Should "old school" ways of doing things change with up-to-date treatments?

Are the newer medics and EMTs coming in to the field with more knowledge base?

Can we and/or should we try to learn from each other?

What do you want to learn from the other generation?

What is your over all perception of the other generation?

How do we make change to better understand each other?

answer 1 or all, however you feel you want to respond!

[ERDoc]

Medicine in a constantly changing field. Everyone needs to keep up to date with the latest literature. I realize that this can be difficult in EMS because of the paucity of research but the field will not advance if you depend on your medical director to know the latest studies.

[dougd]

Should "old school" ways of doing things change with up-to-date treatments?

Unless you're planning on having Johnny and Roy call Rampart for orders to drop 2 of bicarb and start an IV of lactated Ringer's for your calls , I would say yes, the way we treat our patients should continue to evolve based on research. If we find a particular intervention isn't helping patients, or worse is harming them, we should be moving away from it.

[letmesleep]

ok, I don't think the first question was written well......I'm not so much asking if the "old schoolers" should be expected to keep up with the changing treatments of medicine. Obviously they should, and ramming "2 of bicarb" isn't going to cut it. I'm asking more along the lines of the everyday station "way" of doing things, how they talk to the public, so on and so forth. If this question isn't making sense then feel free to just skip it.....any one else have a better example of what is being asked? thanks for the input.

[BEorP]

Should "old school" ways of doing things change with up-to-date treatments?

If we're talking about treatments, yes. If there is evidence that something works better then we should all be doing it. If the "up-to-date treatment" though is really just a minor change in how things are to be done and not based on any specific evidence then I am fine with an experienced medic doing it the way they have always done it.

Are the newer medics and EMTs coming in to the field with more knowledge base?

In Ontario it has been within the last 10 years that the Primary Care Paramedic program became two years long so many of the old guys started out with just a one year program or first aid cert (although they have since had to do a significant amount of continuing education). A good portion of new medics also have undergraduate degrees these days.

Can we and/or should we try to learn from each other?

Yes. Do I have a bunch of physiology courses from university that may help me to understand what is going on with a patient? For sure. But does my partner with 30 years on and not a lot of book learning know how to manage a scene and maintain control better than I do? Definitely.

What do you want to learn from the other generation?

See above. The main thing is how to manage a scene and maintain control in what can sometimes be chaotic situations. You can learn all the medical stuff in school, but you can't learn that.

What is your over all perception of the other generation?

They know how to do the job and I respect them tremendously for that.

How do we make change to better understand each other?

I haven't had any issues with a gap between the old and the new. I think it all lies in both groups respecting what the other has to offer.

[reaper]

I consider myself BOTH. I have the years to be considered old school, but I am always changing with the times.

I see it from both sides. The old school guys look at the new generation as smart mouth kids that can recite a book cover to cover, but can't put it to work on the street. The new school considers the old guys as washed up and hate changes, wants everything to stay the same.

Both are right, for some people. I see veterans that refuse to accept changes and don't want to learn new ways of doing things.

Then I see new guys that refuse to take advice from the older guys. They think that they learned everything they need to know, in school.

So, here is my advice,

Old School: ease up on the new guys, teach them what you can. Accept that EMS is changing by the minute and things will not stay the same. You need to evolve with the industry or you will get left behind.

New School: Drop the I know it all attitude. The older guys can teach you plenty of ways of making your job easier. Remember that they have been there and done that before. Learn from the mistakes of the past. Also try and teach some of the older guys the new things that are coming out. Relax and give the older guys some respect and then give them time to adjust to the changes.

[dougd]

letmesleep - Sorry, I just couldn't pass up the chance to make an Emergency! reference when you were discussing "old-school." I really wasn't being sarcastic towards you or the question.

Now, as for some serious answers:

Should "old school" ways of doing things change with up-to-date treatments?

It's good to know what the "old school" way was of doing it - either so that you know it is a bad idea to try it, or so that you know how to do something when that new gizmo your department has to perform a specific task stops working. But obviously we need to adapt as best we can.

Are the newer medics and EMTs coming in to the field with more knowledge base?

I'm a relatively new EMT, so I probably can't answer that intelligently.

Can we and/or should we try to learn from each other?

What do you want to learn from the other generation?

I put these together... Yes. Anything the guys and girls who have been around the block can show me I'm willing to listen and learn. Experience is a harsh teacher, so any pointers I can pick up in advance is a good thing.

What is your over all perception of the other generation?

Been there. Done that. Honestly, most of the "old school" partner's I have had have been wonderful to work with and very helpful. Of course, the ones who aren't have pretty much gone out of their way to avoid the new guys.

How do we make change to better understand each other?

Too many new guys who think they already know everything about everything. A lot of it has to do with the fact the new guys are, for the most part, gung-ho 19-23 yo's and still think they're invincible. I was like that 10 years ago in everything I did, and I'm willing to bet the "old school" guys were too.

[letmesleep]

no problem, I didn't take it that way, thanks!

please continue!

[bigj1130]

I will throw my hat into just from my observations.

Should "old school" ways of doing things change with up-to-date treatments?

Yes and No. When it comes to technology I have noticed some "old-timers" have a hard time incorporating the new technology into there assessment and tx. The "New School" however seems more reluctant to do assessment and tx. without it. In terms of tx. and being up to date I think most of the old timers will be the ones spearheading most new things. the new school will embrace more and use more but the old school likes it because it can make their job easier and they remember Calling rampart and getting orders for a liter of ringers or d5w and slamming 2 amps sodium bicarb. The new school need to appreciate the fact that some of those old school guys wouldn't take that as gospel and wanted to progress.

Are the newer medics and EMTs coming in to the field with more knowledge base?

I will say they come out with more book knowledge but the book will only get you so far some of my best education came with my training officer here in Austin AFTER I had already practiced medicine for five years. The skill of a good assessment and building rapport is not taught in a book but learned from an "Old-Timer" Scene management and confidence, not ego, are something that comes with experience or something that is learned from "Experience"

What is your over all perception of the other generation?

While some of them may be crusty, crispy, or just plain burnt, others have helped to make my profession what it is today by not getting complacent and wanting to make themselves and EMS better.

How do we make change to better understand each other?

Time, respect, and from a management standpoint... put your paragods with the crustiest medics you got. Management may not be able to eliminate a paragod complex, but a medic who is 5 years younger than dirt and has underwear older than the new medic will get rid of that complex right quick. Also, lead by example. I think new medics have to earn the right to do a lot of things, not hazing or anything like that, but your performance and attitude will earn you a place in the conversation or earn you a spot to write your report at the desk instead of standing and having to use a clipboard. Just the little things. Be first out the door to your unit, be early to work, help clean units on the hospital dock, help crews carry stuff when they have a code 3 return to the hospital, the little things that go a long way. These are all things old and new school should be doing, but when you are really new I think that goes a long way in an old timers eyes. These are the observations of an Old New Schooler.

[Mateo_1387]

This is coming from new skool

Should "old school" ways of doing things change with up-to-date treatments?

I would say that old school treatments should change with up-to-date treatments. There is a lot of research being done today about how our treatments affect the patient's whole hospital stay. If our "old school" treatments are not cutting it, then they need to change. Old school techniques are another story. The experience that old schoolers have with scene management, driving, patient interaction, and tips to facilitate certain procedures is awesome. Experience is just not something that you can get by education alone.

I will say however, there may always be some rare situation where old school treatment may be necessary. For instance, placing a psychotic patient prone. I am not saying that I advocate it, but you just never know. There may always be a time where it may be necessary. I always keep that in the back of my head.

Are the newer medics and EMTs coming in to the field with more knowledge base?

I would say overall yes. Of course this also depends on the type of program the new medic graduated from. Back home, the medics coming from that community college are more often than not undereducated to be paramedics. I was telling people that there is a program there allowing intermediates to take a medic class that has only 56 days of class, at 8 hours each day. Typically they are in class less than 8 hours a day. We are talking 56 days of class! Can you say undereducated?

On the other hand, you go two counties west, and you find medics who graduate from a 2-year program who have an extensive knowledge base. These graduates typically only have street experience from their clinical rotations, but they are educated to be paramedics.

The differences between the two schools are 1) education and 2) experience. It should take the educated paramedic far less time to be a competent self-standing medic, than say the undereducated paramedic. Where the educated medic did most of his learning in class, his biggest goal now is to get experience. The undereducated medic ends up having to play catch-up in the field with sick patients, plus gain the experience.

This leads me to answer the original question. I think that new medics with a degree in general have a larger knowledge base entering the field than the old school medic when he/she entered the field. The old school medic has the experience, which makes the two situations similar. The point I want to make is that I think it will generally take less time for the new educated medic to become a competent self-standing medic than it did for the old school medic.

Remember these are just my observations from the field coming from a new medic in my area.

Back home, the medics are stale. What I mean is they are old school and most choose not to be up to date. I would much rather have green medics with a degree to care for me than the old school medic back home. There are some medics who I know would be considered of “old school” origins who are changing very well with the times. Their knowledge base is amazing. They are able to take what I learned in school and expand my medical knowledge base. They exemplify what is expected of a paramedic. I only know a handful like that, but we need to have more paramedics act as they do. They are definitely a minority.

The medics I talk of had to educate themselves many years after they became "certified." They all have similar backgrounds with inadequate paramedic training. Each of them went on to obtain EMS degrees, and they continually learn about the new. Those are the "old school" paramedics I want to learn from. Their years of experience and education are admirable. Those are the medics that would take many years of experience and continual learning for me, or most people, to surpass. They have a lot to teach, and I have a lot to learn from them. Most old school paramedics I know though know enough just enough to stay afloat. I have no interest in learning from them.

Can we and/or should we try to learn from each other?

I say there are qualities in both we can learn from to make ourselves the best paramedic we can be.

What do you want to learn from the other generation?

It depends on who I am learning from. The educated medic of “old school” origins I want to ride with so I can pick their brains, and learn all that they know. The old school medic who knows just enough to stay afloat, I have not interest to learn from. It is not that they do not have “anything” to teach. It has to do with the mindset of the person.

What is your over all perception of the other generation?

I know an equal number of “good” old school medics, and I know an equal number of “bad” old school medics. I only know a handful of experienced “old school new thinking” medics. So, my perception of the “other generation” is divided.

How do we make change to better understand each other?

This is a good question to ask. It is easy to point everything out, but there needs to be work to fix the problem.

I think there are a few things that would help each generation to understand the other.

First of all, I think everyone should work to be on the same level. It is very important for our profession to get educated, be educated, and stay educated.

On another level, we do not need to divide EMS within, as we do with other medical professions. For example, so many people in EMS keep RN’s and Paramedics professionally divided. The atmosphere of cooperation is not there. I also see that as a problem within our own profession. The old school and new school generations end up dividing themselves. So, I think the atmosphere of EMS should be to strive to be professional and cooperative.