JakeEMTP Posted June 16, 2012 Share Posted June 16, 2012 I think chbare, that the core classes required for a degree, english, maths, 2 semesters of A & P, etc. make for a more well rounded medic. I have seen more and more 4 year paramedic programmes recently which is encouraging. I would argue, that the 2 year programme should be the minimum to enter EMS as a paramedic. I beleive that Canada (as it is the Country I am most familiar with. No offence intended to the other EMS systems Worldwide) does it right, requiring additional education to progress to the next level. We have had this discussion before. Just about anybody can be trained to do the skills. It is the education that allows us to make a better decision in my opinion. In a 7 month training programme, I wonder how much time is spent on report writing, critical thinking skills, algebra, Pharmacology, well you get my point I hope. There just isn't enough time to do it right. Link to comment Share on other sites More sharing options...
chbare Posted June 16, 2012 Share Posted June 16, 2012 However, do you have anything else to bring to the discussion other than what you think or feel? My point being, do we have good literature that we can use to back up the notion of a minimum level of education? Remember, in this day and age, we need good evidence to convince people that a certain procedure or modality is helpful. Should we not expect the same of educational programmes? Link to comment Share on other sites More sharing options...
JakeEMTP Posted June 16, 2012 Share Posted June 16, 2012 That will be difficult to find. Let the search begin. Link to comment Share on other sites More sharing options...
chbare Posted June 16, 2012 Share Posted June 16, 2012 Awesome, I'll look at posting the links I mentioned. Link to comment Share on other sites More sharing options...
chbare Posted June 16, 2012 Share Posted June 16, 2012 (edited) The ADN versus BSN outcome study that everybody loves to quote: http://jama.jamanetwork.com/article.aspx?volume=290&issue=12&page=1617 Unfortunately, it would be difficult to apply this to EMS and the limitations of the study mean that I'd be hesitant to generalise the conclusions many people draw from it. However, it is at least a nod toward increased education possibly leading to better outcomes. Edited June 16, 2012 by chbare Link to comment Share on other sites More sharing options...
DwayneEMTP Posted June 17, 2012 Share Posted June 17, 2012 Great points. I can't really defend my contention that 7 months is to short. I guess my comments weren't meant so much to imply that two years is optimum, but that it's, in the vast majority of places, the best available. And it's probably still a knee jerk reaction as the most common person that I see going into the 'short' programs are also wanting to be firemen. I'm not sure how we would be able to design a study to define an optimum educational length, as the length is only really important based on the little bit that we know of the average students ability to obtain and retain information. Is a physician's length of education optimal? I don't think one can say, though I would be willing to bet much that you couldn't turn out competent physicians in 6 months. And who' going to be willing to compare patient outcomes for long unless the 6mo Docs morbidity and mortality rates stay on track with the average 8yr Doc. For a valid study it seems that it would be necessary to turn out 1yr, 2yr, 3yr and 4yr nurses at the same college, with exactly the same curriculum, taught by all of the same instructors in the same way. Yet even then we'd have to try and quantify the variables of the previous histories of those being taught in the study, right? Yikes..it's going to take a much better man than me... Cool question though! Link to comment Share on other sites More sharing options...
chbare Posted June 17, 2012 Share Posted June 17, 2012 We could potentially look outside of the United States. For example, many countries have a six year medical school curriculum with no undergraduate requirements. How do these providers compare to physicians educated under a different model such as the one used in the United States? I am certainly not going to argue for less education, but I still believe we will need good evidence to convince people that these short courses are not necessarily the best route to take. Another thought is in regards to military trained medics. There are courses that are rough approximations of paramedic school that are intense and around six months in length. I wonder how certain core areas of knowledge that overlap compare to their civilian counterparts? Link to comment Share on other sites More sharing options...
Kiwiology Posted June 17, 2012 Share Posted June 17, 2012 (edited) With the way the US education model is set up certainly it is reasonable that a two year degree be the minimum for Paramedic (ALS), ideally a two year degree would be for sub-Paramedic person and a four year degree for Paramedic (ALS) - comparable to the system in many of the commonwealth countries. It is simply impossible to teach people the necessary scientific and biomedical foundation which can be drawn upon to allow complex clinical decision making and problem solving in any less than two years of full time education at university level. I would even argue two years is not enough. In New Zealand one must complete a three year Bachelors Degree to be eligible to apply to the Ambulance Service for a Paramedic intern position. This Degree is totally specialised and contains no "general education" no history, no maths no philosophy or any other non Paramedic papers (classes) so you spent three years studying nothing but Paramedicine. If you get a Paramedic intern position (which is no easy feat, competition is fight to the death cut throat) you are allowed to independently practice without supervision as a Technician (volunteer level) and can only practice Paramedic level interventions when supervised by a Paramedic or above. This process also requires you to complete skill logs, reflective practice journals etc and have regular meetings with a Clinical Standards Officer to review your progress. This process lasts between six months and a year depending on how you perform. Once you get the OK you sit down with a Medical Advisor and Clinical Standards Officer and are put through a viva voce assessment, a couple of Sim Man assessments and get your performance reviews and logs combed over; if you pass that you can independently practice as a Paramedic. After another one to two years as a Paramedic you can apply to be selected for the Intensive Care course which again involves a selection process and the competition is pretty cut throat. If you are successful you continue to work as a Paramedic while completing extramural university papers and going to a couple of block days at campus. During this time you are paired onto an ALS ambulance with an experienced Intensive Care Paramedic to complete logbook, reflective practice journal etc and can perform Intensive Care level interventions under supervision, should you be required to work with a Paramedic or a Technician one day because of e.g sick leave or no IC on watch you can only practice as a Paramedic. Once you finish the course and all the logs and journals and stuff you again go through an assessment process including oral, written and practical simulations with a Medical Advisor and Clinical Standards Officer and if you pass you become an Intensive Care Paramedic. This entire process takes at a minimum of five to six years and along the way you will earn two thirds of a coursework Masters Degree. Our newly graduated Registered Nurses must go through a very similar process called NETP or new entry to practice. These programs recognise a Degree teaches you the very basic foundation of why, when, how etc and that there is a world of difference between doing something at uni or on placement vs in the real world. Regarding the military, the New Zealand Defence Force runs the Joint Health Service School to train all Army, Navy and Air Force Medics to the same standard. They must undertake two years of education to achieve the Diploma in Health Science (Paramedic) which is the core clinical component of the Bachelors Degree minus the health theory papers like disaster planning, research project, health law etc. This gives them a scope of practice slightly below the Paramedic level, as you need the Degree to apply for Paramedic level. I don't believe they train to Intensive Care Paramedic level in the military as they have Medical Officers to do the more complex things; certainly like intubation is the realm of the military anaesthetist etc In Australia the process is very similar but can take even longer. South Africa requires a two year Certificate for Emergency Care Technician and a four year BTech for Emergency Care Practitioner; in Canada Primary Care Paramedic takes up to two years while all Advanced Care Paramedic programs require three years of total education. The UK now requires a two year DipHE or FDSc for State Registered Paramedic. We are talking about the practice of invasive procedures that carry significant clinical risk in an uncontrolled environment on patients who are often significantly unwell with limited physiologic reserve where limited backup and support exists. How the hell can you even begin to teach anybody the basics of this in seven months? You can't ... for frunk sake Joe Blow the farmer who wants to become a volunteer for his local rural ambulance here has to complete the Diploma which takes longer than seven months! But I must remember what I learnt from living in the US ... the lowest common denominator is king and "will this be on the test?" *sniff sniff, breaks my heart, really Edited June 17, 2012 by Kiwiology Link to comment Share on other sites More sharing options...
chbare Posted June 17, 2012 Share Posted June 17, 2012 However, you've yet to produce any reliable evidence other than anecdote and opinion. You are free to argue, but bring something evidence based to the table. I've linked what little I can find and I understand another study has recently been published with similar results in BS educated nurses with specialty certification. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 17, 2012 Share Posted June 17, 2012 (edited) The types of studies we want to have simply do not exist but there is the strong anecdotal evidence that can be found in AU, UK and NZ that very high levels of education are worthwhile ie - No protocols or protocol monkeys - Complete clinical autonomy and no medical control - Extremely high levels of success with RSI (near 100% consistently) - Much higher levels of pay than in US - More career progression opportunities (Clinical Standards Officer, Motorcycle Response Unit, Ambulance Rescue etc) - The respective Fire Services' want nothing to do with Ambulance Edited June 17, 2012 by Kiwiology Link to comment Share on other sites More sharing options...
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