Teaching EMTs requires balancing art and science

In the movie "Dead Poets Society," Robin Williams' character, Professor John Keating, introduces himself to his students by having them read the opening essay of their "Introduction to Poetry" textbook, by the fictional J. Evans Pritchard, PhD:

"To fully understand poetry, we must first be fluent with its meter, rhyme and figures of speech, then ask two questions:

1. How artfully has the objective of the poem been rendered and

2. How important is that objective"

Question one rates the poem's perfection; question two rates its importance. And once these questions have been answered, determining the poem's greatness becomes a relatively simple matter."

The essay continues on in stultifying, boring fashion, as if the beauty of poetry, and the emotion it invokes, can be measured and quantified like an algebraic formula. Keating allows his students to finish reading the essay, pauses for dramatic effect, and then quietly pronounces, "Excrement."

He goes on to an impassioned and funny soliloquy on the beauty and art of poetry, and how the measure of a poem's greatness is not a plot on a graph, but rather what it awakens in the reader's soul.

A lot of us who teach EMS could stand to be a lot more John Keating, and a lot less J. Evans Pritchard.

That's not to say that J. Evans Pritchard's technical essay didn't have merit. In fact, it was taken nearly word-for-word from a commonly used AP English textbook called "Sound and Sense: An Introduction to Poetry."

Appreciation of a writer's artistry requires a working knowledge of the technique of writing; the rhyme, meter, and figures of speech are important. The same is true of the science of medicine.

But many of us focus too much on the science, and too little on the art.

Buy-in prevails over facts
That point was driven home to me in one of my frequent debates with Nancy Magee on one of her favorite topics, "buy-in." Magee points out in her columns that the vast majority of management initiatives fail because of a lack of buy-in from employees.

Good ideas fail because the field personnel don't share management's vision. Either the employees are unwilling to change their way of thinking, or management wasn't charismatic enough to sell the idea properly.

In other words, too much J. Evans Pritchard, and not enough John Keating.

The example Magee used was the director of a large volunteer EMS organization firmly entrenched in the early 1990s and reflexively opposed to any increase in EMS educational standards. His stock answer to calls for more training was, "Where's the proof that all this extra education our volunteers have to obtain is going to help our patients""

My reply was, well… forceful.

I went into an impassioned rant about willful ignorance in EMS, our continuously evolving understand of medicine, and how one of the problems with lack of knowledge was not being able to perceive your lack of knowledge; the embodiment of the Dunning-Kruger effect. I provided concrete examples like oxygen administration, IV fluid therapy, antiarrhythmic therapy and spinal immobilization.

Magee let my blood pressure subside a little bit and my hands to unclench from the steering wheel, and she asked mildly, "Good rationale. So, how many EMS instructors you know would have delivered it that way, rather than just 'you need more education, for education's sake'""

And I was forced to admit, "Not many."

She paused for effect, winked, and then, in her best John Keating fashion, pronounced, "Buy-in."

I also realized I'd been guilty of the same in my EMT class. I've always told new EMT instructors, "Be what the material isn't. Provide what the textbook does not."

For example, I've always used Joe Mistovich's EMT textbook, "Prehospital Emergency Care," from Brady Publishing, even though my teaching style is more akin to Dan Limmer, author of Brady's other EMT textbook. Joe is cerebral, while Dan is enthusiastic and animated. But my students didn't need a double dose of Dan Limmer or Joe Mistovich, they needed a teacher whose delivery balanced the textbook.

In teaching my hybrid EMT course, with most of the work done in online self-study, I allowed myself to forget that admonition. Since I wasn't directly providing all that essential technical information, and I didn't trust my students to grasp it without my supervision, I wasted valuable classroom time repeating material the textbook already covered nicely.

I was boring my students to death. I was focusing on the science of EMS, and ignoring the art.

Instructors facilitate synthesis and application
So at the very next class, I abandoned the lecture and started using more critical thinking exercises and clinical scenarios. I taught standing over a manikin or a patient assessment victim, rather than in front of a SMART Board.

I realized that, if I made my expectations clear through assessment and testing, my students would get the necessary technical details on their own. My job became exactly what was written in the syllabus, that I had previously neglected to do: the synthesis and application of knowledge.

I let Mistovich be my J. Evans Pritchard, leaving me to be John Keating. He had the science, I handled the art. That was immensely more fun, and more effective.

Remember that in the next class you teach: more Mr. Keating, and less J. Evans Pritchard. If you're good enough, you may have a generation of EMTs address you as "O' Captain, my captain."

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