Separate Text From Context And All That Remains Is The Con. Part 1

"When the clinical experience is lacking, what you wind up with is students who know how to perform psychomotor skills but not why, or even more importantly, why not. "

Kelly Grayson NRP, CCP

For the first 6 months of my Paramedic course back in the late eighties early nineties all we studied was anatomy and physiology. We never touched on the subject of Paramedicine, just slogged through lectures and anatomy cadaver labs rubbing shoulders with nursing and medical students. At the time as a young impatient EMT I saw little need for such a draconian approach although soon in my Paramedic career I really appreciated the value of a strong foundation in anatomy, physiology and subsequently pathophysiology. This had entailed agonisingly long hours of study with my nose buried in my textbooks. What I didn't realise then was that I was starting to pay my dues for the trust and privilege that would be given to me by literally hundreds of thousands of patients.

In the US Paramedics were referred to as "street dancers, ditch doctors" and "the cool kids of medicine." Such titles were surely only granted to mythical figures who did not need to study such mundane earthly matters as the islets of Langerhans or the crypts of Lieberkuhn. We were all about chest decompression, jugular vein cannulation, intubation and other such cool and heady stuff without need for such boring topics as anatomy, physiology and pathophysiology. The fact of the matter is that without a solid educational footing the end result (in the remote prehospital care world especially!) will never be good and possibly lethal to our patients.

To work in the prehospital environment above the level of a first aider requires a solid foundation in anatomy, physiology and that takes hard work and graft. With the advent of the internet and such platforms as youtube this subject can be studied in a far more student friendly format than sifting through the dry and weighty tomes of my original EMT and Paramedic course back in the Dark Ages. The evolution of electronic media and digital animation especially means that this often dry subject can be served to the student in a far more palatable and efficient manner leading to better knowledge and understanding which in turn leads to clinical competence. The further up the level of certification and registration the greater the potential for harm through either intervention or omission and therefore the greater the foundational knowledge required. As the old adage goes,

"with great power comes great responsibility," but this requires hard work and discipline. If we truly want to improve patient outcomes a strong educational foundation using evidence based medicine and practical implementation is needed.

Students should be carefully selected physically, academically and emotionally prior to entrance into the prehospital profession. They should be under no illusion about their responsibilities for their own education including the course load, pre-course learning and assessment methods. This never was and never will be all about bells, whistles, lights and sirens. It's more about hard work, graft, long hours, discipline, self responsibility,/accountability, blood, sweat and tears (and that's just about the educational component never mind the job itself !). Perspective is everything however and this can be achieved in a supportive and academically nurturing environment which leads to one of the most rewarding of careers. As with all things it will not be all rainbows and butterflies nor will it be all dark, oppressive and dower. It should be a healthy combination of the two. Balance....

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