Tuesday, March 3, 2015

The Classical Model of EMS Education, or The Danger of Eating Our Young

THE CLASSICAL MODEL OF EDUCATION

According to the classical model of education, every learner passes through three stages: grammar, dialectic, and rhetorical.


GRAMMAR STAGE
SCHOOL SYSTEM: Elementary/Grammar
COLLEGIATE SYSTEM: Bachelor
EMS: EMT, EMT-Basic

C. O. U. R. A. G. E.
In the grammar stage, a student is given the building blocks she needs. “This is a ‘C.’ This is an ‘O.’ This is a ‘U.’...” The information is concrete and in large, simple chunks. This is your EMT. She learns basic anatomy, basic first aid: ‘If it’s red, cover it up.’ The simpler, the better. If it’s catchy and rhymes, you get extra points (‘AED in less than 3.’).

DIALECTIC STAGE
SCHOOL SYSTEM: Middle School/Junior High
COLLEGIATE SYSTEM: Masters
EMS: AEMT, EMT-I, EMT-D, Cardiac Tech, etc.

...COURAGE...

In the dialectic stage, a student starts piecing the ideas together. She takes the letter blocks and forms the word ‘COURAGE,’ and will even start reading it in context of other words. This is your AEMT. She learns further anatomy and physiology, more pathophysiology, begins to understand how those two interplay, and learns a smattering of advanced skills, a glimpse of the paramedic world beyond.

RHETORICAL STAGE
SCHOOL SYSTEM: High School
COLLEGIATE SYSTEM: Doctorate
EMS: Paramedic/Advanced certifications

‘COURAGE is what it takes to stand up and speak. Courage is also what it takes to sit down and listen.’ ~Winston Churchill

In the rhetorical stage, the student is taught the meaning of the word ‘courage.’ What is courage? What is its essence? How can I exemplify it in my life? This is the paramedic, especially one with more advanced certifications (community paramedicine, critical care, etc.). Yet more A&P, more patho. The nuances, the ‘whys’ are learned and—only here really, if we dare to say it at all—understood (if not, then the stage has not been achieved; learning did not occur).

ADVANCEMENT THROUGH THE LEVELS

Though developmental/intellectual maturity and natural giftings are important factors, one student's advancement through any stage of learning is remarkably similar in difficulty when compared to the other stages. Ideally, the learning will be tailored to the student’s starting point (original foundation), development (speed of learning), and learning style (auditory, visual/written, kinesthetic); however, few institutions are able to provide such attentive education.

The driven will seek outside sources to supplement where their standard education lacks: auditory learners will find podcasts; visual/written learners will read copious articles; kinesthetic learners are the black sheep of the family and often left to flounder. But all—the driven, along with those who are less driven (or are floundering)—will seek...people. Guides. Those who have gone before. Because the students perceive there is either nothing better, or nothing at all, or no one else to go to.

Those guides are in the upper levels. The problem with that is that those in the upper levels see how far they have come up the mountain, and the view is serene and peaceful, their own labor and frustrations (and those who helped them), forgotten. They will have difficulty remembering just how strenuous the climb was, particularly if some of that climb to EMT took place in middle or high school science class which is even easier to forget about (thank a science teacher today).


HELPING OTHERS THROUGH THE LEVELS

For a variety of motives, both good and bad, some of these upper-level learners become teachers. Teaching requires giving chunks of information to people in successively more refined pieces. To someone in the rhetorical stage, teaching someone at the grammar stage seems like spoon feeding--the chunks are large, unwieldy, and inelegant compared to the subtlety and intricacy they are used to learning.

But to someone in the grammar stage, large blocks are all they can handle. If they don’t know what they don’t know, then they often also don’t know how to find an answer to a difficulty they face. They cling to anyone (for example, an out-of-date instructor) who will give them a block, whether it is a good block or not, because they know they will receive something they can build with (this entails a surprising amount of imprinting; think baby ducks). 

If a student reaches a problem, a question, in his building process and reaches out for help, you can hand him one of the most beautiful blocks around. But if it is ground too fine (too advanced), is too unfamiliar, or contradicts his guide, it will only slip through his fingers, and he will return, frustrated, to his huge, sometimes rotten, blocks because it is something he can understand and feel satisfied building with.

Reminding and shaming such a student for his position in the grammar or dialectic stage (often referred to as, “calling out his idiocy”), pleading for him to listen (when every other source in his world contradicts your message), often results only in defensiveness and burned bridges. If this occurs enough, the student—rather than being won over—will stop reaching out for help. A love for learning is lost. It is a rarity for one who has lost a love of learning to ever regain it. Thus educational burn out begins.

To fix this problem, one must understand the dynamic. The block was too refined, too advanced, and whether it should have been easily handled, matters not. In order for the student to build in the desired direction, you must—instead of shaming—give a bigger, more basic block and build the desired structure from a lower foundation. This is, sadly, not always possible, but a solid foundation should be the goal of any good educator.

There is one student where this is especially true: the ingenuitive student—the one who has the potential for critical thinking. This student, when faced with a problem, will often respond with ‘out-of-the-box thinking’ that may have seemingly bizarre results (such as performing CPR on a decapitated woman in order to save the fetus). It’s not that this student is an idiot or not capable of critical thinking, but precisely the opposite: he is solving his building problems, with limited blocks, by inventing his own tools. These students grow into innovators. They are the ones who say, “What happens if we shock this heart?” or  “What happens if we just push on someone’s chest and force the blood to circulate?” These are the very students the future needs the most. Sure, correct the idea, but allow the freedom of thought to remain. What a tragedy it is when such a student is ridiculed instead of being handed the next block or tool he needs.

RESPECT FOR THE PROCESS

The various stages of learning, with all of their frustrations, must be respected. There is no other way to learn than from the bottom up. While it is grand for upper-level learners, teachers, and mentors, to cast a vision for the lower levels, it must never be forgotten that those levels have a purpose and must be respected for the solid foundations they provide. If EMS is to progress in higher learning, the desire to learn should not be rebuffed, for without it, there is no higher learning.