Affective Domain Feat. Kim McKenna

What truly separates an exceptional EMS professional from the rest of the field? While technical expertise and quick clinical decision making are vital, the interpersonal behaviors and professional habits displayed by a Clinician often dictate their ultimate success.

In the latest episode of Registry Insider, host Bill Seifarth sits down with Dr. Kim McKenna, a board member for both CoAEMSP and the National Registry. They explore the critical concept of the affective domain in EMS education, highlighting how empathy, communication, and teamwork are just as essential as passing a cognitive examination. Dr. McKenna notes that most professional workplace issues stem from behavioral breakdowns rather than clinical errors. By establishing clear expectations on day one and providing structured mid-semester feedback, educators can guide students to build strong professional habits early in their careers.

Watch the full episode of Registry Insider on your favorite platform to learn more.

Transcript

SPEAKER_01 0:13

Welcome to the Registry Insider. I'm Bill Seiferth from the National Registry of EMTs. And on today's episode, I have joining me Dr. Kim McKenna. She is a board member for CoEMSP as well as for uh the National Registry of EMTs. So, Kim, thanks for joining me today at a CreditCons conference in uh New Orleans.

SPEAKER_00 0:33

Glad to be here to talk about this really important topic.

SPEAKER_01 0:36

Yes, it is an important topic. And often it's kind of misunderstood or not fully appreciated. Uh, but what we're talking about in today's episode is the effective domain and um certainly what it is, how you assess it, and how it can be really beneficial for students to grow throughout their education process as well throughout their career. So let's start with the first question. What is the effective domain?

SPEAKER_00 1:00

So the affective domain is primarily the professional behaviors and the caring behaviors that you want people to be able to have to function in a clinical setting when they graduate. You want them to be able to have those behaviors in the classroom, in the lab, in the hospital, kind of in every interaction that they have. And if you think about it, a lot of our learners have never worked outside their home. They've never been part of a team. And so they don't really understand good communication skills, good teamwork skills. They don't understand what it's what's appropriate to say and to not say. And those are part of the coaching and teaching skills that you really have to include in your program when you're teaching EMT students or paramedic students, AEMT students, kind of the whole realm.

SPEAKER_01 1:48

I hear those who are involved in quality improvement or quality assurance, quality management, generally speaking, um, the biggest issues that they have to deal with are not necessarily clinical mistakes where, oops, I gave a wrong drug or I did a procedure wrong. It's the affective issues, it's those interactions, those behaviors, those poor interpersonal skills that EMS clinicians sometimes display.

SPEAKER_00 2:16

Sure. When I look back in my career at the hospital, in the fire service, and in the EMS agency, people were not fired for clinical things typically. They were not fired for anything but bad affective behaviors. And so the earlier that you can kind of create that expectation of what the norm is, what the expectations of the professions are, the more important it is. And you know, I the affective domain is linked to good teamwork. It's linked to good patient care in terms of good decision making. And so it's really important to embed that and start to assess that early on in a program.

SPEAKER_01 2:59

So obviously it starts with the edge with the classroom, right? And then um if you instill those behaviors early on, the hope is that they continue throughout the clinician's career and are reinforced. Um as it relates to the classroom, how can educators, how should educators ideally be assessing and what's the frequency of assessing affective domain and and why?

SPEAKER_00 3:23

Well, I think you set the stage right from day one and you tell people what the code of conduct is, and part of that are the affective attributes that you expect them to be able to display. And so typically there's a rubric that explains there's usually, you know, 12 different elements that that go along with it. What are those elements and what behaviors indicate okay performance in communication, in teamwork, and empathy, you know, kind of all of those domains. So you set the expectation for here's what we believe is important, and that violations of the code of conduct will be considered infractions that could lead to performance improvement plans and the fact that those behaviors are expected not only in the classroom, but also in the lab, also in the field, also in clinical. And it's important that you educate the other faculty, the adjuncts, the clinical preceptors, the field preceptors about those expectations. Because if you're saying you expect those things in the class, you should be expecting them throughout. And hopefully, those other faculty are displaying those same behaviors as well.

SPEAKER_01 4:36

So, plus, you have um with the preceptors, the whether it be clinical or field, um, with your lab instructors, your you know, lecturers, if they're all assessing affect and having that expectation, you're getting multiple data points rather than just one or two kind of periodic data points to help assess where that student is and then help them improve, just like you would cognitively, just like you would with your skills.

SPEAKER_00 5:02

Yeah, your coaching behavior for affective domain is critical. So if somebody does something, somebody uh has a microaggression and says, you know, something like, you know, uh, Bill, you're pretty good for an old guy. And then it's up to me as the educator to come up and be the upstander and say, I know you thought that was funny, but it wasn't, so please don't say it again. And that, you know, those small little course corrections are fine. Then you make a note of that and you move on. And a lot of times that's really all that it takes, but you're setting the standard for the expectations that you want everybody to display. So your job is number one, to be a role model, number one, to be an upstander and to not support any of those behaviors in the classroom. Early on, you set those expectations, and then hopefully people will continue to employ them throughout.

SPEAKER_01 5:58

Yeah, because with obviously within a clinical site, um uh there's nurses who are burning out. Um, and they that may not always instill a positive uh reinforcement. And we know in the field, there's a lot of paramedics that, especially if they're running busy shifts, uh difficult shifts, um, there's burnout there as well. So it's important to reinforce the the proper affect, the proper behaviors and the proper relations uh throughout all of it, because uh behaviors are contagious.

SPEAKER_00 6:30

Oh, they are, they really are, and and you really have to nip those things in the bud and make sure that everybody understands that not only did we set this expectation, but we intend to enforce it because that it's equally important to doing a good skill, like you said, or to really knowing your ABCs or whatever it might be that you're teaching in the classroom.

SPEAKER_01 6:54

So obviously, um the why we do affective domain um in the classroom, I think is very well explained. Um, generally speaking, how frequently do it is well explained. As far as the how, are there any tools or um tricks of the trade that perhaps some of our audience could employ to start that within our classrooms or to where to go to maybe find out more about the affective domain and the the tools for assessing it or monitoring it?

SPEAKER_00 7:24

The CoA EMSP has a uh that great resource library. And so they do have an example affective rubric that you can use. Um, the National Association of EMS Educators, Foundations of Education textbook has a whole chapter on the affective domain. You're slightly familiar with that chapter. Yes, it is. Well, I mean, it's sort of sprinkled throughout. Yeah. But I think, you know, importantly, number one, the faculty as role models. That's really a critical thing. Uh, number two is documenting any instances where you think somebody has sort of strayed from that. Uh, number three is feedback. Mid-semester, learners should get feedback in all three domains of learning. So it shouldn't happen at the end. It's gonna be too late if you wait to the end of the program to say you were a jerk.

SPEAKER_01 8:14

Yeah.

SPEAKER_00 8:14

You know, the employers will tell you that once you once they hire them. And so you want to try and correct those behaviors mid-course. So finding an opportunity to just do at least a five-minute meeting with each student, middle of semester. Say, here's what your cognitive grade is, here's how you're doing on your skills progression, and here's here's where we see you're just a rock star in like teamwork, or maybe you need improvement on communication because we're hearing, you know, some instances where maybe that wasn't really the a strong point for you, or even self-confidence, self-motivation, you know, those things are important in our field. You have to be willing to step up and take charge if you're gonna be a successful EMS clinician. And for some people, that is a really hard thing to do.

SPEAKER_01 9:02

Yeah, it's um it is difficult. I've seen it myself as a clinician, but I think it's again the takeaway message is it's got to start in the classroom and it's got to be uh consistent throughout the educational experience, hopefully throughout their career. Uh so they can go to CoA EMSP's uh resource library or to uh NEMC's EMS Educators um textbook, which has a whole chapter and various content throughout that uh textbook to as to how to assess and document and improve the affective domain. Any other closing thoughts as it relates to the affective domain with its importance or any other uh words of wisdom, especially since you're gonna be presenting, I believe, tomorrow on the affective domain here at the conference?

SPEAKER_00 9:46

I think one of the critical things is how you document the affective domain and being able to document individual instances versus patterns becomes extremely important. And so when you document, you want to document what was the specific situation, uh, what was the behavior that the person did, and you know, why why was it important? Why was that not acceptable? That's going to be part of your coaching for the learner. So you want to make sure that you have dates, you know, on this date, the learner made an untoward comment about a patient's weight in front of the family member. And that was very offensive to the family. And then if any action was taken, you're gonna document that. And then once you start seeing, if you have an egregious behavior, obviously you're gonna move right into your uh performance improvement plan or your corrective coaching plan, or if you start seeing a pattern, then that's where you start going up the scale of a performance improvement plan where here are the pattern of behaviors we've seen, here's why that's a problem, here's what we expect going forward, here is when we're gonna reassess it. And if you fail to do this, here are what the consequences that you're gonna face. And at that point, you know, you want to be notifying your medical director for sure, you're gonna get them engaged. And again, it's sort of like just gathering evidence. You cannot assess the affective domain in a one and done. You, you know, unless it's something egregious. You know, it's something that you're gonna observe and hopefully see improvement on over time. And you also want to recognize those really great affective behaviors, you know, to reinforce them. Yeah, to reinforce them uh for folks as well. So that those would be my suggestions anyway.

SPEAKER_01 11:43

Great. Um, good, good uh discussion, uh, great topic, an important topic. And as I shared with you before coming on uh uh on the film, one of my favorite topics to talk about as it relates to EMS education. So uh Kim, thank you for spending some time with me today to talk about the effective domain and its importance in the classroom uh and sharing your your wisdom uh as it relates to that topic.

SPEAKER_00 12:06

Sounds good. Happy to be here.

SPEAKER_01 12:08

Thank you for joining us as well. And as always, stay safe. Thank you for joining us for this episode. If you wouldn't mind, please click the like and subscribe buttons as well as the notifications so you can get notifications of upcoming episodes. Also, for the latest and greatest happenings out of the National Registry, feel free to go to nramt.org. Thank you very much, and again, stay safe.