Student Readiness (Feat. Lance Villers)

Are you preparing your EMS students to simply pass an examination, or are you truly preparing them for the realities of the field?

In this episode of the Registry Insider podcast, Bill Seifarth sat down with Dr. Lance Villers from UT San Antonio. Together, they explored the critical shift from basic educational effectiveness to true field readiness. Dr. Villers introduced four foundational pillars designed to help educators bridge the gap between classroom learning and real world performance, ensuring every student develops into a highly capable Clinician.

These four pillars focus on using proven learning science to challenge students, building trust in their hands-on skills, helping them grow into proud professionals, and using advisory teams to prepare them for the real world. By implementing these structured frameworks, programs can move beyond testing muscle memory and begin teaching the critical emotional regulation, ethics, and communication strategies that every Clinician needs on the street.

Transcript

SPEAKER_00 0:14

Welcome to the Ridge to Insider. I'm Bill Seifert from the National Regid VMTs, and we are uh filming another episode from here in A Credicon at New Orleans. And joining me today is Dr. Lance Villers. He's from he's a professor and chair as well as program director from UT San Antonio. So uh Lance, thanks for joining me.

SPEAKER_01 0:34

Absolutely, love it.

SPEAKER_00 0:35

So uh you did a couple talks or presentations today, and one of which which certainly piqued my interest, and I know will certainly pique the interest of others, is uh it's not about just passing the test, it's about educational effectiveness. And another way to say that is how do you make your EMS students, not clinicians, street ready? So good topic.

SPEAKER_01 0:57

Yeah, well, this all came about because I was involved in a case of recent graduates, this has been 15 years ago, where uh long story short, two recent graduates uh treated a what was a hypovolemic trauma patient, chest pain, shortness of breath, low blood pressure. Um they only had cardiology glasses on. So they saw that as a patient in SVT and synchronized cardiovardium. Um despite the horror, it got me thinking as an educator, they interpreted a set of signs and symptoms and cues, and they did went down a path that was completely wrong. So I I'm always trying to think about uh we know we have to prepare prepare our students to graduate, right? Uh pass our tests, pass our skills, demonstrate competency and pass National Registry to be able to practice. But there's sometimes that disconnect. We hear comments from uh employers or uh employees that say, you know, uh the students these days, they just they may be book smart, but they don't know the streets, and we're gonna teach them everything they really need to know. And so I always wondered why is there such a disconnect? Why, first of all, are we not adequately preparing them for the field? But why do uh um practicing paramedics think that what they learned in class is not what they need? So are we not teaching it correctly? Are we not teaching it effectively? Uh but ultimately my conversation today at Accredicon was to present what I called four pillars that we can try to implement in our classroom to address uh address that perceived or real deficiency that our that our graduates aren't quite field ready.

SPEAKER_00 2:39

So, of course, the natural question is what are those four pillars?

SPEAKER_01 2:42

Sure, I'd love to share that. Um the first one I think is one of the most important ones, and it's one that any faculty, teacher, or instructor can do, and that is to use the literature from the cognitive sciences that has been around for 50 years. We just haven't been taught all these things. You know, we're just not really taught how to teach. But the cognitive sciences um say that our students should be pressed a little bit, and they call it desirable difficulties. And what that means is that learning can be a bit of a struggle. If it was easy, then anybody could do it. And the analogy I make is just like if you want to exercise and stay in shape, to make advancements, you've got to add a little more weight every so often. You've got to run a little bit further every so often to keep advancing. And the same is true in learning. And so one approach is to use retrieval practice uh to help uh teaching. So I'll I wanted to present some things that that faculty can do, instructors can do in their classroom to make effective teaching become effective learning, become effective clinical performance, become effective clinicians. Um to me it starts with uh lecture one, slide one, how you teach in your classroom on day one.

SPEAKER_00 3:57

Good. So that's the pillar. Um and then the the balance of them or the all three?

SPEAKER_01 4:03

The other then the other three. Um the second one is um I I took the literature from medical education and nursing education, and they've been doing this since the early 2000s. They have a concept called entrustable professional activities. So it is a collection of competencies that are all put together, it's a unit of work, but it asks the question not can the student take care of a patient in congestive heart failure, but as the preceptor and as the teacher, do I trust that learner to do that skill right now? And and under what level of supervision?

SPEAKER_00 4:42

And hopefully, as they progress through the program, that level of trust will increase and level of competence through that stretching, through that you know, continual growth of the student. We'll help to make sure that they're uh effective and safe clinicians, but also that the learning is effective.

SPEAKER_01 4:57

Yeah, and I most of us do that anyway. I mean, we have we start at the basic skills and we progress up into more complicated uh skill scenarios and we want them to be able to perform. But the key difference is that an EPA relies on a level of trust. Do I and I think it answers the question that all of us educators in the back of our mind are always saying, Do I trust this student to take care of my spouse? We all say that. But I think the the EPAs make that more visible and more direct in the program. Basically, I want to know if I trust you to do this. It's not necessarily to take care of my spouse, but it's to take care of this particular set of competencies under this uh this type of patient. So that's the first two. Um the third and then the fourth. The third one is kind of a progression because as I progress from uh having being able to perform an EPA, it also requires the learner to have a certain set of affective attributes. And I introduced the concept of professional identity formation. Uh again, I I'm just borrowing these from the medical and nursing literature. Um, but it's it's going beyond just grading professionalism. Professionalisms are traits, but a professional identity is an internalized sense of I uh want to be, uh I want to be a paramedic. I don't want to just do the work of the paramedic, but how do we transition from knows, knows how, to does? And that top peak now in the Miller's uh clinical competency pyramid is now is. So it goes from does to is. And how do we help students transition from just doing the skills to actually embodying the sense of what it means to be a paramedic? And truly be. And typically those go beyond the skills because that's the price of admission. But what is the next step is how do we build uh integrity, honesty? These are all ethical issues that are complicated because uh we're not taught how to teach it. Oftentimes we didn't even realize that that was supposed to be part of our profession to begin with. So it is a challenge to do that. And all of us as educators have a challenge of how do we grade the A-effective domain. And that challenge is still there. But I think that uh the looking at a lens of professional identity formation, it gives us a broader sense of what we can assess on the affective domain. And that's gonna help educators ultimately because we're required to do that and we want to do that in our programs.

SPEAKER_00 7:31

And the effective domain, which um is a topic of of great interest for me, it has been for decades. But if you talk to anyone that's in any quality office or quality management or disciplinary office as it relates to EMS, the number one issue that they have for disciplinary issues, deal with interpersonal affectively. It's not um you know a medication mess up, it's it's a lot of affects. So that that being one of the pillars is I think is really important. Right. So what's the fourth pillar?

SPEAKER_01 8:05

The fourth pillar is something that all programs have to do, and it's kind of the bookend of my four, but it is just utilizing what we already have, and that's our advisory committee. The advisory committee closes the loop on our quality improvement process. So um we always use our advisory committees to review our outcomes, our test results, our attendance, uh, what programs are coming up, what programs how do we do on the last group? But uh I presented some targeted questions that program directors can use in their advisory committee to be more focused on this professional identity. So it's not just, well, uh, how do our graduates do? But questions like after 90 days, what do our graduates struggle with the most? Is it muscle memory of a skill, or is it kind of emotional regulation of the stress of the moment and those kind of things? So those kind of questions draw out more than just um, well, you know, they they don't do very well in uh megacode scenarios, but uh so we really want to know what what are the attitude, what are some attitudinal things, the affective issues that our graduates either display or don't. And uh again, we can use those advisory committees if they come up with a scenario. Let's say your your graduates are are always challenged when they're in the home and they have um a family member who's telling them to do one thing and the patient is doing this other thing, and they they just don't really know what to do. That would be an excellent scenario to create. So we create those EPAs from some of the feedback we can get from the advisory committee. Um and also to use those in scenario creation. So when when um think of a scenario that I don't know of any program that has ever done, but what if um a scenario where you had a colleague who showed up who was uh maybe you suspected we're we're drinking? That that's a realistic scenario scenario. How do we handle that? So you you can do some of those hard, um personal, ethical, again, affective issues with within your scenarios. And we shouldn't, as programs, we shouldn't be afraid to uh present it, test it, assess it, discuss it.

SPEAKER_00 10:19

Yeah, because it's strengthening them. If they're experiencing it in the classroom, it's not gonna be the first encounter they're gonna have it out uh in the field. Right.

SPEAKER_01 10:26

And we can think of others, end-of-life issues. Yeah. Right? Those are those are common issues, but do have we put those into a type of a scenario that draws on several competencies, including how you communicate with families with an end-of-life issue.

SPEAKER_00 10:40

Phenomenal. So um are there additional resources or can people go to find out maybe more information of what you presented? Um, are there any websites or additional insights you want to share?

SPEAKER_01 10:52

There's several uh organizations and journals that are catering to nursing education and medical education. And again, in the medical field, that started in 2003. So there's there's um um lots of information and articles that both uh assess it, like how how are EPAs working in a fourth year medical school curriculum, to much more practical, like how can I implement this in my program.

SPEAKER_00 11:17

Excellent. So uh thank you for joining me for this episode. I appreciate certainly um what you were able to present today, uh, but equally important what you're contributing to the uh the national EMS community.

SPEAKER_01 11:28

Thank you so much. Enjoy the conversation.

SPEAKER_00 11:30

Thank you for joining me 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 about the coming episodes. Also, for the latest and greatest happenings of the National Registry, feel free to go to nrmt.org. Thank you very much, and again, stay safe.