Teaching How to Do Scenarios and How to Learn From Them (BACKGROUND FOR THIS WEEK”S PODCAST)

While checklists are good, teaching  people to perform medicine where 100 proscribed motions and words are delineated may or may not be good. While seemingly contradictory to what I’ve said before, here are the reasons:

Memorization sucks from a safety perspective

• Things are memorized in patterns, when you break the pattern everything shatters to the ground and its very difficult to recover
• So, memorization is good if you can sit there, clear your mind, concentrate without interruption, and regurgitate the components – rarely happens in an emergency

Memorization is a bad way to teach

• Things are learned in chunks (5-7 individual items) that are then bonded together by transitions
  • Airway transitions to breathing exam after you do X, breathing to circulation when you do Y
  • That way all you need to remember under pressure are the transitions, the chunks will be there for you if you learned them properly (repetition)

• People who are not good teachers (or think they are good teachers) teach neophytes by pointing at the list of checkboxes and say “look, dummy you didn’t do this one”. The learner then gets nervous and goes “shoot, I better remember to do that one” this then makes it hard for them to remember the previous step or the one following since they now fixate on the one they missed.
• Checklists are NOT FOR MEMORIZATION. They are safety tools to be used during, or around the heat of the moment to create a situation where you can collect data, analyze, and implement. When you don’t have to memorize, you can go one level deeper into information gathering and analysis, which is usually good (but could be bad if you are not diligent about going back to your checklist and making sure you got everything).

So if you have a checklist why learn anything?

• Because you need to understand the physiology, the presentation, the sequence of signs and symptoms, the safety considerations, the techniques for care (IV’s, intubation and such) and you need to learn how to properly rank priorities and form and carry out a treatment or rescue plan that works.
• The checklist merely allows you to not forget essential safety components

My take on how to teach this:

• Make certain the learner understands the background on everything (what it looks like, what its components are, etc.)

• What respiratory failure is
• What an unsafe environment is
• What shock is, etc.

• Next, insure they understand why the steps in the algorithm are where they are?

• Why is airway first
• Why do we listen to the lungs
• Why do we check peripheral pulses first
• Why do we wear PPE
• Why is an unsafe scene a problem, even when the patient is dying and needs help right away

• Next, ONLY practice the individual steps.

• Do those until you can see the person understands what they need to do and why, and why the algorithm is the way it is..
• Don’t even think of going to step B until they have a grasp on step A
  • Example: don’t move to breathing evaluation until the learner is checked out on airway, and so on

After learning all the steps (airway, breathing, circulation, vital signs, etc.)

• Use YOUR experience and knowledge to help them link the steps
  • Everyone does this a little different, and often there is no right way
  • Will go over in podcast

When you are preparing to test, don’t make them go through the whole evolution if they are screwing up – STOP! You must correct them when they muck up a step or a transition

• How you prepare someone for testing is where your ability as a teacher comes out. It is at this step you can make or break learning and retention
• Remember, in these sorts of things, if they do it wrong once and their mind grabs that bad process, it will take a lot of work (usually 5 perfect repetitions) to eradicate it
• Stop, tell them what they did, and go back at least 2 steps, so they need to practice the step, and the transition in the flow of the problem.

Finally, testing probably needs to be less strict

• I know this is contrary to a lot of what I say, but if someone is getting nervous at the same step in the test over and over again, and they clearly understand the material, and they do everything else right, they probably are competent and shouldn’t be failed. If they are horrible all the way through, get rid of them before they hurt someone.