Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Changing Standards in Education – from other things amanzi

I am often critical of the way EMS keeps trying to make it easier to keep up a steady flow of brand spanking new paramedics. Not because we produce a high quality product (new medics), but because the public is too ignorant to notice.

The main tool is the National Registry of EMTs exam, but other exams aren’t noticeably better. Dr. Bongi, from other things amanzi, has a post up at Better Health by the name of When Incompetence Kills.

Basically the powers that be are not-so-gradually degrading the degree. To them somehow it seems like a good idea.

It becomes difficult to have half a dozen, or more, medics show up for every emergency call, when we have standards. Do we decide that one competent medic is enough, or do we hit them with a double dose of barber shop quartets – in the hope that all the patient really needs is a lot of company, and maybe a song?

Of course, we choose the high quantity, low quality route.

The image is from the Wikipedia Project Triangle article.

Now not all that long ago, to miss free air on an X-ray even as a student was a mistake that would fail you. These days you can easily get through medical school without worrying about trivialities like free air on X-rays. Also, to have perforated bowel causes intense almost unbearable pain. Even a street sweeper would be able to pick this up in the patient.

Seems as if EMS is not alone in the just push them out the door with a card kind of standards.

Yet the doctor at the referring hospital did not miss this easy clinical diagnosis only on one day or two days or three days, but on four days.

About 9 years ago, I stopped teaching paramedic school, because I could not continue to contribute to this farce. I was forbidden from doing anything outside of the limited classroom time. There were 2 people in the class holding everyone else back, but nothing was to be done about them, because they have not failed the ridiculously low criteria to remain in the course. It’s up to their preceptors to pass, or fail, them. According to the program director. I was forbidden from getting rid of the dangerous students future paramedics.

So not only did his treating doctors totally miss a very obvious diagnosis that any 4th year medical student should be able to make and thereby neglect to treat him appropriately, but the one necessary thing they tried to do, because they didn’t know how to do it properly, caused further damage to the poor man.

One student was considered a troublemaker. One reason was that he would ask questions about things that would not be on the test. It was OK to have to essentailly repeat a lecture, because 2 people want to have paramedic cards, but don’t let on that they haven’t grasped the most basic points, the points from the first 5 minutes of the class. Everyone knows that the real evil is to ask a question about something that will not be on the test.

I cast my mind back to when I was still in academic circles. I remember the professors complaining about pressure from the powers that be to pass students even when they felt the students were not suitably prepared.

I guess I was just imagining things, because that would never happen in paramedic school. Dr. Bongi’s description is of medical school.

I myself was asked to examine a student in a practical exam. I failed her because she was simply a danger to any person unlucky enough to become her patient. And yet the powers that be had so changed the system from when I was a pregrad that she could not be failed and was released into the community.

When you cannot change the system from within, the only choice left is to leave or to force them to throw you out. I have taken advantage of both exit strategies.

We are killing them with kindness.

Killing the patients with kindness to the students. But the NR validates everything they do, and they are the experts. And you can’t go wrong buying a house when everyone else is, too. We’ll give you one mortgage on the house and another on the downpayment.

Don’t worry about the interest rate.

Debts like these never come due . . .

except in the real world.

The mortgage sellers and the NR don’t have to deal with their mistakes. They are making money selling their sub-prime product. The patients pay.

Dr. Bongi, you have my sympathies. It is too bad that more people do not understand.