This article was written for our July 2016 Newsletter by By John Spencer, Medical Educator

Take a moment and think about all of the trainings that you have personally attended over the years. Do you remember them all or just some of them? Odds are that you can remember some of them because something memorable happened, either during the training or because of the training. The reality is that all of those trainings are embedded deeply into your mind and when push comes to shove your actions will depend on the quality of the training you have received.

We have all heard the stories about individuals training one way for years and then when faced with a high stress event in real life those individuals fall back on their training and it either works out for the good or for the bad. If their training was realistic and stressful, the odds are that it worked out for them, but if their training wasn’t realistic, odds are the outcome was not so good. Think of Waco, Texas and the federal raid on the Branch Davidian compound where in the end there were dead federal agents that were found with spent cartridges in their hands. They were policing their brass, just as they had been trained to do over and over and over again.

Now think about how we are training our students. We teach them skills, watch them as they practice, test them on the skill, and then send them out into the real world to perform these skills. They should be all set, right? What could possibly go wrong? After all, we watched them intubate a training head 20 times in lab, and they got the tube every time. They should be good to go, right? They performed positive pressure ventilations with a bag-mask device on that same trainer 25 times. They are obviously proficient…in the lab.

We must make our training environment as realistic as possible. Once our students have learned a skill, we must put them into a realistic scenario environment where they are expected to perform the skill proficiently. As they develop, increase the difficulty of the scenario until they are able to perform their skills regardless of what is going on around them.

This philosophy is not just for the practical skills lab either, it should be employed in their didactic training as well. We should engineer a classroom environment where our students must be able to critically think. After all, isn’t that what we are going to expect of them in the field.

We present material to our students in various ways and then we test them to make sure that they are getting the material. We quiz them and have them take exams until we are confident that they have mastered the material. Then, when we are confident that they are able to pass the certification exam, we send them out to take a test unlike any test they have ever seen before. See the problem? Train them the way they will have to fight. Our students will have to perform successfully on an adaptive exam, shouldn’t their training include adaptive testing as well?

In the end we all want the same thing. We want our students to be competent prehospital providers and to be able to make a difference in the real world. To achieve this goal, we must make their learning environment, classroom and practical labs, as realistic as possible. So, if your program is not using computer adaptive testing for your students, why not??