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Truth Telling in Healthcare

This article was originally posted in our April 2017 Newsletter, by Tom Gottschalk, COO, Medical Educator

As an EMS instructor/coordinator I can honestly say that the task of taking new candidates from civilian life to qualified EMS providers is an enormous undertaking. Whether we are training an academy of Emergency Medical Responders for police work or in the business of educating tomorrows Paramedics, I believe we have the hardest job in the world. After talking with folks in the Allied Health and Nursing fields, I get the feeling we are all in the same boat when it pertains to managing students effectively.

This is a topic that has been front and center for many of our EMS, Nursing, and Allied Health educators as they start new cohorts in their programs. “What can we do differently this year to better manage the student who isn’t going to make it?” These students might struggle with the cognitive, psychomotor, or affective domains from the beginning or have a big issues pop up mid course. I am talking about challenges like:

  • They have poor time management skills – Late for class; they leave early or are ill prepared.
  • Lack effective communication skills – Can not speak clearly or adjust to different situations.
  • Demonstrating an Integrity defect – Are dishonest or cannot be trusted when unsupervised.
  • Is unable to successfully pass hands evaluations during skills testing and simulations.
  • Struggle to achieve minimum passing cut scores on formative and summative exams.

So the question remains. What can educators do differently this year about these situations when experience is telling them that candidates may not be cut out for this line of work?

Try implementing an Against Medical Advice (AEA) program. It is a concept that is based upon the AMA practice we use in the provider world when someone does not want to follow our treatment plan. It requires everyone at your school to use a standard one page document that informs students that there are objective indications that they are not meeting the standards needed to qualify for graduation. All of which are signed and dated by the faculty and the candidate just like an old school four page carbon copy AMA’s. These documents are used every single time a mentoring session is held. Make sense? By using this strategy, students are put on notice immediately when they are off track and recognize the importance of addressing the matter quickly. And if push comes to shove, the program director is armed with a stack of written documentation detailing the student was informed of their situation and had written plans of how the student could change to better their position.

Now, in the interest of full disclosure, this system actually started out as tongue in cheek discussion over a decade ago in our neck of the woods (EMS). It has, however, become a practical solution for many dealing with students who are unlikely to succeed. When fully implemented, it works like a charm. With the support from your medical director and advisory group, your team program could have a win/win solution for everyone dealing with these issues