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IMMEDIATE ACTION DRILLS competence), explicit monitoring theory and the neuropsychological construct of habit loops. been acquired, but performance of that skill requires concentration. It's believed that a student who is performing at the conscious competence level might experiSTAGES OF COMPETENCE ence a deterioration of performance if a The four stages of learning a new distraction is introduced during the perforskill, often referred to as the four stages of mance of a skill. competence, come from a theory intended Given suffcient practice, the learner to explain the way we progress through may progress to the fourth stage of the acquisition of a given skill.7 competence. This stage is known as In the frst stage, the learner is unconscious competence and signifes unaware of what they don't know. This is the ability to execute a skill or action often referred to as unconscious incomwithout focused thought. petence and is what might be expected Given sufficient lab time, EMS educaof students at the beginning of a training tors are likely capable of guiding their program. students to skills performance that is In the second stage of competence, consistent with the notion of unconknown as conscious incompetence, the scious competence. However, this still learner becomes aware of their defciency leaves a gap between primary educabut remains inept. Recognition of such tion and actual performance in the field. defciency is an essential precursor to If you ask your local EMS agency training learning. officers, you might hear stories of model The third stage is known as conscious classroom students who struggled to competence. In this stage, a skill has get knowledge from their brain to their hands when faced with a dynamic situation. This might be attributed to an unrecognized fifth stage of competence, which can be referred JSA-400 to as dynamic unconAluminum Break-Apart Stretcher scious competence. In this stage, a given skill can be executed without JSA-400 thought, despite the dynamic characteristics consistent with the practice environment of an Specifications Designed to gently maneuver stretcher under Dimensions: 66 ¼" L x 17 ½" W x 2 5⁄8" H EMS clinician. IADs may patient without rolling or lifting. Folded Length: 49 ½" be one way to promote The center of the Junkin Aluminum Break-Apart Folded Depth: 3 ½" the achievement of Adjustable to: 80" Stretcher can be opened to allow the patient to Load Capacity: 400 lbs. dynamic unconscious be X-rayed while secured on the stretcher. Shipping Weight: 21 ½ lbs. competence and avoid Features sturdy, lightweight aluminum choking under pressure. construction with an adjustable length and three patient restraint straps. Folds for easy storing and separates in half during application and removal. EXPLICIT MONITORING THEORY PROUDLY MANUFACTURED IN THE USA 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 S A F E T Y A P P L I A N C E CO M PA N Y www.junkinsafety.com For More Information Circle 26 on Reader Service Card 52 JUNE 2013 | EMSWORLD.com The explicit monitoring theory provides a partial explanation for the construct of choking under pressure.8 This explanation holds particular relevance to the previously described gap between unconscious competence and the proposed stage of dynamic unconscious competence. According to this theory, mental pressure can lead to a disruption in the automaticity of a welllearned skill by causing the individual to think about the process of what they're doing, rather than simply doing it.9 The threat of focusing too intently on the steps of a particular skill is particularly concerning in the context of EMS education. Consider the number of steps contained in a skill sheet for even the simplest psychomotor skill. Regardless of the specific skill being learned, most EMS skill sheets begin with scene safety and BSI, followed by a laundry list of overly specific actions. It's no wonder a paramedic might choke under pressure when the individual steps brought to mind, following a disruption of automaticity, are not explicitly focused on executing the intended action. Granted, such a high level of detail is imperative for the introduction of new skills, but perhaps we need to evolve our approach once a higher level of performance has been demonstrated. By training paramedic students to utilize brief, targeted sequences, triggered by specific cues, they might be able to maintain the parallel processing associated with unconscious execution of a skill. HABIT LOOPS Habit loops are formed when a sequence of actions is converted into an automatic routine.10 Formation of this loop involves chunking (i.e., clustering) of psychomotor behaviors that are subsequently transferred to the basal ganglia—a paired portion of the brain responsible for recollection of patterns and selection of action in response to those recognized patterns.11 Habit loops involve three stages.10 The first stage is characterized by the activation of a cue, which triggers the routine (i.e., sequence of actions) at the core of the habit loop. Performance of that sequence is the second stage. The third stage of the loop involves some form of reinforcement. This reinforcement can be as simple as a positive