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22 MAY 2016 | EMSWORLD.com they're supposed to manage it. It really helps reinforce positive behavior." • Post-training debriefing is often over- looked. "It's that debriefing process, that reflective process, where the learning actu- ally takes place," says Carhart. "Sometimes we get so caught up in everything we're jug - gling, we get to the end of the simulation and have more of a hasty hot wash than a proper debriefing. That is to our detriment." 'Like Night and Day' "Evidence seems to indicate," the NAEMSE vision paper concludes, "that high-fidelity simulations facilitate learning when used under the right conditions." 2 It offers, from authors led by the University of Miami's Barry Issenberg, MD, 10 habits of effec- tive simulation programs (feedback; repeti - tive practice; integration into the standard educational curriculum; range of difficulty level; adaptability to multiple learning strategies; capture of a wide variety of clinical conditions; controlled environ- ment to make, detect and correct errors without adverse consequences; individual- ized, active learning; defined outcomes and tangible measures; and simulator validity). 3 "W hat we've seen is a remarkable improvement in our students' level of pre- paredness that shows up when they actu- ally get to the field internship," says Heigel. "For many years we did EMT classes in a classroom, and we'd just sort of talk about things: 'OK, here's your patient, you pick them up and put them on the table. Now pretend you're in the back of an ambulance, and imagine you're doing this.' And we'd put students through a variety of steps, basically asking them to visualize what it's going to be like when they get out in the real world, and assuming they'll translate that pretty well. "Well, our students have been getting through those processes for years, and they've been successful. But when we really started incorporating the realism, the feedback we've gotten from our clinical sites and our internship sites is like night and day. The students actually understand what it's like to work in the back of a mov- ing ambulance, because we run scenarios where they have to package the patient in unpredictable situations and get them on a gurney and into the ambulance and do interventions while it's moving. We used to just talk about those things. So I think each component of that better prepares our students for stepping into that real environment." R E F E R E N C E S 1. McKenna KD, Carhart E, Bercher D, Spain A, Todaro J, Freel J. Simulation Use in Paramedic Education Research (SUPER): A Descriptive Study. Prehosp Emerg Care, 2015 Jul–Sep; 19(3): 432–40. 2. National Association of EMS Educators. Simulation in EMS Education: Charting the Future, https://c.ymcdn. com/sites/naemse.site-ym.com/resource/resmgr/Docs/ SimPressRelease15.pdf. 3. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fdelity medical simulations that lead to ef fective learning: a BEME systematic review. Med Teach, 2005 Jan; 27(1): 10–28. H o w t h e N a t i o n a l R e g i s t r y I s Tr a n s i t i o n i n g t o S ce n a r i o - B a s e d E x a m i n a t i o n s There are a few reasons behind the NREMT's move toward scenario-based verification of psychomotor competency for paramedic students. One is to assess students in a way that more simulates actual practice. Another is improve their ability to integrate individual skills into their overall scene and patient management. Certification standards starting this year require stu- dents to have a portfolio of vital skills and show progres- sion from performing simple psychomotor skills and scenarios to integration of skills and assessments in complex simulated scenarios. Next year the NREMT will launch the first phase of its new scenario psychomotor exam. "Scenario examinations," the organization says, "allow the NREMT to incorporate essential attributes of Team Leadership along with scene and patient manage- ment, thus better reflecting actual out-of-hospital care as opposed to continuing to test 12 isolated skills." To prepare educators to construct and deliver these new scenarios, NREMT and the National Association of EMS Educators (NAEMSE) are partnering to put on a series of regional scenario development workshops. These are free two-day classes designed to help program leaders develop offerings of appropriate type, variety and difficulty. They cover areas like scenario writing, calibra- tion and evaluation. Scenarios created in the workshops will be available for use afterward. "While the Registry has not really ever prescribed or done education—we're about verifying competency—in this case we decided educators needed some help," says Heather Davis, EdD, NRP, a member of the NREMT's executive committee and the planning committee for the workshops. "So the Registry partnered with NAEMSE to bring this opportunity to educators and program directors to help them understand the process, what they need to be doing in their skill labs, formative vs. summative sce- narios and how scenarios are different than full-blown simulation. We'll use folks who have already done this successfully in their programs to help answer questions and serve as mentors." There will be more than 20 regional workshops held across the country (see http://naemse.org/nremt) through December, including one on October 4 at EMS World Expo in New Orleans, LA. Feedback is being actively courted and employed to improve the workshops as they go. Resources to help have also been assembled on the NREMT's website, including sample video scenarios and things like sample rotation schedules, student job descrip- tions and an example of a portfolio collection tool. "So often, particularly if you don't have a lot of experi- ence writing scenarios or aren't in the habit of including your faculty in the calibration process, you can think you've written a great scenario, and then it turns out to be a mess when the students actually perform it," says Davis, program director for the UCLA paramedic education program. "Then you don't really get the feedback you'd hoped to gather. So it's really valuable feedback for groups of instructors, and the hope is that they'll leave these workshops and go model this behavior back in their own programs."