EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | OCTOBER 2018 81 OCTOBER 29 - NOVEMBER 2, 2018 NASHVILLE, TENNESSEE any of the five remaining attempts represent a loss of potential EMS providers. Identifying factors related to a candidate's deci- sion to reattempt is important for informing future interventions to improve retesting behaviors. Objective—To identify characteristics associated with reat- tempting the NREMT-C following an unsuccessful first attempt. Methods—Using NREMT test data from 2007–2014, this inves- tigation employed descriptive statistics and multivariable logistic regression analyses to evaluate the relationship between exami- nation reattempts and previous NREMT-C cognitive ability score, examination payer type, candidate demographic characteristics, and program characteristics. Results—Sixty-three percent (70,661/112,213) of eligible can- didates reattempted the exam at least once. Increased age cat- egory (25+) was associated with reduced odds of reattempting the exam compared to those aged 18–25 years. (e.g., 36+ years, OR 0.85; 95% CI, 0.82–0.89). Males had 38% greater odds of making a second exam attempt (OR 1.38; 95% CI, 1.34–1.42). Candidates who identified as Hispanic had 12% lower odds of making a second attempt compared to those who identified as white, non-Hispanic (OR 0.88; 95% CI, 0.85–0.91). Candidates who paid for the first attempt themselves had reduced odds of retesting (OR 0.90; 95% CI, 0.86–0.93). EMT candidates whose programs were affiliated with an accredited paramedic program had increased odds of making a second exam attempt (OR 1.10; 95% CI, 1.07–1.13). Conclusions—More than one-third of eligible EMT candidates never reattempted the exam. Candidates who were female, had a high school education, had self-pay status, attended a school not affiliated with an accredited paramedic program, or identi- fied as Hispanic had reduced odds of making a second exam attempt. Further research is needed to identify underlying causes for the differences observed in this study and identify additional factors associated with the decision to persist after an unsuc- cessful NREMT-C EMT examination attempt. Using Video-Assisted Structured Reflection in Simulated Clinical Scenarios and Real-Life Clinical Experiences in the Flipped Classroom Author: Chris O'Connor, EdD, MSc, Dip. EMT, NRP, HCPC, NQEMT-AP Associate author: Joe O'Hara, PhD Background—This paper explores the attitudes of practi- tioners to the use of video-assisted structured reflection in simulated clinical scenarios and real-life clinical experiences in the context of a flipped classroom to encourage and support reflection and reflective practice among prehospital emergency care practitioners in Ireland. It also examines the experiences of practitioners who participated in this process. Methods—This paper is part of a larger project which con- sisted of three cycles of action research. Data were collected via an online survey questionnaire and by conducting a series of semistructured interviews with various stakeholders. These included all three clinical levels of prehospital emergency care practitioners and educators from emergency service providers, private ambulance services, and volunteer organizations. Findings—When combined, a simulation experience with audiovisual recording and a structured model of reflection in the context of a flipped classroom has become a powerful learning experience. The process of a simulation experience with audio- visual recording and a structured model of reflection appears to dovetail nicely with the concept of the flipped classroom. The review of footage from audiovisual recording in the real-life clini- cal context provides a reliable and accurate means of evaluating clinical performance. At the same time, concerns were raised about the potential for abuse and misuse of audiovisual record- ings. There are perceptions that audiovisual footage of real-life clinical experiences could potentially be used for unintended purposes, such as disciplinary procedures. Recommendations—Since the process of combining a simu- lation experience with audiovisual recording and a structured model of reflection in the context of a flipped classroom has shown great promise as a learning experience, a larger-scale pilot study is proposed. • Develop a pilot program with student practitioners during their undergraduate internship and evaluate its findings. • Develop a policy that clearly defines the use of audiovisual recording footage prior to commencement of the pilot program. • A learning contract for all participants and faculty, including a confidentiality agreement, must be in place prior to establish- ment of the process. It's Good to Talk! Reflective Discussion Forums to Support and Develop Reflective Practice Among Prehospital Emergency Care Practitioners in Ireland Author: Chris O'Connor, EdD, MSc, Dip. EMT, NRP, HCPC, NQEMT-AP Associate author: Joe O'Hara, PhD Background—Since the mid-1980s, reflective practice has become formally acknowledged and adopted as a key strategy for learning and has become one of the cornerstones of medical education for doctors, nurses, and many allied healthcare pro- fessions. In the education of prehospital emergency care prac- titioners in Ireland, it is only in the last decade that the notion of reflective practice has been tentatively approached. Indeed, until recently it has largely been ignored by practitioners and educators alike. This paper explores the attitudes of practitio- ners about the use of a reflective discussion forum to encourage and support reflection and reflective practice among prehospital emergency care practitioners in Ireland. It also examines the experiences of practitioners who participated in a collaborative reflective discussion forum.

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