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Flipping the Emergency Medical Training Classroom



Emergency Medical Technician courses are a natural for the flipped classroom

It’s 17:00 and I’m walking into the high school cafeteria that is currently host to my Emergency Medical Technician class. The room is set up for maybe two hundred students with round and rectangular dining hall tables. A little big for our group if we were doing a traditional lecture style, but just perfect for our discussion and activity based classroom.

My co-instructor has texted me that she’s running a little late, so I am getting the supplies and equipment out of the closet for the class.

At 17:30 she hurries in with tonight’s discussion papers. It’s the fifth class of the course and we’re fifteen chapters into the text book.

At 17:45 our students and lab instructors start to come in. The students sign in and settle into their groups. Each group has three or four students and sits at an assigned table.

At 18:00 we pass out tonight’s discussion prompts to the groups. The discussion prompts are actually the textbook handouts and quizzes that the students, rather than taking them home and doing them individually, work through in class.

There are fifteen students in the class that we have divided into four permanent working groups. Any group activity is done in these assigned groups. The first hour of the class is discussion which is facilitated by a lab instructor. The discussion facilitator’s job is to act as a resource and keep the students on task. The other rule to these discussions is that the students may NOT use their books. They can only use each other and their lab instructor.

At 18:15 a student walks in late. He signs in and sheepishly sits down with his group who give him a relatively good natured hard time about his tardiness. Didn’t he know that this chapter is hard and they needed him?

At 18:45 the students give their reports. Tonight they have been working through the circulatory system and life stages. Each group had a different prompt to work on, so the other three groups take notes during the reports.

At 19:00 we call a five minute break. The students use the restroom or grab a couple of the cookies one of the lab instructors brought in.

At 19:05 the students are in their groups looking over the instruction sheets for the skills they are learning. Tonight’s skill is learning how to insert different airway adjuncts and the first steps in patient assessment. The students work in their groups and lab instructors have set up different stations to teach four different skills. The students rotate through each through the course of the night.

Noticing the Difference

Some of the differences I see in this classroom, as opposed to the traditional way, is that there is no one fighting sleep tonight. All of the students are adults with day jobs– in a typical lecture based class, it takes about fifteen minutes before you start seeing heavy eyes. Nor am I seeing the sly checking of text messages on phones or Facebook on laptops–even though we have made it clear that these devices are welcome. The only time someone uses their device tonight is when they double check a statistic.

The reading schedule for this class is quite heavy–it’s a six credit course and we were very upfront with the students that the workload would be time consuming. The reading schedule has the textbook readings finished halfway through the class. All the students are keeping up with the assigned reading. We know this because there are two open book quizzes assigned each week through the course website.

Tonight, the students are rotating through lab stations where they watching an experienced EMT do a thorough patient assessment and treatment. Each lab station is assigned 20 minutes for the demonstration and discussion.

Inevitably the lab instructors end up telling war stories. Student questions revolve around “what ifs?”. At first the lab instructors do this almost guiltily–In most courses these skill demonstrations take a back seat to lectures and the lab instructors are accustomed to being sensitive to the time constraints of the lecturers. They explain and correct as the students fumble through the skill the first time. Next week the students will be doing assessments on each other and on volunteer patients.

In a typical EMT class, many class sessions  might be taken up entirely with lectures, with limited time for practicing skills. However, these students have already seen tonight’s video lectures. I try to give them videos that are no longer than about fifteen minutes in length because they are very information dense. The short format allows them to easily re-watch the ones they have trouble with.

No Student Left Behind

My co-instructor and I take a few minutes during this time to look through student’s quiz grades. The quizzes are open book and the students are allowed to take them as many times as they need to until they are able to pass at an 85%. The website we are using tracks the amount of times the student takes the quizzes and how long they spent as well as tracking their grades. The software also tracks the individual learning objectives so that we can tell if the class as a whole is confused on a concept. Right now, with students halfway through the textbook, the class average stands at 87% and not a single student is behind.

At 20:50, students finish their final lab demonstration and the groups head back to their tables. Before they leave, we field some questions about logistics for next week and pass on announcements. At 21:00, students are packed up and heading for the parking lot.

As the students leave, the lab instructors and my co-instructor and I gather for a short debrief of the evening. We note which of the students are still weak in certain skills and we plan next week’s activities accordingly.

We have 12 weeks more with these students, but already their skills are stronger than most groups are at the end. In the past, skill training has been left up to training officers in home squads and ride along hours. Unfortunately, time in the back of the ambulance, while invaluable for the student’s experience, is perhaps not the best place to learn skills. Not all experienced medics are good instructors and not all patients want to be assessed by students who fumble through an exam. By practicing the skills in the classroom, the students gain a level of proficiency that make them real assets from their very first ride along.

“Show Me” Engagement

Emergency Medical Technician courses are a natural for the flipped classroom as are other Health and Allied Health fields. The practice of the skills provide ready made activities for the instructor. The students who take EMT classes are commonly “show me” people, strong in spatial reasoning and mechanical intelligence, but not great fits for the classroom environment where they have to sit still for hours on end. The flipped classroom creates a better balance for these folks, especially if online content is presented in ways that allow for immediate feedback.

One of the things the other instructors have commented on is the level of engagement the students have with the course content and each other. Even though the class is the usual mix of introverts and extroverts, no student is getting lost in the crowd. Each group working group is referred to as a crew as they would be in an ambulance –they do their assessments and patient treatment with the crew roles rotating. When giving report to the class the spokesperson changes each time. The students who are more proficient with their skills are encouraged to help those who are less proficient. And during discussions the students who are more comfortable with the theory are able to contribute their understanding.

When we were planning this class, we ran into the usual pushback; how would we know that students were doing the reading? How would we make sure that students were listening to the lectures online? However, my co-instructor has been teaching EMT’s for the state of Vermont for thirty years and was instrumental in convincing our board that this was something to be tried.

Ultimately the format will prove itself (or not) by the pass rate for the national exam. In the mean time, everything about the class is encouraging. Students are clearly engaged and definitely taking responsibility for their own learning. We are also having a really good time.

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