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The Art of EMS
by Steve Whitehead

6 training tips to reach unengaged EMTs

The students most in need of ongoing EMS education are the least likely to engage, but here are some ways to get them to listen

By Steve Whitehead

I can’t lie to you. As an EMS instructor, it’s disheartening. If you’re teaching EMS the way you should teach EMS, it can be particularly soul crushing.

We design and we prepare. We review the latest research in our topic and explore the knowledge tangents that may come up in side-bar conversations or the post lecture Q&A session.

The best EMS instructors are always asking themselves the same three questions:

  • Is this information applicable?
  • Is this information challenging?
  • Is this information interesting?

We know that the very best of EMS education is immediately applicable to our students. It pushes up against the boundaries of their existing knowledge base and it engages the learner in an interesting way. This is the secret recipe that we constantly stir as we prepare our class.

The sad truth

And then it happens. As we stand before the room with our title slide and introduction ready, the students begin to file in and take their seats. We smile and engage the first few students in the room. We ask a few questions and tell a few jokes.

And then someone plops down in a chair and asks the inevitable question all EMS instructors have come to dread: “Is there any chance we can get out of here early today?”

The question is a slap in the face, not because of its content as much as what it reveals about many of our students. While our intention may be to deliver applicable, challenging and interesting content, our students are often more focused on how long it will take and how much will be required.

It’s a sad truth.

EMS caregivers often just want to know the minimum that’s required and exactly how long it will take to achieve that minimum.

The paradox of EMS education

This disheartening attitude is also a self-fulfilling prophecy. There is a direct link between those caregivers who consistently engage in the learning process and those who perform well when the chips are down.

Our most reluctant students are also frequently our worst performers in the pre-hospital arena. This is where the paradox part comes in.

  • When we create continuing education standards, the students most in need of ongoing EMS education are the students who are least likely to engage in the learning process.
  • When we provide spontaneous learning opportunities, the caregivers who seek out the training are often the least likely to need it.
  • When the class is over, the students who have the lowest knowledge base are often the first to complain that the content was boring, redundant or unnecessary.
  • When we write articles to try to motivate EMS caregivers to achieve higher standards, the caregivers who find and read the articles are the ones who are least likely to need the motivation.

Each time I write a motivational piece to inspire EMS caregivers, this weighs in the back of my mind. I know that the comments section will fill with remarks like, “Amen brother” and “I’m going to hang this in our day room!”

But the individuals who really need to read it will walk by unaffected. To steal from the proverb regarding leading horses to water, our most dehydrated horses don’t even know that they need a drink.

So what do we do? Is there any fix for the EMS education paradox?

Perhaps changing the culture of EMS education begins with the recognition that there is no easy fix. Re-engaging disengaged employees and motivating the unmotivated can sometimes seem insurmountable tasks. But there are a few good places to start.

1. Have your educational ducks in a row

Educators who bemoan the EMS education paradox also need to recognize their role in the problem. Much of EMS continuing education is neither applicable nor challenging to experienced medical providers.

We can’t expect to dust off the same old PowerPoint slides year after year and drone through the material. If EMS educators aren’t engaged in creating continuing education that is challenging, interesting and immediately applicable then we can’t expect our students to show up engaged and ready to learn.

2. Raise your own standards first

We need to do a quick self-check on our own educational standards. How strong is our knowledge base? How motivated are our internal field instructors and educators? Are we pushing our own knowledge boundaries as well as challenging others around us to do the same?

If we aren’t openly and actively engaged in the process of ongoing improvement, we can’t demand it from our subordinates.

3. Test and measure personnel’s current knowledge

I’m not a huge fan of operational statistics. I feel that we are often far too tempted to rely on statistics that are easy to gather, like on-scene times and IV success rates (don’t even get me started on averages).

Statistics can distract us from focusing on what matters, like actual observation of our field providers at work. But knowledge and skills testing is extremely useful.

Let individuals know that they will be tested during the next training session and that the results will be used to drive future training and measure ongoing success. Skills should be observed and knowledge objectives should be measured.

4. Use test results to focus education, not single out or discipline

We should never use testing results to drive discipline. Education and discipline should never be related.

Educators need to let administrative staff know that regardless of the type of progressive discipline used within the organization, training records are off limits. Training needs to be a safe place to try and fail with impunity. It is essential to the learning process.

When tests and observations reveal knowledge deficits, these deficits should drive future continuing education and students should be retested to measure retention and educational success. In all aspects of EMS education, our educators should build personnel up, never single them out, tear them down or document reasons for discipline or termination. Field personnel need to know that their educators are trusted advocates.

5. Use educational primers and expect people to complete them

Many EMS educators reject knowledge primers because they require more effort to create, and to monitor compliance. Yet primers are worth the extra time and energy.

Knowledge primers prepare students for success in the classroom. They allow instructors to jump immediately to more challenging content, and they are ideal for moving redundant or review content out of the classroom.

One month before the scheduled class, students should be provided with an assignment. This can include reading, watching online video or e-learning content or listening to a podcast.

This sends a message that the training will be well organized and students will be expected to have a baseline of knowledge when they enter the learning environment. Class should begin with a short review of the primer to gauge compliance and understanding.

6. Politely refuse to lower the acceptable standard

There will be resistance. There is always resistance when we try to encourage a higher standard. It’s natural for people to fear change and try to protect the status quo. This is the way our brain is wired.

Try not to be too frustrated with the obstructionist crowd; they are useful for fine tuning the process. We can be respectful of their fears and do our best to alleviate their concerns, but we don’t have to give in and return to the days of, “Do we get to go home early?”

Politely refuse to accept anything other than full engagement during the learning process. Ask for cell phones to be turned off. When the class takes a five-minute break, begin teaching on minute number six.

Be prepared and respectful of student’s time but demand engagement during the learning process. If the instructor is fully checked in and the content is interesting and useful, there is no reason to demand anything less than 100 percent  from EMS professionals.

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at or at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
George Yaworski George Yaworski Monday, April 14, 2014 7:34:50 AM “Is there any chance we can get out of here early today?”....Is there any chance that you did your reading ahead of time and know the content and what needs to be done to treat the variables? If not, no we can't get out of here early.
Ruth A. Marsh Ruth A. Marsh Thursday, April 24, 2014 6:37:10 AM Our instructor was great and he never lowered his expectations. We started with 17 and finished with 4. We all passed our state exam too.....The way it should be. If you are unwilling to put in the time to study then you don't pass....
Chris Starkey Chris Starkey Thursday, October 30, 2014 6:53:41 AM some people arecontent with staying a BLS provider and we need bls providers yes, how ever people who re self motivated to go on and further them selves, even if your not going up to another skill set, but maybe working to better close support you als providers ion scene is not just good for you but for the team andnhte patient. I want to go on for my medic not because it's more money but because i wantto be able to do more for paients as a provider, this improves my self, witch improves my team, witch improves your squad, and that impoves you comunity. education is important in this line of work. medicine is always changing, and patients seem to have ever evolving medical conditions. bettering your self has better out comes for your job i think in this line of work.
Mike Smertka Mike Smertka Thursday, October 30, 2014 9:17:19 AM This is a well written article, but I think there are also some other things which can help. I would offer some of my experiences. 1. Ask people their opinions while you are presenting. You must convince adult learners to new education, it is not like lecturing at kids. 2. Learn how to give a powerpoint presentation. Nothing is worse than an instructor or presenter reading a wall of text or droning on and on through slides. 3. Don't teach too long without a break. The average adult has an attention span of about 20-30 minutes, if you can keep them engaged to 40 you are really pushing it. But most important, tell them how this information applies to them, how they can apply it to their practice, and give examples of how you as the instructor apply it to your practice. Many university professors make the mistake of thinking because the transition from theory to practice is obvious to them it is obvious to students and nothing could be further from the truth.
Angel Burba Angel Burba Thursday, October 30, 2014 11:28:57 AM There are various types of students. Many in ems seem to be what we call low level non self-directed. This is the barrier that we need to tackle. Educators need to have a stock of short duration activities which are application level that can be used to fill gaps in the schedule. There is really no good reason to ever let students leave the class session early. Even if you complete all of your learning objectives you can engage them in reflection style activities which have been shown to increase the depth of learning, something which is not often done in the classroom due to time constraints.
Mike Doss Mike Doss Thursday, October 30, 2014 12:33:16 PM after reading your article (good read BTW) - I would answer the student that wants to leave early with... "yes, as a matter of fact, you can leave right now and you don't ever have to come back" - that will weed out the ones that actually would like to learn from the ones that just want a paycheck - a true EMS soul will ask "can't we stay a little longer?"
David Lee Black David Lee Black Thursday, October 30, 2014 2:44:46 PM If you are not excited about being an EMT then go do something that does excite you. There is no room for people who do the bare minimum in EMS. Let them suck at life some where else.

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