National Continued Competency Model: How refreshing

The only excuse for a stagnant and repetitive EMS refresher is lack of creativity and work ethic on the part of the instructor


I just finished teaching my last traditional NREMT refresher.

I’ve been teaching them for 22 years and most of the EMTs and medics I know look forward to refresher courses with all the dread of a root canal. Every year about this time, my phone starts ringing with calls from colleagues, acquaintances and friends of friends who want to know if I’m teaching a refresher course.

Between December and March, the calls get more desperate, and the offers more lucrative. Procrastinators are often willing to pay a hefty premium for a last-minute class, and sadly, I also get plenty of people offering obscene money for the certificate without the bother of attending the class.

I love teaching

There are few things quite so rewarding as seeing understanding dawn in students' eyes as they grasp new material or see a veteran’s eyebrows creep up his forehead as you teach him something his years on the street have not. One might even go so far as to call it…refreshing.

But two types of courses really test my patience; EMS refreshers, and Healthcare Provider CPR renewal courses. Participants in both tend to fall prey to the false notion that they have mastered their knowledge base, and refreshing that knowledge base is not so much a learning opportunity as it is an onerous chore, a necessary evil required to continue practicing.

Sadly, actual mastery is something I have rarely encountered. "Come on, it’s just CPR," they’ll wheedle. "You’ve worked with me. You know I know how to do CPR."

And my counter offer is always this: "Make a perfect score on a pre-test and perform flawlessly, with no mistakes whatsoever in your skills checkoff, and I’ll give you a post-test and write you a card. It shouldn’t take you more than an hour. Make a mistake, and you take the full class."

I have yet to encounter someone who met my conditions. Oh, I’m sure they exist. They’re just not the type to ask for a pencil-whipped class.

The same holds true with EMS refreshers and for much the same reason. When you’re an EMT who has been working full time for at least two years, especially when everyone who seems to know what they’re doing repeats the refrain, "The real learning begins when you hit the street," it is easy to rationalize that sitting in a classroom every two years is a monumental waste of time. And who could blame them, when what passes for continuing education in many agencies is an occasional update on protocol minutiae, or a boring rehash of information that was outdated when it first appeared in their textbooks?

Always something new to learn

But while it is nigh impossible to delve into new material in a heavily scripted and video-based AHA course, the only excuse for stagnant and repetitive lessons in EMS refreshers is lack of creativity and work ethic on the part of the instructor. With student-centered learning exercises and the flipped-classroom model, it is far easier to keep the interest of even knowledgeable and jaded paramedics. There is always something new to learn. There is always a perspective on patient care that even a seasoned medic may not have considered.

A few years back, I laid much of the blame for this knowledge stagnation at the feet of NREMT and state EMS agencies for restrictive and outdated refresher requirements. Back then, I said:

"As long as mandatory CEU's and refreshers are as tedious as watching paint dry, there will be a market for phantom classes and pencil-whipped training rosters, and there will be a cadre of unscrupulous EMS instructors willing to exploit that market."

After familiarizing myself with the National Continued Competency Program (to be implemented in my state for personnel recertifying in 2017) I’m happy to say that NREMT has gone a long way toward modernizing EMS continuing education. The "one size fits all," 72-hour aggregate of combined refresher and CEU credit every two years model is gone. The stagnant refresher requirements that have been in place since the 1980s have been replaced by shorter, more flexible requirements which are more relevant to today’s EMS practice environment.

The NCCP breaks education requirements into three broad categories; national, state/local and individual. The core content requirements of the national component are reviewed and updated on a five-year cycle. State and local requirements give individual states and the EMS agencies within them a great deal of flexibility in determining the content that best fits their needs, and individual requirements are left up to the interests and passions of the EMT.

Even better, more than half of those hours can be from non-traditional distributive education sources like magazine CE articles, videos, and other online content. Medics can get 35 of their 60 required hours via distributive education, AEMT can get 28.5 hours of 50, and EMT can get 24 of 40 hours. This is a big step toward making continuing education more accessible for those practicing in rural areas underserved by traditional EMS education programs.

Go read more about the National Continued Competency Program.

Now, if you’ll excuse me, I’ve got new refresher syllabi to write.

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