Why EMS educators need to use problem-based learning

Teaching EMT and paramedic students with problem-based learning prepares them for how they will be expected to practice in the field

Teaching adult learners can be a challenge, especially in emergency services. We’ve all had an instructor, classmate or partner who has the “been there, done that” mentality, not to mention the ones who have no desire to truly take the class or find the content boring because they don’t know how it is even supposed to benefit them. So how do we, as educators, reach these unengaged students without boring them to death with war stories and make them see that carefully crafted learning objectives actually have meaning?

As educators of adult learners, we have to think backwards and start the teaching and learning process there. This can be done through problem-based learning. 

Think of the last call you ran. When you were dispatched, you were informed of a problem. The first thought you probably had was how to solve the problem. 

EMT students and a rescue class use a problem-based learning approach to extricate a patient.
EMT students and a rescue class use a problem-based learning approach to extricate a patient. (Courtesy photo)

But in education, the first thing you often learn is all the basics. Maybe it’s starting with a general lecture in paramedic class on anatomy and physiology. You go through the body systems, break them down, memorize the etiology of disease processes and at some point have a formative assessment. There’s no doubt that you need to understand how the body works in order to treat patients and be an effective clinician, but what if you started at the other end of the spectrum?

If, for example, that call you were dispatched on was for respiratory distress, you probably started thinking about everything that could cause difficulty breathing. You might inquire during the assessment about various signs and symptoms to narrow your differential diagnosis. 

But to do this, you need to know what to look for; then you can further investigate the problem. The same goes for adult learners and problem-based learning. Students want to know what the problem is and how they solve it. Our job is to show them.

Characteristics of adult learners

While you might think that this leads to the development of a technician, rather than a clinician, let’s first take a look at some characteristics of adult learners. Originally, this theory of adult learning was coined by Malcolm Knowles and is still often referred to as andragogy, or the study of adult learners. Andragogy got its roots from the theory that adults learn differently from children and for many decades was simply referred to as adult learning theory. 

According to Knowles, adult learners have a certain set of learning characteristics. Adults want to understand why they need to know something. They rarely accept the information as arbitrarily important. Their self-concept makes them feel responsible for their own learning, determining when they are ready to learn and what they want to learn, and motivating them to do so. 

All of this is shaped by the learner’s previous experiences with not only life but also education itself, which shapes how they will view the material. Educators can use problem-based learning to tap into these characteristics of adult learners.

Instructing with problem-based learning

Problem-based learning is defined as a student-centered approach to teaching in which the instructor presents an open-ended problem to students and acts as a facilitator while the students work through the problem. The instructor guides the students through the problem, posing questions, reinforcing students headed in the right direction, and prompting students as needed. 

One of the most important components of problem-based learning is its relationship to andragogy. Students must have self-efficacy, meaning they must believe that they can succeed in completing a task.

A basic outline of a problem-based learning situation may include:

  • Gaining student interest
  • Controlling frustration
  • Providing timely feedback
  • Modeling processes
  • Questioning

This outline will often continue in a cycle. The instructor gains student interest by presenting a problem. The information from there on will be directed at solving the problem. Students should work through the problem as much as they can, with the instructor guiding them. 

The instructor should allow them to get frustrated, but at a controlled level, stopping them and putting them on the right path before they become so frustrated that they quit. When students are on the right path, the instructor needs to time feedback in order to make sure that the students know they are doing the right thing. 

If students are getting off track, the instructor needs to know when to step in and reorient them. At some point during the cycle, the instructor may have to offer examples of how to solve an aspect of the problem or ask questions to prompt students to further their thinking. Each time this is done, the instructor should be aiming to interest students in the problem, making them want to continue thinking.

Each part of the cycle allows the instructor to step in and add to the students’ knowledge base. Perhaps you have given students a case study in which they must appropriately treat a patient in respiratory distress. You have given them the patient's signs and symptoms, but they are not quite at the level in which they can distinguish between CHF and COPD right away. This would be a good time to review the pathophysiology of any differential diagnoses the students have come up with. Or maybe the students are on the right track, but you stop them to see if they can explain why they are right. Do they have a protocol memorized? Did they take a lucky guess? Or do they truly understand the effects of the medication they want to administer?

Problem-based learning can be applied to adult learning theory in order to meet the needs of emergency services personnel in and out of the classroom. While it may seem like students are learning backwards, the instructor allows students to learn based on a series of questions, including “Why do I have to learn this?” You will be answering that vital desire to understand the importance of a task and its requisite knowledge. 

By encouraging students to work through a problem on their own or with the assistance of their classmates, we are setting them up to be able to problem-solve in the field. They will be able to go on a call for respiratory distress and reason through what they need to do, because we are teaching them in the same manner that they are going to be practicing.  

In the field, our students are going to be given a problem and have to know how to solve it. Let’s teach them the way they are going to be tested in the real world and start with the problem.

1. Demirören, M., Turan, S., & Öztuna, D. (2016). Medical students’ self-efficacy in problem-based learning and its relationship with self-regulated learning. Medical Education Online, 21. doi:http://dx.doi.org/10.3402/meo.v21.30049

2. Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11). doi:10.3109/0142159x.2013.828153

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