Naked EMT instruction: How to deliver powerful presentations

Moving away from the National Standard Curriculum

This article, originally published May 14, 2013, has been updated. 

I had an opportunity to submit proposals a state's annual EMS symposium. It gave me an opportunity to present the concept of "Naked EMT Teaching." The idea was inspired by "The Naked Presenter: Delivering Powerful Presentations With or Without Slides" by Garr Reynolds [1].

I wanted to convey the idea that we are too wedded to PowerPoint presentations and rigid curriculum, which keeps us from doing the best job we can in teaching students our trade. To improve our abilities as educators, we need to develop and embed new concepts in our teaching practice.

Medical critical thinking

The physician model for critical thinking is a three-part activity [2]:

  1. Medical inquiry – history, physical exam and diagnostic testing
  2. Clinical decision-making – a cognitive process that evaluates information to diagnose or manage a patient's condition
  3. Clinical reasoning – combining medical inquiry with clinical decision making and physician knowledge

Dan Limmer, Joe Miscovitch and William Krost wrote about critical thinking for EMTs in a two-part article published in "EMS World Magazine" [3, 4]. Phrases found in the article include:

  • "Differential diagnosis,"
  • "Active, inquisitive, aggressive assessment" and
  • "Develop strategic and dynamic care plans".

These concepts were not part of the 1994 EMT-Basic National Standard Curriculum (NSC).

The take-home concept is that EMTs should function as clinicians not technicians. "An EMT who is a thinking clinician is able to identify patients who are stable or unstable and require prompt transport. The EMT clinician also makes decisions such as when to call for advanced life support or air-medical evacuation, when to perform rapid extrication and when to immobilize the patient before removing him from the vehicle." [3]

Effective clinical learning

Critical thinking is evaluating patient assessment results against past patient encounters and the caregiver's knowledge of the disease process. Application of pathophysiology is a new element in the Educational Standards. Teaching pathophysiology and using it as part of a critical thinking process are new learning outcomes.

These learning outcomes change the role of instructors from vocational trainers to clinical educators. How can dedicated, experienced vocational trainers become clinical educators? It requires a combination of knowledge and teaching techniques beyond an updated PowerPoint presentation.

Pathophysiology resources

There are two EMT transition textbooks that provide essential anatomy, physiology and pathophysiology of the knowledge areas covered in an Education Standard program [5, 6]. Publishers have textbooks to support community college paramedic anatomy, physiology and pathophysiology courses [7, 8, 9].

It would be great if EMT instructors could attend a course providing ems-focused anatomy, physiology and pathophysiology that would include teaching techniques and examples. Lacking that, here are two concepts that may help experienced EMT instructors.

Embrace ambiguity

Two summers ago I taught our first Educational Standard course with a brand-new edition of a popular EMT textbook. I provided this feedback to the editor:

"A frustration is the vagueness of some numbers. For example on page xxx, Table xx-x 'Vital Signs'. Need to read through two paragraphs to parse out what would qualify as a blood pressure reading that would be hypertensive or hypotensive."

I was channeling my vocational instructor need to have the "right" number to define a "normal" blood pressure. In medicine, there is no absolutely correct number for blood pressure determination.

Clinicians appreciate that no patient presents like a textbook case. The goal is to determine what assessment and clinical findings are important to develop a patient care plan and determine transport priority. This requires a willingness on the instructor's part to teach more of the "grey" and less of the "black and white." Yes, it will take longer, and may be more frustrating to students. But the result will be a student who is more willing to look at the big picture, rather than just a number.

Case-based learning through concept mapping

Richard Beebe teaches this technique in his paramedic textbook to get the students to visualize the patient's problem [10]:

"Concept Maps offer a way for instructors to help students conceptualize ideas in the classroom and help them develop the critical-thinking skills necessary for determining a field diagnosis. Each Concept Map, utilizing a typical emergency scenario, walks students through the critical thinking steps used during an EMS response."

A concept map starts with boxes, each representing a component of the patient's condition. Each box needs a:

  • Sign
  • Symptom
  • Associated positive and pertinent negative
  • General EMT impression
  • Other data

The concept map will have six to twenty boxes [11].

Consider how the boxes are related to each other and make connections between each box. Use descriptions, such as FEELING LIGHTHEADED "may be due to" BLOOD PRESSURE 86/52. This process facilitates differential diagnosis and can guide inquisitive assessment, identifying areas for focused assessment. Once all of the concept map boxes are connected, the student has a better understanding of what is happening to the patient and can develop a strategic and dynamic care plan.


1. Reynolds, G. (2010) The Naked Presenter: Delivering Powerful Presentations With or Without Slides. New Riders. ISBN 978-0-321-70445-0.

2. Marx, J (ed), et al. (2009) Rosen's Emergency Medicine – Concepts and Clinical Practice, 7th edition. Mosby. ISBN 978-0323054720

3. Limmer, D. D., et al. (2008) Beyond the basics, the art of critical thinking, Part 1. EMS Magazine 37(4) p. 87.

4. Limmer, D. D., et al. (2008) Beyond the basics, the art of critical thinking, Part 2. EMS Magazine 37(5) p. 76.

5. American Academy of Orthopaedic Surgeons (AAOS). (2013) Emergency Medical Technician Transition Manual: Bridging the Gap to the National EMS Standards. Jones and Bartlett, ISBN 978-1-4496-0915-3.

6. Limmer, D. D. and J. J. Miscovitch (2011) Transition Series: Topics for the EMT. Pearson Education/Brady, ISBN 978-0-13-511351-6.

7. Bledsoe, B. E., et al. (2007) Anatomy & Physiology for Emergency Care, 2nd edition. Prentice Hall. ISBN 978-0132342988

8. Elling, B., el al. (2006) Paramedic: Pathophysiology. American Academy of Orthopaedic Surgeons/Jones and Bartlett, ISBN 978-0763737658.

9. Elling, B., el al. (2005) Anatomy & Physiology Paramedic. American Academy of Orthopaedic Surgeons/Jones and Bartlett, ISBN 978-076373925.

10. Beebe, R. and J. Myers. (2011) Professional Paramedic, Volume III: Trauma Care & EMS Operations. Cengage Learning. ISBN 978-1428323483.

11. Cañas, A. J. and J. D. Novak (2009) Constructing your First Concept Map. Institute for Human and Machine Cognition. Accesses May 14, 2013 from:

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