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Virtual EMS education: Growing pains and lessons learned

Longtime EMS educator shares the lessons he has learned from developing and delivering EMS curricula in a virtual and flipped classroom


In a flipped classroom, students do their classwork at home and their homework in class.

Courtesy photo

This feature is part of our Paramedic Chief Digital Edition, a regular supplement to that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Spring 2017 issue, click here.

By Kelly Grayson

I’ve been an EMS educator for 24 years, and in those 24 years, I’ve developed a pretty effective schtick. I’m good at breaking down complex concepts into easily understood terms. I can switch gears from inspirational to educational to entertaining and back again, all within the same lecture. I can read an audience with the best of them, and adapt my teaching methods on the fly. I can make an audience laugh or cry. I firmly believe that the most effective learning occurs between bouts of laughter.

As I like to say in my lectures, “We’ll reserve you a whole seat, but you’ll only need the edge.”

And very little of that was useful to me in a virtual classroom.

As the EMS Education Coordinator for ACE4EMS, the educational wing of the Louisiana Ambulance Alliance, my job for the past year has been to develop curricula and teaching materials for our initial and continuing EMS education programs. We make extensive use of the internet for virtual, instructor-led training and the flipped classroom model. We utilize a hybrid classroom, a combination of live instruction and self-paced online study. Using the internet allows us to greatly expand our educational footprint, beaming our classes to multiple sites and agencies simultaneously.

In a flipped classroom, students do their classwork at home and their homework in class. Rather than have an instructor impart medical facts in the classroom, and then have the student go home and try to apply those facts in EMS practice, the flipped classroom allows our students to pursue knowledge acquisition at home at their own pace, via their preferred learning methods. In class, we focus on knowledge synthesis and application.

In fact, that’s what we call our live classes: knowledge integration sessions. We do a lot of team-based and scenario-based learning, rather than “death by PowerPoint.”

And it works … very well.

Virtual educator growing pains and lessons

But there have been some hiccups along the way; I thought I’d share some of the growing pains, pearls and pitfalls we’ve encountered.

1. Not every student buys in, even among millennials

It takes a disciplined student to do a constant stream of assignments and projects at home, and then come to class prepared to discuss what we’ve learned. Every EMS educator stresses to their students that homework and reading the material beforehand is essential to classroom success. However, we all know that in a traditional classroom students can often get away with taking notes or mindlessly highlighting passages in their textbook while you lecture. It isn’t ideal, but often, it’ll pass.

This does not work in a flipped classroom. If students don’t do their study assignments, they’re going to be utterly lost in the live class. If you use this model as an educator, strict enforcement of assignment deadlines is essential. Weight scoring for self-study assignments reflects their importance.

Even some of the students who are conscientious about doing their assignments aren’t going to like the flipped model. As one student said to me, “It feels like I’m getting cheated. You’re supposed to teach me, and I’m supposed to learn. Here, I’m just teaching myself.”

At the time, he had the highest grade in the class, and he admitted that he scored much better in my hybrid classroom than he ever had in any traditional learning environment. He passed his NREMT psychomotor exam on the first try, and passed his computer exam in 70 questions. But, at heart, he was a passive learner, and just wanted to memorize the information necessary to get the certification required by his employer.

2. You’ll need an entirely different set of skills

When you’re not looking directly at your audience, it’s almost impossible to read the mood of the room. In a live classroom, you can change pace and keep things interactive with students by using a question-and-answer format and later mixing in scenarios.

But in an internet webcast, it’s much harder. Question and answer just leads to long stretches of dead air, and three-quarters of your students are probably furiously Googling the answer instead of thinking.

Instead, use polls and surveys to gauge student comprehension. They’re much more interactive, and there are a number of inexpensive plugins available that you can use in your webcast platform.

I can easily hold a classroom’s attention for an hour or more if I’m talking to them face-to-face. In an internet classroom, it gets boring easily. Keep PowerPoint lectures, if you must do them, to no more than 30 minutes.

You’ll need to make much more extensive use of multimedia in a virtual classroom. Use videos and photos to illustrate your teaching points.

In return, you’ll need more classroom prep. In a live class, I know my material well enough that if you give me 10 minutes to cull the fat from my slide deck and insert a few videos, I can teach on the fly with little planning. This isn’t the case in a virtual classroom. You’ll need every bit of that “three-hour prep for every one hour of lecture” standard, if not more.

3. You’ll have to abandon your old classroom paradigm

But that’s not necessarily a bad thing. In a traditional classroom, having students focused on their tablets, smartphones or laptops is considered rude. In a hybrid class, it’s almost a necessity. We have the sum total of human knowledge available at the click of a mouse, so why not use it?

I have quoted medical studies in class and struggled to remember the exact statistics, and had students pull up the relevant research while I was talking about it. I’ve also had students pull up contradictory studies and challenge me on certain positions. Isn’t that what we want in our students -- critical thinkers who do not accept dogma at face value?

Allowing personal data devices in your classroom can tremendously enrich the experience, but you have to remain vigilant. For every critical thinker who is engaged in the discussion, there is a slug who is surfing Amazon or updating his Facebook status while you talk. Some VILT platforms allow the instructor to remotely view a student’s desktop, or even activate his webcam. In live class, patrol the classroom frequently to make sure the students are staying on task, and have a written policy in place on use of electronic devices in the classroom.

Even such mundane policies as attendance are turned upside down in the hybrid or virtual classroom. We’ve all had the adult student who couldn’t get a babysitter on a particular class day or someone who was ill and couldn’t attend class because he was contagious. In a virtual classroom, I’ve had students attend from their living rooms, cars, ambulances and even airplanes while on vacation. One particularly dedicated fellow even attended from his hospital room. Moreover, I record all of my live classes and post the videos on the learning management system. This way, students can go back and review later or make up a class they missed.

4. It need not be expensive

In fact, if you use Google Hangouts and a free online learning management system like My Course Sites, it can even be free. For any virtual classroom, you’ll need to address three needs: deliver content, obtain feedback and evaluate comprehension. There are numerous web conferencing platforms that will allow you to do all three. Higher end webcasting platforms, such as iLinc, have greater functionality, but inexpensive options like Adobe Connect or Blue Jeans Network aren’t exactly drawing on a cave wall with a Mastodon bone.

You’ll need, at minimum, a stable broadband internet connection at each end. Avoid satellite internet; too much latency for interactive discussions and bandwidth restrictions make videos unworkable.

You’ll need a good videoconferencing omnidirectional microphone on your end, and your students logging in remotely will need a decent microphone/speaker headset, both of which can be acquired for under $30. Discourage your students from using their built-in laptop speakers and microphone, because background noise and feedback can become quite distracting.

In a similar vein, ask your students to mute their personal microphones unless they are speaking. Of all the elements of an interactive webcast — audio, video and graphics — audio is by far the most important. Audio quality can make or break a webcast.

If you need to deliver content, but don’t require live interaction, a simple narrated PowerPoint lecture makes an effective computer-based teaching assignment. I use a PowerPoint plugin called iSpring (roughly $900) that integrates testing and quizzes into my PowerPoint lectures, and imports grades to my learning management system. Not only will it grade quizzes, but I can also set it to require a certain amount of time to be spent viewing the slides, or a minimum number of slides to be viewed; there’s no skipping straight to the post-test unless I enable it.

Using the internet can broaden the reach of your classroom and make EMS education a richer, more interactive experience for your students. By avoiding some of my mistakes, I hope that you can utilize distance education to the benefit of your students and the communities you serve.

About the author

Kelly Grayson, NRP, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 24 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is president of the Louisiana Society of EMS Educators and a board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. Kelly’s books are available on his author page at You can follow him on Twitter (@AmboDriver) or Facebook, or email him at Kelly is a member of the EMS1 Editorial Advisory Board.

This article, originally published on July 17, 2017, has been updated.

Paramedic Chief Digital Edition is an EMS1 original publication that focuses on some of the most challenging topics facing paramedic chiefs and EMS service leaders everywhere.