By Sean Hulsman
It’s a typical day as a field training officer. Your probie, James, arrives for his third day of training. You’re in the middle of inspecting the rig when the radio crackles, summoning you to an unresponsive person.
James is a brand new EMT with no previous experience, but he drove hot to two calls the previous shift and had no difficulties. He gets you to the call safely and quickly.
However, things break down on scene. You enter the home and find firefighters performing CPR on a teenager. They are clearly stressed, the family is more stressed and James is visibly trembling as you ask him to grab the intubation kit and set up a 7 mm ET tube and a Mac 4 blade for you. He fumbles over to the airway bag, stammers something incoherent and freezes.
He looks at you and catches your annoyed glance.
You snipe, “Dude – the ET kit. Black pouch. Airway bag.”
He remains motionless as you straddle the patient and grab the ET kit yourself. You keep calm on the outside, but inside you’re steaming. “Didn’t we go over intubation equipment the last two days?” you think to yourself.
After the call, James finds you working on your ePCR. He comes over and says, “I’m sorry. I just can’t keep track of everything sometimes.”
What is being in the zone?
In sports, the term “in the zone” describes peak performance from an athlete, but long before 24-hour sports television networks, a guy you’ve never heard of was talking about a less famous zone. Educational psychologist Lev Vygotsky created the concept of the zone of proximal development in the mid-1920s.
Vygotsky’s zone of proximal development, or ZPD, is a staple of pedagogical training. He theorized that a learner’s maximum potential for growth fell in the “zone” between two performance criteria.
On the low end, the ZPD is what a learner can do on his or her own without any assistance. On the high end, it’s what the learner cannot do, even with assistance. To put ZPD in terms of EMS training, it’s the context in which your trainee can perform at his or her level of care with minor prodding from you as the trainer.
James could operate the ambulance hot without assistance or difficulty – the low end of the zone. He was outside of the zone when he was asked for the intubation kit, because even with assistance, James was not able to locate, much less set up, the ET equipment.
Why is the ZPD important in EMS field training?
All students are different. A great pitfall among new EMS FTOs is the assumption that all learners have the same basic knowledge and skills. Nothing could be further from the truth. In fact, it’s not a question of whether one learner is different from another, but more a question of how different they are from one another.
In EMS, your trainee may be a 12-year veteran who has just transferred from another local agency. It’s safe to say that he or she is going to be very different than the trainee who just got his first EMT card in the mail three weeks ago.
And the differences do not need to be this drastic. Two EMTs, each with three years of experience transporting patients at the same volunteer agency, may have tremendous differences. For example, one may have worked for the last four years as an emergency department technician at a local hospital while the other was a short order cook who only transported a few BLS patients each year. The FTO’s skill at determining the ZPD for each trainee he or she is charged with is vital to the success of that trainee. If the FTO keeps the trainee in that zone where he or she can succeed with a just a little help, that trainee will advance most quickly.
How to identify the ZPD?
On the very first shift with a trainee, the FTO should take the time to get to know a little about the trainee’s background both in and outside of EMS. Conversely, the FTO should also build some trust by sharing with the trainee some of the details of his or her own life and career. This exchange allows the learner to understand where the FTO is coming from and, more importantly, allows the FTO to get a feel for how much practical knowledge the learner has. An FTO can inspect the ambulance with a trainee one time, discuss some scenarios, and rapidly determine where that trainee’s knowledge base and comfort level are.
It’s important to note that the ZPD is also dynamic – it changes as the trainee becomes a stronger provider. The FTO must structure training so that it changes in difficulty as the trainee improves. If an educator keeps the instruction at the lowest level of the zone, the learner will get bored and eventually disengage. He or she needs to be challenged to maintain interest and reap the pride of developing new knowledge and skills.
On the other hand, if the FTO’s expectations are so grandiose that the trainee is always operating where he or she can’t succeed even with help, that trainee is going to experience frustration and disengage. The ZPD is an ever-developing, educational equivalent of the “Goldilocks Zone.” Not too hard, not too soft.
What is scaffolding for the FTO to build growth?
Scaffolding is a concept that goes together with the ZPD. The FTO creates scaffolding which is a framework to help the trainee build toward self-reliance. In construction, scaffolding is removed as a structure is slowly completed. For trainees, the scaffolding is removed when the FTO feels the trainee can handle a concept without assistance. As the learner becomes more competent, the scaffolding is slowly removed, and eventually the trainee is operating on his or her own.
Scaffolding can be anything – a mnemonic for setting up equipment, for example, or a system of breaking down an initial assessment into various parts. It’s simply support for the new EMT to build his or her competence. Scaffolding is where an FTO can really shine because he or she gets to create it or alter it to match the needs of the learner. A skilled FTO will have many diverse types of scaffolding and will know from experience which types work with which types of learners.
Part of scaffolding is tracking progress. If an agency does not have a built-in process to track a trainee’s progress, it is an excellent idea for an FTO to create one and implement it so that they and their trainees can see growth over time. Climbing the mountain is a daunting task when the climber is standing at the bottom looking up, but it’s very motivating when that climber looks back and sees she’s covered half the distance to the peak.
Conclusion
The FTO plays a significant role. FTOs not only teach agency operations and medicine, they also teach EMS industry culture. The next time you find yourself with a probie on your rig, do your best to get that person “in the zone.” Chances are good that years from now they’ll still be quoting you when they are FTOs themselves.