Hilary Gates: Hello, Hillary Gates ⁓ and have tuned to the EMS Educator podcast ⁓ and I am thrilled today to be joined by our regular guests ⁓ and hosts.

Rob Lawrence: Hey folks, it's Rob Lawrence in For Ginger Lock, who was promoted to the main show this month with a quick Rob recap. You know, listening to this episode really struck me because it reminded me that EMS education is not about teaching people to memorize answers, it's about preparing human beings to operate in uncertainty. And frankly, that's uncomfortable.

Hilary Gates: of Maya Dorsett and Ginger Locke and Rob Lawrence is on other duties as assigned as he likes to say. So we miss you Rob, but ⁓ I bet you'll come in and drop some wisdom bombs.

Rob Lawrence: As educators, leaders, and clinicians, we love certainty. We love protocols, algorithms, and checklists because they create structure in a profession that can often feel chaotic. But the reality discussed here by Ginger, Meyer, Hilary, and Jeff is that EMS practice lives in the grey. Patients rarely present exactly, like the textbook.

Hilary Gates: We are going to talk about operating in the gray, empowering students to be comfortable with clinical decision making and not always having the right answer, instead using their judgment as best as they can. ⁓ with us today is our guest, Jeff Anderson, ⁓ he's going to talk about some of the things that he has found as a program director, as a long time paramedic, and as someone who. ⁓ has really thought through what it's like to be in the classroom and not always next to your students and watching them go out into the field and come back with stories.

Rob Lawrence: Preceptors don't always agree, medical directors don't always agree either, and students quickly discover that the field is full of nuance, judgment, and context. What really resonated with me was the honesty in this conversation, the admission that educators themselves are still learning, that even experienced clinicians react emotionally, struggle with ego, and occasionally hear students completely misinterpret what they thought.

Hilary Gates: So Jeff, can you please introduce yourself and tell us a little bit about what do and where you are?

Jeff Anderson: Well, my name is Jeff Anderson. live in Bojah City, Louisiana. I'm the program director for the paramedic program at Bojah Paris Community College. I've been a paramedic about 25 years. I still work as a paramedic for a local ambulance service that's hospital-based service about 30 miles, about 50 miles south of here. guess it's not 30. I wish it was 30 miles, but it's more like 50 or 60.

Rob Lawrence: was crystal clear teaching. important because the best educators are not creating robots who blindly follow protocols. They are creating reflective practitioners who can ask questions, stay curious, think critically, and adapt safely when the script no longer fits the patient in front of them. I also love the repeated focus on grace, grace for students, ⁓ for preceptors.

Jeff Anderson: And this particular subject is interesting to me just because I've spent a lot of time over my career as a program director to figure out how to teach my students how to ⁓ clinical judgment. it's a lot of ⁓ work, it's been very enjoyable. ⁓ It's subject.

Hilary Gates: glad to have you here. This all started as a lot of things start in our lives at Prodigy with a conversation that you had with Maya. So I'm going to have Maya talk just a little bit about that conversation and what she started to think about it, think about the topic as a medical director. ⁓

Rob Lawrence: Grace for systems, because in EMS, mistakes and misunderstandings are rarely just about one individual. More often they expose gaps in communication, education, or process. And perhaps the biggest lesson of all: learning often starts at the exact moment discomfort begins. The confused student, the awkward debrief, the that doesn't sound right conversation. That's where growth happens. So

Maia Dorsett: this is really the output of not a single conversation, but Jeff and I have had a fair number of conversations and exchanged emails over years really about thinking about clinical judgment and clinical reasoning. I think as both a paramedic program medical director and Jeff as a paramedic program director, think ⁓ one of the... ⁓

Rob Lawrence: If you're an educator listening to this episode, take heart. The frustration, the questioning, and the grey areas are not signs of failure. They're signs that real learning is taking place. So listen along with me.

Maia Dorsett: maybe it's one of the most vulnerable or kind of the thing that challenges maybe my need to micromanage and control as a medical director is that you have them in the classroom where you're kind of delivering certain messages and then the students go out into the field and the reality is most of their education is not going to happen in the classroom. A lot of their education is going to happen the field and with preceptors. But ⁓ in classroom or in that ⁓ environment, I think often what happens ⁓ early on in teaching, I think in other parts of people's career over time, is people sometimes have ideas of certain absolutes. And I teach people, like as a medical director, the only like thou shall not I have is like, thou shall not abandon a patient and thou shall not lie. And then really, it's hard come up with a lot more like thou shall not because very often you can think of some kind of clinical circumstance or scenario where in that realm of gray that we operate, like sometimes those things are appropriate. And there's that thou shall 99.9 % of the time thou shall not. But like this ⁓ absolute, like ⁓ this is it is, I think is one of those challenges. And so I can think of better to to us about this than Jeff, because I think You have thought about it a ton, and I think have really become kind of a leader in do we think about this and how do we teach on it to paramedic students in particular.

Hilary Gates: Jeff, what do you have to say about that? has your thinking evolved and how does this topic sort of keep you up at night or maybe it doesn't anymore because you've solved it? ⁓

Jeff Anderson: ⁓ it still keeps me up at night. started like a lot of us do ⁓ with the whole two system thinking from Daniel Kahneman. And ⁓ I was actually introduced to that by Dr. Pat Crosscarey. I've read a lot of his And so just got to thinking about how can I teach my students? the information in a way that they can actually use it. Because I think a lot of times it's kind of sterile in the classroom and we just have this list of content that we get through and we don't really teach it in a way that's actually usable. We expect the students to kind of figure that out. And so we create this artificial sense of certainty in class like it's this way or this way when in reality it's really not. And so that's kind of been one of my focuses is just making sure whatever content I'm teaching, is this actually how I use it in the field? Is this how it needs to be used? And that's changed a lot of what I do.

Hilary Gates: Amazing. of course have with us Ginger who ⁓ lives breathes this ⁓ for of her career has been doing it after being in the field, but is a leader in the field of. clinical education and sending ⁓ into hospitals and ride alongs and that kind of thing at Austin Community College. ⁓ what are your thoughts ⁓ kind of overall? Of course, we heard Jeff about system one and system two thinking, which I've heard from you as well, but can you talk through of just the overall theories that you have about what happens in this span of control as an educator?

Ginger Locke: the span of control. Well, before I get to the span of control, to add on to what Jeff and Maya have talked about, I think with some empathy, we can think a brand new learner. They really love to hang on to some things. Like want it like for you to hand them this truth that they can hold and go out into their clinicals and be like, this is the way. And when they go to clinicals, sometimes they'll get feedback from preceptors that will say this is the way. they'll bring that back to campus ⁓ then we muddle through together of figuring out what conversations that often start with it depends, ⁓ your span of control question, do you span of control like locus of control for educators?

Hilary Gates: And maybe we get to that later. So if it's okay if you want to continue with just this idea of the student rather so much than the educator.

Ginger Locke: Yeah, I think of this occasion, just this last semester, a student came to me, popped into class. I was finishing another class and he's popped in and he said, hey, I have a quick question from clinical. And I thought there are no quick questions from clinical. And he, I said, okay, let's talk when I'm out of class. And he was like, no, it's a really short one. And I said, okay, lay it on me. he said, my preceptor said you can't give atropine for AV blocks.

Maia Dorsett: you

Ginger Locke: And I said, okay, this is actually a longer conversation. So as I suspected, talk after class. what out of that, of his need to like figure out, okay, I'm hearing this rule ⁓ in field, y'all have taught us rules, quote unquote. What he was doing, what Maya talks about all the time, Heather Davis about this all the in the prodigy instructor class is that the students... that are reflecting on their experience, they're the ones that are learning. And so I see those moments when they come back to us with these questions of like, ooh, this is their chance for us to really dig in and reflect and do all that critical thinking that Jeff has dedicated his ⁓ career to.

Hilary Gates: I just want to think about an adjacent or an analogous or adjacent situation that you mentioned to me that was so good ⁓ as someone who's been in the classroom where you've had students misquote you, Ginger, to other educators who have them come to you and say, we had a student say that you said this. So how has that affected your already huge of empathy and grace that you give people? ⁓

Ginger Locke: reminds me that when they do come back with these stories that like, okay, there may be some miscommunication expert and novice, right? They didn't understand the full context of what they're talking about and how can I in some blanks? And then also it made me decrease the amount of times that I'm willing to speak in absolutes. So I think when first started teaching, I was trying to hand them that these are some absolutes. ⁓ And I realized like, I need to talk in caveats all the time. and nuance all the time.

Maia Dorsett: I think there's two components to that though. Like one, I Ginger is just generally a better human being than me because sometimes, right? Like she's, think you've worked at it and developing this curiosity. It is a muscle to develop curiosity. Cause people come to me and they're like, my preceptor said this. And I'm like, what? That's crazy. You know? that's my natural, right? That's my natural reaction. And then I need people like Ginger's like, throwing people under the bus, right? And sometimes people are looking to get that reaction for a multitude of reasons. Sometimes a student wants a validation that ⁓ what they knew was right and preceptor was wrong. Sometimes they're asking that question because they're being genuinely reflective. And ⁓ I have to sometimes overcome what's Maya's head coming out my mouth and saying like, ⁓ I need to pause and be generally reflective. And Ginger's experience of what people's miscontruing what she said, I had that exact same experience this year. And the current paramedic class I have, they're amazing. they ⁓ every paramedic has their class, has their characteristic. This paramedic class really wants some absolute truth. ⁓ They want things to be the way they are and hang on. and hang on to something to like, in all of this, can I at least know one thing that's like right most of the time, you know, so that I have it? But we had around bradycardia, you know, think bradycardia and hypotension has this broad differential diagnosis and they went through a scenario where the patient, had a secondary heart block that went into a third degree heart block. And most of the time when I'm talking about bradycardia, I'm like, the answer is not to pace. It's to think about hyperkalemia or all the other reasons. Like, think about why they're bradycardic. Stop pacing everybody. It's almost never indicated. But they missed the almost never. And so they went through the scenario, and some of them didn't pace. And they're like, Maya said never to pace anyone in the field. I was like, I swear I didn't say that. I said,

Ginger Locke: you

Maia Dorsett: I said to think about why you have to say, this a primary conduction problem leading to hypoperfusion in this case? And if I'm thinking how much do I have to sedate this person to tolerate my pacing, I should not be pacing them. They are perfusing enough that you don't need to be pacing, right? Like it doesn't make sense, but they didn't. hear any of, like that didn't hear any of that. And that's really kind of my failure as an educator. But I think when Ginger reflected on that happening, it made me think I'm like, oh God, I gotta be a better human. And I gotta like pause before the words come out of my mouth. I don't know what you think of that, Jeff.

Jeff Anderson: One thing I was going to mention about this, there's another layer to it. I feel like we as the program faculty and the medical directors are like their parents and they're teenagers that go out to hang out with their friends and ride outs and they want to, they want to hang out. They want to be like the friends, not the parents. And so sometimes there's a little friction there where, you know, they're going to, they're going to go with what the preceptor or their coworker said. And then we have to sit back and talk a little bit about it and everything. But I automatically know as soon as I send them out to ride outs, I'm going to be the biggest idiot ever. And so we're just going to have to work through that to get to the end of the program. Yep.

Hilary Gates: You're the punching bag, right? I remember reading something where they did a bunch of research and said, when you talk about parents versus friends, parents often think that they have the biggest influence on their kids growing up, but really it's their friend group and their peers that they hang out with. And if you think about the amount of time kids spend with their peers versus their parents, it might be more, right? They're mostly just sleeping at home and coming home for meals, right? But they're like all day every day for most of their 18 years growing

Jeff Anderson: Yeah.

Hilary Gates: up at school with their their peers. I hadn't thought about that before, so I'm really struck like that memory of me going into the field ⁓ when was a pneumatic and trying to make the preceptor like me, right? I was so worried about like being accepted by them, so I kind of mirrored their language and their vibe, you know, and wanted to do the things that they were doing so that I wasn't that annoying student, right? Like ⁓ you we

Jeff Anderson: ⁓ yeah?

Hilary Gates: talk about this in that system one, system two, and what comes natural and what doesn't, but how much cognitive load, this is another thing I learned from Ginger and Maya, it takes to frame my own personality while I'm on the call and hope I'm doing the right thing while I'm also doing drug calculations.

Jeff Anderson: Right. Yep. Yeah. The taxing on the working memory is tough, especially when you're nervous. I so a good chunk of your working memory is just being there and being nervous and not wanting to mess up. But they loved it. They loved to play their preceptors off against me. Now, Jeff said this and then, okay, now we're going to start an argument. And so I get lots of phone calls during write-outs. Did you really teach them this? Well, hold on. of all, you got to understand what was actually said and then, you know, and then go from there. So there's a lot to it. But yeah, I think showing some grace though is important because I tend to ⁓ angry pretty easy and I've had to really work on that. It's like, no, that's not right. Come on. ⁓

Ginger Locke: You

Hilary Gates: It's a lot. And it's your own ego and pride, right? Because you know you're coming from a place of unconditional positive regard and trying to make sure that you're teaching your students the right thing and they're representing who you are. ⁓ for them to throw you under the bus isn't so nice. Yeah.

Jeff Anderson: Yeah.

Maia Dorsett: Part of that reflective process, it's kind of the same thing as when I'm a medical director and I provide continuing education or I change a protocol or I do something and then I'm like, they didn't do it or they like ⁓ it was wrong or something, right? Like the first thing I need to have is curiosity as to why that is and make the basic assumption that it was actually not like willful disregard, but there was something wrong with the system, including potentially the way that I delivered the education, right? So like this bradycardia and hypotension thing, I came back and was like, I think I need to just cover this thing. I thought I've covered it. I've covered it this way. I've covered it that way. I thought it was sufficient in other classes. And I was like, you know, I have this whole talk I do at conferences. I'm going to do this, and we're going to work through it. And I'm going to start out by saying that the whole point of this is that right answers are hard to come by in EMS. Feeling 100 % confident. The only time I feel 100 % confident, I mean, I don't know. I don't know if I really feel 100 % confident in anything. It's like you're doing CPR. It's like, oh, did this person have a DNR? You could say CPR. should be 100 % confident doing CPR when there's no pulse, except when you shouldn't be doing it on the patient. There's so many what ifs in EMS. And so how to get people to think through that process I think is the most fascinating and literally the best part of our job. Because in EMS, even more than any other place where we have tests that people think are concrete. It's about using all this incomplete information and saying, how if I changed one cue would that change? So you have this patient with this presentation. What if this were true? And that's an educational thing called elaboration. And we do it in emergency medicine too. What if this were true? And I think it's one of the most important cognitive things that you can do because it's true for like clinical decision making. It also helps with bias. Like what if this person was dressed differently? If you picked him up in a different zip code, had a different color skin, smelled differently, right? Like what would your workup and evaluation be? But I think that's a really challenging thing. And for us on the end, it's like what if that's not exactly what the preceptor said?

Jeff Anderson: Well, and another factor to this too is every cohort has their own personality. I think you mentioned that. so you could, I like, I had this my last cohort. had a way I taught a certain thing that has worked well for 10 years and it fell completely flat with the last group. So I had to reevaluate a whole lot of stuff just to get the lesson across to them because it just didn't work with them. And it's very frustrating.

Maia Dorsett: They do.

Hilary Gates: think we also talk about this idea of preparing the

Ginger Locke: And

Hilary Gates: students for that gray area when they get onto the field and then also reacting to when they come back, which is what we've kind of been focusing on. Jeff, you've again spent a lot of time thinking about this idea of clinical judgment and what happens when your students are working through their first few times in the field. What are some ways to kind of help them not be so frustrated by the non-black and white thinking, by their desire to pass the test to get the right answer to choose the right protocol. ⁓ Do you have some tactics or strategies for helping them with discomfort?

Jeff Anderson: Well, there's a quote that I love that's kind of driven a lot of this for me. It was a doctor named Amal Matu from Maryland. He says that classic presentation, ⁓ classic presentation is Latin for 15 % of the time. And so of the things I started doing when I was teaching, you know, whatever is thinking about, okay, well, here's the classic presentation.

Hilary Gates: I know know you will.

Jeff Anderson: How else does this present to and start to introduce some of that into women when I teach it? So it's not like one lesson is different. It's every lesson gets reframed through that lens. Just trying to get and make things more usable. You we talked about schemas. I know I talk about schemas all the time, but it's just trying to build those schemas out in a way that are more functional. the functional not functional functional. can't speak English. I promise.

Hilary Gates: Yeah, we got you.

Jeff Anderson: And just again, try to make the information usable. So when they recall it, they've got some patterns in their head that, ⁓ I remember it could do this. so they're not so concrete, not so ⁓ thinking about the classic presentation only. And then when we do formative assessments, when we do simulations and things like that, we some of that into there so they could see it. And then we make sure that when we do, that's kind of low stakes, so no one's failing because they a zebra for a scenario and they have to think a little bit. But it provides a great opportunity for discussion.

Hilary Gates: Ginger, same question kind of over to you. Like how do you prepare your students when you're sending them out? Like what kinds of things do you tell them to look for or think about?

Ginger Locke: think something really useful for them is learning how to talk to their preceptors and learning how to dig into the preceptor's decision process. so for that, going back to that student that was curious about the atropine and the bradycardia and the AV block, it's like, what conversation could he have had with the preceptor instead of bringing it back to me? Like what, ⁓ how amazing that have been if they had had it, you know, as a debrief after that call, a learning conversation? So just simple like don't. don't use the word why, why did you do this? Instead say how did you decide to do that? And so just coaching them and modeling that of how do you pick into someone's brain without jumping on their ego or activating their ego.

Maia Dorsett: That's really important too, because I've had preceptors writing about students and be like, this student's really difficult. They question everything I do. I was like, I love that learner. They're always asking the why behind something. They're so curious. And so there, it's, I

Ginger Locke: Mm-hmm

Maia Dorsett: think, preparing people how to ask questions with little I think identity threat of like I'm not questioning your competence as a preceptor. I'm interested in your frame the thought process behind ⁓ you do that. I think it's also sometimes the students are like I did ask and they said that's what the protocol says, you know, and I this is where I have to work on my kind of my own emotion regulation because like when when they answer to something is like that's what the protocol says

Ginger Locke: Mm-hmm. Mm-hmm. Yeah.

Maia Dorsett: like a little bit part of me like dies inside because. A protocol is really a clinical guideline that should be applied based on your assessment findings and working And maybe there's a medical director out there who wants the word of every single thing in the clinical guideline or protocol followed exactly, but no protocol is actually written that way. ⁓ Because can't write something for every single. every single scenario. just have to give people essentially tools that they can apply based on their clinical judgment. And so, I mean, one I struggle with. So I'm actually interested in your advice, Ginger, because I think you're probably the best at this, if really anyone I know. When ⁓ you that your ⁓ WTF, like in head, or you feel that kind of negative connotation, what What self talk, how do you control what comes out of your mouth? Or maybe only nice things come to your head. But I think you're also human. You might have had a not nice thought once in a while.

Ginger Locke: ⁓ sure. Yeah, it's just generally interested in systems just like you like systems. How did the system make this outcome? So I just like always like to back it out and do the root cause analysis.

Hilary Gates: pause thing is huge, Maya, because I don't pause either. pause, yeah. ⁓ I heard I was teaching some leadership class and someone said ⁓ a nice acronym called WAIT, which is ⁓ reminder to pause, and WAIT stands for Why Am ⁓ Talking? Yeah. ⁓

Maia Dorsett: you

Ginger Locke: Yeah. Why am I talking?

Hilary Gates: I loved that, right? ⁓ I don't know that I do it well, but ⁓ Jeff, what would you say to that ⁓ kind of reactivity ⁓ thing that happens with us and our own egos as educators?

Jeff Anderson: Like that, yeah. ⁓ I know I suffer from that some too. I don't like hearing crazy things said to me. And so I tend to respond badly when that happens. so I that pause there and just remembering that we don't, you know, we've to choose our reaction, choose how we respond to things. And for me, the biggest thing is just questions and trying to figure out ⁓ what's really behind what they're saying. ⁓ Cause I know students often don't say what they really are thinking. They're trying to figure out the words to actually, so if I can to anticipate that a little bit, ⁓ translate a little bit and then translate what their preceptor said to them, that helps a lot. Because most the time, ⁓ what they say sounds crazy initially, then when you drill down a little bit, it makes perfect sense and then we can go from there. So making sure I'm answering their actual concern or question.

Ginger Locke: Yeah, and where's the real learning needed, right? Like diagnosing, so the fact that the student with the AV block, when they was talking about atropines, like, well, that's a factoid kind of small topic, but what could we actually like dig into here? ⁓ asking, you know, I asked, well, why were they bradycardic, right? Like, let's talk about that. So like shifting when they bring back these, well, my preceptor said this and always this, and it's ⁓ well, let's... dig out what we can really, what my role is as an educator of teaching this critical thinking and assessment-based management, differential diagnosis. Let's like use this as the launching board, but I'm not gonna spend time who's right, who's wrong. It's like what's the curriculum here that we can really build from?

Jeff Anderson: Absolutely.

Maia Dorsett: I think that's also really important skill to ⁓ just for navigating ⁓ life afterwards in medicine, because you interact so many people and you have to say, what their perspective about going on ⁓ here? We definitely, I get referred as a medical director who works. Also in a hospital, right, cases where there's a lot of kind of miscommunication between the emergency department and EMS and everybody's really angry on both sides. I think the route of those miscommunications is not understanding the perspective of the other person. Like everybody has all these thoughts but none of them are shared. And gets lost sight of in those interactions is that... there isn't an agreement about what the patient needs. Or maybe they both have perspective about what the patient needs, but the conversation is not grounded. Like, they have it in their head, but they have very different change ideas about what that is. And so ⁓ I think... even developing that kind of debrief of like they said not to give atropine. It's like maybe the patient was in an AV block and their blood pressure was 120 over 80 and they were sitting on a stretcher chatting and the answer is like, yeah, sure it's an AV block and the heart rate's 34 but they're perfusing. We should hold their hand and be prepared to do something and let the hospital know but I don't actually need to do anything because the question is what does this patient need? And so I think. Practicing that muscle, I think, helps in so many circumstances, where how do I bring every conversation back to what was going on with the patient? What do they need most? And how do the different parts of the system actually get them that? The one thing that I, you know, is kind of as a perspective of somebody who's a medical director in the system, is sometimes cases are brought to me and I'm like, I'm trying to be curious, but that also might just be like ⁓ really not a good idea of actually happened to that patient. I think there are other cases where sometimes it's unprofessional behavior. Sometimes it's a error. In some cases, like, I'm interested as a paramedic program director, like how do you communicate that? Because when it gets communicated to me, like I'm already the medical director of the system. And a lot of what I struggle with is, How do I address this without making it clear that student's bringing a concern and that they're not throwing their preceptor under the bus, but ⁓ I'm approaching this with curiosity about what's going on in our system or how this error occurred or do I need to re-educate somebody or deal with something? So have been a few over the years where I'm like, that probably shouldn't have happened. And then I go look at the case and I'm like, yeah, that's. really shouldn't have happened. And I have to think about how do I correct what the learner has learned without throwing somebody over the bus and then kind of dealing with the system issues on the back end.

Jeff Anderson: And that right there to me is why I'm glad we're talking more about diagnosis because my generation of paramedics, we were almost scared death to even express that we came to a conclusion about what was going on because we're diagnosing, we're not supposed to do that. And it's a situation you're describing to me, ⁓ one of the most effective teaching moments would be, okay, explain to me what you thought going on, what was your diagnosis, and explain me how you got there. And then you'll probably figure out what little piece of knowledge they were missing or misinterpreted or something. And then you can have a real productive discussion. But if they're scared to even express that they came to a conclusion, because that's horrible, then you're never going to get anywhere.

Hilary Gates: Well, and we've talked about ⁓ bystander behavior slash upstander, right? And speaking up when something's going wrong and doing scenarios in the classroom and in the sim lab where ⁓ wrong or someone makes a wrong decision or there's a danger that's going to happen to the patient or a harm ⁓ and our students who are brand new or young or have never been in the field before to say something when they see something. That's a really hard thing. ⁓ I want to pause for just a second and just say I'm listening to this amount of information you're sending ⁓ new student into the field with is it's untenable. mean ⁓ trying get them to not only know all that clinical stuff ⁓ and ready to go start their first IV on a real human ⁓ and not make their preceptor mad and ⁓ ask right questions like it's impossible. And so it's really a testimony that

Jeff Anderson: Absolutely.

Hilary Gates: that you're thinking about all these things and understanding how hard it is for a new student. So maybe ⁓ example or some tips here about when student does come back and say this thing happened and it's clearly wrong. and you do need to kind of intervene as the person who's in charge of the student, whether it was the student's behavior or the preceptor or the field person or whatever. What are some ways that you've dealt with that?

Ginger Locke: I think about this in terms of this is like debriefing a call, right? And I wasn't there. so I'm ⁓ like you couldn't debrief a call from a chart review. You can't debrief until ⁓ having a conversation. And so we have a mechanism for that that wouldn't involve me. It would involve our clinical faculty that talk to the clinical sites. ⁓ And it's ⁓ wouldn't would never be me calling up a preceptor and saying, ⁓ what heck? So a process for that. then I think just, man, this comes up all the time. And it's like, well, which ones do I push forward or which ones do I ask the student to push forward? Because you want to be careful with that relationship too. like, I'll do the initial kind of debriefing with the student to make sure there's some kind of like merit to what they're saying or they're on the right track and like, ⁓ yeah, this does sound kind of... not right before pushing those forward. But I think it's really important to navigate those carefully and not just texting someone. Like if I happen to know that preceptor and be like my student said, right, that would never happen.

Hilary Gates: Jeff, how about you? What are some ways you've handled those situations?

Jeff Anderson: Well, for the most part, my students are going to ride with either program graduates or people I've worked with or people I've attended meetings with. So it's not common where they have a preceptor I don't know personally. And so that makes it a lot easier. Just, you know, okay, so this is what I was told happened. Can you kind of give me some clarity on this? And then we have the conversation and usually it turns out pretty well. Most of the time it's a misunderstanding. Most of the time ⁓ the student was overly confident about a certain thing there was a lot more wiggle room or gray to and ⁓ we worked it out.

Hilary Gates: Amazing. But Maya, you're the big boss. You're the bad guy. Not the bad guy. You're good guy. But seriously, as the medical director, you have a different role there. And you've talked a little bit about this, about these kind of processes you have in place. But your perspective is different than Ginger's, than Jeff's, than someone who's in the classroom. What's that like?

Maia Dorsett: perspective is different, but the approach is kind of similar. Right, like my primary role as a medical director in the system ⁓ is to ⁓ build systems that help people do the right thing. ⁓ And so just like have to because my like, you know, I have a reactive brain. It's like, anybody who knows me right knows there's lots of stuff going on in there and stuff just comes out. And so I have to pause. And every single time, I just want to be like, express the curiosity of when something happens like, What happened? What was the failure in the system? ⁓ even if it turns out that an error happened, right? So like the wrong thing happened for the patient in a way that they potentially The first thing I try and ask myself is like, what ⁓ guidance is given by the system? Like, how do I, when did I verify as a medical director that somebody knew how to do this thing? I like assume that they knew to this thing or that they interpret this thing or that they read the protocol or that they updated it? Because I think we put a lot of individual responsibility. And there is a role in individual responsibility to keep learning and keep updating on things. But there's also a lot of stuff. And ⁓ if ⁓ one person made the error or if ⁓ one person had a delay, then there's possibility that's for everybody. Sometimes it's relatively, I'm a nerd. And so for some things I can. ⁓ think about how would I measure that in the system and I actually go look at the data in the system as a medical director of like, is this happening? of those things are really rare events, right? Like if it's a cardioversion for an unstable patient, that's a pretty rare event. And so my goal, like as a medical director is either to discuss it with their medical director, if I'm not their medical director, or if I'm the medical director, like discuss it the medic and understand like fundamentally ⁓ what happened there. But yeah, like. Not with the goal of like, you're not going to be a paramedic, but with the goal of like, how do I, like, how do I fill this gap in our system or your knowledge or whatever it is once I identify what the root cause. And usually sometimes it's a combination of multiple, of multiple things. But I think it's interesting, there are people that it's easier to do that with than others. And I think you really, the hardest is whether or not, like, ⁓ what you about the person that you're talking to because some people I Have medics that I have a long relationship with and something happens and I'll come like review TF, you know That's how we that's how we talk and then we have a conversation and it's just totally like and they're like, yeah I I can't believe that happened. I did this I was thinking this, know, if we fix this it wouldn't happen and then other people I'm like, hey, I want to talk to you about this call and it's like the tails between the legs ⁓

Ginger Locke: Right. Right.

Maia Dorsett: The last thing I want is them to know, a paramedic student brought this up or something. I have to be really, ⁓ of like really careful on how I approach those things. And so it's a challenge. I am nowhere where I would like to be in the ability to handle every single one of those situations with grace and great productivity. But I try.

Jeff Anderson: I love how you're both talking about the system too, because I think that's a big problem is we want to focus on fixing the people, but fixing the system is usually a lot easier.

Hilary Gates: We can feel it. That's interesting, Jeff. I think if you put that statement out as just a sentence, a lot of people would disagree with you. But if you dig down into what we've just discussed, like with the emotions and humanity and egos and confidence and that kind of thing, ⁓ exactly right. The system isn't full of those things, ⁓ usually. As we come to a close, I'd love to hear from Ginger and Jeff kind of their final thoughts about... giving some tips to educators that are listening. These educators who ⁓ out there doing their very best ⁓ the classroom and in the field all the time, ⁓ what would you say to them after your years of ⁓ this? ⁓ said it happens on a daily basis, some of these ⁓ or disjointed behaviors that happen in the versus in the classroom, and what it's for you as an educator. ⁓ What are some things you would say to folks in terms of making peace with the chaos?

Ginger Locke: Yeah, I have total peace, zero frustration. In fact, that's the stuff I lean into because that's where all the learning is happening. It's right there in those conversations. Like when a student comes to you with a case, that's like, ⁓ we're about to like do the work of learning. so guiding those conversations is, man, it's the meat of it. It's why we're there.

Hilary Gates: Love it, Jeff.

Jeff Anderson: think having relationships with all the people that you ride out with and trying to spend time with the students and making sure that you really want them to learn. Another piece of advice I would have for new educators when it comes to developing a curriculum that doing this kind of thing is don't let perfect be the enemy of good. You can't do everything all at once. It's a lot of work. And so just pick a couple of things, make them better, and then pick two more things, make them better. And eventually you'll get to the point where you've got a really mature curriculum that does a good job preparing them. And you're never going to stop fixing things. You're never going to stop changing things. So don't assume it's ever going to be perfect. And then just be humble enough to accept it when it goes wrong and fix it.

Hilary Gates: Amazing advice from both of you. Thank you for being here and sharing your wisdom, sharing your experience. And Maya, thanks for so vulnerable and telling us about what your heart is doing and what your brain is doing and how to try to get them to work together. I'm in that same boat. Thank you all for today to this ⁓ incredible episode of the EMS educator podcast and our new episodes drop on first Friday of every month. So be sure like subscribe and share with your friends and we'll see you next month.