Wednesday, January 10, 2018

Requirements for Learning

Years ago while discussing Sudden Infant Death Syndrome at a case review meeting, our chief at the time - a newer paramedic and a single man with no children - announced that we would launch a campaign to teach parents not to co-sleep with their babies. Righteously, an EMT - an actual mother who was educated on the subject - spoke out against the proposal, citing conflicting recommendations and schools of thought from multiple sources. The chief had no parenting experience, and therefore no foundational knowledge on which to form an understanding of the needs of a baby or the needs of an exhausted mother, and could not have spoken on the subject with anything greater than specious authority, parroting controversial advice from other entities. In the end, his well-meaning but ill-advised proposal was dropped.

Lately I have been thinking about the prerequisites for ethical instruction and legitimate learning. I have developed a two question test to determine if an instructor is acting ethically, and a subsequent two question test to determine if learning will take place.

Requirement for ethical instruction:
1) The instructor must have a thorough knowledge of the subject, and teach the subject correctly, and
2) The education must be delivered in a constructive (i.e. nonviolent) manner.

Requirements for legitimate learning to take place:
1) The instruction must be ethical, and
2) The instructor must have credibility with the students.

Case Studies

Case #1: Ethical instruction, but no credibility.

While visiting Nazareth, where He was raised, Jesus went to the synagogue and began teaching the people there. Although Jesus had a thorough knowledge of the subject matter, the people proclaimed, "Is this not Joseph's son?", indicating that Jesus had no credibility with them since they had known Him as a boy. Jesus noted, "No prophet is accepted in his own country," and escaped right before the people attempted to hurl Him off a cliff. 

Despite His ethical instruction, no learning took place among the people of the synagogue due to Jesus' lack of credibility among His Nazareth audience.

Case #2: Unethical instruction, with positive credibility.

Marshall Applewhite was the leader of the Heaven's Gate cult and claimed to be God. He held a great amount of credibility with his followers, to the point that the men willingly underwent surgical castratration in Mexico at Applewhite's instruction. In March of 1997 Applewhite told his followers that an alien space ship (hidden from sight by a government conspiracy) following Comet Hale-Bop would transport them to heaven. In order to reach the space ship, Applewhite and 38 of his followers took barbituates and placed plastic bags over their heads in the largest mass suicide of US citizens since Jonestown.

Despite Applewhite's clear credibility with his followers, his instruction was unethical because he was unable to comprehend or correctly advise his followers about the subjects he taught, which finally caused them harm. No legitimate learning took place. 

EMS Implications

There is an idiom in EMS, and I'm sure elsewhere: Those who can't do, teach. People who are incompetent or inexperienced in a subject, and who don't have credibility with their peers, can often achieve  the acceptance they crave from impressionable students who don't know any better. Their instruction is often incorrect, and the instructor lacks a thorough enough comprehension of the subject matter to answer complex questions and advise students appropriately. I once observed a training captain boast to a student, "you know... female, fat, forty... That means diabetes." The student was amazed by the new piece of information gifted to him by his instructor. When I advised both of them that those were  in fact risk factors for gallstones and not diabetes, the instructor attacked me as too young to know what I was talking about, and vehemently defended his incorrect position by claiming to have learned it before I was born. The instructor was willing to continue teaching false information to new EMTs in order to maintain his credibility among his students - a testament to the power of social acceptance as a motivator.

On the other hand, even when the subject matter of the instruction is correct, the education can be delivered in an unethically destructive manner, such as by means of the public embarrassment and emotional flogging characteristic of traditional case review meetings, which leads to no learning taking place. Additionally, some inexperienced EMS leaders may lean on hospital RNs to provide instruction to their paramedics. Even if those RNs end up teaching correct material, few medics will have faith in the nurse who consistently treats them like inferior garbage during patient care hand-offs. This is exacerbated in systems where EMS leaders treat paramedics as inferior providers to those RNs. Consequently, no learning occurs. 

All educators should make an interospective evaluation of their motives for teaching, and test if their actions are ethical. Organization leaders should evaluate their continuing educational systems to determine if actual learning is a realistic expectation of their students. 

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