Medical students as EMTs: skill building, confidence and professional formation

Figures & data

Table 1 Self-reported confidence in patient care skills (N=97)

Survey questions	Pre	Post^a	Mean differential	P
Approaching patients	2.95	3.53	0.58	<0.05
Listening to patients	3.34	3.73	0.39	<0.05
Using appropriate body language	3.02	3.63	0.61	<0.05
Establishing rapport with patients	3.02	3.52	0.49	<0.05
Obtaining a medical history	2.02	3.13	1.11	<0.05
Using appropriate interview styles with patients	2.13	3.18	1.04	<0.05
Understanding a patient's perspective	2.94	3.47	0.54	<0.05
Conducting a basic physical exam	1.55	2.41	.87	<0.05
Responding to a patient's medical issues	1.74	2.71	.97	<0.05
Responding to a patient's psychosocial issues	1.84	2.60	0.76	<0.05
Managing time in individual patient encounters	2.09	2.65	0.56	<0.05
Identifying clinical dilemmas that require ethical decision making	2.31	2.87	0.56	<0.05
On a scale of 1–5, how much confidence do you have right now in patient care skills?	2.74	3.54	0.79	<0.05

^aPre is prior to beginning medical school and post is at end of the CPR course (9 weeks).

Table 2 Self-reported confidence in team building skills (N=97)

Survey questions	Pre	Post^a	Mean differential	P
Understanding my role and responsibilities as a medical student	2.65	3.14	0.49	<0.05
Understanding the roles and responsibilities of others	2.59	3.18	0.59	<0.05
Developing a respectful working alliance	3.56	3.62	0.06	0.43
Setting common goals	3.42	3.49	0.07	0.31
Understanding the strengths of different team members	3.24	3.44	0.21	<0.05
Decision making	2.99	3.14	0.15	0.06
Adapting to a situation	3.47	3.35	−0.12	0.08
Being flexible	3.57	3.49	−0.07	0.29
Anticipating the needs of other team members	3.00	3.07	0.07	0.38
Prioritizing work	3.30	3.16	0.13	0.11
Conflict management	3.08	3.10	0.02	0.78
Trusting other team members	2.98	3.22	0.24	<0.05
On a scale of 1–5, how much confidence do you have right now in team-building skills?	3.98	4.12	0.14	.07

^aPre is prior to beginning medical school and post is at end of CPR course (9 weeks).

Fig. 1.  Self-reported impact of the EMT curriculum and ambulance experiences on students’ patient care skills (N=97).

Fig. 2.  Self-reported impact of the EMT curriculum and ambulance experiences on students’ team-building skills (N=97).

Table 3 Qualitative themes and student quotes time 2 (9 weeks) and time 3 (50 weeks)

Early patient interactions	The EMT curriculum and ambulance experiences have pushed me to approach each patient with an open mind and without bias or preconceptions. It has primed me to consider the fundamentals of medicine, such as circulation and respiration, and to approach patients without jumping to conclusions about diagnoses. They've made me comfortable with the basic skills necessary to take care of patients in a clinical setting (e.g., taking vital signs), and also helped me become comfortable with the elements of a patient history. It's good to be exposed to a tense environment I have more confidence when talking to patients, after spending time on the ambulances you get used to having Conversations with strangers and it prepares you to act even in situations where you may feel nervous or uncomfortable. I think I am more assertive in ICE than I would have been otherwise. I also felt more comfortable with the basics of a physical exam (pulse, blood pressure, respiratory rate, etc.) than I would have otherwise.
Preparation for Initial Clinical Experience (ICE)	I have a greater appreciation for what goes on in the pre-hospital setting and it has prepared me to interact with patients in the clinical setting as well. I had immediate patient contact, and my experience talking to patients in ambulances helped me to become more comfortable talking to patients in ICE. I think the ambulance experiences have helped me in ICE because they have gotten me more comfortable with talking to patients. Also, it gave me some experience in presenting my findings, such as BP, pulse, and respiratory rate, which I think helped me initially in my ICE experiences to make a good positive first impression The EMT shifts provide an opportunity to display you are not just another first-year medical student which often is a problem at the beginning of ICE. Having confidence in interacting with patients and having the title of EMT has translated to confidence that my preceptors have in me. This has resulted in opportunities that may not have occurred otherwise. The EMT curriculum helped me to learn how to ask better questions, to not be afraid to admit something I didn't know, and to balance my role as student and learning how to be an emerging physician.
Team building	It is important to know now what is going on before the patient arrives in the ER. Because medicine is moving toward a ‘team approach’ to care, it is important to understand how each person works within the system. This way information can be exchanged between the EMT and the physician or ER nurse and not lost in the shuffle. More attention and knowledge of the system leads to better patient care. Big picture view of what goes into a patient's medical care, on multiple levels, and how these different areas work together and the need for improvement in communication between these levels.
Transition from person to professional	Good transition from bystander to active participant in the medical field. The certification enabled us to have some credibility and taught us the basics of interacting with patients in a medical setting.
Care in diverse settings across a continuum	I think the EMT curriculum/ambulance experiences did impact my ICE [initial clinical experience] experiences reminding me that the patients we see in our ICE offices go home and have lives beyond those 15–60 minutes that we see them in the office and have to live with their medical conditions all the time. It also gives us insight into our patient's life at home, including daily habits and living conditions. It can be easy to think of the patient as a case to figure out in the office, but remembering back to when I went into people's dwellings, saw where they live their lives, where they keep their medications, where they have their meals, it helps me to see my role better as one part of their larger life. I think that my understanding and appreciation for patients outside of the hospital or office setting was forever changed by my ambulance experiences. Seeing a patient only in the settings that a physician gets to see them in is severely limiting in its context. Like with the rest of medicine, it is almost impossible to diagnose without contextual history, it is also difficult to assess the person as an entirety and a human life without seeing them in their day to day setting. The EMT experience gave me an appreciation for this difficulty that I may never have realized without it.