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EMS Simulation and “Teaching with Your Hands Behind Your Back”

EMS Simulation and “Teaching with Your Hands Behind Your Back”


In a recent post on EMS World, Rommie L. Duckworth, LP reminded EMT instructors that “telling isn’t teaching … for students to be able to perform as emergency medical providers, they must be able to make their own connections with the course material.” This requires a student-centered approach. Ambulance simulators and EMS simulation, in general, make it possible to shift training into a much more student-centered experience. In such an environment, trainees quickly form what Duckworth calls “personal connections” with the skills and materials—vital to building self-reliant responders.

The end goal, according to Duckworth, is never to just communicate some specific technique or item of anatomical trivia, but instead to impart “the most important soft skills of any EMS provider: self-reliance.”


Three Simple Tricks that Increase Trainee Engagement

The best way for an EMT-in-training to make these “personal connections” is to get their hands dirty. But, as a practical matter, instructors tend to lecture. Meanwhile, students are hesitant to speak up or step into the spotlight, where their mistakes will be on display. Duckworth offers several tactics for flipping the teaching space from a lecture with some call-and-response to a highly engaging student-centered workshop.

  1. “Teach With Your Hands Behind Your Back”—Duckworth notes that, during breakout and practical sessions, he literally asks instructors to teach with their hands clasped behind their backs. Instructors may prompt trainees and offer advice, but the trainee must physically struggle with the technique or exercise themselves, even if they fumble. Clearly framing this approach for the trainee is key: Emphasize from the outset that this session is simply a “walk-thru,” not a test. Reiterate that you’re there to “help them move the knowledge from their brains to their hands,” not baby-step them through the entire process.
  2.  “Reward those who are first to jump in and give it a try”—First and foremost, the student who volunteers to step up is overcoming a huge emotional hurdle. That alone deserves praise. But more importantly, students are always more attentive when watching other students (compared to watching an instructor work through a demo). Having a student doing the actual hands-on work promises a huge gain in engagement for the entire group with no greater effort from the instructor.
  3. “The power of the pause”—Keep your mouth shut. Ask a question, and let the awkward pause stretch out until someone offers a tentative answer. Goad students to keep working on a troublesome technique, to find clues, to feel their way forward.


EMS Simulation and “Hands-Off” Teaching in the Ambulance Simulator

Chuck Deakins is the FAAC Training Group lead subject matter specialist (SMS). He has decades of experience with training first responders, including simulation-based EMS training. He’s seen the power of adopting “hands-off” strategies in countless first response agencies.

“Our experience has found that lecture is about 10% retention. Practical application is 65% retention. If you yourself, as an instructor, can turn your student into the instructor in class, it’s 90% retention. That’s always our goal in these programs. … I myself, when I first started [using simulation-based training], I was so used to lecturing and large groups that, when I got to the simulator, I talked way too much. One of the slides I always use today when training trainers is ‘Stop talking, start training.’ Like helping your kid learn to ride a bike. You don’t get anywhere if you lecture them for 15 minutes on what they’re doing wrong, what they’re doing right, and encouraging them. Your heart is in the right place. But the whole time your kid is just sitting there wondering ‘Why won’t you just let me ride the bike?’ So let them ride a ways and crash, and then go pick them up and talk through what went wrong.”

Such an approach is inherently student-based and student-centered. You don’t waste any time re-hashing the parts they get, and quickly zero in on the problem areas. This is a big part of why EMS simulation consistently sees meaningful gains in student engagement and retention.