Throughout this chapter, we have paid attention to the considerable psychomotor skills that EMS providers must acquire, as well as the vast content area of practical knowledge that must be mastered in order to become a credentialed medic. Traditionally, this education has taken the form of classroom teaching in lecture format, using assignments to ensure appropriate progress and written tests to confirm mastery of key concepts. This is usually referred to as “traditional learning.” Alternatively, long-distance communication has been successfully used for many years as an adjunct to, and occasionally as a replacement for, traditional learning. In distance learning (DL), course materials are typically mailed (or, more recently, e-mailed) to the student, regular assignments are given, examinations are administered, and grades or certificates distributed, sometimes without the student and teacher ever physically meeting. With the advent of ubiquitous computers and the World Wide Web, the practice of instructing students over great distances has become an accepted and valuable mode of education in nearly all fields of study. EMS students may learn as well in DL as they do in traditional learning8; however, the medical director who wishes to incorporate DL into a department's educational plan should be aware that there are significant pitfalls to be avoided.
ADVANTAGES OF DISTANCE LEARNING
Students report that they are attracted to, and value, the enormous flexibility that DL offers. The ability to learn, study, and take examinations at virtually any time of day can be of critical importance to working trainees. Many students also find that they can pursue their studies at a pace that suits that individual's learning style. This greater freedom necessitates greater responsibility, and many students appreciate the opportunity to take charge of their own learning plan and gain valuable confidence from their own self-directed success.
DISADVANTAGES OF DISTANCE LEARNING
Unfortunately, the very factors that attract students to this learning format, such as a difficult working schedule or significant family demands, can impair the success of the program as well. A student can significantly underestimate the amount of time required for his or her assignments and fail to plan ahead for large projects and examinations. Another may overestimate his or her own self-discipline and fail to make steady progress without daily classroom structure. Certain students, despite the best of intentions, may require classroom interaction in order to make sure that appropriate learning takes place.
In addition, certain content does not adapt well to an electronic-only format. In particular, procedural knowledge (such as CPR, venous cannulation and intubation skill) is best taught one-on-one, under direct supervision with immediate feedback and correction. For these reasons, most EMS training programs are not suited to a DL-only format.
A hybrid model of DL uses a combination of traditional learning format with elements of DL, in order to capitalize on the most effective qualities of each model. Student groups form and interact more effectively in person than online, while at the same time the smaller number of physical meetings to attend allows students greater freedom to incorporate coursework into a busy work and family schedule. Nonetheless, great care must be taken to preserve these advantages when designing a hybrid course, in order to avoid some of the pitfalls noted above. Since procedural knowledge is key to EMS training, most EMS DL programs will, by necessity, be hybrid programs.
IMPLEMENTING A SUCCESSFUL DL PROGRAM
The vast majority of contemporary DL programs take place using a World Wide Web–based platform; therefore, most DL requires that both the student and the instructor have reliable access to relatively modern computers at convenient times of day with up-to-date Web browsers installed and reliable access to the Internet. Most students meet these requirements at home; however, local libraries, community colleges, and Internet cafés can provide acceptable alternatives. In these cases, it must be stressed to the students that they are responsible for making sure that their access is reliable before undertaking the course.
Many commercial platforms are available for the instructor to organize and deliver both content and testing materials. Ideally, selection of a particular platform will depend upon the content to be delivered, types and frequency of assignments, and the desired method of evaluation. Alternatively, an ambitious instructor could design a course using nothing but a basic word-processing program and standard e-mail; however, between tallying assignments and maintaining testing rigor, administration tasks could quickly become onerous. Practical instructors usually opt for the platform currently in use at the department's affiliated community college. In this case, refer to that college's information systems department for specific computer and Internet requirements before undertaking a DL program.
SETTING STUDENT EXPECTATIONS
One underappreciated aspect of course implementation is the communication of expectations to students. Instructors should be explicit: readings should be finished on time, assignments will be marked down (or not accepted) after their due date, and all efforts are to be the original work of the student and no one else. Students should also be told the approximate number of hours per day (or week) that the course requires, including meetings, readings, assignments, and testing. Early and appropriate action should reinforce these standards if any expectation is not met.
EVALUATING LEARNING GOALS
The appropriate assessment of learning in the student is a complex and sometimes contentious topic; however, a few brief guidelines should be kept in mind. Assignments should probe for depth of knowledge in particular topics, while testing should assess breadth of knowledge across content areas. When designing a test, every test item or procedure should relate to a previously presented learning objective, and all important learning objectives should be represented at some point in testing. Test items should be clear, unambiguous questions regarding physiological knowledge, or clinical presentation. If a question seems “too easy,” move into more difficult content rather than rewriting the question to obscure its base content. Multiple choice questions better discriminate knowledge when there are at least four alternatives to choose from, and when all alternatives could be plausible to a novice. A good question can be recognized when a top student can answer it without looking at the alternatives. Finally, if more than half of the students cannot answer a test item, consider replacing it.
DISTANCE LEARNING AND CONTINUING EDUCATION
Distance learning can provide an effective method for established, motivated learners to maintain and broaden the skills and knowledge they need in order to continually improve the level of care they provide for patients. As in certification education, only those aspects that are easily taught and assessed on paper or the computer screen should be attempted via DL. Also, a medical director may find that once the goal of credentialing has been reached, students may not be as motivated to keep up with their educational commitments. Regular progress reports and coursework deadlines can help keep students on track when undertaking continuing education, and modest incentives may serve to help keep students abreast of new technology and training techniques.