A debate is developing within academia over traditional seat-time versus competency-based educational delivery systems. As accelerated training and e-learning programs gain acceptance and become more attractive with creative graphics and sound, regulatory agencies will need to reconsider the amount of credit to be given to non-traditional education programs.

For most EMS managers, a common frustration is ensuring that all of their agency's paramedics meet their annual recertification hours, as determined by the local regulatory agency. When a few paramedics miss courses, are out on workers compensation or are called out of a class for a response, this becomes complicated. New paramedic responsibilities and increases in hours for initial EMT-I and paramedic course work are placing growing demands on the fire service to provide documented seat time.

This year our agency filled part of the recertification requirements for pediatric respiratory emergencies using Jones & Bartlett's Pre-Hospital Pediatrics for Paramedics Web site. Each paramedic received materials and an individual password. The material was followed up by a practical or skills station conducted by a medical services officer to validate the knowledge gained from the Web site and ensure performance standards.

Consider an agency of 100 paramedics where five or six may be out for vacation or various reasons. If they miss a one-hour class, that's five hours that will need to be made up and a training officer who will need to be found to conduct the class. The training officer's cost per hour far outweighs the cost of several online courses.

The use of Web sites allows the site sponsor to be available to provide expertise and places the instructor in the role of facilitator instead of expert lecturer. The America Stroke Association, a division of the American Heart Association, has an online course designed to teach the finer aspects of stroke assessment. The student can print a certificate of completion that can be used to verify the competency.

The AHA also has partnered with Jones & Bartlett to conduct advanced cardiac life support renewals on a distance-education platform. After going through 20 to 30 cases on a CD-ROM, students undertake a day-long skills check-off and megacode scenario to ensure competencies. The University of Arizona's Advanced Hazmat Life Support recertification for instructors is being conducted entirely online.

Today's paramedic recruits come with a completely different set of skills and learning ability. They have strong sensory input and eye-hand coordination that come with computer surfing. They are proficient with computers and engaged with several aspects of other technology. Many are gamers who thrive on the ability to engage in computer programs that have progressive levels of difficulty in the scenario. Many of the same features that appear in popular computer games also are on medical education Web sites.

Online education often faces criticism for removing responsibility from the participant and for difficulty ensuring the material was learned. With many online programs, the student can move right to the test and complete the program with good guesses. Competency often is in question and presents a liability to the organization if the content is critical to the fire service.

Scenario-based training that is a designed to follow up the material makes the training real and applicable. Our recent pediatric emergency training was followed up with an evaluation of each paramedic in a pediatric cardiac arrest scenario. Test and skills sign-offs through a one-on-one interaction with a supervisor or education coordinator allows for that valuable management time to be applied with its greatest impact. Crews and paramedics who come in and demonstrate competency can be freed up to return to service quickly. Crews or EMS providers that require remediation or perform below standard can receive extra attention by expert trainers.

Several companies and publishing houses are online with Web-based EMS content. Mywebce.com is one example of an EMS training program that meets Continuing Education Coordinating Board for Emergency Medical Services standards and can be used to recertify through the National Registry and most state EMS agencies. Most of these Web sites have a manager feature in which an EMS administrator can monitor and control the material. MyWebCE, Heartstream and CEU4U offer a per-course fee or subscription access. Some online medical products only charge participants if they take the test.

There are two main platforms for delivering online education, Blackboard and WebCT, which are shell programs that have a variety of features. WebCT has a calendar program to alert students of deadlines and when the instructor will be online. Both programs have a “big brother” feature that allows the instructor or the administrator to monitor how long a student is online and what content pages he or she has visited. Another great feature of both programs is the ability to control the time for testing and the ability of the program to automatically grade tests and give the instructor all of the statistical data. Expect major publishing companies to develop products that can be loaded onto WebCT or Blackboard networks. The downside to this type of education is ensuring that the person logging on is the person doing the work.

Another common complaint is over the lack of instructor interaction. Educators can specify online education as either synchronous or asynchronous. Synchronous means that the instructor can communicate with the student via online cafés, bulleting boards, chat rooms or e-mail. Some OSHA topics require that an instructor be immediately available for questions to validate the topic. This could be an instructor at the host site or a training officer. Asynchronous is simply the student logging on and reading the material and taking a test without any interaction with the instructor.

Seat time as it relates to the Carnegie Unit, or a measure of the amount of time a student has studied a subject, will continue to be challenged by those who argue that competency-based learning can be verified only by performance. In the fire science programs at the Community College of Southern Nevada, two sections of the didactic portion of IFSTA Essentials Firefighter I material are offered, one online and one in a traditional classroom setting. The sections have had the same pass rate on the state exam and the same performance on skills exams required by the state fire marshal.

As the demands for medical education continue to climb and budgets diminish, online education will allow for valuable training staff hours to be applied in a more efficient manner to the organization. Online education may be an effective alternative to the time a student is required to sit in the classroom, plus it makes effective use of fire station Internet access and computer time.

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Bruce Evans is the fire science program coordinator at the Community College of Southern Nevada as well as an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. A captain at the Henderson (Nev.) Fire Department, he has an associate's degree in fire management and a master's degree in public administration.

Online Tools

http://asa.trainingcampus.net/uas/modules/trees/index.aspx

A free training program offered by the American Stroke Association on the assessment of a stroke victim.

www.ceu4u.com/v2/catalog.php?pcode=worldwidelearn&aid=9&

A medical and firefighter continuing education site. The site has several options for courses and bloodborne-pathogen training.

www.PEPPsite.com

Pediatric Respiratory Emergencies, which can be secured for online education in conjunction with the American Academy of Pediatrics.

www.mywebce.com

Allows EMS professionals to purchase continuing medical education topics that are eligible for credit with the National Registry and most local regulatory agencies.

www.healthstream.com/ems/courseCat.html

An extensive list of courses offered online for a fee and offers National Registry credit through the Continuing Education Coordinating Board for Emergency Medical Services.

www.eacls.com

Jones and Bartlett have partnered with the American Heart Association to offer online re-certification for advanced cardiac life support.