Practice Makes Perfect
February 22, 2023
Your recertification deadline isn’t far away, and you know what that means—time to head to the College of Emergency Dispatch to complete some Continuing Dispatch Education (CDE) hours. You’re planning to click on a course, maybe from the Advancement Series, and sit back while a disembodied voice tells you the etymology of the word “abdomen” at the beginning of a lesson about abdominal pain.
This isn’t your first recertification rodeo. You know that abdominal pain calls are rarely lethal, and you know that if in the unlikely scenario that someone does call in with a really bad reaction, ProQA® will walk you through handling it with minimal fuss.
At the end of the course, there will be a multiple-choice quiz designed to make sure you were paying attention. Several of the questions will focus on trivial details, like that word history of “abdomen” or how many people die from abdominal pain-related diseases a year. Maybe a semi-tricky one that makes you stop and think for a second before answering.
It’s neither super practical nor totally useless. The best course of action is to get it done as quickly and painlessly as possible. You’re just here to check the boxes and forget about recertifying until two years from now.
But hark! What’s this? There’s a new section on the College called the Practice Series. Starving for novelty, you click on one about abdominal pain. The first thing it wants you to do is take a call. You’re a fairly seasoned emergency dispatcher, but all of a sudden you’re nervous. You haven’t studied! The lesson hasn’t told you how often cardiac arrests are mistaken for abdominal pain!
This new course walks you through handling a 2nd party caller reporting that their 40-year-old brother is having stomach pain. He’s breathing and completely alert. You type the answers into a ProQA simulation just like you would in a live call, then dispatch and disconnect.
That’s not how previous trainings have gone! You’ve never started with a call without getting plenty of background information before. What’s happening at the College? Have they lost their ever-loving minds?
Andrew Palmer, manager of instructional design at the International Academies of Emergency Dispatch® (IAED™), is the mind behind the new Practice Series. This project is based on the philosophy that when people learn something in the way they’ll actually be doing it, retention is better. In this case, it means that having emergency dispatchers practice taking a call will help them sharpen their skills more completely than if they had someone talk them through it abstractly or even watched someone else do it.
Simply put, this new method of training is about trying to develop correct behaviors, and the best way to do that is practice.
As Julie Andrews, Broadway stage and silver screen star, once said in one of her iconic portrayals, “Let’s start at the very beginning—a very good place to start.” Except in the case of the Practice Series, the beginning is the end. Is the end also a very good place to start?
Palmer’s approach to training is to start with the behavioral change you want first, then work backward. Is the goal to increase knowledge? Or is it to change behavior? Sometimes the goal is to increase knowledge. For example, the goal of this Journal article is to increase your knowledge about the new College series. Although we do want you to go check out the Practice Series, the entire point is to explain the reasoning and research behind it for the uninformed and skeptical. Most often, though, when people assign or design a training, they’re looking for a concrete result.
If Calltaker Patel takes the course on abdominal pain and Calltaker Gonzales doesn’t, would someone on the outside be able to tell who did and who didn’t? Or would they have to go into the calltaker records to find out? Patel and Gonzales might both take the call correctly, but is one of them more confident than the other because they practiced more? Does one of them know precisely where to click to submit additional information for the responders? That is part of the behavioral change the Practice Series is trying to bring about.
“The time to learn self-defense isn’t when you’re getting jumped,” Palmer said. “And the best time to learn how to do a CPR call isn’t when it’s happening.”
The method the IAED instructional design team uses is based on more general action mapping principles. You can use it in your own agency to create agency-specific training for behaviors you’d like to see. Just follow this simple formula: Identify the goal ---> Identify what people need to do ---> Design practice activities ---> Identify what people REALLY need to know.1
1) Identify the goal. We’ll return to this again and again—what measurable behavior should result from this training? What visible changes do you want to see when the emergency dispatchers have taken the course? Do you want them to consistently provide PDIs? Do you want them to correctly triage testicular torsion instead of simple abdominal pain? Not only will this help evaluate how successful the training was, it will help you show how your team is contributing to the center’s overall success.
2) Identify what people need to do. You’ve decided you want your emergency dispatchers to be able to identify testicular torsion correctly 100% of the time. Now what? Well, you need to identify how this will happen. Part of achieving that will be explaining the differences between symptoms of testicular torsion versus straight up abdominal pain, and part of it will be having them practice (more on that in the next bullet point).
To identify testicular torsion correctly, the emergency dispatcher must: identify priority symptoms, ask the questions as scripted, and clarify if there’s any confusion. These goals describe action, not knowledge.
In order to figure out which actions they need to take, you also need to figure out why people aren’t taking the necessary actions. What makes it difficult to perform each of those actions? Do they not know what a priority symptom is? Do they lack the motivation to use the exact protocol wording? Is their environment somehow contributing to it? Is there a plague of other emergency dispatchers treating abdominal pain calls apathetically? (In this case, will training solve the problem? Or is it something else entirely?)
3) Design practice activities. This is where role-play comes in handy. Get creative. Don’t just have your emergency dispatchers practice run-of-the-mill calls (although they should practice them at least a little). Have them triage calls based on scenes from TV shows or movies. If someone calls in and says that an alien has exploded from their crewmate’s stomach, do you handle it on the Abdominal Pain Protocol, or does it qualify as a traumatic injury instead?
4) Identify what people REALLY need to know. What knowledge MUST they have to complete the activity? They don’t need to know the history of appendectomies to correctly handle an abdominal pain call, but it certainly won’t hurt for them to have cursory knowledge of what organs are in the abdomen and surrounding areas. For each action, design a separate training activity and check comprehension after each one.
Stay away from seductive details. As the trainer, you might find something super fascinating that tickles your frontal lobe, but it makes no difference if your emergency dispatchers know it. You may be gently weeping at the very thought of cutting these details, and that is why they are called “seductive.” Stay strong.
In a similar vein, avoid fact checks and trivia games. Focus on the principles and critical thinking instead. When a calltaker is handling a call from someone whose abdominal pain might actually be a cardiac arrest, how useful will it be for them to know when the appendix was discovered? There’s a time and place for trivia games, and it’s important that you make sure they aren’t the bulk of your training.
In this type of training, less is more. If in this process you find out that people are struggling to separate abdominal pain calls from pregnancy calls, think about doing a separate training about the pregnancy protocol rather than lumping it in with the abdominal pain one.
You might have negative associations with the word “consequence.” When you were little, an adult (or several) probably told you that your actions would have consequences, and usually those consequences weren’t the ones you wanted. Like, for instance, heeding the siren song of a glowing stove element. Your aunt told you there would be consequences if you touched it, but it was so pretty and inviting, you couldn’t just ignore it. You pressed your hand to the red-hot element and—OUCH!
That, my friend, was a consequence.
The consequences for triaging a call the wrong way or giving incomplete PDIs might be negligible, or they might be catastrophic. If you’ve spoken to another emergency dispatcher who’s made a grave error over their career, they can probably tell you exactly how it made them feel. And they’ll probably never, ever make that mistake again.
But obviously it’s not optimal to have emergency dispatchers making grave errors just to teach them a lesson. While that style of learning is permanent, it also comes at the cost of another human’s safety or even their life.
Simulations that are as close to the real-life experience as possible are invaluable teaching tools—you can make the mistake, experience the consequence (a dead or mortally wounded patient), and have the lesson carved deeply into your synapses. That is why the Practice Series relies so heavily on ProQA simulations. Not only do you practice, you do it the same way you’d take an actual call. Same words, same order, same consequences. While not quite as visceral as an actual call, it’s real enough that it will sink more deeply into your brain than if you did an abstract thought experiment.
Try again! Unlike in real life where you only have one shot to get it right, the Practice Series lets you replay simulations again and again until you feel comfortable and, crucially, confident that you’ll be able to handle this type of call, no matter what kinds of complications arise. When you click a wrong answer, the lesson explains both that it is indeed the wrong choice and why it’s the wrong choice. It shows the consequence rather than preaching or assigning morality to the answer.
Does it feel tedious? It might. “I already know when to triage a call as a miscarriage instead of abdominal pain,” you might be saying. And you probably do! But is it so ingrained in you that choosing miscarriage is second nature? Can you count on your brain having made those synapses so strong there’s no possible way you could choose anything else, even if you’re sleep deprived and overworked? If the answer is yes, hooray for you! If the answer is anything less, remember to get those reps in.
That’s also part of the reason these new lessons aren’t two hours long. Practice is incredibly good for building habits, but it can also become stale and defeat the purpose altogether when repeated to the point of throwing up. Part of the efficacy of this approach is surprising you and keeping you on your toes—after five or ten repeats, it loses some of its shiny newness. That’s also why the College rotates old courses out after a while. Not only does the protocol itself change, warranting an update to how it’s taught, your brain will start craving fresh content.
Does this mean the only courses on the College will be entirely focused on protocol practice? No. We’ll continue developing courses that give background and cover some of the nice-to-know stuff. But we really encourage you to get out of your comfort zone and try something new. You might like it, and your brain will definitely thank you for getting those reps in.
1 Moore C. “Action mapping: A visual approach to training design.” https://blog.cathy-moore.com/action-mapping-a-visual-approach-to-training-design/ (accessed Nov. 21, 2022).