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Critical Thinking: The Only Skill We Always Use

October 11, 2011 2 comments

By: Nick Montelauro, NREMT-P, FP-C, NCE

Because of the variety of hats I get to wear, I get to talk to students at many different points in their EMS careers – many who haven’t even started yet.   The question I get asked the most about our profession and the training and education we give is, “When I’m done with class, what do I get to do?”

My standard response is that the successful student will “get to” be trusted with other people’s emergencies. With the upcoming changes to the National Scope of Practice and new National Educational Standards, everyone seems concerned with who “gets to” poke holes in people or expose them to other potentially harmful procedures and medications.

The question I enjoy is another common one, “What’s the hardest part about becoming an EMT (or paramedic)?”

This question, in many forms, is what students and educators always want a simple answer to.   I’ll submit that there are many things required and different students will have different things that come easily and that will require more of their attention.  But when people ask me to name the one skill required to be a proficient EMS provider, there’s only one answer that stands out – you have to be able to make decisions.  Educators call this critical thinking and it’s a skill that touches literally everything you do from the time you report for your shift to the time you go home.

“But, wait, isn’t airway more important?  If the patient doesn’t have an airway, they die!”

What makes airway so important and why do we spend so much time harping on it?  Because you need to be able to make decisions about how best to manage it.  Is the patient maintaining an adequate airway on his own?  Do I need to intervene?  Which airway is most appropriate?  How invasive do I need to be?  How often do I need to reevaluate?  Each of these decisions could be the most important one you make today.

My students love the fact that skills are currently tested from a published, step-by-step rubric that can simply be memorized to ensure a passing score.  What they don’t love is when I tell them to put the skill sheets down so we can talk about “real life.”  They know I’m going to what-if them to death.  They know I’m going to ask them what to do when the equipment doesn’t work right, when the airway won’t fit, when the transport is prolonged, when the patient’s complaints don’t fit squarely in any one protocol, or when the patient won’t cooperate with what the skill sheet says will always happen.

They know we’re in for some heated discussions, a lot of push and pull, and a lot of agreeing that there’s more than one way to skin a cat and that some bridges can only be crossed when you come to them.  What they may not know is, I’m forcing them to sharpen the axe in a way that some don’t think about – the anguish I’m putting my students through is going to pay off on their first non-traditional call.

The ability to make a decision is a skill that can be studied at great length.  Professionals in many fields -pilots, physicians, quarterbacks, and executives – study decision making and the ones who are the best at their jobs are often the ones who make the best decisions.

And next time you’re in class, or between calls, or doing some self-evaluation to look for ways you can be a better provider, don’t forget the one skill you use on every call: critical thinking.