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September 14, 2009
The EMT Curriculum
For well over 25 years, EMS education has been guided by a series of curricula published by the United States Department of Transportation. These curricula, colloquially referred to as "the DOT," have been the basis for EMS textbooks and licensure and registry testing. Typically, there was a separate curriculum for each level of EMS training. As textbook authors, we pretty much had to stick with what was in the DOT because that was what students were tested on.
Interestingly, most health care professions do not have government-sanctioned curricula. In fact, the idea of a curriculum is more typical of trades such as welding, plumbing, and pet grooming. Instead, most true professions have what are called "core competencies." Core competencies are simply the knowledge and skills necessary to practice the profession. Emergency medicine has core competencies, emergency and critical care nursing have core competencies, and so on. Once these core competencies have been delineated, it is up to the educational institution to determine how to teach them to their students. Quality is assured through interim and graduate testing as well as educational institution accreditation.
Many of the leaders in EMS education once advocated for establishing core competencies, and these were somewhat defined. However, a federal grant was subsequently issued and "instructional guidelines" were later developed and recently released. The instructional guidelines look a lot like a curriculum. In fact, most educators refer to these as the "new DOT" curriculum. Granted, they give textbook authors and instructors a lot more leeway in EMS education and they are certainly better than the old 1995 curricula we were using, but I feel that overly detailed and scripted educational guidelines hold the profession back. For example, manufacturing of the old esophageal obturator airway (EOA) ceased many years ago. But, because it was "in the DOT" and a source of possible test questions, we had to keep it in our books long after it was unavailable. The profession evolves faster than the curriculum and a fixed curriculum holds things back. There are many similar examples.
If EMS is to evolve into a bona fide profession, we have to give our educators the leeway to use their education and expertise to provide the best educational program possible for their students. The United States is heterogeneous and what works in Texas may not work in California or Vermont. As long as you have an educational program that meets minimum standards (i.e. accredited) and have instructors with the necessary credentials, then all you need to have are core competencies. If your graduates do not graduate with the required core competencies, you will quickly lose standing with potential employers, and potential employer feedback is an important part of the accreditation process.
We should leave it to the educators and their respective institutions to determine what style of program delivery best meets the needs of the population they serve. For some, it may be traditional brick-and-mortar classrooms, while for others it may be distance education (or some hybrid thereof). Some may want to teach medical emergencies before trauma while others want the opposite. The instructors know their students and potential EMS employers better than the DOT in Washington. Regardless, let's trust our EMS instructors to make the determination as to the educational delivery model.
Many people entering EMS want their education and certifications as quickly as possible. Often they want the quickest EMT or paramedic program instead of the best. This ultimately holds the profession back. The days of "Ted's Paramedic School" should be a thing of the past. If you want a MD or DO degree in the United States, you know you first need an undergraduate degree and will then attend medical school for four years. In EMS, you can be a paramedic in a few months or over two years—the choice is yours. There is significant variation in course length and quality. Enhanced education is the key to improved professional recognition and improved salaries for EMS providers. But, while many push for enhanced EMS educational standards, many others push back. One of the biggest blows to EMS education was the so-called "dumbing down" of the EMT curriculum that occurred in the 1980s. We are still suffering from that.
In closing, there is no longer a "DOT curriculum" and that is good. The current instructional guidelines will serve as a temporary bridge to the next generation of EMS educational standards that will, hopefully, be core competencies. We’ll do the best we can to get there.