EMS and the Affective Domain: What is a DAV and how can it minimize my liability?
CAAHEP Standards inform us that we must “teach” the affective domain. This aspect of our programs has always been a little “squishy” and fraught with liability. Invariably, behaviors rising to the level of dismissal are met with accusations that “Mr. Lead Instructor just doesn’t like me.”
We have “invented” a system to track and correct problematic behaviors while virtually eliminating liability. It is the “Demonstrated Affective Violation” or “DAV” system. We say all three letters, but you can call it whatever you like. If you are of the generation of demerit systems, you’ll certainly recognize our recycling of the concept!
“Demonstrated” means the behavior clearly fits into one of the categories found in Appendix V of the 2002 “NHTSA Guidelines for Educating EMS Instructors” (http://www.nhtsa.gov/people/injury/ems/Instructor/TableofContents.htm found at the NHTS website: http://www.ems.gov/education.html ). These are conveniently listed on the DAV tool and the user is instructed to choose one or more categories.
“Affective” is the student behavior and demonstration of professionalism (or, more appropriately, lack thereof). The NHTSA tool is excellent in that it provides examples of each category. We encourage you to use this document as a basis for your own program instrument.
“Violation” means the student has directly breached the principles of one or more categories of the NHTSA tool.
Who Can Play?
The key to the system is buy-in by all staff members, and, when appropriate, clinical and field site personnel. Anyone can recommend DAV(s) for a student. It is up to the Lead Instructor to prepare the “Behavioral Counseling Record” (same Appendix V of NHTSA standards) communicating the actual number of DAV’s administered.
Why the final ruling by the Lead Instructor? As we’ve deployed it, if a particular behavior is repeated (regardless of location or context), the number of DAV’s given doubles with each offense. So, if the part-time clinical preceptor recommends one DAV for being late, but the Lead Instructor already has recorded 2 previous DAV events for tardiness, the student actually deserves 4 DAV’s.
Many part-time faculty members find the Counseling Record to be intimidating or “too severe” for a minor infraction. Unfortunately, this means that multiple small violations (which would add up to get us fired from industry) go unaddressed.
How it Works
The DAV (previously administered as a card and now available through Sterling electronically) is very much like a verbal coaching– a single event by the student who had an unfortunate mishap (like a flat tire) will cost nothing. However, in this day of, “I showed up, where’s my trophy?” the DAV provides tangible evidence to the student that a given behavior is not acceptable.
Once a student accumulates 10 DAV’s, they are put on “Behavioral Probation.” At 15 DAV’s, they are suspended from clinical/field rotations pending corrective, remedial action (usually, a writing assignment). There are two purposes behind this action.
Benefits
First, it protects your relationship with the clinical and field sites. A student with 15 DAV’s is not a valid representation of your program. Second, the writing assignment creates “a teachable moment” out of the mistakes—the student’s composition will demonstrate that they recognize the value of an improved behavior and the method to achieve that improvement.
Upon reaching 20 total DAV’s, the student is recommended for removal from the program. Should a student reach the level of dismissal, the recommendation will be composed of multiple observations by multiple individuals with a complete record of notification and corrective actions. Unless the student wishes to claim a massive conspiracy, the Lead Instructor and then Program Director are well-protected from a claim of unequal or undeserved treatment.
Ongoing Affective Evaluations
We still employ the NHTSA tool in both formative and summative ways. DAV’s are immediate, reasonable, and durable for a given semester. You may make the choice to “reset” DAV’s to zero with progression to the next level of education, or, you may choose to keep the DAV count for the duration of student contact.
Please Contact Us for more information on the DAV source document and Printable DAV cards.