The value of storytelling in any type of education is undeniable…when done correctly. We’ve all had those EMS instructors who tell one “war story” after another. They can be very entertaining but minimally informative. If the reason for the story is not clear to the teller, it won’t be clear to the listener.
Done well, storytelling can not only enhance learning of the cognitive domain, but also the affective. The teller shares not only what happened but how they felt–as we all know, in EMS those feelings can be intense. Physiologically, highly emotional events are more readily stored in long-term memory; thus, the more effectively we take our students to the scene with us, the more likely they are to retain the big message.
The primary thing we must do to ensure successful use of this technique is to have a goal. Never tell a story without having the main point in your brain ahead of time. I’ll admit, my biggest weakness is getting so involved in telling the story that I forget where I was “going” with it! That is partially resolved over time–I have a standard set of stories from my past that I use over and over at the same point in the curriculum. Interestingly, about 90% of them involve my personal failures–those calls where I learned hard lessons. Perhaps by using those failures in educating others, the mistakes are somewhat redeemed.
One of my “soapbox” issues is the recognition of CHF. Why? Because in my early ignorance, I put a p
atient in the ICU–I never knew her final outcome. In short, I allowed a pt in mild respiratory distress to walk three whole steps. This failure on my part resulted in fulminating pulmonary edema. Even more telling of my ignorance–I passed the closest facility. Two decades later, my voice still cracks when I tell the story. However, I’ve had numerous students come back from an EMS clinical shift to tell me, “It happened just the way you said it would.” One weight-lifting student told of offering to carry a 100-pound patient (c/o difficulty breathing) down the stairs himself. The crew had the patient walk. The student was anxious, stunned, and powerless to intervene. The patient rapidly deteriorated and was intubated in the ED.
Another technique which can be used to deploy personal stories is to create a “critical thinking” scenario. Think of a call which presented you with questions that weren’t necessarily addressed in your education. Then, simply provide the relevant details of the case with the questions as they developed for you. To enhance the educational value, also add leading questions which might help students make better decisions. For example:
- You are called for an elderly woman who is “lost.” On arrival, PD is already there. You learn the police know this patient from previous encounters– she has Alzheimer’s and the her husband locks her in the home when he runs errands. Physical assessment reveals no evidence of any acute complications. The officer on-scene requests you remove the patient; in the meantime, a supervisor has called the phone number on the patient’s medicalert bracelet and the husband says not to take her anywhere.
- What are your legal responsibilities?
- What are your ethical responsibilities?
- Generally speaking, what is the difference between legal and ethical responsibilities? (included for general knowledge)
- Are there resources at the hospital which might assist in keeping this event from happening again? (to help students make a decision)
- What will you do and why? Consider how you defend your decisions to a supervisor, the medical director, or and jury.
- You end up transporting the patient in “protective custody” (at least that is what the officer said) to the ED. The triage nurse asks you the chief complaint. What do you tell her?
- As you are moving the patient to a room, you encounter the husband who demands you let him have his wife, “RIGHT NOW.” What do you do and why?
Break your students into groups and have them chew on that for about 20 minutes. The resulting discussion is certainly lively, and the students will certainly have a better understanding and greater retention of medico-legal concepts which will help them in their careers.