Category Archive
The following is a list of all entries from the Place and Space category.
Bringing about conceptual change
I’ve written before about the changes in protocol and how I thought that they were simply being reconfigured into a different textual space. I have since learned that I was very wrong.
Paramedics follow algorithms when working through the narrative of a call. These algorithms are tight, linear, reductionist. The move afoot is to transform these flow charts into ‘treatment guidelines’. A one or two page protocol is transformed into pages and pages of details that outline the various parameters of the condition, possible treatments, and some pharmacology. I applaud this move: the textual space reflects the change in the thinking that it represents. A cultural shift seems to be occurring within the service in viewing how paramedics should think about their practice, and their thinking processes when the encounter a call. This drive for change is coming from the top, the vice president of medical programs who is a doctor.
My understanding so far: paramedics are to continue following the protocols. However, what they might encounter may fall outside of the strict definitions of what is in the algorithm. Viewing their scope of practice through the lens of treatment guidelines allows them to take a risk and problem solve based on the evidence. The treatment guidelines are far richer in details that support the paramedic in problem-solving.
I can see this change as being quite difficult to grasp because it seems subtle at first. There has been much talk about the “Protocol Review” and changes to the protocols. When people see that they are still protocols and also contain the algorithms, they may become cynical - “What’s all this hoopla all about?” However, what has changed is what happens if the paramedic strays off the protocol algorithm because of evidence within the treatment guidelines. The paramedic who does this, it appears, will be supported by the medical team, rather than being punished as has happened in the past.
This is my understanding at the moment - but I will need to confer with my SMEs to get further clarification.
The challenge for the 4 hour training session I am designing to support the introduction of this change is to consistently redirect the learners’ attention to the conceptual change. Paramedics get so hung up on the micro-details that I can easily see the session focusing on the details of doing CPR or donning a tyvek suit, all the details of care. I’ve been stuck on how to bring about an experience that demonstrates this change in the conceptual approach - although I think I might have found my answer in the above paragraphs. Going through the narrative of a call, BUT also going through what follows afterwards - what happens if they stray off of the algorithm but remained within the guideline because of what they observed, and problem-solved? Perhaps have a case where the better answer would be one where they would have stray off the algorithm but follow the treatment guidelines?
And what happens if they are wrong?
