Help, Hurt, or no difference?

[Stephanopolous]

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I'll try to summarize this into a short question.

Prior to and during medical school I have been working as a paramedic (8 years total). For my CV, I'm interested in hearing from anyone with PD experience/insight- will this help/hurt/not affect my overall application to an EM residency?

I keep hearing mixed messages; my advisor during the first week of medical school told me he didn't like having paramedics as medical students because they were "difficult to teach". I can see how that type of student exists but I don't agree that's the case 100% of the time. I have also heard from one attending that PD's worry sometimes about paramedics for the same reason mentioned above. I tend to not mention it to my attending on rotations because I don't want them to form a judgement of how I will learn before they even get to know me.

Just looking for some guidance on this.

Thanks in advance!

 

[fahimaz7]

I'll try to summarize this into a short question.

Prior to and during medical school I have been working as a paramedic (8 years total). For my CV, I'm interested in hearing from anyone with PD experience/insight- will this help/hurt/not affect my overall application to an EM residency?

I keep hearing mixed messages; my advisor during the first week of medical school told me he didn't like having paramedics as medical students because they were "difficult to teach". I can see how that type of student exists but I don't agree that's the case 100% of the time. I have also heard from one attending that PD's worry sometimes about paramedics for the same reason mentioned above. I tend to not mention it to my attending on rotations because I don't want them to form a judgement of how I will learn before they even get to know me.

Just looking for some guidance on this.

Thanks in advance!

Just be a good student with good scores and personable during rotations and you'll be fine. Everyone has a background. Make it a strength and not a weakness by being open minded and realizing that our job is different than that of a EMT, paramedic, nurse, tech, etc. Hell, you may decide to be an EMS director when you finish!

 

[RainbowOtterz]

A good number of my co-residents are prior EMS, paramedics, or corpsmen/army medics.

 

[EMedGrrl]

I think in general, having clinical experience before med school and a job where you show up on time, work hard, etc. is a helpful thing for residency applications. As long as your SLOEs and Dean's Letter comments don't say "Jack was a know-it-all and will be a pain in the A$$ resident," it really shouldn't hurt you in most places.

 

[Keladry]

As long as your comments/SLOEs indicate you were teachable, willing to learn, a team player, etc. then it'd probably help your overall application - shows you have some knowledge/skills already but are also able to be taught during residency, which is the only reason I'd think your advisor/other people wouldn't like the prior experience.

 

[gro2001]

I'll try to summarize this into a short question.

Prior to and during medical school I have been working as a paramedic (8 years total). For my CV, I'm interested in hearing from anyone with PD experience/insight- will this help/hurt/not affect my overall application to an EM residency?

I keep hearing mixed messages; my advisor during the first week of medical school told me he didn't like having paramedics as medical students because they were "difficult to teach". I can see how that type of student exists but I don't agree that's the case 100% of the time. I have also heard from one attending that PD's worry sometimes about paramedics for the same reason mentioned above. I tend to not mention it to my attending on rotations because I don't want them to form a judgement of how I will learn before they even get to know me.

Just looking for some guidance on this.

Thanks in advance!

I know quite a few emergency physicians who used to be paramedics, including my residency program director. It's not that uncommon. I doubt being a paramedic will hurt you. In fact, I expect it will be helpful. The one way it can really hurt someone is if they bring the wrong attitude to work with them.

 

[miacomet]

I think paramedic may be a negative for getting into medical school, but a plus for EM, if that makes sense.

 

[CajunMedic]

It was a double edged sword for me. There were a couple things I fell back on in the pre-clinical years (EKG reading, etc) and got burned by it. It made rotations easier, since you're already comfortable with patients and procedures. But, you've got to make sure you don't keep any bad habits, and it may make you more comfortable with sick patients than a program would like you to be. Be ready for the teachability question, every residency interview asked me, even though with was covered in my SLOE.

 

[miacomet]

IME, there is a some truth to this reputation- what is the deal with paramedics?

 

[austintr]

IME, there is a some truth to this reputation- what is the deal with paramedics?

I would say it probably has to do with the dogmatic nature of EMS. I can't speak for everyone, but when I was being taught in paramedic school, my preceptors had extremely strict opinions on a number of things without being able to actually elucidate where their opinions came from. They weren't really able to back most of their ideas up with reason, and become very defensive if you challenged them. So we've pretty much had stupid things beaten into us by the old timers. Also, even the absolute best paramedics still have shortcuts and rudimentary ways of understanding concepts (probably not much unlike most med students), and it's hard to let go of these heuristics when a deeper level of understanding is required. Especially if you've been a medic for a long time.

We have three medics in my class with experience ranging from practically zero to over a decade. The guy with the most experience is probably the most difficult to teach, but also has the most realistic idea of what EM is out of probably everyone in our class (myself included).

 

[austintr]

It was a double edged sword for me. There were a couple things I fell back on in the pre-clinical years (EKG reading, etc) and got burned by it. It made rotations easier, since you're already comfortable with patients and procedures. But, you've got to make sure you don't keep any bad habits, and it may make you more comfortable with sick patients than a program would like you to be. Be ready for the teachability question, every residency interview asked me, even though with was covered in my SLOE.

Same experience here. It sucks having the experience and ability to quickly and accurately interpret an EKG above the required level for preclinical years, but forgetting about Einthoven's stupid triangle and the best way to determine axis within 10 degrees, etc. And those less useful skills often comprise a significant amount of points.

 

[InternistDO]

I would say it probably has to do with the dogmatic nature of EMS. I can't speak for everyone, but when I was being taught in paramedic school, my preceptors had extremely strict opinions on a number of things without being able to actually elucidate where their opinions came from. They weren't really able to back most of their ideas up with reason, and become very defensive if you challenged them. So we've pretty much had stupid things beaten into us by the old timers. Also, even the absolute best paramedics still have shortcuts and rudimentary ways of understanding concepts (probably not much unlike most med students), and it's hard to let go of these heuristics when a deeper level of understanding is required. Especially if you've been a medic for a long time.

We have three medics in my class with experience ranging from practically zero to over a decade. The guy with the most experience is probably the most difficult to teach, but also has the most realistic idea of what EM is out of probably everyone in our class (myself included).

This is basically my experience as well (6 years in EMS). Also lots of the stuff I was taught in class/in the field was wrong. Like, objectively wrong. But it can be hard to let that past "knowledge" go when you have to relearn it. And it's easy to say "oh heart failure? I know how to treat that" when really you just know the half page protocol on HF plus that one EmCrit podcast you listened to one time. Sometimes I struggle with that kind of thing even though I was just a basic.

 

[miacomet]

This is basically my experience as well (6 years in EMS). Also lots of the stuff I was taught in class/in the field was wrong. Like, objectively wrong. But it can be hard to let that past "knowledge" go when you have to relearn it. And it's easy to say "oh heart failure? I know how to treat that" when really you just know the half page protocol on HF plus that one EmCrit podcast you listened to one time. Sometimes I struggle with that kind of thing even though I was just a basic.

We hired a midlevel who had been a paramedic. Oh boy. That was terrible.

 

[Rekt]

After being on several aways, the prior paramedics were by far the most annoying students to work with and it wasn't even close. They all made sure everyone knew they were a paramedic and they had zero boundaries in the ED with nearly everything. I don't write SLOEs so I have no idea if they like these guys, but at least don't be like that when you roll through your auditions.

 

[miacomet]

Lol. Do they teach arrogance in paramedic and nursing school?

 

[InternistDO]

In EMS its just the arrogance of undereducation. We criminally undereducate (and under pay) our medics in the US when compared to the UK/Canada/Australia but give them a relatively wide scope of practice. Since you (theoretically) deal with seriously ill patients in EMS and do some pretty invasive procedures (intubation, cardioversion, needle decompression), you can get comfortable thinking that what you know about 4-5 conditions (CHF, COPD/Asthma, cardiac arrest, trauma, ACLS) makes you a dynamite clinician because you're very insulated from the rest of medicine.

I remember thinking some of things doctors and nurses did were so dumb years ago when I would drop patients off at the ED. Now looking back after being in med school I realize that it was just me having no idea what I was doing.

And of course there are great medics out there, and its a hard, under-appreciated job. It just frustrates me that our educational standards and pay have barely increased since the 1970s while nursing, for example, organized itself and made it a fairly highly paid, higher educated profession. But that's a rant for another day.

 

[miacomet]

In EMS its just the arrogance of undereducation. We criminally undereducate (and under pay) our medics in the US when compared to the UK/Canada/Australia but give them a relatively wide scope of practice. Since you (theoretically) deal with seriously ill patients in EMS and do some pretty invasive procedures (intubation, cardioversion, needle decompression), you can get comfortable thinking that what you know about 4-5 conditions (CHF, COPD/Asthma, cardiac arrest, trauma, ACLS) makes you a dynamite clinician because you're very insulated from the rest of medicine.

I remember thinking some of things doctors and nurses did were so dumb years ago when I would drop patients off at the ED. Now looking back after being in med school I realize that it was just me having no idea what I was doing.

And of course there are great medics out there, and its a hard, under-appreciated job. It just frustrates me that our educational standards and pay have barely increased since the 1970s while nursing, for example, organized itself and made it a fairly highly paid, higher educated profession. But that's a rant for another day.

I hear you about the education, but how can paramedics expect to get paid more with the barriers to entry so low? And what is it with ancillaries always assuming they know more, rather than assuming they don't know anything with their months of Mctraining?

 

[InternistDO]

I hear you about the education, but how can paramedics expect to get paid more with the barriers to entry so low? And what is it with ancillaries always assuming they know more, rather than assuming they don't know anything with their months of Mctraining?

Yeah, its very much a chicken/egg type situation. Why pay medics more when it's at absolute most a community college associates degree, and in many places, a 6-10 month certificate course? But at the same time how can you make medics get a bachelors or at least a minimum of an associates when there are places that pay non-fire medics $12/hr? I don't know the answer, but I don't like the status quo right now, both for patients and for medics.

As for ancillaries I think it's just a healthy dose of Dunning-Kruger. At least that's what it was for me. I had absolutely no idea what sort of training medical school was, nursing school, anything. All I knew was what I was taught in my 180 hour EMT-basic class and I assumed that was sufficient. EMS is worse than nursing because you're completely in an isolated bubble where you drop the patient off at the ED and then never see them again and so never get feedback. You can therefore think you were a rockstar who saved a life when you instead aggressively diuresed someone with pneumonia (my service took furosemide off the trucks for this reason), or thought that an abdominal pain patient was "just BS" because you can't really do anything for abdominal pain in the ambulance, when it may have been serious pathology.

I remember talking to a medic friend of mine who I used to work with. He's a young very confident (cocky?) medic, but also well educated and actually does read new info to stay current. His truck assisted one of the flight crews (hospital didn't have a helipad) transferring a critical care patient into the city and he was absolutely floored. He'd never even heard of some of the medicines that the patient was on, had absolutely no idea what was going on when the flight crew took report from the doc, etc. Most medics never have that moment, and so you never get "called out" for messing up or not knowing something unless you really really **** up.

 

[Apollyon]

Lol. Do they teach arrogance in paramedic and nursing school?

Well, mostly, it's not taught as much as selected for. Many EMS providers have or have had bachelor's degrees in unrelated, and poorly employable, disciplines. Then, there is hierarchical progression; in NY, for example, there are 5 EMS levels, from CFR (Certified First Responder - aimed towards police and firefighters), EMT, EMT-Intermediate, EMT-CC (critical care), and EMT-P (paramedic). Other states may not have so many levels. In NY, you just have to be EMT to take a paramedic class, although many, like me, went through intermediate first. In Western NY, the EMT-3 (CC) just isn't taught, and there are no medical director protocols for them.

So, how do you make a radical? You educate a man, then don't give him a job. I studied - literally - nearly zero for my original class in 1995-96, and, when I recerted in 14 and 17, I literally did not open the book (Nancy Caroline's "Emergency Care In The Streets"). EMS is full of overeducated, moderately to heavily underemployed people. It might be standard now that people have to have a 2 year paramedic program, but it wasn't in the past.

So, the paramedics are the top of the **** pile. And, some of them let it go to their heads. Since they can do a lot of procedures, and can "cut to the front of the line" to talk to the doc on the med call phone, they think they are better than they are; they forget that "technician" is right there in the name. Add to that personality issues/disorders, and you get the "paragod". If they are flight medics, it can be even worse.

 

[Apollyon]

We were posting at the same time!

 

[miacomet]

Yeah, its very much a chicken/egg type situation. Why pay medics more when it's at absolute most a community college associates degree, and in many places, a 6-10 month certificate course? But at the same time how can you make medics get a bachelors or at least a minimum of an associates when there are places that pay non-fire medics $12/hr? I don't know the answer, but I don't like the status quo right now, both for patients and for medics.

As for ancillaries I think it's just a healthy dose of Dunning-Kruger. At least that's what it was for me. I had absolutely no idea what sort of training medical school was, nursing school, anything. All I knew was what I was taught in my 180 hour EMT-basic class and I assumed that was sufficient. EMS is worse than nursing because you're completely in an isolated bubble where you drop the patient off at the ED and then never see them again and so never get feedback. You can therefore think you were a rockstar who saved a life when you instead aggressively diuresed someone with pneumonia (my service took furosemide off the trucks for this reason), or thought that an abdominal pain patient was "just BS" because you can't really do anything for abdominal pain in the ambulance, when it may have been serious pathology.

I remember talking to a medic friend of mine who I used to work with. He's a young very confident (cocky?) medic, but also well educated and actually does read new info to stay current. His truck assisted one of the flight crews (hospital didn't have a helipad) transferring a critical care patient into the city and he was absolutely floored. He'd never even heard of some of the medicines that the patient was on, had absolutely no idea what was going on when the flight crew took report from the doc, etc. Most medics never have that moment, and so you never get "called out" for messing up or not knowing something unless you really really **** up.

I think it's even worse than what you write, which is pretty bad. Most of our medics don't have degrees, so that's not the issue. I think paramedics are in the cop/firefighter sector- it's basically a guaranteed, unionized job for life for uneducated man-children. Just like nursing is a guaranteed job for life. Have a union, can't get fired, get lots of awards, society loves you. We were fulls to go "further."

 

[bravotwozero]

uh, nursing jobs are not all unionized. You won't see nurses unions in right to work states. That said, nursing can be a guaranteed job, but that's because the profession has a high demand in the market, with a pretty high turnover rate.

 

[InternistDO]

I was only unionized when I was a firefighter. No union gigs for EMS anywhere near where I was, except Philly Fire and FDNY, and they were so busy that people would stay the bare minimum to get vested (ten years in Philly, I think) and get out to the burbs. Like bravotwozero said, ****ty medics kept their jobs where I was because there was a constant demand, because people were always leaving to get better union municipal jobs as firefighters or cops, or going back for nursing/med/PA school.

 

[CajunMedic]

\
I remember thinking some of things doctors and nurses did were so dumb years ago when I would drop patients off at the ED. Now looking back after being in med school I realize that it was just me having no idea what I was doing.

Yup, I had a "light bulb" moment in first year where I wondered "How many people have I harmed?" since pretty much everything in my protocols were dogmatic.

So, the paramedics are the top of the **** pile. And, some of them let it go to their heads. Since they can do a lot of procedures, and can "cut to the front of the line" to talk to the doc on the med call phone, they think they are better than they are; they forget that "technician" is right there in the name. Add to that personality issues/disorders, and you get the "paragod". If they are flight medics, it can be even worse.

You hit the nail on the head. They also seem to be the least likely to do any independent study outside what their training department tells them and most likely to use a new procedure or drug just because they can.


No unions for me either. When I started, if you didn't work for one of the large, public utility models in the state, you bounced around from private-to-private, either quitting or getting fired...

 

[Stephanopolous]

Thank you all so much for the perspectives, feedback, and for generating a conversation on this.

I will definitely remain humble throughout my training (and in the future as a doc). It's nice to hear that it's not generally looked down upon. I can understand what people experience in terms of the personalities. It was one of the things that used to frustrate me as a medic because at the end of the day a big ego can get in the way of delivering good patient care. I have to say that my overall experience as a medic was great, but I'm sure this has a lot to do with the training for EMS/emergency medicine in the area where I worked.

I definitely agree with most of your standpoints on why a negative light can be casted on the profession. I hope that in the future we can push towards changing/improving the training and model for EMS education.

Thanks again!

I have an added question if anyone is still reading this thread, does anyone know if the DO emergency medicine residencies are going to be shifting from 4 to 3 years with the upcoming merger?

 

[Stephanopolous]

It was a double edged sword for me. There were a couple things I fell back on in the pre-clinical years (EKG reading, etc) and got burned by it. It made rotations easier, since you're already comfortable with patients and procedures. But, you've got to make sure you don't keep any bad habits, and it may make you more comfortable with sick patients than a program would like you to be. Be ready for the teachability question, every residency interview asked me, even though with was covered in my SLOE.

I really appreciate your feedback on this! I feel like we've been crossing paths a lot for years on these forums, hope all is going well for you and you're enjoying residency!

 

[alpinism]

Seems like most are staying 4 years with a few exceptions.

For example Mt Sinai in Miami Beach went to 3 years.