Episode Transcript
[00:00:07] Hello. Welcome back to another episode of the code 321 podcast. I want to apologize to any of the listeners that were disappointed for not seeing an episode released right on the 15th of the month, this month. So today's episode, we're really going to be talking about some training philosophies, some ways that training programs work really well, and some ways that training programs don't work so well. There's some really common flaws that people run into when they're developing a system. And this could be anything from teaching a new barista how to make an espresso all the way up to, you know, teaching your most complex multi agency, airplane mass casualty incident at a municipal airport or some sort of high stress situation like that. The cool thing about training is that the methodology is the same. It doesn't matter what you're teaching. It could be a simple task or a very complex task, but the way that the individual interacts with the training curriculum and the trainer is relatively similar. So we're going to go over some of the common themes that we see in programs that go really well, in programs that that don't go so well. Speaking of training, I want to give just a short shout out to one of my good friends, Prescott Naidu. He just accepted his first chief of department job over in Hinesburg, and I just want to congratulate him again. It's a great asset to that town and that department, and I wish him nothing but the best. If you're familiar with Prescott, he also has, he's been on the show several times, and he has his own podcast, the Life Fire Layout podcast. You can find it anywhere that you get your podcasts. So let's jump right into it. So one of the things that we see that goes wrong when we're talking about how training programs are developed is we lack these clear objectives. So when people don't have clear objectives about what it is that they're trying to accomplish, it can be hard to actually hit the nail on the head and get done what we want to get done. So some questions that you want to think about before you even start to develop a training program is you want to think about who is the target audience. So it's going to change. You know, if I was teaching tourniquet application to a teacher that works in a school that's never had any CPR courses in their life, then that style of training is going to be different than if I were teaching like a special forces medic or some sort of trauma surgeon. We're going to need to tailor the way that we deliver our program based on who we're teaching. So you might have to do a little bit of research. One of the things I really love to do when I go teach out of state around the country is before the presentation begins for that kind of ten minutes where everyone's kind of filtering in and it's a little bit awkward. I like to actually go mingle with the crowd, and I remember going to trainings, you know, down in New York City with John Sulka and a lot of the folks down there. And what I really appreciated is they would come and talk to you before the presentation started. They'd be carrying around a cup of coffee, and they'd ask, you know, hey, where are you from? What's your department? How big is it? You know, what's your job? Are you a medic? Are you fire, firefighter? You lieutenant? Captain? Chief? And it kind of gives you a little bit of vibe of the room. So you kind of know a little bit about who you're teaching. You can also ask some clarifying questions to try to get your head around who you might be talking to. So if we have a good understanding of the type of audience that we're going to be delivering these lectures to, we can actually tailor our delivery method in a way that's going to be super successful, and I think that's important.
[00:03:29] You see a lot of increase in this type of research when we start talking about generational gaps. So the way that we're going to teach someone from, you know, let's say a Gen Z generation versus a baby boomer or a millennial is going to. It's going to change slightly. You know, we might do things like use airdrop when we're using. When we're working with our Gen Z and millennial population, whereas with the baby boomer population, we may not do things like that. We might use some other techniques. So it's important to understand who it is that you're going to be talking to, and you might have to do a little bit allegrae work ahead of time to figure that out.
[00:04:03] The next thing that's important is when we're talking about, especially, like, simulation and scenario, we want to make sure that we make it abundantly clear what the students can learn from the process. So tell them ahead of time what it is that they can expect to walk away with, with new knowledge or new skill set, because we need to show them where the training program is leading them so that we're kind of on this common goal. Both the student and the teacher is on the common goal of working towards making that successful attempt.
[00:04:34] I find that students do really well if you explain to them, you know, very clear objectives and you let them know what they'll be able to do at the end of the program. Kind of, you know, start with the why, start from the beginning and then work your way towards the end is really important. So when I was teaching the fire recruits, one of the things I would do is, you know, on the first day of class that would get a huge binder, and the binder would include all of the information that I was using as an instructor. So it tells them what each day is going to be, what the test is going to look like. It's going to tell them what's on the test in terms of the content. It's going to tell them, you know, how many questions it's going to be. Is it going to be multiple choice? Is it going to be a hands on scenario or a combination of the two? It's going to tell them, you know, when their breaks are going to be so they can plan ahead, you know, if they need to call their family or check in with anyone. So just really making the student part of the process is important because I find that when students are engaged and they feel like they are contributing towards their own education, they tend to do a lot better.
[00:05:38] Another thing that's important when we talk about building out, especially evaluations at the end of a training program is we need to make sure that we demonstrate what a successful attempt looks like. So this could be something simple like, you know, imagine you're, you are teaching a new advanced EMT student how to do an iv. One of the things we want to do is before we actually start training them, we're going to show them what an IV looks like and what a successful iv attempt looks like. And you've probably heard this before, it's the, you know, show me. You teach me and then have them teach me back. You know, watch one, teach one, do one, that kind of stuff. So you want to make sure that they're really clear on what it is you want from them. There's nothing that's going to frustrate a student or a class more quickly than not having a good understanding of what the expectations are. So if they don't know what they're supposed to do and they don't know what a successful attempt looks like, it can be really frustrating. So as a general rule of thumb, you know, when I was doing more with the fire department and I was out there with the recruits, teaching them skills. One of the things that always treated me well is just make sure you're in your gear, participating in the skillset, because then it's much easier for you to have that flexibility to jump in and give a demonstration. And I find that students are usually more successful and they succeed more quickly when they have a very clear understanding of what they're supposed to be doing. So if you are setting up any type of training, if you follow these kind of three golden rules of understand your target audience, make sure you make it clear to the student what they will be learning from this, this experience in, in this educational realm, and then clearly define what a successful attempt is, what it looks like when they're succeeding in the training environment. I think it's going to work really well.
[00:07:22] Another thing that departments, I think, sometimes make mistakes on is this idea of where to spend your time in terms of your training. There's only so much time and money that organizations have in terms of being able to train. We'd love to train all day long. I mean, I know I would. I know some people would disagree with that, but I'd love to train all day long. And we need to make sure that we're spending the right amount of time on the right types of training, meaning things that are going to have the highest yield in the field for our performance as a team and as an individual. So you've probably heard of this before. I think Gordon Graham was probably one of the first ones that made it super famous. But this idea of stratifying our training methodology into high risk, low risk, high frequency and low frequency, and I can put a link in the show note here. Essentially what's, what this means is that, for example, something that is low risk and high frequency, we're going to be spending the least amount of attention on that. So low risk, high frequency. So I'll give you a quick example. So, uh, like a low risk, high frequency, um, skill in terms of my job right now as a, you know, as a paramedic would be something like making the stretcher, right? We do it after every single call. And if I make the stretcher incorrectly, it's relatively easy for me to rectify that problem. Okay. I forgot a blanket. Not the end of the world. Maybe not the best thing for the patient, but it's not gonna, you know, cause a dramatic risk to the patient because I forgot a blanket. So we don't need to spend a ton of time training on that. Just the repetition alone is going to help us gain competency and little tweaks here and there is going to, is going to be beneficial, but we don't need to set aside 3 hours of our training time during the day to practice making the stretcher.
[00:09:09] Another example would be high risk, high frequency. So we're going to be spending a moderate amount of attention on this. So this could be something like when I was working in 901, maybe. We're doing CPR drills. So we, we do see CPR relatively frequently, frequently around responses to critical patients, and it is high risk. We want to make sure we're doing a good job, because if we're not performing effective ventilations, we're not defibrillating and we're not ventilating properly, we can really dramatically decrease the odds that that person's going to be resuscitated. So we do want to spend some, a moderate amount of attention on that.
[00:09:44] Another stratification here is low risk, low frequency. So low risk, low frequency is something that you're not going to do very often, and there's very low risk associated with it. So I think of, of, you know, an example might be a police officer who has to give a ticket to an 18 wheeler, right? Maybe they haven't done, they haven't ticketed an 18 wheeler very frequently. Maybe they work in a city and they don't see a lot of those.
[00:10:09] Not a huge risk there in terms of actually writing that ticket. If they make a clerical mistake, there's administrative ways that they can rectify that after the fact. And no one's really going to have any harm if they write a ticket improperly, um, even though they don't do it very frequently. So we categorize this as on the job training. So if you had that situation, you can take that discretionary time and you can maybe look up some resources or call a friend or get a supervisor down there that's going to have a little bit more familiarity with how to do that. And it's not really going to affect the outcome because it's a low risk scenario.
[00:10:43] Now, where we need to spend the greatest amount of attention is this low frequency, high risk. So in the fire department, this could be something like an apartment fire or victim trapped. Right. Some of us may go our entire careers without ever rescuing a victim or pulling a victim out of a burning building. And I think that is something where if that's something that you're asked to do, you have to do it. Right. There's really no excuse for you not being able to accomplish that because that's ultimately the most important thing that we do, you know, as firefighters or as paramedics or police officers, is life safety. So you really want to make sure that you're successful, but if you're not practicing it very much, it can be difficult to maintain competency. So when we talk about this high risk, low frequency, the most amount of time should be spent on this in your training because the frequency is so low, it's difficult to have that muscle memory. And the risk is so high that we really want to make sure that we get it right. So as you're starting to build out a training curriculum or you're thinking about where to spend your time, do just remember this chart of high risk, low risk, high frequency, low frequency, and ask yourself, if something goes wrong with this skill, what is the risk that's going to happen to the patient or to us? And then ask yourself, how. How frequently are we doing this skill? And the less, the less frequent you're performing that skill, the more likely it is that you're going to make a mistake. So we really need to make up that gap with our training.
[00:12:13] Some different styles that we talk about with training is making sure that we are matching the methodology of the training with the skill performance or the outcome performance that we're looking for. So if you want someone to have cognitive knowledge, so you want someone to be able to, let's say, you know, know a policy, right? So you want them to be able to apply a policy to a particular situation. You might be able to use a PowerPoint lecture and a written exam to determine if they're competent in that.
[00:12:45] If you are looking for someone to perform a skill, so let's say you're a paramedic and you want to make sure that that paramedic can intubate a patient, you can't give them a PowerPoint and a written exam to determine if they're going to properly intubate the patient, because the methodology that they're going to be performing that in, or the method they're going to be performing that in in the real world is a hands on application. So if you are trying to accomplish hands on competency, the training style needs to be primarily hands on. Doesn't mean that we're going to avoid any sort of, you know, written evaluation or PowerPoint or reading materials. It just means that ultimately, to be successful with a hands on task, you need hands on training. And the same is true for really any area of training. And this could be task. It could be scenario based, could be knowledge, or it could be evaluation.
[00:13:38] But whatever you want them to perform in. In the real world, the. The style of training needs to match that. And that, that makes sense. If you think about it, it's pretty common sense, but I think people sometimes forget, you know, you can't just give someone a multiple choice exam and then determine that they're gonna, you know, know how to synchronize cardiovert a patient with a monitor. You actually have to. In shocking terms, you actually have to bring that monitor out and utilize it to make sure that they understand how that works.
[00:14:06] The next thing I want to just touch on quickly here is this idea of stress inoculation. This is really popular. It's pretty well known these days. But essentially the way that it works is as we gain. As we maintain competency and gain competency in new areas, what we want to do is we want to apply some level of stimulus or stress in order to create new neurological pathways so that when we have stress that comes from our job or from a difficult situation, we are still able to perform that skill. So the idea is that we're mimicking some of the real world environments before they happen in order to make sure that our staff and ourselves are still able to perform that high, acute task, even though we're stressed out. So, generally speaking, the way it works is, let's say, for example, you know, you want someone to be able to, you know, cook a cheeseburger perfectly. And I'm just using that as a simple example to show you that you can apply these techniques to anyone. So the first thing you're going to do is you're obviously going to make sure that you're actually doing the hands on skills. You're going to talk to them about it. You're going to bring the grill out. You're going to show them how to cook a cheeseburger perfectly, and you're going to kind of coach them through that process. Right? And you're going to praise them when they do well, and you're going to give them assistance when they start to fail. And you're going to kind of balance those two things to make sure that they have a successful attempt so they know what the outcome is. You've talked to them appropriately, and they do it successfully. Now, if we want this person to now go work in a fancy restaurant where they're cooking, you know, 200 cheeseburgers a night, and the orders are just coming in five at a time. We can't just take that person and throw them into the restaurant. We need to build up to that pace. So one of the ways I always described it to the firefighters and the recruit academy is imagine that a train is passing the train station and it's going 35 miles an hour. If you're standing still on the platform and you just reach out and grab onto the rail and try to climb on the. On the train, that's going to be relatively uncomfortable for you. But if you are able to get to a full tilt sprint and kind of jump on the train like an action movie, you might actually be able to absorb that difference in speed a little bit better because you already have your own speed to apply to that motion. So you want to make sure that as we're building the stress inoculation, that we're getting more confidence and more successful performance as we add stress.
[00:16:29] Now, here's where it goes wrong. There's been a ton of research out there that shows that if you apply too much stress or too much stimulus too quickly and the subject starts to fail at that skill, they will actually perform worse afterwards than if they had done no training at all. So the example I give people that I ran into myself, among many, is I took a class one time. It was an active threat response class, a medical class. And when we first got there, we were signing in, and then all of a sudden, they're like, let's go outside and do a drill. And they started passing out these rubber rifles and setting off smoke grenades and firing off blanks in the air. And they're like, what are you gonna do? You have all these patients. And I had no idea what the parameters of the drill were, what a successful attempt was. I didn't even know where the patients were. I had no equipment with me. And then afterwards, they're like, oh, how did you feel? You know, was that stressful? And I said, yeah, it's stressful, but it's not stressful because the medicine was difficult. It's stressful because I had no idea what was happening. And now I'm on edge. And if we do another drill, I'm worried that that's going to happen again. So we call that distress. So the three types of stress you can encounter in terms of stress inoculation are you can have this hypo stress, meaning that youre kind of bored. Nothings really happening to you. Youre in state of low stress. You have eustress, which is kind of neutral and productive stress, which is what we want. This is like working out where your heart rate is elevated, but you feel okay. You feel like youre getting a good workout in then distress is that example that I gave you. Its that trying to grab onto a train thats going 35 miles an hour past the station or being so overwhelmed that youre starting to shut down, youre getting the fight, flight, or freeze. Those are things that we want to avoid. And those things that we're seeing in distress can be like fatigue, exhaustion, anxiety, panic, anger. So when you think of high acuity tasks and you felt overwhelmed, think to yourself, you know, did you, did you have those emotions? Did you feel like you had low self esteem? Did you feel burnt out? Did you feel like you were panicking? A little bit. And the way that stress inoculation can really help us out is if we build this scaffolding appropriately at the right level, then we can actually improve the optimal outcome of these subjects in a way where they're going to be able to perform better under high stress.
[00:18:50] And so as the facilitator of these trainings, you really have to manipulate the scenario in real time to accommodate for the changes in the, the subject's response to your training. So you might have a, you know, really competent flight provider that's been working for 30 years. You give them a scenario and it's boring. It's too easy for them, right? They're like, yep, we're going to give push dose epi. We're going to optimize their blood pressure. I'm going to intubate them. It's too easy. So what you need to do is you need to add something. You could add, you know, a very simple thing as a clock.
[00:19:22] I used this a lot when I was running the fire academy programs. Not necessarily adding any sort of stimulus or task, but just adding a time constraint. Hey, you did a great job throwing that ladder. Let's see if you can do it in 30 seconds. Seconds, right. Adding a little bit of time factor is going to help increase that stress level and push them a little bit past into that Eustress, which is great. If you see them starting to enter that fatigue, exhaustion, anxiety, panic, distress, you need to slow it down. You need to remove something, whether that's, you know, giving them an opportunity to get some water, take a break, recover, get a breather if it's, you know, taking away that clock and allowing them more time to do something. But you need to adjust the scenario so that we stay in that Eustress situation. One of the most common things we see, especially in kind of more of the paramilitary, you know, fire police, that kind of stuff, is they're pushing the recruits so hard that they get to this point of fatigue, exhaustion, anxiety, panic. And we just need to recognize that once they get too deep in that distress range, you're not going to get anything more out of them and you're actually going to harm their performance capacity more the longer they stay in that area. So sometimes taking a little break and allowing them to recover and reset is going to give you the best outcome. There are some benefits to being in that distress area to allow those students to understand what it feels like to be there and recognize that. But an important concept of that is you want to make sure that they are aware that that's what's happening, because if they're not aware that you're doing that on purpose, it can be really unsettling. And a lot of times they're not going to enjoy that and they're actually, they'll actually perform worse after you do that.
[00:21:04] And the last thing I want to touch on is something that one of my army buddies mentioned to me. He's a, he's a helicopter pilot for the army, and they talk a lot about this 100% theory, and it seems kind of simple, but basically, if I ask a student to do one thing, 100% of their energy and their mental focus is going on that one thing. So the more things I ask them to do simultaneously, the less attention they're going to be able to pay to each one of those things. There's been some research lately that shows that multitasking really doesn't work very well. And if you do kind of bites, bite sized hyper focus on each thing that you're accomplishing with 100% focus, you're actually more likely to be successful than if you try to do a bunch of things simultaneously. So, for example, if I ask you to do one thing, 100% of your energy and focus is going to go on that one thing. If you're doing three things at once, you're going to get about 33% focus and energy into each one of those things. So as facilitators and trainers, we need to remember that the more things you're asking your student to do, the less attention and energy they're going to be able to apply to each one of those components. And we know that just by the nature of asking them to do that, that performance is likely going to go down, which is okay, but just, we just need to remember that generally speaking, as we add things, their performance may go down and we just need to be careful about how we build that.
[00:22:28] Another important piece that I just want to touch on before we end here is this law of primacy. So the law of primacy basically states that the first way you learn something is going to be the most potent way you remember it, and it's going to be the most difficult to retrain. It's really important that you, as the instructor are careful when you're delivering your initial training to folks, because if you're delivering an initial training to someone and you make a mistake or you teach something that is not the way that they're going to be evaluated, it's very challenging for that student to get rid of it. So, for example, you know, one of the most demoralizing things I experienced in the various jobs that I've worked is when you have an instructor who teaches you something and you learn it and you do it really well, and then the next day you have someone else who's instructing you and they try to correct that behavior and they go, oh, don't do that. Never do it that way. Do it this way, always. And now all of a sudden, what you're running into is your brain is kind of competing to try to come up with the right answer. So your brain remembers all that time and energy you just spent perfecting that skill one way, and now you have an instructor who wants it a different way. And when the skill is new to you as a student, it's really challenging to make that switch. So, you know, we have folks that enter the fire service now who have never been firefighters before. And if I, if you teach them to put their gear on a certain way and then someone else tells them to change it up, that's really challenging. They don't have that naturalistic background where they can kind of make adjustments on the fly because it takes a lot of attention and focus for them to decide how to do something. So when they apply all that energy to the way that you taught them originally, and now all of a sudden we change it, that can be really demoralizing. And it's even worse when the instructors start to penalize the student for that because that is a failure in the training curriculum and methodology. That is not a failure on the student. You know, we know that new students are going to take, it's going to take a lot of energy for them to focus on doing something one way. And if we're changing it up all the time, that's really demoralizing. It goes back to one of those very first slides that I talked about where we want to make sure that we have a clear outcome, where we understand, you know, who the target audience is, letting them know what they're going to learn from the training and making sure that they understand what a successful attempt, attempt is. So this is just a, just a basic, basic example of some of the types of training that we do when we go to these national conferences and speak to mostly training officers and chiefs are a lot of the folks that tend to come to these programs. But if you're interested in hearing more about any of these training methodology pieces or if you have a training program and you're interested in some feedback, you can always get a hold of me. Check out precisiontrainingusa.com and you can always find my contact info in there and reach out to me me. I hope you all are staying safe. I hope you're going out and enjoying all the beautiful things that Vermont has to offer in the fall. And I will see you next month for a new episode of the code 321 podcast.
