New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) FAQ The following questions were asked during the webinar: NEW Appendix G Student Minimum Competency Matrix (effective July 1, 2019), which was offered in July 2017. Logistics. Functionality. Implementation.... 1 Research... 3 Content... 3 Logistics. Functionality. Implementation. 1. Q: Where can I find a copy of the recommendations for the student minimum competencies? A: The recommendations are available on www.coaemsp.org > Self Study Reports > Appendix G - Student Minimum Competency Matrix (effective July 1, 2019). 2. Q: The July 1, 2019 date Is that for programs that begin before this date or end on or after this date? A: Beginning July 1, 2019, the New Appendix G will be required as part of the self-study report and when requested as part of a progress report. 3. Q: When am I required to use the new version of Appendix G? A: July 1, 2019. If a program would like to use it sooner, it may. Based on feedback, the forms may be tweaked prior to that time. The recommended minimums however, will not change prior to the implementation date of July 1, 2019. 4. Q: Which cohort of graduates should the New Appendix G be completed? A: The most recent graduating cohort. 5. Q: Just to confirm, the New Appendix G is a compilation or average of all students portfolios in a single cohort. A: Yes. It will reflect the total accomplishments of the most recent graduating cohort. 6. Q: Is the New Appendix G completed only during the 5-year comprehensive review (self-study report, site visit) or will it be required to submit with the annual report? A: The New Appendix G will be submitted with the self-study report. The New Appendix G may also be requested as part of a program s progress report if necessary. 7. Q: As a program director, may I use either the old or the new version of Appendix G when I submit the selfstudy report? A: Yes, you have the option until June 2019; beginning July 1, 2019, only the NEW form will be accepted.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 2 8. Q: Is the New Appendix G form going to be filled out for each individual student, or is it an average for the cohort? Column 4 would indicate that you need the form for each student s experience. A: The form is based on cohort. 9. Q: When we try to print the form it comes out as a quarter-sheet and is unusable. A: The printing area has been set to allow all tables to fit onto a page causing the irregular printing. A PDF version of the New Appendix G has been created for printing purposes and available on www.coaemsp.org > Self Study Reports > Appendix G - Student Minimum Competency Matrix (effective July 1, 2019). 10. Q: The Excel spreadsheet is locked; is it possible to get an unlocked version? We would like to play with it and modify it for our students to use to track their progress as they work their way through the portfolio and lab experiences. A: For integrity and consistency of data gathering, the form will not be provided in an unlocked format. The reasons for this are to prevent the formulas (many complex) from being broken - and - eliminating the potential for incomplete data or questioning the integrity of it in the future. Since the New Appendix G will be required as of July 1, 2019, if there is an unprotected version floating around, that will impact the integrity of the data because we would question the formulas and would need to compare each New Appendix G provided by programs with the original Appendix G. 11. Q: We recently started to track pediatric age subgroups; therefore, do not have a complete cohort. In the interim, how do I fill out the New Appendix G without the breakdown by age group? A: If you were not tracking by age group, then you really can't complete that area of the New Appendix G. From this point forward on you can gather data by age groups for future cohorts. 12. Q: Will the commercial vendors for student tracking (FISDAP, Platinum Planner) incorporate this New Appendix G format? A: We cannot answer this; this is for the vendors to decide. 13. Q: On the Sequence of Learning Profession table (table #2), I understand the first two columns in column one students do a skill in the lab, column two they advance to doing the skill in the lab / scenario. To me the third and fourth columns are somewhat blurred with live patients. Could you clarify that progression? A: The third column is intended for isolated skills. For example, a student is in the ED and starts an IV on a patient but does not complete an assessment or other patient care. The fourth column is intended for skills completed during a context of total patient care experience and is intended to help the student "put it all together." For example, the student started an IV on a patient after completing an assessment and determined the patient was dehydrated. 14. Q: Regarding basic competencies of spinal immobilization. With many systems going to spinal restriction and limiting or eliminating backboards, does this need to be the traditional full body immobilization or can method of restriction without backboards be incorporated? A: This is always an interesting topic. It is still considered part of the minimal skill set and something students may be tested on even though it is not being used as much. Until there is enough hard science to convince all the entities in charge, it will likely remain in the curriculum.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 3 Research 15. Q: Where did the research originate? A: The evidence came from a retrospective analysis of 3 million Paramedic student educational experiences in clinical and field settings. De-identified data was supplied by FISDAP, Platinum Educational Group, and the National Registry. All of the recommended minimums are shown to be very achievable across the vast demographics of the country's programs. In fact, most programs achieved far more than the recommended minimums. 16. Q: Are these minimums based only on the Paramedic clinical and field or can the Advanced EMT be utilized to meet that number? A: If the AEMT program is part of the Paramedic program, then the answer is yes. If the AEMT program is not part of the Paramedic program, then the answer is no. 17. Q: If these are recommended minimums, if a program uses numbers that are below the recommended minimums, why does the program need to justify the lower numbers? A: The CoAEMSP believes these national averages are extremely achievable. They are also minimums, so the CoAEMSP Board would question why it is not possible to meet the minimums. When the program provides the evidence of why it is setting their minimums below the recommended minimums, it will assist the CoAEMSP Board with its understanding when it reviews its recommendations in the future. Content 18. Q: In the second table, Sequence of Progression Learning, are the minimums in the laboratory required to be completed before the student can then move on to obtaining the minimums in the lab scenario, which then need to be completed before the live patient only, which then need to be completed before the clinical or field experience? I understand that it makes the most sense for it to be completed in this manner, but in the case of the Medical including cardiac assessment where the minimums are 40, do these all have to be completed by each student prior to them being able to complete or attempt the clinical and field experience where the minimums are 10? A: Our understanding of the portfolio process that yes, learning best occurs when the listed chronology is followed. Of course, there are always extenuating circumstances that may be the exception rather than the norm. Specific answers for how to best implement the portfolio are found on the National Registry s website (www.nremt.org) and in their workshops. The CoAEMSP has endorsed the portfolio project and its recommended minimums, but the Registry has led the way towards implementation. Here is a link to a library of portfolio resources online to help programs: https://www.nremt.org/rwd/public/document/paramedic-portfolio
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 4 19. Q: What are the qualifications for the evaluation of the student? Are you suggesting that we use the National Registry Competency forms? If so, are you requiring that a preceptor use that sheet for each of the 40 assessments that need to be completed? I understand that instructors/faculty can do these easily in the lab/scenario environment. My concern is that if this needs to be facilitated in the ED, or the OR, by the preceptors, this could put a limitation on the total number of students that we can have in our class at one time due to resources. A: Please refer to the National Registry materials: https://www.nremt.org/rwd/public/document/paramedicportfolio. 20. Q: The column Live Application Individual Skills (table Sequence of Progression Learning > column Live Application Individual Skills) does not specify how those should be attained. For example, the Putting it all together states that it can be scenario or clinical. Can the same be said for the Live Application Skills? Attaining 40 medical assessments may not be too bad between Oral Stations and Out of Hospital Scenarios, but 20 live IVs would be expensive. Playing devil s advocate, 45 students getting 20 live IVs on each other would cost us nearly $10,000 in supplies. A: These are isolated skills on live patients and can be achieved in lab (standardized patients), hospital clinical or field experience. 21. Q: Some of the numbers that are required in putting it all together seem really high. For example, Direct Orotracheal Intubation Adult and Pediatric, as well as Supraglottic Airway Device all have 12 required to be in scenarios or during clinical. I can speak from experience when I say our students do not get that many airway managements during clinical. Currently students are required to perform 50 Airway Management with the last 20 being successful. To meet the new requirements, would need to run each of my 45 students through 36 scenarios to get the required airway managements; that would be 1,620 scenarios. I agree with CoAEMSP and National Registry in that knowing when to intubate is vitally important, not just teaching the students a skill and then sending them to the field not known when to use it versus less invasive maneuvers. However, I could not see us attaining these kinds of numbers in a strictly scenario based environment. A: Putting it all together gives you the choice of either live or simulated patients. If you struggle getting access to live patients for these categories, you may do them in simulated scenarios. Keep in mind you can build several skills into each scenario for efficiency's sake. 22. Q: What is Neonatal Resuscitation Beyond Routine Newborn Care? Do you have a check-off for this that I can add to our documents? A: We do not have a skill sheet for neonatal resuscitation beyond routine newborn care, but the intention is for a scenario or live encounter to be beyond BLS resuscitation (i.e., ALS). 23. Q: Are we allowed to count patients with multiple diagnosis or complaints who require multiple skills? A: Yes. High acuity patients such as this are encouraged. 24. Q: May live patient encounters for some skills be completed on fellow students? For example, IV/IM/SQ performed on fellow students counting in the "Live Applications" and "Putting is all together" columns? A: Check with your school first to ensure it is not a liability concern. You might also want to confirm the program and students have insurance.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 5 25. Q: Explain a bit on how programs conduct peer evaluations. A: Once students learn a skill, they simply evaluate and offer feedback to one another prior to instructor evaluation. Please consult the Registry Portfolio for further details: https://www.nremt.org/rwd/public/document/paramedic-portfolio 26. Q: Can the entrance exam for students be used to verify the BLS skills? A: Only if the student is considered a Paramedic student at that point. If the entrance exam is used as part of the application phase prior to becoming a student, then no. 27. Q: Explain in greater detail the BLS skills evaluation minimums that occur before and after the capstone field internship. A: Many programs typically do BLS skills evaluation the first week of class and have an instructor available to evaluate and validate the student s BLS skills. The evaluation of the BLS skills must occur prior to the capstone. If the validation of BLS skills occurs the first week of class, fine; if the validation of BLS skills occurs just prior to capstone field internship, that is fine also. 28. Q: How does elective differ from some of the others listed (say seizure)? A: Electives may be any type of patient the instructor believes the student may need. 29. Q: Table headings refer to Capstone Field Internship ; do any of the required skills occur during this time or are they to be completed before Capstone Field Internship? A: Only Team Leads are measured during the Capstone Field Internship. All other competencies should be completed prior to that phase. 30. Q: In trauma there is no minimum number for adult trauma, so could a program meet the minimums by a student having 15 adult pediatric and 15 geriatric? A: Theoretically, yes, but such a scenario would be highly unlikely. 31. Q: For the recommended team lead minimums, do student peer evaluations count? Do these team lead minimums need to be all based on instructor evaluations? A: If this question is in relation to Table 3 (Total Minimum Number of Scenarios Where the Student is Team Leader OR Team Member Throughout the Program but Prior to Capstone Field Internship), these are intended for instructor evaluation. There is nothing wrong with peer evaluations being used for a training/practice scenario. 32. Q: Instructor evaluations in a scenario is that as a team leader or as a member? Is this different from the above Scenario requirements? A: If this is in reference to Table 4 (Basic Competencies to be Evaluated in Laboratory Prior to Any Live Patient Encounters in Clinical, Field Experience or Capstone Field Internship), either is acceptable. 33. Q: Is a signed skill sheet required to prove patient performed Lab experience? Is the instructor s affirmation sufficient? A: Typically, the rule for evidence is a signed skill sheet.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 6 34. Q: Where did the neonate resuscitation come from in the previously listed 33 skills for the portfolio at the bottom? Is that an indication that it will be added to the required skills for the portfolio? A: This is a question for the NREMT to answer. The CoAEMSP attempts to mirror the NREMT s Portfolio as much as possible, but believed the neonatal resuscitation skill was imperative. 35. Q: Why increase the Instructor Evaluation of Basic Skills to two, when the NREMT Portfolio permits instructor check off of basic skills as an "option"? A: The CoAEMSP Board feels strongly about the competency of a Paramedic s basic skills. 36. Q: Would a patient encounter with a standardized patient be able to be counted as a team lead? A: The intent for a team lead is in the capstone is for it to reflect the depth and breadth of the Paramedic scope of practice on live patients in an emergency setting. 37. Q: Regarding minimum requirements, can students accomplish their minimums in a supplemental skills lab? Or must they complete all required minimums (no live requirements) in class? A: As long as the supplemental skills lab is considered part of the paramedic program it would be acceptable. 38. Q: Live patients in the lab. Some programs may not be able to pay for professional patients, while it may be possible to find volunteers, finding pediatric volunteers may be problematic. A: Although this is an acceptable practice, it is not required in the lab setting. 39. Q: Can assessments repeated on the same patient be used in the clinical or field setting? Assessing the pediatric respiratory failure patient at the beginning and end of the shift. A: Although the CoAEMSP recognizes patient conditions change, it has not been the practice to count the same patient as acceptable as a new patient for assessment. 40. Q: Our main focus in the entire last semester is pediatrics. With that being said, can the pediatric scenarios performed (even though capstone has started) be counted in the Putting it all together? A: Pediatrics are considered part of the core curriculum, so the pediatric section should be completed prior to the capstone field internship. Although some experiences may be counted during capstone field experience, the "putting it all together" section is intended to be accomplished prior to the capstone field internship. 41. Q: Under the medical assessments there is ACS as well as chest pain. Those seem very similar, is there a reason to split the two? A: Since there are so many etiologies of chest pain, the CoAEMSP believes in the importance of doing an adequate differential diagnosis that includes many underlying causes as well as acute coronary syndromes. 42. Q: AHA lumps ACS and chest pain into one category and in one point lists chest pain as a symptom of ACS. Is there guidance that you would like us to use to differentiate for our students? A: All chest pain is not ACS and all ACS does not involve chest pain.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 7 43. Q: Is the minimum 50 airway management requirement removed? A: Great question. First, clarification. The CoAEMSP recommends the Paramedic student have no fewer than fifty (50) attempts at airway management across all age levels (neonate, infant, pediatric and adult). And, in order to demonstrate airway competency, the student should be 100% successful in their last twenty (20) attempts at airway management. Airway management may be accomplished utilizing any combination of live patients, high fidelity simulations, low fidelity simulations, or cadaver labs. In most cases, the program's minimum requirement for airway management should still mirror this. This subject will be revisited by the airway committee prior to the New Appendix G implementation. 44. Q: In the grid below, competencies to be performed before clinical, the second column states students are evaluated by instructor in scenario. Is it possible to have these evaluated in the lab setting, too? Currently our instructors are evaluating the team leads and team members as well as watching their performance for feed back in debriefing. To add more check sheets that they need to fill out seems like a lot. We have no problem doing it in a lab setting and making sure they are competent with the skills. A: Yes, evaluation by an instructor in the lab setting is fine for those skills. You are encouraged to incorporate several skills in one patient scenario so use your time efficiently and keep the number of scenarios to a minimum. For example, one patient with multiple issues requiring multiple skills are required and the instructor and students do not have to do separate scenarios for many separate skills. Further examples could include a cardiac patient in a car accident where the student earns credit for a chest pain and trauma patient. A respiratory complaint that turns out to be cardiac and the student can get credit for both a respiratory and arrhythmia.
FAQ: New Appendix G Student Minimum Competency Matrix (effective July 1, 2019) Page 8 45. Q: Can ETI be counted in scenarios in place of supraglottic airways? We do an enormous number of scenarios where we have Paramedic students perform intubations. The Program s Advisory Committee was inquiring about the importance in having a Paramedic student perform an EMT skill at this level and not have emphasis on ETI. A: No, ETI and supraglottic are considered two different types of airways. Although it is great you are doing so many ETIs, the need for supraglottic proficiency is important to the Paramedic when ETI attempts fail or are clearly a better choice for the patient's airway management. 46. Q: Are programs still able to meet a portion of the competencies in high fidelity simulation? Specifically, of the 30 trauma patients listed as the recommendation, could 15 of those be done in simulation? Or the other categories, can we count 50% in high fidelity simulation? A: The patients listed in Table 1 of the New Appendix G are all live patients. A few of the other columns in the other Tables allow for simulation. Remember, each of the categories are minimums and are extremely achievable in programs across the nation.