Attention Public Safety: We’ve been training the wrong way. Obviously there are some caveats to that statement: I’m not talking about the raw physical training, like throwing a ladder. I’m talking about the mental, critical thinking tasks, like patient assessment, incident command, or suspect interrogation. What are we doing wrong? Visualization. Visualization is great for abstract concepts or goal setting. However, when you are trying to train on assessing sensory details and correlating them to learned patterns, visualization is literally backwards from what you should be doing.
In fact, a study on the flow of neurons in the brain compared from seeingversus visualization was able to demonstrate that the direction is reversed : "The visual information from real events that the eyes see flows "up" from the brain's occipital lobe to the parietal lobe, but imagined images flow "down" from the parietal to the occipital." 1. http://www.livescience.com/49244-imagination-reality-brain-flow-direction.html
This seemingly small difference carries vast implications, particularly in how the brain stores the experience in its memory. When you are visualizing, you are accessing the right side of your brain, the creative side. When you are seeing, you are accessing the left side, the analytical. When we tell personnel to "imagine a patient" we aren't letting them exercise the side of the brain responsible for fixing that patient. While creativity is a huge asset to problem-solving, incident management/patient assessment are chiefly left-brain skills, they are algorithmic, analytical.
If you are in public safety, you know exactly what I'm referring to - the realization you learned more from a single call then you did from multitudes of training on the subject. It's no wonder many training officers consider the first year or two "On the job training."
Understand, visualization was forced upon us by necessity, not by design. We lacked the resources, both time and material, to create a realistic scene. (The time of that excuse is waning, ladies and gentlemen.) Let's outline a few details of a typical emergency call we might run. Let's take a cardiac call. Here's how it might sound in a station tabletop:
You have a 56 year old causation male. He's overweight and is diaphoretic. (Profusely sweaty). He is clutching at his chest and leaning forward.
Here, depending at the Fire/EMS staffing, one person might volunteer to act at the patient. Already the simulation has lost its realism, its ability to engage the user. Why is this?
1. The user KNOWs the actor and has seen them on a regular basis
2. The actor looks NOTHING like the patient and carries no sensory data.
3. There may not even BE an actor, requiring the user to visualize everything
We have, as an industry, underestimated this "lack of realism." This can be highlighted by asking the question, what is the user "gaining" out of the exercise? They are obviously gaining "something" otherwise why would anyone even bother? They are gaining some practice as the interviewing process, which is, asking the patient questions. They are also gaining some declarative information, elements like drug dosages or specific differential diagnosis. But they are missing the key piece, one the piece that ties everything about experience together. They are missing the pattern.
What is the pattern and why is it so important? The pattern, simply put, is the sensory data that encompasses a specific condition, hazard, or combination of details. For example, the classic pattern of a coronary event is a sweaty, pale, middle-aged male with significant chest pain. This is visual data: You can see the paleness in the skin and the sweat dripping off it. It is also auditory data as you can hear the labored breathing and the “ouches” of significant chest pain. Your mind will file this information away as a “threat” to be recalled later, instantly, as procedural memory. (I go into more detail on procedural memory in another article). The important point to remember is we must first integrate the pattern before it can be recognized.
Pattern recognition is vital because it is how the human brain evolved to deal with threats. That orange and black striped thing in the brush over there...looks a lot like a tiger, I'd better avoid it. This orange and round fruit is really good, I should grab some while I'm here. Indeed, the concept of a symptom - a singular detail that is part of a condition or illness, shows that pattern recognition is the foremost way the human brain is trained to deal with threats. The entire foundation of medicine is based on the organization of "atypical details" into "typical details."
Medicine, as an industry, seems to understand this and has adapted as best it can: with clinical rotations. Now think about what constitutes a clinical rotation. From a brand new EMT to a 3rd year resident, all medical practitioners rely on them to gain their experience. What exactly are they gaining? They are seeing the pattern of various disease or injury processes, again and again. If you ever work as a preceptor, you will find yourself getting your students and saying, "Look at this patient, I want you to see what this looks like."
Out of all stages of training, the clinical rotation is arguably the most important because it is where the pattern integration and application of knowledge takes place. That practitioner can recognize: "Hey, that guy looks just like all the other guys I saw who were having a heart attack, he's doing all the same things. So I suspect heart attack." This learning is great, the only problem is that when the clinical stop, so does that training. We can't have people on clinical forever and departments can't fill vacancies with trainees. So, we've done the best we can, throwing people out there after giving them as much time as we could afford and wishing them good luck. They do the best they can and learn as fast as they can. If only there was a way continue their "clinical" rotation and accelerate their exposure to more patterns to recognize in their patients or incidents.
This acceleration is possible once we understand and apply the pattern integration model. Our whole concept of “experience” changes. Suddenly the shackles of “time”, the time that it takes to become a veteran, of someone with “years of experience” become more malleable, pliable even. If we realize that the pattern is simply sensory information, we can look to ways of encoding that pattern. The prospect becomes even more exciting when you ask yourself, "What will happen if I expose someone to the patterns of a thousand patients?"