From the frontlines to the classrooms and back

Medical lab technician students at Bronx Community College in New York before classes went remote. (Photo: BCC)

Every time Lynn McGee hears a passing ambulance siren from her seventh-floor apartment street in the Bronx, she thinks of emergency medical technician (EMT) faculty at Borough of Manhattan Community College (BMCC) in New York City.

That’s because those instructors are not only teaching but also working shifts in those ambulances.

“They are almost all deployed right now as they continue to hold their EMT classes on Zoom,” said McGee, BMCC’s communications manager who currently works from home at her kitchen table. “They are exhausted and not returning home to their families after their shifts to ensure they don’t inadvertent infect their loved ones.”

Meghan Williams, an assistant professor and paramedic program director at BMCC, is one of those EMTs and paramedics who is teaching and working in the field. Not only does she teach the next generation of EMTs/paramedics, she is relaying to them current real-life experiences related to the pandemic.

“We just stepped off the ambulance, now we’re teaching, and this is exactly what we saw,” Williams said. “We’re giving them those life lessons, right then and there.”

That not only helps students learn but also prepares them for dealing with the realities of the pandemic. One element the instructors stress in the current environment is that their own safety is paramount.

“They have to step back and take the time to get prepared to go into that house because we see so many people that are getting sick,” Williams said, noting that even the levels of personal protective equipment keep changing.

That’s something they discuss — and why the protocols have changed.

Adjusting courses

BMCC’s EMT/paramedics programs are currently only doing class instruction online, with hands-on instruction and field experience on hold, Williams said. Typically, students would use half the week to learn material and the second part of the week they would practice in the labs, with weekly practices in the field.

The programs had already integrated using technology more into their classwork, such as studying EKGs and online simulations. Since the pandemic, the college has adjusted the programs to keep students progressing.

For example, the programs just started with small-group discussions focused on critical thinking in different scenarios. So instead of a mannequin simulation — which includes inserting an IV, taking blood pressure and temperature, and watching a patient’s breathing — students gather via Zoom and are given a scenario that they talk through as if they were doing it in person on a mannequin or real person.

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To show their skills remotely, students use items found in their homes, such using a rolled-up magazine for splinting or bandaging. Or they grab a person with whom they are quarantined and through Zoom show the steps of a trauma assessment.

“We’ve started to get a little more creative, and it has actually worked out pretty well,” Williams said.

No students are working in the field as EMTs because they are not credentialled. However, paramedics are already EMTs so some of them are working as EMTs while they are in paramedics class, Williams said.

On the nursing front

Nursing programs at community colleges in the City University of New York (CUNY) are all experiencing similar challenges and have quickly adjusted their programs. In March, nursing students at Queensborough Community College (QCC) left their clinicals at hospitals, which felt it was unsafe for them, said Anne Marie Menendez, who chairs the nursing program at QCC.

Within a week, nursing faculty had to move almost the entire program online — not just the classwork, but also the clinical work. For the latter, they are using virtual simulation, case studies and more, she said.

Faculty get online with students typically in the morning for pre-conferences, just like they would at the hospitals, Menendez said. Students have assignments to complete during the day, and at the end of the day they are back online with their clinical instructors for a post-conference.

“It’s been amazing how everyone has pushed forward in a short time,” she said.

There are students in the program who have been working all along in the hospitals, mostly as nursing assistants, but also as medical technicians and EMTs. Several students also have volunteered. Some adjunct faculty members also are at the front lines, running emergency rooms, working in ICUs and screening. Some even volunteer to help with mental support online.

The wider QCC nursing family also has reached out to help, from alumni to family members and friends, Williams said.

“This unprecedented,” she said. “It’s like nothing we’ve ever dealt with in all our years as nurses.”

Forging ahead

This month, the state informed certain colleges with nursing programs that they could apply to have students graduate early to help with the pandemic. With QCC students finishing their program in a few weeks, the college opted to stick with the current timeline, since they would be graduating soon, Menendez said.

“I feel our students have a lot of important content to cover in the next couple of weeks. I want them to be well-prepared, because once they are out, it’s going to be very, very challenging,” she said.

Menendez is currently doing graduate audits for students who will be ready for the workforce as soon as they finish. Their final will be in mid-May. She has already asked them to start the application process for their state licensure and to set up for licensing exams.

Clinicals are not available for many nursing students, but they are still working on their competencies.

“Nursing is not about skills. Nursing is about ‘Are students able to think critically, make good decisions?’ It’s about teamwork, collaboration. It’s about safety,” Menendez said. “So when we are conducting our clinicals, we are not so much thinking about tasks. We are interested in how students are thinking. Are they thinking like a nurse? Are they thinking in a way that keeps their patients safe and themselves safe? Are they able to communicate well as a team?”

Students are assigned case studies to examine these competencies and assigned simulation that mimics hospital settings. Written assignments require them to draft care plans for patients who they watch on videos. Students also must do a de-briefing after with faculty to review what they saw, what they did well and what they would do differently.

“That’s where we’re trying to get students to think critically, and to think like a nurse,” said Menendez, who noted that nearly all the students in the program go into a bachelor’s degree track for nursing at one of the CUNY four-year programs.

A slightly different approach

Hostos Community College did apply for the exemption from the state, which was approved within 24 hours. As many as 23 eligible students may graduate on May 1 instead of June, said Ed King, co-director of the registered nurse program at Hostos.

Many of the students were already working in the field as LPNs or aides, and employers are eager to hire them, noting they have other skills needed to serve the community, including being bilingual, King said.

Hostos also is using the current environment as a teaching opportunity. It’s especially made students more aware of certain parts of their training, such as triaging in a disaster. That brings up ethical dilemmas, such as which patients are priorities when care and supplies are limited.

Students are also studying via case studies about the spread of the virus in nursing homes, which was mainly a result of a failure of infectious disease controls, King said.

“It’s always been in the abstract, and now it’s very real,” he said.

Preparing lab technicians

Medical lab technicians (MLT) are also on the front lines running the COVID-19 screening tests at hospitals, noted Dr. Diane Banks, an assistant professor and director of MLT programs at Bronx Community College.

“Those are graduates from our program,” she said.

Much like with nursing students, the hands-on work experiences for MLTs had stopped, affecting 12 of the 120 students in the MLT program, Banks said. The college is trying to find ways to get those students back into the labs to complete requirements for the program in order to graduate, Banks said. Six students have had their internships at clinical laboratories recently reinstated and are picking up their MLT studies from where they left off before the pandemic.

Easing state-mandated requirements for graduation won’t help, Banks said, because skills learned in “pipetting” — the handling and measuring of samples — are important to properly diagnose patients.

“There are a lot of adverse effects that can happen if a student doesn’t have good pipetting techniques,” Banks said.

That initial testing is vital because it determines the course of action, she explained. A person testing positive goes into isolation. A person with a negative result goes home.

About the Author

Matthew Dembicki
is editor of Community College Daily and serves as publications director for the American Association of Community Colleges.