These five steps—represented by the five R’s of ready, react, review, rules, and repeat—will help prepare EMS educators and their students for their hands-on educational experiences.

Make sure they’re ready—A student who doesn’t feel ready to perform a hands-on skill or participate in a simulation won’t learn anything from it. Most students won’t feel 100% confident the first time they run through a station, and that’s OK. Some level of anxiety and excitement is expected and may even help students focus on their performance.

Whether they’re brand-new or participating in a refresher or continuing education, students must not be left to feel they’re being ambushed. Adult learners who believe you’ve not given them the skills required to succeed will be resentful that you’ve put them in a position to fail. In some cases students may expect this from past experiences. Sometimes you will need to demonstrate hands-on skills or even walk students through every aspect of a hands-on station before they attempt it themselves. Other times it will be appropriate to leave some element of surprise. Keep in mind that an adult learner who feels you’re setting them up for failure is not in a place where effective learning or skills evaluation can occur. Students must feel ready to at least try a station to get anything of value from it.

Let them react—Students must be allowed to react to stations as they go them and figure things out for themselves. While it can be appropriate for educators or facilitators to provide some guidance, the rule in my classrooms is that once the students are trying the skill or scenario themselves, only verbal guidance is allowed. Anyone running or assisting in hands-on stations should work with their hands behind their backs at all times. Doing this reminds Instructors that hands-on refers to the students’ hands. Instructors can provide verbal guidance or, where necessary, demonstration for students to practice while watching, but hands-on stations can quickly turn into minilectures or simply repeats of initial demonstrations. This provides no hands-on value for students. Adult learners must be allowed to react to situations themselves in order to achieve anything close to real-world performance of their skills.

Review afterward—This step is often skipped to save time, though it is where most adult learning occurs. Incorporating a simple debriefing after a hands-on station or scenario can mean the difference between adult learners who lock in their lessons for life and those who get through the station but lose most of their skills before they even walk out the door.

Ask the students briefly describe what they did. Keep them focused on the main points of what happened without yet commenting on their performance.

Ask them, “What did you do that made you think, Oh, yeah! I should definitely do that again!?” The focus is on the different perspectives of the adult learners, rather than the perspective of the expert educator. In fact, this is often where educators learn new things from students.

Ask, “What would you change next time?” Students will tend to focus on failure. This is a dead end for learning. Focusing on what should change allows performance improvement to continue.

Building on the previous three questions, now ask, “What are the rules we need to take away for next time?”

Acquire new rules—The goal of hands-on sessions is for EMS providers to acquire new rules to guide them when they need to adapt in the real world to situations they didn’t quite encounter in the classroom. Students who practice hands-on skills in a way that encourages simply mimicking an educator’s demonstration or relies on educator guidance every step of the way will develop quickly perishable and nonadaptable skills. Students who develop muscle memory along with different ways to apply their techniques will become skilled and adaptable field EMS providers. Thus, great educators help students focus on the key rules that will guide them through situations such as not having preferred equipment, patients who don’t quite fit the picture in the book, and complex situations with competing patient priorities.

Repeat as needed—The final step of education is understanding that the learning doesn’t end when the lesson does. Not only is it important to use these steps consistently for each hands-on station and practical scenario, it is important to make the students aware of the steps as they go through them. Not only will this help students feel more comfortable with the learning process in the classroom, it will help them understand how to improve their performance by applying these principles to real-world situations. Remember, lifelong learning is a crucial performance improvement skill—perhaps the most important practical skill an EMS educator can help an adult learner acquire.