Learning to Drive

A few years ago, I helped teach my nephew to drive. In Colorado, a teenager with a learner’s driving permit needs certain hours of certain kinds of practice. The adults in my nephew’s life took turns riding in the front passenger seat with him to meet those criteria. One day, I had to run a few errands and then make a trip about an hour up into the mountains, so I let him drive. 

How it felt to me...  Source, with permission

What I discovered is that driving requires a person to have a grasp on about 20 things. Your speed, lane position, lane choice, upcoming hazards, what the sign you just passed said (and whether it was important), how close you are to the car in front of you, how many police cars are trying to PIT you, and so on. A brand-new driver has a firm grasp on about five of them. The five concepts my nephew paid attention to rotated through the list of twenty – if he started to change lanes, he lost control of his speed. If he paid attention to his speed, he lost track of where he was. If he read a sign, he would drift into the adjacent lane. Don't even mention turning left through an intersection.

It felt this way to me, too. I was screaming on the inside... Source, with permission

Over time, he could pay attention to six requirements at a time, then ten, and with enough practice he could manage all twenty at the same time. We all went through the same journey. It is called learning to drive.

My job during this process was not to act like my parents acted when I was learning to drive. My mother tried to stomp a hole in the passenger floorboard of her minivan when I was driving. My father took me to the high school parking lot in his ’74 Ford pickup. That truck had three manual gears and a clutch that took about 140 pounds of pressure to hold against the floor. (I think I weighed about 135 then.) Both my parents were perfectionists and shouters (actually, Dad shouted; Mom loudly whimpered and hissed). I tried to be a non-perfectionist and a non-shouter with my nephew. 

He made errors. A lot of errors. A lot. I mean, of course he did – it comes with the territory. Before each leg of a trip, I would verbally go over something for him to work on: “On the way to the store, I want you to pay attention to your speed, okay?” While driving, there were times that he would find his own mistake and fix it without input from me. Other times he would correct himself when I asked simple questions: “How fast are we going now?” Sometimes I would take some of the tasks off his plate: “That sign ahead says the right lane is ending, so we need to move one lane to the left as soon as we can.” Sometimes I would have to tell him what was wrong and the correction directly: “Pick a lane, boy. You’re weaving.” I didn’t have to do it, but if worse came to worse I could have made an adjustment to the steering wheel myself. I could even have made him pull over and let me drive, if it came to that.

Like we all had to learn to drive, each of us had to learn to run an EMS call. I realized that training paramedics (and EMTs; probably medical students, student nurses, and residents, as well) is a similar process to teaching a high schooler to drive. There are about 20 items a trainee has to pay attention to, but they have a firm grasp of only five at a time. My job as a trainer is to increase the parts of the call that a trainee can handle at any one time. I can do that with easy questions: “How does his breathing look to you?” I can choose to take tasks off of their plate when I put the firefighters back in service, or I can wait for the trainee to remember to do that. I can talk about a specific facet of a call to concentrate on before we arrive on scene: “On the next call, I want you to make sure you listen to breath sounds. Make sure to do it, because I will be watching for it.” I can drop big hints during the call by handing medications to the trainee or by spiking an IV bag in front of her. I can choose to watch a minor error happen to see how long it takes for him to realize it on his own and “get back into their own lane.” I can step in and correct bigger errors with specific instructions. I can be a more aggressive trainer and tell the trainee specifically what they need to do. I can even take over the call if it has gone completely pear-shaped. 

When I was helping to teach my nephew to drive, I had to choose my response based on the severity of the situation. When I field train, I make similar choices. Constantly. The important thing is that the trainer (driving or EMS) not base their reaction on emotion. Fear causes shouting. Frustration causes ineffective communication. Apathy is the worst. I try to channel my tolerant side and base my teaching strategies on what is needed, not what feels good. That is how baby medics and baby drivers are similar.