Code 3: The Little Trainee Who Could
“Congratulations on your performance during the interview process, your training academy has been scheduled”. Fresh out of Emergency Medical Technician school, I applied for San Mateo Counties 911 ambulance. Having just graduated at the top of my class, I was very excited to hear back that my application had been accepted. With months of training behind me and my new training set to start, I was delighted and felt I had made it out rather well compared to fellow classmates. Many of them still needed to pass the national registry before they could begin working, while I passed the test on my first try! I was proud to have gotten The job. Carol Dweck’s “Mindset” raises endless questions and arguments regarding the true potential of an individual. Dweck’s main argument explains two states of mind and how they shape the outcomes of events in our lives. These are known as the fixed mindset and the growth mindset. Throughout the book Dweck aims to answer the question “What are the consequences of thinking your intelligence or personality is something you can develop, as opposed to something that is a fixed, deep-seated trait? (p4)”. Dweck argues that one’s mindset is not a permanent part of a person’s makeup and that an individual can adopt the growth mindset which “is based on the belief that your basic qualities are things you can cultivate through your efforts, strategies, and help from others”( p 7). In plain words, Dweck believes that way too often people are made to believe they are too stupid to do or achieve something; when they really just haven’t put in as much time practicing, nor have the same experience as people who are proficient in the skill. My experiences during my EMT field training to work for the county ambulance proved to me not only how one’s mindset can change, but why it is necessary to change from a fixed mindset to a growth mindset. Certainly, some would argue that people are not supposed to change their mindsets, and that someone’s abilities, talents, and traits cannot be grown or improved. Either you have it or you don’t, plain and simple. Infact, those in the fixed mindset often see effort as a weakness, and as a lack of natural ability. They believe that even asking questions when you don’t know something can leave someone in the fixed mindset believing they are deficient.
Early on, by comparing myself to my peers who had not yet secured jobs, I fell into a classic trait of Dweck’s fixed mindset. Dweck describes “When struggling students were given the chance to look at other students’ exam scores, students in the growth mindset looked at tests of students who had far outperformed them while students in the fixed mindset chose to look at the students who had scored far lower than them” (p36). For training, the other trainees and I received thick binders filled with county protocols and various medical information, and we were told to study it. Soon after, I began my actual field training. We replaced the books and classrooms for the streets of San Mateo County. I had zero real world EMT experience outside of the ride alongs I did in school. I was excited to begin my path at such a high level. I had never driven the ambulance, I had never done CPR, I had never even spoken over a radio or taken a blood pressure on somebody I didn’t know. I figured the learning had begun.
Lets just say, it was clear to everybody that it was my first day on the job. I had set a benchmark for my performance meaning my trainer knew pretty much what I did and did not know about the job which at the time was nowhere near close to the skills and knowledge needed to clear the training.. He’s watching my every move and it’s pretty clear if I don’t know something because I would ask, or try and figure it out on my own. I was not too worried as there was only one way up from there. I would receive training and experience to better myself. Dweck states “People with the growth mindset know it takes time for potential to flower” (p25). I knew EMT school prepared me well for the job, but it would take time and experience before my skills and knowledge would truly blossom.
I was very eager to learn. When I asked for ways to improve, my field trainer, someone who is certified to train other EMTs how to do the job, was reluctant to help me. His beliefs aligned with the fixed mindset. Dweck quotes a belief that “You can simply measure the fixed ability right now and project it into the future” (p27). In other words, seeing a trainees performance on day one and believing that sets the permanent benchmark for how well they can perform on the job. I was there to serve the county and put time in to getting better every day. Trusting that I would leave each day performing better than the last. To my trainer, it was a problem that I was hired on with zero prior medical experience. He said I was not allowed to make beginner mistakes stating “people actually die, I don’t think you get what this job is”. My field trainer berated me for not knowing how to apply each piece of gear seamlessly even though I had never put them to use. When I drove emergency mode with lights and sirens on for my very first time while following company protocol I was put down. I was told I am “the reason people don’t pull over for ambulances”. Simple things I had no experience doing such as navigating to the hospitals and ensuring the ambulance was fully stocked with equipment was difficult for me when I was new, let alone the expectation to perform perfectly on a critical call. I anticipated I would gain the experience needed during my training time however I began feeling that there was no room for learning and that I just needed to be able to perform.
I began to believe either I could, or I could not. Dweck, explaining to students who do not believe they can learn, states“isn’t that what school is for? To teach? [you’re] there to learn how to do these things” (p25). I knew great EMTs were not made in school. Some said that because I was fresh out of EMT school, all the knowledge and skills tests were still fresh in my head. Some people said that my errors and need for my trainers to actually train me instead of just rate my performance was unacceptable. “You just graduated, you should know better than all of us! Didn’t they teach you anything in school?” was a common response to my questions on the job. I figured I had gone to school to learn the principles and basics of the job and the real learning would begin when I entered the field and got hands on experience. Thus the reason I strived to be first in my class to pass the registry and begin working. I was eager to begin building my skills.
My trainer on the other hand, believed that the learning was over and it was time to perform. On page 24 in regards to the fixed mindset Dweck states: “you have to be pretty much flawless. And you have to be flawless right away” which is the same belief shared by those who said I shouldn’t need training, tips, or advice since I was fresh out of school. I had the schooling required to work for the ambulance, but that school in no way taught me everything I needed to know in order to be successful at this job, hence the reason for the companies own version of training and even then I still wouldn’t be 100 percent ready for everything I may face on the job. I believed my trainer was there to guide me through the process of learning. Instead, when I would attempt to learn new things my trainer would perceive my need to ask questions about the gear we carried or previous calls we had gone on as me not being competent enough to perform the job. When I struggled and asked for advice on how to improve my trainer would yell at me to “figure it out” and that “I should know what I’m doing if im going to be working here”. My trainer expected me not to have any questions or struggles and simply be at the passing level. I was not polished and my inexperience showed. On days that followed my trainers would call me rude names and degrade me for being curious and inexperienced. I was there to learn and become somebody who would serve the county. But, I failed my training and had to get an extension, it was humiliating and I was constantly nervous. I began wanting to be the EMT my trainers wanted me to be; one who had no questions or struggles which was what I perceived as successful during training. This went against my original plan of wanting to learn as much as I could so I could be the best possible medic.
My trainer told me that I needed experience elsewhere before I got into the 911 system. The fear of failure changed my belief towards my training to something that became strikingly similar to students in the fixed mindset when asked when they feel smart. Students in the fixed mindset said “When I don’t make mistakes” “ When something is easy for me” “When I finish something fast and it’s perfect” (p25). My beliefs changed to that I shouldn’t make any mistakes, training was no longer a time to learn and grow. In the fixed mindset “it’s about being perfect right now”(p25). My new belief became that my training period was a time to “fake it til you make it” and do whatever it takes to get a trainer to pass you and let you work unsupervised. The reason this mindset is dangerous is because if you make a mistake during training you have a trainer who can step in and correct you preventing any errors that may cause patient harm. If you are able to hide your weaknesses and mistakes during your training they will all begin to show once you are on your own and what is a small error committed under a trainer can become a critical mistake that ends up costing a patient their life when you are on your own. Some may say training is a time to demonstrate that you are polished and have nothing more to learn. Some argue that a trainer is there to evaluate whether you can or cannot perform the duties of the job and should not need to have coaching moments with a trainee. I argue that training is actually the best time to make your mistakes and learn because you have a trainer supervising you if anything goes wrong. EMT field trainers have years of experience and are trained to guide new hires towards being successful on the job. I began blaming my trainers incompetence. I would blame the company for having a poor training regiment. I began believing that I was incapable of doing the job due to my inability to perform like a veteran EMT, even though I was the opposite. The criticism of my trainers began weighing me down. I believed that if I passed my training I was a successful, good EMT and if I didnt I was a failure EMT. Dweck describes students responses after a series of hardships throughout a class on page 57, students in the fixed mindset responded to the struggles with “I am the stupidest,” “the teacher is a fat slut,” “the teacher is on crack,” or “I suck!” By complaining about my trainers and training regiment, I began to blame others for my own struggle during training which drove me even further from where I wanted to be. Instead of focusing on my own shortcomings and deficits during my training, I became a victim of my situation. During my following training shifts I wanted to seem polished, confident, and avoid any chance to test myself or have a “teaching moment”. I hoped for the easiest and least invasive calls possible minimizing the chance to show my trainers that I am still learning and there are areas of improvement. I became scared to work. Despite my top of the line medical training, I feared every action I took in the field was wrong because my fear of being seen as a failure was elevated when I was with my trainer. I just wanted to succeed and get it over with even if I entered the field not at the level I wanted to be at. It wasn’t until I failed my training and was given a chance to get extended a few more shifts, that I was able to change my outlook on the situation. Dweck also studied students who did well after a series of hardships. Unlike the fix minded students “[The growth minded students] told us that they sometimes felt overwhelmed but their response was to dig in and do what it takes” (p58). Despite negative trainers and peers, despite poor training regiment, despite anything, I was going to do whatever I needed to do to clear my training and begin serving San Mateo County. Students in the growth mindset, “went over mistakes until they were certain they understood them,” and “were studying to learn, not just to ace the test”( p61). Just as when I first started my training, I regained the sense of wanting to learn the job and be the best I could be, not just have the goal of passing my training as easily as possible. Just like the growth minded students “completely took charge of their learning and motivation”( p.61), I did the same. My beliefs and mindset began to change.
Trainers told me things like “I didn’t belong” or “I was going to fail”. They would call me terrible names such as “retard” or tell me I had “ADHD”. Now, I was able to block it out mentally and just focus on the call we had and caring for the patient whereas before it would get in my head and limit me from doing my best work. I received feedback from my trainers on daily performance reports and would take the feedback directly to the fire station for a 24 hour ride along, running numerous calls with the goal of getting more experienced. I would then take my improved skills and extra practice back to the ambulance company. I became obsessed with becoming the best EMT I could be and got to a point where even if the trainer was saying horrible things to me, I still had the heart (or mindset) to dig in and keep going on. In the face of adversity, I dug in and went to work.
Before I did not want hard calls for fear of showing my weaknesses paralyzed me. Now, I wanted to test myself on all the most invasive cardiac and trauma calls so I could demonstrate my skills and knowledge to my field trainer, as well as gain experience and grow. Growth minded people have routes they can take to become successful in something. Dweck says “If change and growth are possible, there are still many paths to success” ( p37). To me, this means If I didn’t pass my training here in San Mateo, I could take the skills I learned and the experience I gained to apply to other counties or fire departments. My training is a time to make mistakes and learn so I can better serve patients in the field. Before I believed my training was a time to be perfect. It wasn’t until I began working on my skills and deficits that I was able to get the confidence to succeed on any call and success no longer became about passing or failing
So, what if fixed minded field trainers make prospective EMTs for the county develop a fixed mindset as well? The negative mindset hinders the long term success, learning, and hinders the quality of care a patient receives in the field. In this situation an EMT would value the success of passing and no longer value the process of learning and becoming knowledgeable. This can definitely lower the quality of care given by new EMT’s. On the other hand, EMT’s who instill a growth mindset often strive to advance further in the healthcare field and can provide higher levels of care to citizens. If I didn’t change from the fixed mindset of wanting the easiest calls and the chillest trainer just to pass me, and not care about learning during my training, my career would be much more negative. I would not be someone who can teach other EMTs how to do a great job working. I would have carried on the fixed mindset instead of breaking the negative training cycle and beginning the new wave of the growth mindset.
