Home » #EMS2.0 » #Professionalism » Lack of Affect?

Lack of Affect?


I’ve been thinking a lot lately about what it means to be professional in my job. It’s a question that has been asked, discussed and bandied about almost endlessly in various publications, blogs and papers in EMS. It’s been on my mind of late as I’ve watched other medical providers get away with very unprofessional behaviors. Seeing that sort of thing really pisses me off. It also makes me reflect on my own behavior. Am I being a professional? What should I be doing to act professionally?

Fortunately, how to be a professional EMS provider is pretty clear. You just have to act the part. Yes, I know, many people say (somewhat truthfully) that true professionalism only comes from a professional “attitude.” That may be so but the internal dialogue that makes an “attitude” is not objective nor is it in any way measurable. There’s no way to look and see if you (or someone else) is making progress towards becoming a professional if the only yard stick is this nebulous thing called “attitude.”

I say it’s all behavior. And I know a bit of what I speak. When I was teaching paramedics, one of my charges was to educate and evaluate my students on their “Affective Domain.” This is one of the 3 learning domains, along with psychomotor and cognitive,  established in the National Standards Curriculum (NSC) by the National Highway Traffic and Safety Administration (NHTSA) for the education and training of paramedics. According to the NSC, “Students must demonstrate professionalism, conscientiousness and interest in learning.” It further gives guidelines on how to measure them. I think that “professionalism, conscientiousness and interest in learning” are core values of being a paramedic, long after graduating from any paramedic program.

As an instructor and evaluator, I used 11 categories of behavior to monitor and measure a student’s professional behaviors. I know that I can’t change someone’s attitude. I can’t tell someone to stop feeling the way they do. Supervisors can’t order an employee to stop having a bad attitude. All we can do is require our students and employees to exhibit the behaviors of a professional.  By breaking the concept of “professional” into 11 categories, one can zero in on the areas that need improvement as well as praise the areas that show progress.

The categories are:

  1. Integrity
  2. Empathy
  3. Self Motivation
  4. Appearance and Personal Hygiene
  5. Self-Confidence
  6. Communication
  7. Time Management
  8. Teamwork and Diplomacy
  9. Respect
  10. Patient Advocacy
  11. Careful Delivery of Services.

In my affective domain evaluation, I used a list of behaviors that described various levels of each of the 11 categories of professionalism. Students were rated on to what extent they exhibited these behaviors in their clinical program, in the classroom and in the lab. I used an evaluation sheet that could be handed to employers, fellow students, other teachers as well as field and clinical preceptors. Regular usage of the evaluation gave the students feedback on how they were perceived as professionals and where they could improve. Just because we’re no longer in school anymore, doesn’t mean we can’t still do this. We may not find coworkers, teachers and students filling out “Affective Domain Evaluation Forms” but make no mistake; our professionalism and behavior is constantly under scrutiny by the public, coworkers, supervisors and even ourselves.

I will argue that the only thing we can measure and affect are behaviors, in ourselves and those around us. I further offer that, in many cases, the attitude follows the behavior. We become, in many ways, what we repeatedly do. Have you ever made yourself smile when you didn’t want to and found yourself slightly cheered up? I believe that just performing the behaviors of professionalism helps to perpetuate the atmosphere of excellence that is so important for a high-performance EMS agency and the high-performance professionals that work there. Once someone is steeped in that atmosphere, the attitude cannot help but be affected.

Over the next few weeks, I will discuss each of these eleven categories and how they apply to our notions of being EMS professionals. I’ll post a single blog entry for each category and fill it out with my opinions, a few war stories and why I think these things are so important.  I expect there will be a LOT of discussion, argument and quite a few people who will call me an idiot. That’s great. I welcome the “feedback.”


  • http://lonelyemt.blogspot.com Hilinda

    REALLY looking forward to this!
    For one thing, it is rare that I come across anyone who knows what the three learning domains ARE, let alone wants to discuss how to evaluate them.
    And if I do manage to find someone who knows what they are, the affective domain is usually treated like some third cousin that no one wants to talk about.
    But also, because it’s you doing the discussing. :-) Been missing your thoughts for a while.
    Also, I’d love to see your evaluation sheet. Seriously.

  • http://maddogmedic.com maddog medic

    Right you are, Hilinda about the Affective being treated like an
    unwanted relative. I suspect that’s because folks don’t really know how
    to evaluate the affective domain.   I found it a lot easier to have a systematic approach that was consistent in what it evaluated and how it was done. Once you use that, then it’s all about modifying behaviors.