2023 EMS Transformation Update – What’s Promising? What’s Threatening?
The role of EMS continues to dramatically evolve. Medicare and other agencies have issued waivers during the pandemic and may, or may not, become new models for service delivery. Agencies and practitioners are implementing new services that enhance the value EMS bring to patients, payers, hospitals, ACOs, CMOs, and Hospital in the Home providers. This session will provide an overview of the programs implemented over the past year and the ways they are generating value to their key stakeholders.
Learning Objectives:
Understand the ways the role of EMS continues to evolve.
Learn 5 new programs that have been implemented over the past year.
Understand the ways value is being determined for these new programs.
Learning Objectives:
Understand the ways the role of EMS continues to evolve.
Learn 5 new programs that have been implemented over the past year.
Understand the ways value is being determined for these new programs.
Wake Up I am Tired!
Sleep deprivation may just be the root of all evils when it comes to the safety of our personnel. Various studies have proven that sleep fatigue causes heart attacks, vehicle crashes, depression, cancer, and other diseases. Emergency service personnel live a life in their career sleep deprived. Join Dr. Lindsey as he discusses the issues surrounding sleep fatigue and the various options of dealing with this issue.
Learning Objectives:
Discuss the issues surrounding sleep deprivation.
Discuss the negative outcomes of sleep deprivation.
Explain the alternative choices to reduce sleep fatigue.
Learning Objectives:
Discuss the issues surrounding sleep deprivation.
Discuss the negative outcomes of sleep deprivation.
Explain the alternative choices to reduce sleep fatigue.
Prehospital Labs: Why You Should Care
Point of care labs are making an appearance in the prehospital environment. The background on how to manage lab values is not widely provided in most EMS training. Point of care testing machines provide a wide range of labs and deciphering what is important and what can be managed in the prehospital environment is confusing, This talk will cover what are the most impactful labs available and what are the nice to know labs. Answering the question, "What am I going to do with it anyway?" will be answered. This talk will also debunk the notions, "The hospital isn't going to listen" and "The hospital is just going to draw their own labs anyway". Paramedics shouldn't be afraid to add this to their overall assessment. It can only help to make the assessment more complete.
Learning Objectives:
Upon completion, participant will be able to understand what POCT lab values can be managed in the prehospital environment.
Upon completion, participant will be able to understand how POCT can improve their prehospital assessment and understanding of patient physiology.
Upon completion, the participant will be able to understand when POCT should be utilized in the prehospital environment.
Learning Objectives:
Upon completion, participant will be able to understand what POCT lab values can be managed in the prehospital environment.
Upon completion, participant will be able to understand how POCT can improve their prehospital assessment and understanding of patient physiology.
Upon completion, the participant will be able to understand when POCT should be utilized in the prehospital environment.
Advanced Community Paramedicine Team Building-Diversifying Your Practitioners
Although Mobile Integrated Health-Community Paramedicine has been practiced for many years, few communities have a robust portfolio of programs like Crawfordsville, IN. In their endeavor to address healthcare issues and gaps in their communities, Crawfordsville, IN implemented numerous MIH-CP programs including chronic disease management, maternal and infant health program, an overdose response program, aimed at protecting all citizens cradle to grave. These programs have marked their success through collaboration between multi-faceted partnerships, but most recently through the integration of non-traditional roles within their paramedicine programs.
In this presentation, you will hear from experts in nursing, social work, public health, and how they expanded their roles alongside community paramedics using a comprehensive approach to patient care. Featured with stories of how the addition of these personnel helped bridge gaps within care through education, access to services, and program evaluation to reach holistic care.
Learning Objectives:
Identify ways to implement social work and nursing into non-traditional settings.
Define and summarize several challenges and strengths of multisystem MIH-CP programs.
Consider the community needs and match program components to those needs.
In this presentation, you will hear from experts in nursing, social work, public health, and how they expanded their roles alongside community paramedics using a comprehensive approach to patient care. Featured with stories of how the addition of these personnel helped bridge gaps within care through education, access to services, and program evaluation to reach holistic care.
Learning Objectives:
Identify ways to implement social work and nursing into non-traditional settings.
Define and summarize several challenges and strengths of multisystem MIH-CP programs.
Consider the community needs and match program components to those needs.
Back to Basic: Implementation of a Tiered-response BLS Transport Program
Increasing volumes along with ongoing staffing challenges for paramedics has demonstrated the need for creative staffing models to continue to deliver the highest care to patients in the EMS environment. Utilizing a tiered response system with primary Basic Life Support (BLS) response with EMT-B crews is one such staffing model to accomplish this goal. The COVID-19 pandemic lead to increasing staffing challenges in the setting of increased call volumes which lead to the implementation of this BLS response system within New Orleans EMS.
A large portion of EMS calls are lower acuity and do not benefit from ALS interventions. Providing alternative transport opportunity with a BLS transport not only lowers costs and decreases burden of staffing, but also provides patients with the appropriate resources for their stated complaint. We described the successful development and implementation of a tiered response system over a two-year period with BLS transport in an urban EMS agency as well as identify the potential challenges with changing to this model as well as ways to combat these challenges and achieve success.
Learning Objectives:
Upon completion, participants will be able to describe a tiered response system and the benefits of the model
Upon completion, participants will be able to discuss the necessary steps in creation and implementation of a BLS response system
Upon completion, participants will have the knowledge and CQI tools to continue to evaluate and improve a tiered-response system over time
A large portion of EMS calls are lower acuity and do not benefit from ALS interventions. Providing alternative transport opportunity with a BLS transport not only lowers costs and decreases burden of staffing, but also provides patients with the appropriate resources for their stated complaint. We described the successful development and implementation of a tiered response system over a two-year period with BLS transport in an urban EMS agency as well as identify the potential challenges with changing to this model as well as ways to combat these challenges and achieve success.
Learning Objectives:
Upon completion, participants will be able to describe a tiered response system and the benefits of the model
Upon completion, participants will be able to discuss the necessary steps in creation and implementation of a BLS response system
Upon completion, participants will have the knowledge and CQI tools to continue to evaluate and improve a tiered-response system over time
Double Sequential Defibrillation: What's the Hype?
Patients in refractory ventricular fibrillation (VF) cardiac arrest may not respond to standard resuscitation such as defibrillation and antiarrhythmics. Until recently there were no additional treatments available to improve outcomes for these patients in the prehospital setting, resulting in overall poor survival. The recently published DOSE VF Randomized Controlled Trial provided high quality evidence that the use of alternative defibrillation techniques (double sequential defibrillation (DSED) and vector change defibrillation) significantly improved outcomes in patients with refractory VF. This talk will describe the evidence behind the use of DSED and vector change defibrillation, discuss the nuances of implementation of alternative defibrillation techniques and how they can be used to improve cardiac arrest management and patient outcomes.
Learning Objectives:
Upon completion of this presentation, participants will be able to describe the evidence behind the use of double sequential defibrillation, including the results of the DOSE VF randomized controlled trial.
Upon completion of this presentation, participants will be able to describe the situations in which alternative defibrillation techniques may be employed during cardiac arrest management
Upon completion of this presentation, participants will be able to define double sequential defibrillation and list the indications for its use.
Learning Objectives:
Upon completion of this presentation, participants will be able to describe the evidence behind the use of double sequential defibrillation, including the results of the DOSE VF randomized controlled trial.
Upon completion of this presentation, participants will be able to describe the situations in which alternative defibrillation techniques may be employed during cardiac arrest management
Upon completion of this presentation, participants will be able to define double sequential defibrillation and list the indications for its use.
Head Trauma and Increased Intracranial Pressure: A Comprehensive Treatment Protocol for the Paramedic on Scene
This Course will discuss in detail the creation and implementation of the comprehensive medical protocol to treat traumatic brain injury on scene. These treatments are for the critical care level provider however many can be put in place by the Paramedic depending on your state’s scope of practice. These treatments include Rapid Sequence induction discussing different induction agents and paralytics to get the best patient outcome, Seizure Prophylactic utilizing Levetiracetam and The use of Osmotic agents specifically the highly concentrated 23.4% Hypertonic Saline. The Course will present case studies and success stories from this breakthrough prehospital care. The instructors are currently utilizing this protocol at their profession within a Fire based 911 system and will discuss the research sited to justify this aggressive protocol to the regional hospitals and medical director where they serve.
Learning Objectives:
Upon Completion participants will be able to discuss several osmotic agents and their uses in the setting of traumatic brain injury with increased intracranial pressure.
Participants will be able to describe induction agents and paralytics and their individual benefits and disadvantages in treatment of traumatic brain injury.
Upon completion participants will be able to demonstrate the necessary treatment with seizure prophylaxis for the patient with Traumatic brain injury utilizing Levetiracetam.
Learning Objectives:
Upon Completion participants will be able to discuss several osmotic agents and their uses in the setting of traumatic brain injury with increased intracranial pressure.
Participants will be able to describe induction agents and paralytics and their individual benefits and disadvantages in treatment of traumatic brain injury.
Upon completion participants will be able to demonstrate the necessary treatment with seizure prophylaxis for the patient with Traumatic brain injury utilizing Levetiracetam.
Pre-Hospital OB: Complications and Care
Students will learn about the preparation and basic maneuvers for delivering an infant, understand concepts of fetal presentation, cardinal movements of labor, and steps to take in a normal, uncomplicated out-of-hospital delivery. Students will learn what to do when there is a nuchal
cord, how to suction meconium, how to clamp and cut the umbilical cord, placental delivery, management of postpartum hemorrhage and shoulder dystocia, breech delivery, prolapsed cord and fetal head entrapment.
Learning Objectives:
The most important thing you should take away from this course is that you can make a tremendous difference in patient outcome through a series of straightforward actions.
manage the precipitous out-of-hospital childbirth.
List complications associated with the precipitous out-of-hospital childbirth.
cord, how to suction meconium, how to clamp and cut the umbilical cord, placental delivery, management of postpartum hemorrhage and shoulder dystocia, breech delivery, prolapsed cord and fetal head entrapment.
Learning Objectives:
The most important thing you should take away from this course is that you can make a tremendous difference in patient outcome through a series of straightforward actions.
manage the precipitous out-of-hospital childbirth.
List complications associated with the precipitous out-of-hospital childbirth.
The Nightmare Patient: ASA Overdose - Lessons Learned
Join us for this "The Nightmare Patient: ASA Overdose - Lessons Learned." Eric takes a look at a very difficult case of multifactorial resuscitation with an adult female patient. We dive deep into all things resuscitation and analyze factors that drive our decision-making. We dive into the complex world of ASA overdose, with a look at resuscitation, treatment considerations, and overall management. Don't miss this information packed talk!
Learning Objectives:
Define the introduction case study.
Identify assessment pearls of the ASA overdose patient.
Break down the pathophysiologic response to salicylate overdose.
Analyze core resuscitation endpoints in salicylate overdose.
Learning Objectives:
Define the introduction case study.
Identify assessment pearls of the ASA overdose patient.
Break down the pathophysiologic response to salicylate overdose.
Analyze core resuscitation endpoints in salicylate overdose.
Wellness?! Who Has Time for That?
This presentation will provide participants with an understanding of various personal and occupational wellness techniques and activities. Upon the conclusion of the course students will be equipped with the tools to make provider personal wellness a top priority and daily activity among all the noise.
Learning Objectives:
Recognize, evaluate and have greater understanding of occupational wellness
The presentation will provide participants with fun and unique ways to make personal wellness a top priority among all the noise.
Identify circumstances which inhibit personal and occupational wellness and learn tools to adapt and overcome those circumstances.
Learning Objectives:
Recognize, evaluate and have greater understanding of occupational wellness
The presentation will provide participants with fun and unique ways to make personal wellness a top priority among all the noise.
Identify circumstances which inhibit personal and occupational wellness and learn tools to adapt and overcome those circumstances.
Treating PTSD In First Responders: Evaluating The Evidence For Counseling, EMDR, Ketamine, and Hallucinogenics
Acute stress and PTSD are well known issues amongst first responders but how much do we know about treatment? Historically, EMS care was rife with anecdotal evidence. Mental health care is not all that different. We'll look beyond the anecdotes for treating PTSD into the support for or against treatments old and new. We will evaluate typical prognoses for clients using counseling services with and without EMDR. We will also look at what evidence is available for newer treatments like ketamine and hallucinogenics.
Learning Objectives:
The learner will be able to discuss some of the basic treatments offered to PTSD sufferers.
The learner will have knowledge of the prognoses for counseling and/or EMDR treatment for PTSD in first responders.
The learner will have knowledge of the research for/against the use of Ketamine and hallucinogenics in the treatment of PTSD in first responders.
Learning Objectives:
The learner will be able to discuss some of the basic treatments offered to PTSD sufferers.
The learner will have knowledge of the prognoses for counseling and/or EMDR treatment for PTSD in first responders.
The learner will have knowledge of the research for/against the use of Ketamine and hallucinogenics in the treatment of PTSD in first responders.
Medical Considerations for Technical Rescue
Technical rescue incidents present a unique set of challenges to medical providers. Whether assessing and treating suspension injuries at a rope rescue or crush injuries at a structural collapse, special knowledge and skills are required from the provider. Modern medicine now requires medical treatment to begin during the rescue phase, rather than waiting for the victim to be rescued. This presentation focuses on kinematics of trauma, rescue techniques, treatment priorities, and special considerations to result in the best possible patient outcomes.
Learning Objectives:
describe injuries sustained in falls arrest by belay lines, choose the appropriate extraction technique based on injuries, and construct a treatment plan.
predict injuries associated with prolonged suspension, formulate a treatment plan based on known and expect injuries, and compare extraction methods for the best patient outcome.
assess and anticipate crush injuries using basic physics, synthesize a treatment and rescue plan, and justify the use of additional resources for prolonged medical/rescue operations.
Learning Objectives:
describe injuries sustained in falls arrest by belay lines, choose the appropriate extraction technique based on injuries, and construct a treatment plan.
predict injuries associated with prolonged suspension, formulate a treatment plan based on known and expect injuries, and compare extraction methods for the best patient outcome.
assess and anticipate crush injuries using basic physics, synthesize a treatment and rescue plan, and justify the use of additional resources for prolonged medical/rescue operations.
Saving our personnel: what we know about occupational risks and what we can do to prevent them
EMS personnel have an occupational fatality rate that is comparable to police and fire fighters and much higher than the average rates for all U.S. workers. This session will describe the risks and analyze solutions for reducing those risks. The first part of the session will be a synthesis of what we know about risks of occupational injury and fatality for EMS personnel. The review will include information from published journal articles as well as insights from three papers that are about to be submitted for publication. By the end of the first half of the session the attendees will be able to summarize: how paramedicine clinicians are killed and injured; how those risks vary by sex and age; and, how the risks for EMS personnel compare to other occupational groups.
The second half of the session will be a discussion of ways to reduce the risks of injury and fatality for our personnel. We will review solutions that have worked for EMS personnel as well as what we can learn from interventions that worked in other settings. Attendees will leave with a toolbox of solutions that they can use to create risk reduction interventions for their own departments.
Learning Objectives:
Upon completion, participant will be able to summarize how paramedicine clinicians are killed and injured.
Upon completion, participant will be able to compare the risks for paramedicine clinicians to other occupational groups.
Upon completion, participant will be able to create risk reduction interventions for their own departments.
The second half of the session will be a discussion of ways to reduce the risks of injury and fatality for our personnel. We will review solutions that have worked for EMS personnel as well as what we can learn from interventions that worked in other settings. Attendees will leave with a toolbox of solutions that they can use to create risk reduction interventions for their own departments.
Learning Objectives:
Upon completion, participant will be able to summarize how paramedicine clinicians are killed and injured.
Upon completion, participant will be able to compare the risks for paramedicine clinicians to other occupational groups.
Upon completion, participant will be able to create risk reduction interventions for their own departments.
Managing Traumatic Stress to Build a Mentally Resilient Workforce
The nature of work Emergency Medical Services (EMS) responders face day to day is widely acknowledged to be stressful and has the potential to affect an individual’s mental health (Anwar et al, 2019). This persistent occupational stress can result in a variety of mental health conditions, such as depression, anxiety, Post Traumatic Stress Disorder (PTSD) and can be a factor in suicide (Kings College London, 2020). It is imperative that EMS organisational leaders not only understand the risks but are well equipped to support responders at the earliest opportunity in line with best practice. The wellbeing of responders has a direct correlation with the quality of care they deliver to patients (Meadley et al, 2020).
There is a wide variation of support systems being utilised across different EMS providers. Unfortunately some are antiquated and no longer follow the latest evidence whilst some providers negate their moral and legal responsibility to support their responders. The use of an evidenced based peer support system as opposed to a managerial led programme will encourage individuals to access support independently, provide a cost-effective solution and should be relatively easy to implement (Lawn et al, 2020. Smith et al, 2022).
Learning Objectives:
Describe the psychological effects of type 1 and type 2 trauma as well as moral injury, recognise the early signs of mental health deterioration and react appropriately.
Define positive effects of having a robust peer support programme in place and understand how to implement such a tool, including supporting and equipping first-line managers/leaders.
Demonstrate how to approach support in a holistic manner and be able to identify the elements of support which should be prioritised.
There is a wide variation of support systems being utilised across different EMS providers. Unfortunately some are antiquated and no longer follow the latest evidence whilst some providers negate their moral and legal responsibility to support their responders. The use of an evidenced based peer support system as opposed to a managerial led programme will encourage individuals to access support independently, provide a cost-effective solution and should be relatively easy to implement (Lawn et al, 2020. Smith et al, 2022).
Learning Objectives:
Describe the psychological effects of type 1 and type 2 trauma as well as moral injury, recognise the early signs of mental health deterioration and react appropriately.
Define positive effects of having a robust peer support programme in place and understand how to implement such a tool, including supporting and equipping first-line managers/leaders.
Demonstrate how to approach support in a holistic manner and be able to identify the elements of support which should be prioritised.
Revenge of the Nerds - 2023 Edition
Do you like your science served up with a bit of snark? Perhaps a nice, academic no-holds-barred debate on the literature guiding our clinical practice? If so, come see a panel of highly opinionated EMS physicians in a wide-ranging discussion of the key topics of the day. Topics are likely to change to assure they are “hot-off-the-presses” current, but are likely to include cardiac arrest management, medications, and airway management.
Learning Objectives:
describe the main findings of relevant peer reviewed papers on TXA in brain injuries
describe the main findings of relevant peer reviewed papers on heads up CPR
describe the main findings of relevant peer reviewed papers on rapid sedation of violent, agitated patients
Learning Objectives:
describe the main findings of relevant peer reviewed papers on TXA in brain injuries
describe the main findings of relevant peer reviewed papers on heads up CPR
describe the main findings of relevant peer reviewed papers on rapid sedation of violent, agitated patients
Emergency Medicine Physician EMS Telehealth: Leveraging Partners / Force Multiplier
Prehospital care is initiated and managed unilaterally by local emergency medical service (EMS). The majority of patients, regardless of severity are transported by the most expensive mode of transportation (ambulance) and to the highest cost destination (hospital). Conversely, the CDC views Population Health, as an opportunity to utilize non-traditional partnerships among health care systems, industry, local government, and organizations to work together to improve patient outcomes.
Houston Fire has successfully triaged 31,328 patients by telehealth Emergency Medical Physicians (EMP) and 28,123 (90%) patients were transported via non-ambulance methods from December 2014 through November 2022. Medics complete a patient assessment and transfers the ePCR and contacts the physician, who accesses the patient via real-time video/voice conferencing and determines the appropriate disposition. Once triaged, patient transportation is determined by the physician (taxi, ambulance, self-transport) and destination is decided by patient/physician (clinic, emergency department, home care).
After EMS leaves the scene, ETHAN patients can contact the Nurse Health Line for assistance regarding care, transportation, and destination. Recently, our regional Health Information Exchange began providing blinded managed care indicators to the ETHAN Physicians portal for payor/health plan patient navigation, both supports the CDC Population Health utilization algorithm within the EMP telehealth model.
Learning Objectives:
1. To become familiar with the how ETHAN patients are triaged by emergency physicians for prehospital alternative transportation / destination in a major metropolitan fire-base EMS system.
2. Observe how ETHAN will successfully increase efficiency and reduced cost of emergency care by reducing the utilization of EMS and emergency departments.
3. How the ETHAN program utilizes its partners to increase patient satisfaction and outcomes.
Houston Fire has successfully triaged 31,328 patients by telehealth Emergency Medical Physicians (EMP) and 28,123 (90%) patients were transported via non-ambulance methods from December 2014 through November 2022. Medics complete a patient assessment and transfers the ePCR and contacts the physician, who accesses the patient via real-time video/voice conferencing and determines the appropriate disposition. Once triaged, patient transportation is determined by the physician (taxi, ambulance, self-transport) and destination is decided by patient/physician (clinic, emergency department, home care).
After EMS leaves the scene, ETHAN patients can contact the Nurse Health Line for assistance regarding care, transportation, and destination. Recently, our regional Health Information Exchange began providing blinded managed care indicators to the ETHAN Physicians portal for payor/health plan patient navigation, both supports the CDC Population Health utilization algorithm within the EMP telehealth model.
Learning Objectives:
1. To become familiar with the how ETHAN patients are triaged by emergency physicians for prehospital alternative transportation / destination in a major metropolitan fire-base EMS system.
2. Observe how ETHAN will successfully increase efficiency and reduced cost of emergency care by reducing the utilization of EMS and emergency departments.
3. How the ETHAN program utilizes its partners to increase patient satisfaction and outcomes.
Pulseless: How to assess and treat the Ventricular Assist Device Patient
An interactive presentation providing understanding of how the assessment of a patient with a durable Ventricular Assist Device differs from an ordinary patient, what to do in emergency situations and how to respond to an unresponsive VAD patient. Will discuss how to identify and assess VAD equipment and alarms and how to treat. Present several case studies. Provide educational resources for future use.
Learning Objectives:
Describe the purpose, function and components of a Ventricular Assist Device
Understand differences in the assessment of a patient with a Ventricular Assist Device
Identify the steps in assessing an unresponsive patient with a Ventricular Assist Device
Learning Objectives:
Describe the purpose, function and components of a Ventricular Assist Device
Understand differences in the assessment of a patient with a Ventricular Assist Device
Identify the steps in assessing an unresponsive patient with a Ventricular Assist Device
The Implementation of Telemedicine and Community Paramedics into EMS Operations - Our Experience
The healthcare system has been presented with a variety of challenges including the COVID pandemic, staffing shortages, decreased hospital bed capacity, excessive emergency department patient volumes and increased EMS unit wall times. These challenges compelled us to look for alternative pathways to care. This presentation will discuss our experiences using telemedicine and community paramedicine to navigate alternative pathways to care while highlighting our limitations, successes, patient outcome data, and future goals.
Learning Objectives:
Upon completion, participant will be able to identify patients who may benefit from a community paramedic response and / or telemedicine visit as an alternative pathway to care.
Upon completion, participant will be able to describe implementation limitations and success experienced by Novant Health New Hanover Regional Medical Center EMS.
Upon completion, participant will be able to recall Novant Health New Hanover Regional Medical Center telemedicine and community paramedic response outcome data.
Learning Objectives:
Upon completion, participant will be able to identify patients who may benefit from a community paramedic response and / or telemedicine visit as an alternative pathway to care.
Upon completion, participant will be able to describe implementation limitations and success experienced by Novant Health New Hanover Regional Medical Center EMS.
Upon completion, participant will be able to recall Novant Health New Hanover Regional Medical Center telemedicine and community paramedic response outcome data.
A Zebra Disguised As A Horse: Common Complaints That Can Kill
Common things being common, when you hear hoof beats, don't waste time looking for a zebra. Or so the saying goes. In EMS, we aren't worried about the common complaints, we're worried about the complaints that can kill. We should really worry about the benign sounding complaints (really? Another back pain?) that are actually dangers. Dr. Jarvis will present a 'red flag' approach to several frequently encountered presentations that help us isolate the lethal zebras from the rest of the heard.
Learning Objectives:
describe what a “red flag” approach to history taking is and how to use it in patient care.
describe at least two ‘red flags’ for low back pain
describe at least two ‘red flags’ for headache.
Learning Objectives:
describe what a “red flag” approach to history taking is and how to use it in patient care.
describe at least two ‘red flags’ for low back pain
describe at least two ‘red flags’ for headache.
Constructivism in EMS education
Constructivism is a form of knowledge-, skill- and competency-building used in modern education through many fields. It has its merits and its critics. so how can it be embedded in EMS education? Is "building your own world - it is the only one you live in" even compatible with a best practice driven professional field like EMS? Does evidence based medicine allow for "the importance of uncertainty" stated by radical constructivism?
Learning Objectives:
..will be able to describe the roots and main streams of constructivism.
...reflect on constructivism as an educational tool.
...reflect on the possible use of constructivism as part of his / her educational efforts.
Learning Objectives:
..will be able to describe the roots and main streams of constructivism.
...reflect on constructivism as an educational tool.
...reflect on the possible use of constructivism as part of his / her educational efforts.