By: Jeff Grunow

Some paramedic students appear to have the desire to be failed. On occasion, news reports appear that refer to cop-assisted suicide, police-assisted suicide, or the more preferred term, victim-precipitated homicide. The goal of this article is to draw similar parallels between the person attempting to commit suicide-by-cop and paramedic students that want their instructor to end their academic “lives” by failing them or dismissing them from the program. It is important to realize that a non-progression at the college level often still allows students to be awarded an Associate’s Degree, even though they would not be able to sit for the paramedic National Registry examination or a state certification exam. This is important to paramedic educators, especially those programs that are nationally accredited, as attrition rates must be reported annually. Also, many states also require institutions to report program completion rates and accreditation and licensing boards place educational programs on probation for unacceptably high attrition rates. Paramedic education is rigorous and sequential, spanning at least two college semesters and often extending to 16 months. Going to paramedic school is a major life commitment, so one must wonder why at very late stages of the program a student “throws the game” by demonstrating behaviors unbecoming of a certified paramedic. Some regress from performing competently as an ALS team leader, some fail to show up for scheduled clinical or field internship shifts, some develop negative attitudes and behavior patterns, such as complaining that the clinical or field preceptors are being unfair to them, and most common, failing to turn in clinical or field internship documentation in on a timely basis, if at all. Empirically, the “suicide-by-program” students tend to be some of the best academic students in the class. In fact, personal experience over 27 years at four institutions has consistently shown that the students that precipitate failure have always been above average didactic students. In general, the students tend to perform well in skills labs but usually are never stellar. Quite the opposite, average academic students that truly want to be paramedics
attempted to excel in the field internships.

Theory
Thus, after years of observation, an inductive hypothesis that explains the phenomenon of student-precipitated failure is that by a student’s failing a didactic checkpoint, such as a standardized test when the rest of the class passes, places “the blame” squarely on the student, himself or herself, whereby, failing out of field internship because of unfair treatment, or not enough calls, or too many life demands, allows the student to deflect “the blame” on the program, the preceptor, the clinical coordinator or the paramedic program director – anyone but the student. In field internship there is no single focal point and the student is not competing per se against other students. In most institutions of higher learning a faculty member awards the final grade and thus the corollary concept of instructor-assisted failure. Is there correlation in the criminal justice arena? “Victim precipitated homicide” is a still relatively new area of study in criminal justice. While there are numerous studies dealing with post traumatic stress injury to the police officer that unfortunately ended the life of a victim, there are fewer studies delineating the personality and predictable traits of a victim desiring victim-
assisted suicide. Richard Parent, one of the early writers on victim-precipitated homicide refers to these deaths in which the victim is a direct, positive precipitator of the incident. Victim-precipitated homicide is, therefore an act of suicide and the term refers to those incidents in which an individual, determined on self destruction engages in a calculated life-threatening criminal incident in order to force a police officer or another individual to kill him or herself.1 Parent states that “committing suicide by traditional methods that might include jumping from a high structure, crashing a speeding vehicle into a stationary object, or by a self inflicted wounds requires decision and
commitment on the part of the victim.”2 In addition, the stigma and social taboos associated with suicide can be absolved if being terminated by an external mechanism such as the police. As agents of the state, the police officer represents a faceless means of ending someone’s life in a dignified manner. Thus, victim-precipitated homicide that is born out of suicide the difficult decision to end one’s life is made by someone else. There is a strong and clear parallel in EMS education to Parent’s’ theoretical explanation. Having the professor fail the student theoretically has the same outcome for the program as the police officer shooting, albeit a non lethal one. Some students may have been “pressured” into going to paramedic school by family, agency leaders, or colleagues. Failure at the hands of the teacher or academy instructor to many students is a more
acceptable exit than, “I couldn’t meet the expectations of the program.” Fortunately or unfortunately, the EMS educator is not “faceless.” EMS instructors, particularly in paramedic education spend many hours with a student. Instructors are dedicated educators with a natural drive to have every student excel. Although a failure may not be as sudden or fatal as a police shooting, the EMS instructor’s grief of student failure is often a source of great distress. In 1983, the collective views of criminal justice academics was that approximately 10% of all police shootings were police-assisted homicides.3 In a 2009 publication, by Dr. Kris Mohandie, victim-assisted homicides by police were theorized to be nearly 36% of all police shootings.4 Richard Parent suggests the number could be as high as 48%.5 The good news for paramedic programs is that the rates of student-precipitated failures do not appear to come close to approaching the rates of police-assisted suicides.

Educational Correlates
Some programs have benchmark skills exams prior to field internship and may use the National Registry skills sheets. At this point a student may calculate an appropriate failure and may be able to quietly leave the educational program without the knowledge of classmates. Failing a benchmark exam or “double failing” a National Registry skills station, “forces” the issue of progression and/or ultimately certification. Fortunately for the EMS education profession, in comparison to a police officer, we never have to make this decision in a split second. An educational decision can often be crafted to include remediation and/or career redirection. One anecdotal observation of note is that student-precipitated failure during the field internship is always preceded by a documentation issue. Late, lost, incomplete, or even forged, documentation has always been a factor. Since this is an affective domain issue it always bears a thorough investigation by the instructor. There may be subtle signs of an impending student-precipitated failure, such as when a student states, “I don’t think I can do this,” or “all the instructors are against me.” Richard Mendelson wrote in “The Psychology of Failure” that individual failure is a very personal and intimate concept.6 He wrote that failure is not a singular event. Failure is a process that we allow to occur on many different levels before we realize it’s even happening. Failure is systematic breakdown of our focus on a mental, emotional or physical level.8 These are important concepts in striving to avoid losing students to precipitated failures. Using Mendelson’s concept, each time our educational program has a failure in field internship, the faculty should conduct an intense post mortem to determine if the failure could have been predicted earlier. As an example, one student refused to take a same-day retest for the National Registry skills exam which is was the institution’s benchmark for clearance into the field internship. Looking back, the student never volunteered to be first in skill lab and traded with other students to always get the last practical skills examination slot. A reasonable hypothesis might be that the student avoided failure within the class cohort, but then was allowed to progress through the program avoiding the formative affective tests that develop mature competency. As student-precipitated failure in field internship is most closely related to skills lab behaviors, and the skills labs are a group experience, students at risk of field internship failure are those that do “just enough” to pass but not enough to excel, or draw attention to themselves. Theoretically, based on these hypotheses, a paramedic education program that looks carefully at marginal skills lab performers would likely be detecting sentinel events that may identify students at risk for student-precipitated failure. In EMS education, the paramedic program director generally makes a careful, reflective, and collective decision to end a student’s progression to certification. The decision to end a student’s progression should always involve a collaborative and informed consultation among the instructors, the Program Director and the Medical Director.

Conclusion
Victim assisted suicide research is relatively new, about the same age as paramedic education. I believe there is a corollary to student assisted failure that shows some parallels to criminal justice. In almost all paramedic programs, skills evaluations are generally straight forward and valid. Many paramedic programs have valid and reliable didactic benchmarking exams. However, I maintain that early signs of student assisted failure can be found by performing affective domain evaluations in each class and skills lab. Diligent attention to field internship documentation and deadlines also serve as early detectors. I’m a firm believer if professors documented appropriately on marginal performers, particularly in the affective domain, faculty would be able to accurately predict students that will be struggling in the field internship and that they may be able to prevent unfortunate and unnecessary student-precipitated failures.


REFERENCES
1. Parent, Richard B., Victim-Precipitated Homicide: Police Use of Deadly Force, The Social Science Journal, 41 (2004) pp115-121.
2. Ibid
3. Pyers, Louise C., Suicide by Cop – The Ultimate Trap, FBI National Associates Magazine, July/August 2001, Volume 3, No. 4
4. Mohandie, Kris, Meloy, J. R. et.al, Suicide by Cop a Phenomenon in Occurring in Over a Third of North America Shootings by Police, Journal of Forensic Sciences
5. Parent, Richard B., Victim-Precipitated Homicide: Police Use of Deadly Force, The Social Science Journal, 41 (2004) pp115-121.
6. Mendelson, Richard, The Psychology of Failure, Ezine articles, http://ExineArticles.com/?expert=Richard Mendelson.
7. Ibid
8. Stincelli, Rebecca, Suicide By Cop, http://www.suicidebycop.com/7601.html