Wilderness Medicine, and Math

I spent my weeklong April vacation in Moab, Utah, renewing my Wilderness First Responder (WFR) certification. Wilderness medicine covers a range of topics, but the focus i on what to do when someone is hurt or sick and definitive medical care is delayed, perhaps indefinitely. I have worked in outdoor education and spend much of my time away from school hiking, climbing and backpacking when I can, and it’ a useful training to have, although I have rarely needed to use it. Oh, and Moab is pretty cool too.
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But spending time as a student also helped me think about my role as a teacher and what I want my students to think about as they learn math. A WFR course is an interesting cross-section of things that are both very similar to, and very different than, most secondary math classes in the U.S.

The course focuses largely on the body’s critical systems (circulatory, respiratory and nervous) and the big problems associated them. The first day opened with a series of lectures on each system. But these lecture didn’t stand alone. Instead, they were interspersed with case studies — a respiratory infection on an offshore sailing trip, altitude sickness on a climb, a fall while rock climbing — and the effect each of these has on the body’s critical systems. Then, we were presented with scenarios, and had to decide what we would do. At the beginning of the course, our responses were generic. We were asked to decide whether a medical issue was serious or not serious, and whether we thought we could do anything to help in that situation, or would need to evacuate to definitive care. As the course progressed, we had to offer more detailed treatment — what we might use to carry someone to a trailhead, or how we would fashion a certain type of splint.

With these big ideas as our foundation, the next three days were split between lectures on more specific topics — toxins, wound care, spinal injuries — but also full of scenarios where we took turns acting as injured patients and taking on more and more of the responsibilities of medical care. First came identifying major issues, then taking a detailed history, then caring for wounds and splinting musculoskeletal injuries, then considering evacuation, coordination of a search and rescue team, and use of a variety of medications. Scenarios ranged from severe — patients who were severely hypothermic (all acting, of course), had been struck by lightning, or were in diabetic shock, to less serious — indigestion, a broken clavicle, or mild altitude sickness.

What I learned:

Memorization is not evil, but it is also not the same as understanding
This course did a number of things that I want to bring back to my classroom. First, it did not shy away from mnemonics for information that we needed to remember. For instance, STOPEATS is a mnemonic for the different issues that cause a change in brain function (low/high sugar, temperature, oxygen, pressure, electricity, altitude, toxins, or low salt). SAMPLE is our acronym for taking a patient history (signs and symptoms, allergies, medications, past pertinent history, last ins and outs, and events leading up to the incident). These aren’t tricks — they are useful ways to remember important information, in particular in a stressful situation. And there was a huge difference in the quality of my diagnosis from the beginning, where I was relying more on my reference book, to the end, where I had the important information memorized and rarely had to look something up. I still had the same resources — I could always refer to my notes and field guide — but it helped to illustrate for me the meaning of fluency. If I have to look up every step in our patient assessment system, I will miss the subtleties that allow me to analyze and respond effectively. I don’t have to have every detail memorized, but the better I understand the content, the better I can apply it. But most importantly — knowing the acronyms alone would never get me close to the knowledge I needed to respond to a new situation effectively.

Discovery is great, but it come in many shapes and sizes
The course didn’t insist on us discovering every single idea. Instead, we were given the big ideas quickly and efficiently through lecture. Then, we were immediately expected to apply them — first in the context of a case study, then in mixed practice differentiating between medical issues, and then synthesized with a number of other skills. There was plenty of discovery learning — but discovery in applying the big ideas, rather than figuring out what they were in the first place. I learned what the drug Warfarin is through discovery, when I didn’t diagnose a head injury as serious, not knowing that the drug is a high-powered blood thinner that seriously increases the risk of brain injuries. I won’t be forgetting that one any time soon. We could have spent awhile looking at pictures and case studies of snake bites, trying to infer the differences between different types of snakes — or we could hear the information once, then apply it through a few case studies to both cement it and push understanding as we apply other knowledge at the same time.

It all comes back to motivation
The course did a great job of motivating why the material was relevant. This was a pretty motivated group to begin with — raft guides, mountaineers, mountain bikers. But they didn’t take that for granted — theoretical topics were immediately applied in meaningful ways, and there was a sense throughout the course of why we needed to learn something new — we introduced general principles, then looked at case studies where we needed more knowledge than the big picture. This is something I want to improve at — putting my students into positions where they say “oh wow, we’re gonna need some math to answer this question”. It strikes me as a teaching strategy much more versatile than inquiry. While great inquiry lessons are great, bad inquiry lessons are pretty bad — and I always worry about the students who are sitting silently, seeming to wait for someone else to figure out the big idea and tell the class so they don’t have to do the thinking themselves. Instead, this puts every student in the position of wanting to know the answer to a question, and realizing that a piece of knowledge is between them and the answer. It has the same spirit as discovery, from my perspective at least, and is something I want to spend more time thinking about in my teaching.

Expertise matters
It often seems “cool” among teachers to pretend to know as little as possible. We never want to give any information away to students, to always have them do as much thinking as possible. But we were full of questions throughout the course, and the lead instructor answered them effectively and efficiently. He is a physician’s assistant in Crested Butte, Colorado, as well as a Search and Rescue team leader. He had a wealth of experience and a great deal of knowledge — and he honored our interest by giving us chances to ask questions about how we might apply our knowledge in a particular situation. That expertise made a huge difference. It was clear that we were all there to learn as much as we could. We needed to experience it and get our hands dirty, but he didn’t hesitate to tell us something that we wanted to know. I think this is a great analogue with my students’ questions — when are we going to use this? And I often don’t have the expertise to give them great answers. It makes me want to just sit in the Mathalicious office and listen in on all of the work they do creating real-world mathematical experiences for students. My kids have all heard my “math practices strategy and problem solving” and “math opens doors for your future” spiels a few too many times — and there’s so much more to it than that. This was a good reminder that I have plenty of growing left to do, to be the teacher that my students deserve.

All in all this was a humbling experience, and I’m thinking more now of finding situations where I can put myself in the student perspective to think more about what I can do to be a better teacher.

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