In this episode, Lee opens up about a time when he was on the verge of walking away from his EMS career. He struggled with intense self-doubt and wrestled with the question so many of us face: Am I really cut out for this? That turning point came when he found mentors who didn’t just encourage him—but challenged him. They offered constructive criticism, not just praise. That guidance helped him reframe his journey and understand where he truly was in his professional development.
We dive into two key models that help explain how we grow in our careers: the Dreyfus Model of Skill Acquisitionand the Conscious Competence Ladder.
The Dreyfus Model outlines five levels:
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Novice
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Advanced Beginner
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Competent
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Proficient
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Expert
Meanwhile, the Conscious Competence Ladder runs parallel, tracking our awareness of our skills:
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Unconscious Incompetence – You don’t know what you don’t know.
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Conscious Incompetence – You know what you can’t do yet.
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Conscious Competence – You know how to do it, but it takes effort.
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Unconscious Competence – It’s second nature. You do it without thinking.
These models raise two key questions for our field:
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Where do you think most EMS providers—or leaders—fall within these stages?
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At what level do you think providers or leaders are most dangerous—and to whom?
We also touch on concepts from political theory, including Chesterton’s Fence and the Overton Window, to explore how institutional knowledge and boundaries protect against reckless change.
Lee reflects on the “cookbook paramedic” phase—often where advanced beginners live. These providers may stick to the rules and protocols but miss the bigger picture. It’s only through proficiency, where pattern recognition kicks in, that you begin to truly understand what to do—not just follow steps.
At the expert level, practitioners rely on tacit knowledge—intuitive, fast, and often hard to explain. They’ve seen the patterns before. They innovate because they understand the system.
Where are you on that ladder? Where is your team?
Be sure to listen to the next episode, where we finish this conversation and talk about what it really takes to grow as a provider—and what to do when you feel stuck.
Lee’s YouTube: www.youtube.com/@accessmedic
Dylan’s Apple Music: https://music.apple.com/us/artist/dylan-brabham/499664225
Ironed Out Media:
www.IronedOutMedia.com
