Teaching pointing and calling (Shisa Kanko) to reduce error and improve performance

Paramedics operate in high-stakes, cognitively demanding environments where lapses in attention can jeopardize patient safety. While team-based communication strategies are commonly taught, there is a need for self-directed methods that support situational awareness and error prevention. 'Pointing and Calling' (P&C) is a Japanese technique that uses verbal and physical cues to heighten conscious attention and reduce mistakes. P&C was integrated into the Advanced Care Paramedic curriculum over three weeks covering conceptual instruction, guided practice through low-stakes activities, and application in high-fidelity simulations. Students employed P&C during critical tasks and received feedback during debriefings. Evaluation using the Kirkpatrick framework showed positive engagement, skill uptake, and transfer to other learning contexts. Several key lessons were identified for implementing training on P&C, including clarifying that P&C is a personal cognitive tool, not a directive to others. P&C's simplicity, low cost, and existing evidence support implementation across healthcare settings. P&C can be effective in low and high-resource environments alike. P&C represents a practical, scalable approach to improving patient safety.