Medic rotation woe's!

[tskstorm]

On my paramedic field rotations, I'm starting to get a lot of heat from my preceptors for not being aggressive enough.

I accredit my lack of aggression to three things, the first being I'm only like 25% through my class, and simply just don't have enough knowledge. They have been expecting me to have knowledge of things we haven't been held responsible for in class yet, and although this isn't an excuse, it's just a fact. We have a new head instructor this year, and our program is not up to the historical standard of our program. Part of this is, we are just being introduced to protocols because of major changes for January 2008. They didn't want to teach us wrong the first time, and didn't want to teach us things ahead of time. So lack of that knowledge is a big part. I've rectified this the best I can by reading ahead, started memorizing the new protocols ahead of time.

My second problem is my patient exam and interview. We are also just being introduced into vectored exams, and further assessment tools, and again this is stuff our preceptors expect us to know. I have addressed my preceptors explaining to them we just haven't covered these things, and for the most part they don't seem to believe me, or the other students. To rectify this, I'm here looking for advice on vectored exams, important questions to ask every patient etc... Any advice at all on these subjects are greatly appreciated.

Last problem, is confidence, sitting in their ambulance, I feel like it's their show, and I'm only along for the ride. I have no problem doing anything when/if they ask me to but If not asked or prompted I tend to sit back and wait. This is a problem no one can do anything about except myself, and I feel I wont be able to rectify this until I'm further in the program and am more knowledgeable in all subjects of patient care.

(P.S. I batted around where to put it students or patient care. Its a student issue revolving around patient care. So I put it here simply because it will probably get more notice here, please move if needed. Thanks)

~TSK

[spenac]

Step up and take charge. Get in there and take the lead to the level you have been educated to. When not sure ask them to show you proper method.

[tskstorm]

Step up and take charge. Get in there and take the lead to the level you have been educated to. When not sure ask them to show you proper method.

Well we have finished one semester, out of 4. we covered BLS, and mostly preparatory topics, med/legal, ethics, well being, some pathophysiology, some A&P, introductory pharmacology, vascular access, airway management/ventilation, human development, physical exam, patient assessment, critical thinking, lastly communications and documentation.

So short of BLS, maintaining an airway(I can't tube in the field yet) and starting an IV, thats it short of patient assessment, and the problem with patient assessment, and physical exam is we covered how to do them, not when to do them, how they apply, and things of this nature. Ex. I know how to start an IV, I can start one with ease, I understand one reason to start an IV is "in case we need to give medications" but the problem lies in I don't know when and what patients need medications, as we aren't responsible for the protocols and we haven't covered many disease/injury etc.. processes and how to treat them.

I know the preceptors will stop me if I start doing something wrong, but I still don't even want to come close to mistreating a patient.

[spenac]

My school we have to be much further prior to clinicals. It makes no sense to me that you are being sent out so early and so un-prepared. No offense meant by those statements.

[tskstorm]

My school we have to be much further prior to clinicals. It makes no sense to me that you are being sent out so early and so un-prepared. No offense meant by those statements.

None taken. The course is just under 12 months long, and need about 900 clinical hours, if you don't start early you don't finish. Grade wise I'm hanging at the top. 99 on BLS final, 101 on midterm(don't ask,) and 98 on semester final. I comprehend everything we go over, but we haven't gone over enough to be confident field providers even as students, all I'm good for at the moment is BLS, lugging equipment and starting a line.

[spenac]

I guess you get your hours and maybe observe but don't know that prepares you for the field. Here we have to have completed pharmacology, ekg's including 12 lead, advanced airways, really pretty much the entire course prior to doing clinicals. Otherwise like you already mentioned your limited to your BLS.

[buckeyedoc]

I agree that you are being sent out for clinicals too early. The instructors decision to send you out so early is making you look bad. No offense intended at all. My advice would be to talk to your preceptors at the beginning of the shift and explain to them your position. Let them know that you haven't covered the invasive skills yet and that you're only in the first quarter. Also, ask them to teach you something. I wouldn't hover over them all day, but make sure you're close enough so that if they want to instruct you on something, they don't have to look far. Take notes. Either mental or otherwise and ask questions. If the preceptor does something, ask him to explain HIS/HER technique. There is more than one way to perform skills. Don't ask it like, "Why did you do it that way?" and come off like an arse. Say something like, "I've not seen that technique before. Where did you learn it and why did you do it that particular way?" Again, take notes. I've learned more from hands-on experience than from any book. Unless they are a complete jerk (and there are a lot of them out there), they will be more than happy to help out. Just don't ask during chow time.

[AMESEMT]

I agree. They are sending you out and setting you up for failure. The paramedic program I am entering into, we do all our classroom time first then do clinicals after. I went through a basic program that did it the way your program is doing it. Even though you don't learn a lot like paramedic, I still felt apprehensive. I want to know everything I need to know for that level so I am prepared. I believe to do your clinicals you should know everything a paramedic does and have those skills so you can work on perfecting them with perfect practice and get the experience. Isn't that what clinicals are all about!?

TSKStorm, just follow what buckeyedoc said. That is exactly how I REALLY learned the stuff. I knew it, but doing it and being shown the way they do it in the field is different than learning from the book in a classroom setting.

Good luck and hang in there!

Ames

[scparamedic98]

I wouldn't go as far as to say that they are sending you out way too early. I think the paramedics precepting you are poorly prepared. Not a knock on them, but they should be given a idea of where you are in class and what you have covered from your instructor. Do they just kick you out the door and say "good luck, hope you learn something in clinicals" or do they actually follow up on the experience?

If I'm precepting a new paramedic or a paramedic student, I start them off basically doing nothing. Then allow them to transition from a crew member up to being in charge of patient care (within reason and under supervision of course). That way it's letting you get comfortable with your current role before being exposed to more than you are ready for.

It is the same way here in SC, either you start your clinicals early or you don't get finished in time to take the NR test that they have scheduled for you. So we end up with paramedic students that have taken maybe one module and an A&P course.

[Ridryder 911]

If the program is sending you out before you have completed objectives or portion(s) of the program it is missing the whole point of rotations. Clinicals are about obtaining clinical experience in the areas you have covered and applying didactic knowledge to clinical performance, to basically see how it is applicable.

Shame on your program of attempting to "push" or "rush" you through before students are prepared to perform. Sorry, just obtaining clinical time is not the purpose nor will it produce well educated Paramedics. Being able to apply the knowledge in a clinical setting, while being monitored is the sole reason for clnical exposures. It makes no sense to send students out not knowing their objectives (since they have not covered or learned them yet).

R/r 911