PRECEPTING WOES!

[letmesleep]

Let me start off in saying that it doesn’t matter if your student is coming from a degree program, a fly-by-night program, or anything in between. Is anyone else out there sick and tired of MEDIC students that are getting to their clinical rotations and can’t handle simple pt care? How is this happening? Let me qualify the question a bit:

A medic student is working at a department in a non-responding capacity; let’s say they are a secretary. This person decides to educate themselves by going to EMT school so they can improve their billing skills. After approx 10 years of this job choice they take further advantage of the educational bennies their department offers and they attend an accredited medic program, so they can make more money and transfer in to the field. Of course during these last 10 years they have made many friends along the way who have “helped” (and I use that word loosely) them along the way. Now they come to do a ride-a-long and can’t start a simple interview let alone run a call as expected of them.

The above is a fictional story, but pretty damn close to reality.

It seems to me that over the past few years numerous students are coming in to be precepted and have no clue about their meds, how to interview, perform skills, or any combination of such. Is it me? Am I getting old and crotchety? Why is it that my generation of medic is holding this generation of medic to a lower standard?

[fireflymedic]

Let me start off in saying that it doesn’t matter if your student is coming from a degree program, a fly-by-night program, or anything in between. Is anyone else out there sick and tired of MEDIC students that are getting to their clinical rotations and can’t handle simple pt care? How is this happening? Let me qualify the question a bit:

A medic student is working at a department in a non-responding capacity; let’s say they are a secretary. This person decides to educate themselves by going to EMT school so they can improve their billing skills. After approx 10 years of this job choice they take further advantage of the educational bennies their department offers and they attend an accredited medic program, so they can make more money and transfer in to the field. Of course during these last 10 years they have made many friends along the way who have “helped” (and I use that word loosely) them along the way. Now they come to do a ride-a-long and can’t start a simple interview let alone run a call as expected of them.

The above is a fictional story, but pretty damn close to reality.

It seems to me that over the past few years numerous students are coming in to be precepted and have no clue about their meds, how to interview, perform skills, or any combination of such. Is it me? Am I getting old and crotchety? Why is it that my generation of medic is holding this generation of medic to a lower standard?

It is not just you. It is a profession wide weakness that unfortunately I don't see improving unless drastic steps which may hurt some are made. As far as the students - I'm wondering how they managed to successfully complete their ride time if they cannot complete basic functions of patient care. I've been left wondering the same thing a few times. I remember very well when I started and felt like I knew nothing. Everyone has a learning curve and as long as they are willing to listen and learn GREAT ! If not, please keep walking. If you are employed and ride with me, you are expected to know routine treatment for certain conditions, your common protocols, and also be familiar with your common medications you will be using. I will quiz you on the information and yes, I have been known to leave a student at the station writing drug cards during a run and told them come back when they know their drugs (granted I only go with what is on the approved list, not every drug they could possibly see - I'm not that hateful). As a student, you are expected to at least know the basics, and you certainly should by the time you are being precepted as an employee.

[DwayneEMTP]

I was under the impression that an intelligent clinical program was designed to give students those exact skills, right?

Surly I don't have to explain to you that no amount of 'pretend pt assessment' in school prepares them to do well upon entering the clinical setting?

Do you mean to imply that you came out of medic school a seasoned paramedic? I have to doubt that.

Or perhaps you are of the school that believes that only those that have been Basics for so many years should be allowed into paramedic school?

What did you believe that clinical time was for??

Dwayne

Firefly, I was under the impression that he was referring to clinical time, yet it appears you're referring to FI (Field instruction, Field Internship, etc) of a newhire.

Those would be two different areas of education as well as separate conversations I think...

Dwayne

[Timmy]

I have been in this situation myself recently! With 4 weeks to go in Nursing School I failed a placement because I lack basic care and communication skills. I get terribly nervous when on placement and my preceptor was known to be an old battleaxe and hard to please. Within the first 5 minutes of attending to the first patient she was on my case and snapped at me about eye contact, posture, my level of care/compassion, communication ect. Of course I immediately went pale, freaked out and didn't think clearly which didn't help my case.

For the remainder of the shift I fumbled around, looked incompetent, my heart sunk every time I saw her walking towards me, I felt weak at the knees and she kept on snapping at me for minor things and making it awkward when attending to patients. When I finished the shift she threw my assessment folder on the table and tore shreds through me, told me I was incompetent and should never work in healthcare. Just goes to show no matter how close you are to finishing your course, never forget the basics!

I have no problem with medications, clinical techniques, preforming patient assessment etc. I normally have no issue with communicating with people but her negative blanket, always looking over my shoulder and critising my every move just completely such down my confidence which interim resulted in me failing. I've worked in this hospital every other day for over a year, I always feel confident when attending to patients, communicate well and have never had any issues or complaints but when it came to the crunch I crumbled! Amazing how after 2 years of working hard it can all come falling down over an 8 hour assessment.

From myself and other university trained nurses that come through my hospital I see what your talking about. Were not really taught how to communicate with patients and were not given any practical guidance in class before were let out on placement. There seems to be a lot of assuming in higher education, teachers assume everyone does their self directed learning, they assume everyone will memorise and learn all those hundreds of powerpoint slides they go through in lectures, just because you get good marks on exams they assume your competent etc.

I think as a preceptor it's important to identify what the students weakness is and let them know ways to improve - there's no point going off your head telling them there incompetent without providing a rashional.

[mobey]

I voted a -1 so I feel as though I should back it up.

sick and tired of MEDIC students that are getting to their clinical rotations and can’t handle simple pt care?

One sentence really:

Clinicals are part of the educational program.

[Dustdevil]

Anyone in a position to precept students should have a very clear understanding of what both the preparations and expectations of the preceptorship are. Different programmes have different set-ups. Some schools integrate students into the field early to get them early exposure and allow them to integrate education with training and observation. Others do it step by step, not sending them to the field until they have all of their didactic done. Both students will be at different levels of preparation. However, neither should be expected to be competent practitioners of ANYTHING. Expect nothing. Teach them everything. That's your job. If they knew it all, they wouldn't need you.

[DwayneEMTP]

Exactly!

Yours is a failure of the precepting process Timmy, not of your education.

People need time to learn, and an environment conducive to learning. I don't know if you have the option there, but you should seek a different preceptor. Not an easier one, but simply one that doesn't have her head buried firmly in her ass.

Don't let her shake you brother..Just keep on keeping on.

Dwayne

[Timmy]

Never the less, I let my fear and personal feelings interfer with my professional conduct.

Anywho I guess we live and learn by our mistakes, that's what being a student is all about. Despite having my confidence ripped from underneath me she hasn't completely deterred me from a career in healthcare, just made it temporarily harder to reach.

[crotchitymedic1986]

I disagree with blaming the schools for this phenomenon. The schools are there to produce an entry-level employee, not a five-year veteran. As most of you know there is a big transition from book-learning to patient care. The problem is not with the school, it is with our substandard training and orientation programs for new hires and new medics. I think new employees should have to ride third or with a preceptor until they have been checked off (actually ran) every type of arrest (adult and pediatric) and other critical calls. Until the prove their worth on the most critical of calls, they should not be the lead provider on an ambulance. In a busy service, this means they would probably have a 6 month orientation, in a slow service, maybe a year. Do you honestly believe someone who just passed the Bar exam and became a lawyer gets assigned as lead counsel on the highest profile cases 2 months after they get out of school ? There is only so much that can be taught in the classroom with manequins.

[P_Instructor]

Anyone in a position to precept students should have a very clear understanding of what both the preparations and expectations of the preceptorship are. Different programmes have different set-ups. Some schools integrate students into the field early to get them early exposure and allow them to integrate education with training and observation. Others do it step by step, not sending them to the field until they have all of their didactic done. Both students will be at different levels of preparation. However, neither should be expected to be competent practitioners of ANYTHING. Expect nothing. Teach them everything. That's your job. If they knew it all, they wouldn't need you.

Excellent response!