PRECEPTING WOES!

[cosgrojo]

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.

Cannot disagree with that at all.

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.

Wow, that is some rough criteria before you get out into the field. There are some people that will be riding third for decades. I've been in EMS for over 11 years, I've never ran a pedi code. I know that I am just a basic... but I've worked in systems that I am the primary response unit, so I am not going to be held back from responding just because of my license level. I like the concept... but it would be impossible to implement.

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 ?

If they are the only lawyer in town available to handle the case... then yes. But fortunately for the lawyering community, they don't have to be ready to be at the court house in under 10 minutes of the crime, fully prepared to argue their client's innocence... Lawyers and paramedics.... apples and oranges a bit, I think.

[fireflymedic]

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

Sorry for the confusion there. I was actually referring initially to students (thus the drug card comment) as the students I typically see are from a certain program and I know they have not only completed a full pharmacology class as a prerequisite to beginning paramedic class (in addition to cardiology), and then had the medications reviewed yet again as they are going through class within the pharmacology chapter of a larger book, and then again in the separate sections relating to what the medication is commonly used for. By that time they should have a very strong handle on what the drug is expected to do, side effects, and dosage. I keep to a list of about 30 drugs that are common on every ambulance throughout the state. As I stated, I don't go with the added drugs we use, specific to our service. If they know about them, great, if not, I understand not having the knowledge. I'm willing to teach what you want to know and if I don't know, I'll find someone that does ! I know how this program works as it is the same I went through so I am aware what is a reasonable expectation of the students. Occasionally I see outside students, but the majority are from there. They should at least be able to tell what I ask on the common drugs. And to note, this is a program that will not allow ride time until all didactic and clinicals are done so they should have a reasonable knowledge base. For those that come from a different program then adjustments can be made. And no, I don't think I'm being to hard on the typical student from that program - it's how it was done to me (not that I think everything about is was right, and no I don't have the well I survived it you should be able to suck it up too mentality) and I really learned. Instead of focusing on how little I knew about medications, cardiac strips, etc I could focus on learning how to properly treat my patient.

As far as new hires, yes there is still a learning curve and that's cool, but I expect a little more out of you than a students. But as you state, that's for another area. Take care, stay safe.

Edited October 12, 2009 by fireflymedic

[HERBIE1]

Well, I may be a bit of an old fogey- at least that what kids may say...

Generalization alert based on having kids and being a preceptor for years:

I really think there has been a shift in the attitude of the up and coming generations for awhile now. Kids these days seem to have the entitlement mentality down to a science. Whether it's a new college grad with a BA who expects a corner office, 6 weeks paid vacation, a six figure salary, and a company car, or a brand new EMT or medic who thinks they already have all the answers. Granted, the slow economy has toned down those expectations quite a bit, but I still think this is a prevailing attitude.

For some time, I have had to reign in the egos and attitudes of new students and make them realize that as was noted above, book learning AND experience are vital components of being a good provider. Simple things like conducting a proper interview, actively listening to and evaluating the patient are important, and not just to get to the part where they get to use their new found skills on their patients. Patients and their families appreciate the little things- listening, holding a hand when necessary, and realizing the family may need almost as much as your patient, if not more. Most of the time they don't care if you got a difficult IV, did a good assessment of their lung sounds, or maybe even gave them treatment that saved their lives. They want to know you have showed compassion, empathy, and tried to make a bad situation better. I've had far more people thank me for giving them a laugh, listening to their problems, or easing their concerns.

I don't know what the answer is- people are who they are. Our jobs as seasoned professionals is to temper enthusiasm and channel energies in a positive direction.

[bnepon]

Cannot disagree with that at all.

Wow, that is some rough criteria before you get out into the field. There are some people that will be riding third for decades. I've been in EMS for over 11 years, I've never ran a pedi code. I know that I am just a basic... but I've worked in systems that I am the primary response unit, so I am not going to be held back from responding just because of my license level. I like the concept... but it would be impossible to implement.

If they are the only lawyer in town available to handle the case... then yes. But fortunately for the lawyering community, they don't have to be ready to be at the court house in under 10 minutes of the crime, fully prepared to argue their client's innocence... Lawyers and paramedics.... apples and oranges a bit, I think.

[itku2er]

Lawyers and paramedics.... apples and oranges a bit, I think. Quoted by bnepon

*the quote didnt work*

Not really when you think about it, don't they both have someones life in their hands?

[bnepon]

Mind if I jump in? I have been a paramedic for almost 30 years. I still see patients whose diagnosis I am lost on when I arrive at the hospital. However, I expect myself to be able to identify where there are deficits in the patient's presetation, and manage them.

I don't think it is unreasonable to expect the same of paramedic students or new hires, within a reasonable success rate. What I mean is that I wouldn't expect someone I'm precepting to do a good job 100% of the time. That said, I think that a preceptee (student or new hire) should be expected to manage (team lead) patient contacts in a safe, timely, appropriate manner that is within the jurisdiction's treatment guidelines (standard of care, protocols, etc.). I also think that the bar should be set at "entry level" paramedic, regardless of whether the preceptee is a student or a new employee or new volunteer member. Just my $.02. BN

[letmesleep]

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

Agreed!!!! I understand this and have NO issues with being a preceptor, but isn't my job as that preceptor too teach them how to use what they should have learned in school? I do agree with Dust when he says to teach them everything as well, but what is the classroom for if they are coming to me without know there basic drug calcs? Is this still my failure, or the primary educator's? Being able to do a set of VS is something they should learn in the classroom, I will teach them how to do VS in the back of an ambulance that is rolling down the HWY. Am I wrong or mislead?

I don't expect them to be 5 year vets, but they should have learned the basic knowledge of the job in the classroom, otherwise aren't we wasting their time with college courses? We come here and bitch about needing to raise the education standards, but then we don't hold them to any higher level than the bare curriculum. WHY?

[cosgrojo]

I don't think it is fair to expect anyone to know "everything," especially a student ride-along. Not only is it not fair, but it would sap you of obvious teaching opportunities. The best learning experiences are often the ones borne of mistakes. As a preceptor, I want my riders to make some mistakes... that is why they are there, to make mistakes under as controlled an environment that we can provide for them. Hopefully the services have chosen well and provided the preceptee with a smart and experienced preceptor.

I, along with many over the years on this on-line community, have yelped for better education for EMS. I have even done my part in some small way by becoming a part of the education process. Wanting higher standards and more progressive education does not mean that you also have to expect perfection (for lack of a better term). I think it is important not to lose sight of the fact that EVERYTHING is a learning experience, and our students need to be given every opportunity to get the most out of all the different ways there are to learn. Many people learn in different ways. Some may devour the med lists and contraindications like I do buffalo wings, while others learn from going out and seeing it in the field while riding next to letmesleep. I think that this is the reason why we provide them with these various opportunities to learn... and if it isn't the reason... it should be. We aren't like bees... we are not brought into this world knowing everything we need to know. Some of us are slow learners, but once they get it... they get it. It is imperative to remain patient with our riders... even the ones that you don't think are going to make it.

Just some random thoughts based on the convo.

[EMS49393]

Let's discuss American providers exclusively for a moment. The average basic class is 120 hours, intermediate can be as little as 300 (like in Maryland), and paramedic can be as little as 800 hours. You can't honestly expect anyone with that little amount of education to know very much when they start clinicals. Since most clinical rotations in paramedic school start the second month, they really don't know anything. For that reason, I have to agree with Dust, they don't know anything, teach them everything.

I'm in favor of raising the education bar, I'm also in favor of extensive internships. I had an extensive internship and it was more valuable then my classroom time. I had good preceptors that were there to teach, not to belittle. When I precept I take the same approach. A lot of these students probably know the answers or know what they're doing. It's hard to get out there and try to take care of a patient when you've got the big, bad preceptor standing over you pointing out all your flaws. I can guarantee they aren't perfect, no matter how long they've been doing this. It's a lot easier to function as a new person in a more relaxed atmosphere, not one where you are being yelled at or berated.

Don't get me wrong, there are people that try to get into this profession that are just not cut out to do it. You can encourage and teach all you want, and there are going to be people that fail regardless. The thing is, as preceptors we should be giving them every chance to prove they can, not every chance to prove they can't.

[HERBIE1]

One point that is worth mentioning. As any educator knows, people learn in different ways. Some are visual learners, some learn by doing, others need notes, memorization, etc. A good preceptor needs to be aware of this and should adjust their teaching style accordingly. Yes, field training is more about clinical skills, but didactic education is part of the process as well. If you have a student that is having a tough time grasping a concept or applying what he/she has learned to a patient, then it is the responsibility of the preceptor to change tactics. Ask the student how they study- do they take copious notes, do they use mnemonics or other memory tricks, do they rewrite their notes, do they listen to a taped lecture, do they draw pictures or flow charts, etc- and adapt your teaching style to what works best for your student.

Just because you learned by drinking gallons of coffee and rereading your text 10 x's it does not mean that method works for your student.

I have no data to back this up, but I think these days kids are probably more visually oriented than in the past. They are bombarded with multimedia everything, and that's probably a good thing to keep in mind. They learned with flashy power point presentations complete with sounds, video clips, as well as the raw data. Anyone else agree with this, or am I out in left field here?