PRECEPTING WOES!

[fireflymedic]

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?

Herbie,

Point well taken, and if I am teaching the class I will bend over backward to help a student that wants to help themselves. However, sadly I've found many that go through a vast majority of the programs around here brag about the fact they never opened a book and still managed to pass because they could halfway listen to lectures and be able to B.S. their way through a test by guessing right. They skated by in clinical time, and then when they arrived at ride time, they didn't have basic knowledge of things they should. I'm patient and if you don't know it, I'll help you try to figure it out - can't remember drugs? I've done flashcards, CD's students can play in their cars, etc to try to help them. Even did jeopardy with meds to help them learn (candy was involved instead of money lol). I try to get students as involved within the classroom as I can, however, if it's not my class, then we have to figure out where the mistake is. If it is because you didn't put the time in prior I don't have sympathy (which is usually the case), however, if you are working hard to learn it, I'll try to help you find a way to get it to sink in. Ultimately it comes down to though, no matter how good you can treat a patient, you'll still have to be able to pass registry and for that you'll need to recall info from your brain. We just have to figure out how to get you to link the two together.

Most of the students I referenced in leaving to write drug cards was because they had goofed off in class going through the above mentioned way and thought they could just look at me nice and pass ride time. Sorry kids, it don't work that way.

[Medic One]

I along with many preceptors in my area feel the woes of "The Student". I feel 100% as a preceptor is is your job to mold them into EMT's or Paramedics - what ever they are training to be but...........

I know EMTs have little to no road knowledge and skills so remember when you started and mold them accourding to current standards and give them a break....

As far as the Paramedic student....well......

We have found a growing trend in our area that these programs will take someone onboard into a program to further educate them to an ALS level but the instructors are now money based...when I was a student back oh 10+years ago you had to have a minimum of 5yrs city, commercial or very very busy Volunteer experience. Today we have had many students come through that went from EMT directly to Paramedic with no ambulance time....this causes a huge problem for preceptors trying to train the BLS skills throught the ALS skills.

So YES we have a lot of woes but I think a standard of time needs to be put in place by both a state and national level to have a minimum time on an ambulance prior to even starting a paramedic progam.

[HERBIE1]

Herbie,

Point well taken, and if I am teaching the class I will bend over backward to help a student that wants to help themselves. However, sadly I've found many that go through a vast majority of the programs around here brag about the fact they never opened a book and still managed to pass because they could halfway listen to lectures and be able to B.S. their way through a test by guessing right. They skated by in clinical time, and then when they arrived at ride time, they didn't have basic knowledge of things they should. I'm patient and if you don't know it, I'll help you try to figure it out - can't remember drugs? I've done flashcards, CD's students can play in their cars, etc to try to help them. Even did jeopardy with meds to help them learn (candy was involved instead of money lol). I try to get students as involved within the classroom as I can, however, if it's not my class, then we have to figure out where the mistake is. If it is because you didn't put the time in prior I don't have sympathy (which is usually the case), however, if you are working hard to learn it, I'll try to help you find a way to get it to sink in. Ultimately it comes down to though, no matter how good you can treat a patient, you'll still have to be able to pass registry and for that you'll need to recall info from your brain. We just have to figure out how to get you to link the two together.

Most of the students I referenced in leaving to write drug cards was because they had goofed off in class going through the above mentioned way and thought they could just look at me nice and pass ride time. Sorry kids, it don't work that way.

No argument with what you say. I have noticed a "know it all" trend for many- but not all- new students over recent years, probably for the reasons you cite, and more. I don't know the answer, but as a preceptor we have no choice but to stick to our guns. Like you, I will go out of my way to ensure my students grasp what I am teaching them. I "what if" them to death- even on routine calls. "What if" the BP drops, what if their respiratory rate increases, "what if" the patient's mentation changes, etc. You can make any situation into a teaching moment if you are creative enough. I would drive the students crazy- I'd create a scenario where a simply snotty nose turned into a PE or a pneumo, but they learned. LOL

I bowed out of being a preceptor for awhile because a local program was cranking out students who clearly should not have passed their didactic studies. I would give these students poor evaluations after I realized they did not have the required book knowledge and received a bunch of static for it. I would suggest the students get refreshers in their deficient areas, if they were bad enough. The program's solution: simply shift the student to another preceptor who they knew would give them a pass. They were already finished with their didactic portion of the program, took and passed their finals, and would be doing an internship with me when I realized many didn't know basic cardiology concepts, medications, or even basic pharmacology. I voiced my concerns about potential liabilities, and was essentially told this was a numbers game- if these students had a pulse, they graduated. I honestly don't know how some of them ever passed their finals, much less their state exams. (Actually, I DO know, but let's just say that politics and racial issues were involved.)

Eventually enough preceptors complained to the right people, and things finally changed.

I parted company with that program and refused to take on students for quite some time. Eventually they changed program directors who instilled and ENFORCED minimum standards to enter and remain in the program, and the caliber of students improved dramatically. The new directors were people I admired and trusted, and I knew they were not going to cut corners or bend to outside pressures. I was then asked to resume being a preceptor, and I gladly agreed.

My bottom line before I sign off on a student- as with most preceptors, I would assume: Would I trust this person to be my partner, or to work on a family member? Until I can answer that question affirmatively, I will not pass a student.

[fireflymedic]

Well stated Herbie. One day you may be taking care of me or my family. If that is the case, I want to know that you know your stuff. If I don't trust you to do that I'm not going to pass you.

[tskstorm]

***** Side question.... *****

When getting students from the local EMT/Medic school does your service financially compensate you ? or give you any compensation ?

How are the students assigned to preceptors ?

I am unfortunately part of a service where students pick a date and time they are available and they get whatever crew is on the truck at the same time, the students may pick any day, any time another student is not already assigned.

Which is to say it is not unusual for me to have a rookie partner with less then a months experience, and a student from the local program. The service prefers and recommends no one with less then 3-6 months experience drive, which leaves the rookie in the back with a student.

Further I have seen a service preceptor, who had a rookie partner, a new hire riding third, and a student from the local service.

I work for a service with a high turnover rate, that's consistently hiring new personnel.

I have been at this service about 4 years now, no major complaints about the service, and they do try their best to be accommodating and work with you as an individual.

[fireflymedic]

When getting students from the local EMT/Medic school does your service financially compensate you ? or give you any compensation ?

Nope, no compensation granted here that I am aware of, though I know there are contracts in place between the powers that be and run the program that establish those contracts. There is already a pay grade difference for those that are preceptors and regular crew which is pretty nice.

How are the students assigned to preceptors ?

Preceptors are predetermined by the department - there are typically at least two per shift (sometimes more depending on the shift day) and may be at any base (there are 7 bases throughout the state all of which do 911 with the exception of one which is solely a CCT base). They are required to have and maintain their instructor and evaluator cards in order to be a preceptor so they know what is expected of the students and guide them properly to not only prepare them for the streets, but also adequately prepare for NR and they can answer questions as well. Two years of service is a requirement before you are allowed to precept. So no matter what days the student picks to ride there will always be a preceptor available, just perhaps not at the location they want. Many of the preceptors if they connect well with a certain student will give them their schedules and the student will try to schedule those days. If they don't like the person, it gives them a wide opportunity to change. They receive a calendar and pick their days from a listing of available dates. The number of students riding that day may not exceed the number of preceptors available. New hires ride with one of three dedicated FTO's (one per shift) so cross scheduling is not an issue. Service turnover is typically very low so rarely an issue (pretty much only turnover is through retirement out). Hope that helps you some !

Edited October 13, 2009 by fireflymedic

[HERBIE1]

***** Side question.... *****

When getting students from the local EMT/Medic school does your service financially compensate you ? or give you any compensation ?

How are the students assigned to preceptors ?

I am unfortunately part of a service where students pick a date and time they are available and they get whatever crew is on the truck at the same time, the students may pick any day, any time another student is not already assigned.

Which is to say it is not unusual for me to have a rookie partner with less then a months experience, and a student from the local program. The service prefers and recommends no one with less then 3-6 months experience drive, which leaves the rookie in the back with a student.

Further I have seen a service preceptor, who had a rookie partner, a new hire riding third, and a student from the local service.

I work for a service with a high turnover rate, that's consistently hiring new personnel.

I have been at this service about 4 years now, no major complaints about the service, and they do try their best to be accommodating and work with you as an individual.

The only "compensation" we receive is Con-ed hours- no extra pay.

As for how students are assigned, a more experienced preceptor may be given a "problem child" or someone who needs a strong influence. The program coordinators are generally familiar with the personalities and try to match up people based on that. The newer preceptors are often given stronger students until they become more developed as teachers. As I alluded to before, sometimes personality conflicts arise that cannot be resolved, and the student may be given to another preceptor. This is not optimum in my opinion because as we all know, we will not always like our partners, but need to make the situation work at least for that day. I do give the personality situation with a student a little slack in this regard, since it's hard enough to learn the job, and adding personality issues on top of that may be an undue hardship. They can work on the interpersonal issues later, especially since they will have to figure these things out on their own anyway.

The way our program works, each student splits their time between 2 preceptors, and then returns to the original one for a final evaluation. I think this is a pretty good system- the student sees different styles of teaching, different ways of handling patients, and different personalities and hopefully picks up the best of both instructors. If one preceptor has a clash with a student, you can compare the experiences with the 2nd preceptor and see if it's the student or the instructor who needs the help.

[letmesleep]

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

One sentence really:

Clinicals are part of the educational program.

I don't know how I missed this yesterday, but let me just say, REALLY? THANKS!

I think that only a couple of you have understood what my original complaint really is, so let me try to straighten it out a little. My problem is really only with MEDIC students. EMT and intermediates really have no experience and/or knowledge when they come to their ride-a-longs, they are just starting out, we all know this, and these are the students that need hand holding with everything. MEDIC students however, have done time in the hospital setting and have had more exposure by the time they get to their clinical rotations (which are part of the educational program, as pointed out above). By this point they should be able to start a basic assessment on any pt even if it is NOT fine tuned. If a trauma pt needs an oral airway for instance, they should be able to see this and maybe even preform the insertion of said airway, after all they are an EMT at this point.

I totally agree with finding out how they learn and as a preceptor, that becomes MY job, otherwise I am wasting their time as well as mine. The issue that I am having is that we have an abundance of these students making it to their clinicals by BSing their way through, and expecting everybody out there to spoon feed them their education. The last time I checked, this is a college course, which means it is ADULT education. Teaching them is one thing, but spoon feeding and handing them everything is NOT what preceptors are for (in my opinion). We are fine tuning what they have already learned and showing them how to use it in the street. I have NO problem with giving a student every oz of knowledge in my head if they take the bull by the horns when it comes to learning.

As far as compensation goes, in my case neither the District nor I get any compensation from any of the colleges in this area. This is ALL done to educate the future of our careers, and to insure that the next generation hits the street ready to handle anything that they may see. I guess that is my real issue.