Looking for outside help

[EMS-FTO]

Let me start by saying hello to everyone. I have been working Fire/EMS for the past 7 years. I have seen and heard alot in my years of service but far from knowing it all. I was recently given the option of taking on a brand new, fresh out of EMT school, employee at my current job. This guy is so green he is yellow...so to speak. The downside to this is that he is also just out of high school. That being said here is my delima. I have been training this person for the past 4 shifts. When I am teaching him things and using "constructive criticism" he feels as if I am getting onto him for doing something wrong. It has come to the point were he feels more comfortable going to my paramedic partner than me. I have had meetings between my supervisor and education and differences were worked out, however, he still continues to not come to me. What are some ways I can voice my reasons without making him feel like I am "coming down on him"??

[tniuqs]

Words from Kevkie a respected member of EMT City, but worth modifying (a titch) and re posting, you would never find this advice in a search.

You are probably excited and apprehensive about starting your preceptorship. I know I was many years ago when it was my turn. I wondered whether I would make it - whether I was cut out for this job, whether I had spent so much time and effort studying only to fail, to have to hang my head and admit I wasn't cut out for the job.

Do not worry. I know you. You are smart and enthusiastic. I like that. You will pass. Precepting with me will not be a rigid test where you are constantly at risk of having a trap door open beneath you, sending you spiraling out of the profession you have studied so hard to join. If you fall down, I will pick you up. If you forget something during a call, we'll talk about it later. If you miss an IV or a tube, no big deal, you'll get more chances. My only expectations are that you care about being a good paramedic, and that you'll do your best, which if you do, will be good enough. Its my job to see you become one of our BEST.

Here's what I want to see:

I want you to always introduce yourself to your patient by name.

If there are first responders on the scene, I want you to look them in the eye and hear their report, and then thank them. This goes for nurses and bystanders as well.

I don't want to you to cop an attitude with anyone.

I want you to see that the patient is comfortable as can be, and reassured that you are there to help them.

I want you to explain to them what you are doing and why.

I want you to ask questions after the call, anything you didn't understand or were curious about.

Here's what I'll do for you:

I will never badmouth you. If anyone asks how you are doing, I will say great.

I will be honest with you and if I don't know the answer, I will look it up or seek someone who knows.

If I am tired or in a bad mood, if I ever take it out on you, I will apologize to you.

I will do my best to make it a fun, learning experience for you.

I want you to come to me first as it is my job to train you, I have been entrusted to accomplish that.

Precepting should be a buffer period between class and the real world, a chance for you to learn and grow and gain some measure of comfort before having to deal with the job on your own. I am looking forward to precepting you. Precepting is a privilege not only for you, but for me, the preceptor. When I have a preceptee I can look again at this job I love with fresh eyes. I may learn things that I have forgotten as well as lessons I may have missed along the way.

Let's have a good time and do some good.

One could print that out and hand it to your "new partner" at the end of your next shift, I doubt it would hurt. Perhaps its too late in the process as their sounds to be a bit of a trust issue ? I would suggest that you ask the "trainee" to constructively critic himself and use "good listening skills" yourself.

That said:

If the trainee is ignoring your advice you are the FTO and this ain't farking high school its your responsibility to maintain high standards, even though some times one does have draw a line.

Oh shucks where are my manners WELCOME to EMT City ... EMT FTO

AND let us know (good or bad) how things turn out.

cheers

<reason for edit "addition of credit" and info for Dwayne he gets unglued if I forget that>

Edited August 21, 2010 by tniuqs

[DwayneEMTP]

Hey Tniuqs, thanks for reposting that man...

I'd forgotten about that document. If I'd been handed that during my clinicals they would have provided a completely different experience.

I have nothing to add really, except to say that if you read that document and found that you disagreed with all or part of it then it's time to take your pulse as a preceptor, because that's friggin' gold there.

Dwayne

[HERBIE1]

Welcome to the city!

Couple questions. How long have you been an instructor/trainer/FTO? I suggest trying another tactic when issuing advice/criticism.

Are you responsible for an official evaluation of this person- ie filling out paperwork, preparing a report, etc?

If so, then remind him/her that YOU are the one this student needs to come to, NOT anyone else. If you are already having conflicts after only 4 shifts, that is not a good sign.

It's always a delicate balance when you are working with a partner who is also someone who needs training- there needs to be clearly defined boundaries and responsibilities. Explain that they are no longer a student, but they are brand new to the field, and as such, need guidance and someone to show them the ropes.

It might be that this person is simply immature- especially if they are a recent HS grad. It might be there is a personality conflict. It might be the person is unclear, they do not understand their role, the hierarchy/reporting chain of your organization.

You need to have a sit down with the student and explain the facts of life. That document from above is definitely golden. Add to it that this business is no game, that you are dealing with people's lives, and a certain level of maturity is necessary. That maturity means there is a time to listen, to absorb, and to learn.

[Happiness]

As one of the older one's in my station, I have been given the job of helping the new ones get their experience and confidence. First thing I do is say watch how I interact with pts, and remember you treat them the same way you would want to be treated.

When it comes time for them to actually be the attendent then I say "remember everything you have been taught and I will step in when you are veering in the wrong direction, I will not let you down"

After the call, no matter what it was (cpr to a cut finger) we will sit down and discusse what happened, if they thought it went well and what I think. This last bit is very important as new people need to know that you are there to help them. Personally I can be high strung and bit snappy but I do warn people not to take it personally it's me not them.

good luck with the newbie it is stressful but in the end when he is your partner you will know exacually how he is going to be as you have given him your skills.

[fakingpatience]

Let me start off by saying I have never really been a preceptor, only a brand new EMT So this is coming from my experience in that perspective

One of the great things about where I volunteered was that I would change around the crews I road with when I wanted to (I was the 3rd person on the ambulance). For the most part, it was understood that the crews I road with were to help train me, to get me from a new EMT, to someone who was hirable by the agency. From this, I got to experience a lot of different styles of precepting. There were definite style which I liked better, and ones which I don't feel really helped me. One of my main problems was that I lacked confidence in my skills as an EMT. Most of the assessments I could do accurately, but I was never sure of myself. Because of this, it didn't help to have a partner constantly giving me "constructive criticism" I was doing this enough myself. What I really liked was after calls, all calls, no matter if I was the one running the call or another member of the crew, one of them would sit down with me and ask: "Ok, how do you think that call went?" This would help me to use my own critical thinking skills to assess the call, rather than just listening to what I did wrong. It also helped that we did every call, not only mine, so I learned that everyone thinks of this after calls, and it was not just me they were criticizing. Once I said what I though of the call, they would ask, "what could have been done differently?" Again this helped me to think for myself. Of course, if I missed something during the reflection of the call, they would casually mention it, and we could talk about it.

During calls, if it was my turn to take the call, if we had a chance before they got there, we would talk about how the call should run, a quick run down of differential diagnosis based on the dispatch info, and whatnot. Once at the call, they made it clear that they were there to be my assistant, not run the call. I had to ask for everything I needed, right down to which vitals I wanted them to check (This also helped me learn to delegate, and not do it all myself). If i was missing something, but it wasn't something urgent, my partners would give me time to figure it out on my own (It takes a while to develop your own style for talking to/ questioning a patient, which questions to ask first...). On the contrary, I disliked riding with crews who would jump in the second I missed something, as I felt it then was harder to gain the trust of the pt, and continue my assessment. Of course, if I was missing something essential, or if i didn't get it towards the end of the call, my partners would give me a hint, or just ask the pt, themselves. Same goes for treatments. If I didn't get out a nasal cannula right away, they might ask me if I wanted oxygen, or subtly point to it, with a questioning look.

Perhaps you could listen to a few of the conversations your new emt has with your paramedic partner, or ask your paramedic partner what style of teaching he uses, and then try and use that to see if it jives better with your new EMT.

Sorry this is so long, hopefully some of it makes sense and gives you a few ideas!

[EMS-FTO]

Tniuqs, Thanks for the feedback!!! Actually, thanks to everyone for their feedback and advice!

With that being said.....After I read that document I had the same reaction as Dwayne....that is pure gold in this business and If I had that when I first started in this business, it would have helped out more. What I am going to do is approach my trainee first thing Monday morning and explain to him the words from Kevkie and see how it goes from there. After that I am going to explain to him the just of this business and how he is expected to act. I mean...lets face it.....you cant come into a grown ups business acting like a little kid. I feel that he doesnt understand that this is a mature business with mature consequences.

To answer some other people's questions:

I have been involved in the training process at my current job for the past 6 months. However, If you really think about it, we all are trainers/instructors/teachers everyday in this business. No matter how small the task, you can usually show someone something new everyday. I am responsible for his official sign-off to be released as a secondary in our system. However, we also operate a non-emergency system as well as the 911 system in which I work.

I plan on applying everyones advice throught his training process. Again, I appreciate everyones help on this matter. Sometimes it helps to take a look outside the box for help. Expect more from me after my shift on Monday. I will let yall know how it went.

Words from Kevkie a respected member of EMT City, but worth modifying (a titch) and re posting, you would never find this advice in a search.

One could print that out and hand it to your "new partner" at the end of your next shift, I doubt it would hurt. Perhaps its too late in the process as their sounds to be a bit of a trust issue ? I would suggest that you ask the "trainee" to constructively critic himself and use "good listening skills" yourself.

That said:

If the trainee is ignoring your advice you are the FTO and this ain't farking high school its your responsibility to maintain high standards, even though some times one does have draw a line.

Oh shucks where are my manners WELCOME to EMT City ... EMT FTO

AND let us know (good or bad) how things turn out.

cheers

<reason for edit "addition of credit" and info for Dwayne he gets unglued if I forget that>

fakingpatience

I appreciate your side of this story....it is helpful. The bottom line is I cant get my trainee to approach me. No matter what the question he always goes to my Medic. I disagree with this because officially I am his FTO. He should be coming to me with any question, concern, or comments. When i question him after calls I ask him open ended questions allowing him to think and answer for himself. I do, however, think that my teaching style may be a little rough to an extent. I believe thats only because I hold myself to very high standards doing this job. And I guess I am trying to pass that along to him. I want to see him do very well in this business. I am going to try a different tactic on our next shift and see how that goes. The good thing is that with him being so brand new....I have the ability to mold him into what I think is a good EMT. If you come up with any other suggestions please feel free to let me know. And look back Tuesday morning for more.

Let me start off by saying I have never really been a preceptor, only a brand new EMT So this is coming from my experience in that perspective

One of the great things about where I volunteered was that I would change around the crews I road with when I wanted to (I was the 3rd person on the ambulance). For the most part, it was understood that the crews I road with were to help train me, to get me from a new EMT, to someone who was hirable by the agency. From this, I got to experience a lot of different styles of precepting. There were definite style which I liked better, and ones which I don't feel really helped me. One of my main problems was that I lacked confidence in my skills as an EMT. Most of the assessments I could do accurately, but I was never sure of myself. Because of this, it didn't help to have a partner constantly giving me "constructive criticism" I was doing this enough myself. What I really liked was after calls, all calls, no matter if I was the one running the call or another member of the crew, one of them would sit down with me and ask: "Ok, how do you think that call went?" This would help me to use my own critical thinking skills to assess the call, rather than just listening to what I did wrong. It also helped that we did every call, not only mine, so I learned that everyone thinks of this after calls, and it was not just me they were criticizing. Once I said what I though of the call, they would ask, "what could have been done differently?" Again this helped me to think for myself. Of course, if I missed something during the reflection of the call, they would casually mention it, and we could talk about it.

During calls, if it was my turn to take the call, if we had a chance before they got there, we would talk about how the call should run, a quick run down of differential diagnosis based on the dispatch info, and whatnot. Once at the call, they made it clear that they were there to be my assistant, not run the call. I had to ask for everything I needed, right down to which vitals I wanted them to check (This also helped me learn to delegate, and not do it all myself). If i was missing something, but it wasn't something urgent, my partners would give me time to figure it out on my own (It takes a while to develop your own style for talking to/ questioning a patient, which questions to ask first...). On the contrary, I disliked riding with crews who would jump in the second I missed something, as I felt it then was harder to gain the trust of the pt, and continue my assessment. Of course, if I was missing something essential, or if i didn't get it towards the end of the call, my partners would give me a hint, or just ask the pt, themselves. Same goes for treatments. If I didn't get out a nasal cannula right away, they might ask me if I wanted oxygen, or subtly point to it, with a questioning look.

Perhaps you could listen to a few of the conversations your new emt has with your paramedic partner, or ask your paramedic partner what style of teaching he uses, and then try and use that to see if it jives better with your new EMT.

Sorry this is so long, hopefully some of it makes sense and gives you a few ideas!

[Richard B the EMT]

I am also one of those who have not been the preceptor much.

As a student, one instructor pretty much growled at me for everything, both good and bad, and I flubbed it. I requested another instructor to try again, openly saying that the first one probably didn't intend to scare me as he had. The next one was good for me, but it turned out I couldn't do the task.

Oh well, at least I had some better understanding of the task, even if I wasn't going to handle it.

[uglyEMT]

I too, as faking stated, am in the prespective of being the student. Im the rookie in my squad (lol 30 something rookie no less) and have had a few teachers along the way.

I had the gruff teacher, jumped all over me at every turn if it didnt do it "their" way. Made me feel less of an EMT, like I wasnt good enough. Especially if it was done around a patient or their family memebers.

I had a laid back teacher. Kind of a go with the flow man teacher. Well Im just glad I didnt kill anyone.

I had a teacher that let me go about the call the way I wanted but lent a hand if needed. This is and was my best teacher. To this day I learn from this person. When we run calls together I have confidence in myself and it shows. My moves are deliberate, consice, nothing wasted. I have a confident, not arrogant, tone with my questions. My hands feel more, my ears hear more. It is because as I was learning I got to teach myself but with the reassurance that if it was going downhill I had a partner that would step in and help. I had slip ups but wasnt talked about until after the call. That I liked, I wasnt embarresed. I was able to realize what went wrong and why without a spotlight on me.

One thing I will say, I dont know if it goes for everyone, dont call your rookie a rookie, newbie, greenhorn, fresh emt, what-have-you during a call. I had some teachers that would let everyone know I was new and it hurt actually. It made folks turn away from me and talk to my partner instead. That never helped. If you talk on scene talk like the two of you have worked years together. I used to tell folks after my feathers got ruffled enough...

It says EMT on both our sleeves noone knows rank or experience.

Basically all anyone sees is that we are both the same as far as they know, why let them think anything else. Its their emergency the last thing that want is someone, they feel, cant do the job. Even though this rookie may be the best in the business if you call him out on the job (scene) the preception is he cant do anything other than be a go-for.

Good luck in your teaching and hopefully you can get through to him. If not, use it as your learning experience and move on to the next. Some folks just dont mesh well with one another.

[HERBIE1]

I will agree with the idea that you should not broadcast that your partner is new. You need to step in and correct when warranted, and if I sense the patient is nervous about that, I usually make a joke and say yes, this person is new but has been well trained, but I have more than enough experience for the both of us. I'll make a joke about my grey hairs(I earned every one of them) and usually the patient calms down.

If the person picks a less than optimal IV site, for example, (unless its location, size, etc is vital for pushing certain meds) I let it go and address it after the call. As was mentioned, there is a proper time and place to go over details of a call and the actions of a student or newbie. I usually ask THEM how they think the call went, what went well, what they could have done different or better, and more importantly, WHY. It's most effective if a student discovers/realizes mistakes on their own- the lesson tends to sink in much quicker. To me, that says they know what to do, it's just a matter of putting it all together in the proper context.