Clinical Quandry

[Dustdevil]

I have no notions of disbelieving you Lone so I'm going to say Methinks your preceptor is an ASSHOLE!!!!!!!!!!!

Yep. Definitely management material.

[Lone Star]

I was never in any "Preceptor Program". If someone was assigned as a third on my truck, I would at least warn them that, with whatever else happened, we'd probably also take advantage of them, turning them into our "Pack Mule" for the tour. Except when actually carrying a patient down stairs, I never really did that.

I did, however become the "Pack mule" for one of the teams I rode third with, when I started in municipal service.

As both an experienced EMT and a student, I have to point out that the student is there to get experience in the cliical aspects of what we do in the field. 'Schlepping gear' (pack mule, go-fer or whatever other 'friendly name' you wish to put on it) ISN'T a 'clinical skill'.

As a student, do I expect a 'free ride'? Not at all; but there is no reason that I should be 'taken advantage of' simply because of my 'student status' either!

The same applies to the 'station duties' as well. Just because you have a student rider, is no excuse to pile your daily chores on them, simply because they don't know any better than to tell you to do your own job!

When I get to a station, I expect to be included in the daily check off of the trucks (making sure at least the minimum amount of supplies are on the truck), where the equipment is located and answer any questions about how something works and clarifying my responsibilities for patient care.

Washing the truck and scrubbing the trash cans isn't what I'm in school for! And the whole "You can't sit in this recliner because it's reserved for REAL EMT/Medics is pure hogwash, and if I were told that; I would be quick to tell you to stuff it in your ear!

I'm in school to learn how to treat my patients, provide clinically acceptable treatments for their conditions and in some cases even save their lives. I am not there to see how much of a jerk the preceptor can be simply because I'm not a 'real _____________ (insert license level here), and be treated as a second class citizen!

Far too often, a preceptor will 'abuse' their students simply to establish 'the proper pecking order', or to pass on what was done to them when they were a student. All this does is breed contempt, create a hostile work environment and perpetuate the cycle. A question that this type of preceptor needs to ask themselves before passing it down to the student is: "Did I like it when this was done to me?". If you didn't; then why do it to someone else?

I'm not your 'average student', and this ain't my first 'go round' in clinicals. I ususally have more time in EMS than my preceptors. I DO know how things work. Yes, I'm there to learn about patient care, not be a 'wall flower observer'; but by no means am I 'beneath you' simply because I'm a student or working on obtaining a lower license level than you!

[Richard B the EMT]

Perhaps I was not clear on one item. I would TELL them they'd be "Pack Mules", but usually never ASKED them to carry stuff.

[2Rude4MyOwnGood]

Perhaps I was not clear on one item. I would TELL them they'd be "Pack Mules", but usually never ASKED them to carry stuff.

Im absolutely ok with this. I think most students would feel like they are being included, which is pretty important to me. Also, big difference between being told you are going to carry the trash instead of the LifePak and airway kit! All in good fun if you ask me.

One of the worst things a preceptor can do is make the student feel excluded from the group. They dont have to offer me coffee or lunch (which they usually do), but at least talk to me. I dont ask for much, just keep me in the loop when we are heading to a call and more information comes in about the patient via the computer. If a preceptor doesnt want me to practice an ALS skill on their ambulance, im ok with that too. Some guys just arent there to teach, and dont want a student potentially messing things up. I understand.

The worst thing a preceptor can do is just ignore me and make me feel like im in the way.

I rode with a grizzled vet for 12 hours on one of my internship shifts this past semester. He never acknowledged my presence once...literally...not once. If i spoke to him, he would reply. He kept it very short though. I asked if i could start the next IV and he just laughed in my face. A simple 'no' would have sufficed. This guy was a real jackass. HE NEVER WORE GLOVES either. He had no problem starting IVs with his bare hands. I was shocked. And when i asked why our 78 year old female complaining of nausea got an 18g IV instead of a 20g, he told me "everyone gets and 18g from me unless is a small child". Seems a bit cruel if you ask me. Back at the station he began a conversation with another medic about how much he hates students, or anyone who hasnt been getting paid to do this for at least 5 years. I was sitting 10 feet away. Just a cruddy guy who i learned nothing from that day. Thankfully his partner was awesome and would go over calls and class assignments in our downtime.

[Lone Star]

So far, it's just been this one preceptor, everyone else I've had as a preceptor has been really awsome (some even remembered me from EMT and EMT-I days).

I normally have my textbooks and homework to do, so I'm not just sitting around staring at the television.

I don't expect to be coddled during the shift, I'm there to learn how to do what it is we do. The only way for me to learn is to get my hands dirty by doing it.

No, I possess nowhere near the amount of information that my preceptors do (thats why I'm still a student), but don't treat me like a complete idiot either! I'm not the enemy here!

If being a preceptor and having students on your shift bothers you THAT much, maybe you should remove yourself from the preceptor program and being an adjunct instructor.....

[2Rude4MyOwnGood]

So far, it's just been this one preceptor, everyone else I've had as a preceptor has been really awsome (some even remembered me from EMT and EMT-I days).

I normally have my textbooks and homework to do, so I'm not just sitting around staring at the television.

I don't expect to be coddled during the shift, I'm there to learn how to do what it is we do. The only way for me to learn is to get my hands dirty by doing it.

No, I possess nowhere near the amount of information that my preceptors do (thats why I'm still a student), but don't treat me like a complete idiot either! I'm not the enemy here!

If being a preceptor and having students on your shift bothers you THAT much, maybe you should remove yourself from the preceptor program and being an adjunct instructor.....

It may be that they dont have a choice to precept or not, so some might not be as into is as others. The county just throws us on with a medic crew, they often dont even know we are coming, and they sure as heck didnt sign up to precept.

[island emt]

I've found that preceptors like the one you are describing are usually "borderline providers or burnouts" that feel challenged by students and don't want a "newbie to question them about things they may not have knowledge of.

In many systems such as the empire you get to be a preceptor by not showing up on the bosses radar too often . Mediocrity will get you promoted and the browner the nose the worse the quality of precepting.

I would write an honest review of the time spent with this preceptor and make copies to give to the program director or dean and be sure to keep a copy for your own files.

[Lone Star]

It may be that they dont have a choice to precept or not, so some might not be as into is as others. The county just throws us on with a medic crew, they often dont even know we are coming, and they sure as heck didnt sign up to precept.

In order to be a preceptor with the program I'm in, you have to take a course in order to be approved, so I'm thinking that it's not 'just dump the student on the first crew available', not to mention that this guy is also the 'adjunct instructor' for my course....

I've found that preceptors like the one you are describing are usually "borderline providers or burnouts" that feel challenged by students and don't want a "newbie to question them about things they may not have knowledge of.

In many systems such as the empire you get to be a preceptor by not showing up on the bosses radar too often . Mediocrity will get you promoted and the browner the nose the worse the quality of precepting.

I would write an honest review of the time spent with this preceptor and make copies to give to the program director or dean and be sure to keep a copy for your own files.

I had a private chat with my instructor (who happens to also be the Department Head of EMS Education), and was instructed to write an honest objective critique of the preceptor. I've written a 'Memo For Record' narrative that will be included with the packet of forms I had to complete for that rotation. As I said, I'm not thrilled to have to put this on paper, but it's what the program director wants, I have to comply...

As it turned out, that same preceptor/adjunct instructor also was the proctor for my 'hands on' portion of my module finals the other day. By the time I was done with my 'trauma patient', I was into areas that I had no idea how to manage because we hadn't covered it in lecture yet. Yeah, I made a couple of mistakes during the rapid trauma assessment, but when the proctor starts crashing the patient because I don't know how to do a needle decompression yet......I kept telling him that I was in 'over my head', but he kept pushing me to go deeper into 'uncharted territory'....

[Lone Star]

Well, yesterday was our finals for the quarter. Unfortunately, our regular instructor wasn't there because he had some classes he had to attend. The 'substitute teacher' that took his place was a Paramedic with 21 years of EMS experience. Her job was to administer the written exam, and then fill in for one of the 'hands on' testing stations.

When the adjunct instructor that I've been talking about showed up, there were several of us staning in the hallway while the remainder of the class was finishing the written portioin of the exam. Instead of saying 'hello' or any other form of greeting, he looked at us with sadistic glee and simply stated "It's time to cull the herd!". I don't know if this was just an evil plot to play on our nervousness, or because he was actually looking forward to eliminating some of us.

Knowing how I've been treated by him, (not only during clinicals, but during 'lab time' as well), I opted to do the practicals portion of the exam with the 'substitute teacher'.

Going into the practicals, I knew that I could end up with either a trauma patient or a medical patient, so I had to be prepared for anything...

As it turns out, I ended up with a medical patient. My scenario was "You are dispatched to the local school for difficulty breathing. On arrival, you find a 17 year old male in the nurse's office, in respiratory distress. The patient is allergic to nuts and at lunch time began to experience difficulty breathing. You see that the patient has visible urticaria as well. The nurse has administered oral Benedryl about 20-25 minutes prior to your arrival with no relief."

This was a fairly straightforward scenario, but since we haven't covered pharmacology yet, it kind of complicates things because I don't know the dosages yet.

Long story short, I started an IV, administered epi, albuterol and benedryl "per protocol", and explained that on arrival I got a 'poor impression of my patient's condition' and that this would be a 'rapid transport' situation.

The instructor called me this morning and advised me that I earned a grade of 88% on the written and received an overall grade of 4.0 for the quarter!

[Dustdevil]

Going into the practicals, I knew that I could end up with either a trauma patient or a medical patient, so I had to be prepared for anything...

Just be glad your school doesn't give you psych patients. Now that's a great way to cull the heard!

Congrats, Bro!