EMSJunkies Posted August 1, 2013 Posted August 1, 2013 My current student has been riding with me for 7 months now. She knows the info when questioned, given protocols/meds or given scenarios. But she has a poor time interviewing patients. She regularly interrupts them, asks questions out of order (like asking about allergies as the second question instead of asking for more info about the chest pain) and is basically all over the globe when asking. My past students I've been able to break this cycle if they had it. I'm looking for decent websites that have good info on interviewing patients, examples of scenarios with proper questioning or anything else that might help. She a smart kid and wants it but no where near being signed off yet. Typically they're signed off in 5 months of their preceptor time but even if she had a complete 180 today she wouldn't be signed off for at least a month longer to make sure it's not a fluke and she actually "got it". The interview is pretty much what's holding her back. And as we all know the interview & investigation is 90% of our job with the remainder being treating what we find. She's fine with the monkey skills. Just the interview...
island emt Posted August 1, 2013 Posted August 1, 2013 is it because she is not comfortable being extroverted and has a hard time with "new " people? Or did she just not get the skills to interview as a basic?
paramedicmike Posted August 1, 2013 Posted August 1, 2013 Or, and I'm just throwing this out there because we don't know a lot about the OP yet, is she just not doing things like *you'd* do them and is then, therefore, wrong? At this point there are many different considerations to be made about what's going on.
Just Plain Ruff Posted August 1, 2013 Posted August 1, 2013 One question, how many preceptors has she been with. If she's only been with just the OP then they've done a vast disservice to this student. She should never have been paired with just one preceptor for 7 months. As soon as there was a problem identified there should have been a corrective action plan put together, and part of that plan should have been being placed with another preceptor. But to keep her with the same preceptor and expecting different results sort of to me stinks of bad precepting program. But that's just me. I'd like to hear more about this precepting program that this particular service has in place. Why has she been with just this one preceptor or has she been with others as well? Need more info. My suspicions that this issue is more than just this students issue.
craig Posted August 1, 2013 Posted August 1, 2013 Does yhe student get all the answers required from the patient? Has she missed vital questions or just 'got them out of order'? The OP didnt say she missed them, just that she asked questions at inappropriate times. In whose mind did this happen in, her ONLY preceptor? Maybe the way she covers her payient questioning is the way she feels comfirtable doing it and getting things formulated in her mind. If she gets the required answers to allow correct treatment of the patients condition, wheres the probl er m? Howevere if she does not get the required information or her questioning delays definative treatment....well there's a problem Does yhe student get all the answers required from the patient? Has she missed vital questions or just 'got them out of order'? The OP didnt say she missed them, just that she asked questions at inappropriate times. In whose mind did this happen in, her ONLY preceptor? Maybe the way she covers her payient questioning is the way she feels comfirtable doing it and getting things formulated in her mind. If she gets the required answers to allow correct treatment of the patients condition, wheres the probl er m? Howevere if she does not get the required information or her questioning delays definative treatment....well there's a problem Excuse the spelling and typo's small keyboard on the smart phone and early start to the morning....
EMSJunkies Posted August 3, 2013 Author Posted August 3, 2013 I am one of her two preceptors. She received a third one two days ago though. No she isn't "wrong" because she doesn't do it my way. She's wrong because she is wrong. She misses major questions and never gets that info until I get it. While I agree that everyone has their own style one of her issues is that her style misses out on very important info needed. Patients don't just have chest pain. They have pain you think might be cardiac or that you think might not be cardiac. Her interviewing leaves her unable to lean in either direction. Her people skills are fine. She's comfortable speaking to patients. But not comfortable with giving orders for me or EMT's on location of things she'd like done. She has minimal BLS experience which is mostly related to private transport with maybe 20 911 calls with the volunteers over a year period. My county most of the EMT's are very medic dependent and require a medic to tell them what to do even simple things like getting vitals. That's due to the EMT program teaching them that they can't function without a medic telling them what to do. Plus a medic is dispatched on all calls no matter the nature. So she has no interviewing skills. 7 months ago she was horrible and even she admits it. Today she is a 100 times better. She went from no experience, not knowing any of her info like drugs or protocols, not knowing how to document her calls to being proficient with all of that except the interview. She's improved it greatly in the 7 months but has hit a wall over the last month or so. Literally the only thing holding her back is the interview. If I give her a scenario with all of the info she'd ever need without requiring her to ask any questions she'd give the correct treatment. She just can't ask all the right question to get that info on her own. The program is setup that they complete all didactic & clinical time prior to precepting time. Clinicals include riding with a medic for 12 hours every clinical weekend and the other 12 in the hospital. Come precepting time they at least typically know all they need to know to function as a very basic medic. Then precepting time we smooth out the rough edges, help them flow better and educate them on things not learned in school so they know why they're doing treatments and not just because the protocol says to do the treatment. They've changed the experience requirement so you can go from EMT school directly to medic school. No clue why and I have no control over that anyway. As for me someone had asked about my experience. I have over 20 years experience in EMS and 12 in law enforcement. I've had multiple students. I'm a tactical medic on 2 tactical teams for which I'm not only a medic but also an operator. I teach ACLS, PALS, CPR, tactical medicine and multiple others. We rotate between 9 units (a week per unit). Slowest unit is approx 4,000 call volume. Our 2 busiest do approx 8,000 calls each. We have single medic cars, EMT/medic units and dual medic units. Our locals range from rich suburbs, blue collar middle class, industrial and inner-city. Our inner city is listed as one of the most violent cities with one of the highest murder & violent crimes per capita in the US. Shootings are a daily event. Just the homicides alone are high based on capita. So she's exposed to a wide range of calls. It's just that darn interviewing. So back to my original question. Any good site I could use to help with her interviewing?
island emt Posted August 3, 2013 Posted August 3, 2013 AHHH/ A product of the educational system that teaches them basics are useless without a medic, That is the underlying problem that she is having trouble getting past as she was taught and drilled that she was dirt and not really capable of making decisions. need to find a way to re-instill the confidence that was crushed as a basic. time to get back to basics , before moving forward into medic.
rock_shoes Posted August 3, 2013 Posted August 3, 2013 When it comes to investigating a patient complaint give her a system to follow. LOTARP or OPQRST work particularly well for pain complaints. L--Location O--Onset T--Type A--Associated symptoms/Aggravate R--Radiate/Relieve/Remote P--Past medical history (including medications and allergies) O--Onset P--Position/Provoke Q--Quality R--Radiate/Relieve/Remote S--Severity T--Time (Seems redundant but such is life) Personally I prefer LOTARP, but to each their own. Also consider adding some high yield questions to her repertoire. Have you had this (insert complaint) before? If so what was the physician's diagnosis? If something is a chronic condition or has been ongoing for some time. What changed today prompting you to call EMS?
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