Clinicals

[Dustdevil]

Excellent stuff, 8! =D>

You are so absolutely right. If you aren't looking at least half as sharp as me, you aren't getting on my ambo. It has been very common for me to send a student straight to the ironing board right after she walks into the station. Have been known to hand them a shoe shine kit too. Had a couple of them laugh at me. But after I looked them straight in the eye and didn't laugh back, they got the message loud and clear. Never had one anxious to see if I would really call their instructor or not. I had a partner actually order one to take a shower or go home, lol.

And yes, if one of them decides to loaf around and sleep or watch television, I pop a couple of impossible medical questions to them. When they say they don't know the answers, I tell them that's why I expect them to be studying during our down time.

Of course, I also set an example for these students too. My uniform is always immaculately neat and starched, and my shoes highly polished. And when a student is present, I make sure that they see that even the veterans have plenty to study.

Anybody that shows me they are serious, even if I have to start off setting them straight, gets a memorable and valuable field experience. So long as we are making runs, my students will have plenty of patient contact and perform plenty of skills. I'm not denying them anything within their scope of practice unless they are literally endangering a patient. As far as I am concerned, they are a member of the team and will be treated that way. I'm sure more than a few students have left my shifts mumbling about me being a hardass, but none every walked away complaining that I didn't let them participate or that they didn't learn anything. If we make no runs at all the entire shift, they are still going to learn plenty. And at the top of that list is professionalism.

[Ridryder 911]

Interesting, today as I worked in ER, I had a Basic (high school) EMT student. The staff had already warned him, that he would be assigned to me. Apparently all he did was play video games on his cell phone yesterday, when the staff would advise him of "might want to check out room # __) he refused.

So today I forced him to actually touch a patient, observe etc. .. of course I quizzed on something basic knowledge.. i.e strain vs. sprain etc.. of course no clue...

So now it comes time for evaluation... he smiles and even offers to buy me a coke... Unfortunately, I don't think he got the evaluation he wanted. I left note for his instructor to call me as well.

The also had a Paramedic student riding EMS unit as well and apparently did the same thing....my partner threatened to sew his pockets shut... "all he did was put his hands in his pockets and watch us... never wanted to participate in care and helping.us !.......

After a team huddle, we have decided enough is enough... we will now warn them once ... then after wards no further discussion ... Go home !... with unsatisfactory makes and to have a call to instructor. Sorry if you have to make them up...or get kicked out of the program ... get your ducks in a roll and your feces together... if you want to be a medic, you better be ready to learn......!

R/R 911

[Wackie]

I must be crazy since I'm sitting here wishing I could ride with you guys.

"Show me everything you know" :laughing4:

[PrissyEMT]

I've learned that clinicals are what you make of them. If you cling to the wall with your hands in your pockets and your mouth shut the whole time, you're probably not going to get anything out of it. However, if you take some initiative and jump in and show how willing you are to learn, you'll more than likely have an awesome experience. Today I did a 14 hour hospital clinical shift, and some of the guys from my class there were complaining that they didn't get to do anything- these were the same guys who spent all day leaning on the counter in the ED just waiting for someone to come to them with something to do. I personally had tons of fun, and got so much accomplished, simply because I jumped into things and asked lots of questions. You pretty much get out of it what you yourself put into it.

[Dustdevil]

Now, there are very definitely some really jaded nurses who are not kind or receptive to students, even when the students try their best. And I sympathise with those unfortunate students who stumble into their domain. But I also see nurses who start off with great attitudes who eventually lose their patience and tolerance because truly smart and enthusiastic students become the exception, and not the rule. Sometimes you get so used to students who come there without even the basic skills of vital sign taking that you just throw your hands up and no longer assume any student knows how to do them. I think there are apparently a lot of instructors who are not taking personal responsibility for assuring students are prepared to function, and just leaving it to the preceptors to wash them out. That's just wrong.

I can tell you, if I get a bunch of ill prepared students, I am much more likely to confront the instructors than I am to take it out on the students. There is really no excuse for an ill prepared student to even make it to clinicals without the inadequacy being caught by the instructor.

[Ridryder 911]

I agree Dust and part of this is probably true. We are fortunate that the local daytime ER staff is composed with about half of the nurses are former degree Paramedics with a history of > 12 years in the field. So, they are willing to teach, but like you described many are not prepared for clinicals as well. With the increasing number of patients and so much to do, it makes it very difficult to "teach" the student the basics sometimes. I can truly say most of this staff do remember what it was like to be a student, and are fortunate for that type of attitude.

At one of our local technical schools, it is apparently hard for them to "fail" students. the policy is more related to attendance than testing. this is ludicrous. Ones who fail the test cannot sit on the registry, but can attend class. This is something they are attempting to change now. So yes, I believe many allow some students to attend to help "weed" them out. Although, this might not be the best ... I have decided to assist. I am not loaded for bear, but; I will not be as tolerate as I used to be. Like others I felt guilty marking poor clinical grades, but; if the do not perform I grade appropriately, I write suggestions, and if they change their grade will too. If they don't or drop out.... my feeling is they probably would not succeeded in the field.

As I have posted earlier, on some things to be successful in clinicals, many do not present themselves appropriately. Either being lack of interest or apathetic.

I am sure I will get a reputation (if I didn't already have one) of being a smart-ass and being hard on students. I don't care, if you want to learn then I will teach... but, if you want your packet signed off for that nighttime class ride with someone else.

I was amused the other day when a Paramedic student arrived, and one of our newer aggressive Paramedics was going to precept. The student arrived ill prepared, without a stethoscope, ink pen, etc.. He asked the student where his "tools" were ? The student informed he had not purchased any as yet, because he did not know if he would finish the program and did not want to waste his money..... He was lectured on responsibility and how even plumbers come prepared and journeyman have an interest in their job albeit it will be a sh*tty day.

I do think there is a major problem with EMS education as most know my opinions. Restructuring to a more traditional medical program with on site clinical professors, different attire when in hospital settings (other than police type uniform), pre-clinical classes on how to act, perform, appropriate professional behavior and communications should be emphasized. Clinical phase should be given more percentage of their final grade, since this is really where they demonstrate what they have learned and actually is the job they will be performing.

Oh well, we have 4 fresh faces tomorrow... maybe one of these will pleasantly surprise me...

R/R 911

Be safe,

R/R

[IslandEMS]

Clinicals are what you make them to drive your education. I am currently finishing up my clinicals and would highly suggest your clinicals shifts match an ER Shift 8 or 12 hours. This gives you time to have more Pt but also get to know the staff. I was fortunate enough to do a batch of my clinicals together working 12 hour days 5 days within the week, for 3 weeks. I had others to do but the time I put together was the best. There were many benefits to this. The nurses know you and are comfortable with your skills, once you show them what you can do, are willing to do and want to learn. They work with you to further your skills and give you some more room to practice. All but 3 of the nurses, PA, and DR in this ER used to be medics so that helps a lot as well. Willing to learn and do ANYTHING is key. Take labs down after you draw them and see if any thing else needs to go. Help transport pt to x-ray when the ER gets backed up with trauma waiting on x-rax. Stock rooms on downtime and ask ?. Let me say that again ASK QUESTIONS. one of the best ones is: What can I do to help improve my _________ skills? So many staff have different methods and I learned some very useful methods this way. I learned more hanging out with the DR while looking at x-rays and asking him about the Pt and symptoms they presented with. Relationships are everything. I am able to start IV and EKG w/o supervision. I have started a External Jugular IV with the PA watching. Added a few stitches to a hand with the DR and Intubated a guy who coded in the ER. When you are able to build the relationship and willing to learn you become part of the team. When you are willing to do anything the staff will grab you when there is some really good experience for you. Oh ya ask the DR or PA is you can follow them a few days. There assessments blended with the nursing triage is your guide to Paramedic. It is also fun to see the change in stories between what the nurse receives and the Doc.

[Connie31079]

I'd just like to add my 2 cents to this discussion.

During my clinicals for my ACP program, I was gung-ho, ready to go for every shift. Show up for work, clean uniform, polished boots, and EARLY......so that I could help check the truck, and make sure everything that was supposed to be there was there, and working properly before logging on our crew.

Well.....I was black-balled from the beginning by my preceptor, and ya wanna know why?

Because I was overweight and because I'm female, THAT'S WHY!

Can you imagine how I felt when I got a mark of 2/10 for an evaluation when I was done, even though I thought I'd done a fairly good job during my clinical time?

Sometimes preceptors go on a "power-trip", and it goes to their head that they have the ability to pass or fail this person, who wants so badly to do well, and just get a job when they're finished. That's all I wanted.

In the end, I had to do an extra month of clinical time, and my college charged me an extra 700 bucks on top of the 10 grand that I had already paid at the beginning of the program, all because my preceptor didn't think women, especially overweight ones, should become paramedics.

[Dustdevil]

In the end, I had to do an extra month of clinical time, and my college charged me an extra 700 bucks on top of the 10 grand that I had already paid at the beginning of the program, all because my preceptor didn't think women, especially overweight ones, should become paramedics.

Exactly how did he word that opinion on your evaluation?

[Connie31079]

Dust, my instructor wouldn't show me the evaluation from my preceptor, but he told me in so many words, why he (my preceptor) gave me the mark that he did. I guess my instructor and my preceptor had a little discussion amongst themselves, just the 2 of them, and this was the reason my preceptor gave for giving me the mark of 2/10.

As a result, the college that I went to for my ACP program was fully prepared to fail me, based on this mark of 2/10 on my clinical evaluation. I appealed it, saying that it was biased, and that I didn't get a fair shake. I felt that my preceptor had a personal grudge against me because of my size and because I was female.

So, in the end, I was awarded another "chance" to prove that I was indeed a decent ACP, and that I deserved my diploma, but had to do another month of clinical at another site. Thus I was charged for an extra month of clinical ($700), and was not allowed to take part in the graduation ceremonies of my ACP program with my classmates that I had studied and gotten to know very well over the course of a year.

Once I was done my extra month of clinical, and got the marks that I deserved the PREVIOUS month, I was handed my diploma in my instructor's office, and wished the best of luck in finding a job.