A new type of Paramedic Internship (For AnthonyM83)

[Dustdevil]

So, what about my original scenario of the EMT who failed out of his medic internship?

Ooops! Sorry, I somehow got dragged away from the original point. My bad.

In these cases, one of two situations almost always stands to blame for failure; either the school sucks or the student just wasn't medic material. I firmly believe that the former is much more common than the latter. But, since so many schools do suck, it is also extremely common for them to let in people who had no business there in the first place, as well as fail to weed them out.

I think [what seems to be] Marty's point is valid. This is a failure of the educational system in every way, and it must change. But the way to improve education is certainly not to require the students be pre-experienced. That's a total cop out. Experience without a foundation (and EMT school is NOT a foundation, by any means) is not anything that is going to make any significant difference in a paramedic student's educational success. No quality educational institution should be relying on previous "experience" that can neither be qualified nor quantified. Internships should assume nothing that was not taught in the school. Only a shyte system would do that. And there is no inherent, long term benefit to a student being exposed to those scenarios you mention ahead of the educational process. Those lessons are much better learned after a grounding in the basic sciences and concepts of practice. Otherwise, they are learned in a vacuum, without relation to the overall process. Pointless.

Nobody is saying that students don't need experience. What I keep saying is that there is an optimal timing and quality for this experience, and before Paramedic school is not it. Yet, what seems to keep happening is a lot of idiots keep re-arguing that experience is needed, with clueless disregard for the importance of quality, quantity, and timing.

Another problem is that internships should be a learning and teaching experience, not a test. And too many preceptors seem to think their job is to judge if this person fresh out of school is ready to practise independently yet. That too is a cop out. It is their job to prepare this person for practice, not to only judge if they are prepared. That is something that has to change about internships.

But basically, this is all a moot point, because our current system of EMS education cannot be fixed. Sure, you can put lipstick and a skirt on this pig, but it's still just a pig. You can improve internships and produce better medics, but they will still be severely limited by the system which they are a product of. Any meaningful change will require completely erasing the current slate and starting over from scratch.

[Medic26]

But basically, this is all a moot point, because our current system of EMS education cannot be fixed. Sure, you can put lipstick and a skirt on this pig, but it's still just a pig. You can improve internships and produce better medics, but they will still be severely limited by the system which they are a product of. Any meaningful change will require completely erasing the current slate and starting over from scratch.

Now Dust, your an educated person. Wouldn't you rather think that change would more likely come from a gradual approach, slowly increasing the standards until they reach your expected level? Yes its time consuming but the end result would be the same.

[Dustdevil]

Wouldn't you rather think that change would more likely come from a gradual approach, slowly increasing the standards until they reach your expected level?

No. I'd rather see it happen in my lifetime.

We haven't changed a bit in thirty-five years. I don't know how much more "gradual" you would like to see it, but we're more likely to see peace and prosperity in Africa before we see the kind of change that EMS needs.

When we are in this exact same sad situation thirty-five more years from now, and wankers with a few hours of tech school training are still beating their chests over "skills" while whining over their lack of respect, and two more generations of people seriously devoted to the profession have again been forced to leave for greener pastures because EMS turned out to not be a real career, you will have only yourself to blame. Me, I will sleep in my grave with a clear conscience.

EMS doesn't need evolution. EMS needs change. Serious, significant, meaningful, all encompassing change. There is absolutely nothing here that is worth salvaging. Trash it. Start over.

I can list the benefits of rapid change all day long. Can you tell us any benefits to slow, gradual change? I sure can't. In fact, I submit that slow change isn't even possible. This is a fight. It is a vicious fight against multiple opponents, with our own allies conspiring against us. There is not the slightest chance in Hell that you can win that fight conventionally. It's time to go thermonuclear. No pain, no gain.

[AnthonyM83]

Nobody is saying that students don't need experience. What I keep saying is that there is an optimal timing and quality for this experience, and before Paramedic school is not it.

See, I'd agree with this, but considering the way current systems and schools are setup, it's seeming that before paramedic school IS the time to do it in order to survive in these systems. Even if it's a great school in other ways, the school might still be stuck in the current system. So, in order to survive it, it seems like students almost require that previous experience to do well in internships.

[zzyzx]

The best way to learn is not from your own mistakes, but from other people's. The beauty of having several years of 911 experience as an EMT is that you get to see not only how things should be done, but also how they are done badly. Anyone who goes from EMT school to medic school with little or no field experience should not be surprised that their first year as a medic is going to be very stressful as they will have to learn the hard way from their own mistakes. If you know that you're going to get a job working alongside another medic, then you can lean on your partner, but most new medics won't have that luxury as they'll probably work on a private ambulance alongside an EMT partner.

Having said that, I agree with Dust that in a perfect world there would be not EMT's. Instead, if you wanted to become a medic, you'd go to school for several years and your education would be divided between the classroom and the field. After graduating, a new medic would have to work for at least a year alongside an experienced medic mentor before being allowed to work with other new medics.

[jsadin]

The problem these days is that it is increasingly difficult (at least in Massachusetts) to get any 911 experience as a basic. Back when I first started, most services were BLS and ALS was few and far between. I remember well calling for an ALS intercept and being told there were none to be had. These days, most 911 services are running at the medic level which is great. Unfortunately, this leaves the basic EMT with a lot less opportunity for meaningful patient contact (i.e. - not IFT).

It stinks that the medic student in question could not handle himself on a call, but I seriously doubt it was due to the fact that he did not have enough ride time as a basic.

[stcommodore]

the preceptor should have set expectations and an outline to some degree of the progress his/her student would make.

example

Starting from day 1...introdution to each other and the service

day 2...BLS only first 20 calls (minus rare als skills being intubation/chest decompression)

phase 3...getting familar with ALS/operating as ALS

phase 4...operating with little assistance by preceptor

phase 5...independent operations, preceptors final shifts before 'being signed off'

Some people become preceptors because of any number of reasons, but the sad fact is many shouldn't because they lack the ability to actually teach and mentor. I had a rather long experence during my 'paramedic internship' and found that my preceptor(s) where as much teachers as they were mentors. In the 2-6 months you spend with them you spend alot of time with them and that can have alot to do with your sucess or lack there of.

[jsadin]

Some people become preceptors because of any number of reasons, but the sad fact is many shouldn't because they lack the ability to actually teach and mentor

The really sad fact is that many teachers and professors can't teach/mentor. I can't even begin to tell you how many college courses I've taken where I could have done just as well by walking into class, taking down the assignments and walking back out to go home and learn it on my own. My advice; don't rely on anyone but yourself. If you happen to get lucky and get a great preceptor/instructor, consider yourself blessed.

[Just Plain Ruff]

During my paramedic internship I happened to latch on to one of the best most educated paramedics I have ever had the chance to work with. His name was Michael Spuehler. He not only mentored me but he taught as well. We spent every minute of downtime in education topics from mundane to the intense. In fact one evening we were discussing dytonic reactions.

Our next shift we got a call with the classic signs of a dystonic reaction. I clued right into this patients problems. We both discussed the treatment regimen and called medical control and were given the exact orders we requested and the patient was darn near resolved of the condition upon arrival at the er. The doctor gave us "way to go" when we got there.

We discussed this call afterwards and I for one would not have recognized the dystonia if I had not been prepped by Michael the shift before.

I learned a lot from him and took that knowledge back to my paramedic practice and believe that education never stops. It especially does not stop when you pass your medic and get your license. It is only just beginning. I truly believe that if you set expectations, you set guidelines of what your shift is going to be like and the student understands this and follows thru, then if you do your job you will have a competent street ready paramedic in your service.

The same holds true for EMT's if you have them in your service. I remember my experience as an emt new hire. My first day(very first day at the company) I was going in for orientation but they already were backed up 4 911 calls. They pulled me out of orientation and put me on a unit with a medic. Our first call was a pediatric non-breather. I was crapping bricks. I drove to the scene, got the things they asked me to get, did cpr and finally got to drive l&s to the hospital with 3 firemen, a medic and a supervisor in the back. Talk about stress. I did all right and then the day went to the crapper after that.

We had one more code, a major trauma and several critical and some bullshit calls. Talk about trial by fire.

My second day was more sublime but I never did get thru orientation.

That style of orientation should never be done to anyone. But I made it thru.

I prefer a more gradual orientation with classroom time and then graduating to the ambulance and getting a 3 man crew with the orientee being the one being taught.

Never take things for granted and always listen. I may have hijacked this thread but I just couldn't stop typing(Probably should have, too late though).

If your preceptor is too busy talking on the phone or doing personal items and business then request a different preceptor. YOU Have to take charge sometime of your own destiny and that includes asking for a different resource to get you acclimated to the company. If you do not take charge of your career then you have no one but yourself to blame if it doesn't work out.

[DwayneEMTP]

A few thoughts...

I'm just passed my second week of Phase One (of four, 500 hrs/min.) preceptorship after going straight from basic to medic.

The only real challenge I've found so far in relating to patients is the time aspect. It's difficult to get the information I want, apply the monitor, get a BGL, and start an IV (the requirements my preceptor has for me for me for about 85% of our patients.) with the 5-12 minute average transport time that we have..(This is my observation phase)

But why would I be better off gaining this experience with less knowledge? Is the theory that I would do better simply because I would have less to think about? So my empty head is an advantage somehow when it applies to learning assessments, patient interaction, and treatment?

Would I be less nervous if I had a year of experience as a basic? Probably. Should I be doing this at all if I need a year to get over the jitters and learn to speak to patients? Not really for me to say...

For me, I agree with Dust and others...my school did very little to prepare me for preceptorship. We ran few scenarios in school, had no access to the service's protocols before hand, etc.

As well, preceptorship started with the paramedic saying “I don't like the way you've chosen to become a paramedic, it shouldn't be legal, and I'll tell you up front that I won't pass someone like you through on their first attempt.” (Well...alrighty then...)

Not exactly the welcome you'd expect from an educator...and so far I've gotten pretty much what she led me to expect. Common interaction: Me “I didn't really expect her breathing to deteriorate so quickly, what did you see that made it your priority?” Medic “That comes with experience, and you don't have any do you!?” (Was that somehow an answer to my question?)

I perhaps have a somewhat unique view, being older, having held professional, responsible positions most of my adult life, as well as having been responsible for teaching people for the last 20 years or so...

The system is broken. From the expectations set at the beginning of basic, to the 'figure out a way to pass everyone' medic program, to the immature, ill prepared preceptors that many are exposed to. It's a system run on egos and convenience. I'm not sure I have seen even a small percentage of this path that is designed to progress EMS as a career...it needs a good exorcism.

An outstanding example of this?

My preceptor was giving me a scenario that required me to run through my ACLS protocols...She thought the new standards were pretty stupid, and said “The protocols, OK, maybe are written by Dr.s and such, but they haven't seen a patient in 20 years! On the street we ignore them and do what works!”

I came into EMS with high standards, believing I would enjoy spending my days with others that shared these standards, yet at nearly every junction there are educators, preceptors, employers, demanding that you drop those expectations in order to proceed...

Am I cut out for professional EMS? I am, I just can't find any.....