THE AMBULANCE as Classroom

The role of a paramedic preceptor is part teacher and part evaluator... how much of each is up for debate.

     One of the most challenging aspects of becoming a paramedic is making the transition from the classroom to the ambulance. Students approach this part of their training with their brains full of drug calculations and obscure medical conditions. Some students have previous experience as EMTs to prepare them for the road ahead. Many do not.

     Paramedics reminiscing about paramedic training are more likely to recall their time in the back of an ambulance than their time in the classroom. Stories about field training often center on the stress of being watched and judged. The source of the stress? The paramedic preceptor.

     The role of a paramedic preceptor is part teacher and part evaluator. How much of each is up for debate. Nevertheless, most program directors expect a lot of teaching to go on in the back of the ambulance.

     Amanda Cotter coordinates clinical rotations for paramedic students at Greenville Technical College in South Carolina. "The students don't have it all figured out," she says about field time. "They are trying to take the knowledge they have learned from the book and put it all together." That's only going to happen if the students are taught in the back of the ambulance, not just evaluated, she says.

     State requirements for preceptors vary. California, Georgia and Virginia all require potential preceptors to take courses on adult learning concepts and have a minimum of two years' experience. These and other states require paramedic students to ride with one or more trained preceptors, who will grade each student's performance and determine if the student is ready to transition from the classroom to the field. Minnesota, on the other hand, does not require training for paramedic field preceptors. Larry Starks, director of the paramedic degree program at St. Cloud Technical College, says, "There is nothing in the state that requires any minimum standard for a preceptor."

     Starks says his students are assigned to ambulance companies rather than individual preceptors and often ride with different crews on different days.

     Cotter says South Carolina, like Minnesota, does not require training for paramedic preceptors. Despite this, many providers designate preceptors or training officers to guide students and new employees. Cotter works to make sure preceptors from the agencies that participate in her program get the training they need.

     "I have done a train-the-trainer type program," Cotter explains, "and have sent that training CD to the different services that we contract with for their review. If services wanted, I have also gone to their training sessions and taught it for them." Cotter says the training is designed to show potential preceptors "not only what we expect of the preceptor, but what we expect of our students."

     St. Cloud's paramedic students are evaluated by their non-preceptor crews, but the evaluations are only for student feedback and to help Starks. He doesn't use field evaluations to determine students' final grades. In fact, according to Starks, Minnesota statute does not allow non-faculty members to grade students.

     California students, on the other hand, are required to get passing scores from paramedic preceptors in order to graduate. That requirement puts a lot of pressure on training programs to have qualified preceptors readily available to assign to students. It creates a demand so great that many of California's trained preceptors command a price for training paramedic students. The going rate is almost $1,000 per intern.

     Paying a premium for preceptors means students expect quality mentors. Darrell Albino, a paramedic preceptor in California, agrees with that expectation. He believes that simply being a paramedic is not good enough. "You have to have some other skill or knowledge to make a good preceptor," he says. "First of all, you have to have a good base of medical knowledge with experience to draw from. Second, you need good communication skills and to be able to pass on that knowledge."

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