The Preceptor-Student Relationship
The preceptor-student relationship is an indispensable tool for training future healthcare providers. This relationship is intended to teach students the kind of intricacies of the profession that cannot be taught in the classroom. Students can learn, for example, to intubate dozens of manikin heads in the airway lab, but that will only teach a technique. It will not teach students how to wade through vomit to find the trachea or how every person’s airway sits slightly different. But when the preceptor is in the trenches, he can guide students through that first real intubation.
What Is Expected?
Students at all levels must be willing to learn. They also need to communicate with the preceptor where they are in their studies and any particular strengths or weaknesses that they are aware of. For example, a student may say that he is comfortable with the bandaging and splinting skills he learned in class and would like to practice them in the field if the opportunity arises, but that he feels weak in patient-assessment skills and will need help before he can perform them independently.
Preceptors should find out from their students what they hope to achieve during their ride time. This helps meet as many expectations as possible and address unrealistic ones.
Many EMT-Basic students have never been on an ambulance before. They can be excited and intimidated by the prospect of their ride time. The preceptor should expect few skills from students at this level, but will be able to teach them many things.
Students should be expected to show up to their assigned shifts on time and ready to work, and to act professionally. While professionalism may come naturally to some people, for many it is a hard-learned skill. Some students may need to polish their appearance to become more presentable to the public. Others may have an abrasive tongue that needs to be more pleasant at times, such as learning not to use sarcastic or offensive language toward patients. Still others may need to refine their body language to make it more appropriate. For example, crossing their arms or rolling their eyes can communicate to the patient and his family that the EMS responder is not interested in their problems. Thus, professionalism may not be an innate characteristic for everyone, but preceptors can teach it and students can learn it. Being a good role model for students is the most efficient method of teaching them professionalism.
The preceptor is responsible for ensuring that students master many skills. Preceptors will need to teach the EMT-B student the subtleties of how to assess a scene for safety; how to approach and effectively communicate with a patient and their family members; how to progress a call from beginning to end; and how to communicate with other healthcare professionals. It is in these subtleties that preceptors help students become confident in assessment technique, along with basic procedures like checking vital signs, bandaging, splinting, patient-handling and moving, and even proper use of the stretcher.
As EMT-B students may only be required to ride between 24 and 48 hours to complete the Basic curriculum, preceptors are wise not to demand too much from this level, but to focus on serving as positive role models and reinforcing the knowledge and skills taught in the classroom. EMT-B students are extremely nervous because they do not know what to expect, and they are far from competent or confident in their skills; they need a preceptor’s experience to guide them.
The first several calls that students participate in should be limited to observation only. This allows them to begin to appreciate how a call progresses from beginning to end, and how to properly assess a patient without getting tunneled into performing a specific task.
After the first couple of calls, the student should be encouraged to engage the patient, asking some general questions and performing some basic skills, such as taking vitals, bandaging and splinting. The student should probably be steered away from trying to perform more difficult skills, even though they may have had training in them. This is both to protect the patient and to ensure that the student has a rewarding experience and does not become discouraged. However, if you feel that your student is ready to tackle these skills, then guide them through performing them. The goal is to help our beginners who have few hours of exposure to treating patients to get that exposure and the experience to grow in confidence.
EMT-Intermediate students may also only be required to ride between 24 and 48 hours to complete their program. The preceptor should not expect much more out of this level than the first—they may still have only limited experience in the classroom and in the field. EMT-I students need to continue to build upon the skills that they learned as EMT-Basics. These students will have new skills introduced to them through their coursework, depending on which curriculum they were taught. Preceptors should find out what skills their students think they are ready to perform and allow them to do so with supervision.
However, if your student is having difficulty performing basic skills and/or is tunneling in on specific tasks and not taking the whole call progression into account, he should continue to work on mastering these techniques prior to progressing to more difficult ones. Just as babies use furniture to pull themselves up and hang onto while gaining the confidence they need to take that first independent step, EMS students need to pull themselves up on those basic skills in order to build their confidence before attempting more difficult ones.
Students at the EMT-I level should not be expected to organize and progress a call by themselves. In reality, these students may only be capable of asking some basic questions and performing basic skills. They still need considerable guidance from their preceptor in running an entire call.
Paramedic students typically ride 400-plus hours on the ambulance, under the direct supervision of a specific preceptor. They are expected to progress from someone who needs a lot of guidance in skill performance, patient assessment and call progression to someone who is capable of being a team leader on most calls and who has the entry-level skills and knowledge to become an employee at any EMS service nationwide. Please note: I said the student should progress toward the ability to perform entry-level skills and obtaining an entry-level knowledge base.
One misconception in the EMS field is that students graduating as paramedics are able to function at some mythical level that took many of us several years of work experience to obtain. Don’t forget how shaky your skills and knowledge were when you first became a paramedic. It takes up to a year before you actually see the many different patient scenarios presented in the classroom, and more time yet to build the confidence you need to handle all the situations that come your way.
But if the paramedic student is self-motivated in helping the EMS crew complete station duties, as well as willing to study and ask questions during downtime, then soon enough the preceptor can expect to see steady progression in the student’s abilities. He should become more aggressive toward patient care (yet not get egotistical), show great improvement in assessing patients and directing their care, and set the right priorities in order to properly progress a call.
This level of training is where the preceptor can make the most impact in the skills-progression of the student. You will see the student perform in a real setting—unlike the educator who only sees the student in classroom scenarios. The preceptor will begin to recognize the student’s strengths and weaknesses: Praise his strengths, help him to understand his weaknesses, then guide him to set a course on strengthening both.
Some weaknesses may be easy to resolve—like the student who has a low IV success rate because their vein selection is not very good—while other weaknesses may be more difficult, requiring a cooperative effort between preceptor, student and educator to resolve. An example of this type of weakness is experienced by students who have difficulty retaining information taught in the classroom and consequently are not prepared for certain types of patients whose care is dependent on that missing knowledge. The student with this issue may have a learning disability that needs to be addressed or may be motivationally challenged and need to spend more time studying. Neither one of these problems is necessarily easy to fix.
Using Downtime to Advantage
Preceptors should guide all their students productively through whole shifts. Most preceptors understand what to do with a student when they’re running EMS calls, but what you do during downtimes is equally critical. It’s during the downtimes that you can help students grow their knowledge base.
First, use the lull between calls for review. Walk the student through each previous call step by step and discuss why certain things were done and others were not. Answer any questions the student may have about a particular call. Remember that you can offer students a different perspective from the one they were taught in the classroom. It is through integrating these different perspectives that students begin to develop those all-important critical-thinking skills.
Second, use downtime to cover content that the student is having difficulty with. You can possibly present the material in a way that makes more sense to him.
Third, drill your student about the equipment on the ambulance regarding its location, what it’s for and how to use it.
Fourth, use the time to quiz the student on whatever you deem relevant. This will let you know if the student is comprehending and retaining what he needs to know. It will also tell you in which areas the student is strong and which areas are weak.
Last, maintain contact with the student’s training institution concerning any issues that you believe are relevant to his successful progression through the program.
In the October issue:
Students’ Perspectives on the Student-Preceptor Relationship