CATAWBA VALLEY COMMUNITY COLLEGE
EMERGENCY MEDICAL SCIENCE
PRECEPTOR MANUAL
Revised April 2005
Adopted February 1997
Copyrighted 1997
Catawba Valley Community College
Hickory, North Carolina
INTRODUCTION
The faculty of the Emergency Medical Science Program at Catawba Valley
Community College have long recognized the need for and the benefit of
having qualified designated preceptors for its paramedic students.
Indeed the training of paramedic students cannot be successful without
these preceptors for as we all know what happens in the classroom cannot
replace field training and neither one can stand alone without the other.
It has been the good fortune of CVCC to have many qualified, involved
preceptors. CVCC is committed to its preceptors and its annual training
program offered to them. That training, however, will be reinforced and
strengthened by the addition of this manual.
The manual was, in fact, developed mutually by the EMS faculty and
preceptors. It is hoped that the manual will be a dynamic document and will
be modified and/or updated on an annual basis as a result of input from
preceptors, students, administrators, advisory committee recommendations
and the faculty.
Any preceptor is welcome and is, in fact, encouraged to share their thoughts
with the faculty as to how to improve this document. The training paramedic
students receive at CVCC is in no small part due to the efforts of their
preceptors.
2
THE STUDENT’S DILEMMA
There is something I don't know
that I am supposed to know.
I don't know what I don't know,
and yet am supposed to know.
And I feel I look stupid
if I seem both not to know it
and not know what I must pretend to know.
Therefore I pretend to know everything.
I feel you know what I am supposed to know but you can't tell me what it is
because you don't know that I don't know what it is.
You may know what I don't know, but not
that I don't know it,
and I can't tell you. So you will have to
tell me everything.
R.D. Lang, Knots
(1970)
3
COMMUNICATION
As all of us know who have attained a mature age (notice how this changes as
we age) in the workplace and in society, communication is essential in all that we
do.
Communication can be thought of as the exchange of thoughts or messages. If
communication is social, it may have a different goal than professional
communication but either way good communication does not just happen.
Whoever is involved in the process, whether the sender or the receiver, must
be an active participant. Good communication takes work. Work can be made
easier or more difficult by the tools we have available to us and whether we
choose to use those tools and keep them in good repair.
Many different sources are available to anyone who would like to improve their
communication skills. Information on communication like anything else varies
from the most simple to complex. The following sections share information
that will help us all in our efforts to communicate.
4
Principles of Communication
•
Every communication experience is unique. This can certainly be good or
bad depending on how you look at it.
•
Distractions can prevent communication. This is sometimes controllable,
other times not. If it is not possible to control distractions, then you
must make every effort to make sure communication is occurring. For
example, if Martha is trying to talk with a 19-year-old male student when
Cindy Crawford walks by, he just might be distracted and not hear her!
•
Every message is mostly nonverbal. 95% is nonverbal, 5% verbal (depends
on what book you use).
•
There is no
mistaking a student's nonverbal communication when you get "the look".
•
Words need to be clarified. Don't forget that many words have more
Likewise, feedback can be nonverbal as well as verbal.
than one meaning. Also, one person's idea of "You did OK" and another's
are not necessarily the same. Clarifications such as "Does OK mean I
treated the patient well or does it mean I just didn't kill them"?
•
Selective perception can distort the message. They only hear what they
want to hear. Any of you guys married and swear to your spouse that no
you didn't remember them telling you your mother-in-law is coming to visit
for a week?
•
You must send a message of trust. This is easier to establish with some
students than with others. Always try to remember to respect the
student and their feelings even when what you have to say may not be the
most complementary.
•
Face-to-face communication is more personal. This is always best as you
can read the student and the student can read you. It is always best to
be careful and make sure they are reading the right pages.
5
ACTIVE LISTENING
1. Concentrate intensely on what is being said. Don't be doing five things
at once while someone is trying to talk to you. There will be times when
this happens but if we are aware that it is a roadblock to communication
we may be able to overcome it.
2. Use perceptual checks. In other words check in once and awhile and
make sure you are on track. For example, you may want to say "Am I
hearing you say you are nervous about taking over patient care as team
leader?"
3. Remember emotional deaf spots. We all have them--certain words or
situations that ring our bell or push our button. Try to discover what
your "hard of hearing" spots are so you can know when you need to turn
up your hearing aid.
4. Create a positive listening environment. An environment free of
distractions and what is perceived as non-threatening to the student.
Remember what the student perceives as threatening may be totally
benign from your standpoint but to them very real. For example,
correcting them in front of peers or the Medical Director will be very
threatening to them even if that was not the intent.
5. Be mindful of a person’s personal space. If you get into their space they
will feel threatened and be thinking of that rather than what you are
saying. Everyone's personal space is different. Some students will feel
comfortable with the up close and personal, while for others just having
you in the same room is reason for panic. The personal space may also
have to be adjusted according to the gender of the two individuals.
6
25 BARRIERS TO EFFECTIVE COMMUNICATION
Failure to use language that can be clearly understood by those to whom
it is addressed. First level students may not have yet mastered medical
terminology but be very hesitant to let you know that. You may go two
or three weeks before you realize everything you have said to the
student up to that point was like Greek to them.
Failure to recognize that the same words may have different meanings
for different people and under different circumstances.
Incorrect statements.
Failure to distinguish between "fact" and "opinion". This can be really
dicey. You may think someone has an attitude and that is your opinion.
You can, however, point out the fact that the student spends two out of
three hours telling anyone who listens that they already know everything
and they don't know why they are having to do clinical. That would be a
fact. Bet none of us have ever had this student before.
Failure to recognize that words convey not only information but also
sentiments and feelings. Remember the vast majority of communication
is non-verbal. It may be the tone or pacing of what you are saying
rather than the words that are being communicated. You know the old
line, "Gosh, you look great. Is that a new hairdo?" When in fact the
message received is, "What the hell did you do to your hair?"
Failure to recognize that tone of voice and actions also convey meaning.
This one like the one above can take a lot of work to allow good
communication to occur. Let's face it. Sometimes we won't enjoy what
we have to say and it may take a lot of effort to be nonjudgmental but it
is part of the job. That's why it is called work.
Poorly organized communications that are difficult to interpret. Planning
ahead what we are going to share and giving some thought as to how to
do so in a logical and clear cut manner.
7
Lengthy or complicated communications that are difficulty to follow. Go
from the simple to the more complex. We all walked before we ran or
most of us anyway. Remember too that active listening takes a lot of
energy and if you ramble on and on your listener will have a tremendous
amount of trouble focusing, especially if one of his or her bodily
functions are calling.
Incomplete communications - lack of essential facts to support ideas. If
your student is having a problem that must be addressed, such as the
fact that you think their drug knowledge is inadequate, you need to plan.
Set aside ample time to discuss the problem that you see and be
prepared with the facts that support your view. For example, Billy Bob
has just given a 100 mg lido bolus to a guy in CHB and the patient is now
asystole. This is a very good example of a fact that proves his
knowledge is substandard. But as the patient arrests, it would not a
good time for a complete discussion of this matter. A better place and
time would be after you single-handedly rescue your patient from any
early trip to see St. Peter.
Poor timing of communications. Timing can be everything. The same
thing said at a different time can make a world of difference.
Distracting circumstances:
Emotional situations
Noise
Interruptions
Telephone calls
Lack of privacy
Failure to select the method and channels of communications most likely
to accomplish the purpose intended. After 15 years in this business I
still don't know the right way to tell someone they don't seem to have it.
The right way is different for each preceptor and each student.
Sometimes we try so hard not to hurt the student's feelings that we
have sugarcoated our facts to such a degree that they think the talk
they just had was a pat on the back and not a serious discussion about
their ability to progress. If anyone comes up with a fool proof plan for
this, let the rest of us know.
8
Failure to explain or give reasons. For example, "I am giving you an
“unsafe” on patient evaluations because you consistently forget to do
the ABC's on your patient". Any time a student receives an “unsafe” we
must be able to document how their actions was a danger to the patient
or others.
Distortion of meaning in the chain of communications. Remember the old
telephone game that we used to play as children. Well, the game is still
around and it sure hasn't changed much. Another way to look at this is
to know that if you want something communicated to the student
yourself, do it yourself. Don't send a messenger that may have gotten it
mushed around a bit.
Failure to reach all those who should be informed. If you have a student
that is really having trouble, don't keep it to yourself. The faculty and
other preceptors need to be informed. In the best case scenario
someone else may have a suggestion that helps solve the problem.
Failure to ascertain if the communication is understood.
Instead of
asking "Do you understand?" it is preferable to ask "Could you please
repeat what I have just said regarding this patient's cardiac status?"
Failure to take into account the attitudes, feelings and viewpoints of
those involved in or affected by the communication (lack of confidence,
fear, resentment, past experiences, beliefs, etc.). Both preceptor and
student are armed with baggage from their social, cultural, religious and
racial background. If we recognize this, we can make it work. After all,
men and women have been able to communicate more or less for
centuries. If these two foreign entities can do it, so can a preceptor
and student.
Failure to take into account your own attitudes, feelings and viewpoint
(prejudices, beliefs, past experiences, likes, dislikes, etc.). Ah shucks--
this statement makes it look like some of us might be opinionated. That
surely can't be so!
9
Failure to observe the behavior and circumstances with which the
Could this possibly mean we should be
communication is concerned.
careful about what we see or hear from others?
Failure to listen to what others are saying or trying to say. I don't care
what anyone says we all do this sometimes and some of us more than
others. It will do us all good to work on this.
Failure to provide opportunities or encourage others to express facts or
viewpoints and to raise.
Failure to get and hold attention. Might have to get a bit creative here.
Remember, sometimes the more quiet spoken your words are the greater
weight they carry. But remember too you are about to render the most
profound thoughts ever to be uttered if no one hears them............
Taking an arbitrary position which may close the door to reaching an
agreement. Is this another way of saying to try to be approachable and
let the student know you will listen to what they have to say?
Ever forget your
anniversary or a birthday? Did much pleasant communication occur that
evening?
Inadequate advance planning or communications.
Failure to relate the communication to "the demands of the situation".
The situations we will be in with students will often be less than
optimum. Sometimes our communication skills will have to be used when
the circumstances are better. A student may take offense to a tense
"get back in the truck" and will have to be mature enough to know that it
can't always be pretty out there. If they don't realize it, we will have
to effectively point it out at some time.
☺☺ MAKING THE STUDENT FEEL WELCOME ☺☺
10
During the development of this document field preceptors were frequently
asked to help in the development of different sections. Time and time again
preceptors stated that one of the most important things was to make the
student feel welcome when they first arrive at the base.
Remember that one of the principles of communication was to send a message
of trust. This cannot happen if the student is made to feel as if he or she is a
burden or is treated in such a way as to feel that they are lower than an
earthworm. As much as we would rather not admit these things, we have all
seen them happen. Whether we as a student were treated that way or perhaps
we have seen peers treat the student in that way or horror of horrors in some
former life we were that *&^%$ preceptor.
It is difficult at times to reach a good working balance with students. As
preceptors it is not your role to be the student's best friend but a mentor and
teacher. We thus have to develop a relationship in which there exists a
respect for both student and preceptor. Yet both student and preceptor must
recognize the role of the other and act accordingly.
In order to begin establishing this relationship a group of our preceptors have
come up with the following recommendations that they thought would make the
student feel welcome during their time at the base.
11
MAKING STUDENTS FEEL WELCOME (cont.)
Better known as
"Do unto the student as you would have liked
to have been done by your preceptor”
Greet and introduce yourself. Yes, give them your real name when the
student arrives.
Introduce them to the other employees working at that base.
Take the time to go over the entire truck for the location of equipment
and as an ice breaker.
On the other hand don't take all day to go over the equipment because it
could cause a stressful day for the other medic by irritating them.
Explain what exactly is expected of them on a call. Don't wait until you get
on a call to tell them.
Upon completion of the ride time review the evaluation form with the
student with emphasis on their strengths and with suggestions for
improvement in areas that you may have felt were weak. If possible, end
the review with a positive note.
Give personal stories about calls you have run. Try however (HO HUM)
not to do this on a consistent basis. Use your clinical experiences to
illustrate very specific points, not to just fill in a silent spot.
Give the student time to ask questions.
Discuss the call and how the call went after the call is completed. This
may not be possible every single time but it should be the rule rather than
the exception.
Don't quiz the student in front of other employees, students or the
patient. I'm willing to bet my retirement fund you wouldn't want to be
put in that particular spot yourself.
12
Introduce them to the hospital staff. This will demonstrate to the
student that you feel you are part of a team that includes the ED. It also
will make them feel important that you would take the time for this social
function. They will feel like a real person, not a wart on someone's
posterior.
Include the student in all activities such as base clean-up and washing the
units, indeed if they don't jump up begging to help. This is one of those
times you should point out to the students this EMS "stuff" isn't just
about red lights. It is also an opportunity to demonstrate professionalism
by showing the pride you have for your unit and its appearance.
The student needs to understand that patient care is their responsibility
and the preceptor is there to assist or take over if necessary. Bob likes
to say, "You can't hear with your mouth open." My own personal favorite
is "You can't learn if your Mama does it." It may very well be that the
best preceptor is the guy or gal that sits on their hands. Any one of you
that are parents can remember or will soon learn what it feels like to let
"Junior" take that first tumble without you there to catch him. Well as a
preceptor you will have to catch before the patient is in danger but try
your best to make it clear to the student that you expect and want them
to render actual patient care. But also let them know you will be there to
catch them before they fall. The student who feels comfortable with
this concept will be more aggressive and involved in patient care.
13
ROLE OF THE PRECEPTOR
Now let's get to some of the nuts and bolts about this preceptor thing. To
start with, let's define preceptorship and talk criteria.
A preceptorship can be defined as a plan that is organized and educationally
sound developed for the purpose of introducing the student to the role of the
paramedic in the work setting. You as preceptor will be responsible for
accomplishing this goal.
EMS managers are always asking the faculty what criteria should be used in
identifying preceptors. That question is hard to answer. Many a lunch
conversation has been centered on this issue. So far we have determined that
there are both professional and personal qualifications that combine to make
an effective preceptor. The following sections explore some of these
characteristics.
Professional Qualities of the Preceptor
Preceptors like any other teacher must possess certain qualities characteristic
of professional teachers. The following are examples of such qualities:
Knowledgeable of subject matter
Organization skills in making a presentation
Competent in the profession
Resourceful in problem solving
Communicates clearly and concisely
By utilizing these qualities in your daily clinical teaching activities you will have
a positive influence on the student's professional and educational growth.
Students will usually seek assistance from and respect the judgments of those
who keep up to date and are clinically competent. It is essential for preceptors
to maintain their clinical competence, for they are the experts and must be
able to teach the students the practical skills. As a preceptor, you do not want
to be classified as "those who can't do, teach".
14
Personal Appearance
The students that you teach and supervise have a dress code and policies which
they are expected to follow while in the clinical setting. As the clinical
preceptor you are responsible for enforcing policies to make certain that the
students always appear neat and clean.
In order to ensure that students follow the specified rules, it is essential that
you follow the policies yourself. You cannot expect students to follow policies
regarding clean uniforms and appropriate attire such as boots, ironed pants,
etc. if you do not do so yourself. It is important for you to set an example.
Keep in mind that the example you set for your students now will be taken with
them after they graduate.
A copy of the Student Guidelines developed by the CVCC faculty is found in
the appendix of this manual so that you may easily reference what is expected
of CVCC Paramedic Interns.
Professional Behavior
The clinical preceptor must exhibit appropriate professional behavior at all
times.
This professional behavior extends itself to establishing and
maintaining a professional relationship with the students. It is not advisable to
be a close friend and/or confidant to the students you precept. A situation
may come up that will put you in the unenviable role of acting the heavy to a
student you had become very close to. Has this ever happened? Too many
times to count I'd say.
As a professional you have already learned that you are always judged by those
who know you as a paramedic, whether you are on the truck or fly fishing in the
mountains. This sometimes becomes a burden when we want to let loose so to
speak.
15
Imagine if you can a situation where you and your student become close and go
out for a night on the town. Imagine also if you can that you may have just one
drink too many on that evening. Further imagine that you do something stupid.
After all we are entitled every once in a while. Yet take this to the next week
when you are to precept that same student. He or she comes in obviously hung
over from a big night. How will you now in the role of preceptor sanction a
student who is perhaps repeating your behavior of the week before? The same
could be said of sharing confidences with a student that would be more
appropriately shared with peers or friends. It can be a hard job to find that
line one must walk when you are in a preceptor/student role.
Other aspects of professional behavior include using correct grammar,
refraining from using profane language, and conducting yourself professionally
in public.
Demonstration of Ethics
Preceptors must demonstrate ethical behavior. Each individual has a personal
code of ethics which is derived from cultural values, ethnic and religious
influences, family and peer expectations, and other sources.
In addition to a personal code of ethics, as a healthcare worker you were
taught a professional code of ethics. These codes provide guidelines for all
members of that particular profession to follow. By demonstrating appropriate
personal and professional ethics, you will help the students to do the same.
16
THE EMT OATH
Be it pledged as an Emergency Medical Technician, I will honor the physical and
judicial laws of God and man. I will follow that regiment which, according to my
ability and judgment, I consider for the benefit of patients and abstain from
whatever is deleterious and mischievous, nor shall I suggest any such counsel.
Into whatever homes I enter, I will go into them for the benefit of only the
sick and injured, never revealing what I see or hear in the lives of men unless
required by law.
I shall also share my medical knowledge with those who may benefit from what
I have learned. I will serve unselfishly and continuously in order to help make a
better world for mankind.
While I continue to keep this oath unviolated, may it be granted to me to enjoy
life and the practice of the art, respected by all men, in all times. Should I
trespass or violate this oath, may the reverse be my lot. So help me God.
Adopted by the National Association
of Emergency Medical Technicians
1978
THE EMT CODE OF ETHICS
17
Professional status as an Emergency Medical Technician-Paramedic is
maintained and enriched by the willingness of the individual practitioner to
accept and fulfill obligations to society, other medical professionals, and the
profession of Emergency Medical Technician-Paramedic. I solemnly pledge
myself to the following code of professional ethics:
A fundamental responsibility to the Emergency Medical Technician is to
conserve life, to alleviate suffering, to promote health, to do no harm, and to
encourage the quality and equal availability of emergency medical care.
The EMT provides services based on human need, with respect for human
dignity, unrestricted by consideration of nationality, race, creed, color, or
status.
The EMT does not use professional knowledge and skills in any enterprise
detrimental to the public well being.
The EMT respects and holds in confidence all information of a confidential
nature obtained in the course of professional work unless required by law to
divulge such information.
The EMT, as a citizen, understands and upholds the law and performs the
duties of citizenship; as a professional, the EMT has the never-ending
responsibility to work with concerned citizens and other health care
professionals in promoting a high standard of emergency medical care to all
people.
The EMT shall maintain professional competence and demonstrate concern for
the competence of other members of the Emergency Medical Services health
care team.
The EMT assumes responsibility in defining and upholding standards of
professional practice and education.
18
The EMT assumes responsibility for individual professional actions and
judgment, both in dependent and independent emergency functions, and knows
and upholds the laws which affect the practice of the EMT.
The EMT has the responsibility to be aware of and participate in matters of
legislation affecting the EMT and the Emergency Medical Services System.
The EMT adheres to standards of personal ethics which reflect credit upon
the profession.
EMT's, or groups of EMT's, who advertise professional services, do so in
conformity with the dignity of the profession.
The EMT has an obligation to protect the public by not delegating to a person
less qualified, any service which requires the professional competence of an
EMT.
The EMT will work harmoniously with and sustain confidence in EMT associates,
the nurse, the physician, and other members of the Emergency Medical
Services health care team.
The EMT refuses to participate in unethical procedures and assumes the
responsibility to expose incompetence or unethical conduct of others to the
appropriate authority in a proper and professional manner.
The National Association of Emergency Medical Technicians
19
Personal Qualifications of the Clinical Preceptor
A major part of clinical teaching involves instilling appropriate attitudes in the
students and fostering affective growth. Many personal characteristics of the
preceptor help to develop good attitudes.
The following is a list of personal qualities that are characteristic of effective
preceptors:
Enthusiastic
Energetic
Exciting
Empathetic
Humorous
Stimulating
Warm
Approachable
Cheerful
Accessible
Patient
Friendly
Understanding
Imaginative
Honest
Fair
Motivating
Demonstration of these qualities can help to build a positive interpersonal
relationship between the preceptor and the student. The development of
positive interpersonal relationships helps students to grow and improve their
learning.
In order to emphasize the importance of demonstrating these characteristics,
it might be helpful to look at a hypothetical situation:
Karen, a paramedic student in Goose County EMS, is having great
difficulty interpreting the algorithm for V. fib. She approaches Ms.
Jones, her preceptor, and asks for assistance. Ms. Jones replies, "Can't
you ever get that straight? The other students do not have a problem
with this algorithm". Karen appears upset and loses confidence in herself.
She is afraid to get help from Ms. Jones and so she takes the chart to
Mr. Ryan, the shift supervisor. Mr. Ryan smiles and shows Karen how to
interpret the protocol.
20
As evidenced by this example, the preceptor and shift supervisor
demonstrated quite different reactions to Karen's request for assistance. Ms.
Jones' demeaning attitude had a negative effect on Karen to the point where
she asked another staff member for help.
As a preceptor, you will undoubtedly have bad days in which you do not feel like
being cheerful and enthusiastic. However, you must be careful not to convey
this to the student, just as you expect them to display appropriate behavior to
the patients and staff. Demonstrating desirable personal characteristics will
help your students to grow.
21
PRECEPTOR RESPONSIBILITIES IN THE CLINICAL AREA
Provide clinical instruction to the CVCC paramedic intern.
Act as a professional role model to the student.
Act as a liaison between the student and other members of the health care
team.
Be responsible for the student and their actions while at the clinical site.
Discuss the student's goals and your own goals and objectives for the day
clearly and as early in the rotation as possible. Let your student know what
your expectations are of them.
Be present while a student is providing patient care. Never leave the student
unsupervised.
Double check all medications to be administered by the student before they
are administered to a patient.
Don't be intimidated by student questions. Answer to the best of your ability.
If you do not know the answer, admit it and direct the student to the
appropriate reference.
Provide helpful and timely feedback regarding student performance in the
clinical area.
Set aside time at the end of the rotation to review the student's written
evaluation.
Provide a comfortable learning environment for the student.
Should a situation arise in which you feel the student for whatever reason
appears to be unsafe in the clinical setting, dismiss the student from the
clinical site and contact the EMS program director or a faculty member
immediately.
22
Should a situation arise and you are not sure what action should be taken, feel
free to contact the EMS program director or a faculty member at any time.
It is important that a student who performs a task that is unsafe or has
behaviors that are unsafe be identified in writing and/or verbally as soon as
possible. This will give the faculty a chance to do some remedial work with the
student in order to try to correct deficiencies. It is important for you as a
preceptor to know that an “unsafe” documented by a preceptor does not mean
automatic dismissal from the program. It is critical to our patients that the
preceptor identify any student that is unsafe in patient care.
23
WHAT CVCC EXPECTS FROM ITS PRECEPTORS
Attend a preceptor training program that the school provides or that is
available through another agency.
Precept students as assigned.
Talk with the student at the end of each assigned shift with documentation to
the clinical coordinator when appropriate to evaluate current progress and plan
future experiences.
Contact the clinical coordinator when the preceptor has concerns or
suggestions regarding a student. This contact should be made in a timely
manner depending on the urgency of the matter.
Share patient care with students being precepted. Yet be aware that the
preceptor is in fact ultimately responsible for the care of the patient.
Directly observe and evaluate the student’s clinical performance.
Complete documentation of your evaluation of the student and insure the
return of the documentation in a timely fashion to the clinical coordinator.
Familiarize the student with the unit and other staff members. This includes
staff members at the hospital or other agencies that you will frequent.
Plan appropriate learning experiences. The plans will be directed by the
strengths and weaknesses of the students and the facilities available to the
preceptor.
Act as a role model and clinical resource for students being precepted.
Evaluate student’s performance and make recommendations regarding the
student success in achieving clinical goals.
24
CRITERIA FOR SELECTION OF A PRECEPTOR
Clinical Expertise:
Demonstrates ability to provide safe care to patients
Demonstrates critical thinking and decision-making skills
Interpersonal Skills:
Tactful
Patient
Direct
Sensitive
Provides positive and negative feedback
Flexibility
Desire
Leadership and Teaching Skills:
Ability to set priorities and make sound decisions
Identifies learning needs of the student
Professional Attributes:
Participates as a productive member of the health care team
Demonstrates interest in professional growth through continuing
education
In reviewing the preceding page I just realized we have established criteria
that even a saint in good standing would have trouble meeting.
That says a lot about the caliber of our preceptors.
25
RESPONSIBILITIES OF CVCC FACULTY
or
What We Think We Should Be Doing To Make The Preceptorship Work
•
Provide input regarding selection of preceptors according to the policy
of the EMS Department.
•
Provide clinical objectives to the preceptor.
•
Contact preceptors for any special concerns regarding the student or
the clinical experience.
•
Compile preceptor evaluations and distribute them appropriately.
•
The faculty will do everything they can to get these evaluations to
preceptors...preceptors can help by making sure the faculty has current
addresses.
•
Make every effort to be available to preceptors for any concerns or
questions.
•
Listen to preceptor's concerns and/or suggestions.
•
Provide training opportunities for the preceptors.
•
Recognize the importance of the preceptors and clinical internship.
26
What is Expected from the Students by the Preceptors and CVCC Faculty
Identify their own learning needs. When the student arrives on the truck
they should be able to tell you their strengths and weaknesses and indicate
what areas they would like to concentrate on.
Meet with the preceptor and clinical coordinator when requested.
Provide the preceptor with the evaluation forms necessary for
documentation of clinical performance. These forms should be available to
the preceptor at the beginning of each shift. Preceptors certainly have the
right to send a student home from the base if they do not arrive with an
evaluation form.
Arrive at the clinical site in a timely manner, properly dressed out, and in
a manner that is prepared and positive. In the past a student or two have
arrived either unprepared because of a lack of necessary equipment or because
they have not prepared themselves to perform. There has also been a student
or two with an "attitude". The occasional student who was up all night for one
reason or another (I believe we have heard them all by now) is neither
prepared nor safe. The faculty feels it is the student's responsibility to be
ready to perform from the time they arrive at the base. Should a student not
appear prepared for any of the above reasons or for a couple we haven't heard
yet, they should be sent home. The student would not be safe nor would
learning occur. Our patients deserve better than that.
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PRECEPTORSHIP MODEL
Preceptor is prepared for the role.
Consistency in personnel so that the student is with the same preceptor as
much as possible over a period of time.
Learning needs determine the assignment. For example, a student who is
having trouble at the ALS level may be sent to a service with a higher ALS call
volume.
Objective-centered learning. The student has specific objectives to complete
in a designated time frame. These objectives are clearly written on the
evaluation form. These objectives change with each semester.
Specific time frame. A semester lasts 16 weeks. Although if a student
requires more time for competency in a certain area, if it is reasonable to
provide that additional time, we will try to facilitate it. This may be based on
the student's past clinical and classroom performance and attitude toward
learning.
Preceptor guides the experience. The preceptor will have a plan for the
assigned days. For example, if it's a slow day with few calls there will be a plan
so that learning will occur. For example, simulations with other crew members.
Preceptor is the driving force. The preceptor makes it happen for the student.
The Roles of the Preceptor
28
The preceptor has numerous roles:
a)
b)
c)
d)
Director of learning
Role model
Builder of the program and the profession
Liaison
As a preceptor, it is important that you fulfill these roles to the best of your
ability.
A.
The Preceptor as a Director of Learning
As a director of learning, the preceptor has the responsibility of
selecting and organizing the opportunities that will achieve the
learning outcomes desired. Even though you may not be making the
student's major clinical assignments, as a preceptor you are at the
site with the student and must make the day-to-day decisions
regarding a student's clinical experiences.
At times, it may be very difficult to provide the students with
appropriate learning experiences. For example, the truck to which
you are assigned may respond to only two calls on your shift. In
these cases, it is up to the preceptor to provide an alternative
learning type activity such as reviewing algorithms or the drug box,
etc.
Part of the role as director of learning involves structuring the
environment of the clinical setting so that a positive atmosphere may
be achieved. This involves a great deal of effort on your part since
you must deal with various personality types and situations of stress.
Should a conflict occur between a staff member and a student, the
preceptor must be a mediator and help solve the
29
problem. At times, students feel pressured and stressed by their
assignment. It is up to the preceptor to assist the students in coping
with the stress. By controlling factors such as conflict and stress
you will help to create a positive learning environment and facilitate
the learning process.
As the director of learning in the clinical environment, you are
considered by the students and some staff to be the primary
resource person. You are the subject matter expert and must assign
daily learning tasks to the students. In addition to assigning
students to practice specific skills, you must assign tasks that help
students to develop a positive and caring attitude toward the
profession and the patients. In your daily interactions with the
students, you should be emphasizing appropriate attitudes, ethics
and encouraging the students to share their feelings and reactions
concerning their assignments. Group discussions and role playing are
techniques that may be useful to demonstrate appropriate affective
behavior.
B.
The Preceptor as a Role Model
Modeling in education is defined as learning by imitation. Some
preceptors do not recognize the importance of their role as a model
to the students.
The clinical setting is an unfamiliar situation to new students. They
do not know how to act on the truck, and thus tend to imitate
someone who they believe exhibits appropriate behavior. As a
preceptor, you are the most likely choice to be the student's role
model.
When a student follows the example of the preceptor, he/she usually
receives approval from that preceptor and finds this satisfying. The
student will then most likely continue to exhibit similar behavior.
Does this mean we are producing little clones in our image? This
could be a sobering thought for most of us.
30
The imitation form of learning can be very effective, provided that
the preceptor consistently demonstrates appropriate behavior. On
the other hand, if the preceptor is a poor example, the student is
likely to develop similar behaviors. This is especially true if the
preceptor seems to get away with inappropriate behaviors. The
faculty tries to keep this in mind with preceptor selection. However,
we realize that sitting in our offices two counties away that we are
not always privileged with this information. This is one of the
primary reasons that the agency's administration will help us to
identify preceptors for our students.
As the primary role model to the students, it is essential that you
Most preceptors
exhibit appropriate behavior at all times.
demonstrate competence in the necessary skills to the students but
seem to neglect the importance of demonstrating appropriate
attitudes. You should demonstrate the personal and professional
characteristics discussed earlier.
Many times you will notice that the students will model unacceptable
behavior exhibited by other staff members. It is important for you
to help the student realize that the behaviors are unacceptable. The
best way to help them is to demonstrate acceptable behavior
yourself. If you do not, you cannot expect the students to exhibit
good behavior. The saying "Do as I say, not as I do" is inappropriate
for teachers in any setting.
C.
The Preceptor as a Builder of the Program and the Profession
As a preceptor, you have a primary responsibility to the health
agency for which you are employed, as well as to the profession to
which you belong. You must help to build the profession. Part of this
role involves being able to work with the staff of the educational
program. This includes the director, instructors, physicians, and
anyone else responsible for the students' education. You must
respect their attitudes, values, individual talents, and utilize them as
resources.
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In addition to assuming the role of a teacher, it is especially
important for preceptors to be representatives of their health
profession and of health care workers as a whole. This means
keeping up to date with the profession as well as maintaining active
affiliation with your professional organization. If you do not
participate in the organization, you surely cannot expect your
students to participate. As a builder of the program and the
profession, the preceptor demonstrates loyalty and dedication to
both the professions of teaching and of the health occupation field.
D.
The Preceptor as a Liaison
Another major role of the preceptor is that of being a liaison
between the clinical site and the school and between the program
itself and the community. Whether employed by the school or the
health care agency, the preceptor is the key person who understands
the goals and functions of both the school and the clinical site. Any
information that needs to be communicated between the school and
clinical site will be channeled through the preceptor. You, as a
preceptor, will serve as that link between the school and the health
care agency.
The preceptor is also a liaison between the program and the
community. Health care consumers place certain demands and
expectations on health practitioners. As a health care consumer,
member of your profession, and member of the school staff, you
must convey these expectations to future members of the
profession--the students.
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ABOUT TEACHING
There are literally hundreds of thousands of publications about teaching and
learning. It is impossible to impart all that has been written to preceptors
through this manual. It is also not educationally sound to present too much at
any one time in regard to a new subject.
As preceptors your competence and expertise lies in your knowledge of
medicine and patient care. In order to be a good preceptor one must also know
a bit about learning and teaching.
Paramedic students come to us from a variety of different backgrounds. Some
come right from high school, some from other medical fields and others from
no medical background at all. Students have come in at the tender age of 18
and at the more mature age of 40 something. What this all means is that as
preceptors you are dealing with the adult learner. As such they are a
different specie from the so called "traditional student". We must therefore
recognize them as different and gauge our teaching methods to their unique
characteristics.
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CHARACTERISTICS OF THE ADULT LEARNER
*
Need to know why that particular knowledge is important.
*
Self directed.
*
They have a lot of previous experience upon which to build their
knowledge and need to be recognized for that prior experience.
*
Will learn on a need-to-know basis. Not so much theoretic as
what do I need to know to do this job.
*
Task-centered learning. The theoretical knowledge should be
linked to specific tasks and taught interactively.
Most of you probably have past teachers that you remember either with pain
or a warm feeling in your heart or elsewhere. We all do. Those that we
remember made a significant impression on us in one way or another. You may
decide to draw from your own specific memories and adapt a particular
technique that you thought was effective to use for your precepting. Or you
may vow never to do what was done to you.
A fact about which much has been written is that there are many different
kinds of learners. In other words each individual will learn in their own way.
The way in which students learn will depend to some degree on how their brain
was put together, whether there is a learning disability or not.
Some students will be fast learners while others take a slower route. Some
learn by merely hearing or reading something while others may have to repeat
information over and over before it settles in for keeps. Some students will be
strong in the classroom while others will excel in the actual clinical care of the
patient.
All in all we have to help the student identify what works for them as an
individual and then adapt our teaching to what will work for them. No one
method will be effective for all students.
34
The bottom line is to find what works for each particular student. As adult
learners they may very well know what that method is if we ask them. We
must utilize their strengths and correct their weaknesses if any so that they
can prove competence in patient care and become the best paramedic they can
be.
Should you find a student that is having difficulty and you are not being
successful in your role, then call a faculty member and we will all work together
to try to come up with a plan to help that student be successful. You may one
day find a student that you personally are not successful with but one of your
peers is. That is not necessarily a failure on your part but rather a success in a
program that may identify a more successful preceptor/student combination.
Likewise there may be times when no preceptor is able to bring a student to
competence. As sad as that may make everyone, we must remember that we
have a responsibility to those in our care to graduate safe and competent
paramedics.
35
TEACHING PRINCIPLES
*
Start with the simple and proceed to the complex. We start with oral
airways and BLS before we get to the fun ALS stuff. Sometimes we try
to get ahead of ourselves and go right to the top. It doesn't work. ALS
is no good without BLS.
*
Have planned sequences of learning. It takes seven repetitions to
ingrain materials. More than likely a student cannot observe a classroom
demonstration on IV insertion and then get their very first stick. The
faculty is constantly urging the student to practice, then practice some
more and when you think you've got it, practice again. Your support with
this line of thinking would be greatly appreciated!
*
Provide for an immediate application of didactic materials. If your plan
is to discuss splinting with the student, then pulling out your splints and
splinting each other on your downtime would be a great idea and more
learning would certainly occur.
*
The content should direct the teaching methods used. For example, a
lecture on defibrillation would not be appropriate without a lab on the
same and then a clinical opportunity to practice the same. A unit on acid
base may be better suited for a computer tutorial, etc. Acid base for
that matter may be better suited for the circular file ("just kidding").
*
Build on the student’s success and refer back to the success frequently.
It takes a lot of discipline to remember this. If the student didn't get
the IV stick but has good technique that's what we can build on.
Granted there may be a time or two where that one part of success can
be found but if we learn to look hard enough we can find it.
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EVALUATING LEARNING PERFORMANCE
◊
Measure the behavior. For example, supervise the student defibrillating
the patient.
◊
Compare behavior against an established standard of performance for that
behavior. For example, the skill check-off list in the appendix of the
preceptor manual or your SOP for defib in the service.
◊
Appraise whether the observed behavior meets the standard of
performance. For example, did the defib comply with the check-off list for
defib.
◊
Decide based on the appraisal. For example, mark the sheet acceptable or
unsafe. If unsafe is marked, the reason for the unsafe must be clearly
spelled out and documented. You may also want to include your suggestions
to make the skill successful in the future.
In regard to evaluation and teaching a point that we would like to make is that
evaluation and teaching is different depending on whether the student is first
or second level. During the first year some evaluation is occurring as it must
but the priority in that first year is learning. The students are very scared
during these first clinicals. We must demonstrate empathy and help them to
become familiar with us and what is expected. On the other hand, with the
second level students, evaluation becomes more of a priority. These students
will be going out on their own soon and we must assure ourselves of their
competence and safe patient care. These thoughts are not to be found in any
literature but have developed through the experiences of CVCC’s faculty and
from discussion with CVCC’s Medical Director.
37
PEOPLE TO KNOW AT CVCC
ADMINISTRATION:
Cuyler Dunbar
President
Bill Dulin
Dean of Student Services
Wayne Wooten
Dean of Curriculum Programs
EMERGENCY MEDICAL SCIENCE:
Naomi East
Associate Dean, Health Sciences
Martha McCrea
Department Head
Tim Chewning
Faculty
Reid Roper
Faculty
Dr. Jon Giometti
Medical Director
PHONE NUMBER:
828-327-7000
Martha
Ext. 4347
Tim
Ext. 4345
Reid
Ext. 4167
ADDRESS:
Emergency Medical Science
Catawba Valley Community College
2550 Hwy 70 SE
Hickory, NC 26602
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CONCLUSION
The purpose of this document is to provide for you a reference and guide for
your work with paramedic students.
It is expected that along the way you will find questions that are not answered
in this document. It is hoped that as a preceptor you will recognize the EMS
faculty as an additional resource, one that you will feel comfortable contacting
in those situations. A resource that is, we hope, readily available to you
through identified means.
The published goal of the CVCC Emergency Medical Science Program is:
“To prepare students that upon graduation are competent to
perform at an entry level EMT-Paramedic position."
The development and publishing of this manual is one more positive step toward
that goal.
The EMS faculty is forever grateful to the men and women who precept our
students and help develop them into the fine graduates that we are proud to
claim as our own. Without your help and dedication this would not be possible.
39