Improving EMS Clinical Preceptorships

A guest article by Caitlyn Armisteadparamedic-preceptor

Clinicals are a critical component of EMS education. These dynamic educational environments can be complicated to manage in order to ensure a complete education for each student. Consider these points as you structure your program and develop guidelines for the coming year.

1) Support Strong Mentorships

Formal preceptorship relationships are effective in transferring procedures and protocols to a student; however, the informal dynamics of a solid mentorship are even more effective at conveying not only clinical concepts but positive culture as well. The primary ingredients are time and empathy. A strong teaching environment is built over time in hundreds of small interactions. A student needs time to warm up and build trust; the preceptor needs time to identify strengths, weaknesses, and academic needs. The worst possible way to schedule clinical mentoring is to randomly place students with whomever is available on shift that day.

It is also critical to be selective in whom you choose as mentors. New employees look for role models, and their preceptor is an obvious choice. If mentors are chosen simply from the employees with the most time at your service, there is the risk of jaded viewpoints and out-of-date practices. Mentors should be chosen from among the seasoned employees that you want to replicate within your organization, not simply the one who has managed to hold the same position for the longest time.

2) Reduce Power Symbols

Rules concerning student conduct should be well defined in policy manuals and reviewed with students. However, these rules should be reasonable for the conduction of clinicals and not exist solely to create a false appearance of discipline while demeaning and belittling the student. Even when not written in overt policy, many times these mandates exist de facto at a clinical site. These sometimes include:

-students must only sit at a table and study, with no other permissible activity, for an undefined or

  unreasonable amount of time

-students must never sit in comfortable chairs

-students must never eat at the same table

-students must never ride in the cab, never observe driving operations

-students must only ride to calls in the box, in the dark, without air conditioning and/or

  radio contact

-students must never have radio access (at times, this may be a safety issue on scene)

-students must never be allowed the same safety equipment as the personnel

Rules such as these, whether explicit or implicit, send a very strong message to students. The usual response when rules are questioned is that they create discipline in the student and that “students need to know their place.”

The result of such power symbols varies depending on the student. To some, it is merely annoyance with little gain. Others may be reluctant to engage with a mentor and ask necessary questions. Students motivated by affiliation, however, can be demoralized. This can result in a student losing academic momentum or being more likely to choose inappropriate behavior.

3) Teaching techniques are important

New skills and activities should be introduced, modeled, guided, and supported, just as they are in the classroom. Checking off supplies in the truck is a great activity for a student, but when a student is given a paper and expected to go on a scavenger hunt alone, the benefit is minimal and the teaching opportunity–identifying equipment, telling what it’s used for and why it’s in the location that it is–is lost. If a student is expected to learn efficiently, a teacher needs to be present. If a student is expected to ask questions, the preceptor must be available to provide an answer.

4) Use objective evaluations and rubrics

Evaluations should be clear, precise, and as specific as possible. Students are quick to notice when a critique is based more on their football team preference than their skills in the field, but that can be difficult to prove if the guidelines are vaguely written: “gets along well with EMS staff.” When critiques are unreliable and yet used determine a student’s grade, students driven by achievement and autonomy, in particular, are demotivated. These students want to earn their grade on their own merit and want concise goals and boxes to check off. This requires not only well-designed evaluations, but also well-trained preceptors.

5) Avoid turf wars

When two or more students are assigned to the same station, truck, or even the same calls, learning opportunities per student are reduced. This can also lead to the student focusing on jumping calls instead of gaining knowledge and building the mentoring relationship. “Nice” students, who defer calls to others, may end up with sub-par clinical experiences. When setting schedules, attempt to ensure adequate call resources for all students and enforce these guidelines.

6) Choose healthy clinical sites

EMS services with toxic work environments easily infect students with poor work ethic, bad habits, and out-of-date dogma. This becomes critical if laws and standards of care are broken, and huge problems can result if a student is caught in the middle or is forced to become a whistleblower. When all possible, avoid such sites and use other services and hospitals for clinicals.

7) Ensure respect

Female, minority, and older EMS students, participating in FISDAP, reported significantly lower preceptor performance ratings compared to Caucasian males (Page, 2013). While this issue needs further study, in the meantime, it is important that all students be treated with respect and empathy. If uniforms are required, make sure there are options designed for females. Harassment and hazing policies should be easily understood and enforced. Student concerns should be welcomed and anonymous reporting available.

Conclusion

Clinical rotations and field training are expensive for a service; they divert time from the best field personnel to a student or new employee. It only makes sense to make the most of these opportunities. Preceptors must embrace the concept of being a mentor. And the training staff, with the support of administration, needs to provide a healthy environment where both formal and informal education can occur. By constructing thoughtful policies and implementing solid practice, clinicals become a valuable dynamic education experience that pays long-term dividends.

2 Comments

  • daleloberger says:

    One of the problems discussed at another post of this article was the role of the student in reviewing the preceptor. While this feedback is crucial to the success of any such program, there are multiple dangers. To the peril of the preceptor is an unfair and overly critical review by a student who simple may have clashed personalities. Another is more typical and, I believe, far more damaging to the entire program. In this case, a student may feel compelled to grant a “passing grade” to a preceptor based on the image of this instructor being a more senior employee who enjoys enough respect from the administration to represent the organization through their personality and arbitrary show of authority. It is my belief that this is worse because it can not only creates a cynical environment that inhibits learning, but because it perpetuates a division within the field staff.

    The best solution I have heard yet, is a focused list of objectives for scoring the preceptor through statements such as “My preceptor clearly explained his/her expectations of me during the shift”, “My preceptor thoughtfully de-briefed every run with me afterwards”, “My preceptor showed concern for my learning experience and encouraged open questions.”

  • daleloberger says:

    Some helpful definitions:
    pre·cep·tor: teacher responsible to uphold a certain law or tradition
    men·tor: trusted counselor, guide, tutor, or coach

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