See one, Do one, Teach one.
It’s a saying in medicine that dates back to when dirt was new.
We spend months of instruction in the classroom, skills lab and clinical setting being fed the basics we need to reach the final (dreaded) phase: Preceptorship. After months of grooming, blood, sweat and tears (ours mind you, not the patients’), when we are scared just enough tonot be dangerous anymore, we are sent out to “save the world.” Then, after a handful of years, it’s time to start paying it forward and the tables are turned: Now you become the teacher.
As we all know, medicine is a practice; a practice that is continuously evolving, and we have to evolve with it, keeping up on new advances, new techniques and new changes. There is one practice, however, that tends to impede this progress as it gets passed down through generations of medical professionals: The practice of “eating our own young,” so to speak. The, “I was taught this way, so I teach this way” mentality, or my personal favorite, “I had to go through hell, so they should too.” This isn’t isolated to EMS, we also see this behavior in medical and nursing students. It transcends throughout medicine, which seems ironic since we are perceived globally as a caring profession.
Paramedic preceptorship is the phase of training we dread, yet often laugh at when looking back on it. The first few shifts you feel like all thumbs: You question every breath you take and you play the guessing game as to what your preceptor would do and hope they don’t rip your head off. As first responders, we remember these days until the day we retire. We remember our preceptors forever and how they affected us. Some were cherished and respected, and others can cause you to throw PVCs by the mere mention their name.
Having had the privilege to precept in a couple different departments, I’ve seen first-hand how the style, thought process and culture can vary significantly from place to place. So why do some agencies breed fear, resentment and anxiety during this important learning phase? When the objective is to groom the next generation of medics to be great clinicians, why wouldn’t we be anything but supportive, encouraging, enabling and empowering? Shouldn’t we be like parents, finding ways to teach, encourage and grow confidence, priming our young for success? Instead, we still see some preceptors intimidate, ridicule, belittle and destroy trainees, gaining some twisted joy in seeing them squirm and fail.
Now, it’s disclaimer time: NOT EVERYONE IS CUT OUT FOR THIS JOB. There, I said it.
Some trainees must be cut as they simply aren’t able to perform the duties of this job. Period. Even if this is their dream job, sometimes it’s simply not a safe decision to allow these folks to practice medicine on humans or animals, for that matter. However, there are those who have the smarts, the skills and the logic to become incredible practitioners, yet because they land in the hands of a bad preceptor they are emotionally destroyed and walk away.
(Photo Courtesy of Queensland Ambulance and Team Australia EMS – Neil Nobel)
With that said, here are a few things to remember and/or consider when taking on the role and responsibility of an EMS preceptor:
- You were there once too. Remember your basic needs when you were the (baby medic): Support, instruction, guidance and encouragement go a long way. Ridicule, embarrassment and condescension will set you and your trainee back many shifts.
- Confidence builds competence, but arrogance is dangerous. I will take a student who has a great attitude and is eager to learn but struggling to put things together, and work to build them up. A trainee who comes to the lion’s den with a chip on their shoulder and maintains a cocky attitude, sadly has to be broken down (even if relatively knowledgeable). Given good leadership and straight-forward direction, building them back up will hopefully get them walking on a humble and safe path. Karma is a killer in this field and arrogance will bite you in the butt.
- There are different types of stress. Do not equate the fear of being eaten alive by their preceptor with a broader fear of running calls and making decisions. Knowing that you are being watched and critiqued causes even the best of practitioners to get nervous and fumble. “If you can’t handle this, you can’t handle the field”, you may argue. Well, no, not exactly. Some people are amazing test takers but can’t pull it all together when it really matters, while others are forward thinkers and do an incredible job of combining their didactic knowledge with real life but have serious test taking anxiety.
- Show them you’ve got their backs. When a trainee is on the call, everyone on-scene wants a piece of the pie. Don’t let other responders treat them like a pinata. They are your responsibility to not only educate, but also protect from others looking to inflate their own egos.
- Be discrete. If a correction needs to be made, make it, especially if it involves safety or patient care, then discuss and review it in private. Humiliating the student in front of the patient and other crew members is not only unprofessional, but it will destroy the patient’s confidence in your care, it’s horrible for your agency’s public image and will damage your trainees’ (and others’) respect for you.
- Check yourself. Much like parenting styles, just because we were parented a certain way doesn’t necessarily mean it was the right way. Same goes for preceptors. Our parents were learning as they parented, just as you are learning as you precept. Be open-minded to the lessons. Your style will continue to evolve as the years pass.
- Communication is the responsibility of the deliverer. If you don’t set clear expectations and provide examples, the student is set up to fail. Every call, no matter how mundane, is slightly different. Use it as a teaching opportunity and discuss what worked and what didn’t. Often the best way to review is to ask how they thought it went, then listen, often they will figure it out.
- IT’S THEIR TRAINING PERIOD. No professional football player walks out on the field their rookie year as good as they will be after five years in the NFL, so don’t expect the day-one paramedic to make the same timely and expert decisions as you do after 15 years of experience.
- All styles are different. Allow a shift or two of “ghost riding.” Let the student carry equipment, set up lines, do basic stuff, but not be responsible for running the call. Give them a chance to see if you are a “load and go” or a “stay and play” practitioner so they can gauge your style. Some practitioners are very aggressive, while others are more on the conservative side; let them see where you fall.
- Have a good time. Enjoy the ride of watching a new eager little beaver come join the family. The best way to learn is to teach. Not a class day goes by that I don’t take notes of questions asked by my students that spark a reminder of something I want to research or gain a better understanding of. Habits like this will make you a better practitioner, and hey, isn’t that what it’s all about?
Written by: Dannie Wurtz EMT-P, RN, EMS Instructor and Founder of RescueChic.com
~ Stay Safe and do Great Things!