EMS Internship Precepting Goals & Guidelines

EMS Internship PreceptingGoals & Guidelines Amy Gutman MD ~ EMS Medical Director prehospitalmd@gmail.com

Objectives • Define preceptor roles & responsibilities • Define student roles & responsibilities • Define rotation expectations • Review adult learning principles

WelcomeTo Tobey Hospital & TEA! • TEA’s motto “Decus, bonitas et lustumfac” translates to “Pride, Integrity & Professionalism”, literally “Do The Right Thing” • Learning is an ongoing process, not a singular event that ends after initial certification • This presentation is an adjunct to the Prehospital Education Outreach (PEO) Handbook given to each student which you are expected to be familiar with prior to starting your rotation

When You Have A Question • Late to shift or Ill? • ED HUC: 508-273-4680 • During business hours Donna Costa (TEA Office Manager): 508-273-4198 • General Questions? • Your preceptor • Complaints / Concerns / Issues? • Sue Valdez RN (Prehospital Care Coordinator / PCC): 508-274-6690; valdez_986@msn.com • Susan Robbins RN (ED Manager): 508-273-4186 • Amy Gutman MD (EMS Medical Director): 513-255-1353 (text me); prehospitalmd@gmail.com • Paperwork Issues? • www.TEAEMS.com has extra forms, handbooks & presentations in your in “Rotation” section • Ask your preceptor for assistance • All completed forms turned in to Donna Costa for filing in the ED • General Information: • Address: 43 High St, Wareham MA • Parking: Across from front entrance, or in ED parking lot • Tobey ED Phone: 508-273-4680 • Tobey ED Fax: 508-273-4185 • Human Resources: 508-273-4005 • Tobey Main: 508-295-0880 • TEA Website: www.TEAEMS.com • EMS “Wall”: back hallway leading to ED office – constantly updated Tobey Hospital is a Non-Smoking Campus!

Preceptor = Mentor • There is no “EMS For Dummies” – every student, interaction & environment requires attention to detail & modification of educational principles • Your attitudes & actions have a significant impact on the kind of EMT the student will become • The mentoring a student receives is as, if not more important than their initial or recertification classroom training • Students pattern their “style” by observing management strategies of their mentors

Learning Domains • Knowledge: • Facts, procedures & affective phenomena • Cognitive: • Comprehension of facts, procedures & affective phenomenon by analysis of information, synthesis of information & evaluation of the information • Affective: • Receive & respond to knowledge & perceptions in an organized format • Psychomotor: • Articulation, imitation, manipulation & naturalization • Problem Solving: • Analysis of information or situations to develop course of action & judge impact of actions

Adult Learners • Learning is an active change in behavior due to interactions with environments & experiences with acquisition of habits & knowledge • Adult learners different than “new” learners, as they have already developed methods to cope with weaknesses & accentuate strengths • Auditory Learners • Learn by lectures only; may have learning disability diagnosis i.e. dyslexia • Visual Learners • Need to “see” things & concepts • Kinesthetic Learners • Learn by doing • Adult learners often have combination styles of learning that combine auditory, visual and kinesthetic components

Prehospital Care CoordinatorRoles & Responsibilities • Sue Valdez RN, EMT-P is TEA Prehospital Care Coordinator (PCC). Her decades of clinical, didactic & teaching experience in the educational, prehospital & hospital realms are a perfect background for her job • In addition to her responsibilities with TEA & EMS / Fire, Sue provides supervision for student-related activities within the ED & Tobey Hospital • Addresses issues arising during internship • Remediates students identified by preceptor(s) as having difficulties • Brings out the strengths & weaknesses of our students & our preceptors • Sue Valdez and Susan Robbins RN (ED Manager) help coordinate the rotations & act as point of contact for concerns or complaints • The PCC is NOT responsible for making sure your forms are filled out, you show up on time, you are dressed appropriately (etc) – this is a function of fulfilling your “professionalism” requirements

Tobey ED Rotation Goals • Phase One • Student focuses on skills performance & patient assessment • Task oriented, i.e. assigned to start the IV or perform & interpret the EKG • Phase Two • Student begins to assimilate assessment, diagnostic & treatment skills & information to make global decisions as a team leader • Lead team on “straight-forward” patients such as single system trauma, abdominal pain, etc. • Phase Three • Student functions as leader on complex patients under the direct supervision of the preceptor • Focus on decision making, delegation, communication with EMS & ancillary personnel

Preceptor Responsibilities • Provide model for student to emulate & provide climate conducive to learning • Supervise & guide performance • Provide positive & correctional feedback encouraging student development • Be passionate about EMS Education & helping students succeed • Be the eyes & ears of EMS Education • Update educational program to meet students, preceptors & hospital needs • Good communication skills including listening to student • Share practical & didactic knowledge • Completely & honestly fill out evaluation forms • Maintain high degree of professionalism • Keep an open mind • Prevent student from doing harm to patient(s) or themselves

Preceptor 10 Commandments 1. People can surmount their environment, therefore there is rarely a “hopeless” student 2. Try to help everyone become sensitive & compassionate while at the same time be tough-minded & steadfast 3. Students must “own” responsibility for their own conduct & consequences thereof 4. You can learn from your students as they learn from you 5. Professionalism, professionalism, professionalism 6. Remember the sacredness & dignity of your calling as a clinician & a preceptor 7. Your primary responsibility is to the patient to “do no harm” 8. Honor those engaged in the pursuit of learning no matter their background or perceived potential to contribute to the field 9. The students who put more effort in, get more out – the same goes for the preceptor 10. Cherish & maintain an appropriate sense of humor

Adult Learning Teaching Principles • Know student & adapt around anyspecial needs • Use experiences (yours &theirs) • Tie theory to field practice • Provide positive learning climate • Offer a variety of teaching formats • Motivate & inspire with your actions by modeling expected behavior • Assist students in finding resources & answers • Be “success oriented” • Have a positive attitude • Develop feeling of support, acceptance & teamwork • Relate to students’ past experiences, both positive & negative • Provide positive & constructive feedback

Student Goals • Gain experience in provider role • Integrate as a member of the medical team & begin taking role of “team leader” • Take a more global view of provider role by learning about: • Assignment delegation • Transportation choices • Stocking • Daily vehicle & supply checks • Integrate professionalism into every action & interaction • Be humble: no matter your experiences you can always learn from those around you

Student Responsibilities You are responsible to confirm your clinical time…show up prepared to work & learn Arrive at least 10 minutes before the start of the shift Be properly dressed with proper ID Review paperwork with preceptor when questions arise Inform preceptor of your level of training / prior rotations & your expectations for the rotation & / or shift Accept criticism with an open mind Act in a professional manner at all times Review end-of-shift paperwork with preceptor each shift Do homework as assigned

Prior to Each Shift • Preceptor reviews prior field time / ED time student has completed • Preceptor determines student’s perceptions of strengths & weakness • Preceptor determines other preceptors’ / peers perceptions of student’s strengths & weaknesses • Preceptor relays their expectations of the directly to the student, i.e. “Today we’re going to focus on ACLS medications” • Student should relay expectations of the preceptor, i.e. “I really need to work on EKGs today” • Both will review daily routine/responsibilities • Both will review equipment & department / ambulance layout

Student Preparedness Medications procedures • Generic / Trade Name • Mechanism of Action • Pharmacology Class • Indications • Contraindications • Dosage (adult / pediatric) • Reversal Agent • Who gets procedure (i.e. clinical indications)? • What equipment required? • Where do you correctly perform procedure (i.e. IO in medial proximal vs mid-shaft tibia) • When /Whyis procedure indicated & when is it contraindicated? • How is procedure performed & how do you fix potential problems?

Good Students • Communicate clearly with patients, peers & preceptors • Efficiently manage scene / case • Rapidly complete a thorough patient assessment • Identify chief complaint & develop differential diagnosis based upon that complaint • Formulate & provide appropriate management strategies • Provide clear direction & leadership for team members & EMS personnel • Abide by the “100% / 100%” principle – give 100% effort, 100% of the time!

Patient Assessment Evaluation • Allow student to complete their assessment before intervening to ask additional questions • However, if there is a need for a “prompt” or the student asks for help, gently “guide” the assessment conversation • Intervene immediately if student at risk of doing harm • Take mental notes about what student did well, & how they could improve

Skills Performance Evaluation • Positive but honest • Remember that patients & their families are an audience to the educational process • Mentally note weaknesses, then in a timely manner, document on evaluation form as well as speak to student directly • Never let student do harm!

Documentation Evaluation • Ensure chief complaint, history, assessment, management & outcomes are properly documented • Noting pertinent positives & negatives key to developing critical thinking skills • Documentation of variances or unusual aspects enforces critical thinking • i.e. “NTG not given as patient’s SBP <100”

Evaluating Student Performance • NREMT, TEA & paramedicine program skill sheets • Preceptor-Student meetings • Evaluation of skills, knowledge, professionalism • Scenario-driven or specific to a medication, procedure, etc • Early identification of strengths & weaknesses, with timely remediation as needed

After Patient Interactions & Each Shift • Ask student what they think what did and did not go well with that shift or with a specific patient interaction • Positive & correctional feedback, AKA… The “Sh-t Sandwich”: • Say something positive: “You really were professional today”, followed by a negative: “You really did not do a great job missing those IVs today”, followed by another positive: “But you did a GREAT job interpreting EKGs” • Ask what the student believes they could do, or what the group could do to improve patient care • At the end of the rotation, please have student fill out the “Rotation Evaluation” form which can help the PCC & Medical Director continuously adapt the rotation to meet student needs

Problem Solving • Inappropriate attire or without proper ID badge / paperwork • 1st: dismiss from shift & reschedule • 2nd: dismiss from shift & notify prehospital care coordinator • There is no 3rd time without a written request from the student & their paramedicine program • Intern arrives late without adequate explanation / notification • 1st: dismiss from shift & reschedule • 2nd Time: dismiss from shift & notify prehospital care coordinator • There is no 3rd time without written request from the student & their paramedicine program

Problem Solving • After giving correctional feedback, the student states (sic) “I’ve been starting IVs for years…I know what I’m doing!” • Keep calm when you explain this is a breech of professional protocol • Be positive, letting them know you understand they are experienced, but you are trying to help them improve • If student resistant to feedback, dismiss them from shift & notify the PCC • You personally have difficulties working with a student (or vice-versa) • Personality differences are challenging to overcome, but are a part of “real life” that must be overcome. If you both can remain professional, it best serves you to try & work together • If the interpersonal relationships are interfering with the educational environment, request reassignment with no negative consequences for either the preceptor or student

Problem Solving • Student not proficient clinically or didactically • Give task-focused assignments to help the student limit their focus, i.e. “take the BP”, or “focus on the IV” • Notify PCC if pattern of poor performance continues, or student is not making improvements • You are tired, cranky or not “in a good place” to precept this shift • There is nothing wrong with admitting that you may not be in the right frame of mind to give the student the best educational opportunity (it happens to us all) • Notify PCC, ED Manager or Medical Director & see if the student could be placed with a different preceptor

Summaryprehospitalmd@gmail.com • Always “Do The Right Thing” • Our primary responsibility is always to the patient • Mentorship is the best opportunity to provide not just an education, but a model for professionalism • Our goal is to provide a quality & enjoyable rotation, & will adapt our methods to meet the needs of our students, preceptors & patients

References • University of Cincinnati Fire Sciences Program • Trinity Valley College EMS Education Program (Walker S, EMS Education Program Coordinator; Knowles H, EMS Director) • NREMT and NAEMSE Websites • Rogue medic website (www.roguemedic.com) • Adult Learning Theory website: teachinglearningresources.pbworks.com

EMS Internship Precepting Goals & Guidelines