Tag Archives: ems training

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are chosen simply from the employees with the most time at your service, there is the risk of jaded viewpoints and out-of-date practices.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.


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.


Filed under Administration & Leadership, EMS Health & Safety, Opinion, Patient Management, Training & Development

What is "Performance" in EMS? Part 4

This particular series began with the new year in thinking about the characteristics that make and keep an EMS as an efficient, High Performance system. The previous criteria were all focused on factors including Response TimeEffective Care, and being “Community Connected.” Each of these criteria obviously affects patient care either directly or more indirectly as part of the community, but in order for a high level of performance to be sustainable in an agency, it must take the welfare of the providers themselves into account.

Part 4: Provider Culture

Protocols and Standards of Care are documents that describe what should be done for patients, however these actions must be implemented by the people who work for a service. Since the quality of care (and even patient satisfaction) is exclusively implemented by these individuals, often in extreme conditions, it seems counter-intuitive that the jobs they fill are regularly listed in surveys of The 10 Most Underpaid Jobs. Part of the reason the pay remains so low for a position that is so widely recognized as being critical by the public is that it is still seen as a vocation taught at community colleges and even high schools rather than as a profession. In some cases, EMS is even treated as a certification that simply becomes a gateway to another job.

The demands on Emergency Medical Technicians (EMTs) and Paramedics is strenuous both physically and mentally. Some statistics I have heard suggest that one in four EMS workers will suffer a career ending back injury within the first 4 years of service while others may last only 5 years before the accumulated stress becomes almost intolerable. Those who make it longer often become jaded and cynical due in part to monotony or exposure to patients who seem to routinely abuse the system. It is important that the culture of a highly performing EMS service not view an employee seeking help in dealing with stress as being weak but rather look to support that comrade through their feelings. There are resources readily available to help EMS personnel facing burnout Learn to Cope with Stress. From a very practical perspective, it is typically cheaper to retain a senior employee, even one facing issues, than it is to train a new hire in the organizational way of thinking.

Another real fear that EMS agencies should understand is the problem of complacency. Disengaged employees cost the US economy around $300B year. And worse yet, for EMS agencies, this behavior means lawsuits, bad press, patient dissatisfaction, and employee retention problems. A service culture than promotes performance encourages positive role mentors at all levels. It is important to pay attention to the characteristics of new hires and to personally examine what type of personality you bring to your organization. The chart to the right highlights some important character traits to look for in potential employees as well as yourself.

There are two ways to look at the problem of employee satisfaction: is your service hiring the right sorts of people and are you the type of person that the service you actually want to work for is actively hiring? If you don’t know what the criteria of a good employee are, here are 8 Qualities To Look For When Hiring A Responder. But again, the other consideration is whether your service is a place with whom professional minded individuals are interested in working. Here are 6 Culture Building Principles for Your Response Team that promote professional performance and loyalty within the organization.

Leadership is key to authority in any group. Unfortunately, the only form of authority that can be confirmed on anyone is just “command.” The role of “leader” must be earned. True leadership comes from developing respect, not demanding loyalty. It is developed through an understanding of the job you request others to perform and an appreciation for the way the tasks of that job are carried out. A high performing EMS promotes a “just culture” where positive behavior is rewarded at least as much as poor behavior is reprimanded.

Just as their is no single “correct? model for EMS delivery, there is no single pattern of employee relations. Professionally minded employees must find the right service provider culture for them. Similarly, agencies should demand high performance from those who wear their uniform in order to instill pride both ways.


Filed under Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Funding & Staffing, Line of Duty, Training & Development