I am now in the throws of clinicals again with no free weekends until Easter and I’ve been thinking about what makes a good preceptor. When I think about preceptors there are ones I like and ones I don’t, but a lot of that has to do with their personalities and my personality.
When I started thinking about what they do that makes them an excellent preceptor, I immediately thought of one preceptor. I only rode with him once, and as a matter of fact I’ve only ridden with that service that one time. But what he did had a dramatic impact on the quality of the clinical, even if we had very few calls that shift.
How We Do Clinicals
A quick aside about how we do clinicals at Lone Star College-North Harris. At every level you do shifts in the ER and EMS shifts on an ambulance. All scheduling is done via the online service WhenToWork. You request a shift at a certain time and service, the clinical coordinator approves it, and sends it to the service. The service sends back a station assignment.
Hospital shifts are 8 hours long, and your preceptor is a Lone Star employee and often a CTA ( I think that’s Clinical Teaching Assistant) who has taken the online 3 hr course, Methods of Teaching in EMS that I’m also taking this semester. That class uses a lot of NAEMS materials including their textbook. It also lets you get certified in Texas to teach EMS. Not every hospital preceptor is a CTA, but they all have experience working the ER.
For EMS shifts we have the choice of 4 local 911 ambulance services, Harris County ESD-1 (ESD1), Montgomery County Hospital District EMS (MCHD), Cypress Creek EMS (CCEMS), and Northwest EMS (NWEMS). Shifts are 12 hours long, and starting in this semester (year 1 semester 2), you can do two back to back for a 24 hour shift. I’ve not ridden with NWEMS because they are way on the other side of town from my home, but all of the other service’s medics work 24 hours shifts, starting at 0600 or 0700 and continuing to the following morning.
Something I’ve Learned About When To Start
Given I have a full time day job and a family, it is very convenient for me to schedule a 12 hour shift on Friday evening. I get off work and go to the ambulance station, work the night, sleep part of the day on Saturday, and I’m back to normal by Sunday morning.
There is a problem with this, one I’ve about decided is insurmountable and I’ll no longer do those shifts. You are starting in the middle of their shifts. They’ve been on for 12 hours. They checked out the ambulance 12 hours ago. You are an interruption. So they ask what level you are and tell you to make yourself at home till the next call.
What you really need at the beginning of the shift is orientation. In the morning, they need to check out the ambulance and you participate in this. You learn where everything is. You can ask questions about equipment. They are fresh and more willing to answer questions and explain things. This ritual is the part of their day where they reconnect with each other, and you get included in that connecting with them.
Something Every Preceptor Should Do, and One Did
I’ve only done one shift so far with MCHD, but the in-charge was the best preceptor I’ve ever had for some very simple reasons.
First, it was one of those Friday night shifts. Crew was out on a call when I got there, but when he arrived he introduce himself and said, “Let’s go out and I’ll show you the ambulance.” He gave me a complete orientation to the truck and the service and some expectations he had for me.
Secondly, he asked me some questions.
1. What do you think is your biggest strength?
2. What do you think is your biggest weakness?
3. What do you need to do?
4. What would you like to do?
I don’t remember my answer to #1, at the time I was still learning IVs, but had done a number of them in the ER and felt pretty good, though I was a little worried about it on the ambulance.
For #2, I said I was timid. I preferred to hang back unless I was totally sure of myself, and I needed to work on putting myself forward.
For #3, I said I had to write a report on every patient contact and get at least 3 sets of vitals, and at least do OPQRST and SAMPLE on each. This an important question for a preceptor to ask because sometime they think they know what you need, but they don’t. For instance, in most ER rotations the preceptors are very focused on getting us IVs. But for me I really need to focus early on getting my patient assessments. Especially Year 1 Semester 1, where detailed patient assessments were practically complete physicals and took almost an hour.
For #4, I think I said I’d like to get an IV while moving.
The interesting thing was really without any prompting from him, I overcame my weakness and got my first moving ambulance sticks.
At the end of the shift he asked me “What did you learn?” This I remembered because I said I was impress with MCHD. Which probably sounded like brown nosing, but I was impressed with their professionalism. I remember being impressed they had the guts to give every patient a comment card they could fill out and send in to the service.
These things are so simple, but they are the things an excellent preceptor does. It shows he’s thought about actually training. Matter of fact I wondered if he was an FTO for the service and had been trained to do this.
Those of you reading this that are preceptors, this is a great and yet simple thing you can do for the students that show up at your door. We’re clueless, afraid, unsure what to do and how to do it. You are awesome to us, have saved lives and stamped out disease everyday and wear the patch we are working so hard to get and feel totally unworthy of. While we need to learn to be independent, we need leadership now, and this is leadership.
And Terry, if you read this, one thing I learned on that shift was always set up your IV stuff on your dominant side.