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Question for instructors - need advice


MikeEMT

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Your right and we use FTEP as well. Our FTO program is designed to instruct and evaluate. It is not intended to be an Orientation - we have a two week "academy" for that.

Well, respectfully, I beg to differ a little bit. The FTEP is both training AND evaluation, often (but not always) together as mentioned below.

The FTO's do a pretty good job and they are constantly giving feedback to the trainee. The problem lies in the short time an FTO will spend with a trainee and the set up of the program. The trainee will get a minimum of 10 shifts on FTO, however they will rotate through at least 3 FTO's. In addition the FTO is a "working" FTO so the trainee will be a 3rd EMT on board an ambulance responding to calls.

I kind of have a problem with this kind of set up because it doesn't allow problem solving. I feel they should not be assigned to a working ambulance for their first FTO rotation. That FTO should work on driving, navigating, hospitals, etc. I would rate our FTO program as very good usually. They do a good job of getting trainees brought up to speed.

Like you we have an academy (Phase 1a), also for 2 weeks. Unlike what you describe we follow this with a training only phase. This "training only" phase (Phase 1b) is for (up to) six weeks. Bi weekly evals and updates to sups and FTEP/FTO coordinator. There are no daily evals (yet...we found it counter productive at this stage). During this time the trainee is a third rider until cleared as a second by the FTO. Focus is to continue the training and orientation (i.e. mapping, driving, etc) done in the academy with field exposure. We aded this phase after seeing too many new hires fall flat on their face early on. At first we lengthened the academy, but that didnt work. They neeeded a period of in the field orientation before we closed the lid on the pressure cooker.

Then, like your agency, we have a minimum of three FTO's for "Phase 2". During this time training continues, but daily eval's also start. Additionally the bi weekly updates to the FTO/FTEP coordinator continue. During this phase 2 the trainee rides as a second with his FTO, he is not a third rider. IMHO, this is good because it turns up the presure to perform a bit. It takes away any "crutch" he may be using. At any time the traininee can be recycled to either (very short) training phase and a PIP if they demonstrate major issues. EMTs and seasoned medics typically go through 3 six-week FTO rotations before moving on. Brand new medics straight out of school we typically double that automatically. This means a brand new medic will typically be 6 months prior to going on to phase 3.

Phase 3 is a 2 week evaluation only, sink or swim, pass or fail , final field test with an FTO they havent had yet. It is followed by a 1-2 hour sim man test with one of our med control docs, oral review, and a final exam . If they fail they can be recycled to phase II with a PIP.

For phase 4 they are released into "General population". Phase 4 is simply monitoring of their charts and performance for the remainder of thair first year.

So comparing our two programs, it seems part of your programs issues is confusion about the role of evaluation, when to do it, and what to do with trainees who are not meeting standards. I would also say that 10 shifts is probably not much time with an FTO, and perhaps (depending on what schedule you use) that should be pushed out quite a bit.

Its worth noting that for EMT's (who are already employeed) in our system who get their medic cert go through the same process except they bypass the "training only phase" and go straight into phase II. it is assumed..unless noted otherwise by an FTO, that they should already be well oriented to our system.

I have come to the conclusion that I will have a heart to heart on friday when I return to work. My gut is telling me that this is a confidence issue and that they are using the senior EMT as a "crutch". I have a plan in my head that I have come up with that I think I will implement and should be fair to them. If it doesn't work then I will be forced to contact our training coordinator with my concerns and see what they have to say.

As I mentioned, I have no intention to embarrass this trainee which is why I am kind of being vague. I know deep down they will be a good EMT. I am going to do everything I can and am allowed to do to make that happen.

My response would be that sounds like a great idea, but from a legal and ethical point of view you should probably involve your training coordinator earlier. In otherwords, get an idea of the plan , put it on paper, talk it over with the TC PRIOR to hitting up the trainee. The reason you do this is to prevent any legal pitfalls you may unwittingly fall into , or even cause, despite your best efforts.

The meeting with the TC is not a PIP, and therefore doesnt have to be a big deal, do it over coffee, breakfast, what ever. But if the trainee falls flat on his face or there is a critical failure while this training "plan" is in effect, you dont want left holding the bag in a wrongful termination suite.....or worse..a medical malpractice suite. Keeping the TC in the loop protects everyone.

However, we only have about 12 FTO's and we have been in a hiring blitz for almost a year and are continuing to hire. The FTO's have to be getting burnt out. In addition to new hires, they have to do our quarterly CBT's.

This trainee was given to me on a temporary basis (3 weeks) as my regular partner is on special assignment. While I have no formal say so, it is my impression that I was given this trainee to help bring them up to speed and try to fix what the FTO's couldn't. My trainee IS aware of their shortcomings and is making an active effort to correct them, there is just no improvement.

You know we went through the same thing about 5 years ago. It was tough on all of our FTO's because they were also taking paramedic students too. In the end we had to limit the paramedic and EMT students to "mentors" only just to give them a break. It worked out well. Now an FTO can take a medic student on his field internship , but only if he wants to. We still have about 12-15 FTO's... Like your agency, it is a lot of extra work. But its a lot of fun too.

As I mentioned, I have no intention to embarrass this trainee which is why I am kind of being vague. I know deep down they will be a good EMT. I am going to do everything I can and am allowed to do to make that happen.

My only final bit of advice is this. Just because they are a good/nice/smart person and are smart doesnt mean they are a good EMT, and of course the opposite is true as well. The truth is we want/need people who are BOTH. There is a fine line betwen doing "everything you can" and dragging it out".

Being an FTO isnt about personal relationships, though we often build them with our trainees (and that is OK). Being an FTO is about end user performance. No matter how good of a person they are, if they cannot perform in the field at 3am to standards....despite training...then they cannot..must not... pass. I have several friends who have failed the FTO process, they are still my friends. These are two seperate issues.

Good luck.

Edited by croaker260
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Croaker, I like your Ideas. They seem like they would be very successful. I bet you guys turn out some quality employees using that training model.

So I had a heart to heart with the newbie yesterday at the start of shift. I kept it professional and I did fill in a lot of positives that the newbie does but also brought up my concerns. I discussed a couple of ways I was going to try to help them out in resolving my concerns and the newbie was willing to try.

What a difference. The improvements made were astonishing. The newbie made one wrong turn going to the hospital which they immediately recognized. Could have corrected it with a U-turn, but didn't since they didn't think were allowed to make U-turns in this area (can't fault them for erring on the side of caution, especially with a patient). Used an alternate route instead to the hospital.

The only other minor issue was going to stage for a call the GPS gave us wrong directions so we got a little confused (Google maps and our map book also gave us wrong directions). Fortunately fire trucks are big, red and easy to spot.

To say I was impressed would be an understatement. I can honestly say I was very proud of this newbie and I made sure I told them after the end of shift. Now I just need to work on reinforcing those improvements.

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