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Gaining confidence in the field ?


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I'm having trouble building my confidence in the field. I'm precepting as a medic student and I've been running a ton of calls. I've been spending a ton of time on the trucks ... however I have no real confidence in some of the decisions I'm making. I can handle BLS calls with no problem, I'm okay with chest pain calls and trauma calls and arrests ... rather ... I know what to do and I usually do it on most calls .. however I second guess myself as to if I'm doing the right thing in the right order at the right time. Does anyone have any suggestions that would help me build my confidence? I want to be a good medic and do the right things for my patients, I really do ... I just wish I felt more confident.

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There's no magic pill, but it might help to know that this is how we all feel. In fact, it is my opinion that the best paramedics remain nervous, and do their best to avoid the overconfidence and hubris that seems to plague experienced members of our profession. You will feel better about your skills as you work more and more in that role, but don't expect to ever be so good that you can handle everything perfectly every time. It simply doesn't work that way.

I guess I'll take this opportunity to shamelessly plug my blog. I started writing almost three years ago when I was in medic school and have continued though my first years as a "cut loose" medic, so maybe you might find some similarities between our experiences. http://www.babymedic.blogspot.com

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Hello,

It sounds like you are working hard at becoming a well rounded ACP.

Hit the library as well. The more you know the more comfortable you will feel. If possible, try to following up at the ED to see how things went with your patient (if possible).

The ED I am working in now I see some of the newer ACP pop by all the time to see what is going on with a patient they borough in.

Cheers

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I am curious how things are with your preceptors. Are they only pointing out the things that you need improvement on, or are they also pointing out the things you do well? A word of encouragement can go a long way.

Have they given you any "words of wisdom" to improve your confidence?

It sounds like you are doing all the right things to be a good practitioner. Hang in there!

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Sounds like you are doing great. Keep a set of your protocols in the back of the truck. When you are not dealing with pt care look and see if you did everything. Do it so your pt cannot see. Or do it after the call when you have dropped your pt at the ER. If you think should I do this then you should. Never bad to over treat but never good to undertreat. :P:D

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You'll be fine, trust me. I had (and still have) such feelings of "WTF am I doing?" moments. It does ease off some as you progress in your career. Annie brings up a good point. Ask your preceptors for assistance. That is why they are there. It is in their best interest that you treat the patient properly.

Keep up the good work!

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The poster above who asked about the relationship you have with your preceptor is right on in my opinion. Start by making sure you two are on the same page and they are able to constructively criticize you. Even in a busy system during an internship there are only going to be so many "tough" decisions to make. It's more about your thought process and your ability to use common sense and think critically. Your preceptor should be helping you develop this while you are learning to run calls.

1) Make sure you are establishing a detailed order of events (got dizzy then fell and hit head versus fell and hit head and is now dizzy). This will help you feel confident you know what is going on.

2) Also I'm sure you do but know your protocols and what is common practice in your area. These guidelines help alot with tough decisions.

3) Use medical control when you really don't know what to do. This should be "OK" but I imagine your preceptor will step in and help you with the answer.

During my internship I had a PT complaining of chest pain but who was definitely altered (confirmed by family) with possible facial droop (was debatable). I couldn't decide CVA versus MI or both and was stuck in making a treatment decision. My preceptor had me go back through the order of events which I used to establish a differential and rule certain things in and out. Sometimes you just need to slow things down and make sure you know what is going on. It's probably very apparent to you if you can take a step back.

Good luck! Be confident! You've made it this far.

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I have a similar problem. I just passed the national registry and am now a NREMT-P. I've been an LVN working in and out of ER's and ICU's for about 14 years. I was trained as a EMT-B in the Army but always worked as a nurse. I have no box time other than school, which makes me really nervous. I know what I'm doing, I'm not (as) worried about cardiac or medical issues but I'm concerned about the trauma patients. In the ER we have "medical control" beside us directing things, but out in BFE your it. When I have a pt in my ER working them is second nature, but pre-hospital is a whole new world for me. I'm applying for my state cert (Texas) so I can start working some PRN at one of two of the local 911 services. Any suggestions to my dilemma other than jumping in feet first?

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. Any suggestions to my dilemma other than jumping in feet first?
Not really. Trauma in the pre-hospital field isn't all that difficult. We assess, manage airway, control bleeding, splint, pain management and transport. All trauma calls require different degrees of the parts I mentioned, some more, some less. They all revolve around a good assessment and treating accordingly. Of course, I'm probably not telling you anything you don't already know.

I have no idea how much time you were on an ambulance during clinicals, however, I think it's safe to assume you rode enough to treat some trauma patients and having a Military background only reinforces my belief. You will be fine. The key is to relax, do for the patient what you were educated to do.

Good Luck!

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Not really. Trauma in the pre-hospital field isn't all that difficult. We assess, manage airway, control bleeding, splint, pain management and transport. All trauma calls require different degrees of the parts I mentioned, some more, some less. They all revolve around a good assessment and treating accordingly. Of course, I'm probably not telling you anything you don't already know.

I have no idea how much time you were on an ambulance during clinicals, however, I think it's safe to assume you rode enough to treat some trauma patients and having a Military background only reinforces my belief. You will be fine. The key is to relax, do for the patient what you were educated to do.

Good Luck!

I did get to do a good bit in the Army, I would go up in the black hawks when in Germany on some "runs" and did lots of combat/pre-hospital stuff there but never really used it enough for it to be second nature. I'm sure it'll be nerve racking at first, hopefully wherever I go I'll have some good mentors and basics to "babysit" me until I get into the groove of things. thanks for the words of encouragement...

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