A new type of Paramedic Internship (For AnthonyM83)

[AMESEMT]

I have had a preceptor like that for my EMT-B. He was way cocky and told me that I should not go into paramedicine and if he could go back he would not be a paramedic. However, within the same service, I have had a few different preceptors and like Ruff, I latched on. These medics would, as we were enroute to the hospital, they would ask after I had done my assessment and given my findings, "Is there anything else you would like to do?" and if I could not think of anything besides check vitals every so often, they would either say okay or tell me something else I might do and why. Then after the call they would run through with what they saw, we would compare, and they would tell me things I should look for, or other things I might have done if we had time (we have short transport times). I learned a great deal from them. I have thought about doing my field internship with them but they are not exceptionally busy, unlike MAST in Kansas City. Although, I have heard good things about MAST and paramedic interns who went there.

Like Dust said

internships should be a learning and teaching experience, not a test.

I was under the impression that is what they are suppose to be. Like in my accounting field here at college, we can do internships to learn and have a good environment to learn in (with a solid base behind us from school, hopefully).

With the original post, I believe that even going through basic someone should be comfortable with talking to patients, being on-scene, etc...since a basic cannot do much else. With my program we were required to have so many patient contacts (ie. some medical, some trauma). For me, between riding as a student with a busy service that has great preceptors, and now riding with the same service for the experience and the field education has allowed me to be more comfortable with the assessment, talking to patients and family, and learning some of those things they don't really teach you in class like the proper way to apply 3-lead EKG patches (we were not taught how to apply them in Basic), and assisting a paramedic with whatever they might need (the teamwork concept between Basic and paramedic).

I believe at least the internships could to be restructured or tweaked. The basic program had us do preceptor evaluations to see if the program (Mercy) should continue to allow both basic and paramedic students to return to that service. If I remember right there are services they had in the past that they do not allow because of a lack of quality preceptors in the eyes of the student. It has both its positives and negatives but a good evaluation from the student should tell the program what sort of field education (good or bad) they get from that service.

Just my 2 cents.

AMESEMT

[Dustdevil]

Okay, so... time for some plans to improve internships. Off the top of my head, these come immediately to mind:

• 1. Many, many more hours required. The internship process itself should last as long as most firemonkey medic schools. We're talking you being on an ambulance twelve hours a day, 4 to 5 days a week for three or four months. I don't want any of my students taking their first job as a medic and feeling like it's their first job, even if it is. And I don't want their employer to start thinking, "geeze... doesn't that school teach them anything?" Both are bad for my school, my students, and for EMS.

2. A specific, intelligent, progressive plan for educating you, not just haphazardly having you ride and jump in here and there as the "preceptor" chooses. For example, one shift of simply observing the teamwork of the primary crew so, unencumbered by the pressure of having to act, you can take it all in. Then two or three shifts being the secondary, performing all the skills except for assessment, learning to physically function in the field, but without having to make a lot of decisions. Then some shifts of being the primary assessor, doing nothing but the assessment while the crew does all the skills work for you. Then finally, put it altogether and be a full, solo medic, with the crew just there to help at your direction. None of this "sink or swim" nonsense, and none of this, "you just do what I tell you" crap either.

3. Balance of continuity and variety. You obviously should be exposed to a variety of styles and preceptors so you can assimilate the different things they have to offer. But you should spend at least a good week or more with each one so that you have time to progress with each one instead of having to adapt every shift to different personalities and expectations.

4. Preceptors that have themselves been through a programme that educates them on how to precept an intern. They should not just be "good medics" doing what they always do and you along for the ride. If they are not teacher material, they are not preceptor material. And if their education level is less than that of their students, no way.

5. A two-way evaluation process. I want to hear the student's impression of the precepting crew just as much as the crew's impression of the student. That way no conflict goes unnoticed, and we can put a context on any evaluations that are less than positive. If one of them is just a hardass to everybody, it is important for me to know that before I ream a student for that evaluation.

6. As a system administrator, I want to be just as involved in the process as the instructor is. I want to see and hear how each student is doing, and read their evaluations of my employees. If they are representing my agency in a particularly positive or negative way, I need to know this. And I also want to know who the future stars are so I can recruit intelligently. I want to compile a list of who's naughty and who's nice, so my recruiter knows who to pursue, and whose calls to ignore.

• We've bitched enough. Now, please help me make some positive recommendations for improvement.

[JakeEMTP]

We had/have to do an evaluation of our preceptor after completing clinicals. They are then given to the EMS liasion at the hospital after completing Hospital rotations. They are to outline our experiences and how the preceptor treated us, what they taught us, what was our general impression of the time spent in the Hospital.

Also, for another essay, paramedic preceptors were evaluated by the class as well. Some of the same criteria as the hospital experiences, just a little tweaking here and there to more reflect the nature of the environment, as they are completely different.

I have come to enjoy my paramedic clinical time. I have learned so much. I have run with different partners, different squads. The hospital time was eye-opening.

Anyway, enough rambling. off to the MICU for some more clinical time. 8)

[AMESEMT]

Dust, does the amount of hours required for field internships vary from program to program? I ask this because the program I am hopefully going to be accepted to (find out in a few weeks) required 360-600 hours just for the field, that does not include hospital internship. These hours are suppose to take 3-4 months.

AMESEMT

[DwayneEMTP]

And a thought Dust...

Requiring so many field internship hours, in such a full schedule, doesn't that put EMS back in the court of the kids living at home? Doesn't it again disqualify the people that are likely to be better for the profession?

I'm not suggesting a bunch of hours is bad, it's obviously not, but perhaps like someone stated before, the sevices need to step up to the plate and create paid internships for all, or part of the hours.

I haven't really thought it through...

Dwayne

[Dustdevil]

Requiring so many field internship hours, in such a full schedule, doesn't that put EMS back in the court of the kids living at home? Doesn't it again disqualify the people that are likely to be better for the profession?

It's a valid point you have. But four 12 hour shifts a week is only 576 hours over three months time. Most internships seem to last about that long, but with fewer hours. You could drag it out another month or two, but then you end up not riding the same shifts with the same crews, unless they are some lame 24 hour shift system, in which case you would go every third day. That's only 120 hours a month, which comes to right at 600 hours in five months, which I could live with. I'm open to ideas, and a lot depends on the shifts your service is working.

[spenac]

I think schools should focus on the skills rather than the hours of clinicals. The school I attended for my EMT-I required X# of each type of patients and/or skills. I actually got more than 200 hours more than the state required before getting all skills completed. And I did clinicals at a busy service not at small town slowville.

[JakeEMTP]

I think schools should focus on the skills rather than the hours of clinicals. The school I attended for my EMT-I required X# of each type of patients and/or skills.

The problem with this is, and I have first hand knowledge of this, is you/I would have to be lucky enough to be on calls that a patient required pacing, intubation, cardioversion and the like. In theory it sounds great, but the reality is, unless you are exposed to patients requiring the more obscure interventions, it could take forever to complete clinicals.

[DwayneEMTP]

It's a valid point you have. But four 12 hour shifts a week is only 576 hours over three months time. Most internships seem to last about that long, but with fewer hours. You could drag it out another month or two, but then you end up not riding the same shifts with the same crews, unless they are some lame 24 hour shift system, in which case you would go every third day. That's only 120 hours a month, which comes to right at 600 hours in five months, which I could live with. I'm open to ideas, and a lot depends on the shifts your service is working.

I ride 3/12s per week, the maximum they'll allow if you have a job, so with drive time I have about 42-45 hours invested per week...and I'll tell you, it's tough!

We have a 500 hr minimum, plus required skills, as spenac said.

Ideally, the time is supposed to be done in four phases, with a different preceptor each phase, and as we have Pueblo and Colorado Springs to choose from, there are plenty of preceptors on varied schedules.

I'm trying to do my early clinicals in Pueblo, as it's closer, about an hour as opposed to an hour-twenty. But also because fire controls the patients in the Springs...I want to get a few calls under my belt before I get involved in the whole Private v. Fire fiasco.

I guess when I questioned the hours I was assuming the 500 hrs. are an NR requirement, instead of a school requirement.

I think spenac has a good point, pass based on objective/subjective criteria as opposed to time...but then again, that would require educated, competent preceptors that are able to be fair and goal oriented. They would also need to be held accountable for their students, not just negatively, but positively as well.

This seems like a no-brainer to me. Cull preceptors based on the quality of student they produce. Turning out high quality students, with a good attitude and work ethic isn't rocket science...though it certainly is science. Make substantial monetary rewards for objective criteria that would be within the scope of the preceptor to shape...Appearance, promptness, accuracy of reports, sick days taken in first 6 months (as it's based on attitude)...these are not difficult to track, they save the employer money, and has the effect of each generation of preceptor being stronger, more positive, and more fiscally productive than the one before...everyone moves forward.

Still, I guess I won't hold my breath.

Dwayne

[JakeEMTP]

Dwayne,

Don't get me wrong. We have to complete X number of skills and there is also a minimum number of hours. The point I was trying to make, albeit unsuccessfully, is that unless we as students are in the right place at the right time, then obtaining some of the required criteria could prove difficult.