Clinical Preceptors for Emergency Medical Technician (EMT) and Paramedic Students in a Pre-Hospital Clinical Setting

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Paramedic Clinical Preceptor Program

Paramedic Clinical Preceptor Purpose To prepare the experienced Paramedic/ EMT- Intermediate for his/her role as a trainer of Paramedic students. Intro To provide a mechanism for identifying EMS students who do not meet minimum performance standards prior to certification.

Rules and Regulations Department of Human Resources Division of Public Health Office of Emergency Medical Services Effective: 01/01/2007 Review: 01/01/2008 Clinical Preceptors for Emergency Medical Technician (EMT) and Paramedic Students in a Pre-Hospital Clinical Setting I. Procedure-General Information A. The Office of EMS (OEMS) does not certify or license personnel who complete this training. B. Clinical Preceptors must be approved by the Course Coordinator and the Course Medical Director. C. Successful completion of a Clinical i l Preceptor Course does not exempt the individual from additional orientation requirements for the specific program he/she intends to precept. D. The Course Coordinator of the approved Emergency Medical Services (EMS) Course is responsible for assuring that all requirements of the Clinical Preceptor Program are met as outlined in Form T-02A.

Rules and Regs (cont d) E. The Course Coordinator of the approved EMS course will assure that t there is appropriate, objective evaluation of student progress in acquiring the desired competencies and that the Clinical Preceptor meets all requirements set forth in this procedure. F. Individuals currently licensed as EMS Instructors (Level I, II, or III) may be approved as Clinical Preceptors with written approval of the Course Coordinator and Course Medical Director. G. Individuals serving as Clinical Preceptors for students in approved EMS programs that do not meet all of the prerequisites must be approved by the EMS Program Course Coordinator and the Regional EMS Program Director for approval by the department. A complete listing of the Regional EMS Offices is located in the EMS Procedure Manual, Section VIII: Resource Documents, R-01: Regional EMS Offices. H. Paramedic Clinical Preceptors can precept EMT-Basic (EMT-B), EMT- Intermediate (EMT-I), and EMT-Paramedic (EMT-P) students. I. EMT-I Clinical Preceptors can precept EMT-B and EMT-I students.

II. Prerequisites A. Paramedic Clinical Preceptors: 1. Current licensure as a Paramedic with a minimum of two (2) years of advanced life support experience; 2. Written approval of the Course Coordinator and the Course Medical Director of the EMS course, and 3. Successful completion of an approved preceptor course. B. EMT-B BandEMTI EMT-I Clinical Preceptors: 1. Current licensure as an EMT-I, Cardiac Technician, or EMT-P with a minimum of two (2) years experience; 2. Written approval of the Course Coordinator and the Course Medical Director of the EMS course and 3. Successful completion of an approved preceptor course.

A III. Course Requirements A.. All Clinical Preceptor training courses must be taught by an EMS Course Coordinator or EMS Program Clinical Coordinator, licensed as an EMS Instructor. B.. All Clinical Preceptor training courses must follow the approved guidelines as outlined in Form T-02A. C.. All Clinical i l Preceptors successfully completing training i courses should receive a copy of the appropriately signed Form T-02B (Clinical Preceptor Training Record). D D.. Clinical Preceptor training courses may be taught in either a standard classroom setting or in a distributed education format, as long as all guidelines for training are met. Course Coordinators seeking continuing i education credit approval for a training course must apply to the Regional EMS Office in the Region where the program is being taught, as described in PRO-T-05.

IV. Maintenance of Preceptor Status A.. In order to maintain Clinical Preceptor status, t the preceptor must maintain active EMT-I, Cardiac Technician, i or Paramedic licensure. B.. Clinical Preceptors must complete an orientation by the EMT or Paramedic Course Coordinator for each EMS Program he/she intends to precept.

Rules and Regulations (A) Clinical preceptors must be approved by the course coordinator and the course medical director. (B) Clinical preceptors may be required to complete a training course approved by the course coordinator and course medical director. (C) Student clinical records involving clinical preceptors must be maintained by the course coordinator. Intro

Chapter 11 Emergency Medical Services O.C.G.A. OCGA 31-11 11-2.(16.1) 1) Paramedic Clinical Preceptor - means a Georgia certified paramedic with a minimum of two years of emergency medical services experience who meets the standard requirement for paramedic preceptor training as established by the department. Intro

Chapter 11 Emergency Medical Services O.C.G.A. OCGA 31-11 11-54(B) (B) While in training preparatory to becoming certified, paramedic trainees may perform any of the functions specified in the Code section under the direct supervision of a duly licensed physician, a registered nurse, or an approved Paramedic Clinical Preceptor. Intro

Duties and Responsibilities of a Paramedic Preceptor Objectives List eight responsibilities of a clinical i l preceptor. Identify the most important duty of the clinical preceptor. Identify the five characteristics of an effective preceptor. p Chapter 1

Duties and Responsibilities of a Paramedic Preceptor Maintain appropriate p and adequate patient care during the training experience. Provide a positive role model for the Paramedic student. Maintain a continuity of classroom instruction to the field environment. (Pair core knowledge with the patients they see) Assist the trainee in making the transition from classroom to the field environment. (Make em show what they know)

Duties and Responsibilities of a Paramedic Preceptor Guide, monitor and evaluate the student s s performance to assure successful completion and identify those who need remediation. Keep accurate and complete records. (Paperwork will be covered at the end of the presentation.) Provide FEEDBACK. It should be: Constructive Specific Frequent Valid Maintain a PROFESSIONAL demeanor. Lead by example. Each call is a new opportunity. Focus on current situation and move past previous mistakes.

Five Characteristics of an Effective Paramedic Preceptor Strong desire to EDUCATE as well as TRAIN Technically proficient PATIENCE Motivation - Communicative Maturity and Respectful Chapter 1

The Most Important Duty of the Clinical Paramedic Preceptor Provide the student a ROLE MODEL BE POSITIVE AND PROFESSIONAL Chapter 1

** Laws of Learning ** Individuals accept and repeat responses that are pleasant. First impressions are lasting. Repetition yields habit. Skills not practiced are forgotten. Dramatic experiences leave lasting impressions. Chapter 2

Characteristics of Adult Learning Self-directed Participate i t in planning and evaluation Related to previous experience Chapter 2

Establishment of Environment Conducive to Learning Mutual respect Collaborate *NOT* Compete Open communications between Preceptor and student Offer feedback..encourage and enhance growth Everyone is HUMAN. Chapter 2

HUMAN H = Hear them out U = Understand their feelings M = Motivate t their desires A = Acknowledge their efforts N = Never..Never put them down, make Chapter 2 personal attacks, display harsh or blaming attitudes

Role of the Preceptor in the Learning Environment Acts as a facilitator of learning rather than a controller of learning. Directs the process of learning while the student sets the pace, ask questions, and controls the learning. Chapter 2

FEEDBACK.Information that helps people to decide whether their behaviors have had the intended effects. Start with POSITIVE feedback even if all the student did right was not fall down.

Positive Feedback.. re-enforces enforces BEHAVIORS and ENCOURAGES REPETITION of those behaviors by communicating that they had the intended effects.

Negative Feedback.. discourages behaviors by communicating that they did not have the intended effects

Principles of Giving Feedback Intention Recipient open to feedback Changed behavior Behavior vs Generalities Describe Behavior Personal Impact Accept responsibility Understanding Encouragement Chapter 3

Principles of Receiving Feedback Be specific in what you ask Don t act defensively or rationalize the behavior at issue Summarize your understanding Share you thoughts and feelings Chapter 3

Interrupting Communication Stoppers Ridiculing or blaming Ignoring/denying feelings or ideas Mind-Reading or assuming Controlling o Ordering/commanding Chapter 3

Rating Errors.errors in judgement that occur in a systematic manner when an individual observes and evaluates another. What makes these errors so difficult to correct? Chapter 5

Most Common Rating Errors Contrast Effect the tendency for a rater to evaluate a person relative to other individuals rather than on the standard. d Chapter 5

Most Common Rating Errors First Impression the tendency for a rater to make a first favorable or unfavorable judgement and ignore or distort t any further information. Chapter 5

Most Common Rating Errors Halo Effect improper vague judgements from one part of the job performance to all other areas or parts of the job. Chapter 5

Most Common Rating Errors Similar - To - Me - Effect tendency to judge more favorably those whom the rater sees similar to themselves. Chapter 5

Most Common Rating Errors Central Tendency this occurs when people want to just play it safe.everyone meets standards Chapter 5

Most Common Rating Errors Negative and Positive Leniency these errors are committed by a rater who is either too hard or too easy in rating students. Positive leniency may raise unfounded d expectations.while Negative leniency may cause the feeling of inadequacy. Chapter 5

Trouble-Shooting Performance Problems 1. Is there a problem? 2. What is the problem? 3. Is the problem important? 4. Where has the system broken down? Chapter 5

Clinical Paperwork As you well know, documentation is a critical part of EMS. As part of the certification process, the Regional Training Coordinators now do a Student File Review prior to course completion to ensure that all state requirements have been met. Darton students will bring a clinical notebook with them every shift they ride. In this notebook will be several forms that you, as preceptors, will need to complete for them. The following slides will show you each piece of documentation required.

STUDENT PERFORMANCE EVALUATION NOTE TO PRECEPTORS: : For each of the items below,,y you will be asked to rate the Paramedic student assigned to you, using the following scale: 5-Outstanding 4-Exceeds minimum i expectations ti 3-Meets minimum expectations 2-Below minimum standards 1-Unsatisfactory N/O-not observed Checked and restocked ambulance at the beginning g of the shift Reviewed protocols, SOP of ambulance service Performed scene assessment Performed appropriate, p organized patient assessment including history and physical Identified patient problems Established treatment priorities Contacted medical control prior to performing interventions Communicated with medical control in an organized, timely manner (continued)

Met performance objectives in a timely manner (administered O2, started IV, etc) Changed intervention strategy to suit changes in patient condition Reassessed patient en route to hospital Gains and maintains control of situations verbally in calm manner Demonstrates therapeutic communication techniques with patients and family members Communicates in a professional, unbiased manner, verbally and nonverbally, with hospital staff, peers, and preceptor Determines proper cause of action under stressful circumstances Maintains self-control and remains calm under stressful circumstances Accepts criticism in a positive manner and applies feedback to improve performance and further learning Moved, extricated, and transported patient safely Practices proper lifting/carrying techniques Follows infection control guidelines in the disposal of sharps, sharp containers, or contaminated items with blood/body fluids Utilized universal precautions or body substance isolation Follows safety rules with little or no prompting Restocked ambulance after each run Reviewed patient problems with preceptor following each call Used reference text tt to clarify patient t problems and dd document th home medications Reviewed performance with preceptor following each call FORM IS ON THE FOLLOWING SLIDE

Preceptor Evaluation Form In fairness, the students will be asked to rate the Paramedic Preceptor for each of the items below using the following scale: 5-Outstanding 4-Exceeds minimum expectations 3-Meets minimum expectations 2-Below minimum standards, 1-Unsatisfactory N/O-not observed Preceptor was helpful in orientation to the department and its policies and procedures, SOP s, equipment and protocols Preceptor was helpful in assigning work that assured successful completion of the learning objectives Preceptor was helpful in explaining the care being given to the patient, answering questions, etc Preceptor attempted to apply classroom learning to field environment while maintaining continuity of classroom instruction Preceptor provided continuous, constructive feedback on performance Preceptor offered specific suggestions for improvement Preceptor held mini-conference after each run to discuss patient condition, student performance, procedures, etc Preceptor outlined clear performance goals and objectives at the end of each rotation Preceptor exhibited strong desire to assist in the educational aspects of the field internship experience Preceptor was patient and attentive during patient contact and post-run conferences Preceptor was an overall positive role model SEE FORM ON NEXT SLIDE

Preceptor Evaluation Form

Clinical Summary Log Because we have to keep accurate records of what kinds of patients our students see, you will be asked to sign a log sheet containing information about the patients that the students came into contact with on their ride time. Below is a rendering of the left side of the log sheet. Due to HIPPA concerns, we are no longer able to put patient initials on our forms. Now we must use a patient clue. See Below. For the chart below, the student ran 2 calls in 8 hours on 8/7 and only 1 call on 9/6. Date HRS AREA 8/7 8 EMS EMS 9/6 4 EMS PT CLUE AGE PED 10 Adult 20 Geri 10 Chief complaint 1-Red 68 G Chest pain house 2-Big 12 P Dog Bite dog 1-blue shirt 38 A Sick

Clinical Summary Log The right side of the page will look similar to the chart below: See the original form on the next slide. Because we have to keep up with the numbers of patients our students assess in each of the categories below, we developed a check system with the number of required assessments and each of the patient complaints below. On the C/P patient, we checked C/P, SOB, and syncope because the pt exhibited all of those symptoms. Check all that t apply for each patient. t Some pts may not have any boxes checked. Chief Complaint ABD pain 5 AMS 5 C/P 5 OB 5 PSYCH 5 SOB 5 PED SOB 5 SYNC 5 TRAUMA 20 TEAM LDR 10 SIGNATURE/TITLE Chest Pain P. Medic, EMT-P Pain x x x x P. Medic, EMT Dog Bite x x P. Medic, EMTP

Clinical Summary Log

Skills Log Sheets

EMT-I Log Sheets

Last, but not least! Ride Time Log

THANKS SO MUCH!!! Once you have completed the program, please email me at james.mcpherson@darton.edu with the following information: Name Mailing address Original date of certification Georgia EMT or Paramedic number List of current certifications (ACLS, ITLS, PALS, etc) You may submit a resume instead if you like I will forward a program summary form for you to complete and email back to me. Once that is completed, then I will mail you a copy of Form T-02B (Clinical Preceptor Training Record) for your records. WE REALLY APPRECIATE ALL YOU DO!