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The downward spiral of the paramedic program...

Posted Oct 23 2008 1:38pm
A new semester starts this week and soon my city will be inundated with paramedic students. Now don't get me wrong here, we were all wide eyed and brand new at one point. That being said I distinctly remember when I was a student wanting to soak up as much from my preceptors as possible. For the last 2 years I have been bogged down with students who don't ask questions, act as if they are entitled and have nothing left to learn and refuse to truly assess their patients. They want us to only sign off on their paperwork and leave them alone. I divide the blame evenly between the programs, the caliber of student,the parenting, and the preceptors.

We will start with the programs. They have turned into money makers. There is no selectiveness for admission. They do not enforce the rules as they used to. When I went through 8 years ago the classes were smaller, the accelerated class was for military personnel and they enforced the rules. Got caught fudging your paperwork? Goodbye, never to return. Now you get caught? Leave and come back in a year. Everything is skill based now. They have to have so many skills and so many assessments signed off before they can test. It has given people the attitude that once they get those done that they don't have anything left to learn or do. There is very little hands on assessments being taught. Most things now are verbalized. I can tell you that verbalizing your assessment will not cut it in my truck. It will not cut it for your patient either when they need treatment. What happened to teaching people that their assessment was the best and biggest tool in their bag of tricks?
All the toys in the world are great but they don't replace a physical assessment of the patient. These programs are hiring people fresh out of school to teach practical stations. I mean so new that the ink isn't dry on their cert and the gold in their patch is still bling bling shiny. How are these medics supposed to teach students something when they are still trying to get their feet underneath them?

I will combine students and parenting because I have been getting a lot of babies fresh out of high school. Most of them are not mentally or emotionally prepared for what lays ahead. Mostly they spend their time texting or talking on the phone between (and enroute to) calls. They have spent their lives being coddled by their parents, told they are marvelous and having everything handed to them. Parents who are too busy doing all of the above to instill a work ethic, sense of discipline, and an understanding that there are somethings that will NOT be handed to you easily. They get offended when you ask them questions, expect them to perform or go look something up and bring back an answer. God forbid you ask them the dreaded WHY? Then I get the older students who are here because they are being forced to. Their attitude just plain sucks. Granted I'm not saying all my students have been this way. I get a few every now and then that really want to learn and to be on the box. That is like a breath of fresh air.

Lazy Preceptors. Every city/service has them. You know the ones, they say " yeah kid give me your paperwork." It's a row a hastily checked S boxes, a scribbled signature and no comments. They have not really tried to teach the student anything all day. They have mostly tolerated that person being there.

Here are my suggestions on the subject: (for what they are worth)

Programs: WAKE UP!!. Sure you are making money. But what are you doing for the community in which you reside? You are cranking out substandard providers. I'm sure that's who you want to treat your loved ones. Reduce your class sizes. People learn better with more student/teacher face to face time. Have some selective processes to weed out the undesirables who take class space away from people who want to be there. Enforce your rules. If you catch them forging paperwork in school what do you think they are going to do in the real world? Hire some medics to teach practical stations that have experience. We are out there and are willing to do it. Make experience a hiring requirement. CAN WE PLEASE GET SOME HANDS ON ASSESSMENTS?? No more verbalizing. We have to actually touch people in the ambulance. Your students should get comfortable with it while still in class. How about we also reinforce the fact that the assessment is extremelyimportant? Please.

Students: Show up for your ride time prepared to LEARN! Ask us questions. That's why we are here. We won't laugh at you for asking. Your preceptor should be attempting to teach you things while on calls and after. If they are not then ask them. On the flip side of that, I don't know many medics that will hunt you down while back at the station to make you study, but if you ask them they will help you. Use your time wisely. We should all be adults here and we should be behaving appropriately. Get off your phone/stop texting. You are not here to talk to whoever that is. You are here to LEARN. Don't get offended when we ask you questions. It's part of the learning process. We want to hear what you have to say so we can discuss the subject and maybe impart some of our knowledge on you. If you think that your skill sheets being done make you good to go then show me! Don't talk a big game and then not say a word on calls. I will not mark you as team leader for that. ( Yes I do know that you need a certain number of those too) I will if you jump in and begin assessing the patient and tellin me what you think we should do for them. Remember that we will not let you make a fatal mistake. But we will let you make mistakes. It is how we learn. When we correct you it is not because we think your are stupid or because we are trying to be mean. We are teaching you. You should be learning from your mistakes. (are you seeing a trend here?). If we make a suggestion to try something you haven't thought of it is because we have been doing this longer and have learned things that you will not get in school. Again use it as a learning tool. My advice to you lastly is this: Show us that you can do this. DO NOT VERBALIZE YOUR ASSESSMENT! We have to touch people in the real world and you should get used to it now. We should be working together. This precepting thing is a 2 way street. We aren't going to break our necks for someone who shows us they don't want what we have to give.

Preceptors: Be kind to your students. Try to teach them something. Don't pencil whip their paperwork. Try hard to not make them think that you think they are stupid. Remember you were there once too. If you are burned out on having students than ask for a break. It will do you some good and the student will get someone who wants them around.

So that's it. The decline of the paramedic program. That one has been brewing for awhile.
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