THE AMBULANCE as Classroom

     One of the most challenging aspects of becoming a paramedic is making the transition from the classroom to the ambulance. Students approach this part of their training with their brains full of drug calculations and obscure medical conditions. Some students have previous experience as EMTs to prepare them for the road ahead. Many do not.

     Paramedics reminiscing about paramedic training are more likely to recall their time in the back of an ambulance than their time in the classroom. Stories about field training often center on the stress of being watched and judged. The source of the stress? The paramedic preceptor.

     The role of a paramedic preceptor is part teacher and part evaluator. How much of each is up for debate. Nevertheless, most program directors expect a lot of teaching to go on in the back of the ambulance.

VARYING REQUIREMENTS
     Amanda Cotter coordinates clinical rotations for paramedic students at Greenville Technical College in South Carolina. "The students don't have it all figured out," she says about field time. "They are trying to take the knowledge they have learned from the book and put it all together." That's only going to happen if the students are taught in the back of the ambulance, not just evaluated, she says.

     State requirements for preceptors vary. California, Georgia and Virginia all require potential preceptors to take courses on adult learning concepts and have a minimum of two years' experience. These and other states require paramedic students to ride with one or more trained preceptors, who will grade each student's performance and determine if the student is ready to transition from the classroom to the field. Minnesota, on the other hand, does not require training for paramedic field preceptors. Larry Starks, director of the paramedic degree program at St. Cloud Technical College, says, "There is nothing in the state that requires any minimum standard for a preceptor."

     Starks says his students are assigned to ambulance companies rather than individual preceptors and often ride with different crews on different days.

     Cotter says South Carolina, like Minnesota, does not require training for paramedic preceptors. Despite this, many providers designate preceptors or training officers to guide students and new employees. Cotter works to make sure preceptors from the agencies that participate in her program get the training they need.

     "I have done a train-the-trainer type program," Cotter explains, "and have sent that training CD to the different services that we contract with for their review. If services wanted, I have also gone to their training sessions and taught it for them." Cotter says the training is designed to show potential preceptors "not only what we expect of the preceptor, but what we expect of our students."

     St. Cloud's paramedic students are evaluated by their non-preceptor crews, but the evaluations are only for student feedback and to help Starks. He doesn't use field evaluations to determine students' final grades. In fact, according to Starks, Minnesota statute does not allow non-faculty members to grade students.

     California students, on the other hand, are required to get passing scores from paramedic preceptors in order to graduate. That requirement puts a lot of pressure on training programs to have qualified preceptors readily available to assign to students. It creates a demand so great that many of California's trained preceptors command a price for training paramedic students. The going rate is almost $1,000 per intern.

TRAINING THE TRAINERS
     Paying a premium for preceptors means students expect quality mentors. Darrell Albino, a paramedic preceptor in California, agrees with that expectation. He believes that simply being a paramedic is not good enough. "You have to have some other skill or knowledge to make a good preceptor," he says. "First of all, you have to have a good base of medical knowledge with experience to draw from. Second, you need good communication skills and to be able to pass on that knowledge."

     But, can mentoring be taught? Albino thinks so. He believes paramedics can be taught to be preceptors if they really want to teach; however, he's not convinced that a classroom setting is the best place for preceptor training. Albino says the skills that make a good mentor come from the mentors themselves. "I know training is beneficial," he says. "But I think having a preceptor group is just as important as having a preceptor class."

     Paramedics are constantly being called upon to take care of specialized patients. The training paramedics receive has to reflect those expectations. Passing down the wisdom of the field from the older to the younger is a must.

     The training employed to make paramedics into competent preceptors is by no means universal or standardized. Until a curriculum is developed, mentors should at least be familiar with adult learning concepts and various teaching modalities. Every student learns differently. It's the preceptor's job to help them.

     Regardless of whether one is acting in the role of a preceptor as a formal arrangement or just happens to be on the ambulance when a paramedic student arrives, it's important to keep this training experience positive. There's nothing wrong with tough, but being tough isn't the same as being mean. Being mean is hazing.

     Whether or not hazing is a problem, it's certainly on the minds of new interns. Before Blake Nielsen became a paramedic intern in northern California, he worried about hazing. "I've always heard the horror story about the first shift, when the preceptor takes you to Burger King or Taco Bell and makes you go in to pick up an application," he says. "That's your application for the whole 40 shifts. Every time you screw up your drug dose, forget to take a blood pressure or something like that, you fill out one portion of the application." According to the story, says Nielsen, a finished application means a failed internship.

     Albino believes mentoring has no room for hazing. He suggests peer groups for preceptors to increase professionalism. When preceptors are their own peer support group, he says, they "know who they can go to and bounce ideas off to get information on what has worked and what hasn't worked." Preceptors can brainstorm ideas to solve specific issues with students. The test is easy: If an activity doesn't have anything to do with learning, then making a student perform it is hazing.

     Albino also figures that students today are not as likely to take it without a fight.

     Nielsen was relieved to say his experience did not live up to his fears. "The main thing my preceptor has taught me is professionalism," says Nielsen. "He's very ethical." And that is the most important concept any mentor can pass along.

Rod Brouhard is a paramedic for American Medical Response in Modesto, CA, and former director of the EMS program at Modesto Junior College.