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Key Communication Points for EMS Preceptors
Communication is foundational to the clinical experience. How we communicate our assessment findings to our partner or the receiving facility, how we communicate between the first responder on the scene and the ambulance team who will assume care, and most importantly how the preceptor communicates with his student, is at the core of ensuring good patient care. Navigating the intricate dynamics of the EMS clinical educational environment necessitates a thoughtful approach to setting expectations, especially before a student's first assignment. The initiation of this working relationship sets the tone for the subsequent pedagogical interactions and professional development. Explicitly outlining how patient encounters should be conducted serves not only as a pedagogical tool but also as a framework for evaluation and feedback. The preceptor can assess the student's reasoning skills by requiring the student to complete an assessment first, then explain their diagnostic findings and proposed treatment algorithm. This process provides a structured learning experience that allows for tailored instruction and minimizes misunderstandings.
In EMS education, the stakes are high; the actions taken—or not taken—have immediate real-world implications. Mastering the skill of assessment is particularly crucial, as it underpins the art and science of paramedicine. It is one thing to teach someone how to perform a procedure, but another entirely to instill the clinical judgment required to discern when that procedure is necessary. A preceptor’s guidance evolves as the student gains competence, gradually shifting from a directive role to a more collaborative partnership. By acknowledging that the teaching-learning relationship is bidirectional, both preceptor and student can align their expectations, identify challenges early, and establish a rapport that fosters authentic learning and professional growth.
Discuss Expectations Before the First Assignment
It is important to understand expectations before the first assignment. If you have a new student/intern, you may want to outline how you want to see a patient's progress. For the author, he would let his students know that he wanted to see them complete the assessment first. Explain what they found, and then what treatment algorithm they were going to institute. This allows the preceptor a chance to understand how a student arrived at a particular choice. As time progresses, and you know the student understands what they need to perform, you will probably tell the student this isn’t necessary.
Figuring out what is wrong with our patients and what we need to do to treat them, the assessment is the hardest part of what we do. We can find anyone off the street and teach them how to start an IV, give an injection, or insert a supraglottic airway. The hard part is knowing WHEN to use those devices, or what you need to do to resuscitate a patient.
As your student demonstrates greater ability, you may develop a more fluid progression, more akin to a typical ‘partner’ relationship, where the student could concentrate more on infrequent skills or assessment techniques. For example, if you encountered a patient who needed to receive transcutaneous pacing, you might start the IV line and sedate the patient while your student placed the pads and performed other key tasks, leading up to actual pacing if this was a skill or process they have not had a chance to perform.
At the same time find out what the student needs from you. What do they expect or want from you, the preceptor? What are the challenges they are experiencing, and what are the skills that they have trepidation over? This allows the preceptor to work through and identify problems before they occur. More importantly, the preceptor can help the student develop a method or approach to address that issue ahead of time, rather than have it come up in the middle of an assignment. The student may not recognize all of their shortcomings, so there may be calls where they require help on the fly, but they have established a relationship of trust with their preceptor. Here true learning can occur.
The author has had students say (literally) “I am just here to start IVs, push meds, and drop tubes”. While that may be their perception, nothing is further from the truth. The clinical development from student to paramedic is robust, and dynamic, and includes many skills beyond IVs, meds, and ‘tubes’.
Signals
The author worked in a high-volume EMS system, where there was tremendous potential for violence. One signal the author had for his partner and everyone else in the room was to say they needed a hand getting the Reeves stretcher. The Reeves stretcher could easily be carried upstairs by one person, but by asking for help to carry the stretcher, and implying that it required two people, it was a tacit signal that there was a danger that could not be announced and allowed the crew to leave without rousing suspicion or ire.
Another signal the author would use was to say out loud ‘Let me place the portable oxygen over here for a moment’. He would then place it next to the potential danger or person of concern. Once he did this to alert everyone to the presence of a firearm on a nightstand.
Another signal used is between the preceptor and the student. If the student needed help or the preceptor needed to intervene, having a signal that allowed for this transition to take place without causing undue scrutiny or alarm to the family or the patient was essential. These phrases should be innocuous. Some examples include:
- "Would you mind double-checking this (medication dosage, IV, tube, etc.) for me?"
- "Can I get your opinion on this?"
- "I think this might be a good teaching moment." (Used by student or preceptor)
- "Let me help you with that (assessment, treatment, etc.)"
- "Would you mind going over this (ECG, ETI placement, IO access, etc.) with me?"
These phrases sound professional and routine, allowing for the preceptor to step in seamlessly or the student who is facing a challenge the opportunity to seamlessly transition care without causing concern for the patient. This approach respects the need for effective, discreet communication in a clinical setting while respecting the student, the patient, their family, and the preceptor.
Review and Reflection
The post-mortem assessment of an EMS assignment is critical to the learning process. This happens twice, immediately after a call, and later on after the patient is admitted or discharged, and there is a chance to obtain the diagnosis. Sometimes what we feel in the moment, is that the patient needs to be a stroke alert for example, we may only find out later that the patient had a metabolic issue – in this instance, this is a learning moment not only for the student but also for the preceptor.
That immediate post-call review allows for an opportunity to improve performance. You should tell the student immediately what they did correctly. Don’t perform a feedback sandwich, the student will turn you off but do tell them what they did correctly, and be specific. Never just say ‘Good call kid’, but provide them something specific about what they did about their assessment or treatment that was notable.
You should only correct them if they need it. If the call went well you may not need to say anything about what could have been done better. If there is something that needs to be discussed, then, before you launch into what they may have done wrong, ask them to summarize the call. At this point bring up salient points they may have missed, if they missed any (they may not have). Then ask the student what they could have done better. Don’t ask them, 'what did you do wrong.’ This places the student on the defensive. Instead, ask them what would they do better, but more importantly ask why they would make that change. It is during this reflective period that you will find most students are aware of what they did and what they need to do to improve. If they don’t, in a positive tone, point out what could have been performed better, and offer accepted options for improvement.
Summary
The art of effective preceptorship in the EMS educational sphere is far more nuanced than mere didactic instruction; it encompasses an intricate blend of communication, trust, and adaptability. The development and use of pre-established signals and communication points not only serve as mechanisms for real-time feedback but also establish an environment conducive to nuanced understanding and mutual respect. This nuanced dialogue allows the preceptor and student to not only respond effectively to immediate clinical needs but also to anticipate future challenges. It evolves from the foundation of clear expectations set forth at the beginning of the educational journey, becoming an integral part of a dynamic educational feedback loop.
As EMS professionals tasked with critical on-the-spot decision-making, the role of the preceptor extends far beyond that of a traditional educator. They serve as gatekeepers to the professional norms, clinical judgment, and ethical considerations that are fundamental to the field of EMS. Equipped with pedagogical tools tailored to facilitate progressive learning—from setting initial expectations to post-event reflective assessments—the preceptor can guide the student in mastering the complex skills and judgment required in emergency settings. The success of this educational enterprise is gauged not merely by the technical proficiency a student gains but by their ability to integrate these skills seamlessly into a comprehensive approach to patient care. Thus, a thoughtfully implemented preceptorship contributes to the development of proficient practitioners and the evolution of a field continually striving for excellence.
References
1. Foundations of Education: An EMS Approach, 3rd Edition. National Association of EMS Educators, July 29, 2019.
