Re: Students

[Guest guest]

I have wondered that myself ever since I moved to Texas in 1995. In New

York most paramedic programs require at least one year's experience at

the basic level prior to even considering a student for admission into

the paramedic program.

I feel strongly that some people are not cut out to be paramedics, just

as some people are not cut out to be CEOs of major corporations. This

does not mean that the same individual cannot function effectively as an

EMT and be a vital component of the delivery of out-of-hospital medical

care. Additionally, most individuals that complete a basic course and

intermediate course in consecutive semesters are not ready to take the

paramedic course. The individuals should gain experience prior to

having the responsibilities that are associated with being a paramedic,

not after they are certified and the in charge on an ambulance.

Clinical time associated with the EMT course does not constitute

sufficient experience.

Allowing anyone with an EMT course completion certificate to enroll in a

paramedic program, so long as he or she can afford the tuition is

detrimental to EMS' becoming seen as a true profession. I do not think

that you can adequately argue that the state practical and written

examinations are sufficient for screening out those individuals that

should not hold a certification. The board examinations that physicians

take are plenty difficult, but that doesn't mean that anyone who can

afford medical school is automatically accepted.

I truly believe that allowing anyone to enroll in a paramedic course,

regardless of the level of his or her competence or experience, is the

single largest obstacle to EMS' progression to a respected profession.

-Noah Reiter

Students

Why is it some EMS program are allowing students to continue on from

Basic when they are not proficient in basic skills?

For example:

Had a Paramedic student on a rotation the other day. This student also

works for a well know, nation wide, EMS service as a certified basic. On

a call, the student was asked to obtain a B/P. The B/P he gave seemed

appropriate for the pt. and the pts situation. But on re-evaluation the

difference was OVER

100 mmHg!

On completion of the call the student was asked what he thought about

the difference in the B/P. His response was " I guess I should have told

you I couldn't get it " I asked if he just " made up those numbers " The

conversation that followed clearly indicated he had difficulties

obtaining a B/P

How can you be a good Paramedic, if your not a good basic?

Christy

[Guest guest]

Christy,

I don't think all the blame should be placed on the EMS Programs. These

students must all ride with EMS units. Those preceptor need to be picky as

hell!! I have seen many preceptors that are content with minimal

expectations from their students....that only leads to minimal medics.

The colleges rely on the feedback they get from preceptors. If the street

medics are not willing to stand up and say...this student sucks, etc then

what do you expect. Too many medics don't want to be the bad guy. If your

precepting then you need to be as hard on a student as you would be on a new

employee, if not harder. You also need to be willing to spend time with the

student, tell them their deficiencies and help them correct them.

Just my 2 cents....

Wiseman

Students

> Why is it some EMS program are allowing students to continue on from Basic

when they are not proficient in basic skills?

> For example:

> Had a Paramedic student on a rotation the other day. This student also

works for a well know, nation wide, EMS service as a certified basic. On a

call, the student was asked to obtain a B/P. The B/P he gave seemed

appropriate for the pt. and the pts situation. But on re-evaluation the

difference was OVER

> 100 mmHg!

> On completion of the call the student was asked what he thought about the

difference in the B/P. His response was " I guess I should have told you I

couldn't get it " I asked if he just " made up those numbers " The

conversation that followed clearly indicated he had difficulties obtaining a

B/P

> How can you be a good Paramedic, if your not a good basic?

> Christy

>

>

>

[Guest guest]

Hmmmmm. Speaking from an educator's standpoint, it is

very difficult sometimes to totally ensure that a

student is " proficient " when they complete Basic

school. They may have been able to show enough

proficiency to pass the vital signs skills station in

class, and then they had positive evaluations on all

clinical rotations. So how then would the

instructor/coordinator know in some situations that the

student had trouble at times? Everyone has trouble

hearing a blood pressure at one time or another. The

problem here may be more oriented around the student's

sense of right and wrong. In other words, his problem

has more to do with not telling you that he couldn't

hear and making a BP up instead of the fact that maybe

he couldn't hear on that particular patient. Ethics

seems to be more the issue here.

I have had many green EMT's and other levels who have

had difficulty for the first several months in the field

hearing blood pressures in the unit. It is an acquired

skill to become proficient enough to hear a BP in a

running ambulance - heck, I have been hear for over 16

years and still have to palpate in the unit on some

patients. The issue here seems to be more related to

either proper teaching of ethics in patient care or in

the student's own internal grasp of what is ethical and

what is not. Being embarrassed and admitting you can't

do something is ethical. Being embarrassed and making

it up is NOT.

So maybe we need to evaluate a situation like this more

from the standpoint of " how are we teaching ethics in

schools " or " how do we judge whether a person is

trustworhty when we hire them " before we jump off the

ledge that the educator's are not ensuring proficiency

before releasing folks to the field.

Jane Hill

> Why is it some EMS program are allowing students to continue on from Basic

when

> they are not proficient in basic skills?

> For example:

> Had a Paramedic student on a rotation the other day. This student also works

for

> a well know, nation wide, EMS service as a certified basic. On a call, the

> student was asked to obtain a B/P. The B/P he gave seemed appropriate for the

> pt. and the pts situation. But on re-evaluation the difference was OVER

> 100 mmHg!

> On completion of the call the student was asked what he thought about the

> difference in the B/P. His response was " I guess I should have told you I

> couldn't get it " I asked if he just " made up those numbers " The conversation

> that followed clearly indicated he had difficulties obtaining a B/P

> How can you be a good Paramedic, if your not a good basic?

> Christy

>

>

>

[Guest guest]

Exactly, . That was what I was also trying to say

in my post. There are so many people in the mix trying

to judge a student's competence, and many of these well-

meaning preceptors don't want to appear negative or

picky. So unless the student is a threat to a patient's

life, many times nothing is said or written. Whose

fault is this? Hard to say. Many would say educator's

should be more picky about who they get to precept their

students. But many times the educator's are not given a

choice because companies pick their own preceptors

inside their agency. At the hospital, students in ED's

are typically just in a roaming situation with no

specific preceptor - the staff is ALL responsible for

precepting in many hospitals. That makes it difficult.

But since educational institutions cannot afford to PAY

places for a precepting fee, they can really make few

demands - only suggestions. Stuck between the

proverbial rock and a hard place.......

Jane Hill

> Christy,

>

> I don't think all the blame should be placed on the EMS Programs. These

> students must all ride with EMS units. Those preceptor need to be picky as

> hell!! I have seen many preceptors that are content with minimal

> expectations from their students....that only leads to minimal medics.

>

> The colleges rely on the feedback they get from preceptors. If the street

> medics are not willing to stand up and say...this student sucks, etc then

> what do you expect. Too many medics don't want to be the bad guy. If your

> precepting then you need to be as hard on a student as you would be on a new

> employee, if not harder. You also need to be willing to spend time with the

> student, tell them their deficiencies and help them correct them.

>

> Just my 2 cents....

>

> Wiseman

> Students

>

>

> > Why is it some EMS program are allowing students to continue on from Basic

> when they are not proficient in basic skills?

> > For example:

> > Had a Paramedic student on a rotation the other day. This student also

> works for a well know, nation wide, EMS service as a certified basic. On a

> call, the student was asked to obtain a B/P. The B/P he gave seemed

> appropriate for the pt. and the pts situation. But on re-evaluation the

> difference was OVER

> > 100 mmHg!

> > On completion of the call the student was asked what he thought about the

> difference in the B/P. His response was " I guess I should have told you I

> couldn't get it " I asked if he just " made up those numbers " The

> conversation that followed clearly indicated he had difficulties obtaining a

> B/P

> > How can you be a good Paramedic, if your not a good basic?

> > Christy

> >

> >

> >

[Guest guest]

Christy-

I work at a Community College as an instructor and teach and precept students at

EMTB thru EMTP level regularly in class and in various major hospitals around

the Houston / Galveston area. I serve in a Volunteer capacity with 2 services

in my home 10/20. May will mark my 24th year in EMS in Texas.

My personal commitment to the program at the college, EMS in Texas, and my own

little ol' moral code make the issue you raise a no-brainer.....

If I do not think I want an individual under my tutelage to work on my

MOTHER....(significant deficiencies..)

1) I must document the specific deficiencies.

2) Attempt an immediate remediation of the skill or knowledge that is deficient.

(It may be a small matter too, you know...)

3) Report the deficiency to the individuals instructor (If not my student)

4) Test and re-evaluate to assure effective remediation or further document the

individuals need for remediation or evaluation by a third party or removal from

the program if all else fails.

Likewise, if I find a partner on a rig that is below par, I do not accept that

performance. That is what administrators are for....

YOU have to be willing to be the " Picky Bastard " and demand excellence in your

co-workers. You will only loose fair-weather friends. Your real friends will

appreciate your commitment. The EMTB in question may also not have had the

benefit of tough, demanding instructors and my be in desperate need of a little

tune up.....will you be willing to let this person go on un-remediated and treat

YOUR Mom?

Regards-

T.A. Dinerman EMTP

Students

Why is it some EMS program are allowing students to continue on from Basic

when they are not proficient in basic skills?

For example:

Had a Paramedic student on a rotation the other day. This student also works

for a well know, nation wide, EMS service as a certified basic. On a call, the

student was asked to obtain a B/P. The B/P he gave seemed appropriate for the

pt. and the pts situation. But on re-evaluation the difference was OVER

100 mmHg!

On completion of the call the student was asked what he thought about the

difference in the B/P. His response was " I guess I should have told you I

couldn't get it " I asked if he just " made up those numbers " The conversation

that followed clearly indicated he had difficulties obtaining a B/P

How can you be a good Paramedic, if your not a good basic?

Christy

[Guest guest]

It isn't just they're not a good basic. It's they're a lousy employee and

dishonest, and shouldn't work. Period. There is NO excuse for poor patient

care.

Steve

Christy Petty wrote:

> Why is it some EMS program are allowing students to continue on from Basic

when they are not proficient in basic skills?

> For example:

> Had a Paramedic student on a rotation the other day. This student also works

for a well know, nation wide, EMS service as a certified basic. On a call, the

student was asked to obtain a B/P. The B/P he gave seemed appropriate for the

pt. and the pts situation. But on re-evaluation the difference was OVER

> 100 mmHg!

> On completion of the call the student was asked what he thought about the

difference in the B/P. His response was " I guess I should have told you I

couldn't get it " I asked if he just " made up those numbers " The conversation

that followed clearly indicated he had difficulties obtaining a B/P

> How can you be a good Paramedic, if your not a good basic?

> Christy

>

>

[Guest guest]

I have been wondering this for years. How can you do advanced skills- when

your are not proficent (meaning very experienced) in your basic skills?

Remember with out the EMT, you cant have an EMT-P! (In other words- work at

perfecting your basic skills- then move on to more advanced skills)

Jay Hoskins

Students

Why is it some EMS program are allowing students to continue on from Basic

when they are not proficient in basic skills?

For example:

Had a Paramedic student on a rotation the other day. This student also works

for a well know, nation wide, EMS service as a certified basic. On a call, the

student was asked to obtain a B/P. The B/P he gave seemed appropriate for the

pt. and the pts situation. But on re-evaluation the difference was OVER

100 mmHg!

On completion of the call the student was asked what he thought about the

difference in the B/P. His response was " I guess I should have told you I

couldn't get it " I asked if he just " made up those numbers " The conversation

that followed clearly indicated he had difficulties obtaining a B/P

How can you be a good Paramedic, if your not a good basic?

Christy

[Guest guest]

Hmmmmm... Maybe the solution is like we were starting to

adopt at TJC when I left. The preceptors could mail the

bad evals back to the clinical instructor instead of

giving them to the students. Many students just

accidentally lose those evals that make them look bad I

think.

I have found that there are times when students are

taught badly - and sometimes they come out of poor

programs, but sometimes they tell stories to try to

shift the blame back on their instructors. I have had a

student or too try to convince people they were TAUGHT

something in class that was wrong, and they were MY

students. So I KNEW that wasn't what they were taught.

Part of our problem today is that the new breed of

student many times has very little sense of personal

responsibility and " it is always someone else's fault "

that they made a mistake or that they don't know how to

do something.

I am not saying that this particular situation was NOT

an instructor's fault. I am just very wary sometimes

and like to investigate the WHOLE picture. I like to

look at where they went to school and who their

instructors are to see if this is a consistent problem

or if this might be something else entirely. I just

have a problem because too often educators are accused

of falling down on their jobs because of one situation,

when it might not have been the educators' faults. I

like to look at the whole picture? Does this program

generally turn out good students or not? Has their been

a history of students coming from that program who can't

take blood pressures or perform other skills? If that

is the case, then yes, I look harder at the

instructors. If not, maybe there is another problem

that is more centered on that specific student. Who

knows?

Jane

> Jane,

> I understand what you are saying, and the ethical issues were discussed with

> the student.

> I was led to believe that the problem was with the skill itself. The student

> stated he heard a " thump " at 200 (systolic) but thought it was incorrect

> because he had the cuff pumped up over 240!

> Myself as a preceptor on the ambulance have written good evaluations and bad

> evaluations, but the bad ones never seem to make it back to the instructors

> for some reason.

> Christy

> Re: Students

>

>

> > Hmmmmm. Speaking from an educator's standpoint, it is

> > very difficult sometimes to totally ensure that a

> > student is " proficient " when they complete Basic

> > school. They may have been able to show enough

> > proficiency to pass the vital signs skills station in

> > class, and then they had positive evaluations on all

> > clinical rotations. So how then would the

> > instructor/coordinator know in some situations that the

> > student had trouble at times? Everyone has trouble

> > hearing a blood pressure at one time or another. The

> > problem here may be more oriented around the student's

> > sense of right and wrong. In other words, his problem

> > has more to do with not telling you that he couldn't

> > hear and making a BP up instead of the fact that maybe

> > he couldn't hear on that particular patient. Ethics

> > seems to be more the issue here.

> >

> > I have had many green EMT's and other levels who have

> > had difficulty for the first several months in the field

> > hearing blood pressures in the unit. It is an acquired

> > skill to become proficient enough to hear a BP in a

> > running ambulance - heck, I have been hear for over 16

> > years and still have to palpate in the unit on some

> > patients. The issue here seems to be more related to

> > either proper teaching of ethics in patient care or in

> > the student's own internal grasp of what is ethical and

> > what is not. Being embarrassed and admitting you can't

> > do something is ethical. Being embarrassed and making

> > it up is NOT.

> >

> > So maybe we need to evaluate a situation like this more

> > from the standpoint of " how are we teaching ethics in

> > schools " or " how do we judge whether a person is

> > trustworhty when we hire them " before we jump off the

> > ledge that the educator's are not ensuring proficiency

> > before releasing folks to the field.

> >

> > Jane Hill

> > > Why is it some EMS program are allowing students to continue on from

> Basic when

> > > they are not proficient in basic skills?

> > > For example:

> > > Had a Paramedic student on a rotation the other day. This student also

> works for

> > > a well know, nation wide, EMS service as a certified basic. On a call,

> the

> > > student was asked to obtain a B/P. The B/P he gave seemed appropriate

> for the

> > > pt. and the pts situation. But on re-evaluation the difference was OVER

> > > 100 mmHg!

> > > On completion of the call the student was asked what he thought about

> the

> > > difference in the B/P. His response was " I guess I should have told you

> I

> > > couldn't get it " I asked if he just " made up those numbers " The

> conversation

> > > that followed clearly indicated he had difficulties obtaining a B/P

> > > How can you be a good Paramedic, if your not a good basic?

> > > Christy

> > >

> > >

> > >

[Guest guest]

Christy and Jane...

I tend to use email to communicate with the instructors both good and bad.

Sometimes the tool given by the program to evaluate the student isn't

designed to show the problem or be able to support the great job done by a

student.

The instructors I have spoken (emailed) with really like that avenue.

Sometimes it is just better to hear the issue good or bad strait from the

evaluator in his/her own words.

Good luck,

Re: Students

> >

> >

> > > Hmmmmm. Speaking from an educator's standpoint, it is

> > > very difficult sometimes to totally ensure that a

> > > student is " proficient " when they complete Basic

> > > school. They may have been able to show enough

> > > proficiency to pass the vital signs skills station in

> > > class, and then they had positive evaluations on all

> > > clinical rotations. So how then would the

> > > instructor/coordinator know in some situations that the

> > > student had trouble at times? Everyone has trouble

> > > hearing a blood pressure at one time or another. The

> > > problem here may be more oriented around the student's

> > > sense of right and wrong. In other words, his problem

> > > has more to do with not telling you that he couldn't

> > > hear and making a BP up instead of the fact that maybe

> > > he couldn't hear on that particular patient. Ethics

> > > seems to be more the issue here.

> > >

> > > I have had many green EMT's and other levels who have

> > > had difficulty for the first several months in the field

> > > hearing blood pressures in the unit. It is an acquired

> > > skill to become proficient enough to hear a BP in a

> > > running ambulance - heck, I have been hear for over 16

> > > years and still have to palpate in the unit on some

> > > patients. The issue here seems to be more related to

> > > either proper teaching of ethics in patient care or in

> > > the student's own internal grasp of what is ethical and

> > > what is not. Being embarrassed and admitting you can't

> > > do something is ethical. Being embarrassed and making

> > > it up is NOT.

> > >

> > > So maybe we need to evaluate a situation like this more

> > > from the standpoint of " how are we teaching ethics in

> > > schools " or " how do we judge whether a person is

> > > trustworhty when we hire them " before we jump off the

> > > ledge that the educator's are not ensuring proficiency

> > > before releasing folks to the field.

> > >

> > > Jane Hill

> > > > Why is it some EMS program are allowing students to continue on from

> > Basic when

> > > > they are not proficient in basic skills?

> > > > For example:

> > > > Had a Paramedic student on a rotation the other day. This student

also

> > works for

> > > > a well know, nation wide, EMS service as a certified basic. On a

call,

> > the

> > > > student was asked to obtain a B/P. The B/P he gave seemed

appropriate

> > for the

> > > > pt. and the pts situation. But on re-evaluation the difference was

OVER

> > > > 100 mmHg!

> > > > On completion of the call the student was asked what he thought

about

> > the

> > > > difference in the B/P. His response was " I guess I should have told

you

> > I

> > > > couldn't get it " I asked if he just " made up those numbers " The

> > conversation

> > > > that followed clearly indicated he had difficulties obtaining a B/P

> > > > How can you be a good Paramedic, if your not a good basic?

> > > > Christy

> > > >

> > > >

> > > >

[Guest guest]

I agree with that approach. I have had many preceptors

call me in the past with concerns about students, but I

have had many others who never say anything. They just

mark on the sheets that the student was basically

average and make no comments either way to help the

instructor paint an adequate picture of the student's

competence level. I am not sure how to motivate

preceptors to be proactive in reporting on student

performance. Suggestions?

Jane Hill

> Christy and Jane...

>

> I tend to use email to communicate with the instructors both good and bad.

> Sometimes the tool given by the program to evaluate the student isn't

> designed to show the problem or be able to support the great job done by a

> student.

>

> The instructors I have spoken (emailed) with really like that avenue.

> Sometimes it is just better to hear the issue good or bad strait from the

> evaluator in his/her own words.

>

> Good luck,

>

>

> Re: Students

> > >

> > >

> > > > Hmmmmm. Speaking from an educator's standpoint, it is

> > > > very difficult sometimes to totally ensure that a

> > > > student is " proficient " when they complete Basic

> > > > school. They may have been able to show enough

> > > > proficiency to pass the vital signs skills station in

> > > > class, and then they had positive evaluations on all

> > > > clinical rotations. So how then would the

> > > > instructor/coordinator know in some situations that the

> > > > student had trouble at times? Everyone has trouble

> > > > hearing a blood pressure at one time or another. The

> > > > problem here may be more oriented around the student's

> > > > sense of right and wrong. In other words, his problem

> > > > has more to do with not telling you that he couldn't

> > > > hear and making a BP up instead of the fact that maybe

> > > > he couldn't hear on that particular patient. Ethics

> > > > seems to be more the issue here.

> > > >

> > > > I have had many green EMT's and other levels who have

> > > > had difficulty for the first several months in the field

> > > > hearing blood pressures in the unit. It is an acquired

> > > > skill to become proficient enough to hear a BP in a

> > > > running ambulance - heck, I have been hear for over 16

> > > > years and still have to palpate in the unit on some

> > > > patients. The issue here seems to be more related to

> > > > either proper teaching of ethics in patient care or in

> > > > the student's own internal grasp of what is ethical and

> > > > what is not. Being embarrassed and admitting you can't

> > > > do something is ethical. Being embarrassed and making

> > > > it up is NOT.

> > > >

> > > > So maybe we need to evaluate a situation like this more

> > > > from the standpoint of " how are we teaching ethics in

> > > > schools " or " how do we judge whether a person is

> > > > trustworhty when we hire them " before we jump off the

> > > > ledge that the educator's are not ensuring proficiency

> > > > before releasing folks to the field.

> > > >

> > > > Jane Hill

> > > > > Why is it some EMS program are allowing students to continue on from

> > > Basic when

> > > > > they are not proficient in basic skills?

> > > > > For example:

> > > > > Had a Paramedic student on a rotation the other day. This student

> also

> > > works for

> > > > > a well know, nation wide, EMS service as a certified basic. On a

> call,

> > > the

> > > > > student was asked to obtain a B/P. The B/P he gave seemed

> appropriate

> > > for the

> > > > > pt. and the pts situation. But on re-evaluation the difference was

> OVER

> > > > > 100 mmHg!

> > > > > On completion of the call the student was asked what he thought

> about

> > > the

> > > > > difference in the B/P. His response was " I guess I should have told

> you

> > > I

> > > > > couldn't get it " I asked if he just " made up those numbers " The

> > > conversation

> > > > > that followed clearly indicated he had difficulties obtaining a B/P

> > > > > How can you be a good Paramedic, if your not a good basic?

> > > > > Christy

> > > > >

> > > > >

> > > > >