Preceptor Update

1
Preceptor Update

• Mountain Lakes Regional EMS Council
• Northeastern NY EMS Training Corp.

2
Program Overview

• Welcome Introduction
• Overview of AEMT-I CCT Curricula
• Roles, Responsibilities Expectations
• NENYEMSA Internship Guidelines
• Counseling Feedback
• QI Concerns Planning
• Questions Answers

3
CME Audience

• 3 hours of Continuing Education is authorized by
  the NENYEMS Education Corp.
• Course has been mandated for all preceptors by
  REMAC and the NENYEMS Program Agency.
• All preceptors in the Mtn. Lakes Region are
  required to take this update.

4
Objectives

• Define the role responsibilities of preceptors.
• Become familiar with the NYS DOH EMT-Intermediate
  Critical Care course curricula.
• Describe the NENYEMSPA Internship Guidelines and
  credentialling process.

5
Objectives

• Become familiar with the various methods of
  providing feedback counseling to interns.
• Recall specific areas of concern noted through
  the Quality Improvement process and integrate
  those areas into the field internship.

6
DOH Curricula

• EMT - Intermediate
• may be done as a stand-alone course or as the
  beginning of a CCT course.
• Requires several hours of clinical time,
  including
• 24 hrs. ED
• 16 hrs. IV or 15 successful IVs
• 12 hrs. OR or 10 visualization of vocal cords
• 8 hrs. Respiratory
• 60 hrs. Field Internship

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DOH Curricula

• Primarily addresses trauma trauma management.
• Skills include
• Advanced patient assessment
• Advanced airway, including ET, Dual-Lumen, NG
  tube placement, flow restricted ventilator
• Needle decompression
• IV / IO access
• Also includes, clinical decision making!

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DOH Curricula

• EMT - Critical Care
• Requires additional Clinical time
• 16 hrs. ED
• 16 hrs. CCU
• 8 hrs. Respiratory
• 60 hrs. Field Internship
• Focuses on medical emergencies - respiratory
  cardiac primarily.

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DOH Curricula

• Skills include
• Nebulized medication administration
• IV bolus medication
• IO infusion
• IV drip medication
• Subcutaneous Intramuscular Injection
• Static cardiology
• Dynamic cardiology
• Transthoracic pacing
• Cardioversion

10
Roles, Responsibilities Expectations

• A preceptor is a trainer, an educator at the very
  basic level. It is imperative that a preceptor
  lead by example, instruct by the book, and
  nurture by instinct. The long term success of
  many interns may rest solely on the success of
  their internship.

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Roles, Responsibilities Expectations

• Teacher
• helps the intern learn new topics, remediates
  topics which they are already familiar, and helps
  build new psychomotor skills.
• Coach
• help to complete training tasks
• a coach allows practice after after the intern
  begins to understand the basic concepts

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Roles, Responsibilities Expectations

• Mentor
• sometimes between a supervisor the intern
• preceptor must be able to answer questions and
  give guidance, but must also work with the
  chain-of-command for those other issues.
• Role Model
• the intern will follow your lead!
• that means, you need to lead by EXAMPLE!

13
Roles, Responsibilities Expectations

• Evaluator
• must provide feedback, and ALL the time
• interns want to know what they are doing right,
  what they are doing wrong and what they can do
  better not just if they got a good stick
• Counselor / Advisor
• be trustworthy, empathetic an active listener
• facilitate the loop it is field learning

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Roles, Responsibilities Expectations

• Attributes of a Preceptor
• Professional
• Respectful
• Appearance
• Knowledge / Skill
• Attitude
• Interest in Trainee
• Enthusiasm

15
Roles, Responsibilities Expectations

• REMAC Requirements
• must have functioned as a solo AEMT for a minimum
  of 1 year
• must have teaching/training experience at the ALS
  level must posses good written oral
  communication skills
• must be thoroughly familiar with Mtn Lakes ALS
  protocols
• must be nominated by agency chief officer
• must be approved by the local medical control /
  credentialing board
• credentialed for 3 years

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Roles, Responsibilities Expectations

• REMAC Duties
• provide objective subjective evaluation of
  interns performance
• act as a teacher to the intern
• acts as an observer, intervening only when
  patient care is compromised
• must complete the Preceptors Intern Run
  Evaluation Form
• performs call reviews with all members of the crew

17
Internship Guidelines Credentialing

• Process
• some is done as a student and the remainder
  after certification
• once certified an ALS Credentialing Application
  is completed and a TEK is assigned
• internship is then completed based on the
  guidelines established by REMAC
• completed internship packets are submitted to the
  agencys medical director for consideration

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Internship Guidelines Credentialing

• Basic Rules
• Intermediate
• Supervised Course Clinical Activities (student)
• ALS Intermediate care on minimum of 2 calls
• IV / ET / Defibrillation / Signal
• Internship
• 5 calls w/ preceptor
• 3 successful IVs or ETs
• 2 PCRs completed by intern as in-charge
• supervised course clinical calls may be used
• all must be completed within one year

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Internship Guidelines Credentialing

• Critical Care
• Supervised Course Clinical Activities (student)
• ALS CCT care on minimum of 2 calls
• Cardiac rhythm interpretation / fluid
  resuscitation / cardioversion-defibrillation /
  administration of medications / Signal

20
Internship Guidelines Credentialing

• Internship
• 5 calls w/ preceptor
• 2 must include a Signal
• 2 additional must involve a Signal or Rx
  administration on standing orders
• ALL PCRs must be completed by the intern
• 1 call - must submit a patient care research
  report
• pass a Mtn. Lakes Protocol exam w/ an 80
• all must be completed within one year

21
Internship Guidelines Credentialing

• Other Options
• The Buddy System
• Solo Internship Option
• AEMTs from other regions
• Temporary credentials
• Lapses in certification / on-line status

22
Counseling Feedback

• The purpose of counseling interns is to discuss
  and change behavior or performance. Although
  perceived to be negative, counseling should
  always be positive in nature.
• The most common form of counseling is immediate
  feedback to the intern.

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Counseling Feedback

• SMART method of Evaluation
• S - Specific
• M - Measurable
• A - Aggressive / Attainable
• R - Results Oriented
• T - Time-bound

24
Counseling Feedback

• 3-Step Model
• 1) Preceptor should state what they observed and
  conclusions derived from the situation.
• 2) The intern should be allowed to state what
  the observed and what they derived from the
  situation, even if different.
• 3) After both have stated their position, they
  should work toward a common solution. Although
  input from the intern should be carefully
  considered, policies, procedures, protocols and
  experience should prevail.

25
Counseling Feedback

• 5 Step Model
• 1) Test readiness receptivity
• 2) Get the other persons views
• 3) Present your views
• 4) Resolve differences
• 5) Set follow-up and thank

26
Counseling Feedback

• Counseling Guidelines
• focus feedback on performance behavior rather
  than on the person
• dont compare the intern w/ others, but with
  written performance objectives
• dont criticize in front of others
• comment on a situation as soon as possible
• get right to the point

27
Counseling Feedback

• Be positive, but firm
• do not apologize for counseling
• do not be bullied
• always aim to be a success success is measured
  in behavior / performance modification

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QI Concerns Planning

• Preceptors MUST be active in QI
• be involved in agency QI program
• be involved in the regional QI process
• remain current with QI concerns both at the
  agency and regional level
• work to correct actions of interns and other
  providers to make them compliant with QI concerns

29
QI Concerns Planning

• Some QI examples
• poor IV success rates
• always give a big needle in the A/C
• lets start the IV in the house on this one
• LONG on-scene times
• improper immobilization
• protocol compliance

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QI Concerns Planning

• Planning
• put it all together
• where is your intern?
• Do they understand the concepts why?
• Do they understand the techniques how?
• Do they understand the protocols when?
• What do you need to do to facilitate the learning
  environment?

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Questions?