Paramedic Clinical Preceptor Program

Our graduates have served Memphis, West Tennessee, and the Mid- South in a

distinguished fashion over the past three decades. Officially begun in 1973, the program took on a smaller number of

candidates in the first paramedic training program in the area. Since then, the program has trained thousands of individuals as EMT Basics, EMT Intermediates and hundreds of

EMT Advanced/Paramedics during this time.

Shelby State Community College and State Technical Institute at Memphis.

Which consolidated July 1, 2000

“Proof of stellar training is not merely in the longevity of the program, nor in the number of

graduates, but is rather found in the reduction of morbidity and mortality in the population

served. Since this is so very difficult to access from the vantage point of the training site or

college, for now we rely on the assessment of performance of skills by our graduates. Which brings the knowledge base of the learner into

account by observing the objective proficiency of the individual during standardized testing.”

-Dr. Loren CrownEmergency Physician

Medical Director

EMT/Paramedic Program

Southwest Tennessee Community College

Strive to maintain high quality, reasonable cost healthcare by delivering patients

directly to appropriate facilities.

Possess the knowledge, skills

and attitudes consistent with the expectations of the

public and the profession.

Are responsible and accountable to medical direction,

the public, and their peers.

Have fulfilled prescribed

requirements by a credentialing agency to practice the art and

science of “out-of-hospital” medicine in

conjunction with medical direction.

As an advocate for patients, paramedics seek to be proactive

in affective healthcare by

working in conjunction with other providers.

Recognize that they are an essential

component of the continuum of care and serve as a link among

healthcare.

These apply to all levels of EMS providers, including

instructors and preceptors.

Integrity

Empathy

Self-motivation

Appearance/ personal hygiene

Self-confidence

Communications

Time Management

Teamwork and Diplomacy

Respect

Patient Advocacy

Careful delivery of services

To prepare the experienced EMT-

Intermediate/ Paramedic for his/her role as a

preceptor.

To provide a mechanism for identifying EMS students who

do not meet minimum performance standards prior

to certification.

Provide the Preceptor the knowledge to become an

“Effective Preceptor”

Give the Preceptor the tools needed to evaluate

and create a positive clinical/field experience.

PURPOSE

The state does not certify or license the personnel who complete this training.

Clinical preceptors must be approved through the STCC EMT/ Paramedic program.

Successful completion of this course does not exempt the individual from any additional orientation requirements or remediation for the specific program he/she intends to precept.

The course coordinator of the approved EMS preceptor course is responsible for assuring that all requirements of the Clinical Preceptor Program are met as outlined by the State or accreditation department.

Approved preceptors must maintain their licensure that is required for approval, throughout the time as a preceptor.

Paramedic Clinical Preceptors can precept EMT-B, EMT-I and EMT-Paramedic students.

EMT-I Clinical Preceptors are limited to only EMT-B and EMT-I students.

Definition: An identified experienced practitioner who provides transitional role support and learning experiences within a

collegial relationship for a specific time, while continuing to perform some or all of the other

responsibilities of their position.

Written approval from

the STCC program director

Be familiar with adult learning concepts.

Vary teaching modalities.

Know that every student learns differently.

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 field experience that can prepare them for the road ahead, but

many do not!

Past Experience

(if any)

Classroom and Book

Knowledge

ClinicalTime

They are trying to put it all together, as

they reach the clinical phase.

Ethics is generally thought of as the study of right action and morals is the system through which that action is applied.

These are difficult to define and many definitions are acceptable……….

The critical examination and evaluation of what is good, evil, right and wrong in human conduct. (Guy, 2001)

A specific set of principles, values and guidelines for a particular group or organization. (Guy, 2001)

The study of goodness, right action and moral responsibility. It asks what choices and ends we ought to pursue and what moral principles should govern our pursuits and choices. (Madden, 2001)

Those principles and values that actually guide, for better or worse, and individual’s personal conduct. (Guy,2001)

Morality is the informal system of rational beings by which they govern their behavior in order to lessen harm or evil and do good, this system, although informal, enjoys amazing agreement across time and cultures concerning moral rules, moral ideas and moral virtues. (Madden, 2000)

Where emphasis is placed in what is rewarded in an organization and society.

Guiding principles of behavior and conduct.

The core motivator for behaviors.

In-depth knowledge is not required but it is important to have an understanding of some of the major theories, such as……..

Divine Law

God’s will and word

Obeying god’s word

Moral certainty and

guidance

Virtue Ethics

Seeking happiness

and living the good life

Acting virtuously

Virtue is it’s own reward

(self-actualization)

Egoism

What I think is best for me

is good

Promoting what is good for me only

Leads to moral

certainty and moral

autonomy

Ethical Relativism

Whatever the individual

decides is good.

Acting in accord with the groups

values and principles.

Tolerance of others, flexible

thinking and practicality.

Utilitarianism

Happiness/ pleasure,

diminishing misery and pain.

Promoting the greatest good for

the greatest number.

Tolerance of others, flexible

thinking and practicality.

Duty Ethics

Good will that is good- hearted

and extended to others.

Doing your moral duty and

acting as a model for others.

Highly principled behavior,

showing respect for self and

others.

We tend to teach the way we like to learn.

This may be a disservice to our students.

Auditory-visual-

kinesthetic preferences

Analytic and global

learning preference

Social and independent

learning

Learns best through hearing

information

Benefits from oral

presentation

Learns best by taking

info in visually

Benefits from visual

presentation

Learns best by doing it

hands on.

Benefits from taking things apart and making things work.

Process info best when

multi-tasking in busy

environments.

Tend to enjoy study sessions, group projects

and cooperative

learning.

Process info best when

working independently

or isolated.

Tend to work best in quiet, undisturbed, regular study environment.

Describe the order in which a learner prefers to process info received by looking at the whole picture, then breaking it down into individual parts………..

OR

By looking at the individual part and then combining it into a whole.

Also known as “Right Brain, Left Brain”

Process info logically,

sequentially and in small

parts.

They are uncomfortable

with learning that is out of

sequence.

Needs to process the big

picture first, then focus on the individual

parts.

They are uncomfortable learning when

they do not have a sense of the big picture.

Left Brain Right Brain

This is known and defined as

“Pedagogy”

• Involves creative aspects like instructional design, developing classroom presentation skills, etc.

The Art of teaching

• Is based in educational psychology and research and deals with learning theories and preferences, how people think, “The Domains Learning”, and other aspects of learning.

The Science

of teaching

A tool for understanding how people think, feel and act.

By understanding the “Domains of Learning” we can better plan what needs to be taught and how far we

need to go through the material.

Also known as “Depth and Breadth”.

Developed by Benjamin Bloom in 1956,

His research described the major areas of learning and thinking and classified them into

three large groups, known as

“The Domains of Learning”

Cognitive(thinking)

Affective(feeling)

Psycho-motor

(doing)

The “domains of learning”

are used in instructional design to write goals and objectives for a curriculum.

They can also serve as a tool for instructors to

develop lesson plans and test questions.

The Cognitive

Domain

• Deals with didactic information; knowledge and facts

The Psychomotor

Domain

• Deals with skills, actions and manual manipulation.

The Affective

Domain

• Deals with attitudes, beliefs, behaviors, emotions and how much value an individual places on something.

Cognitive

• Use lecture, discussion, reading, diagramming, case studies and drills.

Psychomotor

• Skills practice, scenarios, simulations, and role playing.

Affective

• By modeling behaviors you expect your students to emulate (tolerance, punctuality, respect, kindness, honesty and integrity.

Evaluate the student by asking questions…….

For example:

List the anatomy of the chest.

How would you evaluate a M.I.?

What is the pathophysiology of Cholet cystitis?

How would you care for a head injury?

How would you care for a diabetic?

How would you handle a child abuse case?

Is done through skills evaluation and

check-offs.

Is done through performance evaluations. Each evaluation will be reviewed and discussed at

the end of the presentation.

Research shows that the more senses that are engaged in the learning process, the more

material is retained for a longer period of time.

What we read

What we hear

What we see

What we see and hear40%

10%

20%

30%

We use evaluation techniques as a tool to evaluate if the student has achieved the objectives and goals of

instruction.

The evaluation process can be used to determine strengths and weaknesses of students and of the

program.

Evaluations can also be used to determine if a student is compatible with the EMS field. (By

targeting the affective domain)

Process of making a value judgment based on information from one or more sources.

A mechanism of determining student progress towards, or the attainment of, stated cognitive, psychomotor and affective objectives.

Provide feedback to the student on progress or performance.

Provide student gratification and motivation to succeed.

Measure effectiveness of teaching style and content of lesson.

Measure effectiveness of the educational program in meeting written goals and objectives.

Formative Evaluation: Ongoing evaluation of the students and instruction

conducted throughout the course.

Summative Evaluation: An evaluation that is performed at the completion

of the delivery of a larger section of material, module or program.

Compare the objectives of the course to the testing strategy.

Cognitive component: Testing knowledge

Psychomotor component: Testing skill performance

Affective component: Testing attitudes, beliefs, ethics and morals.

Formative evaluation is important in gaining insight early in the program, to provide

remediation, or to redirect presentations.

1. Module or section testing within a larger topic area.

2. Question the student about the patient care after each call.

3. Give frequent, short-duration written or practical drills or quizzes.

These methods will provide feedback to both the student and instructor, on the progress of the

student.

Performed at the completion of the delivery of the content of a larger section of material, a module or program.

Example: chapter tests, module tests or semester finals.

This will provide feedback to the students of their successful mastery of the content.

1. Survey toolsGather opinions about various aspects of the

course and instruction.

2. Comparison of course and program outcomes.

Determine if all goals and objectives were met.

3. Final exams: written and practical

Depending upon the context in which it is used, a test may represent FORMATIVE and

SUMMATIVE evaluation.

For example: a multiple choice final exam given at the end of a topic will be both FORMATIVE and SUMMATIVE. It is SUMMATIVE because it represents the end of

that topic area

It is FORMATIVE because it represents only a part of a course.

One method of reaching our students in an effective manner that makes the learning

experience more productive and enjoyable is….

FACILITATION

The word Facilitate means to

“MAKE EASIER”

It is a method of interacting with students that enhances their learning experience. A variety of techniques involving coaching,

mentoring and positive reinforcement.

**To be effective at facilitation you need to know and understand your audience!!!**

Adult learning styles are different from children.

Adult learners need to see that “professional development” and their “day-to-day activities” are related and relevant. Adult learners need to “buy-in” to the process,

which means their learning must be meaningful and relevant.

Adults need direct, concrete experiences in which they apply learning to the “real world”

Adult learning has ego involvement. Professional development must be structured to

provide support from peers and to reduce the fear of judgment by others.

Adult learners need constant feedback. Feedback should include performance evaluation

and methods to improve.

Allow input into the feedback. Discuss the correct answer rather than tell the

correct answer.

Adults need to participate in small group activities during the learning experience to move them through the various levels of the domains of learning.

of The Adult Learner

Adults are generally autonomous and self- directed.

They function best in a student centered environment, instead of an instructor centered environment.

Lectures are instructor centered.

Small group activities are student centered.

They need to be free to direct themselves.

Adults have a foundation of life experiences.

Work, family and prev. education all have shaped who they are today.

Instructor needs to connect learning to this knowledge/experience base.

Relate theories and knowledge or concepts, to the “real world”.

Adults are goal- oriented

They are in class for a reason.

They appreciate organization and clearly defined goals and objectives.

As an instructor, you should know what reason each student is in class for.

Adults are relevancy- oriented.

They need to see the reason they are learning something.

Place the learning in context to help motivate them.

Learning has to be applicable in order to have value.

Adults are practical As instructors, we have to show how the content is

useful to the learners. Students tend to only retain what they feel is useful, so

we must show them how all the info is needed.

Adults need to be shown respect Recognize the wealth of experience that students

bring to the classroom.

Students should be treated as peers, not just as “students”.

Encourage students to share their opinions and experiences.

Motivation The best way to motivate is to enhance their

reasons for enrolling in the class, and decrease any barriers*, such as: Lack of time

Lack of money

Lack of confidence

Scheduling problems

Family problems

Transportation issues

* As instructors, we need to try and be understanding of these barriers.

ReinforcementReinforcement should be part of your every day routine,

as a preceptor or instructor. This will help maintain positive behavior.

Positive reinforcement Set expectations and goals at a level that is reachable

for the level of student that is being taught. Challenge Students Each student may need a different level of difficulty.

Provide feedback, in a positive way, from other instructors, peers or other people involved in the experience.

Negative reinforcement It is best to AVOID negative reinforcement It may result in alienation of the student. Which may cause the student to shut down to the

learning process, and you become an ineffective preceptor or instructor.

Students must “RETAIN” the info given in order to benefit from the learning.

As an instructor, we should not “lecture”- give info that is relevant to the subject or discussion.**Too much info = sensory overload = no info retained!!

Retention is directly related to initial learning. If the student didn’t learn the info very well, they will

not retain it. Retention is effected by the amount of practice that

occurs during learning.

Info must be retained before it can be transferred.

Retention

~ The ability to use info learned in a new setting ~ Positive transference

The student uses the behavior or info learned in the course.

Negative transference The student does not use the behavior or info learned, or

uses it incorrectly.

Positive transference is the goal!!!

Reach the student in all 3 domains of learning(cognitive, affective and psychomotor)

to have the greatest transference occur!!!!

Transference

Now that we know our audience a little more…..

Here are some “keys to facilitate learning” in your students.

Create action Avoid lecturing

Engage students in learning through activities.

Create expectation in students that they will participate in learning. Be patient and provide guidance and provide

positive reinforcement. As students succeed, they will change their

expectations.

Some will want to be passive learners despite your best efforts- do not be discouraged, eventually they may participate or other students may influence them to participate.

Lecturing does not lead to active learning

Moving beyond simple lectures will: Build interests

Maximize understanding and retention.

Involve participants

Reinforce what has been presented.

And PROMOTE group discussion!!!!

**But keep in mind….. Not all group discussions will go as planned.

They will need to be lead.

Discussion is one of the best forms of participatory learning.

Tips for facilitating discussion Get all students involved You don’t have to have a comment on each persons

contribution. Paraphrase: check your understanding and the students. Compliment a good comment, and redirect an inaccurate or

incorrect statement. Elaborate- add to or suggest a new way, even when the

student has answered correctly. Energize- use appropriate humor, and prod students for

answers. Disagree (gently) but be able to back up your opinion. Mediate differences in opinions. Pull together ideas. Summarize what occurred in the discussion group.

Level 1: preventing escalation Monitor for early signs of conflict. Intervene immediately. Help control individual student behavior. Encourage spontaneous verbal feedback.

Level 2: empowering students Listen to students concerns. Encourage students to resolve conflict. Coach students on resolution tactics.

Level 3: resolve conflict Ask the students involved, the issue at hand. Ask each student to define their ideal outcome. If a resolution is still not reachable, move forward to level 4.

Level 4: instructor interventions Refer to course syllabus. Refer to student manuals. Involve other members of the teaching team.

Many problems in the classroom will be caused by, or contain an element of miscommunication.

~ The ability to communicate well is a key skill for the EMS instructor, as well as the EMS

provider~

“Good communication ability” is an aspect of

PROFESSIONALISM

The instructor should create a positive environment for communication.

Praise in public and punish in private. Catch people doing things right, and praise them

for the good behavior.

Feedback Provide feedback as immediately as possible after

the action.

Provide feedback about both positive and negative behaviors and performances.

Try to begin with positive statements, cover the negative information (via constructive criticism) and then end on a positive note.

Employ active listening. Listen to what another is saying.

Paraphrase and repeat back what was said, to verify your own understanding.

Check for understanding in the message you send. Ask the student to paraphrase what you said. Provide more clarification, if needed.

Use open body language. Hands and arms are relaxed. Comfortable personal space. Give your full attention to speaker. Neutral or positive facial expression.

Always: Be honest. Protect confidentiality. Address people directly. Treat people how you would want to be treated.

One of the keys to getting students involved and becoming active participants……..

~First step to effectively motivating your students:

Identify the students motivator for taking the class…………..

Is it an INTRINSIC

or EXTRINSIC motivator?

Comes from within the individual.Includes:

Desire to help others.

Wish to perform community service.

Personal growth and development.

Drive to succeed.

Some students have a high level of intrinsic motivator, and may help motivate other students.

Comes from outside of the individual.Includes:

Money or pay raise.

Time off of work.

Job requirement.

These are the students that are in the program because they “HAVE” to be. They are

REQUIRED to take this class for one reason or another.

Students that have an INTRINSIC MOTIVATOR are usually very eager to learn………

They “want” to learn the information.

Students that have an EXTRINSIC MOTIVATOR are usually more difficult to motivate……..

They “have” to learn the information in order to keep their job or to be promoted.

Psychomotor skill development is crucial to good patient care by the EMS provider. Psychomotor skills are used to provide patient care

and also to ensure the safety of the members of the team.

Instructors need to understand the psychomotor domain, in order to teach their students how to perform skills, and to maximize the students abilities.

The psychomotor domain involves the skills of the EMS profession. Skill

Action

Muscle movement

Manual manipulation

There are 5 levels of psychomotor skills.

The 5 levels of

psychomotor skills are:

Imitation Student repeats what is done by the instructor. “see one, do one” Avoid modeling wrong behavior because the student

will do as you do. Some skills are learned entirely by observation, with no

need for formal instruction.

Manipulation Using guidelines as a basis or foundation for the skill

(skill sheets) May make mistakes Making mistakes and thinking through corrective actions is

a significant way to learn.

Perfect practice, makes perfect skill Practice is not enough, the student must perform the skill

correctly. The student will develop his or her own style and

techniques.

Precision The student has practiced sufficiently to perform skill

without mistakes. Can usually only perform the skill in a controlled

environment.

Articulation The student is able to integrate cognitive and affective

components with skill performance. Understands why the skill is done in a certain way Knows when the skill is indicated.

Performs skill proficiently with style. Can perform skill in context.

Naturalization Mastery level skill performance without cognition. AKA “muscle memory” Ability to multi-task effectively. Can perform skill in any situation.

Whole – part – whole technique is useful Requires the skill be demonstrated 3 times as

follows: WHOLE: demonstrate the entire skill, beginning to

end while briefly naming each action or step.

PART: demonstrate the skill again, step-by-step, explaining each step in detail.

WHOLE: demonstrate the entire skill, beginning to end, without interruption and usually without commentary.

This technique provides an accurate example of the skill done in repetition. If students were not completely focused on the skill

demonstration the first time, there are 2 more opportunities for them to get it.

This technique provides a rationale for how the skill is performed. Discussion can be allowed during or at the end of

demonstration.

The technique works well for both analytic and global learners. Analytical learners appreciate the step-by-step

presentation.

Global learners appreciate the overview.

Interrupt and correct the wrong behavior in beginners to prevent mastery of the wrong technique.

Practice sessions should end on a correct performance or demo of the skill.

Allow advanced students to identify and correct their own mistakes under limited supervision.

Reinforce correct and good behaviors. Allow students to develop their own style or

technique, after mastery has been achieved.

As if we do not have enough to worry about, as instructors………….

Then along comes the “Disruptive Student”

Unacceptable classroom behaviors disrupt the learning process and may pose a physical danger to the instructor or students.

Depending on the infraction, disruptive students may still have legal rights and it is important for instructors to learn how to appropriately handle classroom and student problems.

May be grouped into those behaviors that are considered illegal (criminal or tort) and

uncomfortable (disruptive or undesirable).

Violence

Threats of violence

Sexual harassment

Hazing

Discrimination

Destruction of property

Foul language

Loud voices

Angry tone

Sleeping

Non-participation

Prevention and pre-planning Have rules and consequences in writing that tell

the students what is expected.

Share this information with the students in the beginning of the course or clinical time, and revisit it periodically if problems arise. Require the student to sign documentation of receipt

of rules. Give student a copy and keep the signed copy for

students file.

Include information on grievances Students need to know their rights as well as their

responsibilities.

Do not allow yourself to be intimidated by students and avoid disciplining them as a result of that intimidation.

Watch for opportunities to reward good behavior. Be a good role model of courteous and respectful

behavior. Be organized and prepared for each class, to

minimize distractions and down time. See the humor in situations and laugh (when

appropriate) Do not plead with students to behave. If behavior is out of the ordinary for the student-

intervene immediately

Document all infractions to establish a pattern. Time and Date

Any appropriate witness

Description of event

Unacceptable behavior

Corrective action taken

Provide documentation to the student and inform them who will receive copies of this information.

Notify the Clinical coordinator and/ or the Program director immediately, especially if its an illegal or dangerous behavior.

A deliberate educational activity designed to correct deficits identified during formal and

informal evaluations.

Remediation is needed when the student does not perform as expected in any of the 3 domains

of learning.

Identify the problem Evaluate possible causes for the problem

Identify where the deficits came from: student or educational program

Retrain the student

Re-evaluate the student

This process will be done through the program but may start with you.

Age, gender and ethnicity can play a part in a student’s behavior.

Something we must be aware of on the unit, and in the classroom……….

Era in which one grows up puts an indelible imprint on one’s values and expectations.

Age at which an individual is considered an adult and capable of making decisions, varies within groups.

Gender roles- (female physician or medic, male nurse).

Men and Women communicate differently.

Women interact to form relationships.

Men establish hierarchy of order.

Ethnic background includes native language and cultural norms. Holiday observances

Food preferences

Social affiliation

Health care beliefs and preferences

While some Americans are comfortable with self- reliance and independence, this is not true for all cultures in America.

Some ethnic cultures are non- aggressive and non- confrontational. Not comfortable making eye contact when conversing

with a person in authority. (e.g. teacher, physician, nurse etc.)

Many cultures address persons of authority formally (by title or surname) until receiving permission to do otherwise.

Gestures and speech patterns do not have universal meaning. Smile or nod may be a sign of not understanding or not

wishing to disagree with authority. Snickering may be a sign of embarrassment and

confusion. “Yes” may mean, “I heard you” rather than “I agree”. Some groups value silence as a sign of respect and

attentiveness; for others it may be a sign of disagreement.

Humor (particularly sexual in nature) and gestures is offensive to various cultures.

50- 90% of communication is non-verbal Pay attention to body language, facial expression,

and other behavioral cues. Try not to use idioms or slang. Do not take others’ behavior personally. We walk a fine line between understanding and

stereotyping. Be careful not to label individuals simply because you

have a given expectation of their cultural values and traditions.

Remember that we are all different. This includes various educational experiences and

ways of learning.

Must communicate with clinical instructor and notify of any issues.

Provide feedback to the student and the program.

Feedback should be:Constructive SpecificFrequentValid

Keep accurate and complete records Paperwork will be covered at the end of the

presentation.

Thoroughly approve and sign all PCR’s involving the clinical time spent with the preceptor.

Must fill out an evaluation form on every student during each clinical rotation. Form must be signed and sealed and given to the

student.

Maintain a continuity of classroom instruction to the field environment.Pair the core knowledge with the actual patient care.

Assist the student in making the transition from the classroom to the field environment.Allow the student to show you what they know.

***Each call is a new opportunity for each person

involved. Focus on the current situation and move past any previous mistakes.

“Do as I say, AND as I do”

Maintain appropriate and adequate patient care during the training experience.

Lead by example by maintaining a professional demeanor and attitude.

Provide a positive example with motivation and encouragement.

Be a ROLE MODEL

EMS Instructors/Preceptors should develop professional relationships with the students.

Foster growth and development of students through excellent teaching, feedback and support:Help facilitate their progress through the

evaluation process.

Serve as an on-going and renewable resource for students by assisting the process of networking.

Assist other instructors in their development by sharing ideas and experiences.

Your students could show “you” a thing or two!!!

FRONT

BACK

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