Are paramedic precepting/evaluations of paramedic “students” too subjective?

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Permalink Reply by Jeff on August 12, 2009 at 10:11pm

Great questions. The clinical and field internships are so hard to do well but are vital in making good paramedics. Now to respond to your questions specifically.

1. This question would have to be applied to programs individually. There is such a wide variance in the way I have seen precepting done that I just can't make a broad statement about it. Obviously we want to remove as much subjectivity as we can through preceptor training and good evaluation tools.

2. The amount of "power" a preceptor has is going to vary from program to program as well. I don't know of anywhere in the NCS or CoAEMSP standards that prescribes how much authority a preceptor should have. In my program the final decision is up to the program director and the medical director. The field site and preceptor may refuse to sign off on a student but I can always get a second opinion from another preceptor after additional ride time. I am fortunate to have good preceptors in my area and I would be an idiot if I didn't listen to them. But the responsibility for making the final decision is not theirs nor should it be.

This must be a regional issue because I have never heard of a paramedic program giving a preceptor that much responsibility or authority.

3. There are already standards out there that others have referred to. Who would these standards apply to? If you placed them on the program, how would they implement them with preceptors that don't work for them? If the standards were for the service, why would they bother without any kind of compensation? This is an issue that needs attention but a top-down, coerced, solution isn't going to solve it.

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Permalink Reply by robert bethea on August 18, 2009 at 4:27pm

Where to go from here? I do not know how true it is but I think dump trucks have air conditioners too. When I went through the paramedic program some years ago I believe that each chapter listed objectives which were concepts that needed to be achieved in order to do the job. Current programs spit out "shake and bake" medics and we have to train them to do the job. The objective standards are clearly defined and we can objectively "judge" a student's competency based on those objectives. We need programs that deliver door to competency medics so I can quit running a damn daycare.

Rob Robbins said:

Skip, by no means am I judging you and I sincerely apologize if I gave that impression. I honestly think you’re very thought provoking on the topics you address. Furthermore, credentialing is a broad meaning word that I perhaps didn’t use properly. My point is these paramedics are “licensed” “certified” “accredited” “credentialed to enter in to practice because they have graduated and were successful in licensure exams….or what ever you want to call it….to obtain employment with X agency, the candidate needs to be successful in the “accreditation” “credentialing” for that jurisdiction….but in order to get to that, the individual has to be offered employment first at that level of certification. I am still “licensed” in the State of California as a paramedic, but don’t work as a paramedic.

I’ve already attended and was successful academically and met all requirements for state licensure. What I am saying here is that I am concerned that there is no regulatory authority to govern…in true academia you have advisors, and with out my advisors I would have never been successful getting through my doctoral thesis or fellowship…I was a part-time graduate student and a full-time paramedic…Skip I had no idea what I was doing…I was very smart academically coupled with an EMS “fix” the problem and move on mentality….and I can tell you with conviction my advisors and senior fellows were very “objective” which contributed to my success. The point is that we need to be less subjective and more objective. I just don’t feel it’s the place in academics for any one person (preceptor not FTO…two different roles) to be in a teaching role to be telling students that perhaps they choose the wrong college course and that they have been wasting their time and money over the past 18 months….where does the student go from there?


Skip Kirkwood said:

First of all, you have no right to judge me, thank you very much. I will appreciate it if you keep your comments professional, and not make uninformed conclusions about why I believe what I discuss.

Candidates for employment, in EMS agencies or hospitals, are not already credentialed. They have a state license, which is not the same as being credentialed to practice in that hospital or EMS system. Bring your NREMT-P and your NC paramedic license to Wake County, and it will take you another 6 months or more to get credentialed to practice in the system. Hospitals call the process "granting privileges" to physicians - same process.

You describe the very flaw I was pointing out (perhaps too long in academia?) - being a paramedic is not about doing procedures and being proficient therein - it is at least 90% interpersonal communications and getting along with patients, families, and co-responders. Please tell me how you objectify (meaning that it will withstand the tests of statistical validation) those? Perhaps the fact that this is NOT part of what our educational programs deliver is why our field training programs have extended from six months, to a year, to...

The physician education process has closed the gap between school and practice with the residency. EMS agencies still have no choice but to hire individuals for whom that gap has not been bridged, the way that "field experience" is sttructured ann conducted today.

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