Skip to content
Streetwatch: Notes of a Paramedic
Menu
  • Home
  • Killing Season
  • Diamond in the Rough
  • Mortal Men
  • Rescue 471
  • Paramedic
Menu

Precepting

Posted on February 26, 2008August 17, 2021 by medicscribe

Today is the last day my latest preceptee will be with me. Tomorrow he rides with our chief paramedic, who if all goes well will formally approve his being “cut loose” to be a paramedic on his own. My preceptee has been with me for nine weeks and has been, by all standards, “a shit Magnet,” “a dark cloud,” “a horseman of the Apocalypse…” On most days, the tones start going off when he walks in the door and don’t stop until he leaves. While I have had preceptees who couldn’t buy a critical call, we’ve done cardiac arrests (five), respiratory arrests, multiple motor vehicle accidents with prolonged extrication, stabbings, falls from roofs, countless major medicals alerts, seizures, CVAs, internal defibs going off right and left. You name it, we’ve had it, including all the routine ALS calls as well, the UTIs, pneumonias, nausea and vomiting, weakness and malaise calls. He’s done his share of all of them and done them well enough that it is now time to boot him on. Besides I’m ready to start doing calls on my own again. My preceptee, perhaps feeling sorry for me, even let me do the intubation on our cardiac arrest yesterday, while he got a chance to use the EZ-IO drill for the first time. Back when I was being precepted, I remember feeling hurt one day when my preceptor told me he was going to cut me loose because he was getting tired of me. I know the feeling. While I enjoy precepting, sometimes I just want to do the call, get it over with and move on to the next one or at least go back to reading my book or the movie that is paused on the DVD player back at the base. I remember one time my preceptor looking at me like I was an idiot as I fumbled through a call. Finally, in front of the patient and bystanders, he wrote me a note on a piece of paper and handed it to me(instead of slapping me upside the head). “This is a cocaine overdose!” the paper said. I also remember how he would pace about at the hospital as I carefully, painstakingly, tried to write a proper paramedic run form. What now takes me only minutes to write used to take me twenty to thirty minutes, not counting the ones I had to rip up and start over on. When I first became a preceptor I believed that the closer you were to being precepted yourself, the better a preceptor you would be. And now all these years later, in many ways I still feel that is true. While I am much more patient with a new medic’s skills than I was as a new preceptor (miss the IV or the tube, try again, no problem where before I was more likely to elbow a preceptee out of the way,) I find I am less patient at letting them work their way through a scene. I am too quick to say, you can do that in the ambulance (ask a stable alert patient for their democraphic information) or let’s get going (instead of sitting there on scene in the ambulance when we are facing an easy twenty-five minute ride to a distannt hospital) or to interject, ask them when this all started (already!). While part of a preceptor’s job is to teach, the other part is to sit back and be invisible – to let the preceptee figure it out for themselves, but I am finding it harder to be “invisible.” I think maybe I am so far removed from what a new paramedic knows or doesn’t know that I can’t relate as well. I may assume what I shouldn’t or not assume what I should. I had a writing instructor tell me once that the beauty of Chekhov (the great Russian short story writer)’s work was you felt the effects throughout the story and were deeply moved at the end, but you could not see how he produced it. The first novel I ever wrote when I was in college, I had another writer read and his comments were “I never understood how hard it was to write a novel until I read yours.” The point I think was you could see every board and nail, every paint brush stroke. It was very painstaking and transparent. On a routine medical a few weeks ago, a new EMT charged ahead of us, racing down the nursing home hallway and then into the patient’s room where she immediately stuck her fingers on the patient’s neck to count the carotid pulse. The only problem was the patient was alert and oriented and the call was for skin tear to the knee. While the EMT wasn’t wrong to get vital signs, you could painstakingly see the attempt to put classroom learning into the real world. On another call, an EMT interrupted our questioning of the patient with chest pain to proudly announce the patient was allergic to penicillin. In both cases, these EMTs were showing the boards and nails of their craft (getting pulses and taking allergies) but not demonstrating any artistry. They were in fact being quite clumsy. Chekhov probably had a harder time explaining how he put his story together than a freshman English teacher has explaining how to write a basic paragraph. I am not claiming to be a Chekhov of paramedics. Far from it. In addition to having many clumsy moments of my own, paramedicine because it is done in real time, prevents a paramedic from ever demonstrating the flawlessness of a writer, who has ample time to rewrite, and iron out the rough edges of each performance. What I can say is that I do calls better than when I started. I am both more thorough and more concise, and certainly more efficient. There isn’t a lot of wasted motion or time. Ask me how or why I did what I did and the answer is not simple, but more of a dissertation. Not I did B because B follows A and comes before C, but I did G because of K, B, Y, L, P, and several other factors that don’t have letters. When I started precepting I had more simple advice. Never do this. Always do this. Now I find that rules are less rigid. The instruction is more zen theory than facts. I probably am more confusing and make a lot less sense than I did when I started precepting. I know what I told you to do after the last call, but this situation was different. Here’s why. Etc. Etc. And I wonder then if they really understand when they say yes, but have that puzzled look in their eyes. What is he talking about. The preceptee/soon-to-be-medic-on-his-own will do fine. He is an affable young man who treats patients, their families, and other medical staff with respect. While I have had more advanced preceptees and certainly less advanced preceptees, I have to remember that when I precepted years ago, I was far from being at the head of the class in terms of knowledge and experience. What I do know now is that being a good paramedic is less about knowing everything when you first hit the streets than it is about being willing to learn from each call, critique yourself, and constantly seek out ways to improve, to develop your own theories of practice and a style that works for you and your patients. I will give you high marks for your potential. Good luck tomorrow. It has been a pleasure precepting you.

Categories

  • Blogging
  • COVID
  • EMS in City
  • ems-topics
  • Fiction
  • hazmat
  • Humor
  • Lights and Sirens
  • My LIfe
  • obituaries
  • Opioid Crisis
  • Pain Managment
  • Precepting
  • STEMI
  • Street Lessons
  • Trauma
  • Uncategorized
Tweets by medicscribe

Recent Posts

  • Killer Angels
  • An EMT
  • Paramedic! Paramedic!
  • Manifesto
  • TV Interviews
Log in

Archives

  • April 2022
  • March 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021
  • October 2021
  • September 2021
  • August 2021
  • April 2021
  • March 2021
  • February 2021
  • January 2021
  • December 2020
  • November 2020
  • October 2020
  • September 2020
  • August 2020
  • July 2020
  • June 2020
  • May 2020
  • April 2020
  • March 2020
  • February 2020
  • November 2019
  • October 2019
  • September 2019
  • August 2019
  • July 2019
  • May 2019
  • March 2019
  • January 2019
  • December 2018
  • November 2018
  • October 2018
  • September 2018
  • August 2018
  • July 2018
  • June 2018
  • May 2018
  • April 2018
  • January 2018
  • December 2017
  • November 2017
  • October 2017
  • August 2017
  • July 2017
  • June 2017
  • May 2017
  • April 2017
  • February 2017
  • January 2017
  • December 2016
  • November 2016
  • October 2016
  • September 2016
  • August 2016
  • July 2016
  • June 2016
  • May 2016
  • March 2016
  • February 2016
  • January 2016
  • December 2015
  • November 2015
  • October 2015
  • September 2015
  • August 2015
  • June 2015
  • May 2015
  • April 2015
  • March 2015
  • February 2015
  • January 2015
  • December 2014
  • October 2014
  • September 2014
  • March 2014
  • February 2014
  • January 2014
  • December 2013
  • October 2013
  • September 2013
  • July 2013
  • June 2013
  • March 2013
  • February 2013
  • January 2013
  • December 2012
  • November 2012
  • August 2012
  • July 2012
  • June 2012
  • May 2012
  • April 2012
  • March 2012
  • February 2012
  • January 2012
  • November 2011
  • October 2011
  • August 2011
  • June 2011
  • May 2011
  • April 2011
  • March 2011
  • February 2011
  • January 2011
  • December 2010
  • November 2010
  • August 2010
  • June 2010
  • May 2010
  • April 2010
  • March 2010
  • February 2010
  • January 2010
  • December 2009
  • November 2009
  • October 2009
  • September 2009
  • June 2009
  • May 2009
  • April 2009
  • March 2009
  • February 2009
  • January 2009
  • December 2008
  • November 2008
  • October 2008
  • September 2008
  • August 2008
  • July 2008
  • June 2008
  • May 2008
  • April 2008
  • March 2008
  • February 2008
  • January 2008
  • December 2007
  • November 2007
  • October 2007
  • September 2007
  • August 2007
  • July 2007
  • June 2007
  • May 2007
  • April 2007
  • March 2007
  • February 2007
  • January 2007
  • December 2006
  • November 2006
  • October 2006
  • September 2006
  • August 2006
  • July 2006
  • June 2006
  • May 2006
  • March 2006
  • February 2006
  • January 2006
  • December 2005
  • November 2005
  • October 2005
  • September 2005
  • August 2005
  • July 2005
  • June 2005
  • May 2005
  • April 2005
  • March 2005
  • February 2005
  • January 2005
  • December 2004
  • November 2004
  • October 2004
  • September 2004
  • August 2004
© 2022 Streetwatch: Notes of a Paramedic | Powered by Minimalist Blog WordPress Theme