When students come out to do their on-the-job training, they are very nearly a blank slate. They have learned the fundamentals of patient care from the textbook while in the classroom, but now is when the real learning begins. That is why a preceptor’s approach to guiding these students is so important. Potentially, it can make or break their careers.
Is that too dramatic? I do not think so. I’ve personally heard of and seen some real horror stories. But what makes them horror stories? A brief trip into history will likely tell us.
As of 2021, many things have changed in regards to how we, as human beings, are expected to treat each other. Some might say these changes have been good, some might say these changes have been bad. This forum is not the proper one to use to debate political correctness or the effects of the so-called “cancel culture” that seems to have developed over the past few years. However, the one thing that can be said for certain, is that there has been a significant change.
The Past is the Past
For anyone who obtained their education over twenty years ago, the differences in the overall experiences of completing the on-the-job training (OJT) portion of your education have changed dramatically. It’s like night and day, really. The concept of what a preceptor is or should be was very different then to what it is today. Even though I was the student, it seemed to me that preceptors had very little guidance as to what the minimums were when it came to what needed to be done for their students. There were no minimum competencies to be completed or sign-off sheets to be done after every shift or call. It was pretty well solely based on completed hours of ride-along time followed by one written synopsis of how you did, completed by your preceptor at the end. That one review could make or break you. And it often did.
Remembering that before 1999, all of the college programs were still one-year programs for PCP, this review marked the end of the school year. If it was deemed that you failed your OJT, that was it. A whole year lost. There was no recourse. There, of course, was an appeal process but I never knew any appeal to be successful because no one could prove anything factually. Even if you did have some type of proof that your preceptor treated you unfairly, it was a dangerous proposition to bring forward. The reason being the overall culture back then was not always one of inclusivity.
Often quite the opposite in fact. If you raised any concerns at all or became involved in a serious personality clash with a paramedic at the base you were doing your OJT, you were branded as a trouble maker and as someone who would not fit in. Then, when hiring time in your local area came around, it was easy for you to get “blackballed” within the services because all the services were small, and the owners all knew each other personally. One quick phone call and “boom”, the resumé was in the trash bin and the career was over before it ever started. Not because you potentially wouldn’t make a good paramedic, but because your preceptor didn’t teach you anything, treated you like a luggage rack and didn’t like your so-called “attitude.”
Things have changed over the past twenty-five years and we can now leave most of this behaviour in the past.
I say we can leave “most” of this behaviour in the past because it still does exist to some extent. I believe in karma, and that things come full circle. History tells us that the actions and behaviours exhibited today are a product of the actions and behaviours of the past. Every action has an equal and opposite reaction. Sometimes it just takes a couple of decades for that reaction to occur.
What has come full circle today is how on-the-job training and preceptorship are looked at. There is much more accountability for the preceptor’s behaviour as well as the students. It is no longer acceptable to treat students like extra bodies who are there just to carry your bags for you and do chest compressions. They are human beings who are there trying to improve themselves and further their education.
While there still is not a one-size-fits-all formal course on how to be a good preceptor, the colleges have, over the years, developed much better outlines and guides for what skills and competencies the students require, and this has helped preceptors tremendously. As well, a high percentage of paramedics acting as preceptors now are advanced care paramedics (ACPs). The training at this level has taught paramedics how to think more like clinicians and be able to think and work through patient’s problems in a more thorough way than in the past. The increase in the scope of practice of working paramedics has allowed the training experiences of students to be greatly enriched because of what they get a chance to see in the field compared to twenty-five or more years ago. Patient conditions or problems that paramedics were unable to do anything for other than transporting to the hospital can now be at least partially treated in the field and for students to be exposed to this early in their training is of great benefit and can only enhance their chances of success.
Anyone who agrees to precept a student needs to remember that they were there once too. Even if you have now continued on with your own education and become an ACP, you were also, at one time, a blank slate. We all were.
If you are a student and you find yourself assigned to a crew that includes an ACP and a veteran PCP, consider yourself lucky because that is ideal. That veteran PCP has a lot to teach you too. We will get into that more in the next edition.