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 IV�s 12 hrs. OR or 10 visualization of vocal cords 8 hrs. Respiratory 60 hrs. Field Internship

7. 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!

8. 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.

9. 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.

11. 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

12. 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

14. 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

16. Roles, Responsibilities & Expectations REMAC Duties provide objective & subjective evaluation of intern�s performance act as a teacher to the intern acts as an observer, intervening only when patient care is compromised must complete the Preceptor�s 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 agency�s medical director for consideration

18. 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 IV�s or ET�s 2 PCR�s completed by intern as �in-charge� supervised course clinical calls may be used all must be completed within one year

19. 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 PCR�s 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 AEMT�s 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.

23. 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 person�s 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 don�t compare the intern w/ others, but with written performance objectives don�t 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

28. 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

30. 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?

31. Questions?