Instilling Confidence

[MrJones]

Throwing this out there to see what the wisdom of crowds will come up with....

One of the challenges I've noticed w/ student EMTs is a lack of confidence on their part, especially when assigned for ride time with a strong Medic/EMT or Medic/Medic team. In a nutshell, they're reluctant to get in there and do what they've been trained to do, even when the preceptor has made it clear that it's not just OK but also expected. They see the team to which they're assigned work like a well-oiled machine and are either afraid of making a mistake or don't want to get in the way.

My question, then, is how can we train these new students to help them overcome this mental barrier? I ask because, as a graduate assistant in an emergency medical program, I've been tasked with overseeing a ride time program that the college requires all newly-licensed EMTs to complete. I have a few thoughts, but with all the experience represented here I'm betting I'll get many better ideas than what I can come up with on my own.

Annnnnd GO!

 

[vcuemt]

You really can't. Most everyone is going to be tentative their first few times on the truck.

Once you gain a little familiarity is when you start to gain confidence. But I'm not sure that's something you can teach or replicate in the classroom.

 

[planetmike]

It takes quite a few calls to gain that confidence. For me, it took a few that were totally out of my depth as well as a few that I should have been ready for. Then when I finally got the fairly straightforward call when I knew what the medic needed and she didn't have to ask me for it to really feel confident.

I don't know how you can teach that in a classroom setting. Not wanting to get in the way is a big fear.

 

[BASICallyEMT]

They are student's... we are there to guide them and HELP them with their newly acquired skills. A lot of students (i was the same way) are too hard on themselves when they mess up on a call. You have to reiterate to them that they are still students and that's what their field time is for. Unless they are Paramedic students we shouldn't be expecting much from them.

 

[DesertMedic66]

Confidence comes with time and with calls that you run. EMT school doesn't allow students the time or the amount of calls for them to be confident.

Heck normally the students first shift is just about them getting used to how 911 calls are handled. Your taking students from the general population and putting them into a very weird job.

The only students I have seen who are confident are ones who have been involved in the fire department (because they are used to running 911 calls) and the ones who were in the military.

 

[MrJones]

Interesting. With only 3 responses I can't really call it a consensus, but I definitely sense a trend.

So let's change it up just a bit. What can preceptors do to help them/force them to overcome their hesitancy to act?

(And, please, don't hesitate to answer the original question if you have something to add in that regard)

 

[Chimpie]

In most jobs, especially public safety (in my opinion), it's all about having a mentor. Someone who welcome you in, show you where things are, talk about what is expected, explain how the process goes, etc. The mentor is responsible for guiding the student along, making sure they feel comfortable, and making sure the student is getting the information they need.

Now, it shouldn't just be the responsibility of the agency to make the student feel comfortable. The school needs to properly prepare them for the experience.

A great idea would be for the representatives from the agencies/depts that are part of the process to visit the school just prior to the students going out into the field. Seeing people, the uniforms, etc may help with putting them at ease as well.

 

[MrJones]

In most jobs, especially public safety (in my opinion), it's all about having a mentor. Someone who welcome you in, show you where things are, talk about what is expected, explain how the process goes, etc. The mentor is responsible for guiding the student along, making sure they feel comfortable, and making sure the student is getting the information they need.

Now, it shouldn't just be the responsibility of the agency to make the student feel comfortable. The school needs to properly prepare them for the experience.

A great idea would be for the representatives from the agencies/depts that are part of the process to visit the school just prior to the students going out into the field. Seeing people, the uniforms, etc may help with putting them at ease as well.

FWIW, prior to being permitted to schedule ride times, my program requires students to attend orientations at each participating service. These orientations are held at the service's facility and includes an overview of operations, completing any necessary paperwork and a facility tour. Preceptor assignments are also discussed and either made on the spot or w/in 2-3 days. I honestly thought that was a pretty standard requirement.

Beyond that, what (if anything more) would you consider appropriate for a school to "properly prepare the for the experience"?

 

[Jim37F]

I think once the student links up with the crew they'll be running with for the day, they need to drill through a couple of mock calls. Make sure they know they have a clear set of priority's (they should already from the school house but in my relatively limited experience there's a difference between school house scenarios and field scenarios with the actual guys/equipment you'll be working with). It could bee as simple as "Hey, as soon as we make patient contact, I want you to start taking vitals" or "I want you to get me the patients A&O level" and then practice that a few times before the first real call comes in (or after if it drops nice and early)

 

[Ewok Jerky]

So let's change it up just a bit. What can preceptors do to help them/force them to overcome their hesitancy to act?

(And, please, don't hesitate to answer the original question if you have something to add in that regard)

You can't expect a student to feel comfortable running on a 911 call with an experienced ALS crew and potentially an engine crew on scene. A good preceptor will prompt the student what to do and when to do it. We all know how to take a blood pressure but knowing when to jump in and grab an arm for 30 seconds is not intuitive to a newbie... sometimes getting vitals is not priority number 1... what if the pressure is normal and the medic is in the middle of taking a history, should interrupt to tell him/her pressure is normal?

So I guess to answer your question if you want these peeps prepared just make sure they have the skills: vitals, bandaging, spiking bags etc, and also know how to act like a professional. Beyond that I think they key is hooking them up with the right crews who want to have students.

 

[Rin]

I pretty much agree with everyone here.
A few things that might help would be to first have the students check over the truck and learn where things are kept, and take a minute to familiarize them with your company's specific equipment.
Then you can assign them a task, like, "On the next call, I want you to evaluate the patient's breathing and apply a NC or NRB if appropriate. " If the airway/breathing is more acute, the more experienced crew members can step in. That way they know where they fit in the equation.

 

[MrJones]

So, if I'm understanding what I'm reading, the majority opinion would be that it's more on the preceptor/ambulance crew to help the student over his/her lack of confidence. If that's the case, what can or should the school staff do to encourage preceptors/crews to do their part? Should they be trained (for lack of a better word) in how to deal with new students or should we just trust them to do what's right?

 

[Chimpie]

I think it needs to start with an open discussion from all parties.

Schools need to ask the students how they feel and what are some of their concerns about starting with a new crew. Then the schools need to work with the preceptors/crews to share their findings, and together come up a workshop training hour or two (maybe?) to help fix it.

 

[Emergency Metaphysics]

I think it needs to start with an open discussion from all parties.

Schools need to ask the students how they feel and what are some of their concerns about starting with a new crew. Then the schools need to work with the preceptors/crews to share their findings, and together come up a workshop training hour or two (maybe?) to help fix it.

You might be on to something here, Chimpie. I was never "interviewed" by someone with regard to why I wanted to be an EMT or what skills I thought I had that would allow me to not only handle the training but also the stress and demands of the job. Now, nursing schools require an interview, medical schools (P.A.s, M.D., D.O., etc) all require extensive interviews. So, I don't think it's unreasonable to have a sit down with an advisor and be asked some basic questions and to require more substantive answers than, "Oh, I just want to help people."

 

[Chimpie]

It's amazing what can result from open communication.

 

[DesertMedic66]

You might be on to something here, Chimpie. I was never "interviewed" by someone with regard to why I wanted to be an EMT or what skills I thought I had that would allow me to not only handle the training but also the stress and demands of the job. Now, nursing schools require an interview, medical schools (P.A.s, M.D., D.O., etc) all require extensive interviews. So, I don't think it's unreasonable to have a sit down with an advisor and be asked some basic questions and to require more substantive answers than, "Oh, I just want to help people."

For an EMT class that seems a little extensive (remember most programs are only 1 semester long).

We get around 20 students each semester who take the class who don't want to be EMTs or do anything in the medical field at all. They just take the class to help family or friends if they get sick.

For us to do interviews of students who are going to ride out with us will be impossible. We can have a new EMT student rider every single day for 2-3 months (that's going to be a lot of interviews)

 

[MrJones]

...We get around 20 students each semester who take the class who don't want to be EMTs or do anything in the medical field at all....

That's an interesting point that could lead to a good discussion on whether qualifying as an EMT should be a requirement for holding another position. I don't want to derail this thread, though, so I'll be starting another to get that discussion rolling.

 

[Chimpie]

Yeah, doing interviews for ride alongs is not what I was suggesting.

 

[Emergency Metaphysics]

For an EMT class that seems a little extensive (remember most programs are only 1 semester long).

We get around 20 students each semester who take the class who don't want to be EMTs or do anything in the medical field at all. They just take the class to help family or friends if they get sick.

This is a fair point. I'll admit to just assuming that if someone wants to take an EMT class they have the intention of employing those skills in either a paid or volunteer position. I didn't even think someone would specifically take the class as part of at-home care.

Still, as an English teacher, I'm always curious as to what motivations bring my students to a class. I know English and EMT are two radically different programs, but I wonder if understanding students' motivations might better assess their chances of failure or success or, if nothing else, at least assist the instructor in tailoring the class to meet the students' needs.

I'm rambling now, I think.

 

[EMTLMM]

I think once the student links up with the crew they'll be running with for the day, they need to drill through a couple of mock calls. Make sure they know they have a clear set of priority's (they should already from the school house but in my relatively limited experience there's a difference between school house scenarios and field scenarios with the actual guys/equipment you'll be working with). It could bee as simple as "Hey, as soon as we make patient contact, I want you to start taking vitals" or "I want you to get me the patients A&O level" and then practice that a few times before the first real call comes in (or after if it drops nice and early)

As a brand new students in EMT I actually like this idea. I was going to suggest drills (perhaps some at random). The problem I have seen with these short-term classes (even other studies leading to an Associates) is that once one is in the field, the employers and employees seem to expect "years of experience" out of the student fresh out of school. I am quite used to hearing, "Well, you went through school, didn't you?". Sometimes I think employers/employees forget it's all about quality patient care and to make that happen everyone needs to be on the same page. So if this is the case (which it has been for me with the courses of study I have taken in my past) then the student needs to do something now while they are in school; even if it means getting together with other students and discussing it with the instructor. I like that Mr. Jones even put that into a concern because it is a concern for me as a new EMT student. As far as "expecting" instructors or crew members to mentor, I would say it's all about leadership to help instill confidence especially to those newbies who really want to be there. The "Hey, I want you to do this as soon as I....." is a HUGE help for someone new. Eventually the new member will catch on and get into the rhythm of things and learn to do more as they go. But I suppose every student is different. The idea given by Jim37F is exactly what I would want to see happening and this is just my opinion as a new student.