Precepting Paramedics With Intent
We always recall our past preceptors for their good, their bad and their ugly.
One of the things often overlooked in training is the precepting of students and interns, but there is no more crucial a time for a new paramedic than their first foray into ambulance life.
Without a specific emphasis on this skill, it can be easy to forget its importance. How we introduce new staff members to the prehospital world can make all the difference. Not only to their experience in the workplace but in their general attitude, clinical practice, should we become their patients in the future.
On the job learning is vital in healthcare settings, particularly in paramedicine with its unique challenges of autonomy and frontline pressure. It enables new staff to enhance academic knowledge through hands-on experience and develop recently acquired skills in the safety of competent clinical supervision. Overall, they finally get to consolidate training by putting it into practice in real-life situations. With the guidance of an effective preceptor, this venture into each new paramedic's role can provide the perfect opportunity to increase confidence and job satisfaction.
During such a pivotal period, how a preceptor interacts with the student and guides them into paramedicine may make or break their future career. The aim of instilling excellent clinical practice behaviours and professionalism to last a lifetime is clearly crucial, so what are the challenges in delivering to such a high standard?
Terminology: Confusion around terminology has been longstanding, with a combination of mentor, preceptor, facilitator, role model, guide, supervisor and assessor referenced over time.
Approach: Attempts to view every preceptor and every preceptee in the same light have created difficulties in ascertaining a consistently replicable approach.
Standardisation: Minimal industry standards have existed in terms of what the precepting role entails.
Tools: Communication skills and feedback were most often based on individual perception, risking confusion, damage to confidence and development of poor habits.
Workload: Additional workload and increased stress with minimal support or financial remuneration have drained and overwhelmed preceptors in the past.
Lack of clarity in each of these areas causes stress, overwhelm and personal conflict, subsequently reducing willingness to address issues arising in on-road clinical and professional practice. Ultimately, this leads to a more "tick and flick" approach to skills logs. Research and reflection have highlighted areas for improvement and, in more recent years, we see significant headway.
Terminology: The use of preceptor and, less frequently, mentor are now becoming more familiar as terms that envelop ideal traits and qualities for on-road introduction to the paramedic role.
Approach: Recognition of different service pathways, tertiary education formats and individual personalities are beginning to enhance understanding around the need for an all-encompassing approach.
Standardisation: Industry standards are helping to form the basis of performance models, primarily when supported by registration principles.
Tools: Positive feedback methods have been highlighted as successful and are becoming utilised more frequently within ambulance services and education.
Workload: Recognition of the additional demand on paramedic preceptors has seen some success through supportive measures such as peer discussion, allocated time for debriefing or documentation, promotional structures and financial compensation.
This gradual development of each facet is slowly increasing collective desire for paramedics to become preceptors, rather than naturally progressing towards the role without a clear purpose. To help to shape a positive future, what are we aiming for?
Terminology: Clarity and definition around the singular terms "preceptor" and "preceptee" that become globally accepted and recognised throughout prehospital care.
Approach: Selection and training, specific to evidence-based criteria, so that competent paramedics may be educated in precepting for the future.
Standardisation: Industry-wide standards formulated to provide clear expectation and guidance for both preceptor and preceptee to work from. The establishment of clear underpinning principles so that paramedics with excellent clinical and professional standards more readily aspire to become excellent preceptors.
Tools: Development of a range of recognised communication and feedback tools so that both parties have guidance within consistent parameters.
Workload: Implementation of measures to address, alleviate and compensate for the additional workload and emotional labour involved in precepting.
Strong paths are being forged towards defining the role and industry standards in precepting paramedics for the future. The introduction of students and graduates into prehospital care is now more widely discussed, and previous gaps in research are slowly being filled. (There are some theses and articles that are well worth reading in the references list below.) Historically, much of the focus has remained on the difficulties faced by graduates entering the workforce, but there are similar facets to consider in supporting both parties if we are to develop effective precepting programs and foster strong working relationships.
It is well recognised that the learning curve is steep for new paramedics, but that learning curve can also be steep in the preceptor position, too. Just as preceptees don't necessarily know the best ways to approach clinical skills or professional practice, it cannot be assumed that preceptors always have the best answers either. Entry into paramedicine is known to be a difficult time with the balance of personal, emotional, academic, financial and professional commitments, but it stands to reason that this can be the case at any time in the preceptor's life, too.
With so much going on in the background of defining, developing and delivering paramedic preceptorship to a high professional standard, we mustn't forget those currently active within the role. Unless and until we are provided clear guidelines in each organisation, the following prompts may be useful before and during the time we spend with students and graduates.
Think It Through
What benefits are you seeking, and what are you offering in becoming a preceptor?
Are you ready to undertake the additional workload involved right now?
Do you possess positive professional attributes that may be worth replicating?
Are you comfortable delivering and receiving honest feedback without feeling stressed?
Will you be the type of preceptor that you would have benefited from in your early career?
Be Prepared
Make a list of expectations you have of the role so that you can reassess in the future.
Note precepting habits you wish to avoid and check in on them annually to stay on track.
Print out a diagram or chart to follow consistently in working through feedback together.
Refresh reflective practice techniques and find a set method to become familiar with.
Seek formal training in precepting, or research and read material to help you form a plan.
Investigate learning techniques and find out from preceptees which work well for them.
Know what your registration body expects of all paramedics and use this as a baseline.
Create (or join if your organisation has one) a confidential peer preceptor support group.
Find out what additional support exists within your organisation before you get started.
Make a brief list of things useful for new preceptees to know about working with you.
Create a list of questions so that you can tailor and optimise each precepting relationship.
Let the preceptee know your expectations right from the start and find out theirs, too.
The rewards to be gained from precepting are enormous, but they are rarely automatic and must be actively sought. Like many relationships, the more we put in, the more get out. We always recall our past preceptors for both their good and their bad. Now's the time to decide just how we'd like to be remembered ourselves and take steps to precept successfully with intent.
First published in the Australian Emergency Services Magazine, Vol 19, Issue 3, 2020
References
Armitage, E. (2010). Role of paramedic mentors in an evolving profession. Journal of Paramedic Practice, 2(1), 26–31. https://doi.org/10.12968/jpar.2010.2.1.46151
Carver, H. (2016). The Paramedic Preceptor Experience: Improving Preparation and Support. Charles Sturt University. Retrieved from https://researchoutput.csu.edu.au/ws/portalfiles/portal/9316959/
Edwards, D. E. (2018). A Grounded Theory Study of the Preparedness of Paramedics to Undertake the Role of Preceptor in the Clinical Setting. University of Tasmania. Retrieved from https://eprints.utas.edu.au/31638/1/Edwards_whole_thesis.pdf
Myrick, F., Caplan, W., Smitten, J. & Rusk, K. (2011). Preceptor/mentor education: A world of possibilities through e-learning technology. Nurse Education Today, 31, 263-267. https://doi-org.ezproxy.ecu.edu.au/10.1016/j.nedt.2010.10.026
O'Meara, P., Hickson, H., & Huggins, C. (2014). Starting the conversation: what are the issues for paramedic student clinical education? Australasian Journal of Paramedicine, 11(4). https://doi.org/10.33151/ajp.11.4.4
Pitcher, D. (2016). Evaluating a program for preparing nurse practitioner preceptors/mentors. Journal of Doctoral Nursing Practice, 9(1), 158–163. https://doi.org/10.1891/2380-9418.9.1.158
Sibson, L., & Mursell, I. (2010). Mentorship for paramedic practice: are we there yet? Journal of Paramedic Practice, 2(5), 206–209. https://doi.org/10.12968/jpar.2010.2.5.4816
Sibson, L., & Mursell, I. (2010). Mentorship for paramedic practice: is it the end of the road? Journal of Paramedic Practice, 2(8), 374–380. https://doi.org/10.12968/jpar.2010.2.8.78012
Ulrich, B. T. (2019). 2nd ed. Mastering precepting : A nurse's handbook for success. Retrieved from https://ebookcentral.proquest.com
Walker, S., Dwyer, T., Moxham, L., Broadbent, M. & Sander, T. (2013). Facilitator versus preceptor: Which offers the best support to undergraduate nursing students? Nurse Education Today, 33, 53-535. https://doi.org/10.1016/j.nedt.2011.12.005
Williams, A. (2013). The strategies used to deal with emotion work in student paramedic practice. Nurse Education in Practice, 13, 207-212. https://doi-org.ezproxy.ecu.edu.au/10.1016/j.nepr.2012.09.010
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