Smooth Certification: Tips for the clinical portion of your EMT/Paramedic certification
By Scott Cook

So you’ve decided to go for your medical patch: EMT, EMT-I or EMT-P. EMS is part of what we do, and I’m still working on getting my paramedic certification, so this month, I want to share some tips for making your clinical experience a success.

First, a little background about me so you’ll know where I’m coming from: I’ve been a student (in one thing or another) it seems, my whole life. I started in the fire and EMS business in 1988 (EMT), got my EMT-I the first time in 1989 and the second time in 2006 (I let it lapse in ’97), and I’m working on the Paramedic certification now. As well as being a student myself, in the last 20-plus years I’ve had the opportunity to precept a whole bunch of folks.

By no means have I seen everything, but I’ve seen some good stuff. I’ve seen the gamut of students in my time. I’ve made two cry and sent four home, three after calling their preceptor to tell them why, and one after making the student call their preceptor to explain to me why the student should stay. (Please note that it takes a lot from a really poor student for me to reach this point.)

There to Learn
It’s important to know that when obtaining your EMS certification, you aren’t there to do the “s@#! work” (SW); you’re there to learn. The staff of your clinical should not ask you to do SW. I believe that.
I’ve been to clinicals where the staff expected me to do the housekeeping. (The nasty clean-the-s@#! Housekeeping, if you know what I mean.) If the staff asks you to help with the SW, help them and move on with your day. If the staff asks you to do the SW for them, do it, note it, and let your instructor know after your clinical. Help with daily inventory checks, which ultimately helps you later in the clinical.

Ask Questions
Secondly, keeping in mind you aren’t there to do the SW, in order to increase your opportunities to get your skills, you have to volunteer for things, even if the SW.

The questions you should most often ask during your clinical: “What can I do to help you?” or “Can I help you with that?” Then do whatever they ask. Once the staff sees and believes that you’re there to learn the job, and aren’t just there just to get skills and leave, they’ll be more inclined to ensure that your clinical is successful.

When you obtain the trust of the clinical staff, they will give you additional opportunities to learn the interesting stuff. Something as simple as making up an ER bed can lead to opportunities to significantly improve your skills, especially if you use some initiative and do it without being asked. (Sometimes they’ll even let you do some extra stuff under instruction!)

Nine times out of 10, if the preceptor’s question starts with “Do you want to,” or “Will you,” your answer should be “Yes.” Note: I said nine times out of 10; there are exceptions!

Ask other questions related to the task at hand. Then, WAIT for the preceptor to finish answering your question before butting in. Some people—by nature—take a long time to get to where you want to go: Ask them what time it is and they first tell you how to build a watch. Even if you’re dealing with a preceptor like that, WAIT for them to finish. In most cases, the preceptor’s long response is for a specific reason, and may have one seemingly insignificant tidbit that helps you make a better decision a year from now.

No Guesses Allowed
NEVER guess at something. If you don’t know, you don’t know, so ask.

War story warning: I had a student “back in the day,” 1990 or so, who claimed he could take a blood sugar (BS) reading. That student looked the part and told the medic the patient’s BS was in the 30s. Low BS was consistent with altered mental status, so the medic pushed an amp of D50 and we proceeded to the hospital. When I’m cleaning the rig, I notice the d-stick test strip is in the glucometer backward. Not a fatal error in this case, but it called into question the other things the student said and did. And as an added bonus, he got to explain to his preceptor why I sent him home.

NEVER hide or try to hide a mistake. Fess up, own it, be an adult. Confess quickly, as soon as you realize you screwed up. A life may depend on it.

Other Tips
• You’re not there to watch; you’re there to learn and practice your skills. It’s OK to watch one or two calls to get a feel for how the crew works, but after that you have to get in there and start working.
• If a preceptor tells you, “This is how I want it done,” as long as it’s not hazardous to you or your patient and doesn’t violate protocol or standard of care, that’s how you do it. (I’ve had preceptors who would only let me use a Miller blade and 18g, 16g or 14g IV caths.)
• If your preceptor offers to let you perform a skill the patient doesn’t really need, but you need to practice, DO NOT take the skill opportunity—even if the skill won’t hurt the patient. It’s a preceptor trap to see where your head is at. You’re there to learn while keeping the best interest of the patient in mind, not your best interest. Your patient always comes first when weighed against your skill needs.
• If you’re an EMT-I or EMT-P student, unless the precepting crew asks you to perform a specific I or P skill while they handle other stuff, NEVER-EVER-EVER reach for the EKG, IV kit or other advanced skill level stuff until the ABCs/basics have been accomplished. If your patient needs oxygen and you’re starting an IV because you need the skill (or for whatever reason, unless you’re told to), you screwed up. It will show up on your evaluation.
• Use “three-way communication”: When the preceptor asks you to do something, repeat it back to the precpetor and wait for a yes/no response before proceeding.
• If you have a weak spot, or aren’t confident in a specific skill, ask your preceptor to help you with it. They may have a different approach that makes it fall into place for you. They’re there to help you succeed, but they can’t help you if you won’t help yourself by telling them what you need.
• Don’t boast about how you never miss a stick or can tube anyone. To your preceptors, these are dead giveaways that you have no clue.
• If there’s legitimately nothing going on, then your nose should be in your study materials.
• Look for opportunities to help. I can’t say this enough. And you’d be surprised where they appear.
• Expect to feed the meal kitty. The buy-in for the day’s meals is usually $5–10 even on steak day. Unless you’re on a special diet or budget, be prepared to pay into the kitty.

Final Thoughts
Your preceptors must answer for what they let you do. They’re doing you a huge favor and, in some cases, taking a huge risk. Make sure they’re aware of what you’re doing at all times. If you’re planning to perform an advanced skill, get the preceptor’s permission first. Some preceptors will make you defend your position so that they understand that you understand why you’re doing something.

The tips provided here are by no means all-inclusive, but you get the idea. Each of us has our own experiences, and yours may be different. The above works for me, and reflects what I’ve seen work for students.

Scott Cook is the former chief of the Granbury (Texas) Volunteer Fire Department and a fire service instructor. He’s also a member of FireRescue’s editorial board.