# Some of your fellow students... that might not make the cut...



## 8jimi8 (Feb 22, 2010)

Do we have a responsibility to our fellow students to...

step up and say something to them, if we feel they are not ready to pass beyond the classroom setting?  Do we have a responsibility as students of the program to step up and say something to the program director? 

Example:

I just came from my first "weekend skills practice."   Our class is set for 2 practices and then a final psychomotor "test" skills check-off.  Already being a medical professional, I took this very seriously and studied my *** off with the NR skills check off sheets (and all the "Skills Drills" check sheets).  In our course instructions (this is an online course) the rules are very plainly and (importantly) strict and strictly laid out.  "If you are not prepared for this skills check-off practice, we reserve the right for the instructor to send you away from the practice session as 'unprepared.'" At which point they will charge you a penalty $250 to reschedule another practice session.  It rightfully scared me into knowing my skills up to the point that I did not lose a single check-off point (except i forgot to state that I would use an OPA while bagging a head injury patient on my trauma assessment.  thinking back on it, if the patient had an intact gag reflex, this would increase the ICP --- so it may not have been indicated in a head injury patient with unequal pupils, but i digress)

My instructor was so impressed with my didactic knowledge and skills performance that they waived my 2nd practice session and gave me the go-ahead to progress to the final test "skills checkoff."

the other student that was at the practice weekend, sort of rode on my coat-tails.  He let me do all of the skills first (with him as the patient) and the "rookie instructor" ended up "passing" him on all of his skills.

The practice weekend was not at all as strict as it was purported to be.  I was watching him intubate the mannequin and more than 5 times, as his partner I saw critical fails on his check-offs.  Literally every attempt he made at this "skills station" he failed it in one critical way or another.  Trying to insert the laryngoscope and the ETT tube into the oral cavity at the same time... (it was apparent to me that he had not used the NR Skills Checkoff sheet to study the skill) Not removing the syringe from the pilot balloon.  Forgetting to "pre-oxygenate" before suctioning.  Couldn't even pronounce "pre-oxygenate," sounded as if that was the first time he had ever heard the word.  Forgetting to clear the soft-tip suction catheter.  Multiple Multiple Multiple times he forgot to say scene-safety and BSI.

Now then, this was this guy's SECOND skills practice weekend!  I don't know how he passed the first one.  I can't understand HOW he will pass the final "Test" weekend.  And this final testing weekend is run by the director of clinical rotations... because we run under his school as "clinical students."  (My program is accredited through their affiliation with his institution)

Now then i know that the program director isn't aware of his performance because she was not present at any of this student's check-offs. 

Do I have a duty to inform either of them of my intuitions and observations?

I wouldn't ever let this guy care for me if I called 911...


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## medic417 (Feb 22, 2010)

Being aware of the program you are in they will make sure he improves before he gets a course completion.   Also even if he just squeaks by he will not pass NR so no worries.  

Now if you could talk to him and give him some pointers might benefit him and you.  Him as he will see from another set of eyes where he is lacking.  For you it will drive points deeper home as you assist.  There is a rule in many lines of work that goes "see 1 do 1 teach 1" then you have a better grasp of the skill.   

Be careful of you approach though.  Maybe ask if you can run through skills together in person or over the phone.  Then you can be assisting w/o stepping on toes.


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## 8jimi8 (Feb 22, 2010)

Thank you for your input.  My concern is really just the ethical concern knowing that he is squeaking by... at which point, he could really hurt someone.

I did cautiously ask him if i could provide him feedback.  He assented at which point I told him not to pick up the ETT until he actually visualized the cords.  He had this uncontrollable urge to try and insert both devices at the same time!  He started picking up only the laryngoscope, but then started forgetting to leave the syringe attached to the pilot balloon, prior to inserting the ETT.  So his next point of failure was that he immediately began forgetting that he had placed the tube and would let go of it with both hands, in order to attach the syringe and inflate the pilot balloon.  Our "rookie instructor/proctor" would then immediately correct him not to EVER let go of the tube until it was secured.

He really, never completely finished the station successfully, nor were his attempts < 30 seconds from ventilation to ventilation... and he received a pass for the weekend.

It is going to be embarrassing to witness his final check-off situation because he was not equally, but nearly equally lacking in his trauma/medical assessments.  I understand that it could have been nerves, and that some people really shine when it comes down to the wire, but this is like an impending train wreck, where you see the driver trying to start the car that is stuck on the tracks... rather than exiting the vehicle...and you can't close your eyes...

I feel that he gave me the opportunity to provide him with constructive feedback, but he didn't respond to it... and he will be my partner for the final psychomotor weekend, in two weeks... there are only two of us who are scheduled to test and we've already arranged with the clinical director to condense the weekend down to 1 day.


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## rescue99 (Feb 22, 2010)

8jimi8 said:


> Do we have a responsibility to our fellow students to...
> 
> step up and say something to them, if we feel they are not ready to pass beyond the classroom setting?  Do we have a responsibility as students of the program to step up and say something to the program director?
> 
> ...




Have you considered having a few practice sessions with him?  He may not be any better in the end but, you would be :>)


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## 8jimi8 (Feb 22, 2010)

I would be more than willing to help him, but he seems to be pretty resistant to following through feedback... Also, he lives 6 hours away from me.  

But as a side note, I just found out my new neighbor across the street is waiting to take NR for her basic.  So i do have someone to study check-offs with close at hand!  Sadly my friends don't enjoy going over check-offs even if I bribe them with beers!  (And my wife can't help but correct me, rather than letting me 'fail' and telling me at the end what i missed lol!)

But i do agree with the see one, do one, teach one concept.  That got me through nursing school and hopefully will carry me forward to my true dream.  EMT-P baby!


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## rescue99 (Feb 22, 2010)

8jimi8 said:


> I would be more than willing to help him, but he seems to be pretty resistant to following through feedback... Also, he lives 6 hours away from me.
> 
> But as a side note, I just found out my new neighbor across the street is waiting to take NR for her basic.  So i do have someone to study check-offs with close at hand!  Sadly my friends don't enjoy going over check-offs even if I bribe them with beers!  (And my wife can't help but correct me, rather than letting me 'fail' and telling me at the end what i missed lol!)
> 
> But i do agree with the see one, do one, teach one concept.  That got me through nursing school and hopefully will carry me forward to my true dream.  EMT-P baby!



Yeah, there's always the PIA folks who just don't want to succeed and those who study by osmosis.


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## medicteacher (Feb 22, 2010)

In your post you said that you were there for "weekend skills practice" and there were just two of you.  You also mention in the email you got from the school that the "instructor reserves the right to send you away" if you are unprepared.  Personally, as a teacher, if I only have two students to deal with and one is not as prepared as he/she should be, I might try to work with that student more because I have the time if I am not overloaded with students, rather than send the student away.  Practice is practice, testing is testing. You mention there is still testing to go.  Ok, so the student still has to go to a testing session and perform, right?  Sooooo, what are you worried about?  Are you worried that the program will just send him through if he can't "perform" adequately during testing?  Has the program got a reputation for that?  If not, then I would say that the reason for having separate testing would be to see if the student CAN do the skills prior to course completion as is mandated by all accrediting folks for EMS.  And like someone else posted, if the student manages to pull it off for testing somehow, well then good.  But if he/she is just "slid by", then he/she will NOT pass the national testing process.  It is always nice to give the course coordinator a heads up if you are worried about something.  But maybe you should also sit back and not assume that a student will be allowed to pass a test or tests who cannot perform adequately in practice unless he/she actually can do it when it is time to test.  And if the student can do it then, it really doesn't matter HOW they got it together, they did. If they can't, then most programs will require that the student have more remediation and then test again prior to being released from the program.  One other thing I noted in your post, maybe you are trying to take the weight of the world on your own shoulders instead of sitting back and enjoying being a student.  HAHA  Sometimes it is really hard if you find that you are really good at something because you can get frustrated easily by others who struggle.


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## MDewell (Feb 22, 2010)

I'm the kind of guy that I'm lookin out for me first, especially in training. If we're both up for 1 job, I'll let my skills and my resume speak volumes and hopefully he gets weeded out.

As the training goes..maybe voice your concerns to your instructor, but don't expect anything to happen out of it.


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## medicteacher (Feb 22, 2010)

MDewell, please don't sell the instructors as a whole short.  While I realize there are probably some out there that won't care enough or are too afraid to do something about such issues, most DO care and most WILL review the entire situation and respond as needed and if appropriate.  Be aware, however, that usually there are two sides to every story that must be investigated when a student voices a complaint or concern, whether it is about a fellow student or about an instructor.  But due to liability, many instructors cannot necessarily go back and tell the final outcome.  They very likely will take action if it is indicated, such as making the student 8jimi8 mentioned meet criteria to be able to to pass (just as they do the other students) and either remediating the student or failing the student if indicated.  But they won't go back to the original voicing student and say, "Yeah, you were right and this is what we did because...."  And the other side is that what if the other student or instructor turns out to be innocent or manages to learn somehow and meets the criteria after all?  Sometimes it is better to let things lie after the investigation is complete and any necessary actions are taken and go on than to create a two-way adverse hostility situation between the accuser and the accused.  Just my rambling thoughts mostly but I certainly don't want to be "sold short" if I am in that situation as an instructor.    However the smart instructor won't knee-jerk react but instead will investigate thoroughly, give the situation thought and develop a plan of action, and then try to follow the best course for all concerned.


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## firetender (Feb 23, 2010)

*A word of encouragement*

At this early stage of the game I'm not all that convinced it serves you to put any of your energy into what or how someone else is doing or not doing within the context of a learning/testing situation. Do your work.

And as for him? Just remember:
*
TIME WOUNDS ALL HEELS!*


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## EMT Mylo (Feb 23, 2010)

*Stand proud*

I know how you feel in a situation such as this. As a 21 year member of the United States Navy, its tough to know when and how to act accordingly when it comes to others. I myself just completed the EMT-B course and my NREMT and State licenses arrived a few days ago. There were some in my class that I knew would not cut the mustard and during my ride-a-longs on the ambulance I asked myself would I want this person "working" me if I had to call 911? Some individuals have so much pride that they cannot admit if there is a fault in their own skillsets but as a care provider it is your moral and ethical obligation in my opinion to let this person know what they are lacking and not sugarcoat it! If I went into combat "again," I would not want an individual that could not make decisions immediate in nature or could not perform unless there were others to coddle he/she. You are standing proud and I admire your confidence, as the other thread posters have stated, time will weed out those who cannot perform when its down to the wire and yes, the NREMT exam is no joke, I went in prepared and when I clicked the mouse I was like "WHOA!" Fortunately using the skills I was given and paying attention in class paid big dividends and in Florida our course curriculum is over 220 hours. I have faith you will do the right thing and hopefully your classmate improves his skill as well. Best of luck to you.


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## 8jimi8 (Feb 23, 2010)

Well,

i spoke with someone via private message who actually, personally, knows my program director.  He informed me that the PD pride's themselves on turning out quality professionals and this pushed my vacillation over the edge.  I called the PD and explained my concerns.  

I was relieved to know that the PD was *well aware* of this individual's work ethic and performance.  

Sadly, this _2nd_ practice session, for him, was a "100%" improvement from his first session.  

I honestly was trying to give him the benefit of the doubt, which is what my original post was about...

Asking if we had an ethical duty to our fellow students or our programs, to ensure that safe, effective, professional providers are graduated.  This has been a valuable lesson for me.  

The PD is giving him enough slack, to buck up, or hang himself... with no remorse.

I was also given a heartfelt thanks for the heads up and assurance that the final testing proctor will be made well aware of the track record.  

as a side note, I got invited to participate with a panel of 5 other students in a "site visitation" webinar.  

Thank you for your various perspectives.  I will continue to be a guardian of professionalism and hopefully join the ranks of those who carry forward into the realm of "expertise."


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## Veneficus (Feb 23, 2010)

8jimi8 said:


> I was relieved to know that the PD was *well aware* of this individual's work ethic and performance.
> 
> Sadly, this _2nd_ practice session, for him, was a "100%" improvement from his first session.  ."



Most instructors I have worked with have a keen ability to tell when somebody is struggling and why. Usually by the 2nd or 3rd class with a group, it is easy to tell who will not be in class 6 or 50.

The reasons are often varied, not always about ability. Over commitment, family issues, underestimating the demands of paramedic education, even child birth. 

Sometimes people shape up and surpise. Some are slow learners, but in the end accel. Then there is text anxiety to top it all off.

If the person is improving by 100% isn't that a good thing? 

Some people ace the initial education with both academic and clinical awards and become the worst providers I have ever seen. 

I would be careful especially in EMS and healthcare in judging who should be there and who should not. Somebody might make the same judgment of you by a totally different set of values. 

For example, I value critical thinking in a provider above all else. Those who expertly follow the rules to the letter indifferent of mitigating factors I find exceptionally worthless. But it is not for me to decide if they should get to work in the field or not. (and I am an instructor) If they meet the requirements, irregardless of my personal opinions. They pass and go on.

There is a system in place to weed people out.(sometimes it is a court of law) I would just let it work.


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## 8jimi8 (Feb 23, 2010)

Being judgmental is the last thing that i want to do.

But i will not let you endanger patients.  Plain and simple, if you don't cut the mustard, you don't deserve a license.

Same goes for me.  I take patient advocacy deathly serious.


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## Veneficus (Feb 24, 2010)

8jimi8 said:


> Being judgmental is the last thing that i want to do.
> 
> But i will not let you endanger patients.  Plain and simple, if you don't cut the mustard, you don't deserve a license.
> 
> Same goes for me.  I take patient advocacy deathly serious.



It's not that I don't agree with you, but the bar is rather low and who decides what endagers patients?

What I think is dangerous is may be very different from what you do.


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## 8jimi8 (Feb 24, 2010)

Point  taken,

in this case, the deciders are the program director, the final check-off proctor, and possibly, eventually NREMT.

Hey... it is their credentials on the line, not mine.  I did my part: I politely offered feedback to the student, made it more than obvious that I was willing to spend _my_ time at the practice weekend - to catch him up and help him feel comfortable with the skills, and when he didn't take the opportunity and felt that he "knew it," I stepped it up the chain of command.  

I am more than confident that the PD is not going to graduate a substandard student; as well I feel confident that the final check-off proctor will not go easy on him like the practice proctors did.  The program director did tell me that "they just didn't have the heart to send him away," but she thanked me, "for having the courage to speak my mind and voice my concerns." 

You don't know me and I haven't quite represented it in this post, but judgement is not something that I pass on other people.  Even in my estimations of his "emt skills," I would like to remain friends with this person.  Also, it isn't about personality, it is truly only about patient safety and the most positive outcomes achievable.


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## medic417 (Feb 24, 2010)

8jimi8 said:


> The program director did tell me that "they just didn't have the heart to send him away," but she thanked me, "for having the courage to speak my mind and voice my concerns."



As an instructor myself I always hope that I can find a way to reach every student.  You work with them, you talk to them, you remediate them, then if they still don't get it you have to fail them at some point.  I'm sure your PD is still trying to figure a way to reach this student.  But when the time comes if the student doesn't get it they will do whats right for the patients which is not pass the student.  But I hope for the students sake they wake up and get it.


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## firetender (Feb 24, 2010)

*Forgive my rancor...*

The last thing an FNG needs is another FNG putting pressure on him when the Critic doesn't have a clue about how easy it is to get derailed, how hard the walls are that you hit and especially how difficult it is to pick yourself back up while others are drawing a bulls-eye on your butt!

And all that energy is about judging someone who's still in the classroom! I want someone who's working on me to have his complete focus on the work, not on some guy in another truck.


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## 8jimi8 (Feb 24, 2010)

It is also very distracting when we are trying to do an exercise and we have to stop to catch someone up to the point they should have been, when walking through the door.

I didn't put any pressure on him.  I didn't tell him he wasn't doing well.  I simply asked, and was given permission to give him some tips that I use to help me remember things. 

rancor forgiven, but i still don't know what FNG is?


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## firetender (Feb 24, 2010)

8jimi8 said:


> It is also very distracting when we are trying to do an exercise and we have to stop to catch someone up to the point they should have been, when walking through the door.



The truth is, you'll be doing this for a lot of the rest of your career, but this will be with lives at stake and with your partners. Ultimately, you DID handle it well and diplomatically, but in the interim, I think you could have used that energy to strengthen your own abilities so worrying about what the other guy is doing becomes irrelevant because you have your own act together.

FNG, from Viet Nam Military parlance (no, I wasn't) means "Expletive Deleted(ing) New Guy".

(I do acknowledge and appreciate your passion. When channeled.
it will be one of the most potent tools in your Bag of Tricks!)


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## 8jimi8 (Mar 7, 2010)

here we are final psychomotor weekend.  Dude is trying to ask me what the scenarios are, what equipment I picked.  I finally had to say. "Dude, we are testing you have to stop asking me about my scenario."  Sadly, he admitted to me that he had not studied at all for this weekend.  Nice guy, but I hope he doesn't skate.  I know already he was allowed to advance his combitube to the appropriate depth, after being prompted (by admission of the aforementioned).


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## 8jimi8 (Mar 7, 2010)

And the testing session just lost half of it's attendance.  That was awkward.  Maybe he'll be motivated to study for the next one


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## NepoZnati (Mar 7, 2010)

My last week also see dramatic declination in number of students! Loosing people like one boob who ask me what BLS means or is SYS of 70 good (after the 2 and 1/2 month of classes!?) is not something I will cry about.


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## mycrofft (Mar 7, 2010)

*In answer to your question..no.*

But good on you for stepping up.

Every time I've been in on spoonfeeding someone through a course, I've been sorry and so was the feed-ee. Let Darwin and the instructor do their thing

Sometimes, also, a person who learns poorly in class or performs poorly under scrutiny will blossom when out from under the microscope and partnered with the right partner.


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## 8jimi8 (Mar 7, 2010)

Passed all my skills btw!


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