What Happened to the Patient Assessment?

Ok, I may open a can of worms on this one - but here it goes. What happened to the quality of our patient assessments, and why aren't the students of today being taught the importance of the patient assessment?

The new breed of student that gets on the truck nowadays is VERY skill oriented. They want to do skills and get signed off on certain things - but they don't want to "run the call." They want you to figure out what is wrong and then let them step in and start an IV - or intubate? I have a HUGE problem with this.

I personally feel that we can train monkeys to start IVs and Intubate, so as good preceptors, we should NOT emphasize the skills, but rather should ensure they can accurately assess a patient. The shift should always start by asking the student what they're comfort zone is. When they begin talking about skills and IVs, you should redirect the conversation to go something like this. "So are you comfortable walking into a house and interviewing the patient with no assistance?"

I personally offer to assist them with skills and even do some of the skills for them - if they're willing to concentrate on the patient assessment and work on "getting the big picture."

Another thing - don't allow them to use the pulse oximeter and glucometer until they can tell you what THEY think the satuation level and glucose levels will be based on their physical exam of the patient. I say, "so what do you expect their O2 sat to be?" or "what do you expect their glucose to be - are they alert and mentating appropriately?" The good students will suddenly "get it" and think, "Wow, I figured this out without the machines!"

Also come up with a signal ahead of time that the student can use to ask for your help without having to embarrass themselves by asking. I always say, "you go in the house and begin your assessment. I will be standing off to the side. If you get stumped or need me to help you with your questioning, just look up at me and nod your head." This certainly is better than them saying, in front of the patient, "Can you come help me" or "I don't know what else to ask." You will also gain a lot of respect as a preceptor when you treat the student in this manner.

I do lay a lot of the blame with the instructors of today. My friend DJ (9-echo-1) has blogged about this recently. People fresh out of EMT or Paramedic school are now being allowed to teach and they don't have the assessment skills sharpened themselves. I would like to ask all of my fellow preceptors to consider my approach and take away the machines until the student can perform a quality physical exam and interview. Then allow them to confirm their findings with the machine - not base their treatment path on a machine.

Enough for now - keep reading and commenting! Thanks so much to those of you who follow my blogs!