Master Clinicians: Are You Leveraging Them to Your Best Advantage?

One of the biggest challenges EMS leaders face is maintaining quality in their organization. Another is the transfer of institutional knowledge, clinical excellence, history, and values across each class of new recruits.

We may utilize field training officers or field supervisors to provide the crucial feedback for new hires during their probationary period. But not every organization can employ a field training officer. Some departments may use the title, but only when that person is evaluating a staff member during the probationary period or for a yearly evaluation.

In many places, the default person is the on-duty supervisor, and they end up fielding every question: Are there better techniques for using the bougie? Why does the policy specify we use this entrance to the emergency department when we have TB or meningitis patient and not the regular entrance? How do I deal with an upset patient? How come it takes so long to get airway qualified?

Sometimes the supervisor is not the best person for answering these questions and ensuring quality day-to-day or call-to-call.

A Better Way

Michael Zey, PhD, a professor at Montclair State University, has written extensively about the value of mentoring from a sociological perspective for career advancement. Mentoring has numerous organizational benefits as well, especially when we want to communicate the values of our agency and the transfer of institutional knowledge. We have something similar to mentoring in the EMS world.

We know about our apprentice/probationary staff. I tell my EMT and paramedic students that it could take a year or even two before they feel comfortable in their own skin. During this crucial period you are not only learning the fundamental aspects of being an EMT or paramedic, you are learning about the inter- and intrapersonal dynamics and culture of a complex organization.

The journeyman EMT or paramedic has successfully completed their apprenticeship and is developing their skills and competence. The journeyman route may take 3–6 years, depending on expectations and opportunities. Clinical competence increases from the complexity and volume of patient contacts.

Every organization has the go-to person on a particular shift or department when there’s a question. Computers go down in dispatch? Ask Jimmy. Clinical question about where to transport a patient with a confusing clinical picture? Ask Walter. On scene with a suicidal patient? All eyes turn to Mary.

These are the people in our organization who represent excellence. They exhibit what we’re looking for clinically and embrace the values we want to instill in every staff member. They hold the institutional memory for why we do things a certain way, or what to do when all else fails. As educators, they will whip up a model that can demonstrate how the lungs work with a rubber glove and a milk jug.

These clinicians have mastered their craft. They may or may not hold a specific job title, like field training officer, but they are recognized informally by field-level providers as clinical leaders. They have developed the knowledge, skills, abilities, and traits that allow them to impart their expertise and ensure clinical excellence.

Sometimes we find them as the ones we entrust with training new staff members or leading a clinical care review for quality improvement. Whenever we have a new project or initiative, we want that person on the team.

They are master clinicians, and they are a valuable tool and resource in any department.

Leveraging Master EMS Clinicians

These leaders exist everywhere. They develop organically—there is no formal process for them. Organizations that appreciate what they bring to the game, rather than challenge the potential shakeup to the organizational hierarchy, can leverage them to their advantage.

As EMS continues to struggle with attracting new people, master clinicians will be essential for the transfer of institutional knowledge and the values that are crucial to success.

If you aren’t recognizing or using master clinicians, start now. First, acknowledge them with a title: master EMT or paramedic, senior EMT or paramedic, paramedic lead, commander, or whatever works for your agency. Don’t forget that with a title comes compensation. 

Develop a job description and expectations. Do you want the master paramedic to be a field training officer, or to function as a resource for the field training officer and their apprentices? Teaching is critically important, and may occur at the bedside, in the lab, or in the classroom. Encourage them to participate in research and equipment evaluations.

How do we identify and select a master clinician? To quote former Supreme Court Justice Potter Stewart, "I know it when I see it." Here are some common qualities:

• Approachable
• Good, if not great, clinicians
• Naturally curious about the things around them
• Good listeners and good communicators
• Lifelong learners who are willing to share their knowledge with everyone

How can we further develop potential master clinicians or help the continued development of the ones we may already have?

• Secure them subscriptions to trade and peer-reviewed journals and have them lead or participate in journal clubs
• Send them to national conferences to hear the latest in the profession, to network, and to expand their knowledge
• Seek their participation in special projects
• Afford them the opportunity to advance their education and clinical experience
• Match them with masters in respiratory, nursing, and medicine to foster the cross pollination of information and expertise

We can leverage a multitude of tools and experiences to foster development. Don’t leave our master clinicians to their own devices to figure it out. Staff and organizational development, whether it is for the novice or the master clinician, requires an investment.

Consistent Role Models

Master EMS clinicians represent an untapped resource in all EMS departments. They are the people who come to mind who have made a lifelong commitment to being the best clinician possible, for caring for patients, and for educating all levels of providers around them.

As lifelong learners, they share their observations and knowledge with those around them. As role models, they consistently demonstrate the essential paramedic behaviors, including psychosocial awareness, respect for what things cost, patient-centered paradigms, and excellence in clinical care. They are resource that every EMS organization needs to develop.

References

Emergency Medical Services Systems Development. Lessons Learned from the United States of America for Developing Countries: Pan American Health Organization. December 2003. Pan American Health Organization.

Gerard D. Competence and the EMS Dynamic. Ambulance Today Autumn 2017, Issue 3 Volume 14. UK Publication: http://bit.ly/2FfO36b

Zey MG (2020). The mentor connection: Strategic alliances within corporate life. Routledge.

Daniel R. Gerard, MS, RN, NRP, is president of the International Association of EMS Chiefs. He is a recognized expert in EMS system delivery and design, EMS/health-service integration, and service delivery models for out-of-hospital care.