Learning and Teaching Mentorship in Emergency Medicine
“I was you the other day,” Drew told me while we were having our coffee. We have a warm working relationship mostly based on joking about replacing increasing amounts of our medical equipment and coworkers with live raccoons. He’s an empathetic, effective provider and a loving, constant husband; I’m always pleased to see his name on the schedule.
“Oh?” I asked. “You finally made it to the bathroom before you started crying?"
“No, someone else was already crying in there," he said. "I had to use the utility closet. Do you remember the first day I started here?”
“No.” I was unapologetic. My department runs a part-time program; a parade of interchangeable, eager providers with brightly polished shoes are forever introducing themselves, fumbling nervously around my high acuity calls and then getting a full-time job offer six months later.
He briefly summarized:
“We were evaluating a six-year-old who had a ground-level fall and had a laceration on his occipital scalp. It was bleeding enough to make a mess but not nearly enough to be dangerous.”
I was speaking with the caregiver and gestured at Drew, “Can you listen to his lung sounds, please?”
He agreed and managed at least to put the right part of the stethoscope into his ears. I confirmed a lack of loss of consciousness or seizure activity with the caregiver who witnessed his fall. I turned back around to ask Drew what his lung sounds are.
“I ... don’t know.”
“Hm?”
He took a deep breath and said it again. The tension in his body language suggested an expectation of conflict. “I can’t hear them. I have no idea what they are.”
“Gotcha. No worries. I’ll check them.” I walked over to the kid and did so. Clear and equal bilaterally.
We cleared the transport refusal with medical control. The child’s caregiver drove him to urgent care for stitches after I’d ensured he had understood the long list of good reasons to call 9-1-1 again.
Later, I pulled Drew aside, “You did a great job back there.”
“Objectively, I didn’t.”
“No, I meant thank you for being honest with me and not just making up exam findings.”
“I wouldn’t do that.”
“And that’s not necessarily the case for everyone. I know I can trust you now. We’ll go over where to listen to lung sounds when we’re back to station. Nice work. I really mean that.”
“Uh, sure. I’m happy to not assess any patient for you any time you like.”
In the present, I told Drew, “That all sounds vaguely familiar.”
“Same thing happened at my other district," he said. He works two jobs as a part-time firefighter.
“Same thing?”
“Yeah. We have this brand-new kid. You know, graduated EMT school three weeks ago, hands still shake when he assembles a Narcan push and so on. The patient is pretty standard; a 68-year-old female with abdominal pain, and I ask him to take a blood pressure. I’m doing an interview and checking a blood sugar …”
I interrupted his tale to commend him for this. Sometimes the only detectable symptom of diabetic ketoacidosis is abdominal pain.
“Of course. And I ask him what the blood pressure is. And he says, ‘Sir, I am so sorry, but I just can’t hear it.’ So I take it, and we move on. And later we’re back at the station and I tell him that he did a good job, and I know I can trust him now. Obviously, this was not the feedback he was expecting. I explain that I can teach him how to take a blood pressure, that’s fine, but I can’t teach him how to have the integrity it takes to choose looking dumb over making up vital signs. He looked stunned. He definitely thought I was going to yell at him.”
This was perhaps my proudest moment as an EMS educator. It was a supreme gift that he had learned not just the perfect stroke hand-off report but how to sincerely commend a learner for the honesty it takes to immediately choose looking foolish over the hypothetical harm providing fictional vital signs could cause. I’d only taught the first one deliberately.
As proud as I am of Drew and his willingness to mentor and teach others, there’s a flip side of this. I was chatting with a different part-time firefighter, Katrina, who also had a second job at a third, distinct district.
“There’s this new guy who can’t take a blood pressure,” she said while driving the rig back from the hospital.
“We were all that useless once,” I replied, a little surprised that Katrina, whose fatal flaw is a well of compassion for others that has no bottom, needs the reminder. A more profane version of this phrase had been said many times by Lou, a senior firefighter I used to work with. I had always respected him for defending people who weren’t in the room and would never find out he’d stood up for them. I was also impressed that, after over 30 years in the field, he still remembered that he’d once been full of nerves and struggled. He’s moved on to a well-earned promotion, but I try to embody his values now that I’m someone else’s teacher rather than his student.
“No, I know that. He just can’t hear the sounds through the stethoscope.”
“He probably needs a digital one,” I said. Between the decade I’ve spent around sirens and the six times I’ve contracted COVID in the line of duty, I use one exclusively. My hearing is poor enough that Drew, in a characteristic act of responsibility and protectiveness, always ensures that he is between me and traffic on trails and sidewalks because he can hear incoming bicyclists and cars a full five seconds before I can. “But they’re really expensive.”
“Yeah. And no one will work with him until he figures it out.”
“No one will agree to be on a rig with him?”
“That’s right.”
“They’re punishing the wrong behavior. They think they’re discouraging ineptitude, that they’re motivating him to learn, but he was already motivated to learn. He’s going to be really reluctant to admit that he doesn’t understand or can’t do something going forward.”
“You’re preaching to the choir,” she said. “I’ve been taking extra time to teach him. And I told him I’m happy to be on his rig and double-check his readings until he gets it down.”
“Of course you did. He’s lucky to have you.”
She pauses, always reluctant to accept a positive observation about herself as fact. “You’re right. He is. I wish I’d had someone like me, who assumes that he’s trying his best and means well, when I first started.”
“I wish you’d had that, too. But I’m proud of you for breaking that pattern.”
And then she tells me she’s done with feelings for the day, and we move on to planning a cheese plate for dinner at the station.
There’s a traceable lineage of patience with new providers and simultaneously praising their enthusiasm while confirming their skills from Lou to myself to Drew to his student. How you teach matters at least as much as what you do. And it’s a life-affirming pleasure to create a legacy of mentorship you can be proud of rather than yet another obstacle a new provider must move through to succeed.
