On Scene and On Point: Coaching, Remediation, and Discipline in the Field

Coaching, remediation, and discipline are distinct but complementary tools. Confusing them leads to inconsistent training and poor learner outcomes. If we are talking about the onboarding process for new employees, we spend considerable effort to recruit, select, and train them; for students, they are looking to us to help shepherd their way toward a successful clinical experience. The field clinical learning experience should not be an exercise in futility. Ensuring clear differentiation allows our training clinicians to intervene early, proportionally, defensibly, but most importantly constructively, to the benefit of the person they are evaluating.¹

You can’t discipline someone into competence, and you can’t remediate someone out of misconduct. What are the differences?

Coaching

Coaching is meant to optimize performance and accelerate development of a generally capable person. It’s real-time, formative guidance intended to refine technique, strengthen clinical reasoning, and improve efficiency when the trainee already meets minimum expectations or is close to meeting them. It’s truly performed in the moment. It’s informal and relaxed. Confidence and capability are an important part of this process.^1-4

Issues that require coaching include minor concerns with technique or inefficiencies with equipment setup, process, and procedure. It may appear as hesitation with a new piece of equipment or a technique they have never performed before. Performance should improve with minimal guidance. Sometimes it’s a style difference, but this is subjective: As the clinical training officer you have your way of doing something. New hires and students are developing their style as well. We’re trying to inspire confidence.

Remediation

Remediation is meant to correct a specific, identified deficit that is preventing consistent safe or competent performance. It’s a structured, time-limited educational intervention designed to close a defined gap in knowledge, skill, judgment, or professional behavior. We aren’t going to open a classroom and rehash the entire pathophysiology of congestive heart failure (CHF), but for the student who is having an issue related to identifying and treating CHF vs. pneumonia vs. COPD, we might ask them to explain the differences.^1-4

When we see repeated errors, an inability to perform a core skill, knowledge gaps, or a pattern of poor clinical decision making, these are the typical triggers that alert us that this isn’t a coaching issue, this is a remediation issue. We may perform remediation at the scene, but most times it occurs after the call is finished. If the deficit persists, or there are multiple deficits, we may escalate this and refer the person back to their educational program or back to the clinical coordinator before they can proceed in the field.

Discipline

Discipline is meant to address misconduct or violations, not educational gaps. It’s an administrative or HR process used when behavior violates policy, ethics, or professional standards, regardless of clinical competence. Sometimes in this context we may hear the term "willful and wanton," which refers to a standard of misconduct exceeding negligence, describing actions that are intentional (willful) and taken with utter indifference or reckless disregard for the safety or rights of others (wanton). It implies a conscious choice to engage in dangerous behavior likely to cause harm.^1-4

Examples of issues that should require discipline include dishonesty, falsifying documentation, personal boundary violations (comments, offensive touching, etc.), refusal to follow lawful orders or medical direction without cause, harassment, and reckless behavior.

All organizations should have a progressive discipline policy, with verbal counseling or a written reprimand up to suspension or termination. Some offenses may result in immediate termination with a notification to the regulatory or law enforcement agency for followup. Documentation for these types of incidents must be specific and detailed.

Determining Which to Apply

Determining which one to apply doesn’t have to be complicated. A simple decision rule for field training personnel requires asking these three simple questions:

1. Does the trainee know what to do and just needs refinement?
   This is a coaching issue.
2. Is there a reproducible deficit that blocks safe or competent performance?
   This requires remediation.
3. Did the trainee violate policy, ethics, or professional standards?
   This is most likely discipline.

Coaching and Remediation Tools

There are different methods for remediation that may be used in the field. Here are some clear, field-usable definitions of each one. These methods are grounded in adult learning and competency-based education principles.

Modeling is a tool educators use on the first day and during the first few routine calls a new person works. This is the behavior, flow, and typical assessment you want to see from the trainee. Typically, the educator models the first couple of calls, the field evaluator demonstrates the correct performance, then the person repeats it. This is showing the trainee what “good” looks like before expecting independent execution: demonstrate; then explain; then perform.²

Another tool is just-in-time microteaching. This pairs well with the one-minute preceptor methodology. This is a brief, two-to-five minute period of highly focused teaching delivered immediately before, during, or after a patient encounter to correct or refine a single concept. It’s meant to rapidly close a narrow gap in knowledge or technique the moment it becomes relevant. It’s a single objective, and it must be immediately applicable—it can’t be in reference to something occurred on the last shift. It works well for early errors.^3-5

Deliberate practice is another excellent tool. Educators are going to leverage repeated performance of a specific skill, and provide immediate, corrective feedback until a defined performance standard is met. The goal is to build consistency and automaticity for psychomotor skills. Repetition and feedback after every attempt are the two important points to this technique, especially when they are experiencing skill deficits or inconsistent performance.²

Cognitive walkthrough is when someone verbally walks through their thinking process step-by-step while solving a clinical problem. Think of it as if the person is narrating the encounter to you. It’s perfect for exposing reasoning errors or incorrect assumptions and gaps in clinical judgment. Sometimes referred to as think-out-loud process, the concept here is to focus on reasoning, not speed.^2,5 It’s well suited for situations in which someone has poor clinical reasoning or is apt to miss priorities. Ask them to “talk me through how you decided this patient needed CPAP.” Describing what is going on in their mind is often enough to give someone pause and see the rationale for their error.

Scenario replay is a reflection tool used when a clinical error has been made. Performed immediately after a call, it presents a chance to convert a real error into a learning opportunity. You have them re-run a call verbally after to review and to practice improved decisions and actions. Think of it as a pause-reset-reattempt. Ask your trainee, “Let’s run that seizure call again: What will you do differently first?”^2-4

Directed self-study is great for targeted independent learning and is good for filling in foundational gaps in knowledge. You can leverage specific content—for example, local protocols and the references for those protocols—as an assignment to review.  There is an accountability piece here: You will need to ask them to teach it back or explain it to you.⁴ You might say, “Review the RSI protocol and be ready to explain indications tomorrow.” Then have them deliver a short oral presentation and quiz them on key facts. This works great for developing protocol familiarity.

Checklist repetition is along the lines of deliberate practice, where we have someone repeatedly performing a task using a standardized checklist until their performance is consistent. This is a tool right out of Atul Gawande’s Checklist Manifesto. It’s an outstanding tool to reduce variability and omission.⁶ Have someone run through the airway checklist, completely and correctly, three times in a row. Demonstrate or describe the blood transfusion or pacing checklists several times until they can perform it effortlessly. This is a great device for when someone is missing steps in performance or they have sequence errors.

You might use a combination of methods to help remediate someone in the field. You could use deliberate practice with a checklist or combine cognitive walkthrough with teach-back.

Here is a reference you could keep on your phone to help guide you:

Knowing When to Cut Ties 

Sometimes a person isn’t ready for field work. This may mean going back to the training office or termination from employment for not meeting standards. For students who are working through a field internship, every school must have a remediation policy, with guidance for field evaluators to determine when a student needs to come back to the school.

Here is a simple guideline list:

• No improvement after two to three documented remediation cycles
• Deficit spans multiple domains
• Pattern of unsafe performance

This should be developed by the educational institution, but it should be clearly understood by the student or new hire.

Critical Principles

Each tool must be used for its proper purpose. Common pitfalls for field evaluators include using discipline when remediation is needed; ignoring misconduct because the person is clinically strong; failing to document remediation; or letting coaching drag on when a deficit is clear and remediation is clearly needed. Used correctly, these three processes form a continuum of performance management that is fair, defensible, and centered on patient safety. The core principle for the clinical evaluator is that coaching improves performance, remediation corrects deficits, and discipline corrects behavior.

References

1. Gerard, D.R. (2025) The Preceptor’s Tool Belt: Creating Meaningful Field Training for Students and New Hires. EMS World. February 13, 2025. https://www.hmpgloballearningnetwork.com/site/emsworld/feature-story/preceptors-tool-belt-creating-meaningful-field-training-students-and
2. Price, K. M., & Nelson, K. L. (2018). Planning effective instruction: Diversity responsive methods and management. Cengage Learning
3. Gerard, D.R. (2024) Key Communication Points for EMS Preceptors. EMS World. March 4, 2024. https://www.hmpgloballearningnetwork.com/site/emsworld/feature-story/key-communication-points-ems-preceptors
4. Foundations of Education: An EMS Approach, 3rd Edition. National Association of EMS Educators, July 29, 2019.
5. Gerard, D.R. (2020) The One-Minute Preceptor: A Framework for Clinical Education in the Field. EMS World Magazine, March 2020, Issue 3 Volume 49
6. Gawande, A. (2010). The Checklist Manifesto: How to get things right. Metropolitan Books