Clinical Internship Rotations Policies & Procedures

Introduction:

The purpose of the clinical internship rotation is to solidify and apply the course didactic and laboratory training through direct patient care under the direct supervision of a designated preceptor. Students will be exposed to a wide variety of medical and trauma patients ranging from the routine to the complex. During the clinical internship students shall follow the direction of their designated preceptor. At no time shall a student perform any skill outside their scope of training or without direct supervision of their preceptor. During clinical rotations students must keep in mind that while your preceptors are there to assist and educate you their FIRST and PRIMARY responsibility is to provide patient care. Please remember that from time to time situations may arise that your preceptor may not be able to involve you or answer your questions immediately. If or when these situations occur follow your preceptor’s instructions and do not interfere. Your questions will be answered at the appropriate time.A majority of the preceptors you will encounter during your internship have worked closely with CMTI and their students to help provide the best clinical internship experience possible.

Clinical Internship Rotations:

Paramedic students entering the clinical rotation phase of the program will be assigned their clinical rotations by the CMTI Clinical Coordinator. Clinical rotations will involve assignments to various hospitals and medical facilities. The rotations include clinical time in the Emergency Room, Intravenous Therapy, Operating Room, Coronary Care and Intensive Care Units, Pediatrics, Labor and Delivery, and Psychiatric Resource Facilities.
During clinical rotations, the paramedic intern will be assigned a preceptor (physician, nurse, paramedic, specialist /technician), at each clinical rotation site. The preceptor will directly observe and supervise the student during the performance of their skills.

In accordance with OEMS A/R 2-305 (Appendix – B – in your log book) and CMTI requirements all students must complete 100% of the clinical rotation requirements in order to proceed to the field internship phase of the program.

Scheduling of Clinical Time:

Scheduling of clinical rotation shifts will be through the CMTI Clinical Coordinator. Students shall follow their assigned shift schedule only. No student is allowed to schedule their own shift with a clinical site or to show up to a clinical site for a shift they have not been assigned to. In the event a student is unable to make their assigned shift they shall notify the Clinical Coordinator as soon as possible to reschedule the shift. If a student must cancel a shift with less than 24 hours notice or will be late arriving to an assigned shift the student must notify the Clinical Coordinator immediately and also notify the clinical site’s Charge Nurse or Preceptor. Repeated cancellations or late arrivals to clinical shifts may result in a student’s removal from the program.

Confidentiality:

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that took effect in April 2003. The law provides for the protection of personal health information (PHI) of all patients. During the course of the clinical internship rotation students will be exposed to some of the patient’s personal healthinformation. Students are to remember this information is protected and shall never be given out to any unauthorized persons or entities. Students shall follow the HIPAA policies and guidelines of each clinical and field site. Failure to follow these policies and guidelines or the release of any patient’s PHI to any unauthorized persons or entities will result in the student’s removal from the program.

Professional Behavior:

All CMTI students are to conduct themselves in a professional manner during clinical rotations. Students shall not vacate their assigned positions without the permission of the hospital Charge Nurse, Preceptor or CMTI Clinical Coordinator. Failure to follow this policy can result in the student’s removal from the program. Students must remember that they are representing CMTI and any behavioral problems during the clinical setting will not be tolerated.

Examples of unacceptable behavior include:

  • Sexual harassment
  • Stealing
  • Disrespectful or argumentative behavior toward patients or hospital staff
  • Intoxicated during rotation
  • Excessive tardiness or absence
  • Sociably unacceptable behavior
  • Inappropriate use of cell phones (IE: In front of or during evaluation of a patient ) Students shall follow each clinical site’s policy regarding cell phone use

Clinical Attire:

The following clothing shall be worn by all CMTI students during their clinical rotations:

  • Black CMTI golf shirt with approved logo
  • Black shoes
  • Name tag with picture ID
  • Khaki or Navy Blue EMS pants
  • Stethoscope

Failure to follow this policy may result in the student being removed from the site

Personal Hygiene:

All students attending/representing CMTI during their clinical rotations will maintain an acceptable appearance. Student’s hair shall be clean and must be secured back for long hair that is shoulder length or longer. Male students shall be clean shaven or maintain their beard/mustache in a neat/clean fashion. Jewelry that may pose a risk, such as neck chains and long earrings will not be permitted in any clinical rotation. Facial piercings are not allowed in the clinical setting. Students may not wear Cologne or perfume during clinical rotations. Failure to follow this policy may result in the student being removed from the site.

Universal Precautions:

During the clinical internship rotation students will be at risk of exposure to blood borne pathogens and infectious diseases. Students are to remember to take proper body substance isolations (BSI) and don the necessary/required personal protective equipment (PPE) during all patient contacts. Students shall follow each clinical site’s universal precautions policies and procedures.

Examples of PPE include:

  • Gloves
  • Gowns
  • Mask
  • Eye Protection
  • Hand Washing

Unprotected Exposures:

Any student who experiences an unprotected exposure shall immediately report the incident to their designated preceptor or their supervisor. Students shall follow the clinical site’s decontamination procedures and complete the site’s required exposure reporting procedures. Students shall also report the incident to CMTI’s Clinical Coordinator and/or Program Director.

Examples of unprotected exposures include:

  • Needle Stick
  • Exposure to infectious disease
  • Unprotected exposure to blood, vomit, body fluids
  • Body fluid splash in eyes or mouth

Documentation:

Students are responsible for completing their clinical documentation completely and accurately. Students shall complete the documentation as outlined in the Clinical Internship Rotation Requirements and the Clinical Skill Log book. Students must also complete the electronic clinical skills log for each patient encounter and skill performed. Upon completion of the clinical internship the student shall turn their skill log book into the CMTI Clinical Coordinator or Program Director to be reviewed for completeness and accuracy. All entries must be legible and entered in black ink. Illegible entries may be discarded. All required information must be entered and each skill must be signed off by your designated preceptor. Any mistakes in an entry shall be corrected by drawing a single line through the entry and initialing it. The corrected entry shall be entered into a separate line/space. All time entries shall be in the military time format (IE: 9:00 am = 0900 - 1:00pm = 1300 hrs)

Clinical Hours and Skills Requirements:

Clinical Rotation Hours per Department:

Department Minimum Hours

Emergency Department 110

Psychiatric Unit 30

Obstetrical Unit – ( no minimum hours – must achieve 3 live births) N/A

Pediatric Unit 30

Coronary Care / Intensive Care Unit 40

Surgical Unit – (OR) 20

Elective 40

  • Elective hours are to be used in departments/ areas the student may need to fulfill their clinical requirements or to gain more experience or a better understanding in a particular department/area.

Total Hours 270

During the clinical rotation phase of the program each CMTI student must complete the following minimum number of skills as outlined in OEMS A/R 2-305 (attached to log book) and CMTI requirements. All skills must be observed and supervised by the student’s assigned preceptor. All skills and shift assignments must be documented, per the requirements, in the CMTI Clinical Skills Log Book and signed off by the preceptor observing and supervising the skill. Failure to properly document the skill will result in a “no credit” situation and the skill will have to be repeated. Students must also document this information in the electronic CMTI Clinical Skills Log. Remember that these are the minimum number of skills. Students are expected and encouraged to perform more than the minimum number of skills. Students are to remember that all patient contacts are confidential and fall under HIPAA regulations. Student shall follow the clinical sites HIPAA policies and procedures.

Patient Assessment – Adult (age 17 or older) (50)

Patient Assessment – Geriatric (age 65 or older) (30)

Patient Assessment – Pediatric (12)

(minimum must include (2) of each pediatric sub set)

Newborn – (0 to 1 month)

Infant – (1 month – 1 year)

Toddler – (1 – 3 years)

Preschool – (3 – 6 years)

School age – ( 6 – 12 years)

Adolescent – (12 – 18 years)

Patient Assessment – Psychiatric (10)

Obstetrical Delivery (live births) (3)

Intravenous Cannulation (30)

IV Bolus Medications (15)

IV Infusion Medications (10)

Miscellaneous Medications (5)

Cardiac EKG Recognition (20)

Electrical Therapy Skills ** (skill combination) (10)

** Electrical Therapy Skills: If the student is unable to perform the minimum of 10 in the clinical setting they may satisfy this requirement by successfully demonstrating the skill(s) in the lab setting in front of the Medical and/or Program Director.

Airway Interventions (50)

** This skill category requires successful performance of a minimum of 50 airway management skills, with 100% success rate in the last 20 attempts at airway management across all age categories (neonate, infant, pediatric and adult). Airway management may be accomplished utilizing any combination of live patients, high fidelity simulations, low fidelity simulations, or cadaver lab. It is recommended that the majority of attempts be accomplished by using live patients. Realistic simulation labs may be used if this skill is unable to be completed on live patients in the clinical setting. This skill will be performed in front of the Medical and/or Program Director

See OEMR A/R 2-305 (Appendix – B) for additional information.

Assessments:

In addition to the above listed patient assessments skills students must assess and develop a treatment plan for the following:

Trauma Patients: (10)

Medical Patients (35) to include:

Chest Pain (10)

Respiratory (10)

Syncope (10)

Abdominal Pain(5)

Eligibility to Participate in Clinical Internship:

As outlined in the Office of Emergency Medical Service’s Administrative Requirement A/R 2-305 (attached to log book) and CMTI requirements the prerequisites for students to participate in the clinical internship include:

  • Maintaining current Massachusetts and/or National Registry EMT-B or EMT-I /EMT-A certification
  • Maintaining current American Heart Association Basic Life Support- Health Care Provider certification
  • Maintaining current American Heart Association Advanced Cardiac Life Support certification
  • Maintaining current American Heart Association Pediatric Advanced Life Support certification
  • Successful completion of all required education and training prerequisites of the paramedic course
  • Authorization from the Program Director and/or Clinical Coordinator to enter the clinical internship
  • Proof of and maintaining of liability/malpractice insurance
  • Submittal of required immunization documentation

Liability/Malpractice Insurance:

Students will be required to provide proof of liability/malpractice insurance prior to the start of clinical internship rotations. Students will be responsible for providing and maintaining their own liability/malpractice insurance throughout the duration of their clinical rotations. Lapse or loss of liability/malpractice insurance will result in the student’s immediate removal from clinical rotations.

Student Health Requirements:

Comprehensive Medical Teaching Institute is committed to providing a safe environment for patients, staff, visitors, and students. Due to the nature of the environment, any student entering the clinical internship rotation phase of the program must have the required immunizations to protect the health and safety of the student, patients and clinical site staff.

All students shall maintain health insurance during their clinical internship rotation. Prior to the start ofthe clinicalinternship students are required to present evidence of the following immunizations:

  • TB test: Must be a Mantoux (PPD) within six (6) months prior to the start of the first clinical rotation
  • Rubella (measles and German measles): proof of immunity may be documented by:
  • A positive titer to Rubella and a positive titer to Rubella
  • Proof of two (2) immunizations to Rubella or MMR, and proof of immunization to Rubella or MMR vaccine
  • Hepatitis B vaccination
  • Students who have not had chicken pox must notify the Course Director and/ or the Clinical Coordinator
  • Flu shot

Drug Screening Policy:

At this time CMTI does not require students to submit to a drug screening test for entry into the clinical internship. CMTI does reserve the right to require a drug screening, for any student, due to any reasonable suspicion or allegation of drug use.

Students may be subject to a drug screening at any clinical internship site in accordance with their

policies/procedures and requirements.

Clinical Site Conflicts:

Any conflicts that arise at a clinical site during your internship shall be reported to the CMTI Clinical Coordinator and/or Program Director for resolution. At no time shall a student engage in a debate with their preceptor, doctor, nurse or other site staff. Any opinions or concerns regarding site staff, policies or procedures should be directed to the Clinical Coordinator. Students who engage in a debate/ argument with site staff will be subject to removal from the clinical site and possible removal from the program.