I am an invasive cardiovascular technology student enrolled at Spokane Community College in Spokane, currently finishing my final twelve-week clinical rotation. I am nearing the end of the invasive cardiovascular technology program directed by Darren Powell, RCIS, FSICP, and felt compelled to write this article as I mulled over the experiences I have had as a student. I had the privilege of conducting two of my four clinicals at Intermountain Medical Center in Murray, Utah. Intermountain Medical Center (IMC) is a state-of-the-art facility with eight cardiac cath labs, operated by a crew of almost fifty. Two of the labs are dedicated to electrophysiology studies and ablations, one is dedicated to pacemakers and lead revisions, and the remainder perform all types of cardiac diagnostic and interventional procedures. I chose to conduct my clinicals at IMC after hearing Dana Grandy, RCIS, speak to the 2009 class about the facility. I heard about the cutting-edge technology, the research they conducted and the work atmosphere. I was also intrigued by the workload volume. As a student, my training time was limited and it was vital to me to get as much exposure as possible to a wide range of procedures. This certainly proved to be the case and I soon found there were other, less tangible, benefits to working at IMC. I had to work at a place like IMC in order to appreciate the impact it has on the students and employees. Keeping in mind the amount of time spent at your workplace, it is imperative to feel welcome. The attitude of any organization starts at the top and is defined by the core values of the organization. At IMC, the attitude is ‘family.’ People are treated with respect and as equals. A significant factor contributing to this attitude is the policy of cross-training all employees to do each job in the lab. One day you may be the scrub, the next day you may be the circulator. Nurses can monitor, radiologic technologists (RTs) can circulate and cardiovascular technologists (CVTs) can give meds. Anyone with sufficient experience can be the charge for the day. This fosters an attitude of equality and cohesiveness that I have only otherwise experienced in the naval nuclear submarine force. As a nuclear-trained electrician in the Navy, I was in charge of electric power generation, distribution and control, but I was cross-trained to step into the shoes of a machinist or electronics technician, and operate the plant as required. In fact to qualify to wear the Silver Dolphins (designating “Qualified in Submarines”), I had to demonstrate superior knowledge of all the submarine systems, with an emphasis on my ability to fulfill the mission at hand. This system evolved over the years as a way of ensuring submarine safety. Anyone familiar with the safety record of the U.S. Navy submarine force can attest to the wisdom of this philosophy. So it is a natural progression to apply these same principles to patient safety, as stated in the Intermountain Mission Statement: “Excellent service to our patients, customers, and physicians is our most important consideration.” IMC’s commitment to research and training was also very attractive. They are involved with the PARTNER trial (Edwards Lifesciences, Irvine, CA) exploring percutaneous transcatheter aortic valve repair, the MitraClip (Abbott Vascular, Redwood City, CA) catheter-based delivery of a mitral valve repair clip for mitral regurgitation, and the Watchman left atrial appendage occluder device (Atritech, Inc, Minneapolis, MN). IMC’s commitment to training is reflected in their appointment of a student services coordinator to help ensure the smooth transition of the students into and out of the facility as their training curriculum requires. As students, we are tasked with completing 800 clinical hours. I am in the final quarter, completing my final 400 hours. I have been both a student and an instructor at different times in my life, and I have often wondered what other trained technologists experience as they interact with students who are at various levels of competency. This article also reflects my thoughts concerning what a student goes through to reach the goal of “graduate,” and what the teachers, preceptors and mentors experience as well. I will therefore attempt to present some observations and encouragement for students, and also, hopefully, some suggestions and feedback for the “already there” side of the equation. For me it has been a long road. I am in what is now referred to as an “encore career.” I can say that juggling a full-time job, attending school, and being a father while building a house from scratch has created opportunities for me to tap into resources I didn’t know I possessed. I am sure the road to RCIS qualification is a different journey for everyone, but there are some experiences we all have in common. I have met very few classmates in my career that didn’t have the will to succeed. Those that did not have the will to succeed didn’t last very long in the program. We all would like to be noticed and of course, we all endeavor to achieve our personal best. Let us remind ourselves that most of us have had to fight our way through waiting lists and prerequisite courses just to get here. Some of us have had to go begging for financial aid or obligate ourselves to student loans. Many have had to work at least part time while attending school, and some, like me, have had to rely on some combination of all these to continue our education. This kind of dedication is itself cause for celebration. We all have our reasons for wanting to excel or to at least make our situation better economically and professionally. I think it is safe to say we are all better than average. Back to the students. Here we are, in our clinical. For some of us, this is our first experience and we are more than a little nervous. What is expected of me? What if I fail? What if they ask me something I don’t know? What is a sheath? Which end of a “J” wire goes in first? Relax! Let’s take it all in a little at a time. I’d like to start by suggesting that students try looking at a student from the preceptor’s and or the certified technologist’s perspective first. Most of us have spent a fair amount of time in an academic setting prior to clinical and thus have become used to teachers and situations that are designed around meeting our educational/vocational needs. Our first step is to accept that while we are here to learn, in a hospital setting, we are no longer the first priority. In other words, it isn’t “all about us” anymore. Both the lab and ourselves as students would be better served if we accept that the lab’s primary goal is patient care and safety. We as students are secondary to those needs and in some cases, can be a liability, too. Let me illustrate by sharing the following anecdote. During the summer quarter after my first year, I was participating in a three-week clinical at IMC. I was helping to prep a patient on the cath lab table by hooking up the ECG leads, pulse oximeter and the like. The patient had been draped and the scrub tech was hooking up the pressure monitoring and flush lines. I was trying to put a nasal cannula on the patient and in order to have my hands free to rearrange the pillow, I tossed the nasal cannula line, still in its package, onto the sterile drape at the patient’s chest level! I did this without thinking. Needless to say, the tech looked at me in complete surprise. I will never forget the look of alarm and shock on her face, nor will I ever forget her words: “What did you just do?” Luckily this was a simple fix, but the point is that as students, we just don’t always have the same level of awareness concerning sterile technique that we should have. It is indeed by the good graces of the lab director, the lab supervisor and our preceptor that we are allowed to participate. An attitude of humility and gratitude would help us keep things in perspective. Remember that humility is not thinking less of yourself, but thinking of yourself less. I make it a point to express my appreciation and gratitude to each individual who has allowed me to scrub in, monitor or circulate with them. I try to honor their effort by listening carefully to their feedback and criticism. I don’t take it personally. Remember, your mentors are critiquing your job performance, not you personally! As a student just starting clinicals, I would suggest sitting down with your preceptor and writing down a set of clear goals and expectations both of you may have for your experience. Write down a timeline that lists what skills and abilities you should be able to demonstrate and when you should reach each goal. Be willing to ask for feedback from the technologists and nurses with whom you scrub. Accept their feedback and criticism with professionalism. I try to write down the important points of each discussion. Our impression of how well we are doing can sometimes be way off the mark. We are better served if we are willing to defer to expert advice. If there is a skill I need to practice, I will get back to the person who pointed it out to me and let them know how I am doing with it and solicit ongoing feedback. In my clinical site, I scrub with several different people. All of them are very well qualified and competent, but they do have different ways of doing their job. Sometimes this can be a little frustrating for a new person, but remember that some techniques will work for you and some won’t. I am actually grateful to have several teachers because I am exposed to more experience. My feedback to the qualified technologists: Try to remember that the student/teacher experience works both ways. I have found that nothing helps me cement my knowledge about a subject better than when I am forced to teach it. I had the privilege of working in a nuclear shipyard teaching newly hired engineers how submarine systems work. I found gaping holes in my knowledge and had to fill them in fast! When someone asked me a question to which I didn’t have an answer, I saw it as an opportunity to expand my knowledge. When I am teaching or guiding someone in a new skill, I try to remember how I felt when I was the new person. As the student, my nervousness, my desire to perform well and my lack of skill are always on my mind. Sometimes it seems that one day I have a technique mastered, and the next day I am all thumbs and have to be reminded of everything. Patience for everyone is the watchword here. For the teacher/technologist, the payoff is that their hard work and years of experience, the mistakes they have made in the past and all the lessons they have learned get to be passed on. I like to believe that when I am finally the senior technologist, perhaps a student I have taught may someday be able to return the favor and keep me from making a poor choice. I spent nine years on nuclear submarines as an electrician. Lack of experience while operating sixty-nine hundred tons of steel under the ocean can quickly get everyone killed or injured. When I trained a new technician, I always stressed safety. In fact, the whole training program of the nuclear navy was based on the premise that if you knew not just what your equipment and everyone else’s did, but also had an in-depth understanding of why and how it did its job, you would be in a much better position to recognize when something wasn’t working correctly. Students should be willing to set the bar high for themselves. I have to give credit to Peter and Dr. Cheri Zao for teaching me this. They are the directors of the anatomy and physiology courses at North Idaho College in Coeur d’ Alene, Idaho. Their absolute insistence on setting a high standard for academic excellence gave me the initiative to work harder and I found I was willing to put in the extra effort to excel. I was fortunate to attend my second year, first quarter clinical at Kootenai Medical Center (KMC) in Coeur d’ Alene, Idaho, where Tiffany Beck, RCIS, Anthony Morgado, RCIS, and Nick Hare, RCIS, were also willing to ask more of me as a student, and I stepped up and did my best. I remember thanking Tiffany for taking the time to talk about her experiences as we worked and her reply that she didn’t think she made such a good teacher. But indeed her teaching style allowed me to feel comfortable asking questions, which allowed me to relax and learn better. The result was a more effective learning experience. Anthony was a wealth of knowledge, especially concerning groin management. He taught me to respect the Angio-Seal (St. Jude Medical, Minnetonka, MN), a wonderful closure device, but like all closure devices, still subject to hematoma and its adjacent risks. Nick “threw me to the dogs,” but in a way that allowed me to shape up or ship out. His willingness to sit down with me privately in the lab and let me know, “You’re not getting it and I need more from you, fast,” was appreciated, although maybe slightly after the fact! Ronald Jenkins, MD, was one of the cardiologists at KMC. A very busy man and yet was more than happy to allow me to scrub in with him under the supervision of these three technologists. His teaching manner was friendly and direct, and very much appreciated. It is my sincere hope that both students and teachers alike who are reading this will take what works for them and have a better understanding of what impact their actions have on the lives and careers of others. Good luck to all of you. Reprinted with permission from Cath Lab Digest 2010;18:42.