By Lyndal Bolton, Associate Lecturer, WPL Subject Convenor, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University

Alisha McFarlane, Australasian College of Paramedicine Member Engagement Manager, Lecturer in Paramedicine, CSU

Dane Rickwood, Associate Lecturer in Paramedicine, CSU, registered paramedic

'The interprofessional model is critical in preparing students to enter the health workforce, where teamwork and collaboration are vital.'

Paramedics play a critical role in the delivery of healthcare and in emergency service sectors around the world as primary healthcare providers. The demand for ambulance services in Australia has soared in recent decades and the paramedic workforce has grown significantly. At the same time, the nature of our work has been recast to encompass a broader range of clinical interventions and treatment options besides transporting the patient to hospital (1,2). As the profession continues to evolve, so too must pedagogy to ensure the changing demands of graduate paramedic practice are met, and the delivery of optimal healthcare by paramedics in our communities is maintained.

In the dynamic realm of healthcare, innovation often emerges from smaller, collaborative projects between academic institutions and allied healthcare providers. An example of this is the partnership between Charles Sturt University (CSU) and NSW’s Mid North Coast Local Health District (MNCLHD), which has given rise to a transformative initiative - facilitated paramedicine allied health placements.

While facilitated placements may not be an entirely new concept, this project allows students to follow the patient’s journey through the health system while assessing a variety of patient presentations in diverse clinical environments. It is hoped that this approach will develop their knowledge of their allied health partners and the wider health system. This approach has been developed to address the dual challenges of sector-wide shortages of paramedicine ambulance placements and increasing scope of paramedicine practice beyond patient transport and emergency presentations.

The National Priorities and Industry Linkage Fund (NPILF) is a component of the federal government’s job-ready graduates package offering financial support to universities to foster increased collaboration between academic institutions and industry. This project has been funded and supported to increase the

number of internships, practicums, and other innovative approaches to work-integrated learning. Further, it is designed to improve student employment outcomes and support universities to develop and strengthen partnerships with industry.

In this work-integrated learning (WIL) model, paramedicine students undertake a four-week placement block in a hospital and follow the patient journey in its entirety, from the initial presentation through to discharge. Students are allocated in pairs to promote peer-assisted learning and debrief throughout their WIL placement and to provide opportunistic support in an unfamiliar environment. This immersive learning experience is guided and supervised by registered professionals who specialise in specific areas of healthcare, ensuring that students gain practical insights and skills aligned with the diverse challenges they may encounter in their future roles as paramedics.

Supervisors include registered nurses, mental health specialists, occupational therapists, medical doctors, psychologists, radiographers, anaesthetists, and midwives, allowing exposure to a broader scope of practice. Areas of rotation includes, but is not limited to, the paediatric ward, intensive care unit, cardiac catheter lab, the emergency department, community health, radiology, physiotherapy, and surgical theatres. Given current placement shortages and the expansion of the paramedicine scope of practice, this interprofessional allied health placement is highly valuable and needs to be efficiently coordinated and effectively utilised.

In these health service settings, preceptors can foster the growth of students’ understanding of a range of clinical practice areas and support their initiative and development of critical thinking skills. Importantly, the interprofessional allied health placement does not come from a deficit placement model; rather, it is a deliberate and innovative strategy to place paramedicine students in meaningful workplace contexts that will foster the development of a broad range of practice knowledge and skills. The interprofessional model is critical in preparing students to enter the health workforce, where teamwork and collaboration are vital in facilitating strategic goals to produce job-ready graduates and achieve positive patient outcomes.

Interprofessional learning is an essential aspect of education for healthcare professionals and is defined by the World Health Organisation (WHO) Framework for Action on Interprofessional Education and Collaborative Practice (2010) (3) as “when two or more professionals learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional learning enhances communication skills, fosters collaboration and teamwork, and promotes a better understanding of the unique roles, responsibilities, and contributions of each profession. It is a critical requirement in addressing complex healthcare issues, enabling professionals to provide patient-centred care. Work-integrated interprofessional learning should therefore be an integral part of paramedic education. Interprofessional health placements provide purposeful, authentic learning in environments where students learn from professionals in their area of expertise and specialists within their field. Real-world experiences provide many developmental learning opportunities and are shown to be productive and beneficial for students. An extensive qualitative review of experiences of learning, development, and preparedness for clinical practice among both student and graduate/intern paramedics identified these themes regarding facilitated models (4).

Along with the many benefits of the facilitated model, both participants and Paramedic Educators identified that learning from a clinical educator in allied health settings, where established systems of education and mentorship exist, significantly improved the quality of teaching and learning (4).

To extend the facilitated model, the placement is supported by planned debriefing and discussion time, in which the clinical facilitator provides real-time feedback in a small group setting (four to six students). Learning circles harmonise the power of peer and expert-led learning, allowing deliberate focus on the hidden curriculum, including social interaction, deeper reflections, ethical perspectives, and further development of critical thinking (5,6).

These rostered debriefing sessions are emphasised to give students an authentic opportunity to practice the skills of reflection and debriefing that are not often afforded during busy ambulance placements. Students are also supported by a Placement Champion (registered paramedic) who monitors their progress and provides discipline-specific feedback and application to paramedic professional capabilities.

The benefits of assigning students to facilitated placements in groups is widely documented across other health disciplines and has been suggested for exploration as a model in paramedicine4-6. Peer learning, underpinned by social constructivist learning theorists Vygotsky and Piaget, leverages our understanding that learning is best constructed in collaboration with significant others, and that social interaction is integral to developing understanding, knowledge, and cognition (7,8).

Peer learning is not a new concept; however, in medical education literature its contribution to positive student experiences by decreasing stress and anxiety, mitigating challenges, enhancing clinical knowledge, and prompting deeper clinical reasoning by mutually solving problems has been acknowledged5, 6. Working in pairs or groups stimulates the development of new schemas to navigate similar situations or new challenges in the future, enhancing the safety of their patient care (9).

References

1 Townsend R. The role of the law in the professionalisation of paramedicine in Australia [Doctoral Thesis]: The Australian National University; 2017.

2 Chan J, Griffith LE, Costa AP, Leyenaar MS, Agarwal G. Community paramedicine: A systematic review of program descriptions and training. CJEM. 2019; 21(6): 749-61 pp. Available from: https://www.cambridge.org/core/product/93575DE28A2ADE61103459B72F8E2207.

3 World Health Organization. Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization; 2010. Available from: http://apps.who.int/iris/handle/10665/70185.

4 Hanna H, Jordan Z, Stern C, Pearce J. Experiences of learning, development, and preparedness for clinical practice among undergraduate paramedicine students, graduate/intern paramedics, and their preceptors: a qualitative systematic review. JBI Evidence Synthesis. 2021; 19(9). Available from: https://journals.lww.com/jbisrir/fulltext/2021/09000/experiences_of_learning,_development,_and.3.aspx.

5 Markowski M, Bower H, Essex R, Yearley C. Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature. Journal of Clinical Nursing. 2021; 30(11-12): 1519-41 pp. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.15661.

6 Jassim T, Carlson E, Bengtsson M. Preceptors’ and nursing students’ experiences of using peer learning in primary healthcare settings: a qualitative study. BMC Nursing. 2022; 21(1): 66 p. Available from: https://doi.org/10.1186/s12912-022-00844-y.

7 Akpan B, Kennedy TJ. Science Education in Theory and Practice An Introductory Guide to Learning Theory. 1st 2020. ed. Cham: Springer International Publishing; 2020.

8 Mcleod S. Lev Vygotsky’s sociocultural theory of cognitive development 2023. Available from: https://www.simplypsychology.org/vygotsky.html

9 Nagraj S, Harrison J, Hill L, Bowker L, Lindqvist S. Promoting collaboration in emergency medicine. The Clinical Teacher. 2018;15(6):500-5.