Paramedic framework for learning and assessment

Identifying approaches to practice education for paramedics continues to be an ongoing challenge. Appropriate tools for clinical educators/mentors and students alike should arguably reflect what paramedics actually do. The framework discussed within this comment article is grounded in previous research undertaken at the University of Oxford, Department of Education (Freeman-May, 2012).

The research employed in-depth interviews following recalled incidents to generate data from which deductions were made about the underlying capabilities and guiding principles of the work of experienced paramedics. Interviews were supplemented by a questionnaire and data were analysed using a range of theoretical lenses, such as practice theory. The findings from this work suggested that responding to a call can be described as following a sequential series of key activities that, in practice, merge into each other, often in an iterative way: information-gathering, managing situations and people, and treating patients. Such a description leads to an identification of expertise used in the early stages of responding to a call; for example, reducing and managing ambiguity through the use of situated knowledge to generate tentative hypotheses about the nature of the call and developing initial plans for action (Greeno, 1998). Such hypotheses are left open and modifiable in the light of new information actively sought by the expert practitioner and are guided by capabilities such as communication, planning and organising, problem-solving and decision-making, and learning from experience. Additionally, expert paramedic practice is characterised by high levels of resilience, flexibility and the patience to leave plans incomplete for further development in the heat of practice. The findings therefore characterise the expertise underpinning the work of experienced paramedics in a way that transcends attempts to describe paramedic practice through lists of skills, knowledge or competencies. In so doing, the work contributes to the evidence base about the knowledge and skill used by paramedics in practice, and how and where this is developed. It also provides a framework for learning and assessment which resonates with what paramedics do when responding to emergency calls.