A pilot international exchange programme for paramedic students

Expectations

The following extracts are from applications submitted by the two successful exchange participants, and demonstrate their aspirations for academic success, and their expectations for the programme:

Evidently, the students’ expectations, anticipation and excitement were all intertwined. The ability to experience international academic study, gain large amounts of clinical experience, and develop an understanding of ambulance practice in another country, combined with the UK’s accessibility to Europe, was highly attractive.

The possibility of gaining overseas travel experience was particularly alluring, with one of the participants already a passionate traveller, and the other possessing significant desire to travel, yet also wanting to complete their academic studies. This exchange programme allowed for both.

Preparations

Given that this was a new initiative, the period between the selection of applicants and the commencement of the first semester in the UK was approximately two months. This posed one of the first challenges for the students in navigating the exchange process.

The limited time provided to prepare and obtain adequate documentation proved difficult. The students had to fulfil a number of requirements to ensure they were eligible for the exchange. This included the need to gain the United Kingdom Tier 4 (General) student visa at a cost of £289 (Home Office: UK Border Agency, 2013a). Applicants are required to provide evidence of adequate funds to support living costs, which equated to £800 a month, a total of approximately £8000 for the duration of the course (Home Office: UK Border Agency, 2013b). Attendance at the British Consulate in Melbourne was required for biometric enrolment, including finger printing, iris scanning and digital photo identification. Once the letters of acceptance from the University of Hertfordshire were finalised the students were able to apply for student visas. Passports were sent off for visa processing in Canberra, which was concerning for the students and the academic staff, as the passports were not guaranteed to return before the planned departure date.

Travel and living expenses were a major challenge, and this may prove to be an issue for other participants, particularly where supportive parents or relatives may not be in a financial position to assist. For the students, the financial difficulties surrounding the programme became an ongoing concern. This included the cost of student accommodation at the University of Hertfordshire, which exceeded accommodation expenses in Australia.

Local students in the UK are able to cover some of these costs through the Student Finance system, which is a system of loans used for both tuition and living expenses. The maximum maintenance loan ranges from £4 375–7 675 GBP per year (Student Finance England, 2013) based on whether or not students are still living with their parents/guardians and where geographically they are going to live, with the higher rates only being applicable to those living in London. This kind of loan is generally not available to students studying in Australia, although some are eligible for limited support through Youth Allowance and Austudy, which is means tested according to income (including parents’ income), level of independence and study load (Department of Human Services, 2013).

Reflections

The development of this exchange programme highlighted unique aspects of ambulance service delivery in different countries, and therefore became a significant strength of the exchange for both the students participating, and the students learning alongside them. The concept of the ‘paramedic’ has been undoubtedly expanded. The term, what it defines and the connotations associated with it are varied from country to country. This was emphasised in both class discussions and individual conversations, particularly regarding the topic of professional registration, which did not exist in Australia at the time, and paramedic education.

The opportunity to be immersed in a different health system was also extremely beneficial. The students were able to review and understand pathways of care, service provision and paramedic practice in contrast to the Australian system. By being immersed into UK ambulance practice, observing alternative ways of working, different protocols and varying professional approaches to the job, it was possible for the students to question their understanding of best practice, and the concept of professionalism. Hence, greater understanding of professional identity was achieved. The students learnt about paramedic practice beyond the familiar roles in their home country, and developed friendships and contacts within the local and international industry, leading to a greater degree of information sharing across both the countries and services.

From an Australian student perspective, the increased amount of clinical placement hours, as well as time in operating theatres, proved extremely beneficial in developing theoretical knowledge, practical skills and confidence. The emphasis on practical skills in the UK system was a significant benefit and complemented the increased amount of theoretical learning from the home university.

The students believe that clinically, the greatest benefit of the exchange was the consolidation of practical skills. After their time in the UK, they felt their ability to assess, treat and manage patients was at a higher standard than before they left, and is most likely more advanced than it would have been if they did not complete the exchange. The increased level of experience is due to the large block of practice placements, as well as the structure of the learning modules at the University of Hertfordshire. The units focused around paramedics skills and patient assessment, leading to a greater competency and confidence in managing unwell patients.

Personally, the students found being placed at the university amongst a tight-knit student group allowed them the opportunity to become a part of the student paramedic culture and meet lifelong friends and international colleagues.

However, limitations and frustrations of the student exchange also became evident over time. These included the overlapping of theoretical knowledge that had previously been taught and assessed at university in Australia, particularly the research and pathophysiology units. Students also began to recognise that some of the learning undertaken in the UK may be irrelevant to their practice in Australia, and as a result became frustrated learning specific skill sets that may not be relevant in the students’ local practice setting. Admittedly, the basis of paramedic practice is similar in both countries. However, as learning outcomes become more specific, they became more unrelated to practice within another country. As such, it is important that students on exchange continue to study the protocols or practice guidelines utilised in their home country alongside those being used in the country of exchange.

The students found regular contact with an academic supervisor vital in making the transition into a new learning environment. Regular meetings with the supervisor ensured that any issues with the exchange were addressed promptly. This also created a good feedback system on student learning, and offered an outside perspective on the course content and delivery.

The exchange students found it fascinating to compare the concerns of students studying paramedic science in the UK with the paramedic students within Australia. This was recognised as a major benefit of the exchange programme in terms of feedback to the academic leaders. As paramedic education is relatively new to higher education, it is clear that issues will continue to arise that require management by the academic leaders. With students being aware of the teaching and learning priorities of both courses, they were able to provide advice regarding strategies that may support the educational needs of future students. When integrated within a formal benchmarking process, this insight provides opportunities to strengthen the courses and academic departments involved in similar exchanges.

Further to this, the exchange students were also able to share information and experiences with paramedics during clinical placements. Interestingly, paramedics in both countries shared similar concerns about their work environments, for example the focus on performance indicators such as response times. The challenges associated with the clinical supervision of university students in the workplace was also a recurring theme arising from these conversations, as this role was associated with different responsibilities than those of the alternative model of technical education where the student is an employee.

Finally, the international exchange has given the students involved an ability to talk with experience, knowledge and familiarity of another emergency service and health system. This experience provided a greater understanding of the challenges facing the delivery of health services, and highlighted opportunities to influence and facilitate alternative approaches to practice in the home country.

Recommendations

There appears to be considerable benefits associated with this type of exchange programme. However, problems inevitably arise when attempting to develop and implement international exchange programmes. Following the exchange experience, there are a number of recommendations that can be made for both the UK and Australian systems of paramedic education, as well as recommendations that could also assist in ensuring this exchange, and others in the future, are viable.

The consequences of exchange students failing study units/modules is of concern, especially considering the potentially limited time available to re-sit assessments within the university year. This was an issue for one of the students participating in the exchange, with an exam reassessment required with only a week left before leaving the country. This stressful situation was accentuated by the possibility that a second failure could result in failure of the whole year-long exchange. Alternative assessment options or contingency plans should be developed in order to address this prospect, such as opportunities for reassessment at the student's home institution.

Paramedics in Melbourne can feel challenged and poorly prepared to supervise undergraduate students (Wray and McCall, 2009), and to a lesser degree there was some evidence of this in London. One of the most notable differences was the Practice Placement Educator system in the UK, which was implemented by the London Ambulance Service to provide support for university students undertaking clinical placements with the service (Fayers and Bates, 2011). This scheme has no parallel in the students’ home state of Victoria. The implementation of the Practice Placement Educator appears to offer significant benefits in supporting student learning in the workplace.

An additional benefit of integrating an international exchange within a pre-registration/qualification programme is the opportunity this offers to share experiences of commonalities as well as differences between the two countries, both in education and professional practice. This is particularly pertinent in the ongoing construction of a universal concept of what it means to be a paramedic.