This article describes the design, development and purpose behind a new undergraduate part-time programme from the University of Hertfordshire, the BSc (Hons) in applied paramedic science. In attending the programme, paramedics with or without prior experience of higher education have the opportunity to undertake continuing professional development activities, which advance their clinical skills and knowledge. Several exit opportunities, with an academic award are possible; such as a Diploma in applied paramedic science following a minimum of nine months taught academic study. Education is delivered through a blended-learning strategy, using innovative e-learning activities and focused campus attendances, teaching in specialist facilities developing advanced clinical abilities.
Background
The University of Hertfordshire (UH) was one of the first higher education institutions to offer higher education degrees for paramedics, with the first undergraduate students graduating in 2001. Since then, a range of innovative and successful paramedic science programmes have been developed including: undergraduate foundation and BSc (Hons) degrees; postgraduate specialist courses for emergency care practitioners (paramedic practitioner) and critical care paramedics.
The university runs a successful MSc degree programme which is proving popular with paramedics from a variety of trusts. Since 1996, the UH has provided a part-time post-registration degree for paramedics continuing professional development (CPD)—this has been attended by students from South Central, East of England and London Ambulance Service NHS Trusts. The BSc (Hons) applied paramedic science is an innovative, clinically focused replacement designed to address paramedics’ continuing professional development requirements.
Development process
In developing the new programme, we involved previous students and a variety of Ambulance NHS Trusts to ensure it accurately reflected the current scope of paramedic practice while simultaneously providing a broad educational basis for paramedics clinical developmental requirements. It was established that any new programme should reflect contemporary paramedical clinical practice, have a flexible delivery method and equip graduates with the knowledge, skills and attributes to meet and respond to contemporary and future practice challenges. The Health Professions Council (HPC), paramedics regulatory organization, specifically identifies formal education programmes as one mechanism to undertake CPD (HPC, 2011).
Paramedics’ professional body, the College of Paramedics, curriculum framework (College of Paramedics, 2008) further identifies higher education as the preferred professional development route for paramedics. Taking Healthcare to the Patient II (Association of Chief Ambulance Officers, 2011) identifies that diploma-level qualifications will be the future threshold for entry to professional registration for paramedics. Developmental opportunities through educational programmes will further support the evolution of paramedics changing their clinical practice role from a predominately life-saving focus, to health professionals innovatively managing undifferentiated out-of-hospital presentations.
From these drivers, the programme was designed to meet the CPD requirements of two student groups: paramedics without prior paramedic science higher education experience; and foundation degree students ‘topping-up’ their qualification to a BSc/BSc (Hons) degree.
Drawing upon the breadth of clinical expertize within the paramedic science team, key themes of advanced practice including; patient assessment and examination skills, enhanced clinical decision and reasoning strategies, are allied to clinical leadership forming robust, high quality patient and scene management abilities relevant to contemporary paramedic practice. These attributes, if underpinned by substantial knowledge, were considered pivotal to enable paramedics to work innovatively providing effective, appropriate and safe clinical management plans. The breadth of teaching expertize is predominately from the paramedic profession, staff members have worked in various autonomous roles, including specialist and advanced paramedic practice, supported by allied health professionals.
Many of our staff members have gained specialist knowledge acquired through postgraduate education. Module learning outcomes have been mapped to the NHS Knowledge Skills Framework; allowing paramedics and employers to identify CPD achieved through the programmes educational activities.
Recognizing that paramedics are required to make increasingly complex patient-care decisions, modules are designed around a core of advanced practice attributes: patient assessment strategies; examination techniques and knowledge of management/referral options. These advanced clinical attributes are essential for paramedics making appropriate decisions when considering suitable transportation, treatment or referral options during patient care episodes. Educational development allows paramedics to work in different ways, safely and effectively (Cooper et al, 2007; Mason et al, 2007), where paramedics do not possess these attributes their practice is unsafe (Silvestri et al, 2002; Knapp et al, 2009) or unchanged (Snooks et al, 2002; Snooks et al, 2004; Snooks et al, 2005).
Entry routes
Entry on to the programme requires paramedics to be registered with the HPC:
Accreditation of prior experiential learning (APEL)
This is an opportunity for student's to gain academic credit for work-related learning, equally, evidence may be acquired during activities outside of the clinical environment (Scott, 2010). This personal learning is important, and equally valuable as learning achieved through a formal course. APEL claims are assessed by a written portfolio of material, supported by evidence that explains and explores learning at level 5. An introductory day will introduce the procedure, allowing students to explore their areas of learning activity. A programme tutor will mentor candidates throughout this process to ensure successful completion.
Students may not be required to undertake 60 credits of APEL at Level 5, this is the maximum. Credits from academic modules such as an ECG or mentorship module that do not form the total can be used towards it, through accreditation of prior certified learning (APCL), reducing the amount of APEL students are required to produce.
Final and interim exit awards available
Exit awards available to students during the BSc (Hons) applied paramedic science programme are formed from academic credits. Each module has a number of credits attached to it at a specific level, acknowledging student achievement. These can be built in to an award as outlined below, with indicative study times:
Programme delivery
Recognizing that paramedics need a flexible structure of learning, the programme is designed to ensure that education delivery is through a mixture of campus attendance blocks, typically two days of focused study and e-learning activities. This blended learning approach effectively integrates traditional campus attendance face-to-face teaching, with distance learning using internet technology (Garrison and Kanuka, 2004). This provides flexibility, enabling students to control their learning activities and employers to minimize employees’ time away from the workplace. Modules developing clinical skills have increased contact teaching time; supporting development under the supervision of expert teaching staff. Attendance on campus makes use of specialist facilities, including a dedicated paramedic skills laboratory and sophisticated simulation centre to develop advanced examination techniques and clinical abilities.
An educational technologist is available for student support, of any ability, to maximize their e-learning activities. The university's virtual learning environment, StudyNet, provides electronic learning resources including off-campus access to teaching materials, academic journals and electronic books. Complementing these technologies is a robust system of structured academic staff support, available for easy and effective access by students.
Student support
At UH we recognize that post-registration higher education can be challenging for students due to situations such as their personal circumstances and/ or academic concerns (Leese, 2010). To minimize disruption and ensure students opportunities for effective learning are maximized, a wide variety of support is available. The programme team have experience in supporting part-time students and can be contacted on campus, by telephone or email, to provide academic support or referral to services that can provide personal support.
There are several sources of support, both academic and personal, available to students including: a programme tutor, year tutors and module leads; student representatives; an extensive learning resource centre (library and computing facilities); student centre; mathematics drop-in-centre; the students union; disabled student coordinator; equal opportunities office; sport and recreational activities; and personal development planning using MAPS.
Programme structure
Year one—level 5, diploma in applied paramedic science (October to June)
Three modules form this year—the entry point for students without paramedic science higher education experience delivered over 14 days of campus attendance and distance learning:
Pathophysiology and patient assessment (semester A/B) 30 credits
Through the development of patient assessment and management approaches, combined with enhanced pathophysiological knowledge, this module allows students to link these two core subjects in their clinical practice. This allows students to expand their repertoire of options when forming patient management decisions in clinical practice. The module explores examination and assessment models/ frameworks suitable for use in the out-of-hospital environment, allowing students to perform advanced clinical practice.
Material is delivered through a systems-based approach, to advance knowledge and assessment strategies. Ten-days of campus attendance deliver module content, allowing students to receive developmental feedback of their assessment strategies and consolidate enhanced pathophysiological knowledge. Specialist facilities are used during campus attendance to maximize students development opportunities. There are two parts of assessment: a 2000 word assignment related to pathophysiology (60%); and an observed structured clinical examination (OSCE), of comprehensive patient assessment (40%).
Professional development in paramedic practice (semester B) 15 credits
During this module, students identify an aspect of professional practice to reflect upon, appraising the evidence-base/rationale through a critical literature review to develop improvement strategies. Students complete a portfolio documenting and evidencing their CPD. Two campus attendance days are supported by e-learning activities. Assessment is through coursework; a clinical practice case based reflection (60%) and CPD portfolio (40%).
Year two—level 6 BSc applied paramedic science (October to June)
Four modules form this year, the entry point for Foundation degree students, or year one/level 5 students continuing their studies:
Advanced patient assessment (semester A) 15 credits
This module equips students with advanced assessment skills for use in the out-of-hospital environment. Students’ prior experience of patient assessment is enhanced leading to the acquisition of advanced clinical reasoning strategies, underpinned by evidence allowing comprehensive, complex assessment and accurate decision-making processes for patient management. Students will be encouraged to explore, reflect upon and share their clinical experiences to illustrate issues relevant to advanced patient assessment and management by paramedics. Two pieces of coursework form the assessment process: a 2000 word patient assessment case-study (70%); and a comprehensive patient assessment OSCE (30%).
Leadership (semester A) 15 credits
Completion of this module will enhance and further the leadership competence in paramedics’ out-of-hospital care role. Module content is constructed from the key topics of: leadership; decision-making; change processes; team-working and accountability, essential components of competent leadership required by clinicians and managers alike. Students explore evidence-based and theoretical literature, related to contemporary approaches of leadership and decision making occurring within the wider NHS and Ambulance Trusts. One 2500 word assignment forms the module assessment, critically examining leadership, and formulating of a developmental action plan.
Assessment of acute conditions (semester B) 15 credits
Patients presenting in an acute condition require careful differentiation by paramedics to make appropriate advanced level management decisions. This module builds upon students’ prior knowledge, developing enhanced underpinning knowledge through critical evidence appraisal of paramedics practice base and the construction of advanced clinical reasoning strategies. Students will explore, reflect upon, and share their clinical experiences to illustrate issues relevant to paramedics’ assessment and management of acute medical conditions in the out of hospital environment. Coursework forms the module assessment; a 2000 word written assignment (70%) and an OSCE (30%).
Assessment of chronic conditions (semester B) 15 credits
This module is designed to equip students with the skills and ability to manage the increasing numbers of patients with chronic conditions, with who have complex demanding healthcare needs, beyond traditional paramedic preparation for practice. Students will acquire evidence based abilities to effective identification, triage, treat and/or appropriately refer patients presenting with chronic healthcare conditions. Assessment is by a 2000 word patient assessment assignment (70%); and a comprehensive patient assessment and management OSCE (30%).
Year three—level 6 BSc (Hons) paramedic science
This year is composed of three modules, entered by students progressing from level 5 (year two):
Pharmacology for paramedic practice (semester A) 15 credits
This module allows paramedics to use advanced knowledge of pharmacology in their clinical practice. Providing the theoretical basis to effectively, safely, legally and ethically prescribe and administer a range of medicines. It will further paramedics ability to evaluate both pharmacological and non-pharmacological treatment options, facilitating the selection and implementation of appropriate care strategies in a variety of health care settings. One examination forms the module assessment, comprised of case-studies requiring students to demonstrate pathophysiological abnormalities, logical interventions including pharmacological interventions.
Evidence-based practice (semester A/B) 30 credits
Through a blended learning approach, students construct a research question and search strategy, conduct systematic searches of on-line databases, internet and other sources of information; appraising the evidence base of health and social care practice and interventions; critically exploring through discussion and debate, the contextual factors which influence application of evidence to clinical practice. One 5000 coursework assignment forms the assessment; a review of evidence relevant to the paramedic profession, including a systematic literature review approach, question formulation, search strategy, critical appraisal, presentation of recommendations and implications for practice.
Assessment of minor injuries (semester B) 15 credits
Patients with minor injuries require carefully assessment to differentiate injuries which can be managed solely by paramedics, triaged to an alternative care-setting for further management; require referral to an emergency department or directly to a specialist in-patient medical team for appropriate care. Successful completion of the module will equip paramedics with the knowledge, assessment skills and decision making ability to formulate, in conjunction with the patient, an appropriate management plan for them. Assessment is a 2000 word patient management assignment (70%) and a comprehensive patient assessment and management OSCE (30%).
Conclusions
Education can address paramedics’ CPD requirements and provide opportunities for them to advance their clinical abilities. At UH, great pride is taken to design and deliver programmes which lead paramedic education. This programme offers clinical development, in a structured manner to equip paramedics with the attributes to meet current and future developments in the provision of out-of-hospital care.