Today's paramedic practitioners are no longer the stretcher-bearers known only for providing transportation taking patients to the nearest physician. By today's standards, paramedics act autonomously in the community, providing a range of healthcare treatments or referring patients to additional community services wherever necessary. For paramedics to practise safely, they must not only have an advanced understanding of acute and chronic medical conditions and treatment options, but they must be reflective practitioners who can apply advanced problem-solving skills in the most demanding of circumstances.
Action learning
Action learning is attributed to the British researcher Reginald Revans, who during his time as a research student at Cambridge University in the 1940s (Revans, 1982), worked alongside a talented group of scientists, and observed how they shared experiences and reflected upon their work (Trehan and Pedler, 2011). When Revans later went on to work for the UK Mining Association, he adopted a similar technique to those which he had observed with his research colleagues, and asked coal workers what they saw, heard and did. Simply by listening to the coal miners, he noticed an increase in productivity of around 30% (Revans, 1982), which was a big success for the industry.
Although action learning originated in the UK, it has become popular among international audiences, and according to Park et al (2013), it is now a widely used leadership tool which spans a plethora of organisations and countries.
Many examples exist which exemplify how action learning has been used internationally, and in countries such as Australia, New Zealand, Canada, India, a few Asian countires and South Africa (Park et al 2013). Jelas et al (2012), used it to link the classroom to the community in Malaysia, whereas Panwar et al (2014) used an action learning approach in a small Indian village in Haryana to revolutionise the integration of female social workers into the community. Raelin (2008) places the success of action learning at the feet of its tangible outcomes and its effectiveness at solving ‘real life’ challenges, but action learning has also been credited for its simplistic design and its reflective practice focus, as a means of developing participants critical thinking and problem-solving skills (Horvath and Forte, 2011; Revans, 2011).
Numerous definitions of action learning exist, such as that offered by Martineau and Hannum (2004:9) who identify action learning as:
‘…a collaborative inquiry process in which participants work and reflect on real problems with learning partners, producing a tangible outcome, while at the same time learning from the experience.’
and Rigg (2014:3) who defines action learning as:
‘… a rich philosophy of learning and practice that offers a significant contribution to the fields of professional and management education and development, organization change, problem-solving and performance improvement, as well as to action research.’
Action learning is conceptualised as a reflective process that occurs in a structured forum allowing individuals to come together to form a ‘set’ and to share problems experienced during their work and/or study environments. Set members encourage reflection by asking each other ‘insightful questions’ that facilitate the reflective process and learning from the experience. Set members also exchange ideas and experiences with each other during their meetings and this enriches the process of reflection and learning; all of which ultimately allow individual members to go away and take action on their presented problems (Dilworth and Boshyk, 2010). The process is usually facilitated by a mentor, who encourages each member to participate (Beaty and McGill, 2002), although the mentor role is open to some discussion as it is proposed that Reginald Revans originally (before the advancement of action learning) considered facilitators to be prohibitive to the process of action learning (Boshyk, and Dilwrth, 2010). Today, the use of a facilitator depends on personal choice.
In the context of this discussion paper, action learning is defined as
‘… a collective educational process designed to develop individual members’ critical thinking skills by enhancing their ability to ask insightful questions through the medium of reflective practice, to create real solutions to real challenges.’
The relevance of action learning in paramedic education
Paramedic programmes of education must graduate practitioners who can respond appropriately to challenging situations. To achieve this, they must be able to make complex decisions while under pressure, be able to communicate effectively in the most desperate of situations, and should be able to function in many different teams (Paramedics Australasia, 2011; HCPC, 2014). These skills can be developed by routinely using reflective practice, which is a central theme in action learning (Beaty and McGill, 2002). Such skills are developed throughout the daily journey of life, but can be structured and reinforced while studying a programme of paramedic education.
Reported benefits of action learning centre around its ability to develop not only a participant’ s reflective practice skills, but also their team working, problem solving and communication skills (Beaty and McGill, 2002). It does so by providing a focused setting, away from the usual noise of everyday life, allowing set members to learn directly from experience through the process of reflective practice (Argyris, 1992 in Panwar et al, 2014). Participating in action learning has been reported to enable graduates to take action for a specific set of purposes, which contributes toward personal self-development. Edmondson (2005) and Willis (2013) acknowledge the benefits of peer engagement facilitated through action learning and how this has the overall effect of enriching a student's experiences while at university.
From this viewpoint, action learning is well situated in the paramedic curriculum even though there has been some discussion regarding the positionality of action learning within undergraduate programmes. Action learning is currently well established in areas such as postgraduate education, among senior management teams and within leadership programs (Abbott and Mayes 2014), A growing body of evidence is beginning to emerge, which demonstrates its feasibility within undergraduate education (Bourner et al, 2000; Willis 2013).
Virtual action learning (VAL)
Virtual action learning (VAL) appears in the literature from the late 1990s and has been defined as action learning that is undertaken in a virtual environment using a range of enabling, interactive, and collaborative communication technologies (Dickenson et al, 2010). In today's virtual world, and at a time when students are not only expecting more value from their financial investment (their education), but with a growth in the complexity of delivery modes of education (for example via distance learning), the online space is becoming an increasingly popular area to run action learning sets. VAL uses assistive technologies to host online action learning meetings through its teleconferencing features, and to store the related documentation that results from the set meetings within cloud storage.
The term ‘virtual’ in VAL shares similarities with terms such as ‘online’ in online learning (Currie et al, 2012), ‘electronic’ in e-learning and ‘mobile’ in mobile-learning (M-learning) (Hauser, 2010; Al-Emran et al, 2016). For example, mobile learning incorporates the use of mobile devices as a tool for learning, such as smartphones and tablets. VAL requires some form of technology to host it, which can include mobile technology or a desktop computer. The term ‘e-learning’ has evolved over the last century with its original meaning to include learning using electronic devices such as a computer. However, as technology has become more sophisticated and readily available, the UK Joint Information Systems Committee (JISC) recognises e-learning to be:
‘learning facilitated and supported through the use of information and communications technology’. It can cover a spectrum of activities from the use of technology to support learning as part of a ‘blended’ approach (a combination of traditional and e-learning approaches), to learning that is delivered entirely online. Whatever the technology, however, learning is the vital element.’
The definition provided by JISC (2016) acknowledges changes brought about by the advent of the internet, and demonstrates a transferability between the terms online learning, mobile learning and virtual learning.
Virtual action learning is still action learning and as such, can bring all the benefits associated with face-to-face action learning. Virtual action learning has emerged for reasons including advances in technology that have allowed more collaborative communication, and globalisation where the emergence of multi-national and dispersed students have become commonplace (Dickenson et al, 2010). The demand for more flexible access to education by consumers, along with increased expectations for an innovative curriculum delivery, and the exponential expectation placed on universities by the consumer; professional bodies and regulatory bodies are also noted as reasons that have led to the popularity of VAL within the tertiary education sector (Keppel and Ridley, 2012).
Even though virtual action learning has not been widely used in undergraduate paramedic education, there is evidence that this approach has been successfully used in post-registration nursing education within the UK (Currie et al, 2012) and has also been used successfully with students in other areas such as business, education, health, and public services (Bourner et al, 2000).
Reported benefits of AL and VAL
The literature reports numerous benefits of face-to-face action learning (AL) which includes the accessibility of a shared experience with group members, opportunities for team working and commonality among peers (Currie et al, 2012; Abbot and Mayes, 2014). Edmonstone (2015) provides a snapshot of the reported benefits to members who use action learning. These include the building of strong relationships between set members, an increased ability to interpret ambiguous data, an increased willingness and ability to comprehend and initiate changes, increased self-awareness with a better understanding of how personal behaviours affect the team, shared knowledge between colleagues, enhanced flexibility in how problems are solved.
In contrast there is also a growing body of literature that recognise the benefits of using virtual action learning to support their cause (Plack et al 2008; Currie et al, 2012; Jelas et al, 2012). For example, Currie et al (2012) successfully used VAL with advanced nursing practitioners due to its reported abilities to encourage reflection and provide support to geographically dispersed members. Action learning sets were hosted in a virtual environment directly due to the capability of the technology to connect such participants, and among members who presented with significant time and funding constraints who were prevented from attending a face-to-face action learning set.
Participants identified such benefits as being able to use technology within an action learning set to enhance opportunities to network; the ability to keep in touch with other participants remotely; and to share knowledge through the technology. One participant reported how virtual action learning encouraged them to stay connected and involved with the curriculum when it would have been easy to withdraw.
Areas for consideration when using a VAL approach
VAL allows action learning to take place from a distance, and away from other set members, using an online platform. Such platforms usually include a range of tools like discussion boards, chat rooms, and video conferencing (Dickenson et al, 2010; Currie et al, 2012). Even though these services are widely available and free of charge, virtual action learning has been used in single form, e.g. audio-only telephone conferencing; in a form of text-only, which uses only e-mail, as well as using a wider range of tools to include a combination of text, audio and visual communication (Dickenson et al, 2010).
Accessing online platforms capable of hosting virtual action learning is no longer a problem, as many online technologies capable of hosting VAL are readily available and free to use (for example, Google Plus, Skype, Facebook and Zoom. In addition, with today's internet availability, issues of connectivity are rarely a problem.
Reported limitations of virtual action learning have been attributed to both the process of action learning itself and the use of the technology in VAL. The literature reports problems with VAL to include a lack of clarity of the purpose of action learning, set members not participating, set drift, poor continuity between sets, tendency to focus upon solving individual problems as opposed to being a set member, and contributing to their matters, and the process of action learning as a learning mechanism not suiting each member's needs (Currie et al, 2012).
According to Pedler et al (2013), when participating in virtual action learning, in addition to those challenges of running face-to-face action learning, those hosting virtual action learning require additional skills which relate to the management of the technology.
VAL methods
All action learning, regardless of its mode of delivery, involves a group activity also culminating in individual learning and personal development regardless of the delivery mode used. As previously discussed, many different categories of AL exist and the category impacts upon the way the AL is delivered. Table 1 compares two established methods of delivering AL (Pedler et al, 2005; 12 Manage), and a third method designed specifically for paramedic students is proposed (Willis, 2017).
| Pedler et al, 2005 | 12 Manage | Willis, 2017 |
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Why now?
Action learning was developed in the 1940s (Revans 1982), yet it appears that the tertiary sector is still to fully engage with AL and VAL within paramedic programmes. Whilst the literature recognises the many benefits for those who engage in face-to-face (Currie et al 2013; Abbot and Mayes 2014) and VAL (Plack et al, 2008; Currie et al, 2012; Jelas et al, 2012), including to grow and strengthen those skills required by the profession, surprisingly the evidence of uptake within paramedic programmes appears slow, even though it has existed for almost seven decades. In today's digital age, with such excellent access to the worldwide web and enabling technologies, the only barriers to the uptake of virtual action learning within the curriculum appear to be the willingness of education providers to realise its potential and to give it a try.
Conclusions and further research
This discussion paper provides a background and summary of action learning and virtual action learning. It recognises the opportunities that exist for students, education providers and employers in producing graduates with the necessary reflective, critical thinking skills, through the medium of a structured approach to problem-solving (action learning), and identifies how paramedic students may make good recipients for the use of action learning, including virtual action learning.