Over recent years, the scope of practice for paramedics in the UK has noticeably changed and expanded. According to Health Education England (2021), changes have been seen within national frameworks and across many clinical settings. A recent report from the College of Paramedics (CoP) (2018) concluded that 60% of paramedics are now going into roles within GP practices, minor injury units, and walk-in centres, focusing on the management of minor illnesses and injuries. A framework including a skill set was initiated by Collier (2021), which outlined the need for more non-ambulance placements within the undergraduate paramedic curriculum.
According to Brewster (2018), students that are undertaking a BSc in Paramedic Science, spend a small proportion of their clinical time in non-ambulance-based placements. Brewster's (2018) research has shown that this can affect the student's overall ability to understand certain conditions and how they are managed in the prehospital environment.
Recent research by Proctor (2019) reveals that non-ambulance placements offered to student paramedics include spending time on cardiology wards, emergency and acute assessment wards, cardiac catheterisation labs, primary care, paediatric care, and palliative care placements. Collen (2019) notes that such experiences represent an extensive opportunity for student paramedics to not only experience interdisciplinary learning, but enhance their clinical understanding as well. However, research by Baranowski and Armour (2020) found that further research needed to be done on the confidence levels of students, as his study concluded that alternative placements both hinder and support student paramedics in their learning.
The author felt it necessary therefore to establish the confidence levels of student paramedics when managing patients both before and after undertaking a minor illness/injury placement. As a result of this study, a greater understanding of student paramedics' confidence levels will be gained, enabling both the expansion and development of the future paramedic curriculum.
The current article reports the findings of a quantitative study, exploring the confidence levels of student paramedics in managing patients both before and after a minor illness/injury placement.
Background
Research by Credland et al (2019) addressed the need for non-ambulance placements within the paramedic programme, such as walk-in centres, minor injury units, cardiac assessment units and general practice surgeries. Of the 30 participants, 18 felt that there was a degree of uncertainty and a lack of competence before completing such placements; emphasising the need for further research into the opinions of student paramedics after completing a similar placement.
Lewis (2019) and Hoggins et al (2018) showed that 76% of student nurses felt that they had a lack of understanding of minor illnesses and injuries prior to completing a placement. However, this was compared to the completion of a placement where approximately 98% of students felt that long-term conditions, minor injuries and illnesses were strongly considered as a new skill set and competence that was developed during their placement. Gale et al (2016) demonstrated that students came out of the general practice/minor illness placement with both the theory, and practical skills, such as suturing, dealing with common ailments such as ear, nose and throat infections, and the prescribing of antibiotics.
Brown et al (2020) supports Gale (2019), as 66% of physician associates felt that they were more confident after completing a placement within the primary care setting. This demonstrated once again the need for research on the confidence levels of student paramedics. Furthermore, the results from such studies demonstrate a generalised need for more alternative placements for all health professionals, including paramedics (Table 1).
| Name of condition | % Before | % After |
|---|---|---|
| Common cough or cold | 95% | 96% |
| Chest infection | 73% | 75% |
| COPD | 68% | 70% |
| Headaches | 77% | 78% |
| Migraines | 55% | 60% |
| Otitis media | 5% | 7% |
| Otitis externa | 0% | 7% |
| Sinusitis | 27% | 20% |
| Tonsilitis | 55% | 85% |
| Throat infections | 55% | 70% |
| Perforated ear drum | 9% | 4% |
| Mononucleosis | 5% | 25% |
| Conjunctivitis | 18% | 20% |
| Urinary tract infections | 77% | 88% |
| Vomiting and diarrhoea | 86% | 100% |
| Constipation | 41% | 39% |
| Hyperemesis gravidarum | 5% | 4% |
| Skin conditions | 23% | 20% |
| Vertigo/dizziness | 45% | 40% |
| Cellulitis | 55% | 56% |
| Warts, verrucas, and athlete's foot | 23% | 20% |
| Melena | 27% | 20% |
| Gallstones/acute cholecystitis | 50% | 55% |
| Labyrinthitis | 0% | 4% |
| Pleurisy | 18% | 28% |
| Hay fever and allergies | 86% | 0% |
| Vomiting in children | 77% | 88% |
| Vomiting in adults | 86% | 84% |
| Gout | 32% | 30% |
| High temperatures in children | 77% | 100% |
To date, no research has been carried out regarding the confidence levels of student paramedics on alternative placements. This unfortunately shows a research gap in the confidence levels of student paramedics.
Methods
Objective/design setting
A quantitative-based study was conducted to explore the confidence levels of third-year student paramedics completing a minor illness/injury placement, while on their BSc Paramedic Science Programme. This research was conducted through Microsoft Forms both before and after a placement in a minor illness/injury setting.
Participants
This quantitative study was offered to the third-year student paramedics, as they had an upcoming general practice (GP) placement in the final semester of their education. All of these students had at least 1 week of placement within a GP surgery in the Birmingham and Solihull area, with some of the participants having 2 weeks of placement. Both participants and mentors received a placement guidance pack from Jefferies-Lloyd (2023), which included competency standards and a placement checklist 1 week prior to the placement commencing. As part of any practice placement undertaken as a student paramedic, students are given a Practice Assessment Portfolio. Some of the third-year skills included electrocardiogram (ECG) recognition and interpretation, completing adequate documentation of all activities, assessment and treatment of both minor illness and injuries, demonstration of safe and effective care when suturing wounds, gluing wounds, undertaking urinalysis, administering therapeutic medications and when assessing/treating ulcers. While these competencies are set by Birmingham City University (BCU), they are reflected in the CoP (2018) curriculum framework for student paramedics.
Ethical considerations
Full ethical approval (Gubbins/#9782/sub3/Mod/2021/Sep/HELS FAEC-PAR6011) was obtained for the cohort's independent study module prior to the commencement of the study from BCU, Faculty of Health Sciences Ethics department. Participants that expressed an interest in the study were sent a participant information sheet via email. Participants who wished to take part in the study, were emailed a consent form along with a participant number. Consent forms were returned to the researcher's email address, which was provided in the information packs. The purpose of the participant number was to identify the participants, without using any personal data.
All participants were made aware of their right to withdraw at any point (with no penalty), meaning that all of their data would be erased with immediate effect. This could be done by emailing the researcher, along with their participation number. No other organisations except BCU and the GP practices were involved in this study.
Data collection
As part of this research, only quantitative data were collected. These data were collected through two types of questionnaires, with students completing one before the placement and the second after having completed their 1-week block.
Questionnaires were anonymised, requiring participants to include only their participant number. All of the participant consent forms were safeguarded by uploading them to the BCU One Drive, where only the lead researcher could access them. The BCU One Drive was regularly backed up to minimise the risk of data leaks. No paper documents from this research were stored, and paper copies were securely shredded at BCU.
Results
Of the 24 participants that consented to take part in the research (Table 2; Table 3), only 22 completed questionnaire one. It is quite clear that students who undertook the placement in minor illnesses and injury found it beneficial to their overall learning experience and confidence levels (Table 4). Results showed that 85% of participants felt that their confidence had increased after this placement (Table 5). Furthermore, 60% noted they would want to keep this placement for future third-year paramedics, demonstrating its need to be rolled out onto more BSc Paramedic Science programmes across the UK. However, 40% would not recommend this placement for further groups in the future, as students were not exposed to conditions such as Otitis media, Otitis externa, perforated ear drums, conjunctivitis, hyperemesis gravidarum and skin conditions, and skills such as urinalysis and wound closure (under the supervision of a qualified professional) (Table 6; Table 7; Table 8; Table 9).
| Yes | No |
|---|---|
| 27% | 73% |
| Previous employment | Current employment |
|---|---|
| 83% | 17% |
| Yes | No |
|---|---|
| 85% | 15% |
| Yes | No |
|---|---|
| 15% | 85% |
| Before | After |
|---|---|
| 25% | 65% |
| Yes | No |
|---|---|
| 50% | 50% |
| Yes | No |
|---|---|
| 60% | 40% |
| Before | After |
|---|---|
| 17% | 15% |
Overall, the results showed success in students gaining more confidence in common minor ailments (Table 10). Moreover, many of the student paramedics who undertook this placement reported having gained significant levels of confidence in the management of throat infections, bacterial and viral tonsilitis, norovirus-winter vomiting bugs, pleurisy, vomiting in children, high temperatures in children and skin conditions. Sadly, these results also showed a significant drop in exposure of common illnesses such as hay fever, allergies, warts, verrucas, and athlete's foot. It is possible that these increases/decreases in the presentation of these conditions are seasonal; the minor illness and injury placement may need to be repeated in the summer months of the year to see whether this is an accurate judgment.
| Yes | No |
|---|---|
| 75% | 25% |
Throughout the placement, students also had the opportunity to complete new skills such as urinalysis, wound care, and suturing. The post-placement questionnaire results showed that only 65% of the students carried out urinalysis, and only 15% completed wound closure/suturing under supervision, calling into question the benefit of the placement for these skills. Data revealed that 85% of participants found that the minor injury part of the placement did not help with their confidence levels, compared with the 15% of participants that did. The data also revealed that 80% of students did not find the minor injury component of the placement valuable, due to the lack of exposure; compared with 20% of students who did (Table 11).
| Yes | No |
|---|---|
| 20% | 80% |
Overall, the results for the minor injury component showed a lack of confidence and exposure in all of the minor injury competencies. With that being said, it may be worth repeating this piece of research with students completing a week in a minor injury's unit, to get the exposure of managing minor injuries and practising such skills as outlined in the results section.
Furthermore, conditions such as Otitis externa, (outer ear infection), perforated ear drum, constipation and haemorrhoids, gallstones, gout, hyperemesis gravidarum, vertigo, warts, and melena, neither had an increase, nor a decrease in the lack of confidence or exposure. Again, the research may need to be replicated in order to accurately justify these results.
To conclude, the minor illness/injury placement has provided successful results, although the minor injury component was less successful, with over 60% of the students that participated wanting to keep this placement for future cohorts. It would also be beneficial to qualitatively explore how the placement could be adapted to ensure it meets all students' needs.
More research will be needed in order to determine whether the exposure and subsequent increase/decrease in confidence levels in some of the conditions are due to seasonal changes, and to observe whether confidence levels would increase or remain the same if students were to complete a placement in a minor injury setting.
Limitations
One of the limitations of this research is that it was only offered to a single cohort of third-year paramedic science students from one university. Other final-year paramedic science students would need to be offered a chance to participate, to make the results generalisable for the future development of the paramedic curriculum.
Conclusion
More research needs to be done in order for the present piece of research on the confidence levels of student paramedics, both before and after a placement in a minor illness/injury setting, to be deemed successful. Although confidence levels showed a 60% succession rate for minor illnesses, unfortunately, 85% of students had no exposure to seeing patients with minor injuries. It was therefore evaluated that in order for students to have the correct level of exposure to minor injuries, that students would need to complete a 1-week placement in a minor injury unit. This would hopefully reveal whether this result was down to the type of placement setting, or if further work is needed to discover why students were not gaining any exposure.
Finally, this piece of research also established that many students had a lack of/or no exposure to certain types of minor illnesses during their allocated placement in February. It was therefore suggested that the minor illness placement may need to be repeated in the summer months of the year to see whether the results from February 2023 were of an accurate nature.