In this article we present our findings from a scoping review that sought to identify what is known about the transition from industry-based paramedic professional to an academic role within universities. The position and scope of practice of paramedics is evolving (Stirling et al, 2007; Bigham et al, 2010). Traditionally, paramedicine was focused on medical and trauma emergencies within the public safety model of out-of-hospital care. This encompasses the response to medical and trauma emergencies by public safety agencies, such as ambulance services and fire brigades. However, over the last few years, there has been a trend toward paramedics having wider participation in the provision of primary health care, with community paramedic models now more prevalent (Lord, 2003; Stirling et al, 2007; Williams et al, 2009; O'Meara, 2009, 2014; Bigham et al, 2010; Evashkevich and Fitzgerald, 2014). To ensure that paramedics have the knowledge and skills to function in a rapidly changing and diversified health-care system, and different and emerging roles, there is a movement of paramedic education into tertiary education institutions. The move to universities is part of the professionalisation of paramedics, and is similar to the pathways taken by other health professional groups, notably nurses.
Wilensky (1964), states that a group or community of practice (CoP) must engage in a series of steps as they move toward professionalisation. One of the major steps is the establishment of training schools or colleges, with a connection to university education occurring within a few decades. In nursing, the move from vocational, hospital-based programmes into university degree programmes began as early as 1937 in South Africa at the University of the Witwatersrand (Horowitz, 2011). In the United States, following a shortage of trained nurses after World War II, associate degrees in nursing began at junior colleges (also known as community colleges), eventually spawning baccalaureate degrees in the 1960s (Mahaffey, 2002). In Australia, the transition of nurse education from hospital-based apprentice models to the higher education sector occurred in the 1980s, with full baccalaureate degrees granted in the 1990s (Madsen, 2008).
Internationally, there is wide variation in how paramedics are prepared for practice. In Australia, New Zealand, and the United Kingdom, paramedic education is situated in the university system, with graduates achieving undergraduate degrees (Black and Davies, 2005; Lord, 2003). The first paramedic undergraduate degree programme in Australia was established at Charles Sturt University in 1995 with subsequent programmes opening at Monash University the next year (Battersby, 1999; Lord, 2003). Paramedic education in Canada is primarily provided in the community college system (two-year programmes) (Pozner et al, 2004; Ontario Ministry of Health and Long-Term Care, 2014; National Association of Emergency Medical Technicians, 2014), while in the United States, it is provided across a range of institutions, with lengths of study depending on the jurisdiction and qualifications needed. United States' education models extend from basic first-responder training (80 hours) to advanced life support paramedic education in colleges, with 20 known university programmes offering paramedicine degrees. Given the relatively recent move of paramedicine to the tertiary sector, attracting qualified paramedic practitioners to pursue academic careers and fulfil their obligations to both the academy and their profession is challenging.
There is a documented body of knowledge on the experiences of nurses and teachers transitioning from practice into academic roles in universities (Hager, 1995; Korthagen et al, 2005; Trowler and Bamber, 2005; Balogun at al, 2006; Barlow and Antoniou, 2007; Martinez, 2008; Smith, 2010; Boyd and Harris, 2010; Logan et al, 2014); Findlow, 2012). Transferring knowledge and expertise from practice to academia, a focus on scholarship and the acquisition of research funding and publications, professional development within disciplines and academia, and the pressures to achieve performance measures to maintain academic positions have all been documented (Bourdieu, 1977; Anderson et al, 2002; Balogun et al, 2006; Barlow and Antoniou, 2007; Boyd, 2010; Adams et al, 2013; Logan et al, 2014). For the neophyte academic in nursing and education, being a broker between their discipline and the academy, the rise of managerialism within universities, and the challenges associated with adapting to a new professional culture and constructing new professional identities can be challenging (MacIntosh, 2003; Dison, 2004; Balogun et al, 2006; Goodson, 2007; Archer, 2008; Clegg, 2008; Cameron et al, 2009). Given the emergence of degree-level programmes for paramedicine, and the resultant increase in paramedic academics, it is unclear whether issues identified in the nursing and education literature are also faced by paramedic academics.
Background
There are shortages of qualified paramedic academics in Australia, New Zealand and the United Kingdom. The majority of paramedics recruited by universities to academic positions are not prepared with doctoral qualifications and most lack experience or track records in grants and publications (O'Meara, 2006; Jackson, 2009). To enhance recruitment, many universities in Australia and New Zealand are offering lecturer or senior lecturer positions to paramedics with the goal of meeting relatively high salaries that paramedic professionals have within practice. O'Meara (2006) and Jackson (2009) note that this has resulted in a lower level of qualifications amongst paramedic academics compared to other disciplines. Many paramedics recruited to Australia and New Zealand come from North America, the UK, and elsewhere (Munro, 2013). The impact of these individuals on the design of programme curricula, the content of subjects, and their influence on the formation of students' professional identities is currently unknown.
Refashioning the professional identity of a paramedic to become a valued member of the academy presents itself as a challenge in a competitive environment that values research capacity and output, and teaching quality. As early as 2006, leaders in tertiary, paramedic education were drawing attention to these issues (O'Meara, 2006; Williams et al, 2009).
The rationale for our study
Studies across other professional groups, such as nurses and teachers, has identified a multitude of challenges as industry-based professionals make the transition to academic roles within universities. As paramedicine develops further along the professionalisation trajectory, the proliferation of paramedic university programs will increase. Recruiting experienced paramedics from industry positions to academic roles is central but challenging, as individuals have well-developed industry careers with relatively high levels of remuneration. The increasing need for academics to teach and conduct research in paramedic programmes prompted our scoping review. Our aim was to identify research conducted about paramedics making the transition from paramedic practice into academic roles in universities. Through identifying what was known about this transition, our aim was to develop insights that could be used for developing strategies to strengthen academic recruitment and socialisation of paramedics into future academic leadership positions.
| Criterion | Inclusion | Exclusion |
|---|---|---|
| Time period | January 1995 and November 2013 | Any study outside these dates |
| Language | English | Non-English |
| Type of article | Original research article published in a peer-reviewed journal | Any article that was not original and/or unpublished |
| Study focus | Paramedic transition into academia | No reference to paramedic professionals move into academia |
| University | An undergraduate or graduate degree | Not an undergraduate or graduate degree |
| Geographical location of study | Australia, New Zealand, United States and/or United Kingdom | No reference to universities in Australia, New Zealand, United States and/or United Kingdom |
| pulation and sample | Paramedic academics | Non-paramedic academics |
Methods
Study design
The method for our scoping review is based on the work of Arksey and O'Malley (2005) and Davis et al, (2009). Scoping reviews are effective in obtaining a preliminary assessment of the scope of available literature, thus providing conceptual clarity on a given topic (Kenny et al, 2013). Unlike systemic reviews, all types of study designs are utilised and the focus is not on the quality of the study, rather identifying what has been written (Arksey and O'Malley, 2005; Davis et al, 2009). Arksey and O'Malley propose a five-stage framework for scoping reviews to enable replication and strengthen methodological rigour. The five stages include; identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting the results.
| SPIDER Tool | Search terms |
|---|---|
| S | (“paramedic” OR “EMT” OR “ambulance”) AND (“academic” OR “lecture” OR “educator”) |
| P of I | (“transition” OR “entry” OR “induction”) AND (“academia” OR “academy” OR “university”) |
| D/E/R | (“qualitative” OR “quantitative” OR “mixed-method” OR “case study” OR “cohort study”) |
Identifying the research question
To assist with the search process, broad parameters were ascribed to the definitions of key search terms in an attempt to ‘generate breadth of coverage’ (Arksey and O'Malley, 2005). The question; ‘What is known about the transition of industry-based paramedic professionals to academic roles in universities?’ was developed to encompass as wide a scope of potential literature as possible.
Identify the relevant studies
In an effort to streamline the search process and to utilise time and resources economically, inclusion and exclusion criteria were developed. A model utilised by Kenny et al, (2013) was used to develop the criteria for the search.
A challenge for researchers is identifying available methods used to develop a search strategy. One method developed by Kable et al (2012) uses a systemic approach for documenting a search strategy. It provides a clear, 12-step approach that focuses on a rigorous evaluation of the literature, rather than a more narrative approach that is not widely accepted by journals today. The traditional PICO method for developing a search strategy was originally constructed for predominately quantitative or epidemiological study searches (Cooke et al, 2012). The SPIDER tool (Cooke et al, 2012) was developed to enable qualitative researchers to more effectively search databases for documents that were relevant to their areas of interest. The SPIDER tool was used to assist with the determination of the key search terms used in this review.
The term paramedic refers to all levels of out-of-hospital (OOH) providers of emergency medical care delivered by a public safety agency (Paramedics Australasia, 2012). The term EMT or Emergency Medical Technician is widely used, particularly in the United States, to describe a provider of OOH emergency medical care at a basic level (Harris et al, 2006). The term ambulance refers to any public safety agency that provides Emergency Medical Services (EMS) utilising specially equipped transport vehicles National Association of Emergency Medical Technicians, 2016).
Key search terms were selected to achieve the broadest acquisition of potential articles and other sources of information. The terms were used to search Medline, Cochrane, CINAHL, Wiley Online, Informit, and Google Scholar databases.
Study selection
When using all key search terms, over 40,000 articles were returned. This number made a complete search of all articles difficult. When an extensive search of titles was conducted, original articles were sourced and then many were excluded because they pertained to nursing, education, or professions other than paramedicine. Those that did involve paramedics or paramedicine had a subject or focus on clinical or epidemiological outcomes, on the education of paramedics, and the movement toward professionalisation. These were excluded. There were only two articles, published in Australia that focused on paramedic academics that taught at a tertiary level. One was by O'Meara, an editorial in Journal of Emergency Primary Health Care in 2006, and the other a report by Willis et al (2009). Both of these documents explored the issues of developing and recruiting paramedic academics in the tertiary setting in Australia and the 2009 report made some observations based on personal interviews and discussion with an expert panel. The editorial by O'Meara was excluded because it did not meet the inclusion criteria of being an original research article published in a peer-reviewed journal, and the paper by Willis et al (2009) was excluded because the original focus of the report was not on the research topic and information presented was tangential. When the number of key search terms was reduced to using ‘paramedic’ and ‘academic’, no articles were returned by any of the databases.
Data charting and collation
The fourth stage of the Arksey and O'Malley framework is that of describing the charting process. This is done by summarising each article by documenting the information pertaining to author, year, location, study design, methods, and sample. As there were no articles accepted based on the inclusion/exclusion criteria this process did not occur.
Summarising and reporting finding
The final stage of the Arksey and O'Malley framework is to provide an overview of the identified articles that were relevant to the research question. Again, as there were no articles accepted this process did not occur.
Results and discussion
In exploring the question: ‘What is known about the transition of industry-based paramedic professionals to academic roles in universities?’ no articles were deemed relevant.
In adhering to the inclusion/exclusion criteria, the editorial by O'Meara was excluded because it was an editorial and did not report findings of research. The report by Willis et al (2009) was a peer-reviewed report that had been funded by the Australian Learning and Teaching Council (ALTC). It was a collaborative research project that involved the nine Australian universities that were running undergraduate paramedicine programmes at the time and the Australian College of Ambulance Professionals (ACAP). The aims of the study were to determine what could be learned from international pre-hospital service providers, paramedic professional bodies, universities, and the literature, in an attempt to construct meaningful improvements in the Australian paramedicine tertiary education programmes. In addition, a framework for the establishment of a network of paramedic academics was proposed to foster the recruitment and development of paramedic academics in Australia. Some general issues concerning the recruitment and development of paramedic academics were discussed, but not to any substantial depth. Given the absence of literature on paramedic transition to academic roles in universities, there is clearly a knowledge gap.
The dearth of literature on the transition of industry-based paramedics to academic roles within universities is a major gap but perhaps, not surprising, given that paramedicine is still moving toward professionalisation. However, as the paramedic profession matures, the demand for degree level education will increase, with an associated increase in demand for paramedic academics. Developing knowledge of transition experiences will be central to recruitment to ensure that paramedics have a good understanding of what the role will entail. Knowledge on transition will be important in ensuring that orientation, and socialisation processes are tailored to ensure those paramedics recruited are retained, and become future academic leaders. Developing strong academic leadership and a research base, developed through rigorous, high quality research is important for the development of the profession.
With a dearth of knowledge on paramedic transition, the development of recruitment and retention strategies is difficult. However, as the knowledge base is developed there may be some useful learning that can be drawn from the nursing and education professions as the path to professionalisation has been quite similar. New academic nurses bring with them a culture and standards of their clinical profession. They have developed high levels of professional capital within nursing that does not transition well into established cultures within academia. This is supported by Bourdieu's (Moore, 2008) concept of the restricted transportability of high cultural capital from one field to another. As university academics, nurses struggle with a conflict of expectations, in which their students expect them to be nurses, but their employers expect them to be researchers first and good educators second (Findlow, 2012).
For many school teachers leaving the classroom to take up academic roles in universities, there are many changes to their work environment. They are leaving a classroom of new learners (children) and confronting a heterogeneous student body of school leavers and adult learners. They are experiencing a new level of autonomy in the workplace that is one of individual responsibility and self-reliance. The pressure to conduct research and to produce publications is new, along with the link that this has to their performance evaluations, the maintenance of their positions, and to future promotion (Balogun et al, 2006; Martinez, 2008; Cameron et al, 2009). New nursing academics receive little to no education or preparation on how to be an academic. This is received with various degrees of success after entering the academy (MacIntosh, 2003). What is not known is if these same issues, along with others, confront paramedic practitioners when they transition into academic roles in universities.
Limitations
Limitations to this review were that articles were selected from English language-only databases, and did not explore the potential literature that may have been available elsewhere. In addition, because of the numerous articles that appeared based on the selection criteria, some may have been missed due to the volume, but it was determined that because the field is relatively new, there was little chance of finding directly related articles.
Conclusions
The lack of any pertinent literature concerning the issues that paramedic professionals are confronted with when transitioning into academic roles within universities in Australia and New Zealand, demonstrates the need for further study in this area. The number of paramedicine programmes is increasing and the pool of qualified, Australasian, paramedic academics is small and does not appear to be growing despite the fact that paramedics have been graduating from undergraduate paramedicine programmes for 20 years. The lack of suitable candidates has forced many of the programmes to recruit internationally. This movement of academically qualified paramedics from predominately North America and the United Kingdom, has presented additional challenges and issues for both the new academics and the institutions that are employing them. An understanding of the many issues confronting paramedics transitioning into academia will lead to the development of frameworks for the recruitment, induction, socialisation, and professional development of qualified paramedics embarking on careers in academia.