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Student paramedic decision-making: a critical exploration of a patient interaction

02 February 2021
Volume 13 · Issue 2


Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.

Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data in order to select and implement an evidence-based choice of action (Tiffen et al, 2014). In order to evaluate and critically explore this concept, use of the hypothetico-deductive model as advocated for by Elstein et al (1978) has been implemented throughout (Figure 1). Use of this framework may promote patient safety and can help to eliminate uncertainty leading to effective, and reasoned decision-making (Woodford, 2015).

While in clinical practice during second-year placement, the lead author, a third-year student paramedic at the time of writing, attended a 49-year-old palliative care patient, Mr Smith, who was in the final hours of end-stage lung cancer, with his family and a nurse in attendance. Working under the supervision of a paramedic practice educator, a series of clinical, ethical and human factors were considered in the formation of a differential diagnosis and final decision in the care of this patient. Consent was obtained and all reasonable measures have been taken to ensure confidentiality, including the use of pseudonyms and omission of identifying factors (Health and Care Professions Council (HCPC), 2019).

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