Paramedicine is a profession accustomed to change. Our profession has been rapidly changing and advancing, new clinical procedures are continuously introduced and professional responsibilities are expanding, while legislation and accreditation requirements help to enshrine our changing roles and ongoing professional advancement. At the coalface, individual paramedics practise their profession in real-world settings that are inherently diverse, uncontrolled and continuously changing: each case is different, each scene presents different complexities, and each patient has different expectations of their paramedic. How, then, can we ensure that paramedics have the capabilities to thrive within a profession that deals with so much change, complexity and even uncertainty?
‘Messy’ environments
The focus for paramedic training has historically prioritised the technical aspects of practice such as visible skills and measurable procedures (Williams, 2013). However, like so many professions in emergency response and other healthcare environments, paramedic practice relies on human cognition and sociality (Simon, 1962; Khan et al, 2018). The ‘messiness’ of working in these unique environments necessitates not only the gathering of clinical information and the implementation of skills, but also capabilities such as critical thinking, decision-making, reflective and reflexive practice, conflict resolution, team work, leadership and resilience (Flin et al, 2008; Cork, 2012; Shields and Flin, 2013).
‘Soft’ skills
These capabilities are often referred to as non-technical skills or ‘soft’ skills, which are studied through the supporting sciences (sociology, ethics, communications and philosophy, for example). While paramedicine researchers have recognised the importance of these capabilities for quite some time (for example, Michau et al, 2009; Lazarsfeld-Jensen, 2010; Willis et al, 2010; Williams et al, 2010; Ford et al, 2014), these non-technical skills are often not given the attention they deserve within the profession.
We would argue, however, that these non-technical capabilities are in fact the foundations for surviving and thriving in the paramedic profession, which has such an affinity with change, complexity and uncertainty.
Work integrated learning
In recent years, Work Integrated Learning (WIL) has been promoted as a pedagogy that contributes to the development of a practitioner's non-technical capabilities (Patrick et al, 2008; Hastings, 2013; Helyer and Lee, 2014). At Charles Sturt University, we have used WIL designs to promote the development of non-technical capabilities among undergraduate paramedicine students (Delisle and Ebbs, 2018), as well as more recently exploring the use of WIL to develop non-technical capabilities among practitioners from a cross-section of emergency response agencies.
In the current edition of International Paramedic Practice, being published this month, we critically evaluate a WIL activity that occurred in the Republic of Vanuatu, and suggest that properly designed WIL that occurs in diverse settings can, in fact, help achieve what Willis et al (2010: 2) describe as ‘a more solid integration between clinical theory, skills and the supporting sciences’.
Getting the balance right
In the November 2018 issue of the Journal of Paramedic Practice, Aysha Mendes' editorial referred to the importance of ‘ensuring that paramedic training and education cover the many clinical and non-clinical skills that are so important to [paramedic] practice’. We couldn't agree more.
At this time of tremendous change for the paramedic profession, we must ensure we get the balance right in equipping current and future paramedics with both the clinical skills required by the individual patient, and the non-technical capabilities that are required to effectively operate across diverse, uncertain and changing professional environments.