As I mark my first year anniversary as a paramedic for the Scottish Ambulance Service provides a good opportunity to reflect on the past year. Murdoch (2019) wrote about decision-making in paramedic practice, referring to Brenner's Novice to Expert continuum—particularly on how this is applied to newly qualified paramedics.
In April 2022, as a new NQP, I was definitely a novice. Although I had completed my university education, my experience was limited, with Brenner's definition of novice clearly describing me at this time. However, with increased exposure and learned behaviours through experience, people can move up through this continuum over time.
The NQP programme in Scotland is relatively new, compared with the programme in England—the main emphasis being on supported clinical decision-making. Our first 6 months as an NQP give us the opportunity to work with another paramedic to gain experience and increase our confidence. I would argue that as a new NQP, we are already passed the ‘Novice’ level in some areas, sitting somewhere around ‘Advanced Beginner’—though there are undoubtedly some aspects of the job that I still feel ‘novice’ in. Brenner acknowledges pattern recognition as a useful tool to advance from Novice to Expert. In order to gain experience, I am at the mercy of dispatch colleagues. After 1 year, there are still come cases that I have not attended. This raises the question: can I be proficient or competent in one area and be a novice or advanced beginner in another?
Building confidence in clinical decision-making no doubt takes time and experience, regardless of one's educational route. I spend a lot of time reflecting on cases and not just the unusual ones—I am really keen to develop my knowledge and improve my confidence in the more routine cases as well. I regularly seek feedback from receiving units or other health professionals I have spoken with. Often there is no improvement or change in the plan, but positive feedback is as helpful as constructive feedback.
There are regular debriefs for the major jobs, especially those involving other agencies. If I have a student with me while they are on placement, I will ask after every job if they have any questions and will explain anything they did not understand—regardless of how trivial it may seem. I would love to normalise regular feedback and debriefs for routine jobs in my current practice. Everyone can learn from each other and possibly adapt their own practice to become the best possible clinician they can be within their scope. Even at the ‘Proficient’ level, Brenner identifies that the clinician learns from experience and has a more holistic understanding. This will definitely be helped by open discussions with peers and consistent feedback and reflection on all cases.
If I think back to my first few shifts as a paramedic, I would definitely put myself in the ‘Novice’ box. Through reassurance and appropriate support, by the end of my first few weeks, I would have put myself in the ‘Advanced Beginner’ box. One year on, there are still moments where I feel like a novice but would like to think that I am competent at some aspects of my job. I have learned a lot from the experiences I have had over the last year—though there is still so much more to learn and put into practice.