Paramedic education in Scotland has historically, been vocationally driven through the Scottish Ambulance Service (SAS), from Institute of Healthcare Development (IHCD) training through to the DipHE Paramedic Practice, which was delivered in collaboration with Glasgow Caledonian University (GCU). However, with the development of the consultation by the Health and Care Professions Council (HCPC) (2017) on entry level to the register, the first full-time undergraduate degree was approved and commenced delivery in September 2017 at GCU. Following the confirmation of degree-level entry from September 2021 to the register (HCPC, 2018), it was understood that there would be a potential gap, where the number of paramedics qualifying in Scotland, and potentially entering employment with SAS, would be reduced. Therefore, NHS Education Scotland (NES), in collaboration with SAS and the Scottish Government, commissioned delivery of BSc Paramedic Science programmes by a further four higher education institutions (HEIs) with balanced geographical spread:
In 2019/2020, all five HEI programmes were approved and recruited for delivery from September 2020, anticipating the cessation of the DipHE by SAS and ensuring an increased number of graduate paramedics who are eligible for employment in Scotland from 2023.
SCoPE
The Scottish Collaboration of Paramedic Education (SCoPE) was convened to drive the collective development of the five HEIs alongside SAS, NES and the regional NHS boards, with the aim of bringing a ‘Once for Scotland’ approach to paramedic education, while retaining HEI individuality. Regular meetings of stakeholders were held to allow for discussion and shared learning on the delivery of paramedic education in Scotland. Initially, SCoPE navigated the approval of the programmes, agreement of practice education arrangements, and management of delivering the programmes during an international pandemic that had resulted in significant disruption to healthcare education across the UK.
As the programmes all become established in their own regions, it was decided to embark on the development of a national practice assessment document (PAD), which could be delivered in an electronic format and seek to align how practice education was recorded by the five HEIs. This also coincided with the review of the HCPC standards of proficiency for all allied health professionals (AHPs) that would come into effect for student delivery from September 2023 (HCPC, 2022).
National PAD working group
As this project was primarily concerned with paramedic student education, it was decided that the core working group would consist of members from the five HEIs to put together a principal document and agree on how the PAD would be used. There would then be a meeting of all stakeholders to present the PAD, take questions and feedback, and consider any aspects that had not been covered from the stakeholder perspective.
A member of the working group had been involved in the development of the nursing PAD, which is in use by all undergraduate nursing programmes in Scotland (Roxburgh et al, 2018). This was extremely useful in navigating how to bring the PAD together.
However, the group was cognisant of the differences in education, regulation and assessment of practice by both professions. The development of the Scottish national paramedic PAD would need to be rooted in the definition of the profession, sound pedagogy for lifelong learning development and expected standards of the HCPC.
Student-led for lifelong learning
It was felt strongly that the PAD needed to be more student-focused, with a core principle of engaging learners in responsibility for their professional development and a reflective and lifelong learning mindset. Lifelong learning is described as being different from formal education throughout someone's life, as it is concerned with personal development of knowledge and skills, that has the potential to benefit all aspects of life as well as employment prospects (Alsop, 2013).
It is argued that to empower learners to see beyond a task- or assessment-focused mindset, their learning needs to be future-oriented and intrinsically embedded in practice contexts (Bound et al, 2022). On the surface, provision of practice-based learning, in the context of a healthcare professional programme, is rooted in experiential learning theory. However, with the need to develop learners who are not just ‘doing’, but thinking, reflecting, adapting, reasoning and applying knowledge, we also needed to apply several other theories such as transformative, reflective, motivational and constructivist learning (Mukhalalati and Taylor, 2019).
Additionally, it was vital to account for the differences between the five programmes and ensure that the new PAD did not trigger unnecessary institutional or regulatory approval processes. The changes to the HCPC processes for quality assurance and institutional review mean that developing the PAD to align with the new standards of proficiency (SoPs) would facilitate its meeting of the regulator requirements on institutional review (HCPC, 2021). Essentially, the design was intended to flex to the learning outcomes and programme specifications already approved; it would simply change how achievement of practice learning was being recorded. This raised the question of whether this would truly be a ‘unified’ PAD for all five institutions, in a similar vein to the national nursing PAD. Ultimately, the key unifying factors were linking to the new SoPs and use of identical templates to record the different type of evidence required by each HEI. This would allow for consistency in approach to recording practice-based learning, while allowing space for creativity and innovation in the rapidly developing area of professional education.
Stakeholder engagement
During the stakeholder engagement phase, it become clear that this would be more about managing expectations and being very clear about what the PAD was intended to be, and also what it was not going to do. Those partners tasked with sourcing cross-sector practice-based learning (placement not with SAS) appeared to be disappointed that the PAD work was not aimed at structuring and regulating this area of learning across the five HEIs. However, it was accepted and understood on explanation, that it would be counterproductive to try and make this aspect identical in each programme. Geographical differences, as well as educational development and innovation, meant that any attempt to ‘set’ the cross-sector practice experiences across all five HEIs would actually limit the capacity for placement—not expand it.
In working with SAS as a key stakeholder, discussions were centred on how the PAD would help engage practice educators, while not overloading them with report writing and documentation completion. Additionally, there appeared to be a desire for the PAD to guarantee that graduates were ‘road-ready’; however, this was not the focus of the PAD design, which aimed to assess students for registration readiness against the HCPC SoPs. The concept of being ‘road-ready’ is multifaceted and the PAD aimed to help move the profession away the from the historical, reductionist approach of competency ‘sign-off’ dominating the assessment of a graduate's success in practice-based learning (O'Brien et al, 2014).
In early 2023, the final principal document was completed and agreed by the five HEIs. The working group is now in a phase of individual mapping and implementation of the PAD into the programmes for piloting. All HEIs are seeking for this to be delivered via an electronic platform but this will also differ between sites, at least initially, due to financial constraints. Initial piloting will begin this month (September 2023) and evaluation will be conducted throughout academic session 2023/2024 and beyond, to assess for any required amendments and how it is being used and received in the practice-based learning environments.
College of Paramedics: professional body PAD
The programme and professional leads for each of the Scottish programmes are members of the Forum for Higher Education in Paramedic Science (FHEPS) group. In 2022, when a significant amount of work had been completed by the Scottish PAD working group, it was indicated that the professional body, the College of Paramedics, was starting a project to develop a UK national PAD. The idea was to offer some standardisation to aspects of all preregistration programmes, and also to align this more strongly with the transition into practice as a newly qualified paramedic (NQP) and beyond. The lead for the Scottish PAD project met with the College and it became apparent that the work that had been done in Scotland was in line with the ethos and position the College were seeking.
An early decision was to change the terminology from practice assessment document (PAD) to portfolio of practice based learning (PPBL), thereby encouraging the move away from thinking of this as purely a preregistration assessment element to complete and submit to qualify, but the beginning of a lifelong journey of personal development and learning in whichever direction the profession takes an individual.
Subsequently, the work done by the Scottish HEIs has now become integral to the development of the PPBL to be made available to all preregistration programmes in the UK through the College.
Conclusions
The work in Scotland is currently at the stage of each HEI taking the principal document and working with their chosen digital provider to build for piloting. Some HEIs have decided to adopt the PAD in its raw form and deliver it in either paper format or via a virtual learning environment, e.g. Blackboard, Moodle. As the document aligns to the new SoPs for paramedics that need to be delivered to students from 2023, it makes sense to deliver from September 2023, even in a rudimentary format. This will also allow for gentle introduction of the different reporting formats and needs to all stakeholders. The work with the College of Paramedics continues a pace with the PPBL being developed for trial by an English HEI. Due to timing of their programme review and development, they were asked by the Head of Education for the College to take this forward. Next stages will be to pilot and to evaluate implementation of the Scottish PAD and the national portfolio.