Developing Practice and Peer Education

Developing Practice and Peer Education

Introduction

A Practice Educator is defined by the College of Paramedics, (COP), (COP, 2017) as a multi-faceted role with numerous clinical and educational responsibilities towards the learner or student paramedic such as being a good leader, role model, assessor, mentor, coach and teacher in a practice based educational environment. The NHS Leadership Academy, (2019), believes that leaders differ to managers, with their policies, rules and procedures because they are made to show initiative and adapt to situations. Leadership emphasises teamwork, collaboration and connectedness and allows for original thinking and good communication allowing for new perspectives (Alimo-Metcalfe and Alban-Metcalfe 2008; Hartley & Benington, 2010).

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The King’s Fund Review, (2012), also found that a more challenging approach to leadership would make for better engagement and would allow for more diverse perspectives as previously mentioned and unlock a wealth of experience, leading to a stronger organisation with larger potential. Jackson, (2000) and Eriksen, (2001) evidence that empowerment comes from communicative, democratic and/or shared leadership and that discussion and deliberation between all parties are needed to make this a success.

Wheatley & Frieze, (2011), believe that the onus is on these leaders or PEd’s (practice educator’s) to become hosts to their learners’ journey and as stated by the Health and Care Professions Council (HCPC) (2018), provide a safe learning environment in which the right levels or supervision and autonomy are considered on a day to day basis.

When I conclude I will reflect on how this piece of work has changed or not changed my views on practice education and how, moving forward I will be applying these to my own practice and improve and develop as a paramedic. 

Learner outcome 1. 

The HCPC, (2018), state that effective practice-based learning comes from having the correct staffing levels, qualifications and/or appropriate experience to deliver the specifics of the job role in a safe and effective way. It’s also believed that if Practice Educators (PEd’s) are involved in the assessment of the student then they should be prepared to go through training to maintain their own training. If these PEd’s are prepared to complete training and maintain their knowledge, then they are more likely to create a positive and effective learning environment for a student. The question must be asked though that if in a profession that has only been registering its members since the year 2000, does this give the current paramedics enough time, experience and knowledge to become a positive, clinical mentor. Lane, Rouse & Docking, (2016), believe that insufficiencies of the paramedicine mentoring model need to be investigated to enable the improvements to be made to bring it alongside other allied health professionals such as nurses and midwifes.

Lane, Rouse, & Docking, (2016) state that practice educator frameworks began in other health care professions such as midwifery and more prominently in the nursing field where professional mentoring is already well established. In contrast to nursing, mentoring in pre-hospital practice in the UK is a relatively new phenomenon, although it is an expectation of the HCPC that student paramedics are supported by “practice educators” (HCPC, 2017). In the study by Lane, et al (2016) approached the subject of learning from healthcare professionals who already have these established education and mentorship models and maybe allowing them to be mentored by current mentors, allowing for an outlet for them as PEd’s.

Aliakbari, Parvin, Heidari, & Haghani, (2015) state that educational systems are guided mainly by learning theories and that teachers in whatever form, understanding the general principles can be more effective. Completing the relevant online personality and learning style assessments has enabled me to reflect on my current practice and the way in which I learn and act. As a VARK Kinaesthetic learner, I prefer a hands-on approach to learning, learning by doing and through experiencing, which I believe lends itself well to the ambulance service. In the Honey and Mumford (1986), which is an expansion of the fundamentals set out by Kolb’s 1984 model, I am a ‘Theorist’ learner, I approach problems through a logical process, rational and a perfectionist, again lending themselves kindly to the ambulance profession.

Although these learning theory tests can be completed online, Riener & Willingham, (2010) and later, Newton & Miah (2017), argue that there is a lack of evidence to prove that learning theories even exist and that learners learn from all forms of stimulus and to putting learners into boxes saying one learner can only learn one way but not another would be detrimental to their education. Reiner & Willingham (2010) would agree with the idea that learning theories don’t exist, and the learners learn from different forms of audio, visual and cognitive stimulus.

I believe that in the ambulance service behavioural theory is applicable but not the dominant theory, steering the behaviour of the learner and the PEd, when a stimulus appears a response is necessary such as a medical emergency and their reaction to this. This stimulus and reaction approach to learning, Hean, Craddock & O’Halloran, (2009) believe is the most effective learning style in a healthcare environment. Quinn, (2007) however, argues that behaviourist training methods can be flawed by something as simple as the student’s motivation to learn on any particular day and. not enough attention is paid to strengthen intrinsic motivation. However, Simbar, (2004) states that with a disciplined enough environment and the reward of praise from the PEd for a correct answer or correct action would be enough to negate this.

Breaking a task down into its component parts and acquiring a working knowledge of a new behaviour as is suggested in behaviourist theories is something that cognitivist learners disagree with, believing that the learner is better focused on a task if they know the importance or the physiology of the task in healthcare. Zargham, (2004) gives the example of taking a blood pressure measurement, where the behaviourist would gain a measurement and gain praise for this the cognitivist learner would learn the physiology of the heart, the pumps and the vessels and therefore become a more rounded paramedic.

As a future PEd myself, my personal opinion would be that in the ambulance service you evolve as a learner from a behaviourist learner, responding to stimuli such as completing a blood pressure measurement on a pale patient and receiving the reward of praise for recognising that this task needed to be completed. You then evolve whether that be through self-learning, university or PEd led learning to the cognitivist stage of learning and to what Zargam, (2004) and Bastable, Sudbury, Jones & Bartlett, (2017) describe as the ‘iconic stage’ of learning where the blood pressure measurement is completed and the reasons for this can be discussed and correct anatomical and physiological reasoning can be given.

Learner outcome 2. 

The HCPC, (2018) believes that assessments should be effective and fair, and progression and achievement should be allowed to be demonstrated through this process, a process which Kauffman & Mann, (2014) believe requires effective guidance and supervision. Against the HCPC, (2018), standards that a student should have a PEd who is suitably qualified, Thompson, (2015), established that newly qualified registrants who had inadequate exposure to clinical skills and thus lacking in experience were mentoring students.

In the ambulance service, Kauffman & Mann, (2014) state a learner is formatively assessed via observation, mainly by one singular PEd which O’Meara, Williams & Hickson, (2015) believe may be a concern as a singular PEd can lead to poor practice and conversely multiple PEd’s can struggle with confidence and resilience. Another concern raised is that of PEd’s trying to plan and develop their students’ skills in an environment which O’Meara, Hichson and Huggin (2014) describe as mobile and uncontrollable and therefore difficult to set specific timeframes to specific skills.

Although within the nursing environment, Cassidy, (2009) disagrees and states that the needs of the student are met better within the unpredictable environment and nature of the job catapulting the students into eclectic learning environments and allowing opportunities for the diverse learning styles and needs of individual students. A thought that transfers directly, I believe to that of a paramedic student.

A key factor to alleviate a portion of these concerns is to focus on the relationship between the PEd and their student and the mutual influence that one has over the other. This is not about power or autonomy but an effective leaders’ knowledge that in order to motivate and engage their student to achieve their objectives they need to work through them not against them. (Carter, 2011; Wheatley & Frieze, 2011),

Collinson, (2006) and Shamir, Pillai, Bligh & Uhl-Bien, (2007) both believe that this mutual influence may shape the approach that the leader uses with the student and that this influence may involve formal acquired power or that it may involve one showing the other passion, vision and a clear understanding of goals. This positive mutual influence in a relationship can improve service user outcomes by promoting collaborative practice. (Grumbach & Bodenheimer, 2004). This is not a one-way relationship or learning journey and as such support, feedback and guidance for both parties is essential (COP, 2013; Hyatt, Brown, Lipp, 2008).

Although it’s talked about creating positive relationships and paramedics becoming PEd’s this isn’t always the case and there have been many reasons as to why qualified paramedics traditionally avoided mentorship roles such as a lack of motivation, a lack of understanding of learning styles and expectations of PEd’s (Collen, 2017).

One issue that can arise is that of a toxic mentor/PEd environment relationship which Gubbins & Hardwick (2019) believe may come from a toxic relationship between the learner and the practice educator (PEd). Gubbins & Hardwick, (2019) state that there are 4 toxic traits which stop a positive relationship from being established – See appendix A.

A toxic mentor, Vinales, (2015) feels, can also come from a feeling of being an imposter or the PEd having imposter syndrome and due to this, that they shouldn’t be allowed to mentor new staff. Haidrani, (2017), feels that imposter syndrome is something that we all face at one time or another but within healthcare being honest with yourself, reflecting and having someone close to you who is able to be critical with you can only be a positive thing and can reverse the sensations. This thought is mirrored by Houseknecht, Roman, Stolfi, & Borges (2019), who state that many professionals not just those in the care professions experience imposter syndrome, although adequately qualified and experienced believe that they will be exposed as a fraud, reducing confidence and competence. All of the above types of PEd inhibit a positive relationship and create a negative atmosphere in which this relationship can have no foundation.

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Sharples & Kelly, (2007) believe that the PEd should have the correct training and support in order to fail the failing student and that this should come from both education and practice. Duffy’s, (2003) study into failing students highlighted the challenges that mentors face in failing a student and the procedures they had to follow. Cassidy, Coffey & Murphy, (2017) believe that despite concerns about competence, mentors are reluctant to fail students and that this is a wider issue in healthcare education.

A way in which the failing student can be managed effectively is by action planning, setting targets and setting dates by which goals should be met (McKimm, Jollie & Hatter, 2007). One way on which action planning can be done with a failing student by using the SMART approach with Jones & Bennett, (2018) believing that involving and including students in their action plan can make them feel more included and therefore increase the effectiveness of the plan. Setting SMART action plans, Vachon, Camirand, Rodrigue, Quesnel & Grimshaw, (2014) believe enabled the PEd’s to target priorities for their student and also believe that this created improved professional collaboration between PEd, student and learning establishment. 

PEd’s should therefore be supported to integrate these action plans for both the failing student and also to stretch and challenge the over achieving student (Hyatt, Brown & Lipp, 2008). Although plans can be implemented, sometimes these fail and Cassidy, Coffey & Murphy, (2017) state that PEd’s shouldn’t feel the pressure to pass a failing student as they feel they would be failing a fellow professional but should feel supported and educated to do this by the learning establishment. When failing a failing student the PEd would need to remember that although COP, (2017) is bringing the role away from being a mentor to the Practice Educator, a role that in my opinion is more professional and less personal, that their concerns and issues that are being raised should be supported by their professional body and colleagues although this is a view that Cassidy, Coffey & Murphy, (2017) state is not the truth. 

Reflecting on myself as both a learner and a potential future PEd with a SWOT analysis I realised that although I was able to delve into my weaknesses, the opportunities that would arise from these and the threats to my learning I wasn’t able to focus on my strengths and was significantly more negative about myself and my learning. I reflected upon this and was able to empathise with an ‘external’ student coming into the ambulance environment for the first time and that their strengths may come from alternative avenues and that these were as key to highlight as the medical. I believe that this analysis is key to identifying a failing student over one who lacks in confidence.

After starting this module, I have acted on some of the research I have read both as a student and as a preceptor/mentor to a new Emergency Care Assistant (ECA) out on the road, beginning their journey through the apprenticeship programme. I believe that my experiences at university and on this particular module have made me appreciate my responsibilities. I have completed the personality traits testing and have also almost completed the entire Edward Jenner programme, gaining knowledge and insight into my own thoughts, feelings and views that I hadn’t previously considered. As an unofficial mentor to new ECA’s I am able to put into practice the learning styles and methods that I have learnt without having the overall responsibility at the moment which although helpful to my learning can be at times frustrating as I can see what needs to be planned for the student but it isn’t my place to do so.

Learner outcome 3. 

It is clear there are political drivers in training and maintaining paramedics due to many factors affecting the retention of paramedics within the ambulance services (Harris, 2019). “Paramedics are leaving to pursue development and new opportunities outside of the ambulance service, which is reducing the qualified and experienced workforce numbers” (Harris, 2019).

The Department of Health, (2003)The COP, (2013) “Paramedic Evidence Based Education Project” (PEEP), called for numerous improvements and changes to the profession and the way in which paramedics are trained pre and post qualification although stating that no research to date proves the most appropriate way of delivering this education and training.

In order to achieve the goal of an autonomous profession the COP, (2013) called for a more robust training and education system to be put in place. 6 years later and the proposed model of an all graduate paramedic profession is still something that although being worked on has still not come into fruition. Reading the research, it’s clear to see that the visions for the role of the paramedic and the actual view are very different, heading in the same direction but at times an ideal that is yet to be met. COP, (2017) stated that the aim was to achieve ‘Royal College’ status for paramedics to again bring us into line with other medical and health colleges, an aim that again is yet to be met. As a profession in its infancy having only been registered since 2000 it can only be a positive that these aims are in place and that the aim is to bring the profession in line with other more established health care providers.

Lane, Rouse, & Docking, (2016) study concluded that paramedics believed that their organisations didn’t do enough to recognise the extended or additional role as a mentor and that recognition could be given in numerous ways, one of those being an appropriate pay banding. From personal experience this is a contentious debate with the newly qualified paramedic programme limiting university qualified paramedics to a technician banding for a maximum of 2 years post qualification. HCPC, (2017) guidance states that PEd’s must have relevant skills, knowledge and also and I believe key to this argument, the experience to safely support effective learning. Can newly qualified paramedics with no previous experience be expected to have this experience?

With the paramedics in the above study by Lane, et al. (2016) already highlighting a need for recognition in terms of pay then on top of this to ask them to mentor within their first year could seem to be asking too much. Personally, from experience the best mentors that I have been under have been the staff who have years of the on the road experience before they have undertaken the paramedic course.

The operational pressures within the ambulance service lead to the additional need to support the staff at all levels both physically and mentally and in 2019, COP produced a five-year plan which outlined its intention to provide mental health support to paramedics and an intention to improve the wellbeing of its members. If this is successful then I believe that this will go a distance in helping to retain PEd’s and prevent a number of long-term sickness issues and subsequently providing the adequate numbers of trained and experienced staff that the HCPC, (2017) require.

HCPC, (2017) states that PEd’s must undertake regular and appropriate training and that this training will enable the ambulance service to retain its staff and reduce the poor staff retention numbers that are discussed by Harris, (2019). My personal experience is that barriers are currently in place, whether intentional or not that prevent this training and that so called ‘off road’ time is limited along with academic courses and alternative opportunities for these mentors/PEd’s to progress.

Learner outcome 4. 

Throughout my reflections within this piece of work I have considered what it is to be a practice educator, both being mentored by a PEd as a student and how I am going to implement this into my practice upon qualification. One of the key pieces of work completed during this process was the Edward Jenner programme and more specifically the piece of work by Wheatley, M. & Frieze, D. (2011). This has had a profound impact on my thoughts and feelings towards PEd as a process and my leadership and mentoring style both currently and moving forwards. Through this piece of work and through reading this research I have realised that meaningful professional relationships between a PEd and their mentee are built on ongoing feedback, creating development plans and also an understanding and support structure in place for their teaching establishment thus creating a constant support network between PEd, student and university.

Collaboration between these three components of learning can highlight any development areas as early as possible and through the aforementioned development plans and feedback can positively include the student in their own learning and their own improvement. I understand that as a PEd I have responsibilities, both to my PRSB’s and myself to ensure that I am competent and confident in my role and also be able to be a role model for my student and instil this confidence in them in order to develop them as a student, paramedic and one day a successful PEd themselves.

Appendix A

• Gubbins & Hardwick, (2019) state that there are 4 toxic traits which stop a positive relationship from being established:
• Blockers: Block learning and development of their student.
• Avoiders: Avoid situations that require building this relationship,
• Destroyers: Humiliating the student, refusing any feedback opportunities,
• Dumpers: Putting the student into situations in which they are not ready;