Graduates welcome on-road: A culture shift in ambulance preceptorship made clear through retrospective analysis

Abstract

A cultural shift in ambulance services has improved the experience of universityeducated paramedics going on-road for the first time in New South Wales. In the "bad old days", graduate paramedics reported routine rites of initiation, including barbed humour and contempt for skills gained in a university setting. Those educated in the on-road vocational system believed universities did not provide a tough enough environment for future paramedics. In this study, data were drawn from two projects involving university-educated paramedics who graduated between 1996 and 2011 and whose novice on-road experiences were several years apart. Comparative retrospective analysis of data provided evidence of a change in attitude towards New South Wales graduates, with an increase in support and inclusion. Novices with greater confidence in their own capacity was evidence of an attitudinal shift. Engaged on-road preceptors who won the respect of the novice was evidence of an increase in support. Inclusion had been a painful issue for both early cohorts of graduates and industry. Failure to fit is associated with attrition. Early in their on-road practice, recent novices reported a sense of belonging. The authors suggest that the shift in attitude could be attributed, first, to a critical mass of graduates on-road, including increasing numbers with postgraduate qualifications, and secondly, the stated preference of ambulance services in Australia to employ graduates.

Operationalising the Multidimensional Role of the Paramedic Preceptor

“…Consistent with the Council of Ambulance Authorities (6) definition of readiness to practice under supervision, most university paramedicine programs in Australia still require new graduates to undertake a period of internship, albeit of variable form and length, at the completion of their degree before becoming fully qualified (3). As such, an effective and positive preceptorship is essential to the future preparation of graduate paramedics (10). The importance of this on-road period of education has been recognised as the signature pedagogy of paramedicine (3).…”

Nurse preceptors' experience‐based strategies for supporting learning in the ambulance service—A combined focus group and dyadic interview study

“…There is thus a need to address the nurse preceptor role in the Swedish AS as there are no contextualized legal documents regulating teaching and learning, no national Swedish standards for preceptor training, while there are national reports claiming a lack of quality concerning clinical practice. Several research studies report of environmental barriers and challenges for learning in terms of negative workplace attitudes (Lazarsfeld‐Jensen et al, 2014), exposure to violence (Boyle & McKenna, 2017), high emotional demands (Williams, 2013) and limited learning opportunities (Kennedy et al, 2015) in the AS context. The literature concerning preceptors in the AS is limited (Carver and Lazarsfeld‐Jensen, 2018), but some studies indicate that there is sufficient experienced‐based knowledge among preceptors to adjust for challenges that occur when supporting learning in the AS (Carver and Lazarsfeld‐Jensen, 2018; Wallin et al, 2020).…”

Balancing structure and flexibility in the ambulance service: the pursuit of professional judgement in caring and learning

“…Conflicting views on the knowledge needs of AS professionals between higher education institutions academic schooling and the clinical objectives in the ambulance departments had previously been identified in the paramedic educational systems [16,68,[78][79][80]. However, the clinical practice in the educational programmes has been identified as an important function for intertwining conflicting views on knowledge and learning between academic schooling and the clinical realities of AS work [67][68][69][79][80][81][82][83].…”

“…Preceptors trained in adapting a student-centered and reflective attitude rooted in adult learning theory have been found to be important for facilitating the students' work role identification, professional, and personal development during clinical practice [87,102]. However, several studies report of barriers for learning related to paramedic preceptors' knowledge, student hospitality, and varying attitudes toward academic schooling [78,94]. A Swedish study from 2005 describes that new colleagues in the AS are often introduced via an instructive teachercentered model [45], which has been proven to be ineffective in supporting the intertwining of theory and practice and the students' ability to create a deeper understanding of their professional role [102].…”

“…Research from the Australasian paramedic educational system indicates that the preceptors have different views on, and approaches towards, how learning should be supported [69,78,83]. Research on preceptors supporting RNs clinical learning in hospital contexts indicates that there are role ambiguities and inconsistencies in the views on educational needs and learning strategies [103].…”