Preparing paramedic graduates for independent practice : an assessment of the effectiveness of a Paramedicine degree from a university in KwaZulu-Natal

Abstract

Introduction There have been major advances in prehospital emergency care policy, training and practice in South Africa (SA). One of the most notable changes is the transition of paramedic education from vocational technical training to university-based education. This change ultimately led to the development of the bachelor’s degree in Emergency Medical Care (BHSc: EMC) which is a four-year professional degree offered at only four accredited higher education institutions (HEIs) in SA. Since its inception, the degree itself has undergone many changes; however, despite these changes, its effectiveness in achieving its intended and espoused goal has never been investigated. Emerging from this knowledge gap is the purpose of this study – to investigate the effectiveness of the BHSc: EMC degree, specifically at an HEI in KwaZulu-Natal, SA, in preparing students for independent practice. Methodology The study commenced with a critical appraisal of a collection of documents that comprehensively described the version of the BHSc: EMC curriculum delivered during the years 2016 to 2018. The aim of this review was to specifically address objective 1 of the study, which was to examine the content, the instructional design and the minimum competencies that graduates needed to show on successful completion of the degree. This review was then followed by a sequential mixed method exploratory design, which was conducted in two distinct phases, and included the total population of all 45 individuals who identified as 2016–2018 graduates. Phase 1 consisted of interviews designed to specifically elicit the emic views of a purposefully targeted and informationrich sub-group of individuals (n = 18) also from within the total population. The goal of this phase was to use the elicited information to develop a contextually valid, relevant and bespoke questionnaire that was to be used in phase 2, where quantifiable participant responses from the entire population (n = 45) were then collected. Data from phase 1 was qualitatively and thematically analysed and phase 2 data was descriptively and inferentially analysed. Significant results at p < 0.05 are reported. Results The critical appraisal of the curriculum revealed that there was an obvious lack in an espoused consensus on the minimum standards for the degree. There was also notable misalignment between content and modules across subsequent and articulating years of the degree. A closer examination of learning outcomes revealed that they very rarely aligned with principles that ensured consistent clear and specific direction for what students could expect to learn at the end of the respective modules. The survey used to address objectives 2 and 3 achieved a 63% response rate. In relation to graduates’ work readiness, described as students being equipped with the foundational entry-level skills and resources needed to be minimally qualified for a specific occupation as specified by a job description or occupational profile employability, graduates revealed that their paediatric and neonatal assessment and management skills, and their rescue abilities, were not at the level that rendered them adequately prepared for even entry-level jobs. With regard to graduates’ employability, which while closely related to work readiness is defined as having the necessary skills and abilities that render candidates eligible for employment, graduates felt that while they met minimum job requirements, they lacked practical experience as well as confidence. They also alluded to the suggestion that certain aspects of the degree are not aligned with industry needs. Conclusion There is no doubt that the development of and compliance with minimum competency standards which are a result of national consensus will be the cornerstone for a more effective and efficient paramedicine degree. How those minimum standards are achieved and how and when content is delivered to achieve those minimal standards should also be a result of national consensus. In the absence of these standards, there exists the possibility that learning outcomes, content, learning and teaching strategies, assessments, alignment, educational philosophy and standardisation of the BHSc: EMC, which are core constructs for effective teaching and learning in SA paramedics, will continue to receive criticism as highlighted in this study.