The clinical transition of graduate paramedics from dependent to independent practice : a critical participatory action study

Abstract

INTRODUCTION Independent clinical practice is the pinnacle outcome for graduate paramedics in South Africa and abroad. Undergraduate paramedic students train under supervision to acquire clinical skills, knowledge and competencies deemed essential to independently manage critical patients. Irrefutably, there is a paucity of research in the South African Emergency Medical Care (EMC) milieu exploring the clinical transition of graduate paramedics from supervised students to independent practitioners. AIM Through a Critical Theorist stance, this study aimed to explore the clinical transition of graduate paramedics from dependent to independent practice at a selected university in KwaZulu Natal, South Africa. The focus was on how graduate paramedics transition from dependent to independent clinical practice and what mechanism/s should be instituted within the South African EMC profession to support the transition. METHODOLOGY An exploratory sequential mixed method design was adopted. Semi-structured interviews, focus group discussions and reflective journals were used to collect qualitative data. A Delphi study was conducted to validate the recommended support mechanisms. Thematic analysis was used to analyse and interpret qualitative data. Descriptive statistics were used to set a consensus level for the Delphi study. RESULTS Three themes and seven sub-themes were identified in the qualitative data. The identified themes included: i) transitioning into independent practice, ii) employee and employer relations and iii) quality assurance. The Delphi experts reached a consensus on eight recommended praxes that may support the clinical transition of graduate paramedics into independent practice: i) introduction of an internship period, ii) introduction of a workplace clinical mentorship program iii) restructuring of the BHSc EMC program, iv) incorporation of non-clinical workplace orientation program, v) implementation of a clinical case review system, vi) implementation of a clinical iv consultation system, vii) EMS management competency development and viii) introduction of psychological and emotional support services for graduate paramedics.

CONCLUSION The transition from students to professional practice is a crucial phase for graduate paramedics. This study highlights a need for all EMS stakeholders in South Africa to ensure consistent and standardized approaches to guide and support graduate paramedics as they transition to independent practice. Active involvement by the statutory regulators through the development of policies and systems to guide this critical stage of graduate paramedic’s professional development is paramount.