A model of continuous professional development for registered pre-hospital practitioners in Ireland

The introduction of a Regulatory body in Ireland with responsibility for ensuring high standards of education and professionalism for ambulance, and other pre-hospital, practitioners was a welcomed initiative in 2001 due to a need for improvement in care delivered to patients before arrival at hospital. This Regulatory body, the Pre-Hospital Emergency Care Council (PHECC), was established under Statutory Instrument with an initial priority being to develop three levels of pre-hospital practitioner: Emergency Medical Technician (EMT); Paramedic; Advanced Paramedic (AP). The introduction of these three levels meant that only such registered practitioners could practice in the pre-hospital environment. However for practitioners to renew their registration, they had only to meet simple and minimal criteria with no requirement to demonstrate any level of competence. The Council’s 2011-2014 Strategic plan identified the need to introduce a system of continuous professional development/competence as a priority. The purpose of the studies in this thesis was to engage with the three levels of practitioner in Ireland and to seek their views and opinions so as to identify factors that would inform the implementation of a continuous professional competence (CPC) framework for all pre-hospital practitioners. The expectation in when initiating this work was that the results would assist in the introduction of a framework for one group of registrants in particular, EMTs. In reality the outcomes from these studies provided the evidence base when drafting the formal guidance document that was subsequently issued officially to all EMTs in Ireland by the Regulator. Following that introduction of CPC, a retrospective analysis was performed through engagement with those registrants so to allow for further refinement of the process before the framework would subsequently be introduced to the two remaining registrant groups, paramedics and APs. At a practical level, this thesis represents the first series of studies to engage with all levels of pre-hospital emergency care registrants on a national level in Ireland and is one of only very few to report nationwide pre-hospital research. Data were gathered using qualitative and quantitative methods, in the form of on-line surveys and focus groups. These data then formed the basis for the initial introduction of the CPC model. After a six-month period, further engagement with registrants provided the additional data to refine the process further. Therefore, this work represented a meaningful process of consultation with practicing pre-hospital care providers that would inform the information to be provided to them by their Regulator and the format in which that would be delivered. To my knowledge, there is no previously published example of such relationship between pre-hospital practitioners and Regulators internationally. Further, the design of this thesis allowed additional engagement with Irish pre-hospital practitioners following the introduction of CPC. Through publication of the outcomes, the thesis makes a contribution to both the international literature on continuous professional competence (CPC) for pre-hospital practitioners specifically and, in particular, the development of the profession in Ireland. The implementation of CPC aligns Irish pre-hospital practitioners with other well established international best practice models. This thesis, through substantial engagement with registrants, has identified the factors which they believe are important for the successful implementation of CPC and adds to the international literature on pre-hospital care and, in particular, practitioner competence in this regard. The model of CPC will have significant implications for all registrants; organisations who operate in the pre-hospital environment; the Regulator; and will positively impact on patient care by ensuring a national standard of competence exists for all relevant practitioners. While Ireland has been the focus of this thesis, the publication of its findings in peer-reviewed journals means that its relevance may extend beyond the Irish setting to those working more broadly in the fields of continuous professional development and professionalism internationally

A national study of continuous professional competence (CPC) amongst pre-hospital practitioners

Background: Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the introduction of the first CPC framework for Emergency Medical Technicians (EMTs) and the imminent introduction of CPC for Paramedics and Advanced Paramedics (APs) in Ireland, this study aimed to identify attitudes towards CPC and factors that might influence such a framework. Methods: All EMTs (n = 925), Paramedics and APs (n = 1816) registered in Ireland were invited by email to complete an anonymous on-line survey. The study instrument was designed based on continuous professional development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results: The overall response rates were: EMTs 43 % (n = 399), Paramedics and APs 43 % (n = 789), with 82 % of APs and 38 % of Paramedics participating. The majority of participants in all groups agreed that registration was of personal importance and that evidence of CPC should be maintained; 39 % of Paramedics/APs and 78 % of EMTs believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, in excess of 88 % of all respondents indicated practical training scenarios, cardiac re-certification, e-learning supplemented by related practice, and training with simulation manikins were most relevant to these roles. However, least relevant to them were: e-learning alone (Paramedic/AP 36 %; EMT 35 %); project work (Paramedic/AP 27 %; EMT 48 %); and appraisal of journal articles (Paramedic/AP 24 %; EMT 39 %). Conclusion: Irish EMTs, Paramedics and Advanced Paramedics were supportive of CPC and favoured a ‘mixed’ model approach which includes: blended learning, practical skills, simulation, practical/team-based exercises, e-learning combined with practical skills, and evidence of patient contact. It is hoped that these insights will inform the CPC guidelines to be introduced

Continuous professional competence for Irish paramedics and advanced paramedics - a national study

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Continuous professional competence (CPC) for emergency medical technicians in Ireland: educational needs assessment

Background: As in other countries, the Irish Regulator for Pre-Hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), will introduce a Continuous Professional Competence (CPC) framework for all Emergency Medical Technicians (EMTs), Paramedics and Advanced Paramedics (APs). This framework involves EMTs participating in regular and structured training to maintain professional competence and enable continuous professional developments. To inform the development of this framework, this study aimed to identify what EMTs consider the optimum educational outcomes and activity and their attitude towards CPC. Methods: All EMTs registered in Ireland (n = 925) were invited via email to complete an anonymous online survey. Survey questions were designed based on Continuous Professional Development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results: Response rate was 43% (n = 399). 84% of participants had been registered in Ireland for less than 24 months, while 59% had been registered EMTs for more than one year. Outcomes were: evidence of CPC should be a condition for EMT registration in Ireland (95%), 78% believed that EMTs who do not maintain CPC should be denied the option to re-register. Although not required to do so at the time of survey, 69% maintained a professional portfolio and 24% had completed up to 20 hours of CPC activities in the prior 12 months. From a list of 22 proposed CPC activities, 97% stated that practical scenario-based exercises were most relevant to their role. E-learning curricula without practical components were considered irrelevant (32%), but the majority of participants (91%) welcomed access to e-learning when supplemented by related practical modules. Conclusion: EMTs are supportive of CPC as a key part of their professional development and registration. Blended learning, which involves clinical and practical skills and e-learning, is the optimum approach

Continuous professional competence (CPC) for Irish paramedics and advanced paramedics: a national study

Background: Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the imminent introduction of a CPC framework for paramedics and advanced paramedics (APs) in Ireland, this paper aims to identify factors that will inform the implementation of this CPC framework by seeking stakeholder input into the development of a CPC model for use by the regulatory body. Our secondary objective is to determine the attitudes of registrants towards CPC and what they consider as optimal educational outcomes and activities, for the purposes of CPC. Methods: All paramedics and APs registered in Ireland (n = 1816) were invited by email to complete an anonymous on-line survey. The study instrument was designed based on CPD questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results: The overall response rate was 43% (n = 789), with 82% of APs and 38% of paramedics participating. Eighty-nine per cent agreed that registration was of personal importance; 74% agreed that evidence of CPC should be maintained and 39% believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, respondents indicated practical training scenarios (94%), cardiac re-certification (92%), e-learning supplemented by related practice (90%) and training with simulation manikins (88%) were most relevant, while e-learning alone (36%), project work (27%) and reading journal articles (24%) were least relevant. Conclusions: Irish Paramedics and APs are supportive of CPC linked with their professional development and registration. Blended learning, involving evidence of patient contact, team-based learning and practical skills are preferred CPC activities

Additional file 1 of Perceptions of paramedic educators on assessments used in the first year of a paramedic programme: a qualitative exploration

Supplementary Material

Additional file 1: of A national study of Continuous Professional Competence (CPC) amongst pre-hospital practitioners

Core Questionnaire Summary. (DOCX 25 kb

A qualitative assessment of practitioner perspectives post-introduction of the first continuous professional competence (CPC) guidelines for emergency medical technicians in Ireland.

Background: In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)/ continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement. Methods: Five fora were utilised, comprising two distinct groupings: a group of student EMTs (n = 62) and four discrete groups of qualified EMTs (total n = 131) all of whom had commenced the newly-introduced CPC process. All 193 volunteers were members of the Civil Defence (an auxiliary/voluntary organisation) and represented a nationwide distribution of personnel. Responses were categorised as ‘perceived’ challenges to CPC, relating to student EMTs, and ‘experienced’ challenges to CPC, relating to qualified EMTs. Responses also included suggestions from both groups of EMTs on how to improve the current system and guidance material. Audio/visual recordings were made, transcribed and then analysed using NVivo (version 10). A coding framework was developed which identified unifying themes. Results: All participants agreed that CPC for pre-hospital practitioners was a welcomed initiative believing that CPC activities would help ensure that EMTs maintain or enhance their skills and be better enabled to provide quality care to the patients they might encounter. Two specific areas were identified by both groups as being challenging: 1) the practicalities of completing CPC and 2) the governance and administration of the CPC process. Challenging practicalities included: ability of voluntary EMTs to gain access to operational placements with paramedics and advanced paramedics; the ability to experience the number of patient contacts required and the definition of what constitutes a ‘patient contact’. With regard to the governance and administration of CPC, it was suggested that in order to enhance the process, the Regulator should provide: an outline of the CPC audit process; examples of cases studies and reflective practice; templates for portfolios; and should establish a central hub for CPC information. Conclusion: These groups of Irish EMTs appeared keen to participate in continuous professional competence activities. In addition, these EMTs identified areas that, in their opinion, required clarification by the Regulator related to the practicalities of CPC and the governance and administration of CPC. More information, dissemination of sample requirements and further effective engagement with the Regulator could be used to refine the current CPC requirements for EMTs

What clinical crew competencies and qualifications are required for helicopter emergency medical services - A review of the literature

Background: Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis.Methods: MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were systematically searched from 1 January 2009 to 30 August 2019 to identify peer-reviewed articles of relevance. All HEMS studies that mentioned ‘staffing’, ‘configuration’, ‘competencies’ or ‘qualifications’ in the title or abstract were selected for full-text review.Results: Four hundred one studies were identified. Thirty-eight studies, including one systematic review and onerandomised controlled trial, were included. All remaining studies were of an observational design. The vast majority of studies described clinical crews that were primarily doctor-staffed. Descriptions of non-doctor staff competencies were limited, with the exception of one paramedic-staffed model.Conclusions: HEMS clinical crews tended to have a wider range of competencies and experience than ground-basedcrews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.</div

Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper.

Background The Regulatory Body responsible for the registration of Irish pre-hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), identified the need to implement a continuing professional competence (CPC) framework. The first cycle of CPC (focused on Emergency Medical Technicians) commenced in November 2013 creating for the first time a formal relationship between continuing competence and registration to practice. Aims To review current literature and to describe benefits and challenges relevant to CPC, regulation, registration and their respective contributions to professionalism of pre-hospital practitioners: advanced paramedics, paramedics and emergency medical technicians. Methods Online search of Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus with Full Text), Allied and Complementary Medicine (AMED) and ‘Pubmed’ databases using: ‘Continuous Professional Development’; ‘Continuous Professional Development’; ‘emergency medical technician’; ‘paramedic’; ‘registration’; ‘regulation’; and “profession’ for relevant articles published since 2004. Additional policy documents, discussion papers, and guidance documents were identified from bibliographies of papers found. Results Reports, governmental policies for other healthcare professions, and professional developments internationally for allied professions (e.g., nursing, physiotherapy and medicine) link maintenance of competence with requirements for registration to practice. Conclusion We suggest that evolving professionalisation of Irish paramedics should be affirmed through behaviours and competencies that incorporate adherence to professional codes of conduct, reflective practice, and commitment to continuing professional development. While the need for ambulance practitioner CPD was identified in Ireland almost a decade ago, PHECC now has the opportunity to introduce a model of CPD for paramedics linking competence and professionalism to annual registratio