The Theory-Practice Relationship in Paramedic Undergraduate Education

Abstract

A theory-practice gap has previously been proposed as existing in paramedic education. This proposal has been based on the literature, predominantly drawn from nursing, which describes the phenomenon as being a detrimental lack of congruence between the theory that is taught in the classroom and the experiences of students in the practice environment. This submission proposes, rather, that there is a ‘paramedic praxis’ where the relationship between theory and practice is such that the ‘gaps’ discussed in the nursing literature do not manifest in the same, potentially problematic, way. Paramedic students’ views of theory were found to be centred around the components of their programme taught at university, including simulated practice and procedural approaches to skills-based interventions. Practice was predominantly seen as engaging with ‘real’ patients in the out-of-hospital environment, where theory was utilised in varying degrees based on the curriculum area to which the theory related. Practice was also considered by some participants to include university-based practical workshops and simulation exercises. Therefore, the resultant views of theory and practice included ‘border areas’ where no discrete delineation could be found to exist between the two concepts. Paramedic students perceived varying degrees of inconsistency when relating their practice-based experiences to the theoretical components of their programme. These inconsistencies were found to be due predominantly to the contextual and situational challenges associated with the undertaking of paramedic practice, challenges which were considered by the students to be an expected part of practice-based learning and not detrimental to their learning experience. There was found to be a clear appreciation among students that theory can never be exactly matched by their experiences of practice, and not all aspects of practice-based experiences can be fully ‘unpicked’ by reviewing the associated theory, particularly when considering aspects of practice related to the social sciences. Paramedic Practice Educators considered themselves to be a catalyst for learning, a view shared by their students who considered that the role was of greatest benefit when the Practice Educator was an active, engaged partner in the learning process. Learning was, however, also found to have taken place in the absence of an actively engaged Practice Educator. The model of Paramedic Praxis developed through this research has informed the implementation of practices to enhance existing undergraduate paramedic and Practice Educator educational programmes. The model has been utilised when preparing students for practice placements with greater attention being given to encouraging students to better prepare themselves to make the links between theory and practice. Approaches to reflection and reflective practice have been made more practical and applicable to the realities of practice-based learning, supporting students to enter the practice environment with a clearer individual strategy of learning already considered. Practice Educator education has also been developed, both locally and nationally. The model of Paramedic Praxis has informed the development of curricula for academically accredited, paramedic-specific, Practice Educator short courses. The Zip Analogy component of the model has been incorporated as a core concept by the College of Paramedics in its promotion of the role of the Practice Educator as a facilitator of learning. Continued development of these approaches, based on the findings of this research, will go to supporting the development of student paramedics into lifelong learners who will, themselves, become the Practice Educators of the future.