The integration of theory with practice has been identified as an essential element in successful student development (Boyle et al., 2008; Michau et al., 2009; Wongtongkam & Brewster, 2017). There have been a number of studies that have explored the experiences of paramedic undergraduate students during their clinical placements (Boyle et al., 2008; Michau et al., 2009; Waxman & Williams, 2006; Wongtongkam & Brewster, 2017; Wray & McCall, 2009), and in many of these there have been a range of
25 negative learning experiences reported. Students report not being welcome in the placement location (Boyle et al., 2008; Wray & McCall, 2009), their role in the placement not being understood by paramedics (Michau et al., 2009; Wray & McCall, 2009), and experiencing a range of lost learning opportunities in either clinical care or through the misuse of down time (Boyle et al., 2008; Michau et al., 2009; Wray & McCall, 2009). There are, however, positive learner experiences also reported. For example, one Victorian study reported more positive experience in the early year groups, where the requirements of students are lower, while more negative
experiences occurred in higher level students seeking greater involvement (Boyle et al., 2008).
In an early study of student experiences in clinical placement Wray and McCall (2009) identified a range of lost educational opportunities and negative learning experiences which they attributed to preceptor factors. These factors included a lack of familiarity with the needs of learners, a lack of teaching experience and a lack of preceptor preparation in the face of the transition from the vocational models of education to a tertiary model. Their study, conducted in Victoria, suggests an overt resistance from preceptors toward students on placement, also suggesting that preceptors may feel threatened by the knowledge level of their tertiary students. Each of these points presented in this study are based on the information gained form a study of student perspectives, with no investigation of the perspective of preceptors. More recently, a study in NSW by Wongtongkam and Brewster (2017) investigated university student experiences as well as preceptor perspectives on the student placement. They found that students felt welcome in the clinical placement environment. This more recent study also found that students were able to gain opportunities to apply their skills and knowledge during the placement, only reporting lower opportunity when faced with low clinical case volumes. The difference between these two studies may be accounted
26 for by the time frame between them, as the tertiary model of education has become more embedded and a greater number of tertiary pathway paramedics are now in the workforce.
Expectation management is evident as an area poorly addressed in paramedic
education, with research indicating that university students are poorly prepared for and aware of what to expect when entering into a clinical placement, particularly in the face of the diversity in university programs (Hickson, Williams, & O'Meara, 2015; Williams, O'Meara, & Hickson, 2015). The relationship between preferred and actual placement experiences in health sciences students (including paramedics) was explored by Brown et al. (2011), who found that there is a need for greater communication between stakeholders in the clinical education experience to clarify expectations and improve the learning experience.
2.3.1 Who are the learners?
Paramedics supporting learning in the clinical setting are faced with a wide range of diversity in the type of student and education program they are required to support. For example, depending on what their clinical level is and where they are rostered, paramedics might be required to support students on clinical placement from
universities, graduate paramedics undertaking their internship, paramedics undertaking additional clinical education at more advanced levels (e.g. intensive care or extended care), or working with learners in return to work or remediation contexts. Only two studies give passing reference to paramedics working with both undergraduate
students and graduate interns (Boyle et al., 2008; Joyce et al., 2009), however Joyce and colleagues do acknowledge that there is a variation in the nature of the learning
experience required between these two groups (Joyce et al., 2009). This is supported by another study investigating the educational differences between Australia and the
27 United Kingdom, which suggests that graduates are exposed to a different work
environment than might have been pre-conceived whilst a student (Devenish et al., 2015). It is reasonable therefore to postulate that there would be further variation in the nature of learning experience for each of the other types of education programs identified. This is further complicated by the expanding demands on paramedic education to properly prepare paramedics for the changing work role they fulfil. One such change is working with the elderly, in the face of the ageing population and the reported findings that age is a high factor in the increasing demand for ambulance services. Lucas and colleagues describe compulsory clinical placements in aged care facilities and remarks on the challenges associated with finding suitable paramedic clinical supervision (Lucas et al., 2013).
In addition to paramedic learners, paramedics are often required to work with a range of other health professionals. There is limited literature exploring the clinical placement demands faced by paramedics from other professions, however this review identified studies from nursing (Melby, 2000, 2001; Nilsson & Lindström, 2017; Wallin, Fridlund, & Thorén, 2013) and medicine (Brown & Zimitat, 2012).