Bloques y Frentes de las aCCu en el Caribe

Participants highlighted a number of barriers facing ambulance services in finding the right person for the preceptor role. These barriers include the need for preceptors to be: experienced as a paramedic; a capable paramedic; a capable preceptor; and willing to undertake the preceptor role. With regard to experience as a paramedic,

104 the vocational or tertiary models they are allocated a learner, without the opportunity to consolidate their knowledge and gain experience. Brian and Chris explained:

There is an expectation within our organisation that qualified officers

[paramedics] precept both interns and qualified staff, new employees in the organisation. (Brian)

Whenever you got qualified you worked with a student as such, whether it was an intern, probationer, or uni ride-along. As soon as you get qualified you just get put with one of those people. (Chris)

The move from a vocational, apprenticeship model of paramedic education, outlined in Section 1.3.2, to a tertiary model reduced the number of employed paramedic students, as the industry went from employing students for a three-year period of learning to employing interns for one year of workplace learning following graduation and prior to being permitted independent right to practice as a paramedic. While this change reduced the demand on paramedics to work with paid students, conversely there has been a substantial increase in student paramedics seeking placement from universities across the country. The impact of this change was highlighted by Samantha, whose initial assertion was that learners employed in her ambulance service are better off under the new system, but then she acknowledged (with some prompting) that university students on placement receive less than ideal support:

Because we have only got 6 interns in the region now, they are getting the higher level, higher quality preceptors and then when it comes to the ICP students, they get the regular ICP preceptors and return to work people were getting that sort of stuff as well, so it’s all quite a positive training experience at that moment… [the university student

105

students are] not necessarily getting the best people, we got flooded with them this year, there are quite a lot of them… (Samantha)

While it could be argued that the change in educational model may provide some explanation for the lack of choice in undertaking the preceptor role in the current system, Simon confirmed that the lack of choice is not a new problem and precedes the university model:

I’m talking about what, 10 to 15 years ago, we were just lumped with a junior paramedic who we had to mentor through their basics… the paramedics were just told “you are going to have your level one or you are going to have your level two and you are working with them”. (Simon)

A recurring theme amongst responses was that to be a preceptor paramedics must first be good paramedics. The concept of a good paramedic was not explored further in this study, however it presents a potential question for future investigation, seeking

information on what paramedics think constitutes a good paramedic. During data analysis I find myself wondering if there is a relationship between professional

experience and the concept of a good paramedic, as inexperienced paramedics will not have had exposure to more than a narrow range of clinical presentations, and mostly under supervision. Therefore, can a new graduate having just completed their internship be considered a good paramedic, and therefore are suitable to be working with learners? This theme emerged through the data in my research; for example Tracey described the concept that first paramedics need to be good paramedics:

I think to be a good preceptor, you have to be good at the paramedic role in the first place and some of these people are not good in that

106 role [the paramedic role] and then to top it off they are perhaps not

the best for the preceptor role either. (Tracey)

While being a good paramedic was identified as an important element of being suitable for working with learners, the reverse was not considered to be true, that all good paramedics are good with learners. Accepting that not all paramedics are suitable for or have the capabilities for the role of preceptor further supported by Lisa:

I don't think that that blanket rule [that everybody should work with learners] suits everybody. There are some fantastic paramedics out there that just shouldn't teach. (Lisa)

The final barrier reported in this study to finding the right person for the preceptor role is finding someone willing to perform the role. This is not to suggest that there are no paramedics willing to take on the role, but more that willingness is something that can be identified through communication, and which is also affected by the paramedic’s capability of performing the role, as already discussed. Ira explained:

It is really hit and miss, from a mentor’s perspective, you know this paramedic might be really interested, keen and good and can have the package to develop new staff, the next paramedic might be really keen at it but not be very good at it. A paramedic might be good at it but not keen at it. You know, or any combination of those variables. (Ira)

The factors that affect willingness to undertake the preceptor role became a point of discussion for a number of participants. While some reported being intrinsically motivated by their own job satisfaction, others also spoke of extrinsic motivators such as career development and opportunities such as progression in the education field (motivators will be discussed in further detail in Section 8.2.1). Additionally, including

107 reward systems for performing the role, such as a monetary reward, emerged as a common thread within extrinsic motivation. Yet, as Kerrie explained, it is possibly a poor choice of motivator as it is likely to result in the wrong person in the role:

… people that are good at it need to be picked to do it, not the people that don't want to do it… remuneration is bad to offer because people will then do it for the wrong reasons, not because they want to (Kerrie)

Kerrie further outlined that the selection for the role of preceptor should require a selection process and be based on an assessment of staff by their station manager. As Kerrie reflected, a station manager should have the following in mind when deciding who to appoint to the preceptor role:

"these people are really good, they are keen and they are switched on, they are up to date, they have an interest in training". (Kerrie)

In summary, the practice of expecting all paramedics to act in a preceptor role comes with a number of risks for role performance. While there are a number of paramedics to select from, the lack of experience, capabilities in either the paramedic or preceptor role, or the lack of willingness to undertake the role can result in the wrong person being cast as the preceptor.