RETENCIONES EN LA FUENTE

The plan for phase two of this study drew on the data from phase one, where the frequency of technical skills used was identified, this was combined with the earlier identification, in chapter three, of paramedic skills that were graded as complex or simple, using rationale based on clinical grade and the existence of an accepted standard of practice within the profession.

Broadly speaking, the participants for phase two were, on average, within the first five years of their paramedic careers and from a university educated background. The reason for this may be that graduate paramedics are both more research familiar, and therefore willing to participate, and also that they are more comfortable with taking part in simulation.

Prior to, and following the clinical scenario, participants completed

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that the unskilled are unable to recognise issues within their own practice (Higginson & Hicks, 2006; Kruger & Dunning, 1999). Phase two of this study did not necessarily support this and perhaps aligned better with the concept that infrequent practice would result in degradation of competence (Pusic et al., 2012). Furthermore, focussed practise is required to develop competence (Ericsson, 2004). Another factor highlighted during phase two was the

complexity of clinical skills and the potential for them to be considered as solely technical. This was demonstrated well with the lack of attention given to

consent by participants.

There was significant difference in self-reported competence/confidence scores between each of the distinct skills. Pre and post scenario self-reported scores for confidence and competence were significantly different in both oxygen administration and intermediate/advanced airway maintenance; oxygen administration falling post scenario and intermediate/advanced airway

maintenance rising. This identifies that something during the scenario made candidates feel differently when completing the post observation questionnaire, perhaps indicating insight into knowledge and performance, refuting the above literature (Dunning et al., 2003; Higginson & Hicks, 2006). Comparison of pre and post self-reported competence correlated positively, as did confidence. A significant difference was also shown between the actual scenario scores for each of the distinct skills, indicating that participants did view them differently in terms of difficulty. Interestingly the self-reported scores did not align with the actual scenario scores. Pre observation self-report scores for competence and confidence, and actual performance showed no correlation. When the same post observation self-report scores were analysed, a positive correlation was identified for intermediate/advanced airway maintenance.

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In addition to this self-reported and scenario data there were some short

answer, open questions that were designed to obtain some basic reasoning for high or low competence/confidence, responses from these open questions were distilled into four broad categories

 Experience/Exposure to skills/situations

 Personal (FTP - tiredness, illness etc)

 Environment/scene

 Education type/frequency

The data from all aspects of phase one and two will be used in chapter 6 to explore the literature relating to self-perception and the Dunning Kruger effect (Kruger & Dunning, 1999), but also in relation to learning/education strategies such as deliberate practice and forgetting curves (Pusic et al., 2012).

5.5 Summary

Chapter five reported on the data collected during the second phase of this study. It offered a demographic overview of the 69 participants, highlighting that these were largely young university graduates, with a mean time practicing as a paramedic of approximately four years.

Comparison of self-reported competence and confidence scores between the selected clinical skills showed significant difference, indicating that participants perceived them to differ in their complexity. When pre/post scenario self- reported scores were tested, significant difference was also found with oxygen administration and intermediate/advanced airway management, perhaps suggesting that something happened during the clinical scenario with these skills. Further review of these pre/post scenario scores showed correlation between competence and confidence across all.

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Analysis of the scenario performance scores showed that participants did not score highest with the skills where they reported the highest confidence and competence. The two skills that stood out were oxygen administration which was rated the easiest but had the lowest scenario performance scores, and basic airway maintenance, that was rated the third most difficult skill but had the highest scenario scores.

Review of the demographic data with the actual performance scores and self- reported scores showed correlation with participants who were practice educators, who scored higher results when administering oxygen but lower when performing intermediate/advanced airway management.

Exploration of the open ended questions from the questionnaires highlighted some common themes that participants reported as affecting their

confidence/competence, such as educational, personal, experience and environmental.

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Chapter Six: Discussion

6.0 Introduction

This chapter examines the key results from both phases of this study, in relation to the aims and objectives. Discussion draws on relevant literature to enable exploration of the theoretical contributions made by this research. Following on from this, conclusions are drawn about the implications for paramedic practice, as well as future education and research. The main findings discussed in the following section relate to the paramedic role and the skills expected of them in contemporary UK practice; this will include discussion around what constitutes a skill, the prevalence of incident types and the frequency of certain skills.

Discussion then focuses on competence and confidence in skills used by paramedics, specifically exploring teaching and maintenance.

Perception of performance and actual performance is examined with particular focus given to the potential for a mismatch of these two factors and subsequent issues that may exist within practice are explored. The discussion in relation to competence, confidence, perception and the literature will lead to comment on future education, policy and direction of practice/development for paramedic skills.

In addition to the above, discussion around this area of paramedicine can be seen in appendices 17 & 18, a publication by the author based on phase one (Henderson, Endacott, Marsden & Black, 2019) and a poster based on the early

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findings of phase two, presented at the professional body, College of Paramedics, National Conference 2018.