Paramedic turned educationalist 


Becoming a lecturer: See one, do one, teach one.
Paul Thomson-Elliott MCPara shares his experience of leaving the NHS and becoming a lecturer at the University of Sunderland.

Leaving the NHS having worked as a paramedic for some time, was a difficult decision leading me to question; Was there life outside of the NHS for me? Well, YES there was. My journey from paramedic to lecturer.

“Congratulations, we were impressed with your interview and the passion you demonstrate for education. We would like to offer you the post of ‘senior lecturer’ on the paramedic practice program”

This one phone call changed my career trajectory and how I would spend the next four years of my life, if not, the rest of my working career. 

Let’s take a step back; I completed a foundation degree in paramedic science in 2010, this was a program that was jointly delivered by a university and the local ambulance trust. The first year of my course was inspirational due to one tutor, who was not only an accomplished paramedic but an outstanding educationist. Setting the bar high, inspiring all students that they taught. Encouraging us to challenge what we thought it meant to be a paramedic, encouraging us to become critical thinkers and evidenced based practitioners.  This was 12 years ago so all being said, they were a true educationalist and advocate of the development of the paramedic profession. Above all, I remember the passion they possessed for the profession and subject they taught, this was infectious and provided me with a thirst to learn more. 

However, like a cruel twist of fate in a Hollywood blockbuster this tutor vacated the trust and was replaced by a what could be described as an ‘old school trainer’. They lacked theoretical knowledge, clinical ability, or any air of professionalism. This event right here, was the initial spark that ignited my interest in a career in education. I thought to myself; “I could do a better job than that.”

Fast forward a couple of years and the trust I worked for advertised for a clinical tutor in their training department. I saw my opportunity to pursue my career goal. This role was always going to be a steppingstone for me towards my career aspiration of lecturing at a university. I gained, what I thought was valuable experience (to an extent it was) however, on reflection I delivered training packages, concentrating on practical skills mainly surrounding advanced life support and trauma management rather than academic educational courses. While I developed such skills as classroom management, lesson planning and how to engage an audience that may not be that enthusiastic to be taught, it provided me with a false sense of ability regarding my educational prowess.

One year on, an opportunity presented itself and a position became available at a university teaching on an undergraduate paramedic program. I thought to myself, this was my time, this was my opportunity to achieve a career goal I have had since qualifying as a paramedic back in 2010. Having worked within the NHS from the age of 19, I had no experience of an interview outside of an NHS ambulance trust. The task of preparing for an interview, for a job in a world I had little experience of, was a daunting prospect.  I was pushed to develop an understanding of higher education institutes, the framework behind paramedic education, pedagogical theories, and high-fidelity simulation. However, self-reflection and assessment of my own strengths and weaknesses to formulate a professional development plan proved useful during the interview. They could see how I would fit into the university and how they could support and develop me into the team member they needed. 

That was four years ago, and in that time I have taught hundreds of students who have gone onto graduate and find employment in their chosen career. I am often asked by students why I left the ambulance service to pursue a career in education.  This isn’t a simple question to answer. I loved my role as a paramedic, and I will always remain clinical in one role or another but from the moment of thinking ‘I could do a better job as a tutor’ I wanted to prove to myself that I could. I help more patients now than I could have ever helped as a paramedic, educating the next generation of paramedics ensures I continually help patients. Finally, within academia you are in a privileged place to effect real change in the paramedic profession whether that be through research or raising the educational standards of the profession.

Developing as a lecturer requires both personal and professional growth. A wise colleague and good friend of mine explains this as ‘adding to your toolbox’.  The greatest lessons I have learnt regarding engaging students in a topic or how to ensure a lecture is interactive have come from observing colleagues from different disciplines such as sociology and psychology. As with your level of competence in clinical practice is an evolving concept so is your competence as a lecturer. You will never know everything however, you need to have the ability to develop students to enable them to take ownership of their own education and enable them to acquire the higher level thinking they require. Graduate attributes and preparing students for professional practice are essential components of being a lecturer. If you finish a lecture with the students enthused by the topic and wanting to know more, you have done your job.

Advice from personal experience:
Develop yourself as a clinical professional but also your own educational background, an MSc with a clinical focus is useful, however a post graduate qualification in educational practices is vital. 
Have a specialist interest in something outside of teaching clinical modules as this is such a small aspect of a modern paramedic program, law and ethics, communication theory, pharmacology, leadership, and management are just some of the topics you will need to be able to deliver. 
Develop relationships with your local higher education institute, gain some experience of lecturing prior to taking your first post.
Understand the role of a lecturer in its entirety, physical delivery of content is about 20 percent of the overall workload of a lecturer; pastoral support, dissertation supervision, marking, being research active and writing for publication are just some of the other elements involved.  
Don’t expect to be paid large sums of money, “academia is its own reward” true, but be realistic, in the early stages of your academic career you may earn less than you were making in your clinical role. Don’t forget this is a different role all together and the opportunities within academic are vast.

Final thoughts: a question for you.
Think back, to a lecture that you have attended, what makes that lecture stick in your mind? What was it about the lecturer that was so special? Be the lecturer that is remembered by their students’ decades after they were taught.  

Twitter answers:
Credible (ongoing experience active in the subject). Engaging (not just telling but conversational, joint learning). Not taking themselves too seriously and able to talk about own errors and misconceptions. Not ‘do as I say!’ but ‘listen to what I have to say! And review/consider.

The mixture between credibility and humility is so important but often not quite right. Some of my favourite teachers have left me saying to myself “wow you’re impressive…But also approachable and not a totally unrealistic role model”

Passion for subject taught, engaging and interactive, has humility, genuinely cares. My paramedic instructor (for my IHCD course) was all of these. He literally sparked joy in the lessons he taught. I owe him so much.
Encourage learning as a concept rather than facts or an idea.

Paramedics Need Degrees? Why?

Richard Taffler MCPara discusses whether paramedics need degrees.

06 04 2018

On the 4th July 1996 I joined Royal Berkshire Ambulance Service (RBAS) as a direct entry technician, or trainee assistant paramedic as we were called by RBAS. Six weeks of ambulance training, three weeks of driving, a week of local training and I was out on the road responding to 999 calls. My first shift was at Henley on Thames and the only job we went on that night was a murder . . . . I’d never even seen a dead body before, let alone someone who had been killed! 

In my first (trainee) year I was asked at least three times by my mentor if I was sure if this was the right job for me. I was hopeless at talking to patients (well almost anyone) and the old boys (and girls) frequently commented that this was because I hadn’t served my time in PTS before becoming part of the 999 team. They were, however, very supportive, and helped me to survive the first few difficult years in such a challenging job. 

A year later I started my 12-week paramedic course and qualified as an IHCD paramedic around 18 months after that first fateful shift. At that time a training officer turned up on the last Friday of your a & e placement, shook your hand and handed you a set of paramedic epaulettes for you to wear on your next shift! I think I was just about safe, clinically, but it was about 5 years into the job before I felt remotely comfortable talking to patients. 

In those days, the only career pathway for a paramedic was within the ambulance service who also didn’t accept any non-ambulance qualification as any indicator of clinical or other competence. A career for life, or at least until your back gave out…

In the following 17 years I have completed a MSc in Advanced Healthcare Practice, spent 5 years in clinical management before returning to operational ambulance duties and was a clinical representative on the College of Paramedics Post Graduate Curriculum Guidance Group. I have three jobs: Specialist Paramedic (Urgent & Emergency Care) for South Western Ambulance Service NHS Trust, an Advanced Paramedic for Devon Doctors Ltd (our local OOH primary care provider) and I’m also joining the RAF reserves as a paramedic. And I think I’ve learnt how to talk to patients too.

There has been a lot of discussion, particularly on social media, about the HCPC’s announcement that they are soon only going to register new paramedics who have a degree, and is this a good thing for the profession? Surely, it’s people skills that are more important? So let’s discuss this, and I’d like to state that these are my opinions, not my employers’ or those of the College.

The paramedic profession is only about 30 years old in any form that we’d recognise today and ‘paramedic’ has only been a protected title since 2001. We are still a new profession, particularly when compared to modern nursing, which can be traced at least back to 1860 with the establishment of the nursing school at St Thomas’s in London by Florence Nightingale. 

We used to be regarded, and by ourselves too, as the emergency part of the NHS. Unique, out on a limb, not particularly well integrated. This has changed massively in the last 20 years: now we’re a young, small profession (Figure 1) in the wider AHP community. 

Even as a ‘frontline’ NHS paramedic, my role has changed massively in the last 20 years. Then it seemed to be about carrying people in and out of the ambulance as much as it was about clinical skills. Resuscitations often involved squirting large volumes of drugs down an ET tube while waiting for about 5 minutes for the defib to warm up. Everyone who was involved in an RTC was boarded, rapid takedown of patients who had managed to get out of their cars before we arrived were routine...Lidocaine for pulsed VT...IV tramadol for analgesia as we couldn’t give morphine. 

How things have changed. I think I’m now expected to know almost everything about almost any condition (Google is my friend!). The demographics of my ‘ambulance’ patients appears to have changed. Increasingly I see complex patients with exacerbations of chronic conditions and those that would have previously accessed the NHS via other services such as primary care or would have just looked after themselves. On the flip side, we now use increasingly technical and complex equipment and a wider range of medicines. Resuscitations now potentially involve chest compression devices, biphasic defibrillation, drugs administered IO and significant emphasis on post ROSC care. On top of my paramedic exemption drugs (as defined by the Medicines Act), I’m now expected to use a combination of 54 medicine protocols and PGDs. The traditional NHS paramedic role is significantly more technical and academic than it used to be and I believe that the transition to a degree requirement for new registrants appropriately reflects these changes and developments, and not just in my Specialist role.

NHS England and the devolved nation equivalents are quite rightly trying to standardise aspects of AHP roles within the NHS, including titles, initial training and education. This has been facilitated by professional bodies along with other stakeholders such as HEIs and employers, and this is gradually coming to fruition. This will give colleagues, the public and aspirant AHPs an improved understanding of NHS roles and how they relate to each other, while, hopefully, enhancing patient care and safety. These include:

New entry to the relevant professional register requires a degree level qualification;
Progression to a ‘Specialist’ role requires a post graduate diploma and the relevant skills, knowledge and experience;
Progression to an ‘Advanced’ role requires a Masters degree and the relevant skills knowledge and experience;
Aspirant AHP independent prescribers should be working at ‘Advanced’ level, they must have the support from their employer, a doctor as a mentor, a role where prescribing is relevant and complete an approved course of study. 

I know that not all Allied Health Professionals (AHPs) have achieved all of these aspects yet, and, please note, I am not talking just about paramedics, but AHPs in general. 
Therefore, if you meet a specialist nurse, you will have an understanding of their competency and skill level, while they will also, hopefully, understand your ‘Advanced paramedic’ role.

For us, the College of Paramedics has been representing our profession in these developments and one of the first aspects to be published was the Paramedic Post Registration Career Framework (now in its 3rd edition). The Framework Diagram is below:

This has been enhanced by the Paramedic Post Graduate Curriculum Guidance document [insert link], published in 2017, and the Paramedic Digital Career Framework which is jointly published by NHS England and the College of Paramedics. Please take the time to have a look at these documents, they affect you, your colleagues and your profession.

The public, our professional colleagues and members of our own profession sometimes think of a ‘paramedic’ as someone who works on an NHS ambulance responding to 999 calls. These days, I think that’s a very blinkered and ill-informed view, even though that’s where most of us started out in our careers. A search of NHS Jobs for ‘paramedic’ yielded the following results:

• Health Visiting
• Ambulance Service
• Primary Care 
• General Practice
• Emergency Services
• Community Health Services
• Forensic Services
• Adult Mental Health Services
• Administration
• Research
• Senior Lecturer
• Health and Safety
• Prison Service
• 111 Clinician
• Management
• Immigration Services

The number and diversity of these paramedic roles continues to increase as new employers recognise our individual and collective skills, knowledge and experience. For everyone’s benefit we need to ensure that paramedics as a profession and as individuals are highly regarded and valued. The HCPCs requirement for new paramedics to have a degree is part of this. Rather than kicking against this change we should be celebrating the increasing inclusion of paramedics within the wider AHP community and the consequential recognition of the paramedic profession within the NHS and beyond.

As far as the original question of ‘do you need a degree to be a paramedic, surely people skills are more important’? No, you don’t need a degree. There are plenty of non-degree paramedics working in many roles. But I have four riders for this:

1. No paramedic course has consistently produced staff with good people skills. Mine didn’t, and that’s something that I think some of us can only develop over time. Having a degree or not isn’t linked to people skills. A new geeky paramedic who’s hopeless with patients may develop into someone who progresses far in their career. I did!
2. There are a number of paramedic roles which have little or no patient contact, but are quite academic. Please don’t be blinkered.
3. While you might not need a degree to do your job at the moment, your profession needs to progress with common AHP standards, including education, for the benefit of future paramedics, patients and UK healthcare.
4. The paramedic profession is increasingly complex, technical and requires an increasing level of academic as well as experiential knowledge. The changes in the last 20 years are incredible. The next 20 years are only likely to increase the complexity of our work and we need to demonstrate that we are individually up to the task ahead. Academic achievement will only be one aspect of this.

If you’re still unsure about this progressive change for our profession, then please talk to your degree qualified colleagues and perhaps consider a top up of your existing qualifications. 

And no, personally I don’t think current degree courses reflect the needs of the profession moving forward. I’d like to see a greater congruence between the patients that we’re seeing, and are likely to see in our careers, and the content of undergraduate courses. I’d love to see consultation skills taught as compulsory modules in year one and two of all paramedic degree courses. That would potentially benefit every patient contact in our careers...and may address some of the ongoing concerns with interpersonal skills at the same time? And how about a module on ethics & risk management? Rant over, but HEI’s please note!

Remember, we’ve achieved in just over 30 years what it’s taken nursing about 160 years . . . [insert link] [insert link]

Richard Taffler MSc BSc(Hons) BEng FASI MCPara

The opinions expressed by the various contributors are not necessarily those of the College of Paramedics. The inclusion of a blog does not necessarily imply recommendation of its aims, policies or methods. The College of Paramedics will not be liable for any errors or omissions in this information nor for the availability of this information.