Developing a New Paramedic Curriculum

Outputs of the Stakeholder Engagement undertaken in 2023.

What’s driving this change?
Health and care requirements continue to evolve at a remarkable pace, the current environment of NHS Reform, Integrated Care Systems’ continued evolution, workforce challenges, austerity and economic uncertainty against a backdrop of post-covid recovery plans, unprecedented waiting times 
and increasing demand on services is resulting in pressure on the system like never before. This is before we consider population health needs; we have an aging and increasing population bringing greater demands on the system due to more complex needs. 

We all know that paramedics are in high demand now, and will continue to be so, recognised as an extremely valuable member of the modern health and care team. The ability of paramedics to operate autonomously, faced with an unpredictable and undifferentiated case load and in an environment upon which they have limited control makes us both unique and flexible and a growing asset in many parts of the health system. We have seen the popularity of our profession significantly increase in primary and community care over the last decade, the introduction of the additional role reimbursement scheme (ARRS) to support utilisation of paramedics within primary care further propelling the numbers. Initiatives such as virtual wards that are now coming to fruition across Integrated Care Systems (ICS’) are seeing further demands for paramedics. There is also growth in roles across secondary care that spans all levels of post registration practice.

We started with a very big question. Who are we? What is a paramedic?
Aiming to develop an accessible and inclusive curriculum for the 6th time that fuels the development of a modern paramedic, prepared to operate in a complex and evolving health and care system whilst maintaining the unique qualities and capabilities that set us apart from other health care professions. We set about clarifying WHAT IS A PARAMEDIC?

Historically paramedic programmes have prepared learners to focus on accidents and emergencies such as trauma and cardiac arrest. Though absolutely vital that a paramedic can confidently deal with such, these types of incidents represent a very small proportion of the calls that a paramedic would go to as a generalist ambulance clinician. The challenge we have is to incorporate learning and development of the wider skills to enhance capability and competence to perform optimally in the modern health and care world.

The consensus at the workshops was that the new curriculum must include:
• Risk stratification and confident decision making.
• Assessment and management of minor illnesses and injuries.
• Preparing for prescribing.
• Referral to care pathways and avoidance of unnecessary admission.
• Understanding patient’s journeys.
• Cultural Competence.

What is absolutely key, is that we retain the patient and service users at the centre of this activity and all future curricula review and composition, this will ensure that evolving service construction, changing demographics and population health needs are considered appropriately.

Conversations with colleagues in NHSE from the perspective of patient safety monitoring suggest areas such as abdominal assessment, Addisonian crisis and ECG recognition require some additional focused attention and thought. This echoes the discussions in the stakeholder workshops where the need to prepare our new paramedics to undertake thorough, holistic patient assessments thus enabling them to then make sound clinical decisions with robust risk stratification, considering all key factors and primarily seeking solutions for the patient that negate the need for a trip to an Emergency Department was highlighted on many occasions.

It’s imperative that Leadership be emphasised in the pre-registration programmes, enabling our future paramedics to recognise their roles as leaders within the health and care system from the outset not just at first promotion. There have been recent publications highlighting challenges with some aspects of the culture in practice, particularly in NHS ambulance trusts, the narrative emphasises the importance of visible and accountable role models that are accessible to enable freedom to highlight poor behaviour and commence the journey of change. Empowering all paramedics as the leaders that they are from the outset will hopefully assist in addressing some of the historical cultural issues.

Indeed, we heard overwhelmingly from stakeholders that the curriculum should encompass appropriately all four pillars (domains) [clinical, education, research, leadership] of practice, introducing education for lifelong learning in the Foundation Preceptorship phase following graduation and 
covering research in a meaningful and engaging way. 

As a result of the stakeholder engagement we have defined a paramedic at the point of registration:
The College of Paramedic’s defines a paramedic at the point of registration as an independent, graduate-level, generalist clinician commencing a journey of lifelong learning. Approaching their patients holistically, they draw on a range of systems-based assessments, diagnostic tools, and interventional skills; and are able to manage an undifferentiated, diverse, and complex case-load of patients, including the critically ill and injured, doing so in environments over which they have limited control. They advocate for their patients, stratifying risk and navigating changeable health and care systems to implement appropriate person-centred management plans autonomously, and as part of a multidisciplinary team. They support and supervise colleagues, as well as seek advice and support when needed. They exhibit professional values, attributes, skills and knowledge across the four domains of practice that are underpinned by ethical reasoning, research and evidence.

Practice Based Learning
In the last quarter of 2022 colleagues at Health Education England (HEE) undertook coordinated activity across 5 regions (the other 2 HEE regions undertook the activity in 2021) to engage with the learners and educators of paramedic programmes in order to collate a view with regard to the experience of paramedics learners and their educators in practice.

Though there is lots of great practise out there around paramedic learners on placement and in clinical settings, there remains opportunity for improvement. A real challenge is the difficulty in obtaining suitable sustainable placements across the wider health and care system due to the vast number of learners from all disciplines now requiring practice exposure, this includes post registration learners on advancing practice programmes, additionally the impact of queues and delays in handover at hospitals was consistently highlighted resulting in reduced caseloads for learners on ambulances.The reviews also indicated the need for better pre and post preparation of both learners and educators for practice placements, especially in areas and environments that paramedics do not routinely work.The seven workshops resulted in many discussions around the role of the practice educator (PEd) and the need for much greater support and recognition of PEds importance in the development of our learners – this links with the parallel work looking at Practice Assessment Documents. The current 3expectation is that around 50% of learning will ideally occur in the practice setting, in reality placement is currently offering consolidation of learning but little actual continued or formal education. If we are to achieve driven change with the new curriculum this is an area that requires radical reconsideration. Opportunities to learn and engage with teaching in practise should be abundant, a learners experience should not be dependent upon their PEd, consistent learning in practise should be a minimumexpectation for all. Having had the opportunity to discuss this with fellow Allied Health Profession (AHP) educationalists this is not a situation unique to our profession, but a challenge shared by many. The conversations around Practice Based Learning were lively in all of the workshops, and the subject of stipulating hours left many groups split, however a clear majority were in favour of articulating a minimum expectation of both placement hours and settings. We have therefore set a minimum hours expectation in this curriculum, the actual number of hours has been reached by pragmatically considering the wide range of hours currently undertaken across all programmes in the UK. The task and finish group responsible for this section of the curriculum faced a huge challenge and had to be cognisant of the varied challenges associated with placement attainment faced by all of the different paramedic programmes. Though we have every intention in future editions of adding detail around learning in practice that will include the utilisation of simulation, at this stage we have left this section as flexible as we could to enable all education and placement providers to work towards change if required. NHSE were another party keen to see hours stipulated to assist them in budgeting for placement tariff payments into the future.

Ensuring Learner capability
The universities are keen to teach a modern curriculum, embedding an ethos of evidence-based practice and encouraging learners to maximise their potential. There is however the constraining factor of face-to-face teaching hours, these are restricted by university academic regulations and often pose an issue for paramedic pre-registration programmes. Similar constraints pose a challenge around assessment, HEI colleagues face challenges within their institutions when trying to set suitable assessments as they are deemed by some to be too burdensome for the learners. Ambulance Trusts are then reporting concerns around the core capabilities of the new registrants they employ, this typically and consistently applies to resuscitation, drug knowledge and ECG interpretation.Some specific assessment approaches were agreed during the workshops and checked at the final consensus workshop.
These are:
• There must be a summative ALS assessment that aligns with RCUK standards (adult, paediatric and newborn)
• Pharmacology/Drug assessments should be open book with a pass mark of 80%

The employer challenge
A real dichotomy that was highlighted during the workshops is the competing priorities of the main stakeholders, the HEIs and ambulance trusts; the latter ideally would like a ‘road ready’ new paramedic with all of the clinical knowledge and skills, but also the moving and handling capabilities, major incident knowledge and preferably blue light driving ability. Over the course of the workshops we explored what was feasible and recognised the role of the employer in ensuring their staff have an appropriate induction and employment specific education and training.It was agreed that Major Incident knowledge was not required in detail during the pre-registration training as this would be covered in detail once within Trust, instead a suitable introduction is all that’s required. Moving and handling would need to be covered appropriately to ensure learners are safe and effective when on placement in environments across the health and care systems.
As it is not a professional requirement, driving will not feature in the College’s curriculum.

Downloads

The Paramedic Curriculum (6th Edition)