Paramedicine education: Navigating moments for transformation through research

Paramedicine education is at a critical juncture in its evolution, providing an opportunity for the scholarly community's focused attention. Although the destination remains nebulous, the trajectory of the profession indicates that health professions education scholars, inclusive of paramedicine, should heed the progressive signals. Increasingly we see ‘education’ implicated in topics related to professionalization efforts, ¹ to support system innovations and visions, ² personnel well-being, ³ clinical advances, ⁴ and much more. This suggests the need for active paramedicine researchers to create, identify and respond to ‘moments’ for further education research. I focus on this concept of ‘moments’ to stimulate our awareness of them as a catalyst for education research, to promote engagement with the broader health professions education research community, and to examine the role of ‘uniqueness’ when considering scholarly pursuits and contributions.

Moments

While the need to attend to education in paramedicine is clear and warranted, its progress has been inconsistent and fragmented, revealing critical ‘moments’ that stimulate further research and development. By moments I mean stimuli for further research, points of critical experience, observation or a juncture that reveal significant insights or opportunities for deeper inquiry. These can also be critical instances that encapsulate a challenge, discrepancy, or a gap in education knowledge or practice, serving as an impetus for further investigation and improvement. For example, when lagging educational solutions to advances in models of care are systemic,^4,5 this can be viewed as one of those ‘moments’.

There are several examples of ‘moments’ that have shaped education outside of paramedicine. For instance, in the early 1900's, there was widespread concern about the quality and consistency of medical education in the United States and Canada. ⁶ Education lacked standardization and regulation, leading to varying degrees of credibility and rigor, eroding public trust. The Carnegie Foundation commissioned a report led by Abraham Flexner that led to widespread educational reform including more stringent education standards and expectations, ultimately shaping the medical education framework for decades to follow, ⁶ and as a stimulus for looking forward even 100 years later. ⁷ Several additional ‘moments’ have led other health professions toward new research, educational reforms and innovations (see for example the Peplau Report for Nursing, ⁸ the Gies Report for Dentistry, ⁹ the Millis Report for Pharmacy. ¹⁰ Frenk et al., (2010) identified concerns about the ability of health professions education in general to keep pace with health system changes or to solve persistent challenges. ¹¹ They noted how divisions of labor in the health professions also created divisions in education leading to important gaps between the complex realities of health care and how health professions education was structured. This ‘moment’ led to calls for education to, for example, transition from focusing on episodic events to continuous care and interdisciplinary practice. ¹¹

Paramedicine has its own ‘moments’ stimulating further education research. For example, in Canada in the 1960s, Dr Norman McNally identified the need to transform provincial ambulance services that at the time ranged significantly in structure and quality. In addition to introducing new regulations, this also served as an impetus for new educational standards. In the United States in the early and mid-2000's, researchers were beginning to explore the concept of medical necessity and noted how the evidence in support of paramedics engaging in these decisions was lacking. ¹² Here education was and continues to be a factor, suggesting education researchers may not have fully taken advantage of strong signals to address this issue,^13,14 although this can vary internationally. In the early 2010's educational leaders in the United Kingdom identified how education was in crisis. ¹⁵ Poor educational standards, most of which were locally derived, were a threat to the quality of paramedic education and ultimately the provision of healthcare, as well as the advancement and sustainability of the education system and profession overall. ¹⁵

These system level ‘moments’, as opposed to specific research gaps, can expose the misalignments in educational issues or strategies and available evidence. Thought of in this way, disconnects between education and healthcare practices, learner needs, health system requirements and priorities, societal shifts, professionalization trends and much more become apparent. If we look closely, significant disparities and shortcomings are evident in areas such as competency frameworks, how credential offerings are leveled, accreditation expectations, interprofessional educational expectations, and the organizational placement of paramedicine education within academic institutions. With some exceptions, professional silos in the education context are more the rule than the exception and pedagogy or curriculum may be overly static or slow to change, sometimes creating bottlenecks or negative consequences for paramedics, the public, the system and/or the profession. Contemporary or anticipated healthcare challenges that are being addressed with new visions about how to advance paramedicine, ² are likely to struggle in their implementation without first “enhancing knowledge” – including the capacity and desire for knowledge production through education research. ²

These observations, some with implications larger than others, are simply to demonstrate visible ‘moments’ that underscore the necessity for innovative pathways and accelerated advancements in paramedicine education research. Moments or catalysts for further research span paramedicine contexts but are not always or exclusively in the domain of paramedicine education.

Health professions education: paramedicine as unique or not

The challenge for paramedicine and this journal, is to recognize when paramedicine education should be considered as unique or not. In many ways, paramedicine is not unique. Most educational principles and the most compelling educational advances are those that are generalizable or transferrable across contexts. For example, good assessment principles, ¹⁶ or principles guiding the development of expertise, ¹⁷ do not discriminate between physiotherapy, nursing, medicine or paramedicine, even if they may be applied differently. Anchoring paramedicine education work in this broader health professions education research community is vital to the advancement of the broad educational gains, as well as paramedicine education system. This also positions education research as a solution to existing and future profession, learning and health care problems.

Today there is a growing community of health professions education researchers leveraging a broad range of methodologies, theories, conceptual frameworks, paradigms and practice focused advances (see the Wilson Centre for Health Professions Education Research as an example). There are now journals, professional associations, international conferences, funding streams, research centers, and graduate education programs and units dedicated to the field of health professions education research. This is a distinct area of scholarly education inquiry with the participation of most if not all health professions contributing to the advancement of education and its contributions, including paramedicine, but perhaps with not enough of paramedicine. Amongst these scholarly conversations, the paramedicine voice is infrequently present or heard. If the aim is to leverage and advance paramedicine education and understand its role, engagement with this broader community and literature is appropriate and necessary.

There are places where research specific to paramedicine education may be needed. For instance, there may be need to explore our educational processes (e.g., how and why we scaffold learning and progress) and structures (e.g., where education is provided and by whom), where there is uncertainty (e.g., optimal supervision models), where intended and enacted educational activities come apart (e.g., work-place learning), what role education has as a professionalization strategy or how we engage with health systems. There may also be a need to examine philosophies and principles that are guiding our educational choices and pathways. For example, an academic lens which places high value on knowledge, might lead one to conclude that higher education (e.g., university degrees for entry to practice) emphasizing theoretical, scientific and breadth of knowledge provides the necessary foundation for the profession (as Flexner did). However, those holding a vocational lens may disagree, advocating instead for a focus on practical skills and profession-specific practice readiness, arguing anything else is unnecessary, even problematic. Other examples include what counts or should count as readiness, how we scaffold scopes of practice, what related person-level competencies (e.g., cultural awareness, identity, wellness) are needed, or the academic homes or departments of paramedicine education. Even here, in the academic basis of paramedicine education, there is considerable variation with no clear understanding of what this means for the profession or health care system more broadly, and this is clearly a contextual issue.

The reach of education research

Paramedicine education research transcends traditional boundaries, serving as a pivotal force in addressing systemic issues and policy. For instance, in addition to supporting clinical practice, researchers might explore the role of inequities (or other social issues) perpetuated by our educational systems and structures, how education fosters a particular kind of identify or culture, or what role education plays in supporting health care system advances. These too are ‘moments’ that require our attention. Recently, authors have discussed the role of education in informing and shaping policy and practice in healthcare and the health professions. ¹⁸ Often educators are the recipients of policy change. For example, innovations such as the decentralization of healthcare or more integrated models of care lead educators to then structure and implement supportive educational strategies. However, health professions education research may also be how healthcare policy or practices shift. For example, there is large and growing body of research exploring interprofessional education and collaborative practices. ¹⁹ Recent research exploring these same concepts but for non-collocated (i.e., dispersed or distributed) teams is changing how healthcare policy makers are seeing opportunities for new models of care. ²⁰ Other examples include how continuing education and quality are linked, ²¹ how systems are to balance service and education, ²² or how the use of system or patient data can serve as performance data for educational needs analyses as a means of structuring data collection in clinical spaces. ²³ In other words, paramedicine education researchers need not focus narrowly or only on clinical educational practices. Doing so may limit our ability to see and leverage several other ‘moments’ in need of attention and the kinds of education related discussions we can and should have through Paramedicine.

Conclusion

In Paramedicine we seek to ignite rigorous scholarly debate that curates a repository of evidence that will underpin the ongoing transformation and improvement of paramedicine. This work is underway, and we continue to encourage breadth in these endeavors. As a profession, paramedicine is poised for substantial progress, yet it confronts many ‘moments’ where education has a role that must be rigorously studied and reported. Stronger connections with the broader health professions education research ecosystem are likely to promote mutual enrichment and a more robust collective knowledge base. Although paramedicine education shares commonalities with other health disciplines and can benefit from universally applicable educational advances, it also presents distinctive challenges and prospects that at times necessitate specialized research and creative solutions. The education research community for paramedicine must be responsive to and help guide the dynamic demands of education, the profession and healthcare system. By engaging in this research – shared here – we can collectively create that future.