Introduction
The Intensive Care Paramedic (ICP) is a crucial part of SAAS Service Delivery to the community of South Australia. As a group, they have a significant impact on the outcomes of patients and the experiences their colleagues have while at work. While their ability to positively alter the lives of patients is most obvious during the management of high acuity cases, as a result of being clinical leaders, ICPs have significant influence over the workforce at all times. ICPs are being observed and roll-modelled by those they interact with throughout their time at work. The highest level of professionalism is required at all times to ensure that we are positively impacting those around us.
Your internship is a key part of the transition from Paramedic to independent practice as an ICP, and focuses on practical (on the job or work based) training under supervision from senior colleagues, who also provide you with support, feedback, teaching, and assessment.
Your Post-Graduate education will have provided you with knowledge, skills and experience that will assist you greatly in succeeding with the ICP Internship. The aim of the program is to tailor your knowledge and skills so your role as an ICP with SAAS, while providing you with supervised practice so that you are able to expand significantly on the experience you gained while on placement. You will have the opportunity to apply, consolidate and expand your clinical knowledge and skills, and progressively increase your responsibility for providing safe, high-quality patient care.
Throughout the process, the outcomes focus on preparing you to autonomously provide safe, high-quality patient care. By the end of your internship, you should be able to demonstrate the skills and knowledge required for ICP practice with SAAS.
In this guide you will find information about the internship, including the program structure, supervision, assessment, completion, and how to be involved in your training.
You have rights and responsibilities as an employee. You will need to understand the terms and conditions and obligations of your employment, including your responsibility for safe patient care. You have the right to a safe workplace free from bullying, harassment and discrimination.
How is the internship structured?
The total duration of internship is 20 weeks (full-time equivalent) and begins with a 15-day induction workshop, run over 4 calendar weeks which is inclusive of 4 TOIL days to allow for Anaesthetics placements (3 adult, 1 paediatric). You will be expected to complete 16 weeks of supervised on-road practice which excludes annual leave. This period may be extended to allow you to achieve competency and the minimum amount of supervised on-road practice.
A senior clinician, called the course mentor, will oversee the intern training program. They also play an important role in supporting interns and liaising with mentors and CSOs.
What learning opportunities will I have?
The ICP intern workshop is a 15-day course designed to apply your university-acquired knowledge and experience as a Paramedic into ICP practice, through a series of theoretical case-based learning (CBL) exercises, simulation based education (SBE) and skill development activities. The sessions will be delivered by the course mentor, CSOs, senior SAAS clinicians, and subject matter experts, who may be external to SAAS. Simulations will consolidate theoretical knowledge and application to high-fidelity simulated environments, preparing you for your on-road supervised practice. At the end of the workshop, you should have a comprehensive understanding of SAAS ICP Clinical Practice Guidelines (CPGs) and how to apply them, Clinical Practice Procedures (CPPros) and skill application as well as a developing skill-set in non-technical aspects of ICP practice such as leadership, communication and reflective practice.
You will ideally complete the majority of your Anaesthetics placements prior to beginning your supervised practice to develop competencies in airway skills, however placement dates may be dispersed throughout the internship as they are dependent on hospital vacancies and operational requirements. You should meet with the Head of Anaesthetics at the start of your placement to define your learning objectives for the day and their expectations of you. To get the most out of your placements, be proactive and enthusiastic with your time and take any opportunities offered to you. Although you may find you don’t get exactly what you thought you would get out of your placement, take every opportunity to learn from the specialists. Remember that you are representing SAAS, and professionalism and attitude will be highly reflected upon. A lot of work has been done to create networks and relationships within the anaesthetic departments to develop ongoing opportunities for all SAAS clinicians.
At the start of each stage of your supervised practice, you should take some time with your ICP mentor to define learning objectives, their expectations of you, and your role and responsibilities in the team. This provides an important opportunity to designate the specific skills and knowledge that you would like to acquire during the stage. It is worth having the same discussion at the start of each rotation to review the progress on meeting goals and objectives and adapt as necessary. Including your ACTL in early discussions will inform them and you of each other’s expectations and guide them in how best to support you and your mentor during your supervised practice stages.
Your ICP mentor will complete Intensive Care Paramedic Intern Clinical Evaluation Reports (ICPICERs), and will identify learning opportunities and set agreed goals and performance improvement strategies. The goals should be specific, measurable, achievable, relevant and time-based (SMART goals) and will assist with getting the most out of training sessions.
Your course mentor will be committed to guiding and supporting you throughout the internship and will aim to tailor any additional training to your individual learning and development needs.
You will also have a minimum one scheduled shift with a CSO which aims to provide an additional platform to identify learning needs and to devise strategies on how to improve on them.
As well as structured teaching sessions, your internship is likely to involve activities such as:
• Reflective review of cases with your mentor
• Team activities, including:
- Function time
- Reflective case reviews (RCRs) with other staff
- Clinical mornings
• Sessions with mentors, CSOs, CEDOs, other ICP interns and health professionals including lectures and development sessions
• Simulation training
How will I be supervised?
During your internship, you will have continuous observational assessment at a level appropriate to your experience and responsibilities from a designated ICP mentor. These are ICPs who have been selected to mentor, based on their ongoing behaviour and practice exemplifying the key attributes of an ICP. It is unavoidable that your designated ICP mentor will be absent for some shifts (due to leave, sickness etc.). Where possible, you will be assigned another designated ICP mentor, however you may end up performing shifts with other ICP mentors. When working with an ICP other than your designated mentor, the supervision arrangements (how you should be supervised, where you are in your development, areas of strength and weakness) should be clear and explicit. If you have no ICP to work with you must work to a Paramedic ATP.
You will also have several other clinicians with supervisory roles:
• Course mentor – key point of contact for any issues that arise whether they pertain to development, assessment or personal issues that may affect your progression through the internship. The course mentor is responsible for organising and facilitating the induction workshop, assessments and ongoing development activities.
• CSO – contribute to overseeing your development in conjunction with your ICP mentor and course mentor. They will also observe your practice on specific ride-along shifts and will be a secondary source for clinical issues (after your course mentor).
• Lateral ACTL – they will liaise with your ICP mentor and course mentor to help facilitate the best environment for learning and development opportunities within the operational environment. They will be your key contact for operational issues
How will I be assessed?
Assessment is an important part of your internship, as it ensures you have acquired the skills and knowledge necessary to be recommended for independent ICP practice. To prepare, you are encouraged to seek feedback on your performance.
All assessment due dates will be provided within the assessment agreement and any problems relating to meeting deadlines should be raised with the course mentor and Clinical Education in advance.
The assessment has been based on current recommendations from literature as well as in consultation with other Australian ambulance services. The 3 key principles of your assessment are:
• Clear understanding of the process and transparency for all involved
• Assessment captures the essential information for the review panel for determining whether interns have met the requirements and standard and are recommended for credentialling as an ICP
• Assessment process is based on outcomes consistent with the ICP role description
Rather than a reliance on exams, the majority of your assessment will be based on observation of your on-road practice. This will occur constantly by your ICP mentor and will be used to complete ICPICERS. These assessments are not only to provide feedback on your performance and assist your professional development but also provide evidence to support the decision of the panel on whether you will meet the standard required for qualification of ICP.
Your mentor will be looking for whether you can demonstrate the skills and knowledge described in the ICP intern job description and will complete ICPICERS every 3-4 rotations to assess your performance and make recommendations on your progress. They are asked to assess your knowledge, clinical practice, communication, leadership and reflective practice against agreed definitions of a qualified ICP.
You will be rated as either:
• Meets SAAS standards of ICP practice. In respect to their ICP practice, the ICP Intern is:
- safe - effective - autonomous
• Minor development is required to meet SAAS standards of ICP practice
• Moderate development is required to meet SAAS standards of ICP practice
• Significant development is required. Below expected standard for this stage of their ICP internship. Examples of practice that align with these Performance Levels are listed within the ICPICERs, however the mentor will also base their decision on their experience as well as agreed expectations of you. Your mentor will provide you with evidence to support their rating. You must meet the expectations of an ICP across all areas prior to completing your internship to show that you are suitable for independent ICP practice. You will have the opportunity to comment on the mentor rating and any disagreements should be raised and discussed with your ICP mentor and course mentor as required.
A CSO will conduct a review shift with you in week 11 of your on-road component, with the potential for additional shifts if deemed necessary. This is designed to provide a second level of oversight as well as provide further learning, development and assessment opportunities. These shifts are designed to assess your practice in a real-world setting and you will be assessed via a mini-clinical evaluation exercise (mini-CEX) for relevant cases. The observations from the mini-CEX will provide specific examples of strengths and areas for development for individual case types. The CSO will form recommendations based on these review shifts that will provide evidence to support the decision of the panel on whether you should be endorsed for credentialling as an ICP.
You will complete two recorded TNA’s (Training Needs Analysis) during your internship. The first will be conducted at the completion of the induction workshop and is designed to identify areas for development. The second will be midway through your on-road period to show how you have improved in these development areas and how you perform under stressful conditions. Your sim videos will then be observed by members of your final review panel in order to provide further evidence for a broadly considered decision. The intent of recording the simulation is not only for final review, but also for transparency and to assist you in reflecting on your own practice.
You will complete a skills log during your internship to demonstrate competency in ICP-specific skills. There are target numbers of repetitions listed within the logbook for each skill which require completion to demonstrate competency. Due to the nature of your internship, it is unlikely that you will be able to perform all these skills in your on-road practice. Therefore, it is acceptable to complete these in simulated environments.
You will also complete 3 reflective case reviews (RCRs) during your internship. These are designed to develop the thought processes and structures to provide critical and informative review of your own practice to identify areas of development. This will also assist in facilitating RCRs with other clinicians, a key part of ICP practice.
All educational assessments, including the observed simulations, represent an observation at a point in time. Rather than being pass or fail assessments, they will all form a portfolio of evidence for the review panel to base their decision on.
Performance below expectations during these assessments will not define your expected outcome, however may or may not be discussed as part of your panel review process.
All of these assessment documents are available through your ICP course eLearning platform. We recommend you review these documents in advance so that you understand the requirements of each assessment activity.
Your ICP mentor, course mentor and ACTL will meet at the end of each phase of your internship and highlight any concerns or issues raised. If there are any issues with your progress, such as if you are performing below the level your mentors expect from an intern, as a group you will develop strategies to improve your performance. This is an immediate and natural process in the training program that aims to support your professional development. It will be tailored to your specific circumstances and jointly agreed with your ICP mentor, course mentor, CSOs and ACTL, and the outcomes may guide decisions around extra support or extension of your internship.
Completion
To successfully finish the internship, you must complete the minimum time requirements, complete all assessment items (as per your Assessment Agreement) and demonstrate that you have acquired the skills and knowledge expected from the training (ICPICERS, RCRs & Skills log). You must meet the expectations of an ICP across all areas of the ICPICERS to be deemed successful, although this alone may not mean automatic progression to an ICP ATP. At the completion of all assessment materials, you will apply to the SAAS credentialling committee for change in Scope of Practice to ICP. You will sit a final review with a panel consisting of senior staff. This panel review will allow you to provide context for your portfolio material as well as receive feedback to guide goal setting. The panel will decide on whether they will or will not endorse your application to the SAAS credentialling committee based on all available evidence collated in your clinical portfolio and discussions during your review.
If you are deemed successful, you will gain your ICP ATP and can apply for an advertised ICP position in NEEOPTS. If you are deemed to be unsuccessful, you will not gain your ICP ATP and will resume your substantive position at the clinical level of paramedic. Any appeals will to be conducted in accordance with the standard Clinical Education appeals process.
What if I need help?
Your welfare throughout the internship and as you progress further in your career, is of utmost importance. The ICP Internship can not only be physically, intellectually and emotionally challenging, but can also impact on those in your immediate family. There are many resources available to help you if you feel you need help. Starting points include speaking with your fellow interns, ICP mentor, course mentor, CSOs, ACTL, peer support program or the employee assistance program (EAP). The MHPs at Edward Street Psychology have extensive experience in assisting SAAS staff through training and development programs, and seeking proactively is encouraged. As is normal process with the EAP, strict confidentiality applies.
If you witness or experience bullying, harassment or discrimination, there are confidential pathways for reporting, addressing the issue and providing support.
What opportunities are there to be involved?
You have many opportunities to be involved in how your intern training program operates. Taking an active interest in your education and training will benefit both you and your fellow interns. Talk to your course mentor or CSOs to find out how to be involved. We will be seeking your feedback after the induction workshop and at the end of your internship on the entire process, and whether the internship adequately supported your development as an ICP Intern. We ask that you provide honest feedback, so that we can refine the internship to develop the best quality ICPs possible now, and in the future.
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