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›Paramedic Entry to Practice Programme

© WFA Clinical Education Team


Version Control This document has been peer reviewed and moderated. Changes to content must not be made without the approval of the Clinical Education and Training Manager – and a documented moderation process. All teaching packages should be reviewed biannually, or externally moderated. Moderation

Version Control Date Details 29/03/2012 Draft for review

Authorised T Mushet

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›Key Points of Contact •

Glen Mitchell, Clinical Educator Glen.mitchell@wfa.org.nz

Joan Swift, Rosters Specialist, Ph 027 622 1509 Joan.swift@wfa.org.nz

Sarah Parnell, Clinical Educator Sarah.parnell@wfa.org.nz

Team Manager Operations (TMO), Ph 027 675 2215

Todd Mushet, Clinical Education and Training Manager, Ph 027 221 9959 todd.mushet@wfa.org.nz

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Programme Objectives The following learning objectives are taken largely from the Council of Ambulance Authorities (CAA) Paramedic Professional Competency standards (PPCS) document, with some adaption for the New Zealand and local practice context. Interns will complete the programme with varying levels of competency against these standards, this is in line with the concept of continual learning and development, and with the notion of Paramedics taking increased personal responsibility for personal and professional development. ›Learning objectives On completion of the Paramedic Entry to Practice Programme (PETP) students will demonstrate the following competencies: •

Act in accordance with accepted standards of conduct and performance

Have the ability to make informed and considered decisions

Demonstrate professional autonomy and accountability

Demonstrate the knowledge and understanding required for practice as a Paramedic

Operate within a safe practice environment

Identify and assesses health and social care needs in the context of the environment

Formulate and delivers clinical practice to meet health and social care needs within the context of the environment

Deliver healthcare in a manner that recognises the value of partnership, consumer empowerment and acknowledges the importance of the Treaty of Waitangi

Critically evaluates the impact of, or response to Paramedic actions

More Information: W: http://caa.net.au/downloads/Standards_Report.pdf

© WFA Clinical Education Team


© WFA Clinical Education Team


›Introduction In 2004 an Intern paramedic scheme was introduced by WFA to complement the degree programme. This has been retitled as the Paramedic Entry to Practice Programme, (PETP) as it more accurately reflects the expectations and outcomes of the programme. This was extended to include those completing the National Diploma and will incorporate the WFA Intermediate Life Support pathway. Paramedic Interns work alongside experienced and qualified paramedics gaining valuable operational and clinical experience while completing their ambulance qualifications. This guide is an introduction to the philosophy, structure and procedural details of the WFA PETP programme. Oversight of this programme will be managed by the Clinical Education Team (CET) The Entry to Practice Programme does not repeat the learning content of the undergraduate degree programme, but strengthens the application and use of knowledge in clinical situations. Philosophy This programme is designed to place an intern in a supervised situation within an ambulance environment, enabling them to learn, grow and gain operational experience to develop their clinical and non-clinical skills alongside their educational knowledge. This will be a supportive relationship between the Intern, the WFA CET and the Intern’s allocated on road paramedic preceptor. Regular contact between this group of people will ensure that the Intern’s set competencies and goals are being reached. Expectations It is expected that any electronic conversations or feedback assessments will be written with a professional attitude and be based around sharing ideas, knowledge and information. Therefore the conversations must always be constructive and no horizontal violence will be tolerated. As soon as practical after commencement of the programme, each intern will have a specific learning programme tailored to their needs and requirements. This will be completed by the training department and the individual intern collaboratively. Each intern will be required to complete the allocated continuing education points and complete all compulsory sessions outlined by the Clinical Education Team (CET), however this points system does include the Bachelor Health Science - Paramedic,

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National Diploma, ILS pathway and any revalidations that are required annually. It is expected that during the intern training, the intern will develop their own portfolio as a record of the professional practice. An intern with a specific ‘Authority to Practice’ carries the same level of practice and accountability as a full time paramedic practising at that level. Intern patient report forms will be subject to the same scrutiny and enquiry process as those written by full time paramedics. In saying this it is understood that a paramedic preceptor is there to supervise the intern at all times when treating a patient. Role of the Preceptor The preceptor has responsibility for: • • • •

Role modelling Skill building Critical thinking Socialisation

The preceptor is required to • • • • • • •

Accountable for their own practice Practice in accordance with the vision and values of Wellington Free Ambulance Be familiar with the roles and responsibilities of both preceptor, preceptee and the rest of the preceptoring team Be familiar with new tool and policies in the organisation Have input into the performance evaluations of the preceptee, providing constructive feedback on the preceptee’s strengths and areas for improvement Take responsibility to obtain skills and knowledge necessary to guide a preceptee Be familiar with assessment and feedback skills and processes

Role of the Preceptee • • • • • •

Be proactive in stating own learning needs Feeding back on what is going well and not going well Identify learning needs and assisting in preparing own education plan with preceptor Demonstrating awareness of professional accountability and responsibility for own practice Being open to learning and new experiences Being open to receiving constructive feedback

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• • • • •

Evaluating learning experience positively and negatively Integrating into the team and becoming familiar with team/work purpose, philosophy, culture and roles Being proactive with using available resources (critical thinking) Making theory/practice links relevant to the work area Completing generic competencies of the organisation

Role of the Clinical Education Team • • • • • • • • •

Select and match preceptor to preceptee based on skill mix and learning needs analysis Oversee the preceptor/preceptee relationship and process, and be a mediator in conflict Provide added support for preceptors new to the role Receive feedback from the preceptor/preceptee and other staff Provide a structured way for the preceptor to give feedback to preceptee, objectives attained, strengths and weaknesses Sets expectations of safe practice in clinical area to new staff Ensure goal setting is undertaken Assist in evaluation of preceptee progress Support the preceptor in their role, coaching and developing preceptor skills

Role of Line Managers

• • • •

Participate in preceptor/preceptee match process Ensure annual leave for interns is monitored Provide support for preceptors where necessary Help facilitate roster release where necessary

Coordination of Programme Each intern will be ideally rostered to work with the same paramedic for six month cycles where they will complete their log books provided by WFA with the cases they experience. The programme will facilitate interns to complete their studies while gaining experience. Part of this Intern Portfolio is reserved for the formulation of your Individual Learning Plan. There are also sections for recording all skills performed, and a series of shift round reflective tasks. A paramedic Intern forum page is available on axis for interns to discuss and share their operational experiences with each other and provides another avenue of

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collegial learning. This is an additional area where they can request information and ask questions of the training department if any arise. When an intern changes preceptor after the six month time frame or any other significant events occur, the individual learning plan should be revisited. This revision will allow the Individual Learning Plan to remain current and appropriate to the individual interns. Operational Competencies Each stage of the programme has a set of operational competencies and mile stone dates that need to be addressed and signed off by the appropriate Preceptor. The competencies are outlined below: Stage 1 Competencies Complete P1 driving competency within 1month of joining roster Obtain BLS ATP within 2 months of joining operational roster Complete BLS moodle modules Complete Helicopter safety package (Moodle or Lifeflight visit) Complete Moodle MDT package Complete station familiarisation Complete hospital familiarisation (Hutt, Wellington Regional, Kenepuru) Complete monthly Moodle CE articles Complete monthly Moodle 12 Lead ECG End of Placement Review completed with Preceptor and forwarded to TMO

Stage 2 Competencies Complete ILS moodle modules Complete monthly Moodle CE articles (X 6) Complete monthly Moodle 12 Lead ECG (X 6) End of Placement Review completed with Preceptor and forwarded to TMO

Stage 3 Competencies Complete Preceptor Package moodle modules Complete monthly Moodle CE articles (x 6) Complete monthly Moodle 12 Lead ECG (x 6) End of Placement Review completed with Preceptor and forwarded to TMO Attend elective placement (flight, urgent community care, TMO) subject to operational requirements Attend end of programme interview with SDD Manager and CET Manager

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Programme Philosophy The Paramedic Entry to Practice Programme is underpinned by the work of Patricia Benner (1984). Benner developed the nursing theory entitled ‘from novice to expert’. The model proposed by Benner describes five different models of practice and skill acquisition; novice, advanced beginner, competent, proficient and expert. Benner’s model suggests that progression through the levels of skills acquisition is marked by changes in four key aspects of skill performance: •

Movement from reliance on abstract principles and rules to use past, concrete experience

Shift from reliance on analytical thinking to intuition

The ability to extract salient points from situations (rather than seeing all information as equally important)

The passage from detached observer to engaged leader in clinical situations

Benners’ model allows for clinicians to be experts in one practice realm (e.g. ALS Paramedics working on a conventional ambulance) and novices in another context (e.g. ALS Paramedics working in ECP roles). Overview: Novice to Expert

More Information: W: http://ajcc.aacnjournals.org/content/13/6/448.full.pdf

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›Paramedic Entry to Practice Programme Outline Programme Outline

Programme Timetable The PETP programme is broken into 4 stages: Stage 1 2 3 4

Timeline 0-6 Months 6-12 Months 12-18 Months 18-24 Months

Benners Stage Novice Advanced Beginner Competent Proficient

Key Points •

The PETP programme is a two year programme that aims to prepare graduates or near graduates for beginning roles as ILS practitioners.

WFA will provide support for interns in the form of on road clinical educator support and monthly clinical supervision sessions.

Interns will also attend study days and attend a 2-3 day mentoring course. This is subject to operational rostering requirements.

Towards the end of the intern programme students will spend time exploring some of the different practice contexts (Helicopter, Urgent Community Care, Team Manager Operations). These placements are also subject to operational rostering requirements.

At the completion stage of the intern programme, students will be linked into an appropriate post graduate study pathway, have a completion interview and will also be offered an opportunity to attend an assessment centre for a permanent paramedic position.

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Authority to Practice •

All new interns must obtain BLS authority to practice within 2 months of joining the operational roster.

Driving Qualifications •

All new interns will need to complete (as a pre employment requirement) a defensive driving course and a 32 hour Ambulance Operators course. For more information on driving pre requisites please contact the Clinical Education and Training Manager.

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Portfolio Development The concept of continuing professional development (CPD) has become an increasing aspect of professional practice, as has the need for those professionals to be accountable for their practice. CPD should be recorded in a portfolio. Portfolios are a valuable tool for use in the assessment of competence, and have been widely used and tested within many academic courses such as nursing, teaching, medicine and other allied healthcare professions. Portfolio building has become an acceptable method for assessing a level of competence for academic achievement. It allows for student focussed reflective learning. Once paramedics become a registered health profession, portfolios will potentially be the method in which measurement of competency for registration is assessed. The professional portfolio contains evidence of performance, professional development, and involvement in quality and education. The portfolio can be either electronic or paper based, or a combination of the two. There are a number of things that a portfolio should contain: 1. Personal details 2. A contents page 3. A current curriculum vitae 4. A professional profile 5. Your current job description 6. Personal development plan 7. Reflections and articles relevant to reflections 8. Consent forms 9. Certificates 10. Skills log (record of clinical experience) 11. Competencies (ATP) 12. Essential and supplemental evidence Professional Profile This is a summary of your more recent work/practice experience. It may include clinical placements that have been completed during the undergraduate degree; it may include volunteer work, such as event medic or front line work. If you have worked in healthcare in another capacity, this can be discussed in this section. Current Job Description If you do not have a copy of this, one can be requested from HR – or printed off the WFA Axis site: http://axis/RP.jasc?session=FA91C7EB17BCCF32FD3837932EB110&Page=N730P2

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Professional Development Plan This is an agreement between the Intern, their preceptor and the CET. This plan is used in conjunction with your job description to ensure you are meeting WFA requirements. Reflections and articles relevant to reflections Reflecting on experiences is an important learning tool and demonstrates that you are aware of your strengths and weaknesses and can be self critical when necessary. Certificates Evidence of workshop attendance, graduation from a degree (or similar), any other work related certification and letters of thanks from patients or WFA. Essential and supplemental evidence Other forms of evidence of learning you may wish to include, such as discussions with clinicians where there has been a learning outcome, journal articles etc. ›Intern Authority to Practice (ATP) Levels •

All Interns have an ATP of BLS only

Interns that have completed the 3rd year of the degree and have had the classroom teaching with sign off of the skill by the Whitireia BHsc Degree Lecturer, can challenge for recognition of current competency and practice to an ILS level under direct supervision of an ILS Paramedic (at the ILS officer’s discretion)

Interns may practice any skill they have been signed off for in the classroom provided the skills are used under the direct supervision of a paramedic who holds an ATP appropriate for the skill being used.

If offered permanent employment, the intern will then be eligible to undertake an ATP assessment for ILS. All degree trained interns must spend at least 9 months consolidating at BLS level before an ATP assessment for ILS will be approved.

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Conclusion The WFA intern programme is designed to enable interns to complete their education while gaining operational experience under the supervision of a qualified paramedic; in preparation for future employment. This programme is an on job training opportunity that allows interns to progress from being new entrant multi-skilled beginner paramedics to a higher level of competency with increased clinical practice and critical thinking skills. The success of this programme relies on the collaborative effort between all parties involved, ultimately benefitting all involved.

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›Appendices

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›Intern Individual Learning Plan

Introduction An individual learning plan may be described as a route map for your own professional development. It is a living document, which starts from your current level of experience and qualifications, and indicates the stages of progression by which you can achieve your professional goals. It will allow you, your preceptor and your CET supervisor to be clear about your educational needs, set targets, review your progress and, where appropriate, recognise prior learning (RPL). At each stage, you, your preceptor and your CET supervisor will form a plan for the next steps in your development. In short, it is an agreed pathway for getting the best out of you. Why an Individual Learning Plan We are all different. We all have our own preferred learning style, our own optimal rate of learning and our own personal circumstances which may help or hinder learning. Anyone can benefit from an individual learning plan and as an intern you are in a learning environment, so we want you to learn as much as possible in your two years to make you a confident and competent paramedic in the future. This allows you to gain knowledge of the culture of an operational ambulance service, knowledge of day-to-day operational procedures and other non-clinical knowledge as well as expanding your clinical knowledge. An individual learning plan will also enable you to have input into your own learning and steer you in the right direction to what is no doubt you’re end goal – being in a good position for permanent employment. Roles and Responsibilities The job of any education service is to facilitate the development of individuals, teams and groups of employees. The WFA Education Service is essentially a ‘service industry’ for WFA staff. Our undertaking to the wider organisation is that we will plan the use of our resources to deliver the maximum educational benefit to all. To you as an individual, we will allocate time and resources as appropriate to your needs, to enable you to pursue your professional goals. Your responsibility is to make it happen. It is a fundamental principle of adult education that ‘you only learn what you want to learn’. The professionalisation of the

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role of paramedic means that you are responsible for your own learning and development. Access to your Individual Learning Plan The publicly stated values of Wellington Free Ambulance are Passion, Openness, Caring, Integrity and Learning. This sets the context for your Individual Learning Plan. Your Individual Learning Plan is agreed and updated by you, your preceptor and your CET supervisor. An updated copy will be held on your Education Service training file. You, your preceptor, CET supervisor and line manager will be allowed automatic access. There will also be occasions when it will be beneficial for your Individual Learning Plan to be shared with another educator or manager. For example: if you change preceptors, or if there is a need to share your progress with a senior manager. WFA Education Service will ensure that you are notified before giving access to your Individual Learning Plan to any persons other than you, your preceptor, CET supervisor or line manager. It is intended that your learning plan will be revisited each time you change preceptors, however if you and your preceptor wish to revisit the plan during your six months together, that will be encouraged, particularly if your goals are reached and new ones need to be planned.

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›Intern Individual Learning Plan (to be completed jointly every 3 months) Date: :

Intern:

Preceptor:

Current Competence and Background: i.e. Qualifications, experience, present study, ATP etc

End Goals for your two years: Where do you want to be when your internship is finished?

Short Term Plan What do you want to achieve within this 3 month cycle?

What do you need to achieve this?

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›Progress Progress so far:

Achievements so far:

Feedback from your preceptor

Feedback from the Clinical Education Team

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›Preceptor Evaluation Form The following form is given to the students to formally assess your performance as a preceptor. This information is invaluable in helping you to further improve you preceptoring skills. When you receive a form from your student it is very important to thank him/her for the feedback and NOT discuss the feedback itself. Take the feedback (both positive and negative) as opinion and if you do not agree with it, reject it in your head. You do not need to seek justification or discuss the feedback. Discussing the feedback may prevent your student from giving future feedback, or will teach him/her to only report what you want to hear. You can also complete this form online at: http://mentoreval.questionpro.com/

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›Preceptor Evaluation (To be completed by students on preceptors every three months) Name of Student Name of Preceptor Date Completed Mentoring Period Criteria

1 2 3 4 5

At the start of your partnership your preceptor should have made plan with you. How would you rate the adequacy of the planning for your preceptoring? At regular intervals throughout your partnership your preceptor should review progress with you and adjust plans if necessary. How adequately did he/she do this? When coaching you in a particular task, the preceptor will demonstrate the correct way to do it and will explain what he/she is doing and why. How would you rate the adequacy of his/her demonstrations? When observing you perform a task the preceptor watches you and may ask questions to check your understanding. How would you rate his/her ability to observe? When you have managed a case the preceptor will de-brief with you afterwards. In this de-brief s/he will give you a clear and specific feedback on your performance and will question you. How would you rate his/her ability to de-brief after a case? Through out your preceptoring period, how clear were you on what was expected of you? Throughout you preceptoring period, to what extent did you get the opportunity to manage cases on the job? Throughout your preceptoring how would you rate the quality of the feedback on your performance? Throughout your partnership, how well did your preceptor listen to you? Throughout your partnership, how well did your preceptor build your confidence?

Key 1 Very Poor

2 Poor

3 Average

4 Good

5 Very Good

Areas of Strength

Areas for Development Areas of Strength

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Areas for Development

Signed (student) Signed (preceptor) Date ›Please send completed end of placement reviews to Clinical Education and Training Manager at HQAS.

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›End of Placement Review (Preceptor to complete every six months) Paramedic Intern Name Preceptor Name Shift Vehicle Placement Period Clinical Practice Assessment Assessment Criteria (For detailed criteria please refer to CAA PPCS document) Criterion

1 2 3 4

Acts in accordance with accepted standards of conduct and performance Makes informed and reasonable decisions Demonstrates professional autonomy and accountability Demonstrates the knowledge and understanding required for practice as a Paramedic Operates within a safe practice environment Identifies and assesses health and social care needs in the context of the environment Delivers healthcare in a manner that recognises the vale of partnership, consumer empowerment and acknowledges the importance of the treaty of Waitangi Formulates and delivers clinical practice to meet health and social care needs within the context of the environment Critically evaluates the impact of - or response to Paramedic actions

Key Behavioural Description

Grade

Seldom demonstrates required competency, requires constant supervision and direction Occasionally demonstrates required competency, requires frequent supervision and direction Consistently demonstrates required competency – requires occasional supervision and direction Consistently demonstrates required competency to a high standard, requiring supervision only as required by WFA delegation policy Consistently demonstrates required competency to a very high standard, requiring supervision only as required by WFA delegation policy

1 2 3 4 5

Non Clinical Skills (teamwork, administration/stores) (Brief comment from preceptors around performance of non clinical skills)

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General Comments

Signed (Preceptor) Signed (Student) Date ›Please send completed end of placement reviews to Clinical Education and Training Manager at HQAS.

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Programme Descriptor  

Programme Descriptor

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