Experiences of learning, development, and preparedness for clinical practice among undergraduate paramedicine students, graduate/intern paramedics, and their preceptors: a qualitative systematic review
Authors: Hanna Hilding , Jordan Zoe , Stern Cindy , Pearce James 
Published: April 2021

ABSTRACT

Objective:
This systematic review aimed to identify and explore the barriers to and facilitators of learning and preparedness for clinical practice among undergraduate paramedicine students, graduate/intern paramedics, and their preceptors.

Introduction:
The educational landscape for paramedicine has evolved considerably since the introduction of the first paramedicine bachelor degree. A need to identify the contemporary barriers to and facilitators of learning within the context of early career training in paramedicine education is needed.

Inclusion criteria:
Participants were undergraduate paramedicine students, graduate/intern paramedics, newly qualified UK paramedics and their preceptors within Australia, the United Kingdom, and New Zealand. Published and unpublished studies utilizing qualitative research designs were considered. Studies published in English since 1994 were considered for inclusion.

Methods:
Five bibliographic databases (PubMed, CINAHL, ERIC, Embase, and ProQuest Dissertations and Theses) were searched in 2018. A search of websites relevant to paramedic learning and a hand search of paramedicine journals were also undertaken in 2019.
All studies identified from the search were examined against the inclusion criteria. Papers selected for inclusion were assessed by two independent reviewers for methodological quality prior to inclusion in the review.
Qualitative research findings were extracted and pooled. Findings were assembled and categorized based on similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis.

Results:
Twenty-six studies were included in the review. Eleven studies used semi-structured interviews, five used open-ended interviews, and 10 used focus groups. The total sample size was 564 participants. Sixteen studies focused on undergraduate paramedicine students, four involved paramedic preceptors, two focused on paramedic educators at paramedicine universities, and four included undergraduate paramedicine students and their preceptors. A total of 295 findings were extracted and grouped into 28 categories, which were grouped into five synthesized findings: the role of mentoring/preceptorship, opportunities to develop emotional intelligence and communication skills, the role of non-traditional placements/experiences, the role of non-traditional classroom teaching methods, and preparedness for practice.

Conclusions:
A variety of education models exist with associated barriers and facilitators that impact on paramedicine students, graduate paramedics, and preceptors. The findings emphasize the importance of the preceptor to student learning and the need to develop students’ skills/capacity to manage the emotional side of paramedic practice. Paramedicine students and paramedic graduates were found to be underprepared to effectively communicate with patients, families, and other professionals. Most of these barriers could be mitigated by use of non-traditional placements/experiences and non-traditional teaching methods. The introduction of a paramedic facilitator model was shown to have considerable benefits, suggesting that the introduction of a national model similar to other allied health models may be beneficial. The findings indicate a need for more effective communication between the education sector and industry with regard to the challenges in paramedicine education and which models best facilitate learning, development, and preparedness for clinical practice.

Systematic review registration number:
PROSPERO CRD42019119336