Examining resuscitation skill education as a component of paramedics' practice development.

Author: Amy Seymour-Walsh

Seymour-Walsh, Amy, 2017 Examining resuscitation skill education as a component of paramedics' practice development., Flinders University, School of Medicine

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Clinical skills are a fundamental component to health professionals' practice. Training programs maintain a responsibility to health service providers and patients treated by course graduates who are tasked to care for the community. However educational institutions also experience resourcing pressure to ensure this outcome is achieved as cost-effectively as possible.

Recognising these parameters and limitations, my original contribution to knowledge is a multifaceted examination of the cost-effectiveness of an internationally advocated clinical skill instruction method. The findings in this thesis are of relevance to medical education institutions and organisations, health care providers, and clinical educators. To enact these findings, this thesis considers a commonly used four stage skill teaching method, and aims to understand its cost-effectiveness in comparison to a more traditional and arguably more natural two stage approach. Paul Worley's model for symbiotic clinical education (Prideaux, Worley, & Bligh, 2007; Worley, 2002a, 2002b; Worley, Prideaux, Strasser, Magarey, & March, 2006) is used as a theoretical framework upon which to structure definitions and order outcomes and implications for cost and effectiveness, in relation to three of the four key relationships: the clinical, institutional and community axes. A pragmatic approach is adopted throughout the course of study to ensure the research philosophy and design are informed and shaped appropriately by the research question. As such, this mixed methods program includes a post-positivist approach, a social constructionist approach, and others in between.

An initial trial was conducted to compare the two skill teaching methods, and showed no statistically significant difference in paramedic students' ability to acquire manual defibrillation skills with repeated measures analysis. Small sample size is a noted limitation for this study. This thesis then presents the development of a clinically relevant assessment tool for both intraosseous and laryngeal mask airway insertion. A modified Delphi approach has been used to understand expert pre-hospital clinicians' approach when performing these two skills, in order to construct these educational tools, as no appropriately validated specific skill performance checklists was found in the literature. These tools have then been applied to another comparative trial which compares both the acquisition and the retention (6 months later) of paramedic and nursing students in the application of these skills, with a comparison between teaching methods employed. This trial indicates that there is no difference in either acquisition or retention. The clinical skill assessment tools developed will then be critiqued, and a validation argument presented for their appropriate and accurate application in future education and assessment. Incidental data arising from the two trials have indicated that the four stage approach may not be as easy for educators to perform as a traditional two stage approach, and an additional original contribution to knowledge presented in this thesis involves the educator's perspective and perception of such a teaching method. A qualitative study flavoured by tenets of phenomenology will allow educators to understand, for the first time, how the clinical educator's craft and practice are influenced by the four stage approach, and vice-versa.

This doctoral research builds on the work of others who have sought to compare the potential benefit of the four stage teaching method compared to traditional methods (Archer, Van Hoving, & de Villiers, 2014; Bitsika et al., 2013; Greif, Egger, Basciani, Lockey, & Vogt, 2010; Herrmann-Werner et al., 2013; Jenko, Frangež, & Manohin, 2012; Krautter et al., 2011; Lee, Boyd, & Stuart, 2007; Lund et al., 2012; Orde, Celenza, & Pinder, 2010). I have done so using a modern clinical education framework to understand the costs and benefits from a clinical education system approach in order to address the wider impact of skills education. This approach includes relevant discussion of the patient outcomes, institutional demands, clinician workload, and the human resource aspect of clinical education staff.

Keywords: Paramedic, Clinical education, Clinical skills, Defibrillation, Advanced life support, Intraosseous, Laryngeal mask airway

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Hugh Grantham