One of Us: The Values and Beliefs that Underpin a Paramedic Internship

Author: Aaron Caudle

Caudle, Aaron, 2017 One of Us: The Values and Beliefs that Underpin a Paramedic Internship, Flinders University, School of Medicine

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Abstract

Background In Australia, each state-based ambulance service has its own internship programme, therefore if a paramedic moves interstate they are required to redo an internship. Given there is no difference in the role undertaken, there is neither an educational rationale nor a difference in the prevalence or sorts of illness/injury to explain this. As paramedics continue to enhance their professional status, cross state or cross jurisdiction recognition is important. One step would be to simply abolish this duplication of internship training, but such steps are risky without a good prior understanding of the reasons behind the system. Aim The objective of this study is therefore to explore the values and beliefs that underpin the expectation of state-based internship from the perspective of organisational and national culture. Methods Semi-structured interviews were conducted with six major stakeholders of an internship within one state, including managers (operational/general) and ambulance education staff. The interviews were audio-recorded and transcribed. The transcripts were analysed using an interpretative framework by Hofstede and Waisfisz to understand the organisational and national culture. Findings Eight core themes were identified, layered according to the people that hold the greatest influence over the theme and discussed using the study’s interpretative framework (cultural dimensions). These core themes describe the concerns respondents held over elements around the paramedic internship, which include the structure, content, quality, attitudes, behaviours and the profession. It is clear that the paramedic internship is deemed necessary to ensure a paramedic can successfully navigate between competing demands of each dimension. It is to ensure a paramedic can fit into the paramedic culture and is accepted into the organisation. For the organisation to be able to be confident that such enculturation has been achieved, a prolonged observation period of each individual is achieved via the paramedic internship. Understanding dominant cultural insights of the ambulance organisation allows the interpretation of the results into a meaningful picture. Cultural insights include the balance between risk aversion (policy/procedure) versus risk taking (the unknown work environment); structure (militaristic) versus independence (autonomy); hierarchical power relationship and competency power relationship, and finally indulgence (socialisation for organisational acceptance) versus restraint (becoming a professional). Conclusion Internships primarily consolidate knowledge and enable the development of clinical competence, however they also serve a role as an induction into the local organisation and culture. Whilst it is recognised that paramedics who have completed an internship will be competent to practice safely, there remains values and beliefs around the need for local enculturation, for managers and peers to have confidence in their work abilities. A pragmatic solution, for example mandated national registration, is likely to be ineffective because it does not address the importance of the acceptance of each other’s organisational culture. Addressing the issues of confidence and the need for local induction are key issues for the profession to address to enable national recognition of internship training, leading to national registration.

Keywords: Paramedic, Internship, Organisational Culture, National Culture, Values, Beliefs
Subject: Medicine thesis

Thesis type: Masters
Completed: 2017
School: School of Medicine
Supervisor: Associate Professor Linda Sweet