1

Practice Educator Handbook BSc (Hons) Paramedic Science

2

Contents Page No.

Welcome 3

What is a Practice Educator? 3

The benefits of being a Practice Educator 4

Key contacts and information 4

Modules and indicative content 6

OSCE assessments 9

The Clinical Assessment Portfolio (CAP) 11

Scheduled meetings and planning 12

Assessment levels and competencies 13

Action planning 16

Cause for concern early warning checklist 18

Raising concerns in practice and the Problem Resolution Protocol 19

Student support 20

3

Welcome

Welcome to the University of Lincoln and thank you for choosing to become a Practice Educator (PEd) for our paramedic students.

We are committed to supporting our PEds and this handbook is designed to give you helpful information around the role of PEd, practice based education and student support. It also contains information on key contacts, gives an overview of what your student will be learning whilst in university and provides information regarding what to do if a problem arises.

What is a Practice Educator?

“A Practice Educator (PEd) is a multi-faceted role, these include being a Leader, Role Model, Coach, Teacher, Mentor and Assessor, with a responsibility of ensuring the clinical supervision, leadership and development of a learner (student paramedic) in the practice based education environment” (College of Paramedics, 2017, 15).

As a PEd for the University of Lincoln you are essential in the development of competent and confident paramedics. You are integral in allowing students to bridge the theory-practice gap between knowledge learnt in university and the ‘real world’ of the ambulance service.

The role of the PEd has many dimensions, some of which are outlined in figure 1, and you are crucial in educating the paramedics of the future.

Figure 1 The Role of the Practice Educator

• Creating a welcoming and safe environment for learning. • Acting as a role model. • Transmitting a passion for the profession. • Developing appropriate attitudes, behaviour and professional standards. • Developing and enhancing competency in clinical and ‘technical’ skills. • Developing and enhancing communication and team working skills. • Developing and enhancing decision making skills. • Developing and enhancing reflection and reflective practice. • Debriefing. • Helping to build resilience and managing feelings. • Encouraging. • Being approachable and helpful. • Supporting. • Providing learning in a ‘real life’ environment. • Being a patient advocate. • Assessing, providing feedback and action planning.

4

The Benefits of Being a Practice Educator

Practice education is not just beneficial to the student. Becoming a PEd for the University of Lincoln can also benefit you personally and some of the advantages are outlined in figure 2.

Figure 2 The benefits of being a Practice Educator

• Recognition and reward for knowledge, skills, experience and leadership. • Personal satisfaction from seeing your student learn and progress. • The opportunity to contribute to the paramedic profession and develop practice

education. • The opportunity to undertake education, learning and development and to achieve

recognised qualifications in education. • The opportunity to develop leadership and management skills. • Impetus to keep up to date with your own clinical skills and education. • Contribution to you own CPD. • Development of transferrable knowledge, skills and experience which can result in wider

employment opportunities and career development.

Key Contacts and Information

The Interprofessional Practice Support Team

During practice based education, students and PEds are supported by the University of Lincoln Interprofessional Practice Support Teams (IPSTs). These teams are made up of Link Lecturers, who are assigned to work collaboratively with their designated practice based education environments.

Figure 3 shows a breakdown of the IPSTs but for ease there is a single point of contact:

Single Point of Contact

practice.support@lincoln.ac.uk

01522 83 5808

You can also contact Sarah Christopher, Programme Lead for paramedic science:

schristopher@lincoln.ac.uk

01522 83 5039

5

Figure 3 Interprofessional Practice Support teams East Midlands Ambulance Service Lincolnshire Division stations

Interprofessional Practice Support teams

Grantham and South Community Fran Nicol – Practice Support Team Lead Sharon Andrews Alexandra Carlin Chris Craggs Ambulance Stations Bourne Grantham Sleaford Spalding Stamford Holbeach

Lincoln County Hospital Mary Willis – Practice Support Team Lead Paul Bates Sarah Beresford Kerry Lewis Sean Morton Ambulance stations Lincoln

Pilgrim Hospital, Boston Ken Ripley – Practice Support Team Lead Ellie Forbes Milika Matiti Ambulance Stations Boston

North Lincolnshire Sue Viola – Practice Support Team Lead Dianne Ramm Maria Joyce John McKinnon Ambulance Stations Grimsby Brigg Barton Louth Market Rasen Horncastle

West Sally Houltby – Practice Support Team Lead Louise Brereton Helen Chilvers Claire Sobieraj Kerry Welch Ambulance Stations Gainsborough Scunthorpe

All Mental Health Placements Julie Dixon Cath Radford Adam Horner Milly Johnson

The website below will provide further information:

6

Modules and Indicative Content

It is useful for you to have an awareness of what your student will be studying during their time in university. Figure 4 shows the modules that make up the BSc (Hons) paramedic science at the University of Lincoln with figure 5 showing the indicative content of those modules.

Figure 4 Modules

Figure 5 Indicative content

Module title Indicative content Year 1 (level 4) Essential Skills for Paramedic Science

• Kit familiarisation • Basic clinical skills

o Pulse o Respiratory rate o Temperature o Manual blood pressure o BM measurement o Suction o OP/NP/LMA/IGEL o IM injection o ECG placement o Oxygen and Entonox

• Documentation and PRFs (including electronic) • Introduction to basic clinical decision making • Basic medical and trauma assessment • ILS – adult • Basic ECGs • Medical conditions • Cardiac conditions • Sepsis • Anaphylaxis • Neurological conditions • Respiratory conditions • Introduction to evidence based practice • Introduction to reflective practice and the reflective journal, academic

writing and study skills

7

Fundamentals of Anatomy & Physiology

• Introduction to the body • The musculoskeletal system • The cardiovascular system • The respiratory system • The nervous system • The immune and lymphatic system • The endocrine system • The renal system • The digestive system • The integumentary system • The reproductive system • Human growth and development

Interprofessional & Collaborative Practice across the Health Professions

• Professionalism • Professional behaviours, roles, responsibilities and values • Role appreciation • NHS constitution and core values • Communication • Non-oppressive practice and legislation • Unconscious bias and stereotyping • Safeguarding • Service user engagement • CPD and reflective practice • Ethical frameworks in health care • Healthcare law • Sociological and social aspects of health • Contemporary policies and drivers

Applied Behavioural Science • Models of behaviour (cognitive, social, physiological) • Resilience and self-care • Stress and coping • Burnout • Understanding behavioural reactions to illness and disease • Suicide and self-harm • Mental health conditions

Year 2 (level 5) Developing Skills for Paramedic Science

• Clinical decision making • Advanced medical life support • Adult advanced life support • Advanced trauma life support • HOTT approach to traumatic cardiac arrest • Appropriate pharmacological interventions • Major incidents – JESIP, interoperability, ambulance command and control

structure • Triage – sieve and sort

• ECGs • Clinical skills o IV cannulation o IO cannulation o ET intubation o SC injection o Needle thoracocentesis o Needle cricothyroid puncture

Pathophysiology for Prehospital Professionals

• Musculoskeletal conditions • Cardiovascular conditions • Respiratory conditions • Neurological conditions • Immunological conditions • Endocrine conditions • Renal conditions • Digestive conditions

8

Prehospital Paediatrics and Obstetrics

• Anatomical and physiological differences • Assessment and management of the sick child • Medical management of the paediatric patient • Trauma management of the paediatric patient • Paediatric advanced life support • Age related pharmacology • Advocacy for the child • Pain assessment in paediatrics • Child abuse and non-accidental injury • Child protection – a multi-professional approach • The reproductive system • Maternity and obstetrics • Complications in pregnancy • SIDS

Care across the Lifespan • Communication across the lifespan • Older people • Dementia • Loneliness and social exclusion in the ageing population • Death and dying across the lifespan • EoLC • Grief theory • Breaking bad news • Learning disabilities • Nutrition • Genetics

Year 3 (level 6) Advancing Skills for Paramedic Science

• Enhanced assessment (medical model) and clinical decision making • Cranial nerve assessment • The eye – anatomy, conditions and assessment • The ear – anatomy, conditions and assessment • Abdominal assessment • Wound care and closure • Urinalysis • Dental emergencies • Integumentary system and conditions • Managing acute and chronic conditions • Co-morbidities • Alternative care pathways and safety netting • Health promotion and public health (MECC) • Contemporary issues in paramedic science • Career pathways

Clinical Pharmacology for Paramedic Science

• Pharmacokinetics • Pharmacodynamics • Medications and the law • JRCALC drugs • Patient medications • Polypharmacy • Supplements and herbal remedies • Over the counter drugs • Recreational and illegal drugs and alcohol dependence/abuse • Independent & supplementary prescribing • Analgesics and pain management • Blood pressure control, hypertension and antihypertensive drugs • Blood clotting and drugs that interfere with coagulation

Research & Evidence Based Practice

• How to conduct a literature search • The hierarchy of evidence • How to write a literature review • Developing a research proposal • Critical appraisal • Quantitative research methodologies

9

• Qualitative research methodologies • Gathering primary data and data collection • Data analysis • Statistical analysis • Ethical issues in research • Evidence-into-practice, research process in action and relevance • Promoting quality of care, evaluation, governance, and audit • Writing for publish

Leadership & Practice Education

• Learning theory • Leadership and management theory • Organisational culture • Human factors • Change management • Teamwork and motivation • Coaching • Preceptorship • Practice education • Supporting other students and health professionals

As part of the essential skills for paramedic science module, students also undertake mandatory education in order to prepare them for practice based education. This is outlined in figure 6.

Figure 6 Mandatory education • Basic life support • Infection prevention and control • Safeguarding • Fire safety • Equality and diversity • Manual handling • Conflict resolution • Capacity and consent • Conflict resolution • Information governance and data protection • Prevent strategy

OSCE Assessments

Throughout the three years of the programme, students will undertake formative OSCE assessments. This is to ensure that they are safe to practise the task in placement where they will be summatively signed off as competent.

Whilst relevantly qualified and registered health professionals can sign students as competent on individual competencies within their Clinical Assessment Portfolio (CAP) including intermediate and final grades, it is the student’s named PEd that holds the responsibility for signing the student off as competent at each year’s progression point. The CAP is discussed later in this handbook.

10

Figure 7 formative OSCE assessments

Year 1 Baseline Observations Pulses, Respiratory Rate, Blood Pressure, Blood Glucose 3 Lead ECG Placement Airway Management OPA, NPA, LMA & iGel

Intramuscular (IM) Injection Immediate Life Support (ILS) Intermediate Medical Life Support (IMLS) Intermediate Trauma Life Support (ITLS)

Year 2 Endotracheal (ET) Intubation Needle Cricothyroid Puncture Needle Thoracocentesis Subcutaneous (SC) Injection Intravenous (IV) Cannulation Intraosseous (IO) Cannulation Advanced Life Support (ALS) Advanced Medical Life Support (AMLS) Advanced Trauma Life Support (ATLS) Paediatric Advanced Life Support (PALS)

Year 3 Advanced Patient Assessment: Respiratory System Advanced Patient Assessment: Cardiovascular System Advanced Patient Assessment: Neurological System Advanced Patient Assessment: Musculoskeletal System Advanced Patient Assessment: Gastrointestinal System Advanced Patient Assessment: Genitourinary System Wound Closure: Suturing, Stapling, Gluing, Wound Closure Strips

11

The Clinical Assessment Portfolio (CAP)

PEds should read the CAP document in conjunction with EMAS (2017) Clinical skills & competencies for student paramedics undertaking clinical placement with East Midlands Ambulance NHS Trust (EMAS). The CAP provides students with an ongoing record of their placements, allows them to reflect on their learning and personal development and provides evidence that they have achieved the competencies to meet the requirements of the Health and Care Professions Council (HCPC) Standards of Proficiency: Paramedics (2014) and the College of Paramedics (CoP) Curriculum Guidance (2017).

The CAP is comprised of:

1. Three interview records (preliminary, intermediate and final) 2. The Competency Record 3. The Structured Situational Assessment: Episode of Care

Scheduled Interviews

The preliminary interview must take place by the end of the first week of ambulance placement following orientation and induction to placement. This is the opportunity for the student and PEd to discuss the learning outcomes to be achieved. This interview should also be used to arrange learning experiences in other areas, insight visits, inter-professional learning and next meeting dates and times.

The intermediate interview is designed to take stock of progress in all placement areas and to complete the intermediate formative assessment relating the Competency Record. It is also an opportunity for students to plan their Structured Situational Assessment: Episode of Care and consider other insight visits to enrich the learning experience. If any issues or concerns are identified, the student, the PEd and link lecturer should be informed early enough to allow the University link to attend this meeting. Feedback should reflect the progress in the Competency Record.

The final interview is designed to assess and record the achievement on placement with consideration for learning in all placements across the year. The PEd should also identify areas for the student to focus on in the future. The feedback should reflect progress in all parts of the CAP. At this point PEds are required to sign a progression statement which should reflect the outcomes of the CAP. Variance of placement perspective: the wide variety of placements facilitate the greatest holistic learning for the paramedic student, however as the ambulance service is their primary working environment the Structured Situational Assessment: Episode of Care is assessed in this setting. The ambulance PEd functions as the sign off educator for the year. Hospital and other clinical placements contribute to the wider appreciation of interprofessional working, values, integrated care pathways and individual skills as set out in the CAP.

12

The Competency Record The Competency Record is a PASS/REFER assessment based upon direct observation, questioning or discussions with your student. It is designed to assess students continuously throughout placement. By the end of the placement, students must achieve a PASS in each area to pass overall. If a REFER this is anticipated at any stage, the PEd should contact the University link for support and direction regarding re-assessment of the criteria. Structured Situational Assessment: Episode of Care This must be achieved by the end of the mid-year and end of year placement. A practice attempt is permitted during the placement period prior to the actual assessment. Any professional involved in assessing the student should include their name and signature on the Record of Supervisors page. Scheduled Meetings and Planning A formal meeting is required to discuss progress against the learning outcomes on three occasions as outlined in figure 8. Figure 8 Scheduled meetings and planning

First week of placement Intermediate point of placement Final week of placement • Orientation to placement

area. • Complete orientation

checklist. • Undertake placement

induction.

• Ensure student completes the formative self-assessment within this document with supporting evidence or experience to inform formative grade in each of the criteria.

• Ensure student completes their self-assessment within this document.

• Preliminary interview: • Review Competency

Record. • Explore learning

opportunities including exposure to other fields.

• Set learning objectives based on placement profile and skills required.

• To support and inform your judgement, review the Competency Record during the assessment.

• Negotiate formative care episode, demonstrating required skills and discuss assessment.

• Review the Competency Record.

• Seek confirmation of progress and achievement from non-ambulance placements, insight visits and associate PEds.

Set dates for: • Intermediate interview. • Formative assessment. • Final interview.

• Assess all criteria and complete intermediate assessment, providing clear and constructive feedback and recommendations for development.

• Undertake assessment of all criteria, provide clear and constructive feedback.

13

• The student may wish to undertake a SWOT assessment to support identification of developmental needs and learning outcomes.

• Set further learning objectives for remainder of placement including pre- negotiated Episode of Care summative assessment within next two weeks.

• Provide guidance for student and future practice PEd of skills/attributes required in future placement settings.

• A review of the student’s progress towards achieving their learning outcomes must take place at this point.

• Obtain feedback from patients/service users and/or family/carers where possible.

• Obtain feedback from patients/service users and/or family/carers where possible.

A minimum of two assessment interviews are required, Intermediate (I), and Final (F) If you believe the student is not practising at a satisfactory level in one or more of the practise criteria, assess the student more than the minimum number during their placement. If necessary, an action plan can be developed and implemented as soon as problems are identified, at any stage during the placement. This must be communicated to the student and link lecturer

Assessment Levels and Competencies The definitions of the levels at which students should be able to work are outlines in the elements of practise criteria in figure 9. The recommended summative assessment level (criteria level) for competencies by year is outlined in figure 10. Elements are mapped to meet HCPC Paramedics Standards of Proficiency (2014) and the College of Paramedics Curriculum Guidance (2017).

14

Figure 9 Assessment levels and elements of practise criteria

Criteria Level Knowledge/Reasoning Level of Performance Personal and Professional Awareness

Dependent (D) • Lacks knowledge

• No awareness of alternatives

• Unable to explain / give reasons for actions

• Lacks accuracy & confidence

• Needs continuous guidance & supervision

• Poor organisation • No awareness of priorities

• Actions & behaviour are not modified to meet the needs of the client and situation

• No meaningful explanations given • Lacks insight into personal and professional

behaviour

Assisted (A) • Knowledge is usually

accurate

• Little awareness of alternatives

• Identifies reasons for actions

• Accurate performance but some lack of confidence & efficiency.

• Requires frequent direction / supervision

• Some awareness of priorities / requires prompting

• Recognises the need to modify actions / behaviour to the client and situation, but unable to do so in non-routine situations

• Gives standard explanations / does not modify information

Minimal supervision (MS)

• Applies accurate knowledge to practise

• Some awareness of alternatives

• Beginning to make judgements based on contemporary evidence

• Safe and accurate; fairly confident / efficient

• Needs occasional direction or support

• Beginning to initiate appropriate actions

• Identifies priorities with minimal

prompting

• Actions / interventions / behaviours generally appropriate for the client and situation

• Explanation is usually at an appropriate & coherent Level

• Identifies the need for assistance

Independent (I) • Applies

evidence based knowledge

• Demonstrates awareness of alternatives

• Sound rationale for actions

• Makes judgements / decisions based on contem evidence

• Confident / safe / efficient

• Needs minimal direction / support

• Able to prioritise

• Able to adapt to the situation

• Conscious / deliberate planning

• Actions/ interventions/behaviour are appropriate to the client & situation

• Gives coherent / appropriate information

• Identifies & makes appropriate referrals

15

Figure 10 Recommended summative assessment level for competencies by year

Competency Record Criteria Criteria Level Year 1 Year 2 Year 3 Communication MS I Moving and Handling MS I Health & Safety MS I Professional Conduct, Performance and Ethics MS I I Service User Involvement & Wellbeing A MS I Documentation & Record Keeping MS I Patient Assessment I A I I Patient Assessment II MS I Paediatric Patient Assessment MS I Primary & Secondary Survey MS I Airway Management I MS I Airway Management II MS I Intermediate Life Support (ILS) MS I I Advanced Life Support (ALS) MS I Advanced Trauma Life Support (ATLS) MS I Paediatric Advanced Life Support (PALS) MS I Wound Care & Haemorrhage Control MS MS I Wound Closure I Burns Management MS I I Fractures, Immobilisation & Splinting MS I Intramuscular (IM) Injection MS I Assisting the Paramedic MS I Subcutaneous (SC) Injection MS I Intravenous (IV) Cannulation MS I Intraosseous (IO) Cannulation MS I Infusion MS I Needle Thoracocentesis MS I Medicines Management & Administration I A I I Medicines Management & Administration II MS I Clinical Decision Making A MS I Obstetric & Gynaecological Presentations & Management

MS I

Multiple Casualties, Major Incidents & Resource Management

MS I

16

Action Planning

Action plans are an excellent way to identify ways for improvement and to assist students in their development. They enable students to be clear about what they need to do and how to achieve their goals. Additionally, action plans should be put into place if the student has received a referral in any area. Any action plans put into place for reasons of referral should be developed with support from the University and with reference to the cause for concern early warning checklist in figure 12.

All developmental action plans should be SMART

Specific

– Leave no room for ambiguity. The learner should know exactly what is expected of them.

Measurable

– Set outcomes against objective standards, CAP, portfolio document or professional guideline.

Achievable

– Ensure everything within the development action plan is within an appropriate scope of practice and something that can realistically be achieved. A series of small wins will hold motivation better than one seemingly impossible task.

Relevant

– Any development action plan should be relevant to the individual and their development needs.

Time limited

– Implementing a development action plan and timeframe for review of the action.

College of Paramedics (2017, 57)

The template in figure 11 can be used to help you set out any action plans and you can use separate sheets as necessary.

17

Figure 11 Action plan template

ACTION PLAN

CAP Criteria

Action Resources/Support Date for Review

Student name: Signature: Date:

PEd name: Signature: Date:

18

Cause for Concern Early Warning Check List

If concerns are identified at any stage, the statements in the Cause for Concern Early Warning Checklist shown in figure 12 can be used to formulate an action plan in the template provided. Indicate with a against those statements best describing concerns. Where concerns differ from examples, you should document them within the action plan.

Figure 12 Cause for concern early warning check list

Early Warning Concern Comments • Has no insight into weakness so unable to change following constructive feedback • Practical interpersonal and communication skills are not appropriate to their level of experience • Demonstrates inability to deal with difficult situations for their level of experience • Poor written record keeping • Lacks insight into the impact of their communication on others • Demonstrates a lack of empathy, respect, dignity and caring towards clients/ carers and colleagues

• Is preoccupied with personal issues • Is not motivated and shows lack of interest • Does not respond appropriately to feedback • Is unable to effectively work within the team • Shares personal experiences with patients and clients inappropriately • Lacks insight into their behaviour towards others

• Demonstrates inconsistent clinical performance to their level of experience • Has demonstrated unsafe clinical practise • Is unable to demonstrate preparation and organisational skills to their level of experience • Is unable to relate actions to potential risks re self, patients and colleagues • Misuse of IT and/or electronic patient records

• Demonstrates poor professional behaviour and is unaware of professional boundaries • Is unreliable – i.e. persistent lateness/absence/sickness • Evidence of breaching confidentiality, of patients, peer group, placement or University staff • Evidence of inappropriate use of social media • Uses mobile phone to text while in clinical area • Does not adhere to uniform policy • Inappropriate use of electronic mail, text messaging and social network sites • Does not demonstrate respect for all members of the team

• Does not have required knowledge for their level of experience • Has little or no ability to translate numerical calculations into drug administration • Unable to apply theory to practise • Does not meet the required level of competencies for their level of experience • Is unsafe in recognising need for storing, recording or monitoring side effects of medications for example • Appears to have little understanding of legislation around medicines management, legal and ethical frameworks • Does not use initiative in knowledge acquisition around drugs associated with patient profile for placement area, routes of administration, side effects, adverse

reactions for example

19

Raising Concerns in Practice

It may sometimes be necessary for PEds, students or both to raise concerns in practice for a variety of different reasons. When there is a cause for concern it is important that this is raised in a timely manner and the University of Lincoln Problem Resolution Protocol in figure 13 gives guidance should such a situation arise.

Figure 13 Problem resolution protocol

20

Student Support

There will be times when students need support for specific issues. In addition to the support available to the student within East Midlands Ambulance Service, the University of Lincoln have a robust student support mechanism and a variety of services available to help them. Figure 14 gives advice to staff regarding where best to direct students for a range of different issues.

Figure 14 Staff guide to support services for students

The College of Paramedics (2017) have produced the Practice Educator Guidance Handbook which gives detailed guidance that will help you to support your student in your role as PEd.