• Exploring paramedic perceptions of feedback using a phenomenological approach

      Eaton-Williams, Peter; Mold, Freda; Magnusson, Carin (2020-06-01)
      Abstract published with permission. Objectives: Despite widespread advocacy of a feedback culture in healthcare, paramedics receive little feedback on their clinical performance. Provision of ‘outcome feedback’, or information concerning health-related patient outcomes following incidents that paramedics have attended, is proposed, to provide paramedics with a means of assessing and developing their diagnostic and decision-making skills. To inform the design of feedback mechanisms, this study aimed to explore the perceptions of paramedics concerning current feedback provision and to discover their attitudes towards formal provision of patient outcome feedback. Methods: Convenience sampling from a single ambulance station in the United Kingdom (UK) resulted in eight paramedics participating in semi-structured interviews. Interpretative phenomenological analysis was employed to generate descriptive and interpretative themes related to both current and potential feedback provision. Results: The perception that only exceptional incidents initiate feedback, and that often the required depth of information supplied is lacking, resulted in some participants describing an isolation of their daily practice. Barriers and limitations of the informal processes currently employed to access feedback were also highlighted. Formal provision of outcome feedback was anticipated by participants to benefit the integration and progression of the paramedic profession as a whole, in addition to facilitating the continued development and well-being of the individual clinician. Participants anticipated feedback to be delivered electronically to minimise resource demands, with delivery initiated by the individual clinician. However, a level of support or supervision may also be required to minimise the potential for harmful consequences. Conclusions: Establishing a just feedback culture within paramedic practice may reduce a perceived isolation of clinical practice, enabling both individual development and progression of the profession. Carefully designed formal outcome feedback mechanisms should be initiated and subsequently evaluated to establish resultant benefits and costs.
    • Student paramedic decision-making: a critical exploration of a patient interaction

      Costello, Barry; Downs, Simon (2021-02)
      Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction. Abstract published with permission.