Paramedic Degree

[downunderwunda]

However, I do think its entirely possible to become a perfectly competent technician through other forms of training. But if we are to encourage pre-hospital specific research and higher levels of theoretical knowledge as well as achieving professional status amongst other health workers and dictating our own scopes of practice instead of being told what to do in simple steps by Dr.s, then yes, university is the only way to do that. If you want to attract the kinds of people who are predisposed to that sort of thing, in short if we wanna poach people who would have done medicine or science, then yes university is the only way to do that.

Then why are other professions, such as nursing looking at maintaining the degree, but putting more emphasis on vocational training that classroom? Where I work, I have the respect of Doctors, Nurses, & many of the other health related professions, put simply, Professional Status is not just a title, but a lot more. It encompasses a wide range of things & will require higher rates of pay. However, the maitenence of your status becomes YOUR responsibility, YOUR cost, YOUR problem. Currently the service you work for provides you with education, they assist with the maintenence of your skills, at a huge cost. It is estimated to cost in excess of $800000 to train (even with a uni degree) & maintain an officer for a period of 5 years. Are you prepared to wear that cost yourself, even with a professional wage as was offerred in South Australia recently?

My point about peoples age is not there just for length of service, but also demonstrates that if a person is older they have a lot more life experience, they have learned to cope with trauma, (both actual & psychological), & can communicate with people. I do not as you say, have a grudge with University trained officers. What I have a problem with is the attitude that is displayed by too many that join & work with me that they SHOULD be an ICP NOW not have to wait & prove themselves, as well as learning their coping methods.

 

[Melclin]

We might have a misunderstanding when we're talking about vocational training. As it happens, I think the current system does put to much emphasis on education rather than training.

To clear things up (because my last post was a bit combative): while I think the university system is the way to go, we do have a special profession and we can't just have a normal academic degree. As it stands now I feel the degree is getting much better and fast, but it still has many flaws. The degree was atrocious and with so little clinical placement time, I can see graduates coming out of their final exams having aced them and thinking they're god's gift to paramedicine. My class and the ones coming after us have already had more placements than some graduates used, so we are quite aware of the differences between academic knowledge and and practical application and probably more importantly, how to respectfully suggest pt care issues and not to get your head bitten off when interacting with older medics, a lot of whom do have a big grudge against us (sorry if I misjudged you). I think the answer lies not in going back to the old system, but in adjusting the new one - because it has so much to offer if we can work out the kinks.

Nursing is moving more towards vocational education in the sense that they do more placements, but on the job experience and university are not mutually exclusive, as I said above.

There's a difference between paying to achieve the qualification you need to get a job and paying to maintain training with in the employer's organisation. Do I have a probelm paying for my degree? NO. Do I have a problem paying for my MICA grad dip in 5-10yrs time or doing an ECP course and leaving AV to work in primary health care? NO. Achieving qualifications to improve yourself professionally at your own expense is what the rest of the professional world does, why should we be different? However, would I have a problem with paying for training on a new defib that AV is introducing? Yep. For a professional development day on the introduction of a new drug to the AV CPGs. Yep. But again I feel that's a fundamentally different issue than the original education. If we want to focus on that sort of employer mandated training how are we supposed to assert ourselves as autonomous medical practitioners, and work and develop in an environment where, quite soon, practicing paramedicine will not be exclusive to Ambulance service employees (paramedic practioners, ECPs, PAs, health admin).

I take your point about age, and I agree with it, but again it doesn't really have to do with university.

"Younger people have trouble coping/dealing/communicating" is not followed logically by "the degree is flawed", it just means the people doing the degree are not the right ones.

If you want to argue that you should only be allowed to start the degree when you're 25 or 30 then that's fine (I don't agree with mandatory age limits as it happens, but I do think more thought should be put into preparing us for the nasty things). However, that's a separate issue to the overall efficacy of the degree (unless you are arguing about curriculum change like I am).

 

[Ridryder911]

It's nice to see that not only those in U.S. disagree about the education method. I do say though, it is unique to see that one would complain that they are too educated? Then want to apply more of a vocational angle and skills? This can't be done while in the University setting?

We have the total opposite here. All the emphasis is placed upon the skills and very little on the knowledge. So you may have those that are very proficient in applying the skills, it is they just don't know why and when to do them.


R/r 911

 

[Melclin]

This can't be done while in the University setting?


R/r 911

Well thats my point is that it can be.

When the change occurred from vocational to university training, I feel they went a little far, and we ended up churning out medics who knew the text book backwards but couldn't do anything in the real world, but were still keen on telling their partner how to do everything. I had a convo with MelbMICA about it recently. Our state service is having quit a bit of trouble with this at the moment, amongst other things.

But I don't think its a problem with the university model itself. It just needs to be tweaked. There were always ganna be hiccups making such a change. The medics coming through now, have much more on the job experience and the curriculum has been tweaked to improve our ability to apply our skills. And its only getting better. Of course it would be better if we all had street smarts as well, but there's already a shortage, and imagine all the good medics and experience time we'd loose if there was a mandatory entrance age of ~30.

I've seen you have the opposite problem over their, and I don't want us to move backwards, which we would be doing if we went back to un-regulated, in-house training with the ambulance services with the focus on "how" rather than "why".

 

[downunderwunda]

Melclin, I would like to clarify something here.

I take your point about age, and I agree with it, but again it doesn't really have to do with university

Who is attending uni, generalisation, I know but school leavers.

I dont know where you got

"Younger people have trouble coping/dealing/communicating" is not followed logically by "the degree is flawed", it just means the people doing the degree are not the right ones.

I did not at any point say that.

I think you need to read what I wrote before you try to justify this

If you want to argue that you should only be allowed to start the degree when you're 25 or 30 then that's fine (I don't agree with mandatory age limits as it happens, but I do think more thought should be put into preparing us for the nasty things). However, that's a separate issue to the overall efficacy of the degree (unless you are arguing about curriculum change like I am).

I did notsuggest at any time an age limit on starting the degree, however I quoted some statistics on duration of employment. I also said that this is not always the case, there are exceptions.

I would also like to point out, & I am sure all of those who have worked in this field for any period would agree, you cannot teach how to

preparing us for the nasty things

This is something that you learn on the job, with training officers, with peer support, and then you will learn to cope.

One of my biggest problems is that there is too much "I wnna be a ICP NOW". Too many young, inexperienced highly educated people that want all the responsibility, when they have seen a small snapshot of what is done in a probationary period.

Having the education is great, knowing when to use it is better. I can adapt the saying you can train a monkey to hold a hose to You can train a monkey to insert a tube, but you cant teach him to know when to do it appropriatley.

I believe that with the systems in place in Aussieland, (no offence intended to our american friends) our skill levels are more highly appropriate than in the US, with base levels pushing the boundaries of ICP anyway, there should be less of a rush to achieve that until appropriate experience is achieved. We are on similar lines, but looking from different perspectives.

To back this up, I also believe that, in Aussieland we have an opportunity, in at least 3 states, QLD, NSW & Vic, to progress ALL staff to an ICP status very easily. I belive this should be a natural progression for all officers, regardless of Uni degrees. Not for the benefit of Ego, but for the benefit of our patients & their families.

 

[Melclin]

School Leavers
Yeah it is mostly school leavers, but as you say, that's uni in general. It doesn't mean that it has to be that way for a paramedic degree, we already have more mature age students than most degrees. It doesn't make the uni framework wrong for paramedic education.

Quoting You & Age Limits
With the 'quoted' words I used, I wasn't actually quoting you, I was using the quotations to frame an idea conversationally. I was essentially paraphrasing you though. You posted in a thread about the efficacy of a uni degree, that older vocationally trained medics are more likely to stay in the job than younger uni trained ones. It's reasonable to assume you are making the point that the uni model precludes older people from joining the service. Which is what I was disagreeing with, because I see no reason why older people can't, or shouldn't have to go to uni.

I didn't say you specified an age limit, but I was assuming that in your statement about older medics being better suited to the job, that you were suggesting that the model should be focused in some way on older people.
Which was the point of the thread - discussing the efficacy of the uni model. You said you hoped I wasn't suggesting that uni was the only way, and proceeded to use the age issue as an example of why exclusive uni education was flawed. If you weren't suggesting the age issue as part of some argument regarding the model, why was it suggested?

After all this I still don't understand your point about age. Yes it would be better if we were all street smart first, its true of most professions, but we can't wait forever building st smarts before we start work. Other than some loose idea that 'young people go to uni', I don't see your point about why an education system housed within a university framework can't be equally suited to educating people of all ages.

Coping with Death & Misery
On the topic of learning to cope with tough issues, I entirely disagree that you can't be prepared. That's different to being ready. I'd compare it to training for combat. You can train and train and train, do things a thousand times with live fire exercises, but it never makes you ready to deal with combat. But you sure as hell wouldn't suggest that we don't at least try to prepare soldiers not just to cope after combat but to work well in combat.

As it stands now, no body even tries to prepare us for death and misery, because there is this attitude that its impossible so why even try. It's narrow minded and shows a distinct lack of understanding of the reality dealing with nasty situations for the first time. They all found that nothing prepared them so they assumed that nothing could.

I can say with some considerable certainty that
-psychological strategies for dealing with circular thought patterns and guilt driven illogical thoughts (taught to me by my psychiatrist), helped a lot.
-knowing things like "the heart attack was going to happen with or without you, the fact that you were there can only have helped"
-being aware of basic statistics about death that you might take for granted: "bugger all cardiac arrests survive to discharge" (We all start uni thinking VF is no big deal thanks to teli).

I knew these things because I made it my business to know and because I was taught certain things (like with my shrink) in other aspects of my life. Not because uni told me. So when I did my first arrest/fatality, I can honestly say that it was not an issue for me because of these things. I'm not saying I have all the answers, but I am saying that its a cop out not to try. I really feel that their are a number of things that could be added to curriculum for two purposes in this area: 1. preparing students to maintain their calm, and work effectively and retain their knowledge under pressure (just as the defense force does, although I'd question some of their methods). 2. To cope with ongoing emotional strain of the job.

Students & ICPs
Now, continuing with my dissertation , on the issue of ICPs, its difficult for me to comment with any intellectual authority, with my lack of experience. But from what I hear, yes that is a problem.The problems you're describing are no different that what medical interns do, so I think with the ongoing guidance of their superiors, Ambo students can work through their initial arrogance. Part of the problem though, is that a lot of our 'superiors' are not well educated and practice a sort of gung-ho oldschool ambo first aid full of intuition and street smarts, and its hard to take their advice seriously, when they practice very differently from how we have been taught. Just as theory isn't everything, experience isn't everything either. Older ambos may have to accept that their is value in our education. It's hard to accept the criticism of being over educated and naieve from people who seem under educated and burn't out. Now I know I'm making gross generalizations, but I'm just using hyperbole to provide the point of view from the student side. Once again though, I fail to see what exactly this has to do with the uni model in particular. If it doesn't, I'm happy to have a conversation about it all the same, I just want to know if I'm missing something.