A model of continuous professional development for registered pre-hospital practitioners in Ireland

The introduction of a Regulatory body in Ireland with responsibility for ensuring high standards of education and professionalism for ambulance, and other pre-hospital, practitioners was a welcomed initiative in 2001 due to a need for improvement in care delivered to patients before arrival at hospital. This Regulatory body, the Pre-Hospital Emergency Care Council (PHECC), was established under Statutory Instrument with an initial priority being to develop three levels of pre-hospital practitioner: Emergency Medical Technician (EMT); Paramedic; Advanced Paramedic (AP). The introduction of these three levels meant that only such registered practitioners could practice in the pre-hospital environment. However for practitioners to renew their registration, they had only to meet simple and minimal criteria with no requirement to demonstrate any level of competence. The Council’s 2011-2014 Strategic plan identified the need to introduce a system of continuous professional development/competence as a priority. The purpose of the studies in this thesis was to engage with the three levels of practitioner in Ireland and to seek their views and opinions so as to identify factors that would inform the implementation of a continuous professional competence (CPC) framework for all pre-hospital practitioners. The expectation in when initiating this work was that the results would assist in the introduction of a framework for one group of registrants in particular, EMTs. In reality the outcomes from these studies provided the evidence base when drafting the formal guidance document that was subsequently issued officially to all EMTs in Ireland by the Regulator. Following that introduction of CPC, a retrospective analysis was performed through engagement with those registrants so to allow for further refinement of the process before the framework would subsequently be introduced to the two remaining registrant groups, paramedics and APs. At a practical level, this thesis represents the first series of studies to engage with all levels of pre-hospital emergency care registrants on a national level in Ireland and is one of only very few to report nationwide pre-hospital research. Data were gathered using qualitative and quantitative methods, in the form of on-line surveys and focus groups. These data then formed the basis for the initial introduction of the CPC model. After a six-month period, further engagement with registrants provided the additional data to refine the process further. Therefore, this work represented a meaningful process of consultation with practicing pre-hospital care providers that would inform the information to be provided to them by their Regulator and the format in which that would be delivered. To my knowledge, there is no previously published example of such relationship between pre-hospital practitioners and Regulators internationally. Further, the design of this thesis allowed additional engagement with Irish pre-hospital practitioners following the introduction of CPC. Through publication of the outcomes, the thesis makes a contribution to both the international literature on continuous professional competence (CPC) for pre-hospital practitioners specifically and, in particular, the development of the profession in Ireland. The implementation of CPC aligns Irish pre-hospital practitioners with other well established international best practice models. This thesis, through substantial engagement with registrants, has identified the factors which they believe are important for the successful implementation of CPC and adds to the international literature on pre-hospital care and, in particular, practitioner competence in this regard. The model of CPC will have significant implications for all registrants; organisations who operate in the pre-hospital environment; the Regulator; and will positively impact on patient care by ensuring a national standard of competence exists for all relevant practitioners. While Ireland has been the focus of this thesis, the publication of its findings in peer-reviewed journals means that its relevance may extend beyond the Irish setting to those working more broadly in the fields of continuous professional development and professionalism internationally.