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In the past several decades, there has been rapid advancement and improvement in Australasian paramedicine education and clinical standards. These advancements have also seen improvements in the professionalism of Australasian paramedicine. Therefore, having a valid and reliable paramedicine professionalism measure is important. This study aimed to investigate the psychometric properties of the modified Professionalism at Work Questionnaire (PWQ) with Australasian paramedicine students

Data from the PWQ were analysed using a principal component analysis (PCA) followed by orthogonal varimax rotation.

A total of 479 paramedicine students from three Australasian universities completed the modified PWQ. PCA of the 72-items revealed 11 factors with eigenvalues above 1.5, accounting for 50.99% of the total variance. A total of 64 items were found with loadings greater than 0.40 and were used to describe the 11 factors: Professional attitude and behaviour, communication with others, professional identity, professional development, appearance and flexibility, organisational support, comparable professional status, pride in occupation, adherence to rules, responsibility in the workforce and concerns about appropriate use of resources.

Results from this study suggest that the modified 64-item PWQ can be used to measure professionalism in Australasian paramedicine student cohorts. The instrument encompassed many and varied aspects of the attributes and features that have been described as being essential to being a profession. The instrument provides an important measurement tool for the paramedicine profession.

Results from this study suggest that the modified 64-item PWQ can be used to measure professionalism in Australasian paramedicine student cohorts. The instrument encompassed many and varied aspects of the attributes and features that have been described as being essential to being a profession. The instrument provides a critical measurement tool for the paramedicine profession.

The proliferation of undergraduate paramedicine programs has led to a surge in demand for work integrated learning (WIL), placing pressure on domestic ambulance service placement capacity. The objective of this study was to establish a baseline understanding of international WIL in paramedicine university programs.

A cross-sectional study design was utilized to gather data from Australasian universities offering undergraduate paramedicine. A telephone survey was used to gather quantitative and qualitative data using a tailored questionnaire.

Of 15 eligible paramedicine programs, seven program leads participated. All offered international WIL, predominantly short-duration format in locations including United Kingdom, USA, Israel, Nepal, Indonesia, Timor-Leste, New Zealand, South Africa, Finland, Canada and Vanuatu. Two distinct models were identified: academic-accompanied, group “study tours” and unaccompanied individual placements. International WIL is common in paramedicine but placement models, rationale and expected learning experiences are diverse.

International WIL is an increasing component of paramedicine and other health discipline degrees, yet the pedagogical rationale for their inclusion and typology is not always clear. This paper provides an insight into the variance in international WIL typology in a single health discipline highlighting the heterogeneity and need for future research linking into the structure, support and assessment of international WIL.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

Paramedics increasingly attend to mental health-related emergencies; however, there has been little evaluation of the mental health training for paramedics. This study aims to analyze the fit between paramedicine pedagogy, patient needs and the conditions for paramedics’ skill development.

Data were collected in a single, qualitative, critical ethnographic case study of pre-hospital mental health and psychosocial care in paramedicine in Ontario, Canada. Transcripts from interviews (n = 46), observation (n ∼ 90h) and document analysis were thematically analyzed using a constant comparative method. The study is theoretically grounded in a feminist political economy framework.

Tensions are explored in relation to the pedagogy of paramedicine and the conditions of work faced by paramedics. The paper presents challenges and insufficiencies with existing training, the ways in which certain work and training are valued and prioritized, increased emergency care and training needs and the limitations of training to improving care.

Recommendations include more comprehensive didactic training, including the social determinants of health; scenario training; practicum placements in mental health or social services; collaboration with mental health and social services to further develop relevant curriculum and potential inclusion of service users.

This paper addresses the lack of mental health pedagogy in Ontario and internationally and the need for further training pre-certification and while in the workforce. It presents promising practices to ameliorate mental health training and education for paramedics.

Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice.

Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey.

Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration.

Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution.

This study aims to map and examine the existing evidence to provide an overview of what is known about the structure and characteristics of the Anglo-American paramedic system in developed countries.

The review includes results examining the structure and characteristics of the Anglo-American paramedic system in English-speaking developed countries. Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forward and backward searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Finally, data extraction was performed using a customised instrument. Included studies were summarised using narrative synthesis structured around broad themes exploring the structure and characteristics of the Anglo-American paramedic system.

The synthesis of information shows that varying models (or subsystems) exist within the Anglo-American paramedic system. The use of metaphorical models based on philosophical underpinnings are used to describe two novel subsystems within the Anglo-American paramedic system. These are the professionally autonomous and directive paramedic systems, with the directive model being further categorised into the rescue and hospital-managed submodels.

This study is the first of its kind to explore the modern subcategorisation of the Anglo-American paramedic system using a realist lens as the basis for its approach.

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.

A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.

Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.

In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Against a British policy backdrop, which places an ever- increasing emphasis on workplace learning in pre-service professional programmes, the purpose of this paper is to investigate the contribution of the mentor to professional knowledge development in nursing, paramedicine, social work and teaching.

Taking the form of a literature review, it explores the influence of policy, professional and theoretical conceptualisations of the mentor role, and structural factors influencing the mentor’s contribution to professional knowledge.

Where there are clearly delineated policy obligations for the mentor to “teach”, mentors are more likely to make connections between theoretical and practical knowledge. When this responsibility is absent or informal, they are inclined to attend to the development of contextual knowledge with a consequent disconnect between theory and practice. In all four professions, mentors face significant challenges, especially with regard to the conflict between supporting and assessor roles, and the need to attend to heavy contractual workloads, performance targets and mentoring roles in tandem.

The authors argue first for the need for more attention to the pedagogy of mentoring, and second for structural changes to workload allocations, career progression and mentoring education. In order to develop more coherent and interconnected professional knowledge between different domains, and the reconciliation of different perspectives, it would be useful to underpin mentoring pedagogy with Bhabba’s notion of “third space”.

The paper makes a contribution to the field since it considers new obligations incumbent on mentors to assist mentees in reconciling theoretical and practical knowledge by the consequence of policy and also takes a multi-professional perspective.

Paramedics play important roles in healthcare, yet little is known about their decision-making. There is evidence that thinking style is associated with individual preference for intuitive or deliberative decision-making.

Australian and New Zealand paramedics (n = 103; mean age: 38.7; mean 12 years’ experience; 44% female) and paramedic students (n = 101; mean age: 25.7; 59% female) completed a thinking style survey measuring active open-mindedness (AOT), close mindedness (CMT), preference for intuitive thinking (PIT) and preference for effortful thinking (PET). Participants also completed the 7-item Cognitive Reflection Test (CRT) to assess ability to override an attractive but incorrect intuition.

With prior exposure to the CRT controlled, regression analysis found increasing AOT and decreasing age predicted cognitive reflection across all participants (R2/R2 adjusted: 0.198/0.157; F(10, 192) = 4.752, p < 0.001). There were moderate correlations between CMT, age and paramedic experience. There was no difference between paramedics and student performance on the CRT, though more students reported prior exposure to the items (33.7 vs 16.5%; Chi-square (2) = 8.02, p = 0.02). Those who reported prior exposure to the CRT scored significantly higher than those who had not (5.08 [1.44] vs 3.87 [1.70]; F(2, 201) = 14.34, p < 0.001).

Self-reported AOT was associated with cognitive reflection and indicates a role for open-mindedness in paramedics to support decision-making.