Fifteen codes were identified through initial coding before being refined and described into four major emerging themes (Table 5).
Throughout the focus group sessions, participants spontaneously offered suggestions for enhancing the teacher/learner experience, with a particular focus on improvements within the practice learning environment. These suggestions addressed possible solutions to existing challenges. It is important to note that this study did not specifically aim to explore recommendations for practice, and these suggestions did not align with the predefined themes for analysis. Consequently, they were excluded from the analysis conducted in this study. However, these suggestions may be of interest to policymakers or for future research purposes and are available from the main author on request.
Theme 1: Attributes of effective learning
Among the themes identified in the data analysis process, the attributes of effective learning received the most extensive attention. Within this theme, various codes encompassing individual attributes, teaching and learning styles, relationships, and elements of mutual learning and communication were amalgamated. This comprehensive theme explored the various features that contribute to effective learning approaches and conducive learning environments. Attributes and communication were instrumental in providing insights into the expected level of engagement and the establishment of strong connections within working relationships, which were widely recognised as pivotal for both effective learning and teaching styles. Notably, student participants perceived their relationships with PEMs as professional, yet they also viewed them as friendly figures. Conversely, PEMs tended to see their role in a more parental light, fostering a different kind of connection with their students.
“It is like working with kids, you know…” [PEM 1]
Also referring to the act of taking on a student when another PEM is on annual leave as ‘babysitting’ [PEM 2], perhaps denoting their role to be overseeing or preventing mistakes and failure as opposed to teaching and nurturing good practice.
PEMs expressed a clear expectation that student paramedics should be eager to immerse themselves in the learning process and actively expand their own knowledge. One PEM emphasised this by stating:
“I want someone who is going to ask the questions. I want someone who is going to be keen to learn” – [PEM 1]
Students also recognised the importance of keenness as an attribute for effective learning. However, their perspective appeared to involve a slightly more passive role in the learning process. As articulated by one participant:
“I think just somebody who’s willing to think about you and your learning and to invest in that, who will take the time … who’s willing to then come back and say, ‘Let’s talk about this?'” – [SP 4]
Both groups valued enthusiasm for learning, but it is striking that students expected their mentors to take an active role in engaging with them, investing in their educational development, and facilitating discussions. This reflects a desire among students for guidance and mentorship throughout their educational journey.
Students’ experiences varied between the time and place where they undertook practice learning. They identified that applying an appropriate level of pressure and encouraging knowledge exploration were effective strategies for extending their learning comfort zones. However, the success of these strategies appeared to be contingent on the presence of mutual respect between students and their PEMs. One student discussed an experience where they were made to feel unwelcome when their PEM left them unattended for an extended period:
“…they got a call, and I was walking out the door and had all my kit on… and they drove off and left me at the station for two and a half hours and to me, that was a pretty clear sign. It made me feel very unwelcome.” – [SP 6]
This behaviour had implications surrounding the relationship between the student and their PEM. However, two other students praised their PEMs for the enthusiasm and opportunities they were provided, including the great relationships they built up. The framing of relationships through the sharing of knowledge, experiences, and mutual values frequently came up in both data sets.
Theme 2: Academic paradigm
The development of a BSc Paramedic Science programme in Scotland has provoked ambivalent feelings amongst both cohorts with scepticism found among qualified paramedics:
“I think there are people that just do not want to put in the effort…a lot of staff have been in the job for several years and argue that well, it’s not an academic job” – [PEM 2]
This theme, was also reflected amongst students in their experiences of practice placement:
“Sometimes it’s like they don’t like the new system, they don’t trust the system…” – [Student 3]
The same student compared the previous changes in other health care sectors to the more recent changes in paramedic practice, and shared a positive opinion surrounding these changes:
“This happened with midwifery and nursing they both changed, and I feel like for the better to be honest” – [Student 3]
Expectations surrounding the application of theory to practice surfaced opinions of how ‘academic’ the role of a paramedic is perceived to be. Students emphatically believed that the role of a paramedic has evolved, and they expected qualified staff to be accessible for both theoretical and practical inquiries:
“Someone that you can almost go to for advice if you need and be it placement or be it the education kind of side about the theory side of it, just someone you could go to and bring up concerns bring up problems” – [SP 3]
However, students observed that this ideal was not always realised in practice. They recounted instances where the integration of theory into practice was not only absent but also met with resistance. In these experiences, they encountered defensive behaviour from some qualified staff members who appeared reluctant to incorporate new and up-to-date theoretical knowledge:
“There’s a common phrase: ‘This is how I’m going to do it, but this is not how you’re going to do it. This is not the way you’re taught…'” – [SP 4]
These discussions focus on attitudes within the contemporary culture of paramedicine. Students articulated their expectations regarding engagement with the academic program from both students and educators, emphasising how this engagement could influence the learning and teaching that occurs in a practice-based education environment. Furthermore, these conversations highlighted a lack of understanding about the mutual benefits that can result from effectively integrating theoretical knowledge into paramedic practice.
Theme 3: System barriers to effective learning
This study unveiled several barriers to effective learning, encompassing issues related to the education of PEMs and associated communication challenges. One prevalent barrier was the marked lack of communication and engagement concerning academic system knowledge, particularly in the context of assessing students and PEMs using the practice assessment document (PAD). This lack of clarity led to disparities in expectations of students’ clinical abilities, resulting in unequal learning opportunities, as described by one student:
“There’s a lack of consistency… because you have mentors who allow some students to do almost everything, while others won’t even let you measure blood pressure, you know?” – [SP 1]
Furthermore, the study highlighted the stress experienced by qualified staff, compounded by the pressures of additional paperwork and responsibilities. These staff members felt inadequately supported and insufficiently educated by the system that surrounded them:
“Why should I bother, then, if the service isn’t bothered? Why should I be?” – [PEM 1]
Students were aware of this stress within the ambulance service, and they reported experiencing feelings of guilt as a result. They believed that this stressful situation could potentially have been avoided:
“Who decided that being a paramedic would involve a university route now… they throw you into ambulance service placements, and the ambulance service is like, ‘What?’ Like, ‘we were not prepared for this’, and then no one really takes responsibility for it. It’s as if they’ve introduced this new way of learning without the necessary support and infrastructure” – [SP 8]
Collectively, these barriers hindered the establishment of a positive learning and teaching environment. Students reported that the lack of engagement within the service had repercussions on their motivation:
“They need to be motivated because, at the end of the day, if they’re not motivated, it can affect our motivation too” – [SP 1]
The paramedic role, already characterised by its unpredictability, poses numerous challenges to practice placements. However, the reporting of these additional barriers could further complicate the task of creating an effective learning environment.
Theme 4: Changes in expectation
Both students and PEMs were specifically asked to reflect on whether their expectations had evolved over time, be that due to an increasing experience in practice, a developed understanding of the university system, or growing knowledge. This theme also sought to capture any notable expectations from second-year students that might be comparable to those of first-year students. Although no third-year students were recruited, second-year students discussed how they anticipated their expectations would rise and be accompanied by various challenges. They also discussed their perceived expectations from mentors during this phase.
“I also think us going into the third year out on placement. I do think that they will expect – they will have really high expectations. They will expect us to be able to run a job.” – [SP 4]
Second-year students disclosed that they had significantly adjusted their expectations since the beginning of their course, viewing this as a learned mechanism to enhance their learning experiences and environments:
“Now I go in completely blank … that’s kind of one of the only ways as a student you can kind of get over the negativity and just go forward because placement is what you put into it and like obviously what people on the opposite side put in like makes a big difference… I have lowered my expectations considerably since the first day” – [SP 8]
This theme also delved into the factors influencing these changes in expectations. Students appeared to gauge their expectations based on their evolving clinical abilities:
“…as we develop our kind of skills as well, like my expectations of my next placement are going to be different from expectations of my last placement. And because I know more, and I can do more… it’s a very evolving thing” – [SP 2]
In contrast, mentors articulated that they had to tailor their expectations based on their prior experiences, whether due to a lack of understanding of clinical abilities or otherwise:
“I think it all depends on their background… I think when you get the students who are younger or haven’t really had that kind of life experience, your expectations change” – [PEM 2]
This implies that expectations not only evolve over time but also vary according to the individual’s confidence, experience, and comprehension of the field.
