The Advanced Paramedic Training Programme: challenges for an adult workforce entering the university sector

In the last decade, university medical education in Ireland has been increasingly challenged to move outside the traditional undergraduate education/ postgraduate masters’ taught courses. The rapidly changing health service environment demands that medical education respond innovatively to new or changed forms of medical practice. We describe one such challenge and medical education response. Adults entering the university for the first time face specific challenges ; this is particularly so for those whose career and promotional trajectories depend on their achievement or academic success. The Graduate Diploma in Emergency Medical Science (GradDipEMS) is offered jointly by SMMS, UCD and the HSE National Ambulance Service and trains Advanced Paramedics for Ireland’s statutory ambulance services. Advanced practice was established in 2005 by the statutory regulator, the Pre-Hospital Emergency Care Council. The GradDip is a demanding full-time, one year, 80 ECTS credit, level 4 course. Key outcomes include the competencies required to make complex clinical decisions in emergencies, administer more than 50 drugs, carry out interventional procedures and practice with a high level of autonomy. Candidates are principally nominated by HSE, Dublin Fire Brigade and the Defence Forces, have at least three years Paramedic experience and are selected by intense internal competition. Since its inception in 2006, 338 candidates have entered the programme (88% male, mean age 36 (range 24-56), 84.5% from HSE, 10% from DFB, 2.5% Defence Forces and 2.5% others). All have previously undertaken a Diploma level EMS course prior to the GradDip, but only 9% have a primary or higher degree. More than 90% of candidates have successfully completed the programme and 15% have entered Master’s level courses in UCD; several have entered Graduate Entry to Medicine courses and at least two candidates are undertaking PhD programmes. This is a highly motivated candidate group with strong incentives to succeed. A high proportion hold vocational / volunteer qualifications prior to programme entry. The framework, teaching and assessment components of the course required to address the needs of this unique cohort are described. The potential lessons for mainstream health professional education are discussed.