Whilst UK ambulance service Paramedics and EMT’s have for many years been practicing prehospital care, it is a relatively new sub-specialty within UK hospital-based healthcare systems. In fact, prehospital medicine has only recently been recognized by the College of Emergency Medicine and is currently only offered to senior medical students working with London’s Air Ambulance (LAA) and other helicopter services around the UK.
The majority of British physicians, both recent graduates and seasoned veterans, lack the knowledge and experience with the specific challenges faced in a prehospital environment because they are not frequently exposed to prehospital care during their training, even though at some point in their career many will have to deal with a medical emergency outside the “safety” of the hospital environment.
This lack of prehospital training was first addressed through the innovative ambition of Dr. Emma Lightbody, then a second-year medical student. She created and implemented the Prehospital Care Programme (PCP) at Barts and The London School of Medicine & Dentistry in 2007 with the goal of introducing medical undergraduates to this new area of emergency medicine.
The program was designed to capitalize on the medical school’s unique connections with both LAA and the London Ambulance Service (LAS) and was developed by Lightbody, Dr. Anne Weaver (consultant in emergency medicine, Royal London Hospital and LAA lead clinician), Dr. Danë Goodsman (senior lecturer in medical education) and Craig Cassidy (LAS paramedic).
With the exception of Lightbody, the three colleagues continue to run the PCP in their lead clinical, academic and paramedic roles, respectively. The team has also continually included a lead medical student selected from the program.
The PCP provides teaching and support for medical students while engaging them in an integrated, multi-agency educational experience. Students selected after a rigorous application process are enrolled during years 2-5 of their medical training and are placed with mentors from the LAS and LAA, where they participate in full EMS shifts.
Second-year students accompany LAS ambulance crews (usually one paramedic and one EMT), third-year students accompany an LAS paramedic in a fast response unit (FRU) and fourth-year students are placed with the LAA.
In the final year, students continue working with any of their previous mentors who, along with the PCP academic lead, guide them through a written project.
Students work in conjunction with a set of learning objectives and are instructed to complete a specially designed student report form for each case they observe in the field. In addition to their shift-based work, students are required to complete a variety of written assignments and attend academic forums, clinical governance days and LAA team meetings, all of which support and reinforce the knowledge they gain while on shift with their mentors.
The PCP experience supplements the MBBS (Bachelor of Medicine, Bachelor of Surgery) curriculum by offering increased patient contact, one-to-one teaching and truly inter-professional team working. It promotes communication and clinical skill practice, emphasizes the importance of doing the basics well and allows students to familiarize themselves with common medical equipment. In addition, it encourages the medical students to formulate differential diagnoses, recognize medical emergencies, understand appropriate treatments, and practice developing management plans.
The program gives future UK physicians insights and understandings that will enable them to offer not only higher quality prehospital care but also better in-hospital care.
The mentors’ contribution in managing this educational opportunity is central and critical to the program’s success. The role primarily involves assisting students with the completion of the specified learning objectives, being positive role-models, offering general advice and giving guidance and support.
Each mentor must possess a set of key attributes: demonstrate high clinical standards, possess excellent interpersonal and interprofessional skills, exhibit a positive attitude toward their work and have a desire to both teach and learn. This last area is important because experience has shown that, through the program’s symbiotic relationship, mentors learn just as much as the students.
Additionally, the team believes that the interpersonal and interprofessional aspects of the teaching is key: They are working within a “humanistic, student-centered, educational framework which requires mentors to move beyond simply a transmission model of teaching, to one that fosters dialogue and reflective practice between student and mentor,” according to the Prehospital Care Programme Mentor Handbook.
Craig Cassidy, lead paramedic and co-author of this article, says, “As a paramedic, being involved with the PCP has bought me increased job satisfaction, personal fulfillment and pleasure in seeing undergraduate medical students get real-life, real-time understanding of what emergency care outside the hospital environment is really like. I hope that my students will take this knowledge with them and use it for everyone’s benefit; be it our patients, ambulance staff or fellow hospital colleagues.” In his role as mentor manager, he has also noted from both EMTs and paramedics that they have gained experience and confidence by teaching in a non-classroom based environment.
In return for their efforts, the new UK mentors can receive support from the medical school’s teacher coaching program (provided by Dr. Goodsman), which is available to complete as a workplace-based process. Participation in this program has been used for appraisals, continuous professional development and yearly personal development review.
Saoirse Lyons, a former PCP lead medical student and another co-author of this article, says, “The Prehospital Care Programme has been one of the most beneficial parts of my training. It has given me a skill set which stands me apart from my colleagues and given me the confidence to recognize, and manage, acutely unwell patients appropriately. It is something I am exceptionally proud to say that I have been fortunate enough to be part of and wholeheartedly believe it will make me a far better doctor.”
Developing Future Leaders
As far as benefits for the ambulance service, it’s worth noting that these medical students could become our future clinical leaders and medical directors. This program clearly gives them the chance to gain a real-world understanding of the challenges of prehospital care and the skills and knowledge EMTs and paramedics utilize on a daily basis.
This can only lead to an improvement in relationships between all the services and, ultimately, contribute toward better care for patients. In addition, by creating a closer relationship with the teaching of medical students, the ambulance service gains the satisfaction of knowing it has been instrumental in the education of the next generation of clinicians.
Interest in the program from students, mentors and other medical schools has increased exponentially since its inception. Because the PCP and those involved in its instigation have received numerous awards, the first National PCP Conference was held in January.
The PCP has proved to be a successful and immensely popular addition to the MBBS curriculum at Barts and The London School of Medicine. It is a concept the authors highly recommend and are keen to see it spread worldwide.
More information on the Prehospital Care Programme is available at www.prehospitalcareprogramme.org.