In December 2016, Jordan University of Science and Technology (JUST) hosted the Second International Conference of Applied Medicine/Paramedic. The primary aims of the conference were to equip its attendees to deal with medical emergencies currently prevalent in the middle east, to optimize all aspects of care for refugees and victims of war and social awareness, and to promote the spirit of universal participation. A select few students from Anglia Ruskin University (ARU, UK) were invited to attend the conference. Paramedic Diploma students from Anglia Ruskin University underwent a rigorous process of application and selection, after which four students were chosen to attend the conference at JUST.
Along with the conference, students also participated in a Clinical Simulation competition, consisting of students from five international teams. These comprised Royal Arabic Emirates, Jordanian University of Science and Technology, Jordanian Civil Defence, Bahrain and the UK (ARU). Over the course of two days, the events included a conference, one day of simulation exercises, along with poster presentations and theatrical moulage, performed by paramedic students of JUST.
Students from ARU found the simulation exercises a particularly effective give-and-take, as they had to draw on their knowledge and practice, and they also had a glimpse of how paramedics in the middle east may tackle a similar scenario. This article covers the reflection
During the simulation exercise, ARU students had to draw on their knowledge, skills and attributes to participate in the simulated scenario. Each team was allowed 10 minutes to ‘assess, diagnose, manage and package’ the patient. A panel judged the students' competency in clinical care, teamwork, leadership, diagnostic and management skills, and patient-handling. Teams were only allowed to watch the event once they completed their scenario, i.e. they were ‘blinded’ to the full scale of the scenario before their turn.
Following 10 minutes of detailed patient assessment and management, the UK team were able to identify a suspected blunt trauma injury to the patient's chest, which resulted from a sporting injury and subsequently led to cardiac arrest, presenting as Ventricular Fibrillation (VF). Following successful defibrillation and clinical management of the patient, a return of spontaneous circulation (ROSC) became present. The remaining teams subsequently undertook the same scenario. The judges concluded, that the Jordanian Civil Defense team were the winning team. UK ARU team finished second out of the five participating groups.
The seminal work of Dewey (1997) suggests, learning in the practice setting is a reflective process through which action occurs, that students are able to construct meaning from the situation. Lave and Wenger (1991) state that learning is integral to the community in which they operate, that students go from a position of peripheral participation to one of full legitimate participation. Lee (2004) have found that students believed their international experiences had a deep impact on their personal development, helping them make the transition from student to qualified nurse. Levine (2009) joined student nurses embarking upon multiple international journeys, suggesting informants spoke of profound changes in their personal and professional lives as a direct result of their work or study abroad.
Though ours was a short visit and a shorter simulation exercise, some principles of observed learning could be extended to reflections of ARU students. Our four students reflected on their performance of the scenario, while critically analysing both their own, and their fellow students' performance. This reflective process gives a degree of assurance that students have learnt from the scenario (10-minute simulation) on a micro level. ‘Learning by doing’, as often reported in previous studies, gives rise to a model of reflective cycle, which draws on the experience of the event prior to asking about one's feelings, evaluation, analyses, conclusions, and action plans.
However, what was key to our experience is the less formal learning throughout our stay. Such a phenomenon in the context of this Jordanian visit draws on our experience in a country bordering war torn Syria, its position between Palestine and Israel, and the impact upon the humanitarian aid which we believe, from our observations of the visit, is the premise in which paramedics in the region operate.
The socio-cultural setting in which paramedics usually work have an impact on their perspective, and this impact of conflict on the paramedic and medical services of Jordan was evident during our visit. Throughout our stay, we met a number of paramedics from various parts of the Middle East, many had experienced conflict within their working lives either as paramedics or students while boarding areas of conflict, such as in Syria and nearby areas. As a team, we were drawn to the humanitarian aspect of the paramedic role in these regions. In addition to dealing with such traumatic events and injuries, we were inspired by the dedication demonstrated by these professional colleagues, despite great risks to their lives. We witnessed, both through video footage and a re-enactment, horrors and destruction of their politically unstable neighboring regions.
Images of paramedic crews waiting to respond to the next call, followed by subsequent images of paramedics' charred bodies, following a direct hit on their ambulance from artillery shells were scenarios the UK paramedics had not previously encountered. What appeared an exceptional emergency for UK students was not an uncommon circumstance for the Jordanian paramedics to operate in. There was a constant sense of hostility, conflict and potential danger prevalent around the region, although we were never in a position of danger ourselves. The Jordanian paramedics' degree of readiness and presumption of danger were insightful for us. We learnt from their competence in professional practice and their awareness of traditional norms when dealing with patients from other environments.
Some of the ARU team members give an account of the learning taken from the visit below:
‘The final video was produced by some Palestinian students and documented a shocking incident where ambulances attending casualties from a missile attack on the West Bank were themselves hit by another missile, killing five paramedics and several civilians. The whole incident was caught on camera.’
‘The news reports from Aleppo seemed much more real after we had met people directly affected by the conflict. And while our job in the UK has its pressures and problems, they are very different from the ones faced in the Middle East. This was highlighted a few days after our return, when several gunmen attacked police and tourists in Karak, killing 10 people, including a Canadian tourist.’
It is clear from the quotes above, that the experiential learning and epistemological experience of the team, require a broader in-depth context in which to understand this phenomenon. What we had experienced was not necessarily what we had expected. The insight we gleaned from our brief experience may warrant a robust analysis of reflective learning based on existing models, but a more substantial duration of visit is required in order to understand the pedagogy of the context to which we were exposed. Models of experiential learning comprise detailed theoretical models, of which this short article has not been able to fully explore in detail, rather it has given an introduction of how we believe the wider ‘macro’ aspects of experiential learning helped shape and influenced our visit.
The clinical interventions and outlook among international groups differed, but the more striking contrast between our roles and theirs was the humanitarian aspect.
‘some JUST students performed a short play they had written, highlighting some of the challenges faced working so close to a war zone and the refugee crisis in Jordan. There are estimated to be over 2 million Syrian refugees in Jordan who have arrived in the last 2 years. Add to this the huge number of Iraqi and Palestinian refugees and the shocking fact is that roughly a third of the population of Jordan are refugees.’
‘The range of topics covered were thought provoking, leading to informed discussion with peers, and a greater appreciation of the diversity of the paramedic role around the world.’
Paramedic practice helps inform and enhance the student experience of the host nation's practice environment, offering a wider, more in-depth understanding of the challenges presented to paramedic colleagues operating in disparate and often hostile environments. As a group of students and a lecturer, we were humbled by the extent to which our international paramedic colleagues in the Middle East are able to adapt to and care for their fellow man in the midst of such hostility and neglect surrounding their working environments. They were able to demonstrate humanitarian aid to victims regardless of various political and religious beliefs and ideologies.
The learning experience gained from the programme of study was evident, but difficult to measure. Lave and Wenger (1991) suggest trainees (students) want to become part of the community in which they are attached, to become full legitimate participants of that community. This desire was evident throughout our time, as our Jordanian paramedic students strive to become qualified and assist in the humanitarian aid of neighboring countries, along with their own refugees.
We would like to acknowledge, that this visit was funded by the Jordanian University of Science and Technology (JUST), and the team would like to express their sincere thanks and gratitude to Dr Eihab Khasawneh, along with the Faculty of Applied Medical Sciences, for inviting us to this event. We would also like to thank the Faculty of Medical Science at Anglia Ruskin University for supporting this visit, along with the East of England NHS Ambulance Service Trust for helping to accommodate staff to attend the event. Lastly, we would like to acknowledge our sincere gratitude and thanks to all our newfound friends and colleagues from Jordan for sharing their professional, and at times, personal experiences with us. Your stories and experience were very moving and allowed us to reflect upon our own practice back here in the UK.
As a result of our visit, we all believe we have obtained a broader understanding of the context in which our paramedic colleagues in the Middle East operate. This has allowed us the opportunity to reflect upon our own working practices and contextualise this to the relative stable environments in which we all operate. Therefore, we believe, as practitioners, we have gained a great deal from the visit which will further serve to influence our current and future practices as paramedics.