International learning: bridging the gap through exchange programmes

Paramedic education and those who commission it in the United Kingdom (UK) are seeing a call for a number changes in the pedagogical perspectives and theoretical frameworks being used. Student interaction continues to be at the centre of all that has been, and continues to be strived for. The purpose of this article is to expound the benefits of participation in collaborative exchange programmes. Further, to consider the possibility of subsequent ongoing continuous organisational links to foster and promote paramedic student interaction in online learning activities via classroom-based software, online contact or social media. While many established and emerging technologies may offer a range of opportunities for engaging in collaboration (in both synchronous and asynchronous learning environments), it is essential that a true contact bond is established at the onset and maintained throughout in order for high quality distance, blended or collaborative education programmes to be successful.

It is the intention of the authors to describe the history and evolution of the paramedic student exchange programme established between Liverpool John Moores University (LJMU) and Centennial College, Toronto. Exploring the challenges and barriers that undoubtedly all exchanges face in the planning phase should serve as a rudimentary road map for others interested in doing a similar exchange of their own. Further to this, we hope to consider the benefits of the programme for the future—the future of academic paramedicine, the future of patient care directives and the future of employability of those pre-registration students who engage in the programme.

Friend (2000) discusses historical collaboration well, highlighting that while collaboration can be perceived as being ubiquitous, many significant inventions of the twentieth century were made with collaborative efforts occurring in work environments that not only respected such initiatives, but fostered an ethic of sharing. Collaboration isn't just about sharing, it is about respect.

The exchange collaboration started in 2009 as the Student Paramedic International Exchange (SPIE). A small number of paramedic students studying at LJMU had the initial inspiration to look at how students study and paramedics perform in other parts of the world. With a rooted interest in international travel they set about establishing links with students (and staff) at Centennial College. Through dogged determination, tireless effort and untold costs the initial group, supported by both faculties, were able to organise highly professional visits on both sides of the Atlantic to good effect. During the inaugural trip the student paramedics had the opportunity to meet with paramedics and tour their headquarters, following this they were able to ‘ride out’ on twelve-hour shifts. This is quite different to the packed and multi-faceted itinerary of today.

Students and staff at both institutions reason that regular exchange benefits all involved on their academic and professional journey, it also enhances their confidence as they engage in a broader range of practical experiences. The many benefits of work-related learning, improved employability, and the promotion of the education of modern paramedics are also positive factors in such an exchange.

The initiative was welcomed initially by the then Lord Mayor of Liverpool, who praised the demonstration of pride and the enthusiasm the students demonstrated for their programme of study, their university, and the city of Liverpool itself, commenting: ‘You're the perfect advocates for your university and for the city of Liverpool.’ In 2010, the exchange project won an award for student initiative.

Since 2009, many LJMU paramedic students and faculty staff have visited Toronto and a similar number of Centennial students have visited Liverpool. Their experiences have been varied, professional and social. But more importantly they are experiences that they will never forget:

As a result of the exchanges, many lessons have been learnt. This has not only been from the students’ perspective but also the academics. The way in which LJMU's paramedic students are assessed has gone through some changes as a result of discussions that surround research conducted by Centennial's own Walter Tavares. Methods by which multi-casualty incident simulations are delivered have been altered to mirror the training in Toronto. Training which in 2013, LJMU students were part of during their exchange visit. Reciprocally, Centennial was so impressed by the incorporation of reflective practice and the development of a professional portfolio used at LJMU, that it has quickly adopted and integrated this approach as a direct result of the exchange experience. Arguably, the use of reflective practice is not new in Canada, but its application to the paramedic program is.

The sharing of values, systems and pedagogy between the two institutions naturally inspires change that ultimately encourages the graduation of a paramedic who is more competent in his/her professional role which, ultimately, means better care for the patients that they treat. The goal of delivering curriculum that ultimately prepares professionals who can deliver care at the highest standard and ensure patient safety remains a universal goal for higher education.

May 2013 will see the delivery of a pilot project between Centennial and York EMS (Toronto) of a community paramedicine program. This is a further direct product of this exchange. The exchange has allowed Toronto educators to witness paramedic students who (on completion of their programme) have the ability, experience and qualification to respond to emergency calls and manage their patient based on the individual's needs. This may mean establishing appointments and using resources that ultimately spare the patient from a lengthy stay in an emergency department. This can be seen as a significant cost saving to the healthcare system, and more importantly, appropriate for patient care in many circumstances. Faculty at Centennial College saw the potential for the role to be expanded in Ontario and several years later, they are doing just that. Given the relatively short period of time this exchange has been running, the fact that a new program is born here that expands and develops the role and scope of practice of Ontario paramedics is significant to say the least.

The exchange reinforces what we already know to be true; people are inherently the same across the world, and this includes patients. We are inflicted with similarly devastating illnesses that become a more unified global issue as we share ideas, morals and values that often, are not in our best interest. All one needs to do is look at the dissemination of the Western diet and its effect on global health. What is seen to be different is how we organise and deliver our care along with the way our governments and systems that support that effort. In sharing our worlds of paramedicine, it has afforded the opportunity to look at what is being done internationally and comparing that to our own back yards. The potential to grow roots and be a stepping stone for introducing novel approaches to healthcare within the bricks and mortar we learn in, as well as looking to our leaders and government officials to consider a new way to deliver care that is cost-effective and highly efficient and competent in nature. Once the experience of someone else's system from top to bottom has been had, it provides a vast breeding ground for ideas to take flight.

In this day and age, it seems we have a duty, not just an interest, to share what we know. Centennial College has built its reputation in Canada as a leader in its adoption and integration of global citizenship and equity, in what it calls the Signature Learning Experience (SLE). All students who pass through the College experience the SLE through formal and informal ways to meet six objectives throughout their program of choice. The exchange program embodies the spirit of what it means to become a global citizen. Both institutions subscribe to the belief that this sharing of ideas, curriculum and culture helps all involved to see the world of paramedicine from a global perspective. The threats we've seen over the past few decades alone behove us to think globally and advance our profession in the same direction towards high levels of care and understanding.

Inherent in any exchange program, there are barriers that need to be acknowledged and overcome. To date, the organisations have met each barrier with creative and cost-efficient solutions. Nothing happens without money, so breaking down the financial barrier and securing support from one's institution is primordial. Understanding each other's delivery of curriculum becomes crucial so that the chosen dates of exchange support the efforts on both sides. Are the students in class or on placement? Exams, practical assessments and employment interview processes need to be respected. It needs to be right and fit for all parties on both sides, otherwise it becomes ineffective in meeting pre-determined goals. Getting faculty to buy into the process, while not imperative at the beginning, is important to plan for. Engaging the team in the actual travel and the planning helps to ensure that all are a witness to and part of the success of the program and outcomes. It takes time.

So how do we ensure that this continues to occur? Joining curriculum within a programme can be difficult enough at times in itself, but the authors propose to test their expertise in this field further still. Maintaining momentum from the exchange visits is relatively simple in an ever-shrinking technological world—the use of social networks in order to keep in contact with ‘professional friends’ has already been tried and tested successfully by many. But now is the time to try and use those domains for learning purposes. Both academic establishments use online learning to a good standard and the test will come during the next semester when first year students are challenged to organise, create and deliver a student conference in November 2013. The organisation and creation will have to be conducted online via the various resources available, testing the various challenges that they may face. The final test will be while Centennial College paramedic students are in Liverpool and they deliver their joint effort to a faculty and online audience.

Paramedic students engaging in international collaboration become more ‘rounded’ professionals. All good educational programmes will offer knowledge, skills and professionalism as part of their curriculum, but exchanges such as this offer that added value in all areas:

The exchange is not, and should never be seen as merely a holiday. It is not a placement opportunity either though. Nor is it just another piece of evidence to add to an academic/professional portfolio or curriculum vitae. It is more of an opportunity to broaden horizons and expand understanding of a very dynamic profession—it is more about accepting that modern paramedicine is a lifestyle, with family members worldwide.

Nonetheless, the future offers even more. There are talks of inter-professionalism, alumni relations and more longitudinal stays. There are thoughts which surround collaborative research and international postgraduate education for paramedics. Further to this, consideration is being made relating to how the UK paramedic registration system with the Health and Care Professions Council will compare to the Canadian Ministry of Health system being proposed in Toronto. Exciting, developmental, professional times!

A companion article written by students from Liverpool John Moores University and Centennial College, highlighting lessons learnt from the exchange programme, can be found in the Journal of Paramedic Practice, Volume 5, Issue 5.