Placements and placement documentation

Hospital and Community (Out of Ambulance placements): Information for clinical staff

Students' pre-placement guidance

We give the students pre-placement briefings in which we discuss with them how placements are organised, what we expect them to do, what expectations we have of their conduct and behaviour, and how to contact you. These are also available as recorded presentations for the students to refer to for placement information. They also have a site with placement information on their Canvas Dashboard.

We inform the students that hospital and community placements are primarily observational rather than specifically about the practice of techniques and procedures. In general, the objectives of these placements are to expose them to a range of learning opportunities, for example:

  • to follow the patient journey beyond their handover at ED
  • observe and practice history-taking and examination skills under supervision of registered healthcare professionals
  • learn from specialists in their field
  • further develop and refine critical reasoning and clinical decision-making skills according to the most up-to-date practice guidelines.

If there are opportunities to be facilitated to practice supervised examination skills with the consent of the patient, they may do so.

Students will require signatures to evidence their attendance in placement. We teach them how to approach coaching conversations and write their Learning Logs. For hospital and community placements, we expect them to contact you for placement arrangements (e.g. shifts) no less than two weeks ahead.

Student Paramedics in Out of Ambulance placements

The Paramedic Science BSc students in out of ambulance placements are:

  • Year 1: Medical Admissions Unit or equivalent placement for one week
  • Year 2: Mental Health (one week) and Emergency Department (one week)
  • Year 3:
    • 2021/22: Emergency Department (two weeks), Theatres (two weeks) and Paediatrics (one week)
    • 2022/23: Critical Care (one week) and Maternity Care (one week)

There are also Diploma Paramedic Studies students who are current employees of the East of England Ambulance Service and have been sponsored to complete a one year programme. This programme will end by May 2022.

Paramedic student practice documentation

The students bring a Practice Learning Log (PLL) with them to record their learning activities. This takes a form that will likely be familiar to you as the Coaching Model (TGROW) used in Nursing and other AH practice documentation.

For paramedic students, all their assessment is formative - there is no summative element, however they are required to complete a 'Learning Log' for each shift. This requires the Practice Supervisor to give a few sentences of feedback to account for their learning and conduct.

Each PLL explains the Coaching Conversation and we have written instructions about the Learning Log for both students and Practice Supervisors to refer to. Some examples are below:

You can also download the Level 4 Placement Learning Log for 2020-21 (PDF).

There are no specific learning outcomes for Out of Ambulance placements: learning outcomes are met during their Ambulance placement over their course. However we do expect students to complete their daily practice learning log and to read an information booklet we have developed for each setting to help them understand the potential learning opportunities. These are available for you to review here:

We have also provided Posters for each area of placement which you and your staff may refer to for a summary of key messages for these student placements. These are available here:

Conduct and performance

We expect our students to arrive on time, always identify themselves as a Paramedic student, respect confidentiality at all times and be courteous. They are also expected to apply themselves, be accountable, and remember that they are an ambassador for ARU and the paramedic profession.

If the student’s conduct falls below this standard, then we have Cause for Concern forms (Word doc) which may be used to raise issues about students placed with you. The Cause for Concern process helps ARU to identify students requiring additional support.

Practice Supervisors should ensure they communicate the reason for this form with the student and send it to the Practice Support Facilitator and Personal Tutor, whose details you can find at the beginning of the PLL and the student paramedic support page. We then action your concerns by arranging meetings with the student to discuss the issues raised and agree an Action Plan.

Students will require signatures to evidence their attendance in placement. We teach them how to approach and write their Learning Logs and we instruct them to contact you for placement arrangements (e.g. shifts) no less than two weeks ahead.

How Practice Supervisors can support paramedic students in Out of Ambulance placements

  • Access our e:Vision system for placement administration – Practice Supervisors or Educational Leads for each area are called ‘Student Liaison Contacts’ on this system. If you are new to this role, you will need to contact the Practice Support Facilitators or Education Champion to have this requested from our IT service. Practice Supervisors will receive a username for this system by email and create their own password. They will then be able to run a report so that they may view which students to expect and their start dates in placement.
  • Organise the student's rota once they receive contact from them.
  • Complete and document an induction and orientation on their first day in placement.
  • Have coaching conversations with these students to provide guidance about how they will spend the shift under supervision with yourself or delegated healthcare professionals in your setting.
  • Provide feedback at the end of the shift and document this on their Learning Log.
  • Sign their timesheet.
  • Complete our Cause for Concern process for those students you have concerns about.
  • Contact the Practice Support Facilitators if you would like to discuss any placement or student issues.

Covid-related issues in placement

All ARU students complete an internal covid risk assessment process and if flagged, they may undergo further review from our OH provider before they attend placement. If their assessment recommends specific restrictions to their practice, e.g. what covid risk level areas they may be exposed to, this will be discussed with the placement area.

They should be facilitated to wear appropriately fitted masks at all times during placement activity and conform to the Trust’s covid policy. They will have been fitted for masks prior to placement, however if they have required hoods they should be able to bring these with them to placement. They have been asked to make enquiries with you directly if they have any concerns about bringing this PPE with them to placement.

Ambulance placements

Students' pre-placement guidance

Students have a pre-placement briefing alongside briefings provided by the Ambulance Trusts so that they understand:

  • How placements are organised
  • What we expect them to do
  • What expectations we have of their conduct and behaviour
  • The completion of their Practice Learning Log (PLL).

This information is also made available as recorded presentations for the students on their Placement Information site at ARU.

Students will require signatures to evidence their attendance on each shift. We teach them about how to approach and write their Learning Logs and have coaching conversations with their PEd.

Student documentation – The Practice Learning Log

Students need to achieve competence to meet the HCPC Standards of Proficiency for Paramedics and the HCPC Standards of Conduct, Performance and Ethics. Competence against these skills is assessed in practice in a summative, pass/fail manner by PEds at the end of their third year placement.

By this point, students should identify, with support, an area of focus for their learning during the shifts and record this in their Learning Log. In the curriculum there are seven ‘domains’ which match against the broad areas of competence needed to complete a patient care episode. Students should aim to complete at least two Learning Logs that refer to each of the ‘domain’ areas.

The domains are:

  • Communication
  • Consultation, history taking and physical examination
  • Development of differential diagnosis
  • Development of an appropriate clinical management plan
  • Medicines management
  • Safe referral
  • Extrication and onward transportation to hospital (when required) including manual handing

The students need to achieve a minimum of 16 throughout all stages of their placement. These should be self-directed by the student and completed by them. They will document their discussions with you about their practice in all seven domains, and then at the end of each Learning Log the PEd will need to give a summary of their feedback. This approach to practice learning is based on a coaching model.

The principles of coaching

Coaching concerns the facilitation of learning through the development of a professional relationship based on rapport and trust. This can support the development of interpersonal and communication skills, professional behaviours and critical thinking.

A PEd who is encouraging, sets boundaries and actively builds respect and trust can create a sense of safety, so that the PEd may be able to hold more challenging conversations that arise during the student’s supervision and teaching. A relationship like this also encourages students to discuss their learning requirements and believe that these will be heard and addressed.

The environment for learning matters and the mentoring relationship is embedded in everyday interactions in the whole environment the student is exposed to, whether this is at the station or on the road, and in formal or informal settings. The PEd role-models behaviours these students will adopt in their own clinical practice and development.

The coaching principles also inform some key mentor skills:

  • High quality listening skills: this means attentive listening that responds to cues the PEd recognises from the student, and the use of clarification to ensure a shared understanding when giving instructions or constructive feedback. It also helps to ensure the PEd’s expectations match with those of the student, and may facilitate the sharing of different opinions and perceptions to be discussed and explored more openly.
  • Skilful questioning: the use of open questions (the ‘what’s, when’s, how’s and why’s’) and helps the students develop critical reasoning necessary for their evolving clinical judgement.
  • Chunking and checking: breaking explanations down into digestible pieces (particularly when this is long or complex) and asking students to repeat it or explain it in their own words to ensure they have understood what has been said.

The TGROW model

This is the coaching model used to help structure a student-led coaching conversation in order to formulate a learning goal which is recorded in the Learning Log.

The student needs to choose a topic that relates to one of the seven domains. This conversation is then structured to reflect the TGROW model:

  • Topic
  • Goal
  • Reality
  • Options
  • Way forward

The student will choose a learning goal arising from one of the competency domains (Topic). They then need to consider what experience they have of this in the past (Reality) and if there will be opportunities to meet their goal and how they may approach it (Options). The goal is agreed in partnership and is a much less prescriptive approach to learning that can be more tailored to the particular needs of the individual student.

You can view some sample Learning Logs here:

We have also created Posters for each Trust to make available to their staff to help them understand the student’s learning needs and Practice Learning Log:

The PEd will need to complete a mid-point and end-point review of placement in which they give the student verbal and written feedback on how they are progressing for each domain. We recommend that the student agrees a date with their PEd to hold these reviews and allow sufficient time to clarify where the student stands and further areas for development.

If the student is having consistent difficulties in their progress in a domain or their approach to learning and conduct, please consider whether a Cause for Concern form (Word doc) would be an appropriate way to address their needs and ensure improvement. Unlike the Cause for Concern process, a DAP will not draw in additional resources from the University or Trust to support you or the student in your work together to progress their development. Please refer to the student paramedic support page for further details on the Cause for concern process.

Conduct and performance

We expect our students to arrive on time, always identify themselves as a Paramedic student, respect confidentiality at all times and be courteous. They are also expected to apply themselves, be accountable, and remember that they are an ambassador for ARU, the Trust and the paramedic profession as a whole. They are expected to demonstrate professionalism in line with the HCPC ‘Guidance on conduct and ethics for students’.

If there are concerns around aspects of conduct or professional practice please refer to the student paramedic support page.

Covid-related issues in placement

All ARU students complete an internal covid risk assessment process and if flagged, they may undergo further OH review before being cleared for placement. EEAST also have a covid Assessment process prior to placement. They should be facilitated to wear appropriately PPE at all times during placement activity that conforms to the Trust’s covid policy.