The Theory-Practice Relationship in Paramedic Undergraduate Education Vincent Clarke The Theory-Practice Relationship in Paramedic Undergraduate Education Vincent Michael Clarke Submitted to the University of Hertfordshire in partial fulfilment of the requirements of the degree of EdD May 2018 Acknowledgements I would like to thank my supervision team of Roger Levy and Rosemary Allen for their continued support and guidance throughout the doctoral process, it is much appreciated. I would also like to thank my former paramedic colleagues and current friends, Paul Bates, Bob Fellows and Paul Townsend for their considerable support, professional insight and humour which has enabled me to carry on with my studies despite the challenges faced by us as a team. Most importantly, I must acknowledge the enormous support that I have been afforded by my family during my studies. Leah and Summer have been so very understanding, if somewhat bemused, throughout my undertaking of this journey. You both make me so proud. Vince Clarke The Theory-Practice Relationship in Paramedic Undergraduate Education Contents Table of Figures ......................................................................................................... 4 Tables ........................................................................................................................ 6 Abstract ...................................................................................................................... 7 Chapter 1 : Introduction ............................................................................................... 9 1.1 Introduction ................................................................................................... 9 1.1.1 Background to the study .................................................................................. 9 1.1.2 The research question ................................................................................... 10 1.1.3 Structure of the submission ............................................................................ 12 1.2 Setting the scene - Paramedic: a new profession ....................................... 13 1.2.1 The development of paramedic education in the UK ...................................... 13 1.2.2 The move to a graduate profession ................................................................ 16 1.3 Paramedic Practice Education .................................................................... 18 1.3.1 Paramedic practice placements ..................................................................... 19 1.3.2 The uniqueness of the paramedic role ........................................................... 21 1.3.3 Paramedic students as practice-based learners ............................................. 23 1.4 Summary ..................................................................................................... 25 Chapter 2 : Theory, practice and knowledge in paramedic education ...................... 27 2.1 Introduction ................................................................................................. 27 2.2 Theory ......................................................................................................... 28 2.2.1 Concepts of theory ......................................................................................... 28 2.2.2 Theory as an ‘idealised’ concept .................................................................... 34 2.2.3 Profession-specific theories ........................................................................... 36 2.2.4 Personal professional theory .......................................................................... 40 2.2.5 Theory: a conceptual framework .................................................................... 41 2.3 Practice ....................................................................................................... 45 2.3.1 Concepts of practice ...................................................................................... 45 2.3.2 Evidence-based practice ................................................................................ 46 2.3.3 Skills and simulation: between theory and practice ........................................ 48 2.3.4 Practice: a conceptual framework .................................................................. 50 2.4 Knowledge and its relationship to theory and practice ................................ 53 2.4.1 Concepts of knowledge .................................................................................. 55 2.4.2 Tacit knowledge ............................................................................................. 59 Page 0 of 346 Vince Clarke The Theory-Practice Relationship in Paramedic Undergraduate Education 2.4.3 Personal professional knowledge ................................................................... 64 2.4.4 Knowledge: a conceptual framework ............................................................. 67 2.5 Conceptualisation of theory, practice and knowledge ................................. 70 2.6 Summary ..................................................................................................... 74 Chapter 3 : Exploring the theory-practice relationship .............................................. 75 3.1 Introduction ................................................................................................. 75 3.2 Perspectives of the theory-practice relationship .......................................... 76 3.2.1 The theory-practice gap ................................................................................. 76 3.2.2 The ideal versus reality .................................................................................. 81 3.2.3 Theory, practice and learning ......................................................................... 83 3.2.4 Reflective practice and the relationship between theory and practice ............ 90 3.3 Paramedic education and the theory-practice relationship............................ 101 3.3.1 Curriculum design ........................................................................................ 101 3.3.2 The hidden curriculum ................................................................................. 105 3.3.3 Practice Educators and the theory-practice relationship ............................... 106 3.3.4 Experiences of practice-based learning ....................................................... 111 3.3.5 Praxis as a representation of the theory-practice relationship ...................... 113 3.4 Conceptual frameworks representing the theory-practice relationship ...... 118 3.4.1 Theory and practice as ‘domains’ ................................................................. 118 3.4.2 The dissolution of the theory-practice gap .................................................... 119 3.4.3 The position of knowledge and reflection ..................................................... 126 3.4.4 The Praxis Model ......................................................................................... 128 3.5 Summary ................................................................................................... 130 Chapter 4 : The research approach........................................................................ 131 4.1 Introduction ............................................................................................... 131 4.1.1 The philosophical position: a pragmatic approach ........................................ 131 4.2 Designing the research ............................................................................. 133 4.2.1 Pragmatic qualitative research ..................................................................... 133 4.2.2 Utilising mixed methods ............................................................................... 134 4.2.3 The study focus ........................................................................................... 138 4.2.4 Ethics ........................................................................................................... 140 4.2.5 Selection of student participants .................................................................. 141 4.2.6 Selection of Practice Educator participants .................................................. 143 4.3 Data collection: the questionnaire survey .................................................. 144 4.3.1 Rationale ..................................................................................................... 144 Page 1 of 346 Vince Clarke The Theory-Practice Relationship in Paramedic Undergraduate Education 4.3.2 Approach ..................................................................................................... 145 4.3.3 Response rates ............................................................................................ 148 4.4 Data collection: Focus group interviews .................................................... 148 4.4.1 Rationale ..................................................................................................... 148 4.4.2 Approach ..................................................................................................... 149 4.4.3 Interviews .................................................................................................... 153 4.5 Approaches to data analysis ..................................................................... 153 4.5.1 Primary coding ............................................................................................