In 2019, the Ontario provincial government announced a funding freeze for paramedic services. At the time, I worked for Peel Regional Paramedic Services in the Greater Toronto Area. In response to this announcement, Peel’s paramedic leadership team swiftly chose to suspend programs such as driver training, autonomous intravenous access training for Primary Care Paramedics, and Advanced Care Paramedic training. I suspect similar decisions were made in other municipalities at the time and that many paramedic organizations across Canada have faced similar circumstances over the years. The loss of training programs due to budget costs has been a longstanding concern among learning and development professionals[2-5]. Consequently, many learning experts and managers strategize to build training programs able to withstand budget cuts by linking learning objectives to business goals and effectively measuring the impact of training programs[6-8]. In other words, designing programs that meet specific performance goals and measuring the success of these programs is paramount to justifying their existence.
I have worked as a paramedic educator for the County of Frontenac and the Region of Peel in Ontario. Both organizations take great pride in their education programs and in my opinion are leaders in paramedic education within the province and perhaps the country. Yet, I believe that while I was in these positions, my teams failed to demonstrate the value we added to the organization. We did not design training programs in a manner that ensured improved learner and/or organizational performance. More specifically, we did not follow structured and consistent methods for creating effective training programs. Furthermore, we poorly evaluated training. Instead, we reported on program performance in terms of training hours, number of employees trained, and learner satisfaction. This hardly provides justification for programs and is therefore inadequate. Although this perspective is based on personal experience with only two Ontario municipalities, I believe it may be applicable to many more paramedic organizations across Canada.
Paramedic chiefs, collaboratively with their management and human resource teams, must address instructional design and training program evaluation shortcomings to ensure accountability and continued funding of essential paramedic training programs. The purpose of this article is to examine the current structure of paramedic education departments and to suggest a different approach that may help organisations produce indisputably valuable training programs.
The Case for Instructional Designers
The paramedic educators I have worked with or met in my career have been skilled, experienced, and well-intentioned paramedics who were passionate about education. Many of them, before deciding to leave the frontlines for full-time educator roles, were also preceptors, college educators, mentors, and/or base hospital instructors. I do not believe that the education department deficiencies I raise in this article should be examined at the individual level. Rather, it is important to first consider the systems in place that support education programs within Paramedic Services.
I recently reviewed six paramedic educator job descriptions from four different Paramedic Services in Ontario. These organizations agreed to contribute to this article and share their job descriptions on the basis of anonymity. The positions included three frontline educators, two training supervisors, and one field training officer-type position. All positions were directly involved in the design and/or delivery of training programs, including the two supervisory roles. Interestingly, the job descriptions revealed a discrepancy between educators’ expected responsibilities and required qualifications. The documents revealed that management teams expect their paramedic educators to perform many duties that primarily fall into three distinct functions: Subject matter expert (SME), instructional designer, and trainer/facilitator. However, job descriptions also showed that organizations hire paramedics into these educator roles mostly because of their subject matter expertise, as indicated by strict requirements for paramedic certifications and experience but loose requirements for education-related credentials. For example, all positions required paramedic certification and all but one specified current/active certification. Moreover, four out of six positions required a minimum amount of paramedic experience ranging from two to five years. Conversely, only one job description required a certification in adult education while two more preferred such credential. Four out of six positions vaguely required experience in training program design and only one of those roles mentioned program evaluation. These job descriptions provide valuable information for paramedic managers to consider when assessing their training team’s ability to create impactful programs.
Hiring SMEs as full-time paramedic educators is problematic in many ways and may contribute to training departments’ inadequacies described at the outset of this article. First, SMEs will always be plentiful within Paramedic Services and therefore I question the value gained by securing one individual permanently. Second, these paramedics’ expertise and currency may soon diminish because of their new administrative role, essentially erasing the main asset for which they were hired. Lastly, subject matter expertise is very distinct from instructional design expertise and the former does not necessarily translate into the latter10. It is a risk to organizations and unfair to paramedics to make this assumption within hiring practices because instructional design is such an important and intricate component of the position.
In fact, I suggest instructional designer is the most valuable role an educator can play within a paramedic organization. The Association for Talent Development defines instructional design as “the creation of learning experiences and materials in a manner that results in the acquisition and application of knowledge and skills”11. Instructional designers are skilled at methodically creating needs-based programs that connect learning with performance. In other words, they are process experts that can make training more efficient and effective. Additionally, programs designed using instructional design methodologies are created with evaluation in mind. Indeed, training evaluation is an essential component of the design process11. It is for these reasons that I believe instructional design is the most important skill a paramedic educator can be hired for, especially when subject matter expertise and facilitator skills can be leveraged in many other ways within the organization.
Arguably, instructional designers can come from different fields and still be great assets because of their focus on process rather than content. This is common in many organizations, especially in the context of organizational development teams. For example, I once supervised a team of training and development specialists that was responsible for creating training programs, including software training, within the Human Services department at the Region of Peel. These individuals were able to create effective computer training programs, despite not having information technology backgrounds, because they followed instructional design methodologies. In these cases, my staff worked closely with and relied on SMEs to contribute and validate the content. I would not necessarily support this approach and am certainly not making the case, in this article, for non-paramedic educators within Paramedic Services. Rather, I am emphasizing the value of instructional design and program evaluation expertise within organizations and the necessity of shifting priorities and expectations for paramedic education teams. Nevertheless, with a team skilled in instructional design, one could consider expanding the purpose and scope of the department to impact not only paramedic education, but also superintendent training, logistics technician training, and so on.
Building Instructional Design Capabilities
Building complex educational structures that include many distinct positions such as instructional designers, subject matter experts, and facilitators may not be necessary for Paramedic Services. Furthermore, I believe educators within Paramedic Services should be experienced paramedics and skilled facilitators, despite my arguments in the previous section. There is indeed much value in having educators who are in tune with the cultural context of the system and profession they work within. Nevertheless, I believe instructional design expertise is lacking within paramedic education departments and this requires attention. Therefore, I recommend that paramedic management and human resource teams strategically build instructional capabilities within their education departments.
First, develop instructional design skills within your existing team by enrolling staff in basic instructional design courses. More importantly, establish a plan for each educator to obtain a professional designation such as Certified Training and Development Professional™ from the Institute for Performance and Learning (I4PL) or Certified Professional in Talent Development (CPTD) from the Association for Talent Development (ATD). I believe obtaining such a designation is crucial to this process because it will ensure that paramedic educators apply and maintain their newly acquired instructional design skills, thus changing the way paramedic training is designed. In fact, ATD reports that 75 percent of surveyed employers agreed that CPTDs were more efficient in their work. Go to www.td.org or www.performanceandlearning.ca for more information on instructional design courses and the professional designation certification process from ATD and I4PL, respectively.
Second, adjust hiring practices and job requirements to ensure that all newly hired paramedic educators have at least a certificate in a learning-related field such as Adult Education or Instructional Design. Then, spend a significant amount of time testing candidates’ instructional design knowledge, skills, and experience during the hiring process. For example, in addition to having candidates present or teach a short lesson, have them breakdown the process they followed to create the presentation and discuss how they would evaluate their program. Lastly, enroll new paramedic educators in the same professional designation journey as your existing team members, as described in the previous paragraph.
With these two recommendations in place, paramedic educators would be better equipped to create training programs that address specific performance gaps and that draw clear lines between organizational needs, training delivery methods, learning outcomes, and most importantly, performance outcomes. Consequently, training supervisors or managers would be better prepared to evaluate and justify training programs and in turn improve or even eliminate programs that are ineffective or inefficient. Paramedic chiefs could then effectively support ongoing training programs during budget talks because only evidence-based programs would be put on the table.
To survive, education departments within Paramedic Services must produce effective training programs and demonstrate evidence of their impact. Instructional design methodologies can help training teams achieve this objective. Unfortunately, I believe many of them lack this expertise. I have suggested here that a reason for this knowledge and skills gap in organizations is the focus on paramedic educators as SMEs rather than instructional designers. I have also made a few recommendations on how paramedic managers and human resource teams can begin to shift their education departments’ primary function from content experts to process experts. These recommendations may not be appropriate, necessary, or even feasible for all organizations. I also recognize that for many, there is no such thing as an education department. However, my experience with paramedic educators and training teams suggests this may be an accurate representation for many organizations. Therefore, I hope this article can spark some discussions among leaders and educators on future directions for education teams within Paramedic Services. In subsequent articles, I hope to describe instructional design and training evaluation methodologies and give examples of how to apply these to paramedic training programs.
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