Postgraduate education in South African emergency care practitioners : a social realist study

Abstract

INTRODUCTION The paucity of research originating from low- and middle-income countries, particularly in the field of emergency care, demands that those entrenched in the healthcare system go on to make meaningful contributions to the knowledge economy of low- and middle income countries. While the rest of the world builds an appetite for highly skilled South African prehospital practitioners, the emergency care field in South Africa desperately needs practitioners who can engage with research and advance the profession through evidence-based practice. Achieving this requires emergency care practitioners to embark on postgraduate education programmes to learn research skills. Given the shortage of emergency care practitioners in South Africa, the paucity of prehospital-specific research and the large number of paramedics that pursue employment and education abroad, understanding the factors that influence emergency care practitioner’s agency in pursuing or eschewing postgraduate education is extremely important as this affects the paramedic workforce and the development of the field in South Africa. AIM The study aimed to formulate a deeper understanding of why ECPs pursue or eschew postgraduate education. METHODS The study made use of a mixed method exploratory sequential research design. Using both quantitative and qualitative methods generated a thorough understanding of the research problem in the given context. The qualitative phase constituted Phase 1 of the study and used focus group discussions and one-on-one interviews with key stakeholders in the emergency medical services. The findings of this phase informed the quantitative phase (Phase 2) of the study, in which an online structured questionnaire was administered to emergency care practitioners.

FINDINGS More than half (54%) of the sample of emergency care practitioners pursued postgraduate education. Among the 46% of emergency care practitioners who eschewed postgraduate education, the majority applied their profession in South Africa. This study, therefore, found a decrease in the likelihood of pursuing postgraduate education among emergency care practitioners working in South Africa compared to those working abroad (OR 0.57, CI: 0.25–1.25). The largest proportion (81%) of those who pursued postgraduate education occupied roles within academia. Those emergency care practitioners within operational (72.1%) and managerial (15.6%) roles constituted the largest proportion of those who eschewed postgraduate education. Structural conditions owing to the paucity of financial incentives (86%), support (57%) and career progression pathways (92%) predominantly motivated emergency care practitioners within the South African prehospital milieu to eschew postgraduate education. Cultural conditions motivated emergency care practitioners, regardless of location or area of speciality, to pursue postgraduate education. The constructs of the individual or collectively held ideals, beliefs, and values were identified as the cultural conditions, which are not easy to change and have lasting conditional influence among emergency care practitioners. CONCLUSION In conclusion, the study established and presented, from the emergency care practitioners’ point of view, the cultural and structural conditions that influence their agency: motivations to pursue or eschew postgraduate education. The findings highlight the structural and cultural dynamic and interchangeable nature and the overlap of the prehospital milieu's values, practices and behaviours. It notably identified the interconnections as all the practices and behaviours underpinned by the motivations emerging from the prehospital milieu. The study further demonstrated that a comprehensive and deeper understanding of how individuals interpret their structural and cultural conditions, is essential. The objective goal of developing the profession is

interlinked with establishing institutional and cultural norms that capacitate and support those within the profession.