Title:Continuous Professional Competence (CPC) for Irish Paramedics and Advanced Paramedics: a national study

Transcription

1 Author's response to reviews Title:Continuous Professional Competence (CPC) for Irish Paramedics and Advanced Paramedics: a national study Authors: Shane Knox Mr (shaneknox7@gmail.com) Walter Cullen Professor (walter.cullen@ul.ie) Colum Dunne Professor (colum.dunne@ul.ie) Version:2Date:29 January 2014 Author's response to reviews: The authors thank the editor and reviewers for their time in reading our manuscript. All reviewer comments are copied below (pages 1-5) and each point raised by the reviewer is addressed in Bold Italics. 1st Reviewer: Mark Dixon Discretionary revisions: The paper explores CPC requirements and perceptions from Irish paramedic and advanced paramedics. Comparisons are drawn between other first world EMS systems - consideration should be given to a definition of a paramedic and advanced paramedic training and role in the Irish setting as such practitioner titles are different in most 1st world EMS systems. As an example in all other jurisdictions a paramedic is an ALS provider and has undertaken a course of advanced training which would incorporate CPC avenues. Response: This has now been explained on page 4 in the manuscript 4 by describing the difference in practice between a paramedic and an advanced paramedic. - Consider adding a comment to highlight anamolies in the survey replies e.g. 88% 538/615 of replies highlighted access to medical journals as an essential component or cpc - however, in a seperate question only 24% of replies indicated the appraisal of clinical journals as relevent - large difference.. Response: This anomaly has been included in the last paragraph of Page 12 in the manuscript and a potential explanation provided. The demographics section points out the majority of respondents and participants were male - within this profession all training, expectation and

2 deployment is non gender specific, why is it relevent in CPC? Response: This information is provided as the fact of male dominance of the organisations concerned may be of interest to readers who, within their field of expertise, focus on gender-related aspects of professional development. 2ndReviewer: Joseph Acker 1) MINOR ESSENTIAL REVISION: I would suggest that the research question be adjusted to align better with the reported outcomes and discussion. Currently, in the background information (p. 2) it states this paper aims to identify factors that might influence this CPC framework what registrants considered optimal educational outcomes and activities attitudes toward CPC. While I believe this paper has answered these three research objectives, I am not clear what the main objective is. For example, are the outcomes of this paper going to legitimately inform the implementation of PHECC CPC processes? Is the main objective to understand the paramedics perceptions of barriers to CPC? Is the intention for this work to be seen as stakeholder input into the development of the national CPC scheme? I would suggest that the authors consider their major objectives and articulate the research question appropriately. Response: Page 2 (the Abstract) has now been modified to describe the primary purpose of the research as informing the implementation of a CPC framework by the regulatory body by seeking stakeholder input. Secondary objectives include determining the attitudes towards CPC and to elicit what activities registrants believe are important for the purposes of CPC. This has also been clarified in the final paragraph of the introduction section. 2. MINOR ESSENTIAL REVISION: The discussions and conclusions appear to be well supported by the data and provide a generally balanced perspective. The only recommendation that I think should be drilled down more is the recommendation on between 20 to 60 hours of CPC activities per annum (p. 14). This is a wide range across three of the potential survey options. I would suggest that more analysis of this data is required to make a more precise recommendation; particularly if this work is intended to inform the regulator for future CPC initiatives. Response: This has been modified to include a further breakdown of the data

3 and explains that 35% believe hours is adequate while 26% believe hours is adequate. In addition, we have suggested that the Regulator should start at the lower end of the scale with a view to reviewing this after the first cycle 3. MAJOR COMPULSORY REVISION: The only concern I have is with the citing of the Canadian NOCP document (reference # 8). This reference is cited on page 3 and page 11. This reference is cited as a previous study and literature that reports the development of ambulance CPD programmes. In fact, the Canadian NOCP document is not a study, nor is it a model for CPD, rather it is an entry to practice standard for paramedics in Canada. The authors may have mistakenly cited this document or intended to use a different source. Response: This reference was mistakenly cited and has been removed and replaced. There is now no reference to the NOCP. 4. DISCRETIONARY REVISIONS: I would suggest that the authors make a final proof reading of the paper as there are some minor grammatical and typographical errors, for example: Page 3 the last sentence on the page is awkwardly worded and too long consider re-writing. Response: This sentence has been re-worded. Page 5 paragraph 2, the word is is missing between questionnaire and based Response: This has been corrected Page 7 I would suggest qualifying the word organisation as it could be taken as the respondents ambulance service or the regulator. Response: The word employer has replaced the word organisation. Page 8 and 9 the long list of responses to the question about preferred type of CPC is best presented in a table instead of the long list in the paragraph form. I suggest presenting highlights only instead of the complete list. Response: This information is included in Table 2 to show the entire range of activities.

4 3rd Review Feedback 1. Is the question posed by the authors well defined? First, I commend the authors for investigating CPC in paramedic practice and for sharing the results of a national survey of nationally registered paramedics. This is very important work and understanding barriers to CPC is usefully internationally. MINOR ESSENTIAL REVISION: I would suggest that the research question be adjusted to align better with the reported outcomes and discussion. Currently, in the background information (p. 2) it states this paper aims to identify factors that might influence this CPC framework what registrants considered optimal educational outcomes and activities attitudes toward CPC. While I believe this paper has answered these three research objectives, I am not clear what the main objective is. For example, are the outcomes of this paper going to legitimately inform the implementation of PHECC CPC processes? Is the main objective to understand the paramedics perceptions of barriers to CPC? Is the intention for this work to be seen as stakeholder input into the development of the national CPC scheme? I would suggest that the authors consider their major objectives and articulate the research question appropriately. Response: This has been changed as described above 2. Are the methods appropriate and well described? The methods are sound and it is nice to see that a national database exists for all registered paramedics. The N of 1816 is an excellent pool to survey and while it is always nice to have

5 higher response rates, I believe that 43% is reasonable for an ed survey to a body of practitioners. I would have liked to read about your strategy (if any) to increase response rates. Response: This has now been explained on Page 4 of the manuscript and a reference included (12) to support the strategy. 3. Are the data sound? The data is presented in a reasonable manner with sufficient detail. The tables are clear and easy to read. 4. Does the manuscript adhere to the relevant standards for reporting and data deposition? No concerns here. 5. Are the discussion and conclusions well balanced and adequately supported by the data? MINOR ESSENTIAL REVISION: The discussions and conclusions appear to be well supported by the data and provide a generally balanced perspective. The only recommendation that I think should be drilled down more is the recommendation on between 20 to 60 hours of CPC activities per annum (p. 14). This is a wide range across three of the potential survey options. I would suggest that more analysis of this data is required to make a more precise recommendation; particularly if this work is intended to inform the regulator for future CPC initiatives. Response: This has now been amended as stated above MAJOR COMPULSORY REVISION: The only concern I have is with the citing of the Canadian NOCP document (reference # 8). This reference is cited on page 3 and page 11. This reference is cited as a previous study and literature that reports the development of ambulance CPD programmes. In fact, the Canadian NOCP document is not a study, nor is it a model for CPD, rather it is an entry to practice standard for paramedics in Canada. The authors

6 may have mistakenly cited this document or intended to use a different source. Response: This has now been amended as stated above 8. Do the title and abstract accurately convey what has been found? DISCRETIONARY REVISION: For an international audience I would suggest adding the geographical context in the title, for example: Continuous Professional Competence (CPC) for Irish Paramedics and Advanced Paramedics: a national study Response: The Title has now been amended and includes Irish. 9. Is the writing acceptable? DISCRETIONARY REVISIONS: I would suggest that the authors make a final proof reading of the paper as there are some minor grammatical and typographical errors, for example: Page 3 the last sentence on the page is awkwardly worded and too long consider re-writing. Page 5 paragraph 2, the word is is missing between questionnaire and based Page 7 I would suggest qualifying the word organisation as it could be taken as the respondents ambulance service or the regulator. Page 8 and 9 the long list of responses to the question about preferred type of CPC is best presented in a table instead of the long list in the paragraph form. I suggest presenting highlights only instead of the complete list. These points have all been addressed as described above