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Table 1 Selection of responses to the four questions posed to both cohorts: Student EMTs and Experienced EMTs (Nodes coded to are in bold)

From: A qualitative assessment of practitioner perspectives post-introduction of the first Continuous Professional Competence (CPC) guidelines for emergency medical technicians in Ireland

Question 1: Is CPC a Good Idea?
Student EMTs Experienced EMTs
Yes because: Yes because:
• “Because it keeps your mind ticking over you have to think about what you’re doing” • “It keeps you up to date”
• “It keeps your skills up” • “Helps you learn”
• “It is nearly a better thing for the voluntary organisations to do ‘cos we don’t get the same exposure” • “Could be ready for any exam, it’s been 3 years since I’ve done my course”
• “Keeps the skills up, keeps you on your toes, good to keep a record”
• “If you are not getting patient contacts…you need to, to keep up to date
• “It is absolutely necessary, it’s a good thing”
Question: Questions:
“Is this model concrete or can it change?” • “Do you see PHECC [Regulator]organising placements for us with HSE [Health Authority] so that we can get experience to build up our patient contact”
  Suggestions:
• “I think it’s a good idea but as an EMT we are part of an organisation and we do work for the CDOs (Civil Defence Officers) but it would be a good thing to bring them up and tell them what we have to do, cos sometimes they’d just say ‘well that’s your problem, not ours’.”
• “You could go to other counties to get events”
Question 2: What problems to you foresee in completing CPC?
Student EMTs Experienced EMTs
Points for clarification: Questions:
• “What are we going to do if we go to events but don’t get any patient contacts?” • “What are you looking recorded when you are recording patient contact; heart attack, what, what detail?”
• “If you go out and do loads of duties and no patient contact, if you keep a log … can that be counted?” • “Is it from January to January”
• “Clarification required on mentoring, who does it, is it a non-instructor, can they mentor?” • “Unsure what is expected from us”
• “There seems to be confusion with regard to when …we have to submit this. Every year or 18 months or every three years, this needs clarification” • “What about stuff we did two years ago will PHECC [Regulator] count this?”
• “Who signs off on this? On our points?” • “In relation to new EMTS are they still backdated from November 2013?
• “In relation to our training, we do a lot of first aid classes and we refresh all our training – that should be counted?” • “One of them here says that you have to have mentoring…you get a point for each hour, but it must be signed by a paramedic or advanced paramedic…but what if you haven’t got one?”
• “What is the mechanism for audit?” Duties:
• “Should there be points for checking your ambulance equipment? • “If you are working as a community first responder…can you count that?”
• “We are not in the ambulance service, all that we can get is minor …but no casualties contact, should that not count?” • “If we put down a couple of duties we have done do we document it?”
• “Where do we get information regarding the seminars, conferences and activities where do we get this information? Should be on the PHECC [the Regulator] website like their calendar for exams” • “Does this apply to our private lives or in our work then if we get a patient… like I work in the county council and if I get called as a first aider so should we be filling out PCRs (Patient Care Reports)?”
• “Continuous placements, ambulance placements, it’s all well and good training, training, training but unless you actually see real patients, you know” • “Time on duty is different in the voluntary services”
• “Are you allowed to get CPC points from other organisations, I am also a member of the RNLI [The Royal National Lifeboat Institution], are we allowed to use their courses?” Patient contacts:
• “How much do we need to do, is it 2 pages of a case study or ten pages, or how many words should it be?” • “At least 12 patient contacts per year, what’s the situation if you can’t get the 12 patient contacts?”
• “How do we get a case study, we need patient contacts and a case study may be difficult for us?” • “Is patient contact a completed PCR (patient care report) or ACR (ambulatory care report)?”
• “The evidence of at least 12 patient contacts per year, is that just like 12 plasters on 12 patients, what type of evidence do you need to show?” • “If you’re in the situation where you are off duty and the ambulance service arrive, can you ask them for that PCR (patient care report) number as evidence of your patient contact?”
• “It is very important for EMTs to get ambulance placements. “ • “With regard to patient contact, I haven’t been out as I had a baby, so is that over the years, the 12 patient contacts or just for one year?”
• “Up-skilling [to new practice guidelines] if EMTs do refresher courses up-skilling will you get CPC recognition for that?” • “Is the evidence of the patient contacts just the PCR (patient care report)? I’ve had the experience of the ambulance service were they don’t take mine but start a new one”
  • “If we are filling out pcrs, and the patients’ contact details are on it obviously should we be handing over the top copy to the paramedic, and we hold on to the second copy and you’re not in the Civil Defence you should cover your details…..?”
• “From a duty point of view It’s hard to get 12 patient contacts, we are not out often enough in reality we don’t attend so many patients in a year”
• “I’m out every weekend, but I won’t get 12 patients”
• “We’re trying to keep the thing going at home, we are getting plenty of duties, we’re just not getting patients, so unless we start pushing people off horses or something…we’re not going to get patients”
• “The 12 patient contacts per year, it’s too many”
• “Like, we have 10 EMTs in the county like, that’s 120 patients a year, it just won’t happen”
Templates:
• “If there was a template that you just wanted to record… it would be good to complete rather than try to store Patient Care Reports”
Practical challenges: Practical Challenges:
• “There is a need for more clarity in the booklet for an alternative to patient contact” • “You should not be allowed to get 8 points for the one activity, it is not stated clearly that these 8 points cannot be all for one activity.”
• “With regard to Cardiac First Response [or CPR] recertifying, we only refresh every two years. Do we have to do more? This needs clarification” • “Templates for case studies etc. its kinda vague”
Suggestions: Suggestions:
• “It does not tell us where to go to get courses, it should tell us” • “Examples of what should be in your portfolio, would be good”
• “More points for quality of care”
• “What about scoring higher points if you have more serious casualties, as well as points for skills should there be, say, points for medications and stuff; cardiac chest pain compared to a plaster?” Comment:
• “On the case study there should be key points or a template or for your reflective practice” • “How do you know if I have made it up?”
  • “People working in the HSE [Health Authority] have the advantage of meeting more patients”
• “I suppose it’s like the American system as well there is a difference between the volunteer EMTs and the professional EMTs (do you want a cert with Volunteer written on it?)What I’m saying is, we don’t spend our time out in ambulances, or in the back of ambulances we have other jobs, we don’t have the same chances…”
• “Who will audit the whole process of CPC?”
Question 3: What is unclear about the related activities section of the CPC booklet for EMTs (supplementary information is included in Table 2 )
Student EMTs Experienced EMTs
Coordination of CPC information: Coordination of CPC information:
• “How will we know about seminars and conferences and the costs of those?” • “Where are the courses out there, how would you check that they are relevant, does PHECC [Regulator] say they are relevant?”
• “There should be a central hub”  
• “Should PHECC [the Regulator] not have these on their website?”
Suggestions: Suggestions:
• “Perhaps other voluntaries could all come together across the country and have CPC days.” • “EMTs mentoring or assisting on EMT courses should get CPC points”
• “There should be regional training centres for CPC – organisational”  
• “Linking CPC points with your work, if you are a first aider in work and you have to treat someone in work should that count?”
• “We are charged quite a lot for voluntary members to do CPC, could we be subsidised to help us with the costs?”
• “Regional training days, you should utilise EMTs to instruct and teach and to gain CPC points”
Clarification: Clarification:
• “What if you are involved in community responder schemes and can those casualties be counted as your patient contacts because it doesn’t say it in the book?” • “It says the student must document evidence by a paramedic or AP, the likes of EMT who are assisting EFR and CFR the likes of that you are not going to get a paramedic or advanced paramedic to say you assisted, or does that not count is that relevant will you get credit for training/helping?”
• “If we were to participate with paramedic class exercises, major incidents exercises etc., could we get CPC points?” • “And we start this from last November?”
• “Maybe different points for seminars, if you are only there for a couple of hours or a few days, what counts?” • “So any training of any class counts, is that right?”
• “Seminar CPC points should not be standard, more clarification on points PHECC [Regulator] should allocate points for conferences etc. • “So you don’t have to put points down, just all the stuff we do?”
  • “The emergency CPC online where does that fall on-line? How can you prove how many hours you’ve done on it? What’s there to say you could log on and do more?”
• “Is there a limit to how many points you can get for an activity?”
• “You have to get 8 points from related activities is it compulsory that we can’t get all of them together is it compulsory that it’s a mix?”
  Comment or unrelated question to the question:
• “Have the organisation considered how many more EMTs they will be training or CPC days?”
• “The duty on its own is no use to you, if you don’t get patients”
Question 4: Learning Portfolio: What is your understanding of what a learning portfolio is?
Student EMTs Experienced EMTs
Definition of Portfolio: Definition of Portfolio:
• “Put your certificates into it” • “A record of activities”
• “Something to show evidence of what you’re doing to maintain competence” • “Something to retain to show evidence of your yearly practice”
• “A folder which you keep to show evidence of practice” • “A folder you keep to be able to reflect on and show what you’ve been doing”
• “A record of all that you do in the previous year”  
Clarification required: Benefits of a Portfolio:
• “Who do you submit it to” • “It helps you learn what you’ve done, you can reflect”
• “How long do you need to keep your portfolio for” • “A good way of looking back and learning”
• “Where is the portfolio kept do you have to keep it or is it on line” • “It’s on the 3 years that we do that is, over the 3 years”
• “In regard to confidentiality and data protection what must we do” • “You can identify areas you need to improve on”
• “If you were managing a patient on the street could the ambulance sign you off for managing the patient before they arrived?”  
Suggestions Suggestions:
:“If you had a template for the portfolio” • “What about CPC on-line learning portfolio?
• “PHECC [Regulator] should have a web page with all the CPC information”  
• “There should be a hub or webpage with all CPC information, conferences, templates, information”
• “there could be a phone app that would give you notifications about CPC activities that are on”
• “A Gmail calendar to notify you of events on your phone”