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The interplay of occupational subcultures and HE curricula changes how and what student professionals learn

by John Donaghy

At the SRHE International Conference in December 2023, I was delighted to have the opportunity to present an insight into my doctoral thesis: ‘An Examination of University Paramedic Students’ Enculturation into the Ambulance Service.’ This was my first time at the SRHE conference, consequently the inevitable nerves were always with me. However, I had no reason to worry, the warm welcome and supportive environment with liked minded people was an excellent opportunity for me to ‘tell my story’.  My EdD viva in 2021 followed an ethnography over several years (starting in 2013) which explored university paramedic students’ enculturation (the process of being socialised in a certain culture), into a traditional National Health Service (NHS) Ambulance Service Trust.

The research illustrates the many challenges and dichotomies which faced neophyte paramedics as they went from a university classroom setting into their day-to-day clinical work placements. The challenges they faced were not the result of individuals alone, rather they resulted from an inherent subculture ingrained within the very fabric of the organisational structures of the ambulance service and paramedic profession. This ethnography contributes to the social science literature on health and social care by presenting an introduction to the sociological perspective of student enculturation, from the university classroom into an often-chaotic working environment of the ambulance service.

The research uncovered the way cultural meanings, institutionalised rules, professional identity and working practices determined the working behaviours in the subculture of paramedic practice, as individual situations and experiences were contextualised. Drawing on the work of seminal authors and experts in the field, such as Metz (1981), Mannon (1992) and McCann (2022), this research explores the subculture along with the hidden curriculum which gave rise to it, as it seeks to understand how and why this appeared to hamper and impede the pedagogy experienced by students. This is not the pedagogy taught and encouraged in university, rather a pedagogy which arises out of the intricacies and nuances of the traditional working environment of the paramedic.

There is a complex interplay of subcultural integration between experienced paramedics and students. The work draws on the peculiarity of the language, behaviours, values and working practices of paramedics and students to illustrate the subculture and hidden curriculum which is inherent in their day-to-day working practices. How students transpose what they learn in the university classroom setting to their clinical work placement is examined and unpacked to help illuminate how students contextualise the knowledge formally taught in the university learning environment, to that of the practice setting.

Supported by a plethora of fieldnotes and interviews with students and paramedics, along with my reflective and reflexive accounts collected over a period of eighteen months, my research informs and contributes to the unfolding developments within the paramedic profession. There are working customs and practices not seen by members of the public or portrayed by media representations.

With Professor Diane Waller (OBE) I am co-authoring a book (to be published by Routledge in March 2024) based on my research journey, along with the obstacles, challenges and opportunities presented to me as the principal research investigator. As an experienced paramedic with over 30 years working for a busy inner city NHS ambulance service trust, and 20 years as an academic, teaching student paramedics, I illustrate the various situations that were presented. We delve into the professionalisation of paramedics as we try and make sense of the research findings. One aspect of the doctoral journey shone a light on the insider/outsider dichotomy, which I encountered in the field collecting data.

The ethnography allowed me to engage and witness, first hand, how and why students became so reliant on the subculture and hidden curriculum which O’Reilly (2009), Brewer (2000) and others also highlight, claiming that ethnography can provide forms of in-depth data. It gave me the opportunity to work with participants, to see and be part of their community of practice (Lave & Wenger, 1991), share in their frustrations, anxieties, disappointments and at times sadness which confronted them in their challenging day-to-day work. The intricacies, nuances, colloquialisms, attitudes, and behaviours become exposed, whilst I grappled with the emic position of researcher as I became one of them (Brewer, 2000). I took Burgess’s (1984) advice, that the emic position provides the researcher with full participant observation status, who already belongs to the group being researched. At the same time, I was reminded of Walford (2008), whose opinion highlights the danger of the emic researcher going native – I was keen that my position would not compromise my research findings. Considering the dichotomy between the emic and etic researcher and the potential influence on my study, I illustrate how this dichotomy was managed in the field. 

My insider observations helped me to slip between insider (emic) and outsider (etic) roles, to create a persona that encouraged and cajoled participants to disclose and illuminate more confidential and detailed accounts of their day-to-day practices. I was also aware that my research evolved through a reflexive stance related to my personal practice experience throughout the research. Hunt & Sampson (2006) and Van-Maanen (2011) advise using reflexivity to examine the self and voice to help harness and understand the responsibility of the researcher within the research. I combined a meaningful personal, professional and researcher self to the research (Van Maanen, 2007), as I became an integral part of the participants’ community. I worked with them, I copied their language, their slangy terms, their anecdotes and at times their offensive language, to help cement my place within the community. Developments of social research and in particular ethnography, have stimulated discussion on the advantages and disadvantages of ‘insider’ and ‘outsider’ researcher (Allen, 2004).

There were occasions, such as when I was required to treat patients as a paramedic, whereby I removed myself from the research process, then slipped back into the emic role as soon as I had cared for the patient. There were dichotomies within the discourse, as students revealed startling accounts of inappropriate behaviour, or I witnessed criminal damage to the ambulance. These actions often required me to switch between the emic to etic researcher as I continued with the ambulance shift. I questioned myself, at times not really knowing what to do, whether to speak up, or remain silent and ensure my acceptance into their workplace community.

I was riding out with Rupert, a second year Foundation Degree student. This meant that Rupert was employed by the ambulance service as a student paramedic, who returned to university in blocks to commence his academic studies. This also meant that Rupert was working one-to-one with his crewmate (working partner), an experienced old-timer called Albert. The shift was due to start at 15-00 hours and finish at 23-00 hours at Newmoon ambulance station situated in the outskirts of the city. Albert arrived for the shift ten minutes late, although we had not received any emergency calls, so ambulance control was unaware of the situation. At 15-10 Albert arrived and parked his car on the station. I had not met the paramedic (Albert) before, but Rupert had been working with him for a while now and appeared to get on well with him. It was not long within the shift, after attending our second emergency call, that whilst sitting in the ambulance that I could smell alcohol on Albert’s breath as we were talking. Albert was the driver of the ambulance that day and it soon became apparent that Albert had been drinking alcohol prior to starting the shift and driving the ambulance. I found a moment to speak with Rupert privately about my suspicions and to my surprise Rupert was aware of the situation, stating: “Oh don’t worry John (researcher) he often has a little drink before the shift, he only has a couple of pints at lunchtime, everyone knows him around here, it’s okay it’s just something he does”. Taken from my fieldnotes. *
On this occasion I was riding out with Jenny, a foundation degree student. Jenny was driving the ambulance whilst we had a patient in the back of the vehicle taking them to hospital. I sat in the front of the cab so I could talk to Jenny on route to hospital. The patient was in a stable condition, suffering just minor abdominal discomfort. Suddenly, Jenny miscalculated the distance between a passing car and a parked motor vehicle (van) causing us to strike the parked van. I could see from looking through the ambulance wing mirror that we had shattered the van’s right-hand side mirror, which was hanging from the vehicle with shattered glass and debris on the road as we continued passing various vehicles. I looked at Jenny who promptly said: “pretend you didn’t see that John (researcher)” and laughed as we continued en route to hospital. Taken from my fieldnotes. *

* All names and environments have been anonymised with pseudonyms.

The two accounts above, taken from my fieldnotes, illustrate the dichotomy of my insider/outsider relationship which had formed over time with the participants. O’Reilly (2009:110) claims that it is the “insiders’ explicit goal to gain an insider perspective and to collect insider accounts”. It was therefore important for me to have their trust, assurance and be part of their community if I were to witness and experience their real-life working relationships and behaviours. These were real and challenging dichotomies and ethical tensions which I had to grapple with as I spent time in the field as researcher.

Events such as these were difficult and morally challenging situations which stretched and tested my professional and moral compass.

John Donaghy is a Registered Paramedic and academic, with over thirty years’ experience working in an inner-city NHS Ambulance Service Trust, prior to moving into academia twenty years ago as a Principal Lecturer and Professional Lead for Paramedic Science. He has a professional doctorate in Education (EdD) and is a Fellow of the College of Paramedics. He works extensively with both the UK and Irish Regulator of Pre-hospital Emergency Care and continues to undertake clinical shifts at Wembley National Stadium in London, UK. His research interests lie within the professionalisation of practice which led him to explore the ambulance and paramedic service.

References

Allen, D (2004) ‘Ethnomethodological insights into insider-outsider relationships in nursing ethnographies of healthcare settings’ Nursing Inquiry, 11(1), 14–24 

Brewer, J. D (2000) Ethnography – Understanding Social Research. 1st, edn, Open University Press. New York, USA. 

Hunt, C. & Sampson, F. (2006) Writing self & reflexivity. 3rd edn, New York: Palgrave. 

Mannon, MJ (1992) Emergency Encounters – EMTs and their Work. 1st edn, Boston, MA: Jones and Bartlett, Boston 

Metz, LD (1981) Running Hot-Structure and Stress in Ambulance Work 1st edn. Edited by D Metz USA: Abt Books, Cambridge, Massachusetts, USA. 

O’Reilly, K. (2009) Key Concepts in Ethnography. 1st edn, London: Sage. Los Angeles, London, New Deli, Singapore, Washington DC. 

Walford, G (2008) How to do Educational Ethnography 1st edn, London, UK: The Tufnell Press 


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Fostering a sense of safety in higher education

by Lauren McAllister, Luke Ward, and Lauren Young

From left to right: Lauren Young, Lauren McAllister, and Luke Ward

As three lecturers who have taught on a postgraduate course for several years that covers topics around race, gender, identities, parenting, development, disabilities, mental health, wellbeing, and the associated experiences of managing these oppressive and regulatory discourses – we began to question how we can keep ourselves, and our students ‘safe’. We had reflected that we were not talking about a physical sense of safety here, but rather a felt sense of feeling understood, or perhaps even contained.

Having spoken to colleagues and other lecturers who similarly teach some topics that may be deemed ‘challenging’ or ‘sensitive’, we found that there was very little agreement with regards to how to approach some of these topics and discussions.

What does it mean to feel ‘safe’ within the higher education classroom?

Historically, this idea of a feeling of being ‘safe’ derived from feminist movements where a physical space was created for like-minded individuals to meet and explore their experiences (Flesner and Von Der Lippe, 2019). Within UK universities, safe space is also explored in the context of addressing sexual violence, harassment and discrimination (see: Anker and Von der Lippe, 2018; Uksaysnomore.org, 2022).  Research which did explore safety in the context of a relational sense in the classroom, either positioned the achievement of safety as unrealistic (Du Preez, 2012) or as necessary to ensure both educators and students feel comfortable unpacking difficult dialogues (Nolan and Roberts, 2021). Despite this discrepancy, there was a general agreement that lecturers felt anxious and ill-equipped when teaching sensitive/contested/difficult topics – often leading to them avoiding or minimising engagement in the teaching of such topics (Sue et al, 2010; Warde et al, 2022). We also noted that there was not a clear sense of agreement with regards to what is considered ‘sensitive’ in teaching. In fact, some pedagogical researchers argue that students experience topics differently, and assuming students homogenously feel safe fails to consider this diversity (Barrett, 2010).

As a result, we felt we had several core unanswered questions which drove our research, including: how then as educators do we manage the complexity of experiences, when topics are differently experienced? How do we balance our own anxieties around teaching topics that are differently experienced, and morally/ethically ensuring are students are feeling ‘safe’? And finally, are we as educators responsible for this management of the classroom space?

Our research: What did we do and what did we find?

Our research used collaborative methods to explore both students’ and lecturers’ experiences of ‘safety’ within the HE classroom. We conducted our project in four clear stages to ensure that lived experience was at the heart of any recommendations we established.

Firstly, we conducted five focus groups with students, unpacking the notion of safety and jointly creating a vignette which would be used to scaffold the lecturers’ focus group discussions. We then conducted four lecturer focus groups in which we similarly explored this notion of safety, before using the collaboratively created vignette. This vignette was presented in four stages, with discussion encouraged at each stage. The vignette anchored discussions and enabled lecturers to explore how they prepared for difficult topics; the management of an in-class disclosure; the impact of a dominant voice; and finally, how they end their sessions. Following the focus groups, both groups were thematically analysed separately, before themes were established across the groups, with the support of two students from the student focus groups. The final stage of the project was then to establish some useable recommendations in the form of a workbook/resource for lecturers, which was similarly created with the support of students.

Within the focus groups we found that both the students and the lecturers focused less on whether a topic was deemed ‘sensitive’ or not, and more so on the space ‘between’. Students for example talked about the need to feel heard, the trust between the group and the worry about how their contributions could be perceived. Lecturers noted the impossibility of being able to prepare students for challenging discussions, and many explored the need for students to feel uncomfortable and uncontained, as part of their learning.

Our findings raised two core areas of focus which we used as basis for the development of our workbook: the development of the foundation of relational trust, and the scaffolding of discussions. Building on scholars who positioned relationality as core to teaching and learning (Hobson and Morrison-Saunders, 2013), we developed the concept of ‘relational trust’. We conceptualised relational trust as this shared or mutual understanding between all members of the group (students and lecturers), of an expectation of disagreement, misunderstanding and challenge. We also recognised that this foundation was not a set or established entity, rather it was relationally created and needing to be continually nurtured through considered teaching and learning activities/experiences. In the implementation of our findings, we therefore began to focus less on the framing of a particular topic (ie as inherently safe, or not), and more so on ways through which conversations could be scaffolded within our teaching.

Ok, but what can I ‘take away’ from this and use within my teaching?

Based on the discussions with the students and staff, we can make several usable recommendations to support educators:

  1. Development of a classroom agreement: Firstly, we explored the importance of this foundation of relational trust, whilst also acknowledging that this foundation is never truly ‘set’ or done – rather it is something that needs to be continually nurtured (and revisited). Lecturers and students explored the benefits of a ‘class contract’ during the induction of a new group, whilst also acknowledging some key barriers to the effectiveness of this contract. We explored the importance of needing to revisit this class contract, acknowledging that this relational trust changes with the introduction of new members to the group, changes in topic, general changes in dynamic etc.
  2. Clear expectations of roles: Both lecturers and students lacked clarity with regards to the role of the lecturer – and in turn, the student – in the classroom space. In particular, there was a clear blurring of expectation of what was expected of the lecturer when engaging in discussions that may be considered challenging.  Lecturers generally have multiple roles within higher education, but our findings suggest there is an expectation for lecturers always to fulfil all these roles within the classroom, and that lecturer roles are not neatly compartmentalised into ‘teaching’, ‘module coordination’, ‘office hours’, ‘dissertation supervision’, ‘personal academic tutor sessions’ etc. Therefore, we explored the importance of having a discussion/activity where you actively engage with your students, considering the different expectations of the student, lecturer, and other facilities – to ensure that there is a mutual and shared understanding of roles.
  3. Scaffolding of discussions: Using ecological systems theory (Bronfenbrenner, 1992) and trauma-informed pedagogical practices (Carello and Butler, 2013; Dana, 2018; Perry and Hambrick, 2008), as a basis, we recognised the multiple layers of comfort and safety and how these could be scaffolded within classroom discussions (see Figure 1). We have therefore provided a framework below through which lecturers can frame their discussions, enabling students to contribute and be heard in spaces that gradually feel more comfortable, negotiating possible language and elements of disclosure. For this activity, it is useful to consider an element of teaching, eg a core topic, an activity, discussion, skills practice, and reflect on/plan out how this might look, starting at the ‘individually’ zone and working your way towards ‘wider group/class’. For example, the activity might be a discussion point on ‘what childhood means to you’, which you may then ask students to (1) reflect on individually for a few minutes, and note this down on a post-it, before then (2) discussing this with the person next to them, noting areas of similarity and difference. Later, the students are then tasked with (3) forming small groups and assigning a particular developmental stage, asking them to mind-map the main themes of childhood for particular developmental stages. Before then (4) bringing the class together, asking each group, in turn, to share their discussions, starting with the group who was assigned the youngest developmental stage, working up to early adulthood, to produce a co-constructed developmental trajectory.

Figure 1: Zones of Comfort

Four circles all within each other showing how a task can gradually include more people (individual, pairs, small groups, and wider group)

Beyond these useable recommendations, we also argue that there needs to be more of a systemic shift within the university culture where work that involves caring for students needs is often undervalued or unseen (Baker et al, 2021). For example, some universities do not provide hours for staff to prepare and undertake course inductions which promote this relational trust, nor are they given time throughout the course delivery to consider activities that purposefully consider inter-class relationships.

Want to hear more? You can find us on Twitter: @Lauren8McA, @Lukewrd, @Laurenyoungcbt

Dr Lauren McAllister is a senior lecturer and programme lead for the MSc Child and Adolescent Mental Health course at the University of Northampton.

Dr Luke Ward is a lecturer in child and adolescent mental health and a registered therapist working with children, young people, and families who have experienced trauma.

Lauren Young is a lecturer in child and adolescent mental health, a registered cognitive behavioural therapist, and a registered children’s nurse.

References

Anker, T and Von der Lippe, M (2018) ‘Controversial issues in religious education: How teachers deal with terrorism in their teaching’ in Schweitzer, F and Boschki, R (eds) Researching religious education: classroom processes and outcomes  Waxmann Verlag GmbH

Bronfenbrenner, U (1992) Ecological systems theory Jessica Kingsley Publishers.

Dana, D (2018) The Polyvagal theory in therapy: Engaging the rhythm of regulation WW Norton & Company

Perry, BD and Hambrick, EP (2008) ‘The neurosequential model of therapeutics’ Reclaiming children and youth 17(3): 38-43

Ian Kinchin


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Comparisons between excellent concept mapping and excellent teaching

By Prof Ian Kinchin

There are some serious misconceptions in the literature on concept mapping that threaten to undermine the authenticity and potential of the tool.

When reading research papers on concept mapping, alarm bells are immediately triggered when the authors introduce their work with statements about “concept maps as a classroom strategy“. A concept map is not a teaching strategy any more than a blackboard or a textbook are teaching strategies. They are teaching tools that need to be embedded into a teaching strategy. So with the textbook, you could tell the class to go away and read the book, and come back in two weeks with any questions. Or you could sit and read through the book with the class. Or you could teach the class using all sorts of innovative classroom interventions and simply use the book for background reading. Three very different strategies using the same tool. It is the same with concept mapping. The teacher has to be clear how the tool is going to be used and how that will complement other learning activities.

Other generic and unqualified statements that can often be found include: Continue reading →