Research Article: The bargaining of professionalism in emergency care practice: NHS paramedics and higher education

Date Published: November 10, 2017

Publisher: Springer Netherlands

Author(s): Assaf Givati, Chris Markham, Ken Street.


Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals’ education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal–political circumstances affecting its provision and demand. Based on interviews with front-line paramedics, paramedic educators and paramedic science students in the South of England, this article examines how the reforms to paramedic education have impacted the professionalization of paramedics and their discourse of professionalism. Framed within to the ‘new’ sociology of professions, the case of British paramedics demonstrates the complex nature of the relationship between the university and professional practice. It appears that universities, the providers of paramedic education, are caught between two opposing discourses of professionalism: on the one hand, that of providing a platform for students’ socialization and engagement with professionalism ‘from within’ practice which is based on students’ common goals and mutual experiences, and, on the other hand, serving as a conduit for managerial/organizational strategies of professionalism which appear to undermine the role of university socialization.

Partial Text

Defining professional work has been an elusive and increasingly complex exercise for social scientists, due to the fast-changing environment in terms of cultural–organizational, societal and policy changes, global-international influences and the blurring borders between the public and private sectors (Evetts 2013; Noordegraaf 2007). The ‘classic’ approach to the study of professional work has been mainly in relation to professionalization, which is the process by which occupational groups obtain higher status and economic gains as well as the monopoly protection of the occupational jurisdiction, through occupational closure (Abbott 1988; Freidson 1986; Larson 1980; Parkin 1979; Witz 1990). Such occupational closure is achieved by restricting access to the occupational group’s knowledge and skills-base, typically through credentialism, which is the standardization of professional knowledge and the establishment of certification programs (Collins 1979, 1990), typically, in HEIs (MacDonald 1995). From an occupational closure view,….the key to the definition of a profession remains the sheltered position of professions in the marketplace, with entry to the professions usually gained through obtaining relevant higher education credentials (Saks 2012, p. 4).
Occupational closure was effective in considering the collective strategies of occupational groups in their quest to enhance their economic and social standing and prestige. However, Evetts (2006, 2013) suggests that the preoccupation with closure strategies neglects the impact of the “internal” professional culture and the role of practitioners in shaping the profession ‘from within’ (Freidson 2001). This “new” sociology of professions recognizes the emergence of occupational strategies of professionalism which are generated by practitioners themselves, resulting from their ability to apply knowledge in practice, from their self-regulation and from their conduct, rather than from being “passive” members of a professional group (Cant et al. 2011; Noordegraaf 2007).

This narrative-based qualitative research study was conducted during the academic year 2015/16, at a university providing Paramedic Science education in collaboration with the regional ambulance service in the South of England. Narrative-led research is an umbrella term that is designed to capture personal and human dimensions of experience over time in the context of the relationship between the individual experience and its social context (Connelly and Clandinin 2000). In practical terms, it is the systematic gathering, analysis, and representation of people’s own stories as they tell them. This approach allows analyzing the experiences as well as the meanings, values, beliefs and interpretations that the study participants attach to their lived experiences, and positioning them in relation to the theoretical framework guiding the investigation.

Participants’ narratives illustrate a number of important challenges to paramedics’ professional culture, in light of the reforms to paramedic education: the tension between the value of practice-experience and personality traits, and the increasing emphasis on the acquisition of academic knowledge in HEIs; the friction between the experienced paramedics (and ambulance technicians)1 who were trained prior to the educational reforms, and the “knowledgeable yet often inexperienced” university graduates; the perceived loss of the important worksite socialization, which is paralleled with the increased individualization and perceived “practice/practitioner isolation” that followed the reforms; and an assertion that university education opened greater job-opportunities to the new graduates, yet, may have a negative impact on job-retention and on the sustainability of the paramedic workforce.

Our investigation, although limited in size and in scope, offers primary findings and observations, which call for further studies across the UK and further afield. Participants’ narratives embody and personify the impact of the educational reforms on paramedics’ professional identity and professional culture while illuminating central concepts in the study of the relationship between higher education and professional practice in health and social care.




Leave a Reply

Your email address will not be published.