A systems approach to learning, practice and reflection in emergency primary health care: Student perspectives


sports medicine
transformative learning
critical reflection

How to Cite

Mellifont D, Barr N, Dunn P. A systems approach to learning, practice and reflection in emergency primary health care: Student perspectives. Australasian Journal of Paramedicine [Internet]. 2014May5 [cited 2023Jan.26];11(3). Available from: https://ajp.paramedics.org/index.php/ajp/article/view/13



Clinical decision making skills are essential for professional practice in primary emergency healthcare and are an intended outcome of clinical and professional programs. This article documents an interdisciplinary exploration of learning and teaching of clinical decision making and critical dialectical reflection (the systems approach) at The University of the Sunshine Coast (USC), Australia.


Using an online survey we explored students’ perspectives on how working with the systems approach impacted upon their confidence and capacity to engage in emergency clinical scenarios.


USC’s systems approach, integrated with a focus on critical reflection and case-based learning, is strongly associated with improved student confidence to engage in emergency primary health care scenarios. Most participants reported increased confidence post intervention and believed that the systems approach helped them to improve their capacity for other critical components.


This study indicates the beneficial nature of a systems approach to the learning and teaching of clinical decision-making.  The tool could be further developed, to improve perceived ability to communicate more effectively.



Schwartz A. Medical Decision Making and Medical Education: Challenges and Opportunities. Perspectives in Biology and Medicine. 2011;54(1):68-74.

Shaban R. Paramedics’ clinical judgment and mental health assessments in emergency contexts: Research, practice, and tools of the trade. Journal of Emergency Primary Health Care. 2006;4(2):1-13.

Wyatt A. Paramedic Practice - Knowledge Invested in Action. Australasian Journal of Paramedicine. 2003;1(3):Art 9.

Shaban RZ, Wyatt Smith CM, Cumming JJ. Uncertainty, Error and Risk in Human Clinical Judgment: Introductory Theoretical Frameworks in Paramedic Practice. Journal of Emergency Primary Health Care. 2004;2(1-2):1-12.

Anantharaman G. Standards and Standardization in Paramedic Protocols. Journal of Emergency Primary Health Care. 2004;2(1-2):1-3.

Croskerry P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Advances in Health Sciences Education. 2009/09/01 2009;14(1):27-35.

Croskerry P. A Universal Model of Diagnostic Reasoning. Academic Medicine. 2009;84(8):1022-1028 1010.1097/ACM.1020b1013e3181ace1703.

Cayten CG, Staroscik R, Walker K, Morganroth J, Oler J. Impact of prehospital cardiac algorithms on ventricular fibrillation survival rates. Annals of Emergency Medicine. 1981;10(8):432-436.

Hunt RC, Bass RR, G. GR. Standing orders versus voice control. Journal of Emergency Medical Service. 1982;7:26-31.

Margolis CZ. Uses of Clinical Algorithms. JAMA: The Journal of the American Medical Association. February 4, 1983 1983;249(5):627-632.

Hoffman J, O'Neill N, Luo J. Algorithm use in the treatment of pre-hospital ventricular fibrillation: an analysis of 160 cases. Resuscitation. 1989;17:131-141.

Hoffman J, Luo J, Schriger D, Silver L. Does Paramedic-Base Hospital Contact Result in Beneficial Deviations From Standard Prehospital Protocols? Western Journal of Medicine. 1990;153(3):283-287.

Hopkins JA, Shoemaker WC, Greenfield S, Chang PC, McAuliffe T, Sproat RW. Treatment of Surgical Emergencies With and Without an Algorithm. Archives of Surgery. 1980;115(6):745-750.

Pointer JE, Osur MA. Effect of standing orders on field times. Annals of Emergency Medicine. 1989;18(10):1119-1121.

Wang HE, Kupas DF, Greenwood MJ, et al. An Algorithmic Approach to Prehospital Airway Management. Prehospital Emergency Care. 2005;9(2):145-155.

Armstrong B, Simpson H, Crouch R, Deakin C. Prehospital Clearance of the Cervical Spine: Does it Need to be a Pain in the Neck? Emergency medicine journal : EMJ. 2007;24(7):501-503.

Heard AMB, Green RJ, Eakins P. The formulation and introduction of a ‘can't intubate, can't ventilate’ algorithm into clinical practice. Anaesthesia. 2009;64(6):601-608.

Chalkias AF. Prehospital emergency thoracotomy: when to do it? Journal of Emergency Primary Health Care. 2009;7(4):1-12.

Flavell E, Boyle MJ. Which is more effective for ventilation in the prehospital setting during cardiopulmonary resuscitation, the laryngeal mask airway or the bag-valve-mask? - A review of the literature. Journal of Emergency Primary Health Care. 2010.

Australian Resuscitation Council. Australian Resuscitation Council: Index of Guidelines. 2012; http://www.resus.org.au. Accessed 10/1/2012, 2012.

Cayten CG, Oler J, Staroscik R, et al. Clinical Algorithms for Prehospital Cardiac Care. Medical Care. 1983;21(2):147-156.

Mezirow J. Transformative Learning as Discourse. Journal of Transformative Education. 2003;1(1):58-63.

Paramedics Australia. What is a Paramedic. 2013; https://www.paramedics.org/paramedics/what-is-a-paramedic/. Accessed 3/12/2013, 2013.

Sports Medicine Australia. Sports Medicine for Sports Trainers. 10th ed. Sydney: Mosby Elsevier; 2013.

R: A language and environment for statistical computing. [computer program]. Vienna, Austria: R Foundation for Statistical Computing; 2011.

Stemler S. An overview of content analysis. Practical assessment, research and evaluation http://pareonline.net/getvn.asp?v=7&n=17 2001;7(17).

Punch K. Introduction to Research Methods in Education. London: Sage; 2009.