Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / South African Advanced Life Support (ALS) providers follow an autonomous practice model of care. This advanced role profile is characterized by clinical skill competence and autonomous decision making whilst demonstrating a high level of awareness of their own ethical attitudes, values and beliefs. It is through a professional commitment that ALS providers deliver an advanced evidence based practice that should be maintained constantly within a dynamic environment. Continuous Professional Development (CPD) is seen as an instrument for this. CPD should also serve as a means to acquire professional excellence and going beyond the boundaries of meeting the base level standard with the aim of providing the finest quality of care in the interest of patient safety. Purpose of the research The purpose of this research is to identify gaps in the professional development of out-of-hospital ALS providers trained in South Africa by assessing frequency of performance of ALS clinical skills, by determining perceived level of competence and predictors of confidence, and by sourcing information on attendance of CPD activities and training needs. vi Methodology This study used a quantitative non-experimental design. Data was attained from an e-mail based descriptive survey that was limited to a precise and concise questionnaire. The data from 140 (N) ALS providers was subjected to a descriptive statistical analysis using the PASW statistics version 18.0 to systematically show patterns and trends. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using Chi-square and Pearson correlation tests. Results Results indicated that ALS providers performed clinical skills infrequently. Of the total number of respondents 140 (N), the average ALS clinical skills performance was 6 (4.8%) daily. In the 2-6 times a week category 8 (6.4%) ALS clinical skills were performed. ALS clinical skills performance in the once a week category showed an average of 7 (5.6%) and the once a month category, an average of 17 (13.7%) ALS skills were performed. An average of 31 (25%) ALS skills were performed in the once in six months category whilst an average of 54 (43.5%) were performed in the greater than six months category. CPD activities that are appropriate to ensuring the maintenance of competence for these clinical skills were not adequately undertaken. Medical updates were mostly attended by ALS providers, 52 (42.9%) whilst CPD events that addressed clinical skills, was mostly limited vii to the ACLS course 42 (34.7%). The needs assessment for CPD showed that 56 (53%) of respondents expressed a need for paediatric and obstetric simulated skill sessions, whilst 43 (40.9%) requested clinical skills workshops and 39 (37.1%) expressed a need for clinical practice in theatre and coronary care units. Conclusions and recommendations This study shows that ALS clinical skill competence is maintained by frequent practice and appropriateness of CPD activities. The infrequent performance of ALS skills coupled with the lack of appropriate and diverse CPD activity attendance results in poor maintenance of competence. The loss of competence can be related to poor reported levels of confidence which consequently places patient safety at risk. To safeguard against medical error and ensure patient safety, it is strongly recommended that CPD audits be undertaken on all ALS providers for appropriate CPD compliance related to clinical skills performance. In addition to a clinical skills audit, it is recommended that a national clinical skills registry be established with the intention of facilitating clinical skill surveillance, to determine a notifiable, high risk skill set. To safeguard against knowledge and clinical skill attrition and loss of competence, the delivery of CPD activities should be assessed for effectiveness and appropriateness.

ENGLISH ABSTRACT: The setting for this study was the University of the Western Cape, Faculty of Community and Health Sciences, first year undergraduate students. All students who participated in the compulsory interprofessional programme were from the following disciplines: Occupational Therapy; Physiotherapy; Psychology; Social Work; Natural Medicine; Dietetics; Human Ecology; Sports Sciences and Nursing. The objectives of this study were to measure the attitudes and perceptions of first year students who participated in an undergraduate interprofessional programme. The attitudes and perceptions were further measured in relation to the specific lecturers involved, the age of the students, their gender, race, background as well their specific discipline. This was primarily a quantitative study incorporating two qualitative questions in which 657 students were issued with a questionnaire designed to determine their attitudes and perceptions towards interprofessional education. A sample size of 264 students resulted in 95% confidence intervals with a maximum precision of 5%. The questionnaire was adapted, with permission, from Cameron; Rennie; DiProspero; Langlois & Wagner (2009). MS Excel was used to capture the data and STATISTICA version 9 (StatSoft Inc. (2009) STATISTICA (data analysis software system), www.statsoft.com.) was used to analyze the data from the questionnaires. Descriptive statistics was used to describe the main features of the sample of this study and summary statistics was further used to summarize the findings of this study in order to communicate the bulk of the information as simple as possible. Two open-ended questions were included at the end of the questionnaire and this was used to triangulate the data. The Kruskal-Wallace test was used to measure the results, whereby a p-value of <0.05 indicated statistical significance. Of all the factors used to measure the attitudes and perceptions of students, the following three were significant: Gender; Race and Discipline. No other factors impact on the attitudes and perceptions of students towards interprofessional education. Student attitudes and perceptions towards interprofessional education were found to be very positive. The findings revealed that the most significant factor in the study was the lack of understanding of various disciplines participating in the programme and their understanding of the relevance of the teaching approach (interprofessional) as well as their specific role in the health care team. This clearly illustrated the need to recommend to the co-ordinating unit of the programme that this be defined more clearly for the students and specifically the Sports Sciences students. / AFRIKAANSE OPSOMMING: Die studie het plaasgevind by die Universiteit van die Wes-Kaap, in die Fakulteit van Gemeenskap en Gesondheidswetenskappe, met eerste jaar voorgraadse studente wat die verpligte interprofessionele program doen. Studente sluit in die volgende dissiplines: Arbeidsterapie; Fisioterapie, Sielkunde, Maatskaplike Werk, Natuurlike Medisyne, Dieetkunde, Menslike Ekologie, Sport en Verpleegkunde. Die doelwitte van hierdie studie was om die houdings en persepsies van die eerste jaar studente wat deelgeneem het in 'n voorgraadse interprofessionele program te meet. Houdings en persepsies was gemeet met betrekking tot die ouderdom geslag, ras,agtergrond sowel dissipline van spesifieke studente. Daar was ook gekyk of die betrokke dosente ń invloed het op studente se houdings en persepsies teenoor die program. Die studie was hoofsaaklik kwantitatiewe met n kwalitatiewe komponent. Vraelyse was uitgereik aan 657 studente om hul houdings en persepsies teenoor interprofessionele onderwys te bepaal. 'n Steekproefgrootte van 264 studente het in 95% vertrouensintervalle met 'n maksimum akkuraatheid van 5%. Die vraelys is aangepas, met toestemming, van Cameron, Rennie; DiProspero Langlois & Wagner (2009). MS Excel was gebruik om die data op te vang en Statistica weergawe 9 [StatSoft Inc (2009) STATISTICA (data-analise sagteware stelsel), www.statsoft.com] is gebruik om die data van die vraelyste te analiseer. Beskrywende statistiek is gebruik om te beskryf die belangrikste kenmerke van die steekproef van hierdie studie. Opsommingstatistiek is verder gebruik om op te som die bevindinge van hierdie studie met die doel om die grootste deel van die inligting so eenvoudig as moontlik te kommunikeer. Twee oop vrae is ingesluit aan die einde van die vraelys en dit is gebruik om die data te trianguleer. Die Kruskal-Wallace-toets is gebruik om die resultate, waar 'n p-waarde van <0,05 aangedui word statistiese betekenisvolheid te meet. Van al die faktore wat gebruik was om die houdings en persepsies van studente te meet, was die volgende drie beduidende: geslag, ras en dissipline. Geen ander faktore impakteer op die houdings en persepsies van studente in interprofessionele onderwys. Studente se houdings en persepsies teenoor interprofessionele onderwys was beduidend positief. Die studie het bevind dat daar ń algemene gebrek aan begrip is vir die relevansie van die program. Dit sluit in hoekom die verskillende dissiplines aan die program deelneem as ook wat hulle spesifieke rolle in die gesondheidsorg span is. Die aanbeveling is dus dat die koördinerings eenheid van die program die kursus meer duidelik sal moet definieer om so doende die studente se kennis in terme van relevansie van die interprofessionele program uit te brei met spesifiek verwysing na die Sport studente.