title: Interprofessional learning and rural paramedic care.
abstract: BACKGROUND
  The traditional view of paramedic practice is one of provision of emergency care and transport within community or industrial settings. With greater integration of emergency services with the overall health system, this role is changing. Paramedics, especially in rural areas, are now working more closely with other professions in new and extended roles that incorporate non-emergency community-based care, preventative medicine and social care. Workforce shortages, health service budget cuts, population size and the changing demographic profile of many rural and remote communities highlight the need for effective interaction between the health professions to respond to the health needs of these communities. The rural environment therefore provides an opportune setting in which to explore the evolving role of paramedics and their interaction with other healthcare professionals in ways that can improve health outcomes for patients and the community. This article presents a critical review of the literature in this area and identifies gaps in which further research is required to further interprofessional learning (IPL) for paramedics.
  
  
  METHODS
  Search databases included MEDLINE, SCOPUS, CINAHL and the University of Tasmania (UTAS) electronic library. Specific journal searches included the Journal of Emergency Pre-Hospital Care (JEPHC) and the Journal of Interprofessional Care. Search terms for this literature review consisted of a combination of prefixes 'inter' and 'multi' with adjectives 'professional', 'disciplinary' and 'shared' and the nouns 'education', 'learning' and 'training'. These search terms were then used in combination with each of the terms 'rural' and 'remote' then with 'paramedic/s' and 'pre-hospital' in order to source reports of interprofessional activities in these areas. Each of these was also combined with the search term 'collaboration'. On completion of the initial search process, the reference lists of relevant articles were examined for reports of professional interactions and rural paramedic care.
  
  
  RESULTS
  Three major concepts emerged from 24 articles: interprofessional education (IPE), multidisciplinary teamwork, and interprofessional learning. Six articles focused on IPE; nine concerned multidisciplinary teamwork and nine IPL. Examination of the reference lists of these articles revealed a further eight articles with the theme of IPL incorporating paramedics. Predominantly, IPL was associated with new roles for rural paramedics where collaborative practice incorporated community-based care rather than being focused on emergency treatment and transport to hospital. Only two articles reported on a measurable patient care outcome related to IPL. The majority of articles described programs or interventions without having directly examined the interactions and relationships between professions.
  
  
  CONCLUSIONS
  Rural paramedics are involved with other healthcare professionals, often in new or expanded roles. Published journal articles that report on this interaction are largely descriptive in nature and few describe the dynamics of this interaction or the conditions under which interprofessional activity could yield potential benefit to health service delivery or patient outcomes. As an overarching construct, IPL may be used to frame further investigation of this interaction and may help shape the emerging role of paramedics in rural settings where population size and other factors limit the availability of health professionals.
authors.affiliation: Department of Rural Health, University of Tasmania, Launceston, Tasmania, Australia. peter.mulholland@utas.edu.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Mulholland
authors.affiliation: Department of Rural Health, University of Tasmania, Launceston, Tasmania, Australia. tony.barnett@utas.edu.au.
authors.forename: Tony
authors.initials: T
authors.lastname: Barnett
authors.affiliation: Department of Rural Health, University of Tasmania, Launceston, Tasmania, Australia. j.spencer@utas.edu.au.
authors.forename: Judy
authors.initials: J
authors.lastname: Spencer
mesh_terms: D000488:Allied Health Personnel / Q000193:education*; D003299:Cooperative Behavior; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D019035:Rural Health Services / Q000458:organization & administration*