Aims: This study aimed to evaluate the ‘think aloud’ teaching exercise's ability to develop clinical reasoning skills of student paramedics, and to ascertain its feasibility as an ongoing method to enhance clinical reasoning teaching and potentially alleviate problems around applying theoretical learning to practice. Methods: A qualitative approach was taken to seek the opinions and experiences of students taking part in the activity to determine levels of enjoyment, how relatable it was to students, and awareness of the skills it was intended to develop. Data collected via an online survey tool were analysed to identify themes and comments. Findings: Student enjoyment and engagement were evident, and the exercise permitted independence of thought and working, promoting self-appraisal among students of the effectiveness of the working strategy. Conclusion: The results of this case study indicate that the think aloud exercise could be effective in developing students' clinical reasoning skills. It complements established teaching strategies, such as core lectures, seminars and supervised practice.

Background: Pain is one of the commonest symptoms in patients of all ages presenting to ambulance services. Children in pain make up a relatively small proportion of the number of those attended by prehospital care and pain management is needed in only 40% of cases. This might go some way to explain why the management of paediatric pain is perceived to be poor. Aim: The primary aim of this study was to explore the experiences of UK paramedics in treating children in pain. Methods: A phenomenological study was undertaken using a purposeful sample of UK paramedics (n=12) to explore their experiences and decision-making during the treatment of children in pain. Results: Five themes became apparent through analysis—preparation and education; adaptation and change of approach; organisational and legal factors; support and guidance; familial and carer impact—with some crossover between themes noted. Conclusion: Clinicians are aware of multimodal techniques for managing pain in children but are often less confident in the use of pharmacological than non-pharmacological management methods. Advances in the use of technology in practice have enabled clinicians to use alternative measures to manage children in pain. However, while using these methods, practitioners lack confidence that they are meeting social expectations of their roles.

Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.

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D (2022) How to write an action plan with a nurse or nursing student. Nursing Standard.