Houli, Rebecca (2025) A Modified Delphi Study: Performance Indicators to Support the Australian Paramedic Professional Capability Tool (APPCAT). Research Master thesis, Victoria University.

Abstract

Background: Work-Integrated Learning (WIL) is a cornerstone of paramedicine education, providing students with real-world experience. Undergraduate students should be assessed against the Professional Capabilities for Registered Paramedics (PCFRP) to ensure readiness for safe and professional practice. Since 2018, paramedicine has been regulated under the Australian Health Practitioner Regulation Agency (AHPRA), requiring national standards. However, unlike other allied health disciplines, paramedicine lacks a validated, standardised WIL assessment tool that aligns with accreditation and professional registration requirements. The Australian Paramedic Professional Capability Tool (APPCAT) is being developed to address this gap, using the PCFRP framework of five domains and 23 capabilities. Yet, the PCFRP is not conveyed in language suited to WIL or education, limiting its direct use. To bridge this gap, performance indicators (PIs) need to be developed that are observable, contextual and measurable. A performance indicator tool can support supervisors in conducting consistent evaluations and assist students in understanding expectations of safe and professional practice. Objective: This study sought expert consensus to develop PIs that enable supervisors to assess undergraduate students’ attainment of professional practice against the PCFRP. The tool was intentionally designed to be concise (2–3 pages) and user-friendly, with 4–8 indicators per capability. Drawing from established allied health practices, the study aimed to provide a practical and nationally applicable framework for WIL assessment. This approach bridges the gap between theoretical registration frameworks and practical WIL assessment requirements. Methods: A modified Delphi methodology was used with participants, comprising paramedicine academics from all Australian states and one New Zealand region. The process allowed anonymity, iterative feedback, and group-informed responses. Surveys were conducted in multiple rounds using Qualtrics, with indicators selected and ranked against the PCFRP descriptors. Statistical measures (frequency, median, mean) and an ≥80% consensus threshold guided adoption, while items with ≥70% and qualitative feedback were reconsidered in moderation meetings. Independent moderation in the final round ensured clarity, national applicability and final consensus. Results: The participants were academics registered with AHPRA, half of whom also remained clinically operational. Their professional experience ranged from 6 to >21 years, and their qualifications included paramedicine, education, nursing, psychology, epidemiology, and health policy. This breadth of experience provided a robust foundation for consensus. Across four Delphi rounds, an initial 475 indicators were refined to 182, aligned with the 23 PCFRP capabilities. Each capability was supported by 5–11 indicators (average 8), creating a tool that is comprehensive yet concise. Conclusion: This study contributes to paramedicine education by developing a consensus-based tool for assessing undergraduate students’ professional capabilities during WIL. Through a rigorous Delphi process, the performance indicators achieved strong content validity, ensuring they are observable, contextualised, and nationally relevant. The tool provides clear guidance for supervisors and students, supporting consistency and transparency in assessment. While further research is needed to establish reliability and predictive validity in practice, this work lays a robust foundation for national harmonisation, standardisation, and alignment with accreditation and registration standards in paramedicine education, thereby supporting clearer expectations and contributing to better preparation of students for professional practice.

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