GENERAL ARTICLES

 

A descriptive literature review of recognition of prior learning for vocational learners in emergency medical care in South Africa

 

 

D. Winstanley^{I, II}; C. Cunningham^III

^IPhD student University of Cape Town
^IIQuality Planning and Research Unit Boston City Campus Johannesburg, South Africa https://orcid.org/0000-0003-1501-5531
^IIIDivision of Emergency Medicine University of Cape Town Cape Town, South Africa https://orcid.org/0000-0002-8188-0307

 

 

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ABSTRACT

Radical advances in emergency medical care education in South Africa have resulted in both advancements and suppression. After short-course vocational training, the emergency care provider could seek employment in an emergency service. With the realignment of emergency medical care programmes to the National Qualifications Framework (NQF), these short vocational courses were phased out by 2018. Although necessary for educational advancement, these changes prevented vocationally trained emergency care providers from articulating into higher education without returning to full-time academia. Moreover, despite recognition of prior learning (RPL) policies in higher education, few institutes offering emergency medical care programmes offered this as an access option.
This descriptive literature review aimed to analyse the RPL processes in South Africa and globally. Additionally, insight into RPL candidates" support requirements for postgraduate studies was gained. A systematic search of peer-reviewed journal articles, periodicals, dissertations, and governmental reports from 2000 to 2021 was conducted. Various databases were accessed, including Proquest, EBSCOhost, LearnTechLib, JSTOR, ERIC, Google Scholar, and the Thesis Repository. The lack of literature focusing on the prehospital RPL system in South Africa prompted search expansions into the field of health science internationally. Of the 401 screened sources, 19 met the researcher's inclusion criteria. Two additional articles were sourced in a repeated search in February 2022. The findings revealed enablers and barriers for RPL students and expanded on their personal and academic transitions. The themes identified through the enablers and barriers can assist in identifying additional support for RPL students during their educational journey. Ultimately, despite vital institutional transitions in RPL processes, intrinsic motivation inspired these students to embrace the challenges they faced, and their process of personal transition and lifelong learning began.

Keywords: recognition of prior learning, vocational learning, emergency medical providers, paramedic, higher education

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INTRODUCTION

Emergency care education in South Africa has evolved rapidly over the last decade and is dynamic and continuously changing. Previously, emergency care providers could qualify as "vocationally trained" through a short-course tiered system, progressing from basic to advanced life support emergency care providers. After successfully completing the relevant course, a certificate was issued, and one would be able to enter the prehospital emergency system as a vocationally trained emergency care provider. However, these certificate courses were not aligned with the National Qualification Framework (NQF). They were discontinued in 2018, meaning emergency care providers could no longer qualify or advance in emergency care education via vocational or short-course pathways. Their educational j ourney was further halted as those who qualified in this system were unable to articulate into other qualifications as they did not meet NQF entry requirements. Table 1 details the NQF levels and current emergency medical care qualifications.

Vocationally trained emergency care providers are essential in the emergency medical system. Due to the diverse geographical communities within South Africa, emergency care providers are often the only providers in rural and marginalised communities. This, together with fulltime employment, family responsibility, and financial challenges, prevent the emergency care provider from returning to full-time education. Since the emergency medical NQF programme required to advance the scope of practice would take four years, educational advancement is thus out of reach for most vocationally trained emergency care providers. These vocational workers were suspended at a time when education was rapidly advancing, yet theirs limited them.

Recognition of prior learning in South Africa

South African vocational emergency care providers have a wealth of operational experience, and many perform mentorship roles for undergraduate students. Their advancement in career and education (via tertiary education) can be recognised through recognition of prior learning (RPL). The South Africa Qualifications Association defines this concept as "a process through which non-formal learning and informal learning are measured, mediated across different contexts, and certified against the requirements for credit, access, inclusion, or advancement in formal education and training system or workplace" (South African Qualifications Authority 2020).

The RPL process is multi-dimensional; non-formal and informal learning are measured across different contexts and certified against credit, access, inclusion, or advancement placement within an NQF-aligned qualification (The South African Qualifications Authority 2013). Through the RPL process, placement into NQF-aligned educational programmes could provide the answer vocationally trained emergency care providers have been looking for.

 

EDUCATIONAL OPPORTUNITIES FOR VOCATIONAL EMERGENCY CARE PROVIDERS

In 2014, the University of Cape Town's Department of Surgery, Division of Emergency Medicine, applied to the Council on Higher Education to add a Postgraduate Diploma in Emergency Care (PGDIP EC) to their offerings. It took a few years to attain the necessary permissions, additional time was required for course design, and the first course was launched in 2021. The one-year standalone programme was designed as an interdisciplinary course to equip doctors, nurses, and emergency care providers working in emergency care systems with theoretical, clinical, research and management skills that promote the development of evidence-based emergency care across the African content. Entirely online, this NQF level 8 programme allows for distance learning while working full time. Practitioners could improve knowledge and, at the same time, develop management and research-based skills in an interdisciplinary realm. Students would develop through carefully designed courses over the year, focusing on accessing and using best practice evidence-based methods in theoretical, research, and management science to improve emergency systems.

The Division of Emergency Medicine offers this programme to emergency care providers, nurses, and doctors with at least a four-year degree or NQF level 7 qualification. It also considers those who successfully completed an RPL portfolio demonstrating experience and knowledge. Through recognition of the RPL process, the vocational emergency care provider can apply for access and gain a postgraduate diploma with successful completion. This could then facilitate access to and eligibility for higher postgraduate programmes in tertiary education.

As the first offering promoting individuals' transition to a higher education qualification at NQF 8 for vocationally trained emergency care providers, the PGDip EC qualification offers many opportunities using the RPL process. The online programme overcomes the necessity of class attendance but creates new challenges in transitioning vocationally trained emergency care providers to postgraduate studies.

The rapidly evolving educational environment provides an exciting area for research. This study thus reviewed existing literature detailing the support requirements of vocationally qualified emergency care providers who have gained access to postgraduate emergency care programmes using a descriptive approach. The findings will provide a deeper understanding of RPL and offer insight into successful programmes, potential gaps, and challenges experienced by institutions and RPL participants. As there is limited knowledge about RPL and support requirements at the postgraduate level, this study contributes to the emerging knowledge base.

 

DESIGN AND METHODS

Study design

A systematic, descriptive review design was used to analyse the RPL process in South Africa and globally. Insight to support RPL candidates' postgraduate studies could be gained from this review. The information sources used to conduct this literature review included peer-reviewed journal articles, periodicals, dissertations, and governmental reports. Using the University of Cape Town library portal, Proquest, EBSCOhost, Proquest, LearnTechLib, JSTOR, ERIC, Google Scholar, and the Thesis Repository were accessed.

Search strategy

A systematic search was conducted using the "advanced search function" on the abovementioned databases. The following search terms were used in various combinations: "recognition of prior learning or RPL", "vocational or skill training or vocational education or skill-based training", "emergency care provider or emergency medical care or emergency care", "support needs" and "postgraduate studies". Further specifications of the date range from 2000 to current, and English language, were included. The review was done from July 2021 to January 2022. The lack of literature focusing on the prehospital RPL system in South Africa prompted search expansions into the health science field. As only a few articles were found in the South African context, the search was broadened to include international studies, and a total of 401 non-duplicate articles were found.

Inclusions and exclusions

After reviewing the titles and abstracts, 355 articles were excluded as they did not relate to the adult learner or were irrelevant to the study. Of the 46 articles reviewed, 19 were included in this literature review. Two additional articles were sourced in a repeated search in February 2022. Figure 1 represents the literature collection process.

 

RESULTS

This literature review aimed to explore RPL processes within South Africa and gain insight into vocational emergency care providers' support requirements when transitioning into postgraduate studies.

Of the 19 articles relating to this study's aims, four were internationally based, three were within the African continent, and 12 were from South Africa. A majority of the literature used qualitative methodology, where one-on-one interviews expanded the journey into higher education through RPL and students' experiences while studying.

Transition through Recognition of Prior Learning

In research exploring Malaysian postgraduates' support requirements, Abiddin and Ismail epitomised higher education by identifying the only constant as change (Abiddin and Ismail 2014). For the current study, the researcher views the South African education system, within the definition of change, as an ever-transforming system (Oxford English Dictionary 2017). Through the dire need for transformation, the concept of RPL was expanded with the vision of facilitating educational access and developing those previously unable to advance into higher education (Jooste and Jasper 2010; Cermak 2016). However, despite the RPL process' intentions, the execution was slow, particularly in the field of health science, with little to no focus on the prehospital context (Cermak 2016). Institutional capacity was also recognised as one of the most significant challenges for the successful implementation of RPL (Cermak 2016; Fox 2005).

To determine students' support requirements, barriers and enablers must be explored. Enablers in the context of this research include support structures that had a positive influence on the students' journey throughout the programme. Conversely, barriers can be considered as those that had a negative influence or effect. By exploring these two concepts, areas that promoted and impacted individuals' learning and successful transition could be identified. Support requirements should thus be investigated, enhancing those already in place, and implementing new measures in areas where support may be insufficient or completely lacking through participatory action research.

 

Table 2

 

Individual enablers and barriers

To quantify personal growth and transition during education is difficult due to the nature of this concept, yet this theme was repeatedly presented during the literature review (Abiddin and Ismail 2014; Asamoah 2019; Brenner et al. 2021; Cermak 2016; Donoghue et al. 2002; Dykes 2009; Hoffman and Julie 2012; Miguel, Ornelas, and Maroco 2016).

Through the actual RPL process, applicants experience the first concept of transition. For many, successful acceptance in the RPL process increased self-confidence and boosted self-motivation, allowing a generic feeling of achievement (Abiddin and Ismail 2014; Andersson et al. 2013; Cermak 2016; Snyman and van den Berg 2021; Snyman 2013; Dykes 2009). This intrinsic motivation based on elevation of self-worth enhances the learning experience for the RPL student; that which was not possible is now achievable (Snyman and van den Berg 2018). For the vocational learner who previously did not meet entry requirements to higher education, this process of proving self-worth and self-confidence could be internalised as the first achievement in educational progression.

Hoffman and Julie (2012) explored the academic transition process and argued that many educational transitional challenges are linked to the primary motivation for pursuing further studies. Self-actualisation and improvement on an existing body of knowledge were identified as the most significant intrinsic motivational factors (Miguel et al. 2016). Moreover, although progression in education was initially thought to promote professionalism and employability, the main effect was personal (Miguel et al. 2016). Academic transition was the concept feared by most students, where words such as "fear of failure" were used during interviews (Snyman and van den Berg 2018; Hamer 2012). This perceived and potential barrier could prevent successful progression due to the ideology of failure.

Based on the positive personal transition most students experienced when entering postgraduate studies through the RPL process, family support structures were further explored in this literature review; family and peer support was rated the most valuable (Miguel et al. 2016; Cermak 2016; Snyman and van den Berg 2018). Moreover, of the social support students received, the support acquired from fellow students was identified as the most influential (Brenner 2018; Dykes 2009; Snyman and van den Berg 2021). A degree of commonality amongst RPL students resulted in private workgroups, increased inter-student support, and a perceived sense of belonging. The education journey can be lonesome and despairing, especially for the RPL candidate who does not carry the institutional experience. The need for acceptance is intrinsic in the social being; thus, inter-student support promotes motivation, inspiration and a positive experience (Dykes 2009). Hamer epitomises this concept by exploring a philosophy of recognition in RPL and human agency, concluding that "this is a way to see and be seen" (Hamer 2012). This emphasis on self-worth and belonging can support and motivate learning (Hamer 2012).

Financial challenges, including loss of income and concern over additional expenses, were highlighted as a significant hindrance and often resulted in the non-completion of postgraduate studies (Dykes 2009; Donoghue et al. 2002; Visser 2011). Secondary to finances, time was identified as one of the greatest sacrifices RPL students made (Visser 2011). The implication of balancing study, work and family often hindered students' transition into postgraduate studies, resulting in conflicting role demands (Brenner 2018; Visser 2011).

Academic enablers and barriers

This theme outlined the most barriers RPL students experienced. In using the RPL process to access postgraduate studies, many steps within academic growth are omitted. Together with individuals' lack of knowledge of academic protocol, it was noted that these students initially relied on emotion and personal experience to guide their writing rather than data or scientific research (Brenner 2018). Due to the pedagogical "rote-learning" style that many vocational learners were exposed to pre-apartheid, pre-university learning fails as a foundation of critical thinking skills (Mothokoa and Maritz 2018). Mastering language and interpretation of meaning was another challenge experienced (Miguel et al. 2016; Mothokoa and Maritz 2018). Most South African universities use English or Afrikaans as the language of instruction, which is not the first language of the majority of South Africans, further challenging the educational journey (Visser 2011). This linguo-cultural barrier compounds the stress dynamic, especially in the transition phase into higher education (Brenner 2018; Mutanana and Pedzisai 2020; Hoffman and Julie 2012). The time required to learn a new vocabulary and understand departmental meaning in assessments and academic-related concepts is deemed a barrier that could articulate across the programme.

Although personal experience was considered an enabler, the downside was age and the years since studying last took place. Many students who were interviewed expressed the need to "learn to study" again (Walters and Koetsier 2006; Visser 2011). This process of learning to study, the pressure for critical thinking and scientific writing, together with a new orientation to the university culture, often resulted in delays in adjusting to the learning process. It was noted the flexibility of online programmes assisted as the mature learner could engage in learning material at any time (Visser 2011).

Asamoah (2019) identifies that effective teaching depends on rich knowledge, critical thinking, expertise in subj ect matter and the use of technology. While the former are educational and experience requirements, technology can both hinder and support online learning. Asamoah (2019) further eludes that the advances in technology directed for higher education has been augmented with the intrinsic motivation of students presenting with a desire to learn without barriers (Asamoah 2019). As education transitions from traditional to the online platform, technological expertise is no longer a recommendation but a necessity. Moreover, at the postgraduate level, the assumption of technological competence exists. This assumption is based on the premise that students advance from undergraduate to postgraduate studies, and technological knowledge expands during this journey. However, the RPL candidate entering the postgraduate level may not have experienced the necessity to grow in the technological domain and therefore faces an additional challenge in his journey of learning (Asamoah 2019).

Moreover, to access the learner management systems used by universities, an electronic device that supports internet connectivity is required. Although almost every student owns a smartphone, the size of the screen does not allow for effective reading, completion of assessments or generic course-related scholarly events (Winstanley 2018). This can become a costly addition to study material, especially when specialised platforms, applications or systems are required. In addition, despite the flexibility of online studying, the national and global energy crisis results in unreliable electricity supply and internet inconsistencies, which delay scheduled study sessions (Hoffman and Julie 2012; Asamoah 2019).

Institutional enablers and barriers

A common theme among students who had never attended university was a lack of orientation to the institutional culture (Walters and Koetsier 2006; Singh 2011; Visser 2011; Donoghue et al. 2002; Brenner et al. 2021). Orientation ranged from gaining an understanding of lines of communication within the university and the department responsible for the programme, exploring additional services offered, and generic movement from registration to admission, and then the learning system used. Brenner (2018) similarly suggests that a link between the RPL students' unfamiliarity with university processes and lack of cultural capital may be a barrier and delay transition. The natural causal sequence thus requires additional interrogation, delaying the rapid adaption required in terms of workload, schedules and performance (Brenner 2018).

Each higher education institution comprises interdepartmental components that aid the student's journey. One would start with registration, and progress through finance and logistics to the specific programme-related teaching divisions. Roles are clearly defined among registrars, educators and tutors, and most learning management systems clearly display the relevant persons to approach when support is required. Yet this multi-layered staff organogram conflicts with many emergency medical care vocational courses. In these, one or two educators play multiple roles in terms of administration, education, and generic go-to-person for almost all course-related issues. In the reviewed literature, vocationally taught students thus expressed confusion in understanding this interdepartmental approach and tended to contact the programme manager for most issues (Visser 2011; Brenner et al. 2021). As this often requires a query redirection, time frustrations can be perceived as a lack of support or guidance (Visser 2011; Donoghue et al. 2002).

Despite this, most higher education institutions have multiple support centres to aid students' transition and educational journey, but minimal references to these departments were found in the reviewed literature within South African boundaries. by RPL students in South Africa, it can be assumed that these were underutilised, although the reasons for this should be further explored.

RPL students' transition

To grasp the transition process, one must be cognizant of both the academic and personal journey undertaken by the RPL student. Through intrinsic motivation, these RPL student have held onto a dream of purpose. Dykes (2009) claims if prior knowledge and learning are devalued and disregarded, their importance is negated. By suppressing this knowledge, the student's transformation towards lifelong learning is silenced (Dykes 2009).

When entering a postgraduate programme, the goal is graduation and certification, but the journey to this point necessitates change. While the primary expectation of change entails student transition, the need for quality education has warranted a reform of higher education (Abiddin and Ismail 2014). The varied backgrounds of the mature RPL students add a unique and unequalled experience to each programme, and it is this experience that higher education facilities should harness in further developing RPL policies.

 

CONCLUSION

Despite a floundering start, the conception of RPL is gaining momentum in South Africa, and slowly spreading throughout Africa. To disregard vocational learners' wealth of knowledge is deleterious and would cement the future of the mature student. Equally, to advance the vocational learner infers an understanding of their requirements and support needs.

After evaluating the enablers and barriers in the literature reviewed for this study, multiple themes were identified. These were categorised into subthemes based on individual, academic and institutional enablers and barriers. To accurately determine RPL students' support requirements, an understanding of their challenges and support areas is vital. Although many enablers were identified, there are multiple areas where support requirements can be actioned for improved transition. It is of interest to note that despite barriers' potential negative impact, many students embrace these as opportunities and, on reflection, realise that the barriers became enablers through their personal transition during studies. It is in this growth process where true transition occurs.

 

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