Emergency care practitioners’ perceptions of the transition from student to independent practitioner: a qualitative exploration
Lombard et al. · African Journal of Emergency Medicine · 2026
Qualitative Study · n = 12
Medical Education · ECP Students · Internship · South Africa
Written by: Stephen Colman
New graduates feel under-prepared and overwhelmed when making high-risk clinical decisions. Formal mentorship programs and curriculum adjustments at university may help better prepare graduates for transition to independent practice.
This study took place in South Africa and included ECPs from multiple provinces, in both the private and public sector. A total of 12 ECPs were interviewed online after initial purposive sampling was followed by a snowball recruitment strategy (existing participants recruit new participants for the study) . Online interviews were conducted and categories were developed to describe the perceptions of ECPs who had been practicing for 3 - 16 years. The following categories were identified:
| Categories | |
|---|---|
| A. | New graduates feel underprepared and overwhelmed. |
| B. | Feeling overwhelmed necessitates actions to change. |
| C. | There is a need for change in the workplace and university training. |
New ECPs were expected to balance leadership and clinical responsibilities, which potentially contributed to ‘transition shock’ among newly-qualified practitioners. A reliance on newly-qualified ECPs to act as student preceptors was also noted as simply asking too much (Hannah et al, 2021). A contrast between the private and public sector indicated that there was more clinical support for ECPs working in the private sector than those in the public sector. Training gaps at university highlighted limited time spent on neonatal and paediatric preparation relative to adults, resulting in less confidence with this cohort of patients. Participants reported only becoming comfortable with their practice after 6 - 12 months. Most participants established peer support networks to help them cope with this transition. Some participants also cited lack of equipment as an acute challenge for newly qualified ECPs. Increased confidence was reported amongst public sector ECPs due to the large caseload. There was a significant call for formalised mentorship, internship, and life-coaching for South African ECPs. This was consistent among the participants, which aligns with literature advocating for structured support and feedback to ensure safe practice of high-risk interventions
Internationally, paramedics must undergo an internship before being allowed to practice independently as critical care providers. Locally, this may be impractical in ECP-sparse settings, where alternative options could be explored.
The authors suggest that ECPs could register as ‘junior’ and ‘senior’ practitioners. They propose that senior status could be achieved after acquiring post-qualification experience, the ability to provide psychological safety, and demonstrated teaching ability for mentoring roles. A structured workplace internship or tiered registration may assist newly-qualified ECPs to establish themselves before fully transitioning to independent practice. This could differ in delivery or duration, depending on resource constraints regionally.
Additionally, changes to the university curriculum could include implementing rescue modules as stand-alone qualifications, replacing them instead with neonatal, paediatric, and clinical preparation subjects.
