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Afr J Emerg Med
Afr J Emerg Med
African Journal of Emergency Medicine
2211-419X
2211-4203
African Federation for Emergency Medicine

S2211-419X(24)00037-5
10.1016/j.afjem.2024.08.008
VSI: Health Professions Education in African Emergency Care
From vocational to graduation: A mixed methods study of support needs for vocational learners pursuing post-graduate education in South Africa
Groome Debbi debbi@storage.co.za
ab⁎
Cunningham Charmaine a
a Division of Emergency Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
b Boston City Campus, Stellenbosch, Cape Town, South Africa
⁎ Corresponding author. debbi@storage.co.za
12 9 2024
12 2024
12 9 2024
14 4 263267
12 3 2024
21 8 2024
23 8 2024
© 2024 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.
2024

https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Highlights

• Vocational learning has been the cornerstone of Africa's educational heritage, providing essential skills within communities.

• Recognition of Prior Learning aims to connect informal learning histories with formal academic qualifications, a critical step in correcting historical educational imbalances across Africa.

• The current Recognition of Prior Learning framework in South Africa fails to effectively address vocational learners' unique needs and challenges entering postgraduate education.

Introduction

Vocational learning has been critical in shaping South Africa's workforce, especially for paramedicine. The introduction of the National Qualification Framework (NQF) in 1995 phased out previous short course learning systems and redesigned qualifications within the framework. While recognition of prior learning is well advocated in the NQF, the predominant focus is undergraduate studies. The leap from vocational to Higher Education can be significant, especially for non-seasoned learners, and additional support may be required to ensure a successful transition. This study describes the support needs of vocational paramedics transitioning to post-graduate education.

Methods

The study used a two-phase sequential design to achieve the aims. The first phase was conducted in 2021 and involved an analysis of grades followed by semi-structured interviews to obtain qualitative insights. The second phase, conducted in 2022, focused exclusively on collecting quantitative data to validate and expand upon the initial findings from phase one.

Results

Analysis of the academic results over two years between Recognition of Prior Learning (RPL) and non-RPL candidates showed a difference of 4 % in the aggregated mark. This indicates that the RPL candidates have the academic acumen to succeed in a post-graduate diploma education program. Interview analysis revealed the support requirements were not academic but rather technological and institutional, with navigation of the university's learning management system being a common challenge. Hesitancy to access formal support services was noted as a university barrier.

Conclusion

This study highlights the academic ability of students from vocational backgrounds to succeed in post-graduate programs. These learners demonstrated strong academic performance despite entering higher education through a non-traditional pathway. Whilst advocating for consideration and refinement of the role of RPL within the NQF, this research suggests a re-evaluation of current support systems for vocational learners transitioning to post-graduate studies.

Keywords

Recognition of Prior Learning
Vocational learning
Vocational paramedic
Postgraduate studies
Support needs
Medical education
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pmcIntroduction

Historically, vocational learning has served as an invaluable pathway for individuals entering the workforce, particularly those without traditional academic credentials. Emphasising practical skills and job-specific training, vocational learning adopts a direct, hands-on approach, equipping learners with the competencies vital for specific occupations [1]. This form of education has proven instrumental in empowering individuals by offering a practical route to employment [1]. The emphasis on hands-on training ensures alignment with the dynamic needs of evolving industries. Moreover, the accessibility of vocational learning and the possibility of earning a wage or stipend during the training period enhances its appeal. Vocational learning is pivotal for those seeking swift integration into the job market and desiring sustainable personal and professional growth.

Despite the vital role of vocational learning in bridging industry gaps, a pressing need emerged for transformation and formalised education structures in South Africa to eliminate marginalisation and foster equal opportunities for learners. In response, the National Qualifications Framework (NQF) was established, serving as a cornerstone in orchestrating the nation's educational and vocational terrain [2]. Initiated in 1995, the NQF systematically organises various qualifications into levels that reflect academic progression and serves as a benchmark to ensure that the standards and quality of education remain consistent across different institutions and sectors [2]. It encompasses formal, informal, and workplace-based learning and is governed by the South African Qualifications Authority (SAQA) - a regulatory body responsible for developing, upholding, and aligning the NQF [2,3].

SAQA's functions extend to validating qualifications and ensuring that educational endeavours are recognised across varied spheres [2]. A noteworthy initiative under SAQA is the endorsement of the Recognition of Prior Learning (RPL), which values informal skills acquisition, promoting the visibility and credibility of non-traditional learning paths and access [2,3]. By internationalising the standards of the NQF, South Africa elevates the standing of its qualifications on the global stage, fostering a highly competitive and proficient workforce.

Without the RPL framework, vocational learners would encounter significant barriers to having prior learning experiences recognised, hindering progression in education and professional development. Though RPL focuses on undergraduate programmes, the potential for transition to postgraduate level also exists. The classification of qualifications and emphasis on credit accumulation and transfer within the NQF create a defined pathway for career growth, reducing the risk of marginalising some learners [2].

Despite the vision of empowering the vocational learner, many sectors experienced challenges transitioning to NQF-aligned qualifications. The gap between vocational training and the NQF benchmark is apparent in South Africa's prehospital emergency services sector. Traditionally, the path to becoming a paramedic in South Africa was through a short course-tiered system accredited by the Health Professions Council of South Africa [4]. However, these short courses lacked alignment with the NQF and SAQA, and a comprehensive review of emergency care programs ensued. This led to the development of NQF-aligned qualifications in emergency care and the phasing out of the short-course approach in 2018 [5,6].

The non-alignment of the paramedical short course curriculum to the NQF and SAQA framework prevented the direct articulation of the vocational paramedics into formal education. Despite the objective set by the NQF to ‘accelerate the redress of past unfair discrimination in education, training, and employment opportunities’, the vocational workforce now faced the challenge of aligning diverse vocational skills with the standardised levels and categories outlined within the framework [2]. The NQF, while enhancing the recognition of formal education, could inadvertently leave behind those who have traditionally thrived in vocational learning environments.

Recognition of prior learning

RPL is defined 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 the formal education and training system, or workplace’ [7].

For vocational paramedics, RPL enables them to leverage knowledge and practical experience to meet the academic prerequisites necessary for transitioning into postgraduate studies.

Although RPL is crucial for paramedics to progress academically, more tailored RPL initiatives are needed in the emergency care sector. Vocational paramedics, often primary breadwinners in mid-career, face hurdles like full-time work, remote locations, and limited university access [8]. Many are based in remote areas, and most higher education institutions are urban-based.

There are opportunities and challenges within the educational landscape for vocational paramedics. While RPL is acclaimed as a national pathway to undergraduate education, offering a gateway for seasoned providers to formalise their expertise, the available RPL programs in South Africa are limited. This gap presents a considerable obstacle for those seeking to elevate their professional qualifications within the educational framework [9]. While the scope of this study is centred on the South African context, the insights gained are believed to have implications for and applicability to other regions that are developing or implementing out-of-hospital emergency care systems.

Educational transformation

In 2021, the Division of Emergency Medicine at the University of Cape Town (UCT) launched the Postgraduate Diploma in Emergency Care (PGDIP EC), an NQF level 8 qualification. Designed as a one-year interdisciplinary program, it aims to enhance the skills of medical professionals in emergency systems, focusing on theory, clinical practice, research, and leadership, particularly benefiting those in rural settings. Its online delivery allows learners to continue working full-time, transcending geographical barriers [10]. The program draws a broad range of participants from across Africa. It incorporates RPL to provide access to vocationally trained nurses and paramedics.

Problem statement

Navigating the transition from vocational training to postgraduate education demands understanding the needs of vocational learners. Identifying the needs and barriers they face during this transformative period is essential. By recognising these and tailoring support mechanisms to address them, educational institutions can develop effective support systems that facilitate a smoother transition for vocational learners. This will enable the successful navigation of the academic terrain.

Aims

The aims of this study were to determine the performance of RPL candidates in comparison to non-RPL candidates, and whether RPL students need additional support during the programme.

Study design

A two-stage sequential design was followed. The first stage used an explanatory mixed-method approach, beginning with an analysis of grades followed by semi-structured interviews. Inclusion criteria: the 2021 PGDIP EC cohort that completed the program. The second stage included the 2022 cohort, and quantitative data were collected to expand and triangulate the phase one findings. Fig. 1 shows the research design with the stages and phases.Fig. 1 Visual display of research design.

Fig 1:

Trustworthiness

The study was designed to meet Guba and Lincoln's criteria for trustworthiness [11]. An interview guide was used during the semi-structured interviews to ensure consistency across all participants. During the thematic analysis stage, coding was conducted after each interview. An external research assistant completed independent coding to minimise bias and enhance dependability, followed by a comparison and discussion of any discrepancies. As this study is embedded within a larger study, the results were triangulated against multiple data sources, including quantitative data from all stages, to enhance confirmability. A reflexive journal was maintained throughout the research process, allowing the researcher to document personal insights and reflect on potential biases, further contributing to the study's rigour.

Ethical consideration

Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town (reference numbers 041/2022 and 042/2022). In addition, permission was granted by the Department of Student Affairs at the University of Cape Town to include UCT candidates in the research.

Data collection

Stage one

Stage one, phase one

Stage one, phase one, included the analysis of the final grades from the 2021 PGDIP EC cohort. This entailed comparing the academic progress and outcomes of RPL students against the non-RPL peers to gauge and differentiate respective academic performances.

Stage one, phase two

All RPL candidates from the 2021 PGDIP EC cohort were invited to participate in semi-structured interviews. The purpose was to explore their experiences, challenges and the support required. Interviews were arranged approximately six weeks before the end of the program, allowing the capture of immediate reflections while avoiding disruption of exam preparations.

Participants were contacted via email, providing information about the study and the interview process. If they provided written consent, they were contacted for an online interview. Microsoft Teams (Microsoft Corporation; Redmond, Washington, U.S.) was used to conduct these interviews. The written consent was followed by verbal consent as the interview started.

Interviews were conducted in English and audio-recorded. Audio files were securely deleted after transcription. The transcribed data are stored on an encrypted OneDrive account (OneDrive, Microsoft Corporation; Redmond, Washington, U.S.).

The framework developed by Braun and Clarke was used to perform thematic analysis [12]. Enablers and barriers were identified and further categorised into themes, see Table 2.

Stage two

Stage two, phase one

This stage focused on the PGDIP EC 2022 cohort. Again, the final grades between RPL and non-RPL were compared and then contextualised by comparing the results with the PGDIP EC 2021 cohort.

Stage two, phase two

A survey was sent to the PGDIP EC 2022 RPL candidates at the end of the programme. It was designed to ascertain the support students found most valuable in their academic journey. Participation in the survey was voluntary.

Responses were entered into a password-protected Microsoft Excel spreadsheet. The answers were analysed to identify correlations, specifically emphasising the support requirements. The results of these surveys were also correlated against the qualitative data collection in phase one. This ensured triangulation of results [13,14].

Results

The analysis of the 2021 and 2022 cohorts indicated significant performance trends. In 2021, the 10 RPL candidates attained an average grade of 69 %, slightly lower than the 73 % achieved by non-RPL candidates, with the average standing at 71 %. Notably, all RPL candidates exceeded the 50 % pass threshold, with five surpassing the grade averages of their non-RPL peers (Table 1).Table 1 Grades of RPL and Non-RPL candidates.

Table 1:Cohort of PGDIP EC	Number of candidates per cohort per year	Grade average per cohort per year	
	2021	2022	2021	2022	
RPL candidates	10	21	69 %	68 %	
Non-RPL candidates	13	9	73 %	72 %	

In the 2022 PGDIP EC program, twenty-one RPL candidates scored an average grade of 68 %, approaching the 72 % average of non-RPL candidates and surpassing the overall cohort average of 63 %. All RPL candidates achieved a 50 % pass rate; twelve exceeded the program's average grade.

Nine of the possible ten RPL candidates gave consent to be interviewed. One was unavailable due to a work assignment. Interviews lasted between 30 and 40 minutes. Three primary themes were identified: individual, academic, and institutional, each comprising distinct enablers and barriers. Written reflections were made to support further analysis.

Table 2 reflects the codes and themes found in the thematic analysis. To maintain anonymity, participants are labelled as P(number).Table 2 Themes and codes identified in thematic analysis of interviews.

Table 2:Quotation	Theme	Code	
‘…battled to write academically, English is not my first language' (P4)	Academic > Scientific writing	Academic Barrier	
‘The way I used to read a paper and the way I read the paper now is like worlds apart. And then there was the actual academic writing, I struggled with that' (P6)	Academic > Scientific writing		
‘...academic writing to complete our assignments was really difficult and it took me at least four or five of the assignments to work out what they wanted.' (P7)	Academic > Scientific writing		
'been many years since I studied formally, so it took a while to get back into it' (P2)	Academic > Ability to learn		
'I had to go and buy a new computer for the course because mine was at outdated..' (P3)	Academic > Technology		
had to keep up as never knew when the internet wouldn't work.' (P4)	Academic > Technology		
'I was the middle of the (rural) and there was literally no (internet) signal.' (P8)	Academic > Technology		
‘It was not easy because there were so many deadlines.' (P4)	Individual > Time	Individual Barrier	
‘I can remember a lot of weekends indoors. That's one thing I recall because I always thought to myself I will be done by Thursday and I'm gonna be off this weekend, but I found I almost spent every weekend working.' (P9)	Individual > Time		
‘I think the students integrate well; we had a lot of group work with people that qualified through university. They never looked down on us guys.' (P1)	Individual >fear of failure		
‘I was able to discuss and interact with people in a way where my opinion means something, even if it may have been wrong.' (P8)	Individual > fear of failure		
‘…family were really supportive and understanding' (P9)	Individual >support structures	Individual Enabler	
‘I called friends in (local emergency medical service) to help me when I got stuck (P6)	Individual >support structures		
‘…wanted to prove myself, so worked really hard’ (P2)	Individual > personal motivation		
‘I battled with how this (Learning Management system) works and how the online libraries worked' (P2)	Institutional > orientation	Institutional barrier	
‘I didn't know which department in the varsity to go to so I asked (course convenor)’ P5	Institutional >orientation		

The online questionnaires sent to the 2022 cohort of RPL candidates focused on specific support areas within the program, providing multiple-choice responses and open-ended feedback. To determine which university support systems had been used during their studies, various scenario questions were posed to the RPL candidates, requesting them to indicate their chosen answer, such as, 'If you battled with (learning management system) after hours, who did you ask for help?’ and ' If you did not understand an academic concept, who would you ask for help?’. Analysis of both tick box options and free text revealed a marked preference among the candidates for engaging directly with the program convenor to address all issues related to their academic pursuits. This preference spanned matters ranging from technology and financial assistance to everyday academic challenges. This is despite detailed information provided regarding support departments and individual course lecturer details.

Discussion

RPL is a transformative approach within Higher Education, vital in widening access and advocating the philosophy that learning occurs through a myriad of avenues outside formal educational structures [3,9]. Its strategic implementation retrospectively acknowledges the wealth of knowledge and skills that individuals learn through work and life experiences, thereby offering a remedial pathway to formal qualifications and, by extension, educational advancement. The RPL framework is crucial for inclusion and has the potential to recalibrate academic outcomes, as it brings diverse perspectives and expertise into the academic sphere.

Evaluation of RPL candidates' academic performance presents compelling evidence concerning their intellectual mettle. The comparative results indicated an insignificant difference between the academic accomplishments of RPL and non-RPL candidates, as noted by a 4 % grade difference, reinforcing the assertion that RPL candidates are academically proficient and capable of standing their ground within the educational landscape. While seemingly slight, this modest grade disparity between RPL and non-RPL students has implications within the broader academic trajectory of RPL candidates. It ascertains the efficacy of RPL as a conduit for integrating vocational learners into formal education. RPL students met the foundational benchmarks and consistently aligned with the competencies expected at the NQF Level 8. The proximity of their performance to their non-RPL peers highlights the legitimacy of prior vocational and life learning as a substantive indicator of academic capability and potential. This suggests that the RPL process, in its current implementation, successfully facilitates a transition into higher education for individuals possessing substantial professional experience, positioning them well within the academic expectations of postgraduate study.

In the thematic analysis, three main themes of support emerged – individual, academic, and institutional support. This aligns with another study that explored the support requirements of vocational learners articulating to post-graduate education [8].

Barriers were evident, particularly in adjusting to the technological requirements. Accustomed to traditional classroom settings and textbooks, vocational learners encountered challenges adapting to digital learning environments. They required additional support in technological literacy, navigating online platforms, and utilising referencing tools. In this study, age disparities were initially considered a potential cause of these barriers, but it was noted that the average age of the 2021 PGDIP EC cohort was 39.25 years, with RPL candidates averaging 38.72 years and non-RPL candidates 37.84 years. These similar age groups indicate that the challenges faced were not necessarily age-related but stemmed from adjusting to new learning modalities. This may suggest a disconnect between their prior educational experiences and the expectations of postgraduate studies.

Institutional barriers included hesitancy in accessing formal support services provided by the university, such as writing centres. Curiously, the RPL students often turned to the program convenor for guidance on issues not directly pertinent to the program content, such as difficulties accessing the learning management system. This suggests a reliance on the program convenor, which mirrors the vocational learning environment where a singular coordinator is often responsible for managing the student's vocational training, serving as a central point of contact for any support. It may indicate a gap in how institutional support structures are communicated and perceived by RPL candidates. To bridge this divide and provide additional assistance, institutions may consider revising their orientation and strategies to highlight university support centres, enhancing the accessibility and personalisation of services for this student cohort. Additionally, universities could ensure that available services are well-communicated regularly. This could foster smoother transitions for RPL candidates.

Limitations

The study focused on the vocational paramedic sector in South Africa, thereby limiting the applicability of its findings to other vocational fields or regions as the results may not reflect the broader vocational learner population or other disciplines that could have different challenges. Further studies with more diverse vocational disciplines are necessary.

Conclusion

The study illuminated the academic landscape for vocational learners who gained access to a postgraduate diploma program via an RPL process. Despite navigating a non-traditional pathway into higher education, the learners demonstrated academic performance, consistently meeting and often exceeding the standards required at a postgraduate level. However, the integration of RPL into South Africa's NQF invites scrutiny over the equitable recognition of vocational education and the persistent barriers that impede the smoother transition into higher education institutions. It is essential to carefully refine the role of RPL within the NQF, re-evaluating support systems and advocating for approaches recognizing the unique pathways. Ensuring fairness and accessibility, such deliberation is crucial to enriching the educational landscape with the diverse skills and experiences that vocational learners introduce. Additional research across various vocational professions and regions could reinforce these findings and provide a broader understanding of the support needed for successful transitions to higher education.

Dissemination of results

The results of this survey were shared with the Division of Emergency Care, University of Cape Town. They were also presented at the Western Cape Provincial Emergency Medical Services research day.

Contributions

Authors contributed as follows to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content: DG contributed 70 %, and CC 30 %. All authors approved the publication of the version and agreed to be accountable for all aspects of the work.

Declaration of competing interest

The authors declared no conflicts of interest.
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