Some years ago, while working as a paramedic in Durban, Michael McCaul realised he not only wanted to learn more about being a better paramedic, but that he wanted to influence how paramedics practice for the better.
“I'd just finished my degree and I remember clearly sitting in my response car and thinking to myself, 'I'm going out on this call and I know what will happen: I know what the current guidelines say I must do; yet it's not what I should do - and I'm powerless to change it.
“I decided there and then that I was going to study Clinical Epidemiology, which is about making evidence-based healthcare decisions, at Stellenbosch University," McCaul said.
McCaul, a senior lecturer in the Division of Epidemiology and Biostatistics at Stellenbosch University's Department of Global Health and (who first completed his MSc Clinical Epidemiology) is graduating with his PhD, for which he published seven peer-reviewed journal articles.
His PhD explores how to strengthen prehospital clinical practice guideline development and implementation in low-resource settings.
Professor Taryn Young, Executive Head: Department of Global Health praised McCaul for including “innovative strategies" to communicate his research beyond publication.
McCaul, who is passionate about pre-hospital emergency care and research, has worked as an operational paramedic in Cape Town, Durban and internationally. He first qualified as an Emergency Care Practitioner, getting his BTech in Emergency Medical Care at the Durban University of Technology, before attaining his MSc and a PhD in Public Health. His research interests include evidence synthesis, biostatistics, guideline development and emergency care.
According to Young, McCaul's PhD used the African Federation for Emergency Medicine prehospital clinical practice guideline as a case study. “He used various research methods to i) identify, map and appraise global and regional prehospital guidelines; ii) describe and strengthen guideline development methods; and iii) identify guideline implementation challenges and solutions. This dissertation provides emergency care guideline developers with a critical reflection and roadmap for developing robust clinical practice guidelines that are fit-for purpose, responsive to end-user needs and more likely to improve healthcare delivery and health."
McCaul was also eventually involved in developing the new prehospital paramedic guidelines led by the federation which are now being implemented nationally in South Africa. “Although the guidelines have implementation issues, it's a fantastic move forward for the profession. We have moved from eminence-based guidance (protocols) to guidance formed by best available evidence," he said.
McCaul added that publishing one's scientific findings is not enough. “The evidence is not enough to get people to change behaviour. We need to be able to persuade people with not just the evidence (the logos)… but through creating a grand narrative (the pathos) and we need to be good orators for our research findings (the ethos).
“So I set out to not just publish my Phd findings, but to translate that knowledge to policy and practice. Part of how we did that was a targeted dissemination strategy to paramedics through social media, infograms etc. and then to get decision-makers - including regulators and the National Department of Health - involved with the research from the start. I believe a key reason the project was so successful is precisely because we involved decision makers in the research from the get go."
Asked why he believes that strengthening prehospital clinical practice guideline development and implementation in low-resources settings is important, he said: “For one, we know that prehospital guideline literacy and quality in Africa is not where it should be. The guideline work is important because we want paramedics to make those key treatment decisions on evidence we can trust, that comes from a guideline process that is transparent, rigorous and contextually appropriate, that doesn't duplicate and draws from existing high-quality guidelines to inform recommendations.
“Being efficient, not duplicating work and getting the most 'bang' for your buck is important, specifically for guidelines in prehospital care, where a single misstep can be life or death for a patient."
On his plans for the future, McCaul said: “I am very interested in evidence synthesis and guideline development." He hopes to move towards associate professorship and to contribute to clinical practices guidance literacy in Africa specifically in emergency care, using the best available evidence to make good healthcare decisions.
Caption: Dr Michael McCaul. Photo by Stefan Els