The State of EMS Education Research Project

In August 2002, the National Association of EMS Educators (NAEMSE) and National Highway Traffic Safety Administration (NHTSA) began work on the State of EMS Education Research Project (SEERP). The goal was to examine the current EMS education system's readiness to implement NHTSA's EMS Education Agenda for the Future.

     The soaring cost of healthcare in the United States has created a demand for accountability in the allocation and delivery of all medical care, including prehospital emergency medical services. A significant contributor to the rising cost of healthcare services has been the cost associated with educating healthcare providers.

     Large-scale studies of health and health-education professions, in particular those of medicine and nursing, have been undertaken and funded by professional organizations, as well as the federal government. Yet the characteristics of persons who teach in EMS and their work environment had not been previously examined.

     The researchers believed that describing the current state of the EMS education system would be an essential element for analyzing the cost and efficacy of emergency medical care systems in general and crucial for the professional development of EMS educators and the systems in which they work. Based on this, SEERP was designed with a dual purpose. The first was the collection and analysis of relevant data to serve as the groundwork for developing EMS education standards as outlined in the Education Agenda. Understanding current resources, both human and structural, is critical to the successful development and implementation of education standards. SEERP was based on the following research questions:

1. Who are the EMS instructors of today?
2. What is the state of the current U.S. EMS educational infrastructure?
3. What attributes should the future EMS instructor possess in order to design, organize, implement and evaluate EMS instruction based upon the Education Agenda's standards?

     SEERP was to further define, based on data, a series of common practices for EMS educators in order to identify critical components of the educational infrastructure.

Study Design
     The study reported and analyzed the characteristics, background and work setting of EMS educators in current systems in the United States. Through an instructor questionnaire, investigators sought descriptions of education preparation, experience, teaching environment, level of comfort with teaching activities, availability and frequency of use of standard teaching resources, and satisfaction levels from a random national sample of EMS educators.

     A total of 15,278 EMS instructors and/or programs were identified. Proportional sampling for all 50 states was conducted, and 5,000 individuals were randomly selected. Slightly more than 1,690 EMS instructors participated in this study, a 33.8% response rate. Only those respondents who taught either EMT-Basics or EMT-Paramedics were included.

Highlights Of The Findings
     The study's findings should be interpreted with the following limitations in mind: First, the educators in this study comprised a random sample from a population generated by state certification/licensure records. Second, educators who indicated that their primary role was to provide continuing education were excluded from the majority of the survey.

Satisfaction and longevity
     Of respondents who answered, 97.6% indicated they were "satisfied" or "very satisfied" with their EMS teaching experience. The major reason why respondents remained educators was enjoyment of teaching (79.5%). The degree of satisfaction may be related to how long educators see themselves teaching into the future: 73% indicated they would continue to teach at least six years or more; only 3.2% planned on leaving the field within the year. These findings verify that the majority of the educators in this study will be responsible for the education and training of EMS professionals into the future. It is of note that more than 50% of the respondents indicated that the reason why they began teaching in EMS was to improve the level of EMS instruction in their areas.

Gender, nationality, salary
     Of those who responded, 71.8% were male, and 93.8% were white, not of Hispanic origin. The largest minority category reported was Hispanic, at 1.9%. Most respondents worked part-time, often for free. Over 50% reported earning under $10,000 annually from EMS education, while 16.6% reported teaching as volunteers. Nearly 73% reported working 20 hours or less weekly. Slightly more than half (54%) indicated they'd obtained an associate's degree or higher.

Location and resources
     Surveyed educators taught in a variety of locations. More than a quarter (26%) of respondents indicated they taught in community college settings. Fewer than 5% taught at four-year colleges or universities. Almost half (45%) indicated they taught in some type of service-oriented setting (e.g., fire station, fire/EMS academy or for an EMS service). While educators had ample access to basic teaching resources such as copy services and media/AV support such as projectors, less than half reported having access to other significant resources such as secretaries, legal consultants, librarians or remedial instructors for students experiencing difficulties in the classroom.

Job requirements
     More than four-fifths (82%) of respondents indicated that some type of specialty certificate was needed in order to be hired as an instructor; three-fourths also reported needing some amount of clinical experience, although the exact amount was not determined. However, over 90% of respondents indicated that they had at least seven years of field experience. Just over half indicated they needed some type of previous teaching experience as a prerequisite to teaching in their current positions. Only 20% indicated that they needed a college degree in order to teach in their current programs. In contrast, 95% said they were required to maintain a certificate or license as an EMS provider. As well, 78% indicated that they were required to have some type of EMS instructor certificate. An overwhelming majority of respondents were required to take some type of state-approved EMS instructor class in order to obtain an instructor certificate.

Teaching role
     Nearly half of the respondents reported that their primary audience was EMT-Basic students; 16% reported teaching primarily paramedic students. Fewer than 5% taught EMT-Intermediates. When asked what their primary role in EMS education was, 24% indicated they were course coordinators, 19% considered their primary roles as lecturers, and 16% stated they were primarily skills instructors. It is unknown how many wore "multiple hats." However, respondents did indicate that they did not perform any one particular facet of their jobs exclusively. While many respondents reported that they spent much of their time delivering lectures, a significant number said they spent 1-5 hours a week performing tasks such as administration, counseling and preparation.

     Nine-tenths of respondents (91%) indicated they used lesson plans when they taught. Just under half reported using the DOT national standard curriculum (NSC) as the source of their lesson plans. The remainder developed their own, used commercially prepared ones or used another instructor's lesson plan. When using the NSC, nearly three-fourths indicated they used both the objectives and content outline. This is of note; future education standards may only include a set of terminal objectives.

Teaching skills
     Most educators reported they were "very comfortable" with each of the task items listed, such as classroom management, delivering lectures and developing simulations and scenarios. However, almost half said they were only "somewhat comfortable" with tasks such as using state and/or national tests to make course changes (48%) or writing objectives for specific lessons (47%). Other tasks where educators felt "somewhat comfortable" included marking coursework assignments to provide feedback to students (34%), searching the Internet and other sources for subject materials (39%), using student evaluations to make course changes (35%), using test results to modify instruction (37%) and writing test questions based upon objectives (47%). The last figure is noteworthy, considering nearly two-thirds of respondents indicated they were responsible for developing written tests.

Teaching resources
     EMS educators reported having access to, and utilizing, a variety of educational tools in their practices. Common items were EMS equipment (100%), EMS textbooks (99%), CPR manikins (99%), videotapes (93%), PowerPoint presentations (85%), anatomy models (78%) and overhead/transparencies (70%). Respondents reported not having access to several items, such as dialup Internet connections in the classroom (66%), high-speed Internet in the classroom/lab (56%) and mock ambulance environments (42%).

A Call For Action
     Today's EMS students expect to receive individualized instruction centered on increasing their ability to perform effectively in the world of EMS. EMS educators face the challenge of meeting these expectations while imparting the knowledge, skills and abilities of contemporary prehospital care to their students.

     After considering all their findings, SEERP investigators presented the following recommendations:

• National EMS education standards should include instructor guides and lesson plans until such time as EMS educators have a better understanding of effective curriculum and course design.
• The EMS educator must be trained to use tools and resources to design and apply evaluation techniques that test each student's critical thinking and understanding of the knowledge, skills and abilities used in the delivery of prehospital care.
• Policy makers must promote, support and facilitate substantial changes in instructor training, capabilities and educational resources.
• Policy makers and educational institutions should promote, support and assist with developing requirements for EMS educators to obtain and maintain state instructor certifications that include training in teaching techniques.
• EMS educators should promote, support and demonstrate cultural competency in teaching practices, and should recruit students that reflect the diversity of the population.
• Policy makers should promote, support and require national accreditation of EMS education programs in order to address concerns related to instructor preparation, teacher characteristics, course resources and curriculum design.
• Vendors should promote, support and develop valid test-item banks for educators to purchase. Instruction in the basics of test development and use of test results must be included in instructor courses and CE offerings.

     There is a demonstrated need to increase the theory and knowledge base of EMS educators, to prepare the classroom for change and to improve evaluation of student performance. The integration of educational technologies should become a high priority in order to serve the rural and volunteer EMS provider's needs. Prior to making any changes in the system, regulators, administrators and leaders must understand the current condition of the EMS education setting and the projected changes in the EMS education workforce. Only then can we begin to realize the vision of the EMS Education Agenda for the Future.

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Judith A. Ruple, PhD, is a professor in the Department of Health Professions at the University of Toledo's College of Health and Human Services.