Trends in EMT and Paramedic Continuing Ed Requirements

Earlier this year the National Registry of EMTs (NREMT) announced the launch of a new web tool to streamline EMS professionals’ recertification and education requirement tracking. It was the latest of several tools the Registry has built since launching a new model for recertification, the National Continued Competency Program (NCCP), in 2012. 

The NCCP is a foundational part of the Registry’s efforts to support the EMS profession’s shift toward a model of lifelong professional learning and evidence-based education. The model offers state and local agencies, along with medical directors, more say in specifying training requirements for their EMS providers. 

A number of states have gone on to implement the NCCP, which sets parameters for the breakdown of training requirements between national, local, and individual requirements for EMTs and paramedics (50%, 25%, and 25% of recertification) and the percentage of each category that may be fulfilled with distributive education, as defined by the Commission on Accreditation for Prehospital Continuing Education (CAPCE).

This article explores trends in EMS continuing education and training in light of the paradigm shift spurred by adoption of the NCCP through interviews with four EMS professionals: a medical director; a longtime online EMS educator and practitioner; a quality improvement expert who is also an EMS educator and lifelong learner; and a training officer at Pro EMS, a Cambridge, Mass.-based ambulance service that built its own learning management system to help meet its training and education needs. 

Lifelong Learning

One reason NREMT transitioned to the NCCP model of recertification was to help the EMS profession move toward a focus on career-long learning as a part of the recertification process, much like other healthcare professions (e.g., doctors and nurses). For many EMS leaders on the front lines of education and quality care, it was a welcome change aimed at encouraging professional growth. 

“For a long time paramedics were tacitly given the message that they’re complete when they graduate—they’ve learned what they need to know,” says Mike Taigman, a quality improvement guide at FirstWatch, a leading data analytics and quality improvement firm, and former general manager for AMR in California. “But when you graduate from medical school, the model is, that’s when your education really starts, and it continues for a lifetime. Paramedics didn’t have that mental mode built into the culture. Continuing education was almost never continuing; it was mostly regurgitation.”

Taigman sees the new approach ushered in by the NCCP as an opportunity for EMS leaders and educators to redesign the message of EMS education programs to convey that initial certification is a baseline education and to reconfigure and reimagine CE as a whole.

“The next step is to move into more of an internship/apprenticeship system, to show not just that you’ve done the ride-along hours or whatever the requirements are but that you’ve really gained the base competencies,” says Taigman. “I would include on that competency list the hunger for continuously learning and developing yourself professionally.”

James DiClemente is paramedic program director for Pro EMS in Cambridge, Mass., which also recently launched a new learning management system. DiClemente says greater flexibility for EMS professionals to pursue training they want or need is a huge value of the NCCP model. 

“One of the changes spurred by the Registry is a move away from very rigid recertification guidelines,” says DiClemente. “If you look at the physician model for continuing education, they are given some very broad topics in which they need CMEs. They can obtain those CMEs in a lot of different ways. If you’re a healthcare professional, you should be smart enough to understand what you need to study and what makes the most sense for your professional education. I think we’re starting to see EMS move in that direction, towards self-directed requirements.”

The shift in EMS continuing education has implications for EMS professionals, quality of care, and the profession as a whole in terms of credibility. 

“The more we interact and intersect with the rest of the healthcare system, the more awake people will become to what we need to do as a profession to hold our seat at the professional table,” says Taigman, who recently served as lead facilitator for the EMS Agenda 2050 technical expert panel. Continuous education and learning and rigorous recertification are key components. 

Greater Flexibility

Many leaders in EMS education see the field in a critical transition period. As a result training and recertification programs are making changes and offering more blended classrooms and greater flexibility for students through combinations of classroom learning, simulation labs, online classes, videos, and other forms of digital content. 

“The traditional classroom—come in, sit down, go do labs—has changed into what’s more practical in the field,” says David Becker, an online instructor at Columbia Southern University, educator for more than 40 years, and immediate past chair of the EMS Section of the International Association of Fire Chiefs. 

Becker points out that people’s expectations of requirements for training and curricula have dramatically shifted with the widespread use of mobile technology. “The fact is, people don’t want to sit down and read a 100-page chapter on cardiology and try to digest that anymore,” Becker says. “They’re not programmed to learn that way. We have to break it up into smaller pieces for them.” 

In addition to being more in line with how people consume information now, training on digital platforms has other advantages. Students can work when it’s convenient for them. For agencies and training officers, it is also trackable, and reporting software can show which team members have or have not taken certain classes. It’s also self-paced, allowing students to create a path that’s suited for their needs.

“Take learning to accurately read an EKG, for example—you don’t just pick that up reading 25 or 30 EKGs,” says Becker. “There isn’t enough time to go back over multiple EKGs, so an online format is a good way to do it.” 

Top Training Needs

For EMS agencies digital platforms offer opportunities to develop more robust recertification tracking tools, distribute new training content widely and quickly, and provide real-time tracking of training. 

Peter Antevy, MD, EMS medical director for the Coral Springs Fire Department, Davie Fire Rescue, Southwest Ranches Fire Rescue and American Ambulance in Florida, says he values two key things in an online learning system: 1) high-quality training content and 2) a ready distribution channel that provides support for medical directors like him to quickly reach many people in dispersed locations with important training information. 

“I work in Palm Beach County, which is the largest county east of the Mississippi. We have 1,500 medics at more than 50 stations. I also work at a private ambulance company where we have another 400 employees dispersed all over the county, which means I’m working with about 2,000 paramedics at any time,” Antevy says. “So if we change a protocol, we need a way to quickly educate everyone about it. For example, right now we’re working with a shortage of ketamine, which means we’re purchasing it in a different concentration and have to mix it differently. I need a way to tell all my medics this. It needs to be offered in a way they can watch it on their phones or at home or live at the base, and it needs to be trackable.”

Antevy sees a lot of opportunity in online learning and training, including platforms that seamlessly blend live learning and meet the needs for mobile-friendly content and interaction. Paramedic requirements should also be adaptable for each agency.

“I think the key is creating a combination of quality live learning offered remotely with the ability for an agency to track it, store it, and have people watch it offline,” Antevy says. “Even with online learning, I think people still want to feel a connection to a person who is there live, which is very powerful.” 

Building Your Own

The need for a more robust learning management system led Pro EMS to build its own platform. The organization had tried numerous other online CE systems but found none met the needs of its training officers, paramedics, and EMTs.

So in 2016 it created Prodigy, an online learning management system built around the new NCCP model and designed to address the requirements of EMS personnel and the regional agencies and fire departments Pro EMS trains. It is flexible enough to meet the needs of agencies not using the NCCP model, DiClemente says. 

“Previously in Massachusetts there was no live requirement for recertification, so we were just using all distributive education for our recert,” says DiClemente, who took a lead role in developing the system. “But when we moved to the National Registry requirements, we needed to do more live education for our organization, as well as the other organizations we train.”

DiClemente says Pro EMS faced logistics and management challenges in offering consistent, high-quality live training and began to look at online platforms as a possible solution. 

“We wanted to stay within the spirit of the NCCP and allow providers to do some of their own training off site as well as choose what training they did live or distributive,” he says. “We thought that if the flexibility is there in the recertification guidelines, the flexibility should be there in the training platform.”

The Pro EMS team can now create and distribute new content quickly, track which classes are completed, and provide consistent high-quality coursework across the agency and to other services, and it now has an interface to meet both providers’ and training officers’ needs. 

DiClemente and others on the Pro EMS team see more robust digital training platforms as a critical part of the future of EMS continuing education as the industry moves toward a lifelong learning model focused on evidence-based medicine.  

Susanna J. Smith is a content strategist and freelance writer who focuses on the future of healthcare and how new technologies and care models are reshaping the healthcare industry. She holds a master’s in public health from Columbia University and has worked as a writer, editor, and researcher for more than 10 years. Follow her work at @SusannaJSmith.