It is clear that paramedic education has come on in leaps and bounds over the last two decades. The challenging journey we have taken from traditional, predominantly skills-based training courses towards broader, university education is well documented (Donaghy, 2008).
However, I am left wondering if this transition has been primarily one of improving educational method rather improving clinical relevance. We now have a better understanding of the roles that mentorship, reflective practice, simulation and e-learning, for example, play in the education of paramedics, but I am not convinced that we have the same depth of understanding in terms of what we should be using these methods to teach. I think we are pretty clear in terms of the generic, transferable skills such as critical thinking, clinical decision-making and ethics, which over time have proven themselves to be valuable components of a wide range of healthcare curricula, but I'm not sure we have the same clarity, cognitive and psychomotor skills required to meet our patients’ clinical needs.
As early as 2000, Lendrum et al (2000) demonstrated a mismatch between ambulance provider course curriculum and case mix, but since then, little has been published in this area and many questions remain unanswered. For example, how do we ensure that our curricula are clinically relevant? How do we balance emphasis during precious teaching time to achieve clinical competence across a range of common and rare clinical presentations, or simple and complex clinical skills? Are we emphasising areas of practice that have been proven to, or are likely to improve patient outcomes? And indeed, who are the patients that those successfully completing the course will be called upon to treat?
In my experience, the focus of the curriculum development process has been mapping the proposed course outcomes to an educational framework and ensuring relevance through stakeholder engagement. It is the latter part that is troublingly under-developed. To my knowledge there are no validated tools for curriculum developers or curriculum evaluators to use to ensure clinical relevance. This is a glaring hole in the education process.
This is not to say that the efforts to research how to teach better are unimportant. I am merely arguing that research regarding the clinical drivers for curriculum development is lagging. We know that prehospital care research is lacking generally, and it might be that the disproportionate scholarship in the area of education methods reflects the natural expansion of activity from a well-established educational research discipline. It is just that we might be becoming ever better at teaching the wrong stuff.