What are the educational and curriculum needs for emergency medical technicians in Taiwan? A scoping review

Figures & data

Figure 1 The hierarchy of EMTs’ scope of practice in Taiwan.

Note: i-gel^®, Intersurgical Ltd, Wokingham, UK.
Abbreviations: AED, automated external defibrillator; EMT, emergency medical technician.

Figure 2 Study selection process and result.

Abbreviations: AMED, Allied and Complementary Medicine Database; ERIC, Education Resources Information Center.

Table 1 Overview of included articles

Year	Reference	Location	Study type	Study question	Aim(s)	Population	Main findings
2000	Melby^Citation49	UK	Qualitative	Are nursing students on ambulance placement both educational and valuable?	To explore the effects of experiential learning in prehospital emergency care by nursing students on placement	191 nursing students from University of Ulster who undertook trauma placement between 1992 and 1999	Experiential learning has great potential for expanding and understanding knowledge and skills. The study recommends that experiential learning placement in prehospital emergency care is made a compulsory part of preregistration education for nurses
2004	Kilner^Citation16	UK	Mixed method	What are the desirable attributes of the ambulance technician, paramedic, and clinical supervisor?	To identify those attributes experts regard as desirable qualities in the ambulance technician, paramedic, and clinical supervisor	Expert panel: 93 people in the first round and 42 in the second round	This study identified some of the desirable attributes in three occupational groups within contemporary ambulance services in the UK. The curriculum has become the driving force for defining the occupational groups
2004	Kilner^Citation24	UK	Quantitative method (factor analysis)	Can desirable attributes inform future curriculum development?	To use information about the desirable attributes of the ambulance technician, paramedic, and clinical supervisor to inform future curriculum development	Expert panel: 93 people in the first round and 42 in the second round	The profile of desirable attributes emerging from this study is remarkably similar to the generic benchmark statements for health care programs outlined by the Quality Assurance Agency for Higher Education
2005	Russ-Eft et al^Citation36	US	Quantitative	The major questions revolved around issues related to the quality and costs of the instruction	This study aimed to identify the needed literature on the role of training and instructional quality, particularly as perceived by trainees on EMT preparedness	185,000 EMTs in NREMT database	Results showed significant differences based on instructor quality in the ratings on different dimensions of EMT preparedness for both EMT Basic and EMT-Paramedic
2005	Williams^Citation38	Australia	Literature review	Is there scope for this educational paradigm in prehospital education?	This paper discusses the findings of a literature review of CBL from a multidisciplinary health science education perspective, and attempts to draw comparisons with the available literature relating to prehospital education and CBL	Available literature relating to prehospital education and CBL	The majority of the evidence revealed that CBL was enjoyed by both students and tutors
2005	Brown et al^Citation42	US	Quantitative	How to quantify EMTs’ professional behavior by their peers?	Uses peer evaluation methodology to assess the effective competencies of practicing EMS providers	2,443 randomly selected EMTs	Overall, EMTs’ peer evaluation of professional behavior was “good”. Different levels of EMT, as a peer, considered different professional behavior as important to their partners
2005	Cooper^Citation13	UK	Qualitative	What are the perspectives of training course stakeholders of contemporary UK paramedic training and education?	To develop an understanding of the current system and future development of training and education within a large UK ambulance trust, based upon the experiences, beliefs, and opinions of stakeholders	44 interviews with a range of ambulance staff	This study indicated that the ambulance service in the UK is in a transition stage with organizational, professional, and cultural challenges
2006	Williams^Citation19	Australia	Qualitative	N/A	Introduction of web-based innovative teaching and learning landscape for BEH-P	N/A	This innovative CBL approach supports students in a paramedic bachelor program
2006	Williams^Citation39	Australia	Qualitative	What are student paramedic perceptions of CBL in the clinical curriculum of the BEH degree at Monash University?	To identify student paramedic perceptions of CBL in the clinical curriculum of the BEH degree at Monash University	69 second- and third-year students participated	CBL appears to be a useful and enjoyable teaching and learning approach.
2007	Salzman et al^Citation32	US	Retrospective quantitative study	Can paramedic students complete the NSC-P internship recommendation?	To examine the completion of the NSC-P internship recommendation by paramedic students	1,817 students from 98 paramedic programs in 38 states	Most paramedic students did not complete the requirements for NSC-P. It is necessary for educators to create new approaches to prepare paramedic students to complete NSC-P recommendations
2007	Boyle et al^Citation51	Australia	Qualitative	How can a paramedic clinical simulation center meet needs in Victoria?	To describe how the indoor simulation center and the outdoor road trauma simulation center provide a more realistic experience for undergraduate paramedic students in Victoria	N/A	Clinical simulation can improve prehospital care
2007	Hallikainen et al^Citation14	Finland	Quantitative (questionnaire)	What are the levels of satisfaction for an interprofessional education program in paramedic and medical students?	To describe the concept of interprofessional education in medical students and paramedics in emergency medicine	47 students completed the program in 2001 and 2005	Coeducation in emergency medicine of paramedics and medical students has worked well to the satisfaction of both students and teachers
2008	Hamilton^Citation55	Australia	Qualitative	Does the teaching and learning model improve the quality of the first-year student learning experience?	To present a teaching and learning model applied within a first-year core subject taught within the Prehospital Care course at Charles Sturt University	N/A	Information literacy can develop graduate attributes and improve learning outcomes
2008	Reeve et al^Citation23	Australia	Quantitative (questionnaire)	What are the perceptions of paramedics after finishing a Rural and Remote Paramedic Practice course?	To describe the experiences of paramedics doing the population health component of the Graduate Certificate in Rural and Remote Paramedic Practice	29 students based in 27 rural and remote Queensland locations	The findings suggest that the culture of rural and remote paramedics within the Queensland Ambulance Service is changing to incorporate a longitudinal perspective in the form of primary health care
2008	Boyle et al^Citation47	Australia	Quantitative (questionnaire)	What are the perceptions of paramedic students of clinical placement?	To identify students’ experiences during ambulance clinical placement and to provide feedback to the ambulance services	77 students participated in the survey	This study demonstrated that students’ experiences on clinical placement were not positive due to self-doubt in their performance in the working environment
2009	Williams^Citation40	Australia	Quantitative (questionnaire)	What are the perceptions and attitudes of paramedic students to the CBL process?	To assess BEH students’ perceptions and attitudes as participants in a CBL process	247 paramedic students	CBL appears to be a useful and enjoyable teaching and learning tool for students enrolled in a paramedic bachelor program
2009	Hryciw^Citation37	Australia	Quantitative	What are the perceptions of paramedic students to the health fact sheet assessment task?	The aims of the assessment task were to improve their understanding of basic anatomy and physiology, and to enhance essential workplace skills such as communicating scientific concepts to members of the general public	166 students completed the task	The health fact sheet assessment task was a valuable tool in an undergraduate paramedic curriculum, reinforcing skills that are relevant to an allied health career
2009	Margolis et al^Citation17	US	Quantitative	What are the educational strategies that can be used by paramedic educational programs?	To identify the specific educational strategies used by paramedic educational programs that have attained consistently high success rates on the NREMT examination	12 programs were invited to participate	12 specific strategies were identified by high-performing paramedic education programs
2009	Michau et al^Citation56	Australia	Quantitative (questionnaire)	What is the theory–practice gap in undergraduate paramedic education?	To investigate the theory–practice gap for paramedic students by linking education and skill level to case exposure and skills praxis during clinical placements	84 paramedic students	This study highlighted the need for additional support in clinical placements to enhance students’ experience in clinical skill practice and applied knowledge in the field
2009	Williams et al^Citation50	Australia	Mixed method	Can DVD simulations provide an effective alternative for paramedic clinical placement education?	To evaluate the usability of DVD simulations, their impact on student learning satisfaction, and the potential for using DVD simulations to reduce the clinical placement burden on the current health care system	97 paramedic students from Monash University	Paramedic students reported the simulations as being educationally, professionally, and clinically relevant. The students also identified some aspects of current clinical placements that may be replaced by using DVD simulations
2009	Wray and McCall^Citation18	Australia	Qualitative	What are the perceptions of undergraduate midwifery, paramedic, and medical students’ experiences of educational reform in the clinical teaching environment?	This paper reports on medical, midwifery, and paramedic students’ perception of the impact of education reform that they experienced in the clinical setting	130 undergraduate and graduate students	Curriculum developers and academics involved in developing new programs or modifying existing programs need to engage with change management models and draw on the experiences of the professions who have demonstrated managing education reforms successfully
2010	Willis et al^Citation20	Australia	Qualitative	What are the perceptions of an interview and focus group of the gap between university- and industrial-based paramedics?	To identify the gap between university- and industrial-based paramedics	Seven focus groups were interviewed, with 12 people in each group	Lack of graduate maturity and road-readiness is a major gap in university-based education
2010	Williams et al^Citation12	Australia	Quantitative (questionnaire)	Which graduate attributes best meet the current and future needs of the Australian paramedic discipline?	To establish which graduate attributes best meet the current and future needs of the Australian paramedic discipline	63 expert participants	It is critical that empirically based paramedic graduate attributes are developed and agreed upon by both industry and teaching institutions. Until this occurs, national standardization, accreditation, and benchmarking of Australian paramedic education programs will not be possible
2011	Brown et al^Citation48	Australia	Quantitative (questionnaire)	What is the mismatch between perceived and preferred expectations of undergraduate health science students?	To investigate how undergraduate students enrolled in health-related education programs view their clinical learning environments and, specifically, to compare students’ perception of their “actual” clinical learning environment to that of their “preferred/ideal” clinical learning environment	548 undergraduate health science students from Monash University	The study indicated the importance of a supportive clinical learning environment for students and two-way communication between instructors and students to improve the learning environment
2011	Brown et al^Citation29	Australia	Quantitative (questionnaire)	What are student perceptions of learning environments at a major Australian university?	To investigate student perceptions of learning environments at a major Australian university	548 undergraduate health science students from Monash University	The positive perception held by Monash University health science students towards their education and learning environments is hopefully indicative of similar courses within Australia and internationally
2013	Ross et al^Citation57	Australia	Quantitative (questionnaire)	What are students’ views of teachers using the Clinical Teaching Effectiveness Inventory?	To examine undergraduate students’ views of paramedic clinical teachers from a large Australian university	57 Monash University Emergency Health undergraduate students	The results of this study indicated that the clinical teachers involved are able to assist graduates with the integration of theory into practice by providing a positive learning environment that promotes great depth of understanding and autonomy
2012	Alanazi^Citation11	Kingdom of Saudi Arabia	Qualitative	How to design an EMS curriculum in a logical approach?	To discuss the major adaptations required for adoption of the fully fledged PBL curriculum, use of sequential blocks, and multilayer alignment of the curriculum	An expert panel	There is a need to “localize/adopt” curriculums to specific regions (taking into account health priority areas and cultural norms and practices), and not just to implement existing curriculums from other universities
2012	Williams et al^Citation25	Australia	Quantitative method (factor analysis)	Can Rasch analysis and factor analysis be used to perform construct validity of the PGAS?	To examine the construct validity of the PGAS using factor analysis and Rasch analysis	872 participants	The seven-factor PGAS produced a good fit to the Rasch model and exhibited good reliability and unidimensionality, offering the Australian paramedic discipline a set of empirically based graduate attributes
2012	Kuo et al^Citation21	Taiwan	Quantitative (questionnaire)	What are the in-service education needs for EMTs in New Taipei City?	To explore EMT in-service education needs in New Taipei City	1,127 participants	This study suggested that it is necessary to consider the contents of an in-service education program for EMTs in different EMS units to meet their professional development requirements
2013	Williams et al^Citation53	Australia	Quantitative (questionnaire)	Are paramedic students ready for self-directed learning?	To determine undergraduate paramedic students’ attitudes and readiness towards self-directed learning at four Australian universities	259 student participants	This study suggested undergraduate paramedic students from four different Australian universities possess an adequate level of self-directed learning readiness. As paramedic-orientated degree programs continue to emerge and develop, establishing SDL needs will assist paramedic educators in diagnosing student learning needs, and assist in shaping contemporary and student-centered curricula
2013	Williams et al^Citation41	Australia	Quantitative (questionnaire)	Are paramedic students ready for interprofessional learning?	To assess the attitudes of paramedic students to interprofessional learning across five Australian universities	303 paramedic students from five universities	This study discussed students’ readiness for interprofessional cooperation and found that tertiary institutions produced different levels of interprofessional education
2014	Williams et al^Citation43	Australia	Quantitative (questionnaire)	How is peer-teaching perceived by first-year paramedic students?	To examine the perceptions of first-year paramedic peer learners being taught by peer teachers over a three-year period	361 peer learners participated	Results suggest that peer learners believe teaching is an important role for paramedics, and communication between peer learners and teachers was slightly better compared with their tutors
2014	Ross and Williams^Citation35	Australia	Quantitative (questionnaire)	Would paramedic students’ active engagement with elderly patients enhance their ability to develop rapport with elderly patients?	To investigate whether paramedic students’ active engagement with elderly patients would enhance their ability to develop rapport with elderly patients, and what impact guided self-reflection would have on this	11 undergraduate students	Students recorded improved confidence, empathy, and overall ability to build rapport with the elderly through this engagement activity
2014	Williams and Fowler^Citation46	Australia	Quantitative	Can near-peer teaching improve academic performance?	To examine whether a near-peer teaching program improved the overall clinical unit scores of undergraduate paramedic near-peer teachers	74 students participated	This study demonstrated that participation in a near-peer teaching program can result in improved overall clinical unit grades for undergraduate paramedic near-peer teachers
2014	Brice et al^Citation34	US	Qualitative	How to develop an EMS curriculum for emergency medicine fellows?	To describe a curriculum that is congruent with current EMS core content, as well as providing a 12-month format to deploy the curriculum in an EMS fellowship program	N/A	This study indicated elements and factors for the development of an EMS curriculum in each step
2014	O’Meara et al^Citation30	Australia	Qualitative	What can the paramedic curriculum change to extend their community role?	To describe one rural community paramedic model and identify enablers related to the implementation of the model	40 participants from different focus groups	Educational programs hoping to include a wider range of topics face the twin challenges of an already crowded curriculum and predominately young students who fail to see the relevance of community primary care content
2014	Abelsson et al^Citation52	Sweden	Qualitative	How does simulation affect the paramedic learning process?	To provide an overview of the development and foci of research on simulation in prehospital care practice	N/A	Simulation was described as a positive training and education method for prehospital medical staff. It provides opportunities to train in assessment, treatment, and the implementation of procedures and devices under realistic conditions
2015	Brooks et al^Citation31	Australia/US	Qualitative	What is the changing process of the US EMS education system and its current status?	To describe US EMS education milestones and identify themes that provide context to readers outside the US	N/A	Implementation and evaluation of the national US EMS system would be a valuable addition to the US EMS literature
2015	Williams et al^Citation45	Australia	Quantitative (questionnaire)	What are the learning and teaching experiences of peer teachers on a paramedic course?	To examine the effects of an educational intervention on students’ PAL experiences as peer teachers	38 peers participated in this study	This PAL project yielded important information for the continual development of paramedic education. Although PAL increases students’ confidence, the full role of PAL in education remains unexplored
2015	Williams et al^Citation44	Australia	Quantitative (questionnaire)	What are the experiences of near-peer teaching program in third-year paramedic students in Monash University?	To examine the perceptions and satisfaction levels of students participating in NPT over a 3-year period at a large Australian university	74 peer teachers involved in this study	The near-peer teaching program has been effective in the education of the paramedic students who participated, developing teaching, mentoring, and learning skills to adopt during their graduate year and future career in the paramedic discipline
2015	Renkiewicz and Hubble^Citation54	US	Mixed method	Does the preparatory program positively affect the attrition rate in EMS students?	To measure the impact of a preparatory course designed to address academic and psychosocial skills affecting EMT course completion	200 EMTs participated	Students who participated in an EMS preparatory course were five times more likely to achieve course completion and the proportion that enrolled but never attended an EMT course was reduced
2015	Thompson et al^Citation15	Australia	Qualitative	Paramedic capstone education model: How to build work-ready graduates by applying the paramedic capstone education model?	Capstone subjects target the final preparation of the graduating student, with a strong emphasis on articulating them successfully with their chosen industrial settings	N/A	It is clear from the research that no single teaching approach or assessment method offers the panacea of paramedic education, but what is clear is a need to recognize the different ways students learn and to be adaptable in embracing new methods and generational technologies
2009	Pullum et al^Citation58	US	Qualitative	What is the effect and experience of prehospital providers in rural areas?	To provide a retrospective analysis of training methods used by rural Montana’s prehospital care providers	N/A	Emergency medical services administrators, educators, instructors, trainers, and providers must all challenge themselves to look for creative solutions to meet the educational demands and needs of the 21st century
2012	Ministry of the Interior; Republic of China (Taiwan)^Citation59	Taiwan	Legislation document	N/A	N/A	N/A	This regulation falls under the EMS Act that lists the EMT and EMT training organization’s administration rules, including the standard curricula topics for all levels of EMT
2011	Paramedic Association of Canada^Citation10	Canada	Competency and standards document	N/A	N/A	N/A	This document includes the competencies and the performance environment for all levels of paramedics in Canada
2010	Council of Ambulance Authorities Inc^Citation28	Australia	Competency and standards document	N/A	N/A	N/A	This document lists the graduate competencies for Australian paramedics
2014	College of Paramedics^Citation9	UK	Competency and standards document	N/A	N/A	N/A	This is curriculum guidance includes paramedic curriculum standards, and outlines the content of each curricula topic
2014	Prehospital Emergency Care Council^Citation7	Ireland	Competency and standards document	N/A	N/A	N/A	This document lists the scope of practice and the description of each practice
2007	National Highway Traffic Safety Administration^Citation8	US	Competency and standards document	N/A	N/A	N/A	This document provides a national scope of practice for all levels of EMT in the US. It also describes the training and accreditation system for EMS professionals
2009	Health Professional Council of South Africa^Citation6	South Africa	Competency and standards document	N/A	N/A	N/A	This document provides detailed information about the education system and curriculum design in South Africa. It also includes the requirements of education institutions and student enrollment

Abbreviations: DVD, digital video disk; EMT, emergency medical technician; NREMT, National Registry of Emergency Medical Technicians; CBL, case-based learning; EMS, emergency medical services; BEH-P, Bachelor of Emergency Health Paramedic; BEH, Bachelor of Emergency Health; NSC-P, National Standard of Curriculum Paramedic; PBL, problem-based learning; PGAS, Paramedic Graduate Attribute Scale; SDL, self-directed learning; PAL, peer-assisted learning; N/A, not available; NPT, near-peer teaching.

Table 2 Overview of global EMT-Paramedic competencies and standards

Items/countries	Taiwan	Australia	US	UK	Ireland	Canada	South Africa
Education/training system (vocational and/or university)	Vocational	University	Both	Both	Both	Vocational	Both
Professionalism	X	X	X	X	X	X	X
Clinical decision making		X	X	X	X	X	X
Ethics and law	X	X	X	X	X	X	X
Communication	X	X	X	X	X	X	X
Demonstration of knowledge	X	X	X	X	X	X	X
Occupational safety		X	X	X	X	X	X
Identifying and assessing social care		X	X	X	X	X	X
Identifying and assessing mental care	X	X	X	X	X	X	X
Identifying and assessing health care	X	X	X	X	X	X	X
Formulating and delivering clinical practice	X	X	X	X	X	X	X
Clinical skills	X	X	X	X	X	X	X
Criticality assessment	X	X	X	X	X	X	X
Academic skills		X		X			X
Interprofessional skills		X					X

Notes: X = the general competency item is included in the competencies and standards document. Data from references 5–10 and 28.

Abbreviation: EMT, emergency medical technician.

Table

MEDLINE/EMBASE/AMED search strategy
1. EMT.tw 2. EMS.tw 3. ambulance.tw
4. paramedic*.tw
5. emergency medical technician.tw
6. emergency medical services.tw
7. *Emergency Medical Technicians/ed [Education]
8. Emergency Medical Technicians/st [Standards]
9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8
10. Curriculum.tw
11. exp Curriculum/st [Standards]
12. *Curriculum/mt [Methods]
13. *Education/mt [Methods] or
14. *Teaching/mt, st [Methods, Standards]
15. 10 or 11 or 12 or 13 or 14
16. 9 and 15
Scopus search strategy
1. ((TITLE-ABS-KEY (emt) OR TITLE-ABS-KEY (ems) OR TITLE-ABS-KEY (ambulance) OR TITLE-ABS-KEY (paramedic*) OR TITLE-ABS-KEY (emergency medical technician) OR TITLE-ABS-KEY (emergency medical services) OR TITLE-ABS-KEY (emergency medical technician AND education) OR TITLE-ABS-KEY (emergency medical technician AND standards)))
2. ((TITLE-ABS-KEY (curriculum) OR TITLE-ABS-KEY (curriculum AND standards) OR TITLE-ABS-KEY (curriculum AND methods) OR TITLE-ABS-KEY (*education AND methods) OR TITLE-ABS-KEY (*teaching AND methods) OR TITLE-ABS-KEY (*teaching AND standards)))
3. (EXCLUDE (SUBJAREA, “ENGI”) OR EXCLUDE (SUBJAREA, “AGRI”) OR EXCLUDE (SUBJAREA, “BIOC”) OR EXCLUDE (SUBJAREA, “COMP”) OR EXCLUDE (SUBJAREA, “PHYS”) OR EXCLUDE (SUBJAREA, “SOCI”) OR EXCLUDE (SUBJAREA, “VETE”) OR EXCLUDE (SUBJAREA, “ENVI”) OR EXCLUDE (SUBJAREA, “MATH”) OR EXCLUDE (SUBJAREA, “MATE”) OR EXCLUDE (SUBJAREA, “PHAR”) OR EXCLUDE (SUBJAREA, “EART”) OR EXCLUDE (SUBJAREA, “CHEM”) OR EXCLUDE (SUBJAREA, “IMMU”) OR EXCLUDE (SUBJAREA, “NEUR”) OR EXCLUDE (SUBJAREA, “PSYC”) OR EXCLUDE (SUBJAREA, “CENG”) OR EXCLUDE (SUBJAREA, “ENER”) OR EXCLUDE (SUBJAREA, “BUSI”) OR EXCLUDE (SUBJAREA, “DECI”) OR EXCLUDE (SUBJAREA, “ARTS”) OR EXCLUDE (SUBJAREA, “ECON”) OR EXCLUDE (SUBJAREA, “MULT”) OR EXCLUDE (SUBJAREA, “DENT”) OR EXCLUDE (SUBJAREA, “Undefined”))
4. 1 and 2 and 3
ERIC search strategy
1. (EMT OR (EMS OR ambulance) OR (paramedic* OR emergency medical technician) OR (emergency medical services))
2. (curriculum OR standards OR methods OR education OR teaching)
3. 1 and 2
Narrow down by source type
(Scholarly Journals OR Reports OR Dissertations & Theses) NOT (Other Sources AND Books AND Encyclopedias & Reference Works)

Abbreviations: AMED, Allied and Complementary Medicine Database; ERIC, Education Resources Information Center.

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