Development of new core competencies for Taiwanese Emergency Medical Technicians

Figures & data

Table 1 Correlation matrix (principal component analysis with Varimax rotation) of EMT-1 (n=43)

Factors	Items	Factors loading			Communalities
		1	2	3
Factor 1: professionalism and safety behavior Cronbach’s alpha=0.99	50 Operate within appropriate ethical and legal boundaries	0.945			0.90
	45 Caring and empathic	0.925			0.87
	54 Exhibit physical strength and fitness consistent with the requirements of professional practice	0.903			0.86
	44 Nonjudgmental and nondiscriminatory	0.899			0.83
	47 Understand their role in providing a primary care health service	0.899			0.85
	49 Accept guidance from colleagues	0.898			0.82
	57 Practice within an approved scope of practice	0.886			0.81
	46 Able to see things from the patients’ point of view	0.882			0.81
	53 Manage stress	0.875			0.83
	52 Aware of, and regard for, professional issues such as accountability and confidentiality	0.856			0.82
	58 Develop and maintain personal health and wellbeing strategies	0.851			0.76
	32 Adhere to a code of ethics	0.846			0.74
	59 Respond to changes in the provision of healthcare due to evolving community expectations	0.839			0.83
	48 Good understanding of their patients’ welfare	0.836			0.85
	61 Embrace social responsibility	0.834			0.72
	60 Understand the role of paramedic care within the broader healthcare system	0.825			0.80
	37 Practice infection control	0.818			0.79
	41 Conduct ongoing assessments and provide care	0.806			0.83
	35 Recognize and react appropriately to persons exhibiting emotional reactions	0.802			0.80
	56 Trustworthy	0.801			0.79
	42 Drive ambulance or emergency response vehicle	0.793			0.66
	51 Ability to work independently as well as a member of a team	0.748	0.437		0.75
	34 Collaborate with law enforcement agencies in the management of crime scenes	0.746			0.70
	55 Able to provide leadership, mentoring and supervision skills	0.743	0.446		0.76
	40 Provide care to meet the needs of unique patient group	0.727	0.503		0.81
Factor 2: continuing professional development and caring network in community Cronbach’s alpha=0.97	12 Interpret evidence in medical literature and assess relevance to practice		0.904		0.86
	11 Audit, reflect on and review practice		0.862		0.76
	13 Integrate professional practice into community care		0.859		0.77
	18 Clinical reasoning skills		0.856		0.78
	6 Capacity to undertake self-directed approaches to learning		0.834		0.80
	7 Continue to learn and to help others to learn		0.833		0.79
	9 Capacity for enquiry and research		0.827		0.75
	15 Critical thinking		0.819		0.73
	14 Contribute to public safety through collaboration with other emergency response agencies		0.811		0.75
	19 Clinical competence		0.811		0.76
	24 Apply knowledge of the basic sciences	0.426	0.746		0.75
	23 Theoretical knowledge	0.495	0.733		0.79
	10 Ability to learn including the ability to use reflection and learn from experience		0.724		0.64
	16 Respectful and consider moral, ethical, social, religious aspects of healthcare		0.711		0.66
	29 Use clinical reasoning and problem-solving skills to determine clinical judgments and appropriate actions	0.511	0.679		0.73
	4 Commitment to self-development		0.622	0.554	0.71
Factor 3: communication skills Cronbach’s alpha=0.84	3 Effective written and oral communication skills		0.574	0.686	0.82
	2 Capacity to use communication and information technology effectively and appropriately		0.505	0.632	0.70
Eigenvalue		25.353	7.051	1.104
Explained variance (%)		58.961	16.398	2.568

Note: The items in gray shading belongs to Factor loading.

Abbreviation: EMT, Emergency Medical Technician.

Table 2 Correlation matrix (principal component analysis with Varimax rotation) of EMT-2 (n=49)

Factors	Items	Factors loading			Communalities
		1	2	3
Factor 1: professionalism and safety behavior Cronbach’s alpha=0.99	50 Operate within appropriate ethical and legal boundaries	0.944			0.91
	49 Accept guidance from colleagues	0.936			0.91
	52 Aware of and regard for, professional issues such as accountability and confidentiality	0.936			0.92
	45 Caring and empathic	0.933			0.90
	57 Practice within an approved scope of practice	0.932			0.89
	56 Trustworthy	0.932			0.93
	47 Understand their role in providing a primary care health service	0.927			0.90
	46 Able to see things from the patients’ point of view	0.924			0.90
	54 Exhibit physical strength and fitness consistent with the requirements of professional practice	0.920			0.89
	42 Drive ambulance or emergency response vehicle	0.912			0.84
	41 Conduct ongoing assessments and provide care	0.907			0.92
	44 Nonjudgmental and nondiscriminatory	0.904			0.84
	51 Ability to work independently as well as a member of a team	0.900			0.89
	48 Good understanding of their patients’ welfare	0.894			0.88
	53 Manage stress	0.893			0.87
	58 Develop and maintain personal health and wellbeing strategies	0.885			0.82
	35 Recognize and react appropriately to persons exhibiting emotional reactions	0.882			0.87
	38 Conduct triage in a multiple-patient incident	0.881			0.87
	60 Understand the role of paramedic care within the broader healthcare system	0.880			0.84
	55 Able to provide leadership, mentoring and supervision skills	0.879			0.86
	37 Practice infection control	0.879			0.86
	59 Respond to changes in the provision of healthcare due to evolving community expectations	0.876			0.85
	61 Embrace social responsibility	0.876			0.80
	32 Adhere to a code of ethics	0.875			0.80
	31 Apply infection control procedures which recognize risks to patients and those treating them	0.867			0.83
	30 Act in accordance with applicable health and safety legislation, and any relevant safety policies and procedures	0.853			0.83
	39 Utilize differential diagnosis skills, decision-making skills and psychomotor skills in providing care to patients	0.848			0.89
	40 Provide care to meet the needs of unique patient group	0.834			0.86
	33 Demonstrates the requisite knowledge and skills to participate in mass casualty or major incident	0.833			0.84
	34 Collaborate with law enforcement agencies in the management of crime scenes	0.831			0.79
	36 Conduct procedures and operations consistent with Workplace Hazardous Materials Information System (WHMIS) and hazardous materials management requirement	0.811			0.85
	27 Maintain records appropriately	0.746			0.76
	29 Use clinical reasoning and problem-solving skills to determine clinical judgments and appropriate actions	0.691		0.437	0.73
	43 Transfer patient to air ambulance	0.675			0.55
Factor 2: continuing professional development and collaboration communication skills Cronbach’s alpha=0.93	4 Commitment to self-development		0.813		0.74
	3 Effective written and oral communication skills		0.791		0.67
	1 Able to work in interdisciplinary teams		0.766		0.67
	2 Capacity to use communication and information technology effectively and appropriately		0.758		0.67
	6 Capacity to undertake self-directed approaches to learning		0.714	0.475	0.77
	7 Continue to learn and to help others to learn		0.694	0.478	0.74
	5 Assess scene for safety		0.685		0.53
	9 Capacity for enquiry and research		0.666	0.474	0.69
	10 Ability to learn including the ability to use reflection and learn from experience		0.620	0.433	0.64
Factor 3: performing clinical reasoning skills and providing integrated caring network in community Cronbach’s alpha=0.95	18 Clinical reasoning skills			0.794	0.84
	19 Clinical competence			0.777	0.82
	12 Interpret evidence in medical literature and assess relevance to practice	0.428		0.763	0.83
	13 Integrate professional practice into community care			0.739	0.69
	15 Critical thinking			0.738	0.74
	14 Contribute to public safety through collaboration with other emergency response agencies			0.737	0.80
Eigenvalue		31.858	6.398	1.474
Explained variance (%)		65.015	13.058	3.008

Note: The items in gray shading belongs to Factor loading.

Abbreviation: EMT, Emergency Medical Technician.

Table 3 Correlation matrix (principal component analysis with Varimax rotation) of EMT-P (n=32)

Factors	Items	Factors loading					Communalities
		1	2	3	4	5
Factor 1: clinical competency and professionalism Cronbach’s alpha=0.96	26 Conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely	0.788					0.84
	56 Trustworthy	0.735					0.76
	28 Specialist knowledge (eg, practitioner or extended scope roles)	0.724					0.79
	57 Practice within an approved scope of practice	0.723					0.77
	55 Able to provide leadership, mentoring and supervision skills	0.706					0.75
	39 Utilize differential diagnosis skills, decision-making skills and psychomotor skills in providing care to patients	0.674					0.78
	29 Use clinical reasoning and problem-solving skills to determine clinical judgments and appropriate actions	0.652			0.484		0.80
	41 Conduct ongoing assessments and provide care	0.643		0.435			0.80
	25 Formulate specific and appropriate patient care and treatment actions	0.623			0.527		0.80
	27 Maintain records appropriately	0.620					0.71
	37 Practice infection control	0.578					0.57
	19 Clinical competence	0.558			0.510		0.78
Factor 2: patient-centered practice Cronbach’s alpha=0.91	45 Caring and empathic		0.821				0.83
	44 Nonjudgmental and nondiscriminatory		0.807				0.67
	50 Operate within appropriate ethical and legal boundaries		0.785				0.69
	49 Accept guidance from colleagues		0.782				0.76
	46 Able to see things from the patients’ point of view		0.723				0.73
	51 Ability to work independently as well as a member of a team	0.502	0.578				0.66
Factor 3: continuing professional development Cronbach’s alpha=0.90	8 Willing to undertake ongoing education			0.845			0.82
	9 Capacity for enquiry and research			0.721			0.77
	6 Capacity to undertake self-directed approaches to learning			0.700		0.445	0.78
	1 Able to work in interdisciplinary teams			0.687			0.59
	11 Audit, reflect on and review practice			0.670			0.71
	7 Continue to learn and to help others to learn			0.589		0.475	0.73
Factor 4: comprehensive management of self-condition and patient safety Cronbach’s alpha=0.86	53 Manage stress		0.450		0.737		0.78
	36 Conduct procedures and operations consistent with Workplace Hazardous Materials Information System (WHMIS) and hazardous materials management requirement				0.662		0.74
	54 Exhibit physical strength and fitness consistent with the requirements of professional practice		0.551		0.661		0.82
	43 Transfer patient to air ambulance				0.659		0.63
	34 Collaborate with law enforcement agencies in the management of crime scenes	0.461			0.619		0.70
Factor 5: clinical reasoning skills Cronbach’s alpha=0.70	12 Interpret evidence in medical literature and assess relevance to practice					0.736	0.75
	15 Critical thinking					0.644	0.49
	18 Clinical reasoning skills	0.532				0.545	0.74
Eigenvalue		16.364	3.155	1.508	1.435	1.078
Explained variance (%)		51.139	9.859	4.712	4.484	3.367

Note: The items in gray shading belongs to Factor loading.

Abbreviation: EMT, Emergency Medical Technician.

Table S1 Overview of global EMT/paramedic competencies and standards12

Items/countries	Taiwan	Australia	USA	UK	Ireland	Canada	South Africa
Education/training system	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 healthcare	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

Note: X indicates that the general competency item is included in the competencies and standards document.

Abbreviation: EMT, Emergency Medical Technician.

Table S2 Distribution of scores for the 61 core competency items at all levels of EMT

Core competencies	EMT-P		EMT-2		EMT-1
	Mean	SD	Mean	SD	Mean	SD
1 Able to work in interdisciplinary teams	8.29	1.39	6.41	1.88	4.37	2.62
2 Capacity to use communication and information technology effectively and appropriately	8.35	1.44	6.69	2.06	5.17	2.60
3 Effective written and oral communication skills	8.04	1.38	6.25	1.92	4.60	2.47
4 Commitment to self-development	8.30	1.44	6.18	1.93	4.88	2.54
5 Assess scene for safety	8.90	1.21	7.87	1.62	6.42	2.49
6 Capacity to undertake self-directed approaches to learning	8.59	1.17	6.15	1.94	4.75	2.47
7 Continue to learn and to help others to learn	8.62	1.14	6.34	2.00	4.67	2.59
8 Willing to undertake ongoing education	8.86	1.31	7.10	2.28	6.22	2.76
9 Capacity for enquiry and research	8.49	1.31	5.81	2.28	4.53	2.66
10 Ability to learn including the ability to use reflection and learn from experience	8.67	1.18	6.74	2.11	5.62	2.73
11 Audit, reflect on and review practice	8.82	1.03	6.24	2.12	4.81	2.67
12 Interpret evidence in medical literature and assess relevance to practice	7.54	1.98	4.86	2.47	3.75	2.78
13 Integrate professional practice into community care	7.00	2.30	4.87	2.61	3.99	2.75
14 Contribute to public safety through collaboration with other emergency response agencies	7.69	1.78	5.83	2.39	4.70	2.85
15 Critical thinking	7.77	1.69	5.57	2.27	4.17	2.71
16 Be respectful and consider moral, ethical, social, religious aspects of healthcare	8.05	1.63	6.77	2.35	6.06	2.82
17 Culturally sensitive and have an inclusive approach to differences	8.42	1.51	7.58	2.25	7.24	2.70
18 Clinical reasoning skills	8.19	1.46	5.60	1.99	3.77	2.40
19 Clinical competence	8.07	1.40	5.61	2.06	4.13	2.44
20 Literate and numerate	7.57	1.77	6.11	2.00	5.25	2.47
21 Good listener	7.94	1.96	6.93	2.08	6.42	2.62
22 Follow evidence-based practice	8.40	1.49	6.93	2.16	6.36	2.64
23 Theoretical knowledge	8.40	1.30	6.06	2.12	4.64	2.64
24 Apply knowledge of the basic sciences	7.64	1.82	5.95	2.21	4.75	2.63
25 Formulate specific and appropriate patient care and treatment actions	8.40	1.27	6.58	2.01	5.36	2.73
26 Conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely	8.49	1.26	6.44	1.88	5.15	2.64
27 Maintain records appropriately	8.43	1.50	7.14	2.19	6.09	2.90
28 Specialist knowledge (eg, practitioner or extended scope roles)	8.33	1.29	6.04	1.90	4.62	2.52
29 Use clinical reasoning and problem-solving skills to determine clinical judgments and appropriate actions	8.31	1.37	5.88	1.99	4.46	2.61
30 Act in accordance with applicable health and safety legislation, and any relevant safety policies and procedures	8.38	1.32	6.84	2.12	5.95	2.73
31 Apply infection control procedures which recognize risks to patients and those treating them	8.43	1.35	6.82	2.08	5.95	2.60
32 Adhere to a code of ethics	8.75	1.23	7.95	1.86	7.64	2.29
33 Demonstrate the requisite knowledge and skills to participate in mass casualty or major incident	8.73	1.17	6.32	2.10	4.88	2.68
34 Collaborate with law enforcement agencies in the management of crime scenes	7.93	1.85	7.01	2.31	6.17	2.83
35 Recognize and react appropriately to persons exhibiting emotional reactions	8.29	1.26	6.97	1.86	6.01	2.47
36 Conduct procedures and operations consistent with Workplace Hazardous Materials Information System (WHMIS) and hazardous materials management requirement	7.78	1.80	6.14	2.15	4.67	2.73
37 Practice infection control	8.55	1.20	7.05	2.13	5.96	2.72
38 Conduct triage in a multiple-patient incident	8.93	1.19	6.95	1.89	4.89	2.76
39 Utilize differential diagnosis skills, decision-making skills and psychomotor skills in providing care to patients	8.54	1.24	6.25	1.96	4.46	2.48
40 Provide care to meet the needs of unique patient group	7.83	1.73	5.88	2.15	4.77	2.68
41 Conduct ongoing assessments and provide care	8.75	1.26	7.08	1.95	5.81	2.74
42 Drive ambulance or emergency response vehicle	9.07	1.11	8.61	1.58	7.41	2.93
43 Transfer patient to air ambulance	6.87	2.50	4.44	2.38	2.89	2.08
44 Nonjudgmental and nondiscriminatory	7.97	1.88	7.61	2.08	7.41	2.27
45 Caring and empathic	8.45	1.54	7.95	1.92	7.72	2.20
46 Able to see things from the patients’ point of view	8.32	1.62	7.41	1.96	7.01	2.20
47 Understand their role in providing a primary care health service	8.61	1.34	7.39	2.00	6.69	2.45
48 Good understanding of their patients’ welfare	7.92	1.74	6.60	2.06	5.76	2.58
49 Accept guidance from colleagues	8.39	1.65	7.69	1.82	7.69	2.25
50 Operate within appropriate ethical and legal boundaries	8.61	1.51	8.01	1.91	7.84	2.19
51 Ability to work independently as well as a member of a team	8.89	1.46	6.99	1.99	5.03	2.66
52 Aware of, and regard for, professional issues such as accountability and confidentiality	8.81	1.35	7.49	1.86	6.36	2.54
53 Manage stress	7.61	1.90	6.67	2.00	6.12	2.38
54 Exhibit physical strength and fitness consistent with the requirements of professional practice	8.03	1.77	7.21	1.93	6.47	2.36
55 Able to provide leadership, mentoring and supervision skills	8.61	1.33	6.49	1.82	4.88	2.50
56 Trustworthy	8.95	1.20	7.23	1.87	5.65	2.71
57 Practice within an approved scope of practice	9.12	1.13	8.04	1.91	7.29	2.57
58 Develop and maintain personal health and wellbeing strategies	8.29	1.64	7.41	1.94	6.87	2.45
59 Respond to changes in the provision of healthcare due to evolving community expectations	7.84	1.96	6.65	2.08	5.87	2.54
60 Understand the role of paramedic care within the broader healthcare system	8.57	1.53	7.15	2.00	6.28	2.62
61 Embrace social responsibility	8.29	1.52	7.33	1.95	6.91	2.41

Abbreviation: EMT, Emergency Medical Technician; EMT-P, EMT-Paramedic.