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

Authors Chang YT, Tsai KC , Williams B 

Received 1 May 2017

Accepted for publication 17 August 2017

Published 22 September 2017 Volume 2017:8 Pages 649—667


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Md Anwarul Azim Majumder

Yu-Tung Chang,1,2 Kuang-Chau Tsai,2 Brett Williams1

1Department of Community Emergency Health and Paramedic Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia; 2Emergency Medicine Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan

Purpose: The development of emergency medical services (EMS) training in Taiwan is in a transitional phase because of increasing demand for, and advancements in, clinical skill sets. The aim of this study is to review the current literature to compare the key factors of EMS training and education development in different countries in order to provide a new curricula blueprint for the Taiwanese EMS training system.
Method: The method follows Arksey and O’Malley’s six stages of scoping review.
Results: Five databases were searched for relevant articles: MEDLINE, EMBASE, Allied and Complementary Medicine Database; Education Resources Information Center, and Google Scholar. The initial search of five databases produced 1,230 articles, of which title and abstract screening excluded 1,156 articles. The 74 remaining articles underwent a full-text screening process, which further reduced the number of articles to 22. Researching references and citations produced an additional 23 articles, national curriculum standards produced a further six documents, and one article derived from emergency medical technician (EMT) regulation in Taiwan. In total, 52 articles were included in the study, categorized by competency and standards, EMT education and learning environment, curriculum design, and teaching and learning method.
Conclusion: This study reviewed international EMS training and education literature and documents to summarize the essential elements for developing an EMS education system: for example, core competencies and standards, education environment, curriculum design, and teaching and learning method. By connecting the essential elements for developing an EMS education system, a blueprint for the Taiwanese EMS education system can be identified. Analysis and study of the essential elements will provide educators with clear direction in developing the EMS education system in Taiwan.

EMT, EMS, curriculum, education standards, teaching methods


The primary cause of death in Taiwan is due to chronic diseases such as cancer, cardio- and cerebrovascular disease, pneumonia, and diabetes which places a considerable burden on the Taiwanese health care system.1 Combined with the epidemiology of health issues and an affordable public health care and welfare system, the increasing demand on the health care system, including the emergency medical services (EMS), is considerable.1,2 The EMS in Taiwan have served over 23 million people and covered an area of 36,000 km2 for more than 20 years.3 In 1995, the first EMS Act was legislated and became the stepping stone for the development of an EMS system in Taiwan. The EMS Act designated the EMS as one of the essential missions for Fire Departments which are overseen by the National Fire Agency (NFA) and the Health Department. The current annual EMS workload is one million cases, projected to increase by an average of two percent each year.2,4

In 2015, there were 12,555 firefighter-emergency medical technicians (EMTs) in the Fire Departments across Taiwan, responsible for Fire Rescue and EMS duties in their designated jurisdictions.4 There are three levels of EMT in Taiwan: EMT-1, EMT-2, and EMT-Paramedic. Eleven percent of all firefighter-EMTs are at EMT-1 which is the basic level of EMT, while the majority (over 80 percent) of firefighter-EMTs are at EMT-2 level. The highest level is EMT-Paramedic which accounts for less than 10 percent of all firefighter-EMTs.4,5 Figure 1 illustrates the hierarchy of EMT levels and their scope of practice as listed in the EMT Administration Regulation.5 The EMT Administration Regulation stipulates that to be eligible to teach on the EMT-Paramedic training course, instructors must be a doctor, a registered nurse, an EMT-Paramedic, or an EMT-2 with at least three years’ experience in EMS.5

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.

The EMS Act and the EMT Administration Regulation shape the Taiwanese EMT training system through license-based vocational training. Qualified organizations in Taiwan are eligible to provide training courses from EMT-1 level to EMT-Paramedic level, overseen by the Health Department. These EMT training organizations provide a license to practice to students who successfully pass all examinations. EMT-Paramedic courses and exams are provided by third-party organizations (e.g. the Taiwan Emergency Medicine Association), and the EMT-Paramedic license is authorized by the Health Department.5

Internationally, EMS training and education systems have evolved in different ways influenced by the operational needs of individual EMS systems.510 A review of the literature highlighted three predominant EMS education and training systems: vocational licensure, graduated certification, and a combination of both. Vocational systems, such as the Taiwanese EMS, rely on training organizations to issue licenses to practice at a nonuniversity level. University or college EMT-Paramedic courses, for example in Australia, provide graduated certification (such as a bachelor degree) for graduate students. The two-tier system, for example in the United States, operates vocational licensure and graduated certification for both private and public EMS needs.

The review of EMS training and education literature suggests there are a number of factors that might affect the development of training and education: national standards and curriculum; teaching method and learning environment; research development; and Acts and Regulations.1120 For example, the EMT Administration Regulation as part of the EMS Act in Taiwan sets the number of training hours and curricula topics for the three levels of EMT and leads training course structure and operation within the vocational licensure system.

Taiwanese EMS training development is currently in a transitional phase due to increasing demand and advancements in clinical skill sets.4 The findings of a study by Kuo et al which investigated EMT-2s’ requirement for in-service education revealed a gap between curricula standards in EMT Administration Regulation and clinical practice needs for first-line EMS workers in Taiwan.21 In order to remedy this disconnect, there is a clear need to review and modify training and education content in Taiwan across all levels of EMT training. Therefore, the aim of this study was to review the current literature to compare the key factors of EMS training and education development in different countries. The findings offer educators in Taiwan opportunities for developing a new curricula blueprint for the national EMS training system.


The scope of the literature review was restricted to searches on the subject of EMS training and education, with findings from the key studies summarized to assist identification of the primary needs of the EMT educational curriculum in Taiwan. The method follows the six stages of scoping review structure as outlined by Arksey and O’Malley’s.22

Identify the research question

The following research question was developed to inform the review: “What factors can meet the educational and curriculum needs for EMTs in Taiwan?”

Identify relevant studies

Five databases were searched for relevant articles in this study: MEDLINE, EMBASE, Allied and Complementary Medicine Database; Education Resources Information Center, and Google Scholar. The gray literature sites,,,, and were searched for non-peer-reviewed articles and national EMS educational/curricula standards. Hand-searching and backward and forward reference searching of articles and documents were also conducted. The year of searched articles was limited from 2000 to 2016. The search terms used in the strategy combined with two research concepts: EMT/EMS and curriculum/education-related MeSH and keywords. The EMT/EMS group of terms were: “EMT”, “EMS”, “ambulance”, “paramedic*”, “emergency medical technician”, and “emergency medical services”. The curriculum/education terms were: “curriculum”, “education”, “standards”, and “teaching methods”. The search strategies for each database are listed in the Supplementary material.

Study selection

The initial search of five databases produced 1,230 articles after elimination of duplicates. The process of title and abstract screening excluded 1,158 articles which were not relevant to the aim of this study. The remaining 72 articles underwent a full-text screening process by two independent reviewers. Of these, 25 pre-2000 articles were excluded due to curriculum and/or standards being too old; a further 25 articles had no supportive data or, ultimately, failed to address the research question. Twenty-two articles remained after full-text review. There were 23 additional articles produced by reference and citation research and consultation with international EMS education experts, six documents from national EMT curricula standards, and one from EMT Administration Regulation in Taiwan. The final yield for the literature review was 52 articles (Figure 2).

Figure 2 Study selection process and result.

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

Charting the data

Charting data is a valid descriptive analytical method and uses a standardized form to collect and organize information from literature searches.22 Table 1 displays the summary of charting data through categorization of year, author, location, study type, population, and main findings.

Table 1 Overview of included articles

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.

Collating, summarizing, and reporting results

Of the 45 peer-reviewed articles, 18 were qualitative studies, 24 were quantitative studies, and three were mixed method. Sixteen studies from the 45 articles collected data from questionnaires. Of these, 28 were from Australia, nine from the US, four from the UK, and four from Finland, Sweden, the Kingdom of Saudi Arabia, and Taiwan. Five main topics or themes were identified from the 45 articles: EMT competency; EMT education; curriculum design; training standards; and teaching and learning methods. The following discussion will be based on the findings of articles on each topic.

Expert consultation

Several international EMS education experts were consulted which resulted in the addition of further papers.


The findings from the studies included in the literature review indicated that EMS training and education in many countries is in a transitional stage.4,13 Searching and reviewing the available literature identified several factors that can be considered essential in relation to EMS education. These include competency and standards, curriculum design, registration and accreditation, teaching and learning methods, acts and regulations, research in EMS, and training organization administration. No available literature was found on Taiwanese EMS curriculum and education system design. This discussion therefore focuses on the themes suggested by the literature review which offer opportunities for informing, updating, and improving the current EMS training and education system in Taiwan.

EMT-Paramedic competencies and standards

Core competencies and standards for paramedics are essential for educational quality assurance, accreditation, benchmarking, and informed and improved clinical practice.12,15,16,2327 In order to compare the international EMT-Paramedic competencies and standards to the current situation in Taiwan, Table 2 summarizes EMT-Paramedic competencies and standards in Taiwan, Australia, the US, the UK, Ireland, Canada, and South Africa.510,28 These countries were chosen as they all have well-established EMS systems and are likely to offer international consensus for comparison with Taiwan. The competencies and standards documents from the EMS or ambulance services, education accreditation councils, or national legislation in each country were searched and screened.

Table 2 Overview of global EMT-Paramedic competencies and standards

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 2 lists the type of training and education system in each country (vocational training, university degree, or both) and extracts of general items from each competency document across each of the selected countries. Each competency document listed or described the competencies and standards of EMT-Paramedic in the respective country. The general competency items in Table 2 are derived from similar descriptions of competencies and standards in the documents from each country: professionalism; clinical decision making; ethics and law, and communication; demonstration of knowledge; occupational safety; identifying and assessing social care; identifying and assessing mental care; identifying and assessing health care; formulating and delivering clinical practice; clinical skills; criticality assessment; academic skills; and interprofessional skills.

The findings indicate that Australia is the only country that trains paramedics completely at university level with other countries adopting a combination of university and vocational-based training systems. Of the countries reviewed, Taiwan and Canada use the vocational training system solely for training EMTs and paramedics. The only countries that contain all the general competency items in their competency documents are Australia and South Africa. In the UK, paramedic competency includes 13 of the 14 general items, the only exception being interprofessional skills. Although the US paramedic education system includes university-based education, academic and interprofessional skills are not mentioned in the relevant competency documents. In the Taiwanese context, EMT-Paramedic competencies cover fewer items than in the other six countries.

Compared to other countries, the approach in Taiwan to setting EMT-Paramedic competencies and standards is unique. The EMT Administration Regulation is a legal document that contains regulations for EMT-Paramedic in Taiwan including the administration of training organizations, the competencies expected of EMTs, and course structure for all levels of EMT.5 In reviewing the 20-year history of the Taiwanese EMS, it is clear that the populace’s demand for ambulance services has exceeded stakeholders’ expectations, including those of EMTs and paramedics themselves. Hence, there is a need for the role and mission of EMT-Paramedic to be reviewed by the EMS governance agencies.4 However, the ability to monitor the quality of EMT services in Taiwan is restricted by issues concerning total training hours, course content, the qualification criteria of EMT instructors, and the lack of national evaluation standards within training organizations.5

For example, the skill-based vocational training of EMTs in Taiwan offers limited training hours, and courses therefore may not be able to cover nontechnical skills such as clinical decision making, identifying and assessing social care, and academic and interprofessional skills – items recognized as essential competencies for EMT-Paramedic in other countries. With Taiwanese EMT training in transition, it is necessary to reconsider what constitutes core competencies and to ensure they are consistent with modern EMS requirements and international standards, and societal expectations in Taiwan.

EMT education and learning environment

Internationally, universities and vocational training organizations offer different course content weighting on EMT-Paramedic training. Willis et al conducted a qualitative study in 2011 using interview focus groups in both university education and industry training to address graduate maturity and road-readiness.20 The study revealed that conflict existed between paramedic university education and the industry environment where results indicated that the university arena provided students with longer teaching and learning hours compared with vocational training. University EMT-Paramedic training also offered more comprehensive and in-depth knowledge of prehospital care, academic resources, and supportive sciences such as psychological and sociological management to enhance graduate maturity, develop students’ interpersonal skills and ability to apply knowledge.20 Moreover, Brown et al’s study in 2011 showed that health science students (including paramedics) in universities had positive perceptions of a learning environment in which they were exposed to a combination of traditional classroom-based teaching, practical skills workshops, and clinical fieldwork or practice education placements.29 Although students in universities have less exposure to clinical practice in the field than industry-trained paramedics, the comprehensive medical and health science knowledge taught in universities has been shown to provide students with the necessary theoretical and practical skills required to become a health care practitioner.20,30

The evaluation of EMS/Paramedic education is an essential component in the quality control of EMTs and paramedics. In 2015, Brooks et al reviewed the EMS education system in the US and observed an inconsistency in EMT-Paramedic registration between individual states which acted as a barrier to attempts by education providers to implement national EMS education standards.31 The same authors contrasted the situation in Australia where ambulance services determine paramedics’ scope of practice in their respective jurisdictions, and tertiary qualification provides employers with comparable levels of skill and knowledge, thereby enabling portability of qualifications across states.31 Based on such findings, the EMS education environment, education agenda and standards, and the scope of ambulance services’ practice are interrelated and influence the quality of EMS education. In Taiwan, one single document, the EMT Administration Regulation, indicates the scope of practice and curriculum standards for all levels of EMT, but no national EMT-related training and education standards exist for EMT instructors as guidance for training and curriculum design.

Curriculum design

A review of UK paramedic training, with the aim of better understanding education issues and determining future recommendations, identified four issues concerning curricula: entry level (accrediting prior learning); program issues (content and time); assessment and competency; and moving towards a graduate profession.13 In essence, the authors concluded that for EMS in transition, in working towards a graduate profession, stakeholders should review current societal needs and the demands placed on the health care system, and modify curricula accordingly to ensure better prehospital care services. Salzman et al indicated that paramedic students’ completion rate of the National Standard of Curriculum Paramedic was low and recommended that curriculum design and national standards be made available and adapted at the local level.32

Other studies have suggested additional solutions for developing an improved EMT-Paramedic curriculum including that of Margolis which identified 12 strategies to provide a general concept of curriculum design.33 In exploring concepts to design more effective curricula for paramedic courses at university level, several authors have demonstrated that courses, curricula, and standards from one national setting can be successfully adapted for EMS training and education in other countries.11,34 Such studies provide guidance for Taiwanese EMS training instructors in redesigning current curricula standards and content.

EMT-Paramedic training institutes in Taiwan follow the training curriculum standards in the EMT Administration Regulation where the training hours that are set for each course subject in the curriculum reflect the skills-centered context and skills-based training culture. For example, Kuo et al in surveying the continuous professional development (CPD) needs of EMT-2 in the New Taipei City Fire Department recommended the redesign of the Fire Department’s in-service education program.21 Their study identified that the CPD needs of EMT-2s vary according to the type of response unit, for example advanced life support or basic life support units. However, the findings of this study were at odds with the compulsory CPD program requirements as outlined in the EMT Administration Regulation. The education needs identified, such as communication skills and emotional management, were not included in the compulsory CPD course for all levels of EMT in Taiwan. This highlights the importance of providing clear direction to the Taiwanese EMS training and education system in establishing core EMT competencies and leading the design of curriculum for EMTs.

Teaching and learning methods

It has been documented that teaching and learning approaches can influence the efficiency of education and affect student performance.3537 In the Taiwanese context, where EMT training organizations and the learning environment are still based on traditional T&L approaches, there are no studies that have reviewed or discussed T&L methods in EMT-Paramedic training. The EMT training curriculum in Taiwan determines the training hours for each subject,5 which forces instructors to reduce course content, leading to situations where they struggle to teach the necessary knowledge and skills in some subjects. The implementation of novel T&L methods, as identified in the literature review, in EMT curricula in Taiwan might increase the efficiency of teaching for instructors. A number of specific methods are discussed later in this paper.

Case-based learning

Case-based learning (CBL) is derived from problem-based learning and is applied widely in health care education across the globe.38 Williams conducted a series of studies investigating the implementation of CBL in paramedic education curricula in Australia between 2005 and 2009.19,3840 The results demonstrated that CBL not only provided enjoyable learning experiences for students but also improved their interaction with peers and teachers.19,39 Williams also expanded the experience of using CBL to an online education platform that allowed students to reduce the amount of time spent in the classroom whilst maintaining a similar learning environment and participation in activities.38,39 In this research, cases are based on authentic clinical situations where students explore real scenarios in depth and respond to them by applying the knowledge they have learnt. Within the short timeframes of EMT training in Taiwan, students have far fewer opportunities for CBL and exposure to real clinical scenarios and patients (there are no placements for EMT-1; 96 hours for EMT-2; and, 240 hours for EMT-Paramedic). CBL therefore offers Taiwanese EMT students opportunities to practice and apply their knowledge to real cases before they start work in the field.

Interprofessional education

Interprofessional work is a common feature of the health care environment in which the various health care disciplines work with each other to ensure continuity of care for patients.41 Two studies were identified in the literature review that highlight the necessity of implementing interprofessional education (IPE) in paramedic curriculum.14,41 Williams et al50 also state that timing introduction of IPE is essential and that it must be viewed as a professional development process. The Taiwanese EMT Administration Regulation does not currently include IPE in either the EMT competencies or standard curriculum sections. As demand for EMS in Taiwan increases, IPE is an essential requirement for EMTs to ensure the Taiwanese health care system works in an effective and efficient manner.

Peer teaching

Peer-assisted learning (PAL) has been used in health care education for several decades, and has a proven track record in benefitting paramedic students’ performance in both the clinical and academic arenas.4246 In Taiwan, peers have no teaching role in EMT training courses due to restrictions on time available for training and low numbers of instructors and peers in training organizations. It is recommended that PAL is adopted as a key component in the development of EMT training in Taiwan.

Clinical placements

Clinical placements are an integral part of the learning process in EMT-Paramedic education.47 For EMT-Paramedic students, clinical placement provides them with a real working environment and patients to manage, and opportunities to apply the knowledge they have learned in the classroom. In addition to prehospital placements, paramedics also undertake ambulance placements, affording students opportunities to work with nursing students and emergency room nurses, thereby increasing their experience and improving their interprofessional skills.18,4750 With the exception of EMT-1 level, EMT students in Taiwan are required to complete ambulance and emergency room placement as part of their course. However, the fact that clinical placement occupies more than half of the available training hours on EMT-2 and EMT-Paramedic courses means that in-class and practice training hours are significantly less than in EMT-Paramedic training in other countries.5 Securing an ideal balance between in-class and placement hours requires further exploration using approaches that measure the number of training hours needed to acquire skills and core competencies.

Other methods

Simulation is recognized internationally as an important component in health care education in universities and hospitals. Several studies have highlighted the value of simulation as a method of learning in paramedic training, with significant benefits in terms of handling medical and trauma emergencies and students’ professional development.51,52 It should be acknowledged, however, that setting up a simulation service can present a challenge to many training organizations, due to the high costs involved and finding available space.

Williams et al purport that establishing self-directed learning (SDL) needs will assist paramedic educators in diagnosing student learning needs, and assist in shaping a contemporary and student-centered curriculum.53 Preparatory courses for reducing attrition rates in EMT training are another recommendation for improving the delivery of EMT training.54 Opportunities to introduce SDL and preparatory courses to EMT training and education in Taiwan should therefore be explored.


Only articles in English and Chinese were included in the search process, and it is possible that some EMS education-related articles in other languages may have been missed.

Future research

This study compared Taiwanese EMT competencies to international standards, and explored several key factors for improving EMT training and education curricula in Taiwan. According to the findings of this scoping review, current EMT scope of practice and curriculum standards in Taiwan do not provide clear direction and guidance for stakeholders in the EMT training system. There is a clear need to establish EMT core competencies in Taiwan to improve the training system and modify curricula content, with the purpose of meeting societal and the health care system’s needs. It is therefore recommended that future research explores all levels of EMT core competencies in Taiwan to establish a clear direction for the development and implementation of an improved Taiwanese EMT education system.


This study reviewed the international EMS training and education literature and documents to summarize the essential elements for developing an EMS education system. These essential elements were identified as core competencies and standards, education environment, curriculum design, and teaching and learning method. Comparison of Taiwanese EMS training standards and scope of practice with those in other countries demonstrated that EMS training conditions, development, and research in Taiwan are insufficient to meet current demand. Connecting the essential elements for developing an EMS education system and studying and analyzing each element provides educators in Taiwan with guidance and a blueprint for the future development of the Taiwanese EMS education system.


The authors report no conflicts of interest in this work.



Ministry of Health and Welfare. [2015 statistics of causes of death]; 2016. Accessed May 15, 2017. Chinese.


Ministry of Interior, National Fire Agency. Statistics of EMS in 2015. Available from: Accessed May 17, 2017.


Ministry of the Interior, Department of Statistics. Census data; 2016. Available from: Accessed May 17, 2017. Chinese.


Ministry of Interior, National Fire Agency. The review of 20 years of EMS development in Taiwan. 2014. Available from: Accessed May 14, 2017. Chinese.


Laws & Regulations Database of the Republic of China. Emergency Medical Technicians Administration Regulation; 1996. Available at: Accessed May 17, 2017. Chinese.


Health Professions Council of South Africa. Emergency Care Assistant Curriculum. Available at: Accessed May 18, 2017.


Pre-Hospital Emergency Care Council. STN016 – advanced paramedic education and training standard-V1; 2014. Available from: Accessed May 15, 2017.


National Highway Traffic Safety Administration. National EMS scope of practice model; 2007. Available from: Accessed May 12, 2017.


College of Paramedics. Paramedic Curriculum Guidance; 2014. Available from: Accessed May 15, 2017.


Paramedic Association of Canada. National occupational competency profile. Available at: Accessed May 12, 2017.


Alanazi AF. Curriculum design of emergency medical services program at the College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences. Adv Med Educ Pract. 2012;3:7–18.


Williams B, Onsman A, Brown T. Australian paramedic graduate attributes: a pilot study using exploratory factor analysis. Emerg Med J. 2010;27(10):794–799.


Cooper S. Contemporary UK paramedical training and education. How do we train? How should we educate? Emerg Med J. 2005;22(5):375–379.


Hallikainen J, Väisänen O, Rosenberg PH, Silfvast T, Niemi-Murola L. Interprofessional education of medical students and paramedics in emergency medicine. Acta Anaesthesiol Scand. 2007;51(3):372–377.


Thompson J, Grantham H, Houston D. Paramedic capstone education model: building work-ready graduates. Australas J Paramed. 2015;12(3).


Kilner T. Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: findings from a Delphi study. Emerg Med J. 2004;21(3):374–378.


Margolis GS, Romero GA, Fernandez AR, Studnek JR. Strategies of high-performing paramedic educational programs. Prehosp Emerg Care. 2009;13(4):505–511.


Wray N, McCall L. “They don’t know much about us”: educational reform impacts on students’ learning in the clinical environment. Adv Health Sci Educ Theory Pract. 2009;14(5):665–676.


Williams B. Qualitative analysis of undergraduate paramedic students’ perceptions of using case-based learning in an online learning environment. J Emerg Prim Health Care. 2006;4(3).


Willis E, Williams B, Brightwell R, O’Meara P, Pointon T. Road-ready paramedics and the supporting sciences curriculum. Focus Health Prof Educ. 2010;11(2):1–13.


Kuo S, Kao Y, Chang K. In-service educational programs for Class II Emergency Medical Technicians in New Taipei City: a needs assessment. J Nurs Healthc Res. 2012;8(4):288.


Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.


Reeve C, Pashen D, Mumme H, De la Rue S, Cheffins T. Expanding the role of paramedics in northern Queensland: an evaluation of population health training. Aust J Rural Health. 2008;16(6):370–375.


Kilner T. Educating the ambulance technician, paramedic, and clinical supervisor: using factor analysis to inform the curriculum. Emerg Med J. 2004;21(3):379–385.


Williams B, Onsman A, Brown T. A Rasch and factor analysis of a Paramedic Graduate Attribute scale. Eval Health Prof. 2012;35(2):148–168.


Limmer DD. Charting a new course. An introduction to the new EMS Education Standards: part 1. EMS Mag. 2009;38(9):27–28, 30–32.


Limmer DD. Getting down to details. An introduction to the new EMS Education Standards: part 2. EMS Mag. 2009;38(10):47–51, 97.


The Council of Ambulance Authorities. Professional competency standards; Paramedics; 2010. Available from: Accessed May 16, 2017.


Brown T, Williams B, Lynch M. The Australian DREEM: evaluating student perceptions of academic learning environments within eight health science courses. Int J Med Educ. 2011;2:94–101.


O’Meara P, Ruest M, Stirling C. Community paramedicine: higher education as an enabling factor. Australas J Paramed. 2014;11(2).


Brooks IA, Sayre MR, Spencer C, Archer FL. An historical examination of the development of emergency medical services education in the US through key reports (1966–2014). Prehosp Disaster Med. 2015;31(1):90–97.


Salzman JG, Page DI, Kaye K, Stetham N. Paramedic student adherence to the National Standard Curriculum recommendations. Prehosp Emerg Care. 2007;11(4):448–452.


Margolis GS. The Role of Bachelor’s Degree Emergency Medical Services Programs in the Professionalization of Paramedicine [doctoral thesis]. Pittsburgh: University of Pittsburgh; 2005.


Brice JH, Perina DG, Liu JM, Braude DA, Rinnert KJ, MacDonald RD. Development of an EMS curriculum. Prehosp Emerg Care. 2014;18(1):98–105.


Ross L, Williams B. Paramedics developing rapport with the elderly: a pilot study. J Paramed Pract. 2014;6(3):128–136.


Russ-Eft DF, Dickison PD, Levine R. Instructor quality affecting emergency medical technician (EMT) preparedness: a LEADS project. Int J Train Dev. 2005;9(4):256–270.


Hryciw DH. Enhancing an undergraduate Paramedic degree through the introduction of a health fact sheet assessment task. J Emerg Prim Health Care. 2009;7(3).


Williams B. Case based learning – a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J. 2005;22(8):577–581.


Williams B. Using creative and contemporary teaching strategies to promote emancipation, empowerment and achievement in undergraduate paramedic students – a personal reflection. J Emerg Prim Health Care. 2006;4(2):13.


Williams B. Do undergraduate paramedic students embrace case-based learning using a blended teaching approach? A 3-year review. Australas J Educ Technol. 2009;25(3):421–439.


Williams B, Boyle M, Brightwell R, et al. A cross-sectional study of paramedics’ readiness for interprofessional learning and cooperation: results from five universities. Nurse Educ Today. 2013;33(11):1369–1375.


Brown WE Jr, Margolis G, Levine R. Peer evaluation of the professional behaviors of emergency medical technicians. Prehosp Disaster Med. 2005;20(2):107–114.


Williams B, Wallis J, McKenna L. How is peer-teaching perceived by first year paramedic students? Results from three years. J Nurs Educ Pract. 2014;4(11):8–15.


Williams B, Hardy K, McKenna L. Near-peer teaching in paramedic education: results from 2011 to 2013. Med Sci Educ. 2015;25(2):149–156.


Williams B, Olaussen A, Peterson EL. Peer-assisted teaching: an interventional study. Nurse Educ Pract. 2015;15(4):293–298.


Williams B, Fowler J. Can near-peer teaching improve academic performance? Int J High Educ. 2014;3(4):142–149.


Boyle MJ, Williams B, Cooper J, Adams B, Alford K. Ambulance clinical placements – a pilot study of students’ experience. BMC Med Educ. 2008;8:19.


Brown T, Williams B, McKenna L, Palermo C, McCall L, Roller L. Practice education learning environments: the mismatch between perceived and preferred expectations of undergraduate health science students. Nurse Educ Today. 2011;31(8):e22–e28.


Melby V. Experiential learning in pre-hospital emergency care: a qualitative study. Nurse Educ Today. 2000;20(8):638–645.


Williams B, French J, Brown T. Can interprofessional education DVD simulations provide an alternative method for clinical placements in nursing? Nurse Educ Today. 2009;29(6):666–670.


Boyle M, Williams B, Burgess S. Contemporary simulation education for undergraduate paramedic students. Emerg Med J. 2007;24(12):854–857.


Abelsson A, Rystedt I, Suserud BO, Lindwall L. Mapping the use of simulation in prehospital care – a literature review. Scand J Trauma Resusc Emerg Med. 2014;22:22.


Williams B, Boyle M, Winship C, Brightwell R, Devenish S, Munro G. Examination of self-directed learning readiness of paramedic undergraduates: a multi-institutional study. J Nurs Educ Pract. 2013;3(2):102–111.


Renkiewicz GK, Hubble MW. The attrition condition: use of a preparatory course to reduce EMT course attrition and improve performance on North Carolina certification exams. Prehosp Emerg Care. 2015;19(2):260–266.


Hamilton L. Embedding information literacy into the prehospital care curriculum. Australasian Journal of Paramedicine. 2008;6(1):1–6.


Michau R, Roberts S, Williams B, Boyle M. An investigation of theory-practice gap in undergraduate paramedic education. BMC Medical Education. 2009,9:23.


Ross L, Wallis J, Huggins C, Williams B. Students’ views of teachers using the Clinical Teaching Effectiveness Inventory. Journal of Paramedic Practice. 2013;5(6):336–340.


Pullum JD, Sanddal ND, Obbink K. Training for rural prehospital providers: A retrospective analysis from montana. Prehospital Emergency Care. 1999;3(3):231–238.


Ministry of the Interior; Republic of China (Taiwan). Laws and Regulations; Regulations for Emergency Medical Services. Available from: Accessed May 14, 2017.

Supplementary materials

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

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