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Abstract

Trans Abstract

Ⅰ. Introduction

In order to produce personnel to properly respond to various types of emergencies such as disasters and accidents across the country, department of emergency medical services was created in universities in 1995 and the department began educating paramedics. Due to an increase in cardiovascular and cerebrovascular patients and deaths and severe trauma patients, the need for emergency medical personnel who could perform emergency medical service before the patients arrive the hospital or inside the emergency room (ER) of the hospital was reflected in healthcare personnel policies, and as a result, 15,371 paramedics have been produced thus far [1].

Recently, the types of accidents are becoming more diversified in accordance with progress in science and society, and the types of disasters are also changing. As the population ages and the distribution of occurred diseases changes, it changes paramedics’ job description. In addition, paramedics’ professionalism and diversity required by society has changed the education or academic system of educational institutions which train paramedics. In other words, department of emergency medical services, which began in 2-year colleges in 1995, was re-organized into 3-year colleges or 4-year universities in 2001 and started developing talents who were adequate to perform professional tasks [2]. The paramedic national test consists of written and practical tests, and a paramedic applicant should acquire 60% or higher out of 290 points to earn his or her certification [3].

Even though paramedics, who are produced through a 3-year or 4-year curriculum in university and then the national test, provide professional emergency medical service to patients, they are certified, not licensed, and hence it places some limitations on enhancing their professionalism.

This study aims to re-establish the education system to develop paramedics’ core competency, to explore changes to ensure that the national test scheme reflects paramedics’ job competencies, and to review whether a “certification” is acceptable in consideration of paramedics’ job duties.

Ⅱ. Methods

Ⅲ. Results

1. Improving the paramedic education system

1) Job core competencies

Based on two paramedic job analyses in 2001 and 2013 and expert meetings, this study derived 9 core competencies for paramedics: 1. Vocational responsibility competency, 2. Communication and cooperation competency, 3. Emergency telecommunications competency, 4. Emergency patient evaluation competency, 5. Professional emergency medical service competency, 6. Disaster and safety management competency, 7. Transport and ambulance operation competency, 8. Medical assistance competency, and 9. Self-development competency. More than 90% of the questionnaire subjects agreed with 9 core competencies and 35 abilities <Table 1>.

Table 1.

Agreement with paramedics’ job-based core competencies in respondents (N=277)

2) Suggesting the standardized paramedic curriculum and job competency matrix related to curriculum courses

Based on the analysis results of curriculum tables of 17 4-year universities and 21 3-year colleges and the questionnaire survey results [4], this study proposed a standardized paramedic curriculum with increasing disaster management 2 credits to 3 credits by focus group interview. For the standardized curriculum, this study suggested 27 courses in total with 94 credits: 2 general education courses, 6 basic medicine courses, 3 advanced emergency medical service – general courses, 2 emergency patient management courses, 9 advanced emergency medical service – specific courses, 1 law course, 1 medical assistance course, and 3 field practice courses.

An expert panel meeting was held to review the standardized draft curriculum and a “job competency matrix based on the standardized curriculum for paramedics” was developed. Following a public hearing, further revisions were introduced and the final draft of the curriculum was confirmed <Table 2>.

Table 2.

The standardized paramedic curriculum and job competency matrix related to curriculum courses

2. Improving the national paramedic examination

Korea’s national paramedic examination consists of written and practical tests. The written test is comprised of 230 points in total: basic medicine (30 points), emergency patient management (40 points), advanced emergency medical service-general (30 points), emergency medical service law (20 points), and advanced emergency medical service-specific (110 points). The practical test is 60 points in total and made up of 3 subjects in practical 1 (30 points), 9 subjects in practical 2 (20 points), and physical health (abdominal muscle strength) (10 points). The applicant randomly chooses 1 item in practical 1 and 1 item in practical 2 to take the test.

This study surveyed expert comments on the relevance of the national test (written and practical tests) to paramedic job duties. The expert comments on the written test’s relevance to paramedic job duties showed that 48.2% of education experts “agreed” and 16.9% of them “strongly agreed” while 39.2% of field experts “agreed” and 18.9% of them “strongly agreed”. About the practical test’s relevance on paramedic job duties, on the other hand, 38.6% of education experts “agreed” and 9.6% of them “strongly agreed” while 38.1% of field experts “agreed” and 12.1% of them “strongly agreed”. Overall, the survey results demonstrated that the national test was relevant to paramedic job duties <Table 3>.

Table 3.

National test relevance to paramedics job performance (N=277)

1) Suggestion to improve the written test

39% of the experts agreed to the suggestion to consolidate the current 5 subjects in the written test, while 28.9% “disagreed” to this idea and the rest said they were not decided. In regards to the number of consolidated subjects, 43.9% said they preferred 3 subjects (advanced emergency medical service-general, advanced emergency medical service-specific, and emergency patient management), 20.8% 2 subjects (advanced emergency medical service-general and advanced emergency medical service-specific), and 15.6% 2 subjects (advanced emergency medical service and basic medicine).

2) Suggestion to improve the practical test

(1) Results of the survey about how to improve the practical test

47.3% of the respondents said the simple performance test and the scenario test should go in tandem with one another as a way to improve the practical test, and 28.5% said scenario questions for around 10 minutes based on cases should be developed <Table 4>.

Table 4.

Survey on improvement of the practical test (N=277)

(2) Suggestion to set critical criteria

In regards to applying critical criteria to simple performance (a procedure-based practical test) in the practical test, the majority 83.1% of the experts–87.5% of the education experts and 81.3% of the field experts–said critical criteria should be put in place <Table 5>.

Table 5.

Survey on critical criteria for subjects in the practical test (N=272)

3) Suggestions for determining the passing standard for the national paramedic examination

An expert survey was conducted to identify the written and practical test criteria to determine the passing standard for the national paramedic examination. The results showed that the majority (62.6%) of the experts responded that “the passing standard should be set according to a pass/fail basis for the practical test and a raw score for the written test.” Specifically, 71.6% of experts in education and 58.7% of field experts responded that the passing standard should be determined by a written test only <Table 6>.

Table 6.

Expert survey on improvement measures for determining passing criteria for the national examination (N=275)

3. Improving the paramedic certification scheme

About paramedics’ certification, 254 education and field experts, 92.7% of 274, said that certification should “change to license” in response to the question whether to “convert certification into license” <Table 7>.

Table 7.

Converting the paramedic certification scheme into the license one (N=274)

About the reason why certification should convert into license, many experts said “paramedics’ scope of work amounts to medical service” and “they are experts who perform invasive emergency medical service that treats life”. Some respondents said, “Since they are qualified with a certification, illegal certifications are produced in large numbers, reducing the quality of emergency medical service” <Table 8>.

Table 8.

Reasons for conversion of paramedics’ certification to license

Ⅳ. Discussion

In order to enhance paramedic’s competences for expanded job duties as required by the contemporary society, it would be one of the most important roles to standardize the curriculum in different universities, develop new education courses that keep up with today’s world, and educate and produce paramedics so that they could be equipped with specialized job competencies. Thus far, the second paramedic job analysis was conducted in 2013 [5], that is, the paramedic job was categorized into 10 duties, 57 tasks, 240 task elements. Based on these analyses, this study set forth “1. Vocational responsibility competency and 2. Communication and cooperation competency” as core competences for required general education courses and “3. Emergency telecommunications competency, 4. Emergency patient evaluation competency, 5. Professional emergency medical service competency, 6. Disaster and safety management competency, 7. Transport and ambulance operation competency, 8. Medical assistance competency, and 9. Self-development competency” as core competences for major courses. In addition, based on the standardized curriculum developed by analyzing the curriculums of 17 4-year universities and 21 3-year colleges that produce paramedics [4], this study derived the “core competencies matrix” of job duties for subjects in the standardized paramedic curriculum. This would be significantly meaningful in that it lays the foundation for universities and colleges that produce paramedics to operate their curriculum based on the standardized curriculum and core job competencies.

While both education and field experts answered yes to the question whether written and practical tests in the national test are relevant to paramedic job duties, it would be needed to make the written test more focused on practical competencies and problem solving and to consolidate the current 5 subjects into fewer ones.

The current passing standard for the practical test is a score of 60% or higher of the total score. However, previous studies have suggested that criteria should be set whereby the applicant fails the test if a seriously decisive error is found for any test item [6]. In the US, critical criteria have been suggested for the practical test items in national examination for paramedics whereby the applicant fails if he or she fails to “secure an IV line” and “perform endotracheal intubation” within a given time limit or cannot explain the practice of body substance isolation prior to venipuncture [7]. In the present study, 87.5% of experts in education and 81.3% of field experts agreed on establishing failing criteria.

Therefore, the practical test needs to expand the number of evaluated subjects required on the field and develop scenario-based performance subjects. For the practical test, it would be equally needed to set critical criteria in the simple performance test among other protocols so that evaluation criteria are put in place to ensure an appropriate level of difficulty in the national test.

Paramedics are the personnel who are at the forefront in performing works to ensure the health and safety of people. Given their significance that they are providing invasive emergency medical service that treats life, their current certification needs to convert into a license. In this rapidly changing emergency medical service environment, it would be needed to establish a quality refresher education system and to manage paramedics’ qualification so that paramedics could continue to learn the latest knowledge and views instead of staying where they are.

If a reasonable and appropriately difficult national test makes sure a certification is given to those who could fully tap into their potential based on the standardized education system as suggested in the aforementioned results of this study, it would greatly contribute to nurturing and producing paramedics who are extraordinary in their ability to adapt to the situation on the site. When the paramedic education system, the national test scheme, and the certification management system create a virtuous cycle, it would improve the quality of emergency medical service in Korea.

Ⅴ. Conclusion

With the purpose of educating and producing outstanding paramedics by enhancing their competencies, this study aimed to make policy suggestions to re-establish the education system and improve the national examination and the certification scheme.

This study suggested 27 courses with 94 credits as the standardized curriculum and derived paramedics’ 9 core competencies. For the national examination, this study suggested consolidating written test subjects, adding scenario questions to the practical test, and applying critical criteria to the simple practical test that performs a procedure, grading practical test on pass/fail basis. This study also suggested converting certification into license, reflecting paramedics’ healthcare job characteristics.

In conclusion, the quality of emergency medical services in Korea would improve when those with core competencies produced from the standardized curriculum based on the results of this study acquire their certification through the national test scheme, and the certification management system creates a virtuous cycle to further enhance paramedics’ professionalism.

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