There is an impending shortage of paramedics within the United States, complicated by low success rates on the national credentialing examination and decreased access to clinical and field internship opportunities. The use of computer based-clinical simulations within paramedic education has the potential to provide improved access to student-patient interactions and a cost-effective, objectively measured, experiential-learning environment that may improve examination pass rates and ameliorate the paramedic shortage.
The primary objective of this study was to investigate differences in scores obtained on the national paramedic credentialing examination associated with use of computer-based clinical simulations, paramedic service type, and gender, after controlling for scores obtained on the national emergency medical technician (EMT) credentialing examination. A secondary purpose was to investigate faculty use of coaching, scaffolding, debriefing, and remediation pedagogies when implementing computer-based clinical simulations.
The quantitative research data, provided by the National Registry of Emergency Medical Technicians (NREMT), included 5966 student records completing the national paramedic credentialing examination during the inclusive dates of July 1, 2007 and June 30, 2008. The qualitative research data, provided by Elsevier Inc., producer of a clinical simulation product called Virtual Patient Encounters (VPE), included responses to focus group interview questions from 9 paramedic faculty who used the VPE during the inclusive dates of the study.
Major findings of the quantitative analysis of this study included the absence of a significant effect of VPE usage on student examination performance, as well as an absence of significant higher order interaction effects. ANCOVA analysis revealed significant main effects for both service type and gender. Study participants indicating service type as fire-based or gender as male tended to achieve higher scores on the national paramedic credentialing examination, than did those study participants who indicated service type as non–fire-based or gender as female. However, the effect sizes were very small, suggesting little practical significance to these findings. The qualitative analysis of this study revealed paramedic faculty made little, if any, pedagogical changes when implementing the computer-based clinical simulation in the classroom. The lack of improvement in student examination scores is disappointing; however, it is clear that the use of VPE did not degrade student performance. This is an important finding when combined with the evidence that faculty failed to implement the computer-based clinical simulation product as recommended by the developer and failed to utilize the pedagogies necessary for success. This suggests that the use of computer-based clinical simulations may indeed improve student performance, if students are provided with the necessary tools and education to effectively use reflective thinking and faculty use the necessary pedagogies related to technology-based education.
The causal comparative nature of the current research suggests that future research in this arena should include a true experimental, balanced design that provides some level of understanding about the causal link between educational practice and educational outcomes. Additional lines of inquiry, such as the theory underlying knowledge creation in simulation environments and the educator’s belief system with respect to educational simulations, are recommended.