# Prevalence and Impact of Simulation Substitution on Paramedic Educational Program Success: A National Examination

## TL;DR

This study examines how often paramedic programs use simulation instead of real clinical training and finds that heavy reliance on simulation may lower success rates on certification exams.

## Contribution

The study quantifies the prevalence of simulation substitution in paramedic education and links it to certification exam outcomes for the first time.

## Key findings

- 59% of paramedic programs used simulation substitution for clinical skills.
- Programs substituting more than five skills had lower first-attempt certification exam success.
- Simulation substitution above five skills was associated with reduced odds of exam success.

## Abstract

Objectives

Paramedic educational programs require sufficient rigor to prepare students to perform complex, life-saving skills. Occasionally, live clinical training opportunities are unavailable, leading to simulated skill substitution to meet training requirements. The objective of this study is to describe the prevalence of simulation substitution for clinical skills and its association with paramedic educational program success.

Methods

The current study is a cross-sectional evaluation of paramedic educational programs graduating students in 2019. The study utilizes the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions' annual report, which includes data on program demographics, outcomes, and questions on the use of simulation. Simulation substitution was assessed using a composite of 11 commonly taught adult/pediatric clinical skills. Descriptive statistics (n, %) and multivariable logistic regression modeling (odds ratio (OR), 95% confidence intervals (CI)) were used to describe the association of simulation substitution frequency and first-attempt certification exam success, defined as a program pass rate ≥75%, adjusting for program characteristics.

Results

A total of 640 paramedic educational programs met the inclusion criteria. Of these, 59% (379/640) had simulation substitution of skills, with the extent of substitution being variable (1-5 skills: 25% (161/640); 6-7 skills: 18% (118/640); ≥8 skills: 16% (100/640)). Paramedic program first-attempt certification examination success decreased as simulation substitution increased above five skills (OR, 95% CI: 1-5 skills: 0.71, 0.46-1.08; 6-7 skills: 0.51, 0.32-0.82; ≥8 skills: 0.53, 0.32-0.87; referent 0 skills).

Conclusions

Simulation substitution for isolated clinical skills is common in paramedic educational programs; however, frequent reliance on simulation may reduce the likelihood of first-attempt program success on the national certification examination.