Medical Directors, Facilities, and Finances: Resource Deficiencies in Accredited Paramedic Programs

Figures & data

Figure 1. Flow chart of the paramedic program RAM deficiencies and their distributions. A total of 143 of 626 programs report RAM deficiencies, with a cumulative total of 406 deficiencies ((1 * 54) + (2 * 33) + etc.).

Table 1. Demographics of paramedic educational programs that are RAM-compliant or have RAM deficiencies.

	RAM-compliant N = 483	RAM deficiencies N = 143
Program Graduation, % median (IQR)	81 (72, 90)	79 (65, 86)
Students enrolled in programs
Total students enrolled	13,244	4,178
Median (IQR)	18 (11, 30)	17.5 (12, 30)
Months to program completion, median (IQR)	12 (12, 16)	12 (12, 17)
Total hours to instruction, median (IQR)	1168 (1060, 1311)	1200 (1065, 1290)
Full-time faculty, median (IQR)	2 (1, 2)	2 (1, 2)
Graduated cohort categories by programs (n = 626)
1	308 (63%)	92 (66%)
2	95 (20%)	31 (22%)
3	44 (9%)	3 (2%)
≥ 4	39 (8%)	14 (10%)
Graduating programs by NASEMSO regions (n = 626)
East	68 (14%)	35 (25%)
South	192 (40%)	48 (34%)
Great Lakes	110 (23%)	26 (19%)
Western Plains	63 (13%)	11 (8%)
West	53 (11%)	19 (14%)
N/A	0	1
Annual program budget (n = 620)
$1–$100,000	171 (35%)	42 (30%)
$100,001–$500,000	211 (44%)	72 (52%)
$500,001–$1,000,000	45 (9%)	8 (6%)
$1,000,001–$1,500,000	18 (4%)	3 (2%)
1,500,001–$2,000,000	4 (1%)	1 (1%)
Prefer not to answer	33 (7%)	12 (9%)

Table 2. Identified RAM deficiency domains and their frequencies (n = 406 deficiencies).

	Frequency (%) N = 406
Medical director	55 (14%)
Facilities	54 (13%)
Financial resources	51 (13%)
Support personnel	46 (11%)
Physician interaction	43 (11%)
Program faculty	42 (10%)
Clinical resources	32 (8%)
Field resources	29 (7%)
Curriculum	28 (7%)
Learning resources	26 (6%)

Table 3. Theme frequency for each RAM domain.

Domain	Theme	Frequency (%)
Medical director	Limited interaction with program and/or students	39/43 (91)
	Lack of understanding of survey question	2/43 (5)
	Medical director turnover	2/43 (5)
Facilities	Lack of classroom space and/or equipment	17/42 (40)
	Lack of lab time and/or equipment	15/42 (36)
	Temperature management/ too hot/cold	8/42 (19)
	No identified lab space	2/42 (5)
Financial resources	Lack of equipment and/or lack of faculty	17/34 (50)
	Lack of scholarship/financial aid and/or contact with the financial aid office	13/34 (38)
	Lack of professional development for faculty	2/34 (4)
	Lack of understanding of survey question	1/34 (2)
	Lack of special education opportunities such as field trips	1/34 (2)
Support personnel	Lack of clerical staffing	17/34 (50)
	Lack of educational staffing	9/34 (26)
	Lack of academic advising	3/34 (9)
	Lack of admissions support	3/34 (9)
	Lack of support staff	1/34 (3)
	Lack of library support	1/34 (3)
Physician interaction	Lack of interaction with students/program	32/34 (94)
	Lack of understanding of survey question	2/34 (6)
Program faculty	Lack of or inadequate faculty/faculty communication	20/21 (95)
	Lack of administrative support	1/21 (5)
Clinical resources	Lack of clinical sites	6/15 (40)
	Insufficient hospital orientation	3/15 (20)
	Loss of clinical coordinator	2/15 (13)
	Lack of clear evaluation methods/preceptor consistency	2/15 (13)
	Lack of patient contacts	1/15 (7)
	Lack of understanding of survey question	1/15 (7)
Field resources	Lack of clear evaluation methods/preceptor consistency	4/13 (31)
	Lack of understanding of survey question	2/13 (15)
	Lack of adequate patient encounters	2/13 (15)
	Lack of adequate field sites	2/13 (15)
	Lack of or inadequate field orientation	2/13 (15)
	Lack of preceptors	1/13 (8)
Learning resources	Lack of access to library or reference material	8/16 (50)
	Lack of lab time and/or equipment	3/16 (19)
	Lack of best practices for educational delivery	2/16 (13)
	Lack of technology in the classroom	2/16 (13)
	Lack of training for faculty	1/16 (6)
Curriculum	Inadequate sequencing of lecture/lab content	4/12 (33)
	Lack of educational best practices	4/12 (33)
	Textbook change	2/12 (17)
	Lack of faculty	1/12 (8)
	Lack of simulation training	1/12 (8)

Table 4. Common action plans identified for each deficiency domain.

Domain	Action Plan
Medical director	Seek to hire a new medical director
	Seek to hire an assistant medical director
	Speak to medical director about program involvement
	Continue to monitor
Facilities	Advocate to build a new facility
	Build a new facility/building underway
	Provide more staffing support in skill labs
	Continue to monitor
Financial resources	Improve laboratory space
	Increase staffing time in the laboratory
	Increase communication between the financial aid office
	Advocate to hire additional faculty
	Continue to monitor
Support personnel	Advocate for additional clerical staff
	Hire additional clerical staff
	Continue to monitor
Physician interaction	Increase medical director commitment in the classroom
	Ask medical director to speak to clinical sites about physician interaction
	Review with students the intent of the question
	Continue to monitor
Program faculty	Advocate for hiring additional faculty members
	Hire additional faculty members/hiring is in progress
	Increase communication between clinical coordinator and students
Clinical resources	Increase clinical sites/ number of preceptors
	Develop preceptor training
	Increase communication between clinical coordinator and students
	Hire a clinical coordinator
Field resources	Increase field sites/ number of preceptors
	Develop preceptor training/ increased oversight of preceptors
Learning resources	Increase opportunities for professional development
	Continue to monitor
Curriculum	Increase time in the classroom
	Increase time in the skill lab
	Complete additional lesson plans/mapping