Examining distress among Saudi paramedics in responding to traumatic events: A mixed-methods study.

INTRODUCTION: Paramedics are critical in providing timely medical care to injured patients and responding to trauma events. However, they are often exposed to traumatic events such as death, serious injuries, and violence, which can increase their risk of developing mental health disorders. The nature of their work, including uncontrolled environments and frequent exposure to trauma, as well as the severity of the patient's conditions, all contribute to this risk. This study aims to investigate the distress experienced by Saudi paramedics in response to traumatic events. METHODS: An explanatory sequential mixed-methods approach was used to explore the experiences of distress among a sample of paramedics following traumatic events. RESULTS: The study found that the participants ranked assaults and road traffic collisions as the most concerning traumatic events. Qualitative analysis of the data revealed several themes related to the participants' experiences, including emotional well-being, violence, road traffic collisions, death, personal limitations, culture, coping strategies, and professional support. CONCLUSIONS: The study highlights the high levels of distress experienced by paramedics in response to road traffic collisions, with intrusion and avoidance symptoms being the most commonly reported.

The Perceptions and Expectations of the Clinical Learning Environment in Saudi Arabia: a Multidisciplinary Study.

Background: The clinical learning environment is a fundamental component of healthcare education. In this setting, students can develop the skills and knowledge necessary to become competent and efficient healthcare practitioners. Due to the importance of clinically based education, it is crucial to have a valid and reliable tool to enable its evaluation. Objective: The aim of this study was to use the Clinical Learning Environment Inventory (CLEI) to examine the perceptions of Saudi undergraduate healthcare students regarding their actual and preferred clinical learning environment and explore the differences between the two viewpoints. Methods: A cross-sectional survey design was utilised with a cohort of Saudi undergraduate healthcare students. Data regarding perceptions of the 'actual' and 'preferred' clinical learning environments were gathered with the Clinical Learning Environment Inventory tool. Results: A total of 194 students participated and nine healthcare disciplines were represented. The highest mean score for both 'actual' and 'preferred' clinical learning environment was for the subscale Task Orientation. Significant differences between 'actual' and 'preferred' environments were demonstrated for Innovation and Individualization, with both subscales scoring higher for the 'preferred' environment. All five subscales-Individualization, Innovation, Involvement, Personalization, and Task Orientation-appear to be important aspects contributing to student satisfaction with their clinical learning environment. Conclusion: Saudi healthcare students demonstrate a preference for a clinical learning environment with the utilization of new and interesting experiences, as well as recognition and accommodation of student individuality. Additionally, student satisfaction appears to be multifactorial in origin. Therefore, there may be many avenues available to enhance the clinical experiences of healthcare students, which is vitally important for the optimization of clinical learning opportunities.

No Two Systems Are the Same: Paramedic Perceptions of Contemporary System Performance Using Prehospital Quality Indicators.

Introduction In recent years, researchers have identified two new models of paramedicine within the Anglo-American paramedic system known as the Directive and Professionally Autonomous paramedic systems. The research team now seek to compare paramedic perception of system performance between the two systems using prehospital quality indicators. Methods Paramedics employed within Anglo-American paramedic systems undertook a survey evaluating their experience and perception of system performance against a set of modified prehospital quality indicators. Data were collected using a survey combining single-choice questions with matrix multiple-choice questions. Key results were cross-tabulated with demographic (informant) and system factors to compare performance between the two new paramedic systems. Results The survey indicated a substantial difference in perceived clinical and operational performance between the Professionally Autonomous and Directive paramedic systems, with the Professionally Autonomous paramedic system performing consistently better in all 11 prehospital quality indicator domains. Conclusion The results of this survey are a vital step in helping paramedics, health leaders, and academics understand the complex relationship between paramedic system design and system performance, and, for the first time, provides empirical evidence upon which to make a conscious decision to adopt one system or the other.

Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization.

BACKGROUND: Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. OBJECTIVE: To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. METHODS: This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. RESULTS: A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. CONCLUSION: This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.

Clinical reasoning in undergraduate paramedicine: utilisation of a script concordance test.

INTRODUCTION: Clinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students? METHODS: This was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses. RESULTS: Eighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p < 0.001). DISCUSSION: Clinical reasoning skills are not easily acquired as they are a culmination of education, experience and the ability to apply this in the context to a specific patient. The SCT has shown to be reliable and effective in measuring clinical reasoning in undergraduate paramedics as it has in other health professions such as nursing and medicine. More investigation is required to establish effective pedogeological techniques to optimise clinical reasoning in student and novice paramedics who are devoid of experience.

A conceptual framework for the exploration of the relationship between systems of paramedicine and system performance.

BACKGROUND: Over the past 60 years since its inception, the Anglo-American Paramedic System has continued to grow and evolve. While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a paucity of research that explores and identifies sub-models of paramedicine within the Anglo-American Paramedic System. OBJECTIVES: This article describes a conceptual framework that sets a roadmap for defining and comparing two newly identified sub-models of the Anglo-American Paramedic System. METHODS: A conceptual framework for the exploration of these novel sub-models was developed on the basis of the work completed by Donabedian as well as Turncock and Handler. These two sub-models worked to develop a model for quality assessment and performance measurement in the public health system. RESULTS: The conceptual framework consists of six components that are strongly related to each other: system design, macro context, mission and purpose, structure, service delivery models and quality outcome measures. While this framework relates specifically to two novel paramedic systems known as the Professionally Autonomous an Directive paramedic systems, it can be used to measure any integrated health model. CONCLUSION: The conceptual framework described in this paper provides a stepwise roadmap for the definition and comparison of the newly identified paramedic systems to better inform future research that defines and compares paramedic system design and performance.

Comparison of physical demanding paramedic work tasks between an Australian and Canadian ambulance service.

Ambulance services require candidates to pass physical employment tests (PETs) to be deemed suitable for the paramedic role. Whilst some research has been undertaken to improve to relevance of these tests, they are often arbitrary and not based on research. The first phase in developing PETs is to generate a list of job tasks. To examine the utility of universal physical tasks tests for ambulance work, we conducted a cross-sectional study, utilising the results from previous work in a Canadian ambulance service to create a physical tasks checklist. These lists were then used by paramedics working for an Australian Service to identify physical tasks in their workplace, and the results from the two services were compared. Patient transfer tasks were similar in frequency and description for both services. Stretcher handling and manoeuvring was identified by Canadian paramedics as highly strenuous, (mean rating of perceived exertion (RPE) 7/10) but were rated mean RPE <3/10 by AV paramedics. Although some tasks between these two services were similar, the ambulance services in this study differed sufficiently with regard to equipment, training and policies mean that similarly titled jobs are not comparable, cross-nationally. Service specific job task analysis is required to develop PETs that ensure employees are specifically selected to meet the requirements of that service.

From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system.

BACKGROUND: This narrative review presents a brief chronological history of the Anglo-American paramedic system, combining decades of stories from across ambulance services in western, English-speaking developed countries METHODS: Databases, including Embase, MEDLINE, Web of Science, CINAHL and Google Scholar were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forwards and backwards searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Included studies were summarised using narrative synthesis structured around the exploration of the history of the Anglo-American paramedic system. RESULTS: The research team structured the narrative in chronological order and used metaphorical models based on philosophical underpinnings to describe in detail each era of paramedicine. The narrative explores several key milestones including, industrial orientation, scope of practice, innovation, education and training, regulation as well as significant clinical and technological advancements in the delivery of traditional and non-traditional paramedic care to patients. CONCLUSIONS: Paramedicine, like other allied health professions, has successfully navigated the pathway toward professionalisation in a considerably short period of time. From its noble beginnings as stretcher bearers in times of war, the profession has looked outwards to emulate the success of our healthcare colleagues in establishing its own unique body of knowledge supported by strong clinical governance, national registration, professional regulatory boards, self-regulation, and a move towards higher education supported by the development of entry-to-practice degrees. Whilst the profession has achieved many great milestones, their application across multiple jurisdictions within the Anglo-American paramedic system remains inconsistent, and more research is needed to explore why this is.

Saudi female paramedics' perceptions of challenges in the workplace: A qualitative study.

BACKGROUND: It is immensely important that Saudi women become involved in the field of paramedicine in larger numbers; however, anecdotally they continue to experience significant challenges that limit their opportunities for recruitment and deployment in the field. This study set out to explore working female paramedics' perceptions of challenges in their workplace in the Kingdom of Saudi Arabia (KSA). METHODS: This study utilised a descriptive qualitative approach. Fifteen Saudi female paramedics were recruited to attend one of four focus groups in Riyadh, Saudi Arabia. Data were assessed using thematic analysis. RESULTS: Three themes emerged from the focus groups that described the perceptions of Saudi female paramedics: personal factors, social factors and employment-related factors. They faced several challenges that could affect their family responsibilities, workplace duties and capacity to work in the field of paramedicine. Saudi society also challenged female paramedics, as the culture and traditions of the KSA limited their participation in the paramedicine workforce. Furthermore, they reported experiencing many employment issues related to recruitment to pre-hospital settings, resulting from organisational policies and procedures. CONCLUSION: This study investigated the perceptions held by a cohort of female Saudi paramedics of the personal and professional challenges they faced in the workplace in the KSA. The study findings and their implications for female paramedics suggest further research is required to understand the unique challenges they face and to develop various strategies to manage them.

Saudi Arabian Community Perceptions on Saudi Female Paramedics: A Cross-Sectional Study.

INTRODUCTION: Although emergency medical services (EMS) stakeholders acknowledge the need for both male and female paramedics in the EMS field, the Saudi EMS system is currently only staffed by male paramedics and emergency medical technicians (EMTs) working in EMS organisations. AIM: To understand and explore the Saudi Arabian community's perceptions on engaging Saudi female paramedics in the EMS workforce. MATERIAL AND METHODS: This was a cross-sectional survey design using convenience sampling of the public in Riyadh city by self-administered English and Arabic language questionnaires. Questionnaire validity was assessed by face and content validity. RESULTS: Of the 3603 surveys distributed, 3132 were returned (87% completion response rate). Most respondents were aged between 18 and 29 years (n = 1308, 41%), and the sex distribution was (n = 1646, 52.6%) male and (n = 1486, 47.4%) female. Overall, 77% (n = 2412) of the respondents supported the need for female paramedics in Saudi Arabian ambulance services, and 74.8% (n = 2343) preferred that female paramedics treated female patients. CONCLUSION: This is the first public study to explore Saudi public perceptions about female paramedics in EMS in the Riyadh region, Saudi Arabia. The Saudi public is supportive of female paramedics being employed as paramedics in the country. Moreover, significant differences in perceptions were evidenced in the sex groups over any other factors.

Becoming a better paramedic through the special needs school placement program.

Paramedics provide care in medical emergencies to patients with varying ages and from a range of settings, cultures, backgrounds and experiences. As such, the paramedic needs a very diverse skill set which is difficult to obtain at university. For this reason, undergraduate paramedic students often engage in clinical placements to apply their knowledge to real world experiences. Most of these placements, however, are in hospitals or ambulance settings, but part of the diverse community that paramedics treat are children with special needs, including children with disabilities. This study measured the attitudes of paramedic students to people with disabilities and explored the effectiveness of paramedic student clinical placements in special needs schools. 109 paramedic students enrolled in their first year of the Bachelor of Paramedicine at Monash University undertook placements in special needs schools across Victoria, Australia. These students completed the Interactions with Disabled Persons Scale. Of these students, 5 participated in two focus groups to gain a deeper understanding of their placement experience. The results showed that paramedic students enjoyed their placements and gained a more positive attitude towards special needs students, but also felt challenged and overwhelmed. Also found were four main characteristics that students believed paramedics needed to be effective; empathy, being genuine, the ability to listen to someone even though they are not speaking to you verbally, and the ability to gain the trust of someone quickly where gaining trust is difficult. This study was the first time an entire cohort of paramedic students have undertaken placements at special needs schools. The findings provide a baseline and incentive for further exploration of the benefits of the placement of paramedic students (and student from a variety of healthcare professions) in special needs schools, as well as other marginalised communities.

Defining two novel sub models of the Anglo-American paramedic system: A Delphi study.

INTRODUCTION: While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a lack of research that explores and identifies new sub-models of paramedicine within the Anglo-American paramedic system. METHODS: A Delphi method was used to gain consensus among international paramedic experts regarding two new models of paramedicine known as the Directive and Professionally Autonomous paramedic systems. Following the development of a preliminary definition, a set of questions were established for experts aimed at defining the new sub-models; the responses were reviewed and amended based on feedback before being re-distributed to an expanded group of participants for further rounds of questions. Rounds continued until consensus was achieved. RESULTS: Consensus was achieved for both statements regarding the Professionally Autonomous paramedic system definition in round 2, 85.7% (n = 18). Following analysis and revision of the definition, the additional two statements regarding the Directive paramedic system achieved consensus in round 3, 100% (n = 19). CONCLUSION: This Delphi study was the first study to explore a standardised definition for two newly identified sub-models of the Anglo-American paramedic system with the overall results used to help inform high performing system design for modern Anglo-American paramedic systems into the future.

Ten-Year Comparison of Medication Complications Rates in Public and Private Hospitals in Victoria, Australia.

Medication errors occur as a result of failure in the treatment process at any point in the healthcare system. This is a retrospective study aimed at determining the rates of medication-related errors over a 10-year period in hospitals in Victoria, Australia. From 2009 to 2019, the overall rate for adverse drug events, accidental poisoning and undetermined intent were 86.15, 1.3 and 0.17 per 10,000 hospital separations, respectively. Medication complications occurred more in public hospitals. Adverse drug events account for less than 1% of all hospital separations. Medication errors contributing factors should be investigated in out of hospital environment.

Impact of COVID-19 on paramedicine students: A mixed methods study.

BACKGROUND: Viral epidemics have negative and sometimes extreme impacts on psychological well-being, particularly in health care workers. Studies have reported higher levels of depression, anxiety, insomnia, stress, distress, fear, burnout, and post-traumatic symptoms. OBJECTIVE: This research aimed to explore the psychological impacts of COVID 19 on paramedicine students. METHODS: A convergent mixed method design study was undertaken using self-reporting instruments and qualitative interviews. RESULTS: Responses were received from 151 students (38.3% responses rate). Most students experienced some level of anxiety (62%), although severe levels were only reported by 6% of respondents. Students had significantly greater odds (OR = 2.05, p = 0.045, 95% CI: 1.02, 4.12) of higher anxiety levels if they were female. Thematic analysis of the interviews largely supported these results, with themes focused on changing approaches to study, financial situation, social support, University adaptation, acceptance and career pathway choice. CONCLUSIONS: This study identified and explored the anxiety and coping strategies in an undergraduate paramedicine cohort when faced with a viral epidemic. Although most of the responding paramedic students reported above normal levels of anxiety in the initial stages of the COVID-19 outbreak, many students, with the help of learning, financial and social support, and a range of positive coping strategies, have adapted well to the impact of the pandemic and associated lockdown period.

What impact does maths anxiety have on university students?

BACKGROUND: Maths anxiety is defined as a feeling of tension and apprehension that interferes with maths performance ability, the manipulation of numbers and the solving of mathematical problems in a wide variety of ordinary life and academic situations. Our aim was to identify the facilitators and barriers of maths anxiety in university students. METHOD: A scoping review methodology was used in this study. A search of databases including: Cumulative Index of Nursing and Allied Health Literature, Embase, Scopus, PsycInfo, Medline, Education Resources Information Centre, Google Scholar and grey literature. Articles were included if they addressed the maths anxiety concept, identified barriers and facilitators of maths anxiety, had a study population comprised of university students and were in Arabic or English languages. RESULTS AND DISCUSSION: After duplicate removal and applying the inclusion criteria, 10 articles were included in this study. Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. The following themes emerged from the included papers: gender, self-awareness, numerical ability, and learning difficulty. The pattern in which gender impacts maths anxiety differs across countries and disciplines. There was a significant positive relationship between students' maths self-efficacy and maths performance and between maths self-efficacy, drug calculation self-efficacy and drug calculation performance. CONCLUSION: Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. Developing anxiety toward maths might be affected by gender; females are more prone to maths anxiety than males. Maths confidence, maths values and self-efficacy are related to self-awareness. Improving these concepts could end up with overcoming maths anxiety and improving performance.

The Correlation between Mathematics Anxiety, Numerical Ability and Drug Calculation Ability of Paramedic Students: An Explanatory Mixed Method Study.

INTRODUCTION: Numeracy is the ability to reason and to apply simple numerical concepts. Numerical and drug calculation skills are essential for patient safety. Health-care providers who perform drug calculation in their work required good math skills, especially numerical ability. The aims of this study were to explore the relationship between numerical ability, math anxiety and drug calculation performance and to explore the factors that contribute to drug calculation ability among paramedic students. METHODS: A sequential explanatory mixed-method approach that included a paper-based questionnaire followed by face-to-face interviews was used in this study. The participants completed a 30-minute survey that is composed of demographics, the 10-item Mathematics Anxiety Rating Scale (MARS), a 12-question numerical ability test (NAT) and a 9-question drug calculation ability test (DCAT) and then were invited for a structured interview. RESULTS: The mean MARS scores were higher for the second-year students than the third students. The NAT and DCAT scores for the third-year students were higher than the second-year students. There was a significant difference in the mean drug calculation ability test scores (DCAT) (t (106) = 2.13, p = 0.035 and Cohen's d = 0.43 between males (5.05 (2.32)) and females (4.03 (2.43))). Math education prior joining the university (beta = 0.862, p = 0.030) made the strongest unique contribution when controlling for the other variables followed by numerical ability (beta =0.25, p <0.001). The themes that emerged from the interviews included the impact of technology, classmates' impact, mathematics competence and the mental block. CONCLUSION: Drug calculation is fundamental in paramedic practice. It is affected by the numerical ability of the students and is negatively and indirectly impacted by mathematics anxiety. Modifications of a paramedic program curriculum can improve student's ability to think critically and to overcome medication dosage problems.

Challenges Faced by Female Healthcare Professionals in the Workforce: A Scoping Review.

BACKGROUND: The number of women entering the medical and healthcare workforce globally has increased in the past several decades. Women have many roles and positions in healthcare organizations, hospitals and healthcare education settings. Although there has been an increase in the number of women, female workers continue to face many workplace challenges. This scoping review aimed to explore the challenges female healthcare professionals face in the workforce. METHODS: A scoping review utilizing Arksey and O'Malley's six-step framework was undertaken to identify and map available literature addressing challenges faced by female healthcare professionals in the workforce. The databases searched included Embase, EmCare, Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Business Source Complete (BSC). Additional searches were performed using Google Scholar, Trove and grey literature. RESULTS: The initial search yielded 2455 publications (Medline n=369; EmCare n=276; Embase n=612; CINAHL n=1088; Business Source Complete n=109; mixed grey literature n=1). After removal of duplicates, 1782 citations remained. Abstract and title screening reduced the field to 36 publications, following which full-text reviews were conducted. Consensus was reached on 16 publications for final review. After analyzing the articles, three themes were identified: i) family responsibilities, ii) workplace environment and iii) stereotyping. CONCLUSION: Findings confirm that female healthcare professionals face circumstances that may affect their family lives, as well as factors relating to the workplace environment and stereotypes. Implementing strategies such as reduced work hours, flexible timing and part-time work can support women in the workplace, which then enhances and supports gender equality in healthcare organizations.

Assessment of a new tool to improve case manager identification of delayed return to work in the first two weeks of a workers' compensation claim.

OBJECTIVE: To determine whether the Plan of Action for a Case (PACE) tool improved identification of workers at risk of delayed return to work. DESIGN: Prospective cohort of workers with accepted workers' compensation claims in the state of New South Wales, Australia. INTERVENTIONS: The 41-item PACE tool was completed by the case manager within the first two weeks of a claim. The tool gathered information from the worker, employer and treating practitioner. Multivariate logistic regression models predicted work time loss of at least one and three months. RESULTS: There were 524 claimants with complete PACE information. A total of 195 (37.2%) had work time loss of at least one month and 83 (15.8%) had time loss of at least three months. Being male, injury location, an Orebro Musculoskeletal Pain Screening Questionnaire-Short Form score >50, having a small employer, suitable duties not being available, being certified unfit, and the worker having low one-month recovery expectations predicted time loss of over one month. For three months, injury location, a Short Form Orebro score >50, no return-to-work coordinator, and being certified unfit were significant predictors. The model incorporating PACE information provided a significantly better prediction of both one- and three-month outcomes than baseline information (area-under-the-curve statistics-one month: 0.85 and 0.68, respectively; three months: 0.85 and 0.69, respectively; both P < 0.001). CONCLUSION: The PACE tool improved the ability to identify workers at risk of ongoing work disability and identified modifiable factors suited to case manager-led intervention.

Development and Pilot Assessment of the PACE Tool: Helping Case Managers Identify and Respond to Risk Factors in Workers' Compensation Case Management.

Purpose The aim was to develop a tool to be applied by workers' compensation case managers to guide intervention and avoid delayed return to work. Methods The Plan of Action for a CasE (PACE) tool was developed based on a review of existing literature, focus groups with case managers and analysis of existing claims data. Combined with analysis of existing case manager practice, these sources were used to determine key constructs for inclusion in the tool to be aligned with the demands of case manager workload. Mapping of existing interventions was used to match risk identified by the tool with appropriate intervention. Results The final PACE tool consisted of 41 questions divided into Ready (worker), Set (employer) and Go (treating practitioner) categories. Questions in the tool were linked to appropriate case manager actions. Data collection was completed by case managers for 524 claims within the first 2 weeks of the claim being accepted. The most commonly identified risks for delayed RTW included both worker and employer expectations of RTW, as well as certification of capacity. Factor analysis identified two factors operating across the tool categories. Case managers reported benefits in using the tool, but reported it also increased their workload. Conclusions The PACE tool is a unique example of the implementation of risk identification in case management practice. It demonstrates that case managers are ideally placed to collect information to identify risk of delayed RTW. Future work will establish the impact of case-manager led intervention based on identified risks on outcomes for injured workers.

Experiential education enhancing paramedic perspective and interpersonal communication with older patients: a controlled study.

BACKGROUND: Paramedics are required to provide care to an aging population with multidimensional and complex issues. As such educators need to prepare undergraduate paramedics to recognise, assess and manage a broad range of psychosocial care and support issues beyond somatic conditions. Experiential educational interventions with older people provide realistic and contextualised experience which can improve the provision of holistic patient focused care. METHODS: This was a single institution controlled before-after study with parallel groups, conducted in Australia in 2017. It was designed to compare the effectiveness of an educational program related to older people (intervention), verses no intervention (control) on paramedic student attitudes, knowledge and behavior with older patients. RESULTS: A total of 124 second year paramedic students were included in this study; 60 in the intervention and 64 in the control group. Their demographics and Time 1 baseline results were homogeneous. Both groups showed improvement in communication skills with real older patients (p < 0.001, η2 = 0.41) and (p < 0.001, η2 = 0.35). The intervention group showed greater improvements in the 'understands the patient's perspective' element for both the self-assessment (p < 0.001) and the clinician assessment (p = 0.01). Multiple linear regression Model 1 found gender (ß = - 0.25; p = 0.01) was the best predictor of clinician-assessed communication, with females having higher scores. Knowledge and attitudes remained relatively unchanged for both groups. CONCLUSIONS: As the first study to observe, measure and report on the interpersonal communication skills of paramedic student's with 'real' older patients we can report that these skills were from fair to good at baseline and improved from good to very good post the intervention. Overall improvement was notably better in the 'understanding the patients perspective element' for the intervention group who had conducted one-one visits with an older person.