Why real experience makes successful EMS instructors

The data shows that trained, experienced and certified EMS instructors are a better predictor of success than an academic setting

Recently the National Association of EMS Educators posted this question on social media: "Do you think EMT programs should only be taught at a hospital or college?" The answer is not simple.

An assumption in the NAEMSE question is that moving EMT training from the apparatus bay in the rescue squad building to a college or hospital would improve the academic experience. Yet in my experience, many EMT programs that are run though a college or hospital facility may not benefit from the same evaluation as a course providing academic credit or medical CEUs.

I spent a decade participating in the College Credit Recommendation Service (CREDIT) with the American Council on Education. ACE CREDIT provides course equivalency information to facilitate credit award decisions. Participating organizations include corporations, professional and volunteer associations, schools, training suppliers, labor unions and government agencies.

It was a fascinating experience looking at training programs and applying the requirements needed to make an academic credit recommendation. Programs where we could make a college credit recommendation had features that are often lacking in turnkey EMS programs, regardless of venue.

How EMS education got its start

The original 1971 EMT-Ambulance was a vocational job where the student had to demonstrate a set of relatively simple tasks and regurgitate concepts, procedures, definitions and treatment though a multiple choice written exam.[1]

A 1992 survey by the National Center for Educational Statistics found that vocational teachers averaged 17 years of teaching experience, 14 of which had been in their primary teaching assignment.

Around this time, primary EMS instructors transitioned from being physicians and nurses to EMTs and paramedics with significantly less medical and educational preparation.[3,4]

The survey found that although vocational education teachers had considerably more "real-life" experience in their field than academic teachers; they tended to have fewer years of formal schooling. Only 88 percent of vocational teachers had attained at least a bachelor's degree, while virtually all academic teachers had a bachelor's degree and 60 percent held a higher degree.[2]

Streamlined teaching packages

EMS textbooks were also evolving from dense text and black line drawings into colorful multimedia experiences.

Student workbooks, PowerPoint presentations, instructor guides, videos and multiple-choice test banks created complete teaching packages that streamlined training. This turnkey approach would allow a minimally prepared instructor to deliver a program that covered the national standard curriculum.

Most states provided scant EMT instructor training or preparation, and state agencies pointed out the challenge when the community-based EMT instructor taught one class every two years.

Yet because EMT education has become so self-contained within a national standard curriculum and turnkey learning packages, college and hospital administrations assume it meets the standards.

Factors of a great EMS program, regardless of location

In 2007, the National Registry of Emergency Medical Technicians looked at programs that have attained consistently high success rates on the NREMT examination from 2001 to 2005.

They made the following recommendations:

  • Secure strong institution support to ensure that the EMT-Basic program has the resources necessary for success.
  • Hire lead instructors who have EMT instructor training/certification, EMT-level clinical experience, and EMT teaching experience, as well as formal educational credentials.
  • Strive for instructional consistency through the development of clear objectives, standardized lesson plans, and frequent communications among and between EMT faculty members.
  • Recruit students who are positively motivated to succeed.
  • Admit students who, either through prerequisite coursework or pretesting, have demonstrated that they have the academic skills necessary to complete the course.
  • Develop student test-taking skills by frequently administering written, practical assessments and provide timely feedback on performance.
  • Encourage excellence by establishing passing standards that exceed minimum competency.[4]

Many describe their experience in EMS as "the best worst class I attended." The turnkey packages have all of the resources to make a great course, but the instructors need to use the lesson plans, provide clear expectations to the students, frequently access student progress and provide frequent feedback.


1. National Highway Traffic Safety Administration (1971) “Emergency Medical Technician – Ambulance National Standard Curriculum.” Washington, DC: U. S. Department of Transportation.

2. National Center for Educational Statistics. (1994, January) “Public Secondary School Teacher Survey on Vocational Education” Report NCES 94-409. Washington DC: U. S. Department of Education.

3. Margolis, G. S. (2007 July/August) “Emergency Medical Services Education: Past, Present, and Future.” North Carolina Medical Journal. Volume 68, Number 4. Pages 249 – 252.  Accessed May 30, 2014

4. Margolis, Gregg S., Jonathan R. Studnek, Antonio R. Fernandez, Joseph Mistovich. Strategies of High Performing EMT-Basic Educational Programs. Prehosp Emergency Care. 2008;12:206–211.

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