Student Paramedics Research Articles

Mental wellbeing of student paramedics before and after first ambulance placement

Background: Emergency ambulance workers are at risk of poor mental wellbeing. Student paramedics in the UK attend ambulance placements, which expose them to the same stresses; they also have their own stress factors. Little research has explored how these placements affect student mental wellbeing. Aim: This pilot study aims to address this gap into the ways in which students'mental wellbeing may be affected by ambulance placements. Methods: A mixed-method approach, using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), with two questionnaires including wellbeing scores and open questions, was used to collect quantitative and qualitative data on first-year student paramedics before and after their first ambulance placement. Results: Twenty participants were included in the final analysis, three-quarters of whom witnessed at least one traumatic event during their placement. There was a statistically insignificant difference between wellbeing scores before and after the placement. There were five themes: positive learning experience; theory-practice gap; student-mentor relationship; student resilience; and career consolidation. Conclusion: Mental wellbeing did not change significantly after the first ambulance placement. Placement was overall a positive experience that confirmed career choice and narrowed the theory-practice gap. Mentor support was protective during traumatic events. A similar, larger study could track student wellbeing throughout their course and identify factors that may protect or damage wellbeing.

“This is how I'm going to do it, but this is not how you're going to do it”: the expectation gap between student paramedics and mentors in East and Central Scotland

BackgroundThe role of paramedics has expanded significantly over the past two decades, requiring advanced skills and education to meet the demands of diverse healthcare settings. In 2021, the academic requirements for paramedics were raised to a bachelor’s degree to align with other registered professions. The limited evidence on effective paramedic practice education necessitates a novel or new examination of unique learning methods, emphasising the need to establish effective learning relationships between mentors and learners to enhance professional respect and support achieving learning outcomes. This study aimed to investigate expectations between student paramedics and their mentors, focusing on the learning dynamics within paramedic education.MethodsThis qualitative study used purposive sampling to recruit participants from two distinct cohorts: student paramedics from the University of Stirling and Practice Educator Mentors from the Scottish Ambulance Service. Focus groups were conducted to illuminate comprehensive insights into participants' expectations regarding practice education and their respective roles in the learning process. Codebook thematic analysis was used to assess the alignment of these expectations.ResultsFindings illustrate important challenges within practice placement across learning paradigms and highlight the attitudes surrounding the integration of higher education and expectations of practice placements. These challenges encompass systemic barriers, including the support provided to mentors as they assume increased responsibilities and barriers that deter qualified staff from initially undertaking this role.ConclusionThe study aimed to assess expectations between practice educators and students within the paramedic profession in Scotland. The methodology effectively identified key themes from comprehensive data, marking the first primary research in this field. There are disparities in learning styles, expectation measurement, and attitudes toward higher education during practice placements, which could significantly impact the teaching and assessment processes. The findings suggest increased support for practice educators, educational programs addressing challenges of mentorship, and stronger links between higher education institutes and the Scottish Ambulance Service. Further research is needed to understand the extent of the expectation gap, how expectations evolve, and to develop strategies to address disparities.

Time performance of scoop stretcher versus vacuum mattress for prehospital spinal stabilization: open-label simulation-based randomized controlled trial

Recent research has yielded conflicting results on the use of spinal stabilization in prehospital care, with some guidelines expressing concerns about its potential lack of benefit or harm. Transportation on a backboard can cause pain, discomfort, and pressure ulcers, whereas the log-roll technique can cause unnecessary movement and aggravate existing injuries. The scoop stretcher and vacuum mattress provide comparable or better immobilization and comfort than the backboard. Prehospital time is critical, and patients with life-threatening conditions should undergo rapid stabilization procedures. Despite this, some studies have overlooked the scoop stretcher as a spinal stabilization device. The primary goal was to compare the time required to achieve spinal stabilization using a scoop stretcher versus a vacuum mattress. This was a monocentric, parallel, randomized (sealed envelope), superiority, open-label, controlled simulation experiment. All student paramedics, registered paramedics, and EMTs who work in the participating EMS were eligible to participate in the study apart of the study team. The experimental group had to use a scoop stretcher, whereas the control group used a vacuum mattress. Fifteen participants were included. The scoop stretcher group required less time to complete the stabilization procedure (median [Q1; Q3]: 127 seconds [111;145] versus 212 [156;237], p=0.005). Using a scoop stretcher for spinal stabilization is more time-efficient than a vacuum mattress, making it a viable option for unstable trauma patients in the prehospital setting. More research is needed to determine its efficacy in actual clinical practice.

CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial

BackgroundAn out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. MethodsThis multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. ResultsIn total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57–70.98) and the second attempt (48.68, 95% CI 31.31–66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54–227.37) compared with the second attempt (136.95, 95% CI 87.03–186.88, p = 0.1). ConclusionA dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.

Ambulance clinicians implementing evidence-based practice: mind the gap! Attitudes, perceptions and experiences of student paramedics.

Evidence-based practice (EBP) represents the conscientious and judicious use of the best contemporaneous evidence in partnership with patient values and clinical expertise to guide healthcare professionals. As a result, EBP is a recommended component of undergraduate education and considered fundamental for improving patient outcomes. EBP principles have thus become deeply rooted in higher education curricula, but only in recent years has this begun to permeate the world of paramedic practice. Despite this paradigm, the impact of EBP may be limited because ambulance clinicians may struggle with implementation, as a variety of barriers influence translation and application. A survey study aimed to gain insight into the epistemological and metacognitive barriers impacting student experience in order to help improve teaching and learning practices. A sample of 64 students, across two different undergraduate paramedic science programmes, were recruited. Of these, 70% of BSc (Hons) students versus 33% of DipHE students agreed to some extent or greater that EBP represented minimal benefit in real-world practice due to Trust policy and the guidelines set out by the Joint Royal Colleges Ambulance Liaison Committee (Welch's t = 2.571, df = 26, p = 0.016 two-sided). Furthermore, 25% felt standard operating procedures negatively impacted their ability to implement EBP, and 39% reported their EBP learning had improved their ability to implement improved levels of patient care. A disparity between theoretical learning and EBP implementation was identified. EBP may not dovetail with standard operating procedure within UK ambulance Trusts, resulting in confusion among student paramedics as to the true worth of EBP.

“We lie about what we do. We lie to our students about what they're going to do”: Unstandardizing standardized ways of knowing in health professions education

In Health Professions Education, students’ and their educators’ work in the 21st century is geared towards demonstrating “competence” in order to gain certification or licensure to practice. Drawing on two complementary Institutional Ethnographic studies, we explicate the dominance of standardization through text-mediated epistemologies or ways of knowing, for student doctors and student paramedics. We examine different lines of fault where the actual work of becoming a health professional is subsumed by an accountability focused agenda, contributing to students feeling unprepared for their (non-standard) clinical work and work settings at a time where burnout is recognized as a big issue in healthcare. We also discuss how educators are located at a line of fault between what counts institutionally as good educational knowledge/practice and teaching practices geared towards the everyday actualities of complex work and work settings. We advocate for a more generous approach to certification of health professionals, based on non-standardized patients and the realities of ever-evolving work settings that healthcare work must orient to and is organized by.

Raring to go? A cross-sectional survey of student paramedics on how well they perceive their UK pre-registration course to be preparing them to manage suspected seizures

BackgroundParamedics convey a high proportion of seizure patients with no clinical need to emergency departments (EDs). In a landmark study, only 27% of UK paramedics reported being “Very…”/ “Extremely confident” making seizure conveyance decisions. Improved pre-registration education on seizures for paramedics is proposed. Clarity is needed on its potential given recent changes to how UK paramedics train (namely, degree, rather than brief vocational course). This study sought to describe UK student paramedics’ perceived readiness to manage seizures and educational needs; compare this to what they report for other presentations; and, explore subgroup differences.MethodsSix hundred thirty-eight students, in year 2 or beyond of their pre-registration programme completed a cross-sectional survey. They rated perceived confidence, knowledge, ability to care for, and educational needs for seizures, breathing problems and, headache. Primary measure was conveyance decision confidence.ResultsFor seizures, 45.3% (95% CI 41.4–49.2) said they were “Very…”/“Extremely confident” to make conveyance decisions. This was similar to breathing problems, but higher than for headache (25.9%, 95% CI 22.6–29.5). Two hundred and thirty-nine participants (37.9%, 95% CI 34.1–41.8) said more seizure education was required – lower than for headache, but higher than for breathing problems. Subgroup differences included students on university-based programmes reporting more confidence for conveyance decisions than those completing degree level apprenticeships.ConclusionsStudent paramedics report relatively high perceived readiness for managing seizures. Magnitude of benefit from enhancements to pre-registration education may be more limited than anticipated. Additional factors need attention if a sizeable reduction to unnecessary conveyances for seizures is to happen.

Novel moving, handling and extraction simulation for students in a soft play area

Background: Emergency medical services often have to extricate patients from their location and take them to an ambulance. High-quality training is required to ensure patient and staff safety during moving, handling and extrication manoeuvres. This study aimed to determine student satisfaction and self-confidence regarding what they had learnt after a novel moving, handling and extrication simulation exercise in a children's soft play area. Methods: A mixed-methods cross-sectional survey was adopted, using the validated Student Satisfaction and Self-Confidence in Learning survey tool. Qualitative data were collected from an open question for additional comments. Student paramedics and student emergency medical technicians from one higher education institution completed four time-limited scenarios, each of which involved moving an immobile patient away from their environment. Descriptive statistics were determined for the participant characteristics and survey responses. Thematic analysis was performed on the qualitative data. Results: The student participants were aged 18–47 years and the majority were women. They were satisfied with both their learning and their self-confidence in what they had learnt after the simulation event, and felt their communication and teamwork skills had improved. They enjoyed the event more than classroom-based simulation. While they felt the simulation was realistic, suggestions were made to make it more so. Conclusion: Use of a children's soft play area for a moving, handling and extrication simulation provided student satisfaction and self-confidence in learning.

The impact of dementia education on student paramedics' preparedness to care, knowledge, confidence and attitudes towards dementia: an analytic survey.

Paramedics play a vital role in the emergency healthcare of people living with dementia. People with dementia often have complex needs, posing challenges for paramedics. Paramedics often lack the confidence and skills to assess people with dementia appropriately, and receive little, if any, dementia education. To evaluate the impact of dementia education on student paramedics' preparedness to care, knowledge, confidence and attitudes towards dementia. A 6-hour education programme on dementia was developed, implemented and evaluated. A pre-test-post-test design using self-completion validated questionnaires was used, to evaluate first-year undergraduate student paramedics' knowledge, confidence and attitudes towards dementia, as well as their preparedness to care for people with dementia. A total of 43 paramedic students attended the education programme, with 41 fully completed questionnaires being collected pre-training and 32 post-training. Students reported feeling significantly more preparedness to care for people with dementia after the education session (p < 0.001). They felt their knowledge (100%), confidence (87.5%) and attitudes (87.5%) towards dementia had significantly increased following the education session. Using validated measures, the impact of education was found to be the highest on dementia knowledge (13.8 vs 17.5; p < 0.001) and on confidence (29.14 vs 34.06; p = 0.001), with only a minimal effect on attitudes (101.5 vs 103.4; p = 0.485). The education programme itself was well-evaluated. As paramedics are central to the emergency healthcare of people living with dementia, it is essential that the emerging paramedic workforce is equipped with the knowledge, attitudes and confidence to provide quality care for this population. We need to ensure dementia education is embedded in undergraduate curricula, and that consideration is given to the subjects, level and pedagogic approach taken to ensure positive outcomes are maximised.

Preparing undergraduate student paramedics to consider their mental health during clinical placement in Australia

IntroductionThis article explores the impact of mental health issues on paramedics in Australia, particularly Post-Traumatic Stress Disorder, caused by their exposure to high levels of stress. The prevalence of Post-Traumatic Stress Disorder is higher among paramedics than any other occupation, and this could be a cause for concern, especially for undergraduate student paramedics. The article examines the need to build resilience among student paramedics to help them handle the trauma they may experience during clinical placement. MethodsThis study conducted a two-step process to review literature and university handbooks to determine the level of education provided to paramedic students on Post-Traumatic Stress Disorder and resilience during clinical placement, due to the lack of research in this area. The first step involved a search for relevant articles, while the second step involved a search of the Australian Health Practitioner Regulation Agency website to identify paramedicine programs and a manual evaluation of each undergraduate pre-registration paramedicine curriculum in Australia. ResultsThis study conducted a systematic search of national and international literature and Australian undergraduate pre-registration paramedicine programs to identify any studies pertaining to the education of paramedic students in resilience and Post Traumatic Stress Disorder. The search found that only 15 (5.95 %) of the 252 reviewed subjects had reference to mental health, resilience or Post-Traumatic Stress Disorder, with only 4 (1.59 %) of them discussing these topics in preparation for clinical practice. The study highlights the lack of emphasis on student paramedic self-care as an essential underpinning for clinical placement preparation in the curriculum. ConclusionThis literature review concludes that appropriate training and support, teaching resilience, and promoting self-care are crucial in preparing paramedic students for the emotional and psychological demands of their work. Equipping students with these tools and resources can improve their mental health and well-being and enhance their ability to provide high-quality care to patients. Promoting self-care as a core value in the profession is essential in creating a culture that supports paramedics in maintaining their own mental health and well-being.

An Evaluation of Practice Supervisor Training for Student Paramedics

Background: Registered health professionals have a responsibility to facilitate learning in the workplace and those who are supporting students should have the skills and knowledge to take on this role. Paramedics are now working in a variety of healthcare settings. Regulatory bodies recognise that students should have opportunities to develop their supervision skills before qualifying, so practice supervisor training was implemented into the final year curriculum at one university. Aim: To explore the value of incorporating practice supervisor training into the curriculum. Methods: Final-year student paramedics were provided with practice supervisor training as part of their degree. This training was delivered over three seminars before the students’ final preregistration placement. Students were invited to provide anonymous feedback via an evaluation form. Findings: A significant number of students felt prepared to take on the practice supervisor role when qualified. Conclusion: Practice supervisor training, when delivered as part of the curriculum, is of benefit to students.

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

IntroductionClinical 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?MethodsThis 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.ResultsEighty-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).DiscussionClinical 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.

Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case

ObjectiveThe International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students. MethodsForty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used. ResultsWhen using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue. ConclusionsAudio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.

The Use of Virtual Reality in Training Paramedics for a Mass Casualty Incident

This paper presents the design of a virtual reality learning module inspired by the exercises of healthcare professionals and its limitations as a result of action research carried out by the authors’ collective. The module is implemented on a car crash scenario as a emergency event. Virtual reality training is presented here as an important supplement to traditional paramedic training with the potential to reduce costs and make paramedic training more effective as part of their refresher training for their job roles. Real-time training and its limitations are described, especially regarding patient triage, this aspect being considered as one of the key aspects in the context of virtual reality. Furthermore, the results of a questionnaire survey among the mannequins and interviews with the trainees are presented, while the virtual reality environment of the module was designed to be intuitive for each student with the possibility of self-service without major demands on the logistical organization of the staff for the updating training. The authors relied on an expert group of multi-disciplinary experts for development. The outcome of the action research and the data collected by it is a fully prepared module for teaching selected skills in reflection of the situational context of a traffic accident with mass casualties. In the context of the presented module, measurements are being prepared to compare selected variables between real training and virtual reality training with the same scenario on student paramedics and professional paramedics.

Lateral versus over-the-head chest compression quality in student paramedic

Background: Chest compressions are one of the few interventions proven to improve survival from out-of-hospital cardiac arrest. While rescuer position has been investigated before, few studies have sought to assess how rescuer position affects the quality of chest compressions in a cohort of student paramedics. Aim: This study sought to determine if chest compressions performed from an over-the-head (OTH) position were more effective than those performed from a lateral (LAT) position in a cohort of student paramedics. Methods: Seventy-five student paramedics performed both OTH and LAT chest compressions in this randomised, crossover study. Metrics including chest compression rate, depth and recoil were used in the assessment of quality. Findings: No significant differences were observed between performance in the two positions in this study. Conclusion: There was no significant difference in the quality of chest compressions between the two positions studied. It seems OTH compressions are equally effective and are a viable alternative in the difficult-to-access arrested patient.

Evaluation of the CARES skills framework as a peer support model in the paramedic undergraduate curriculum: facilitating challenging discussions in a safe environment

Objective: Infant or child death is reported as being the most distressing type of case paramedics attend. Student paramedics also identify supporting bereaved families as an area associated with low confidence. This study evaluated the CARES skills framework (Connect to emotion, Attention training, Reflective listening, Empathy, Support help seeking) as a peer support model to encourage student paramedics to talk about grief and death related to infants and children. Method: A convenience sample of first-year paramedic students (target n = 154) was recruited from a single Australian regional university. A modified nominal group technique method was used following a student debriefing session designed to identify problems, generate solutions, and make decisions regarding the efficacy of the CARES skills framework. Results: Of 154 eligible participants, 141 participated (92% response rate). Peer social support normalized students’ emotions related to death and dying. Although naming emotions was challenging, students reported that the CARES model facilitated a safe environment to talk about death and dying. Students reported feeling heard and connected to their peers during the exercise and an enhanced sense of belonging after the exercise. Conclusions: Findings contribute to evidence that suggests the CARES model is a useful mechanism to enhance peer social support in paramedic students.

Knowledge of local folk healers, the so-called whisperers, among paramedic students from eastern Poland

ContextSo far, the phenomenon of folk healers in Podlasie (eastern Poland) has not attracted the interest of medical professionals. There are no statistics describing the scale of the phenomenon. The study aimed to find out whether young adults undertaking studies and those around them use the help of whisperers. Design and setting43 student paramedics took part in the study. Parents of all participants lived in Podlasie or adjacent counties. They answered the survey questions and participated in the discussion on alternative methods of treatment. ResultsEvery fourth student paramedic reported that a whisperer was active within a radius of 20 km from his/her parents' residence. 60.5% of student paramedics have personal/family experience or friends using a whisperer. ConclusionsUsing the help of whisperers seems to have the features of a lifestyle element among educated young people from Podlasie. Non-disappearance of the tradition of healing by whispering and obligatory transfer of heritage to younger people before the expected loss of physical strength or death of a whisperer makes it possible to plan interesting biomedical research on healing and healers' predispositions.

How do paramedics and student paramedics cope? A cross-sectional study

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality.

‘Giving a piece of you’: the lecturer experience of aiding student wellbeing

Background: The mental health of ambulance clinicians is a national priority. For student paramedics, the risk and inherent vulnerability to poor mental wellbeing are significant. However, evidence exploring support in universities for paramedic students and the role of academic faculty in this within paramedic preregistration programmes is limited. Aims: To explore the experiences and perceptions of university lecturers towards supporting student paramedic wellbeing. Methods: A qualitative research design was adopted to explore the experiences of six paramedic senior lecturers from three urban universities. Data were collected via semi-structured interviews and thematically analysed using interpretative phenomenological analysis. Findings: Themes of ‘navigating the professional role,’ ‘the whole student’, ‘enabling cultural change’ and ‘supporting resilience and preparedness for practice’ were identified. Conclusions: University lecturers play a crucial role in student paramedic wellbeing and the unique role and identity of paramedic academics should be embraced. Paramedic programmes should consider a proactive approach to emotional health within the curriculum, alongside peer support, student-centred initiatives and tailored trauma support.

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial.

Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton’s four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.