Date of Award


Document Type


Degree Name

Doctor of Philosophy


School of Education


Leadership PhD

First Advisor

Duane M. Covrig

Second Advisor

Shawn Collins

Third Advisor

Shirley Freed


Problem: Paramedic educators have a short time frame (840 didactic/laboratory plus 500 clinical/internship hours) and limited resources to prepare their students to have competent clinical skills, safe medical practice, and appropriate leadership and teamwork skills. New learning approaches including simulation, audiovisual feedback, and structured debriefing have been suggested as a way to meet this challenge within paramedic education. While some individual components have been studied, no study has examined these three technologies together in paramedic training programs. The overarching research question that guided this study was: What and how do paramedic students learn in a high-fidelity healthcare simulation program that includes audio/video and instructor-facilitated feedback?

Method: The investigation was a mixed methods study; however, the study tended towards qualitative methods primarily using intrinsic case study methodology based on the work of Yin and Stake. The investigation reviewed the outcomes achieved through the use of high-fidelity healthcare simulation coupled with audio-visual feedback, when implemented within a paramedic education program. A variety of data was collected including audio-visual recordings of briefs, simulations, and debriefs, multiple student documents and logs, and copious researcher notes and documents.

Results: The simulation laboratory was a realistic, safe, controlled setting allowing students to make autonomous decisions without potential harm to human life as a consequence of errors. Simulation technology augmented traditional clinical experiences by providing more uniformity of experiences between students, providing less familiar clinical experiences, and acting as a time-efficient method for achieving deficit competencies. In evaluating student skill performance, simulation provided better quantified measures and observation accuracy.

Leadership skills were developed in simulation by taking advantage of safe learning aspects; an environment to learn from mistakes which used leadership skill autonomous practice. Participation as a leader and follower allowed the learner a better understanding of the leadership role when exposed to well-crafted scenarios. Simulation was a unique methodology facilitating safe learning from errors committed by students, a result of knowledge gaps within individual learning. Simulation was unlike traditional learning methods such as lecture, laboratory, or clinical experiences.

The facilitator/debriefer assisted the paramedic in learning within the simulation environment by: creating a safe learning environment, helping learners identify what knowledge was needed, reinforcing identified needed learning, assisting participants to identify correct actions in response to individualized errors, and promoting learner reflection. A debriefing provided the environment whereby the bulk of learning took place in the simulation experience. The simulation environment contributed to student growth in three domains (cognitive, psychomotor and affective) of learning identifying knowledge or performance gaps for students in the specific practice of assessment, leadership, treatments, planning, evaluation, situational awareness, communications, and teamwork. Simulation provided an alternate method for achieving clinical experiences not available in the actual setting. During the debriefing, the audio-visual feedback and interactive probing procedures worked together to promote student learning. The audio-visual component provided a "big picture" viewpoint for the learner used by the debriefer during interactive probing to help students identify errors and alternate actions.

A learning model was constructed which represented how students learn. The use of simulation allowed the participant to determine unknown knowledge gaps from previous learning through processes of simulation experience, identification during debriefing, and reflection on alternate-decision pathways. Learning occurred in learning process conclusion: the application of alternate pathways in behavior. The learning process has been summarized in a simulation learning model presented in this study. The simulation learning model is applicable for cognitive, affective, and psychomotor elements.

Within the study, analysis developed emergent themes. Emergent themes included: Context Is Vital, We Often Don't Know What We Don't Know, Learning From Mistakes, Learners Must Have a Safe Learning Environment, Learning Lessons From Other Industries, and Teaching Leadership Challenges for Paramedics.

Conclusions and Recommendations: Students often don't know what they don't know in individualized previous learned knowledge; thus, a learning mechanism is required, such as simulation with facilitated debriefing interactive audiovisual feedback. Simulation technology acts as a safe and non-threatening environment to allow learning from mistakes without a human cost. Valid fidelity healthcare simulations augment traditional clinical experiences by providing unfamiliar virtual realities in a uniform way to strengthen the participants' overall experience repertoire. This study recommends that the Emergency Medical Services (EMS) industry, educators, and policy makers establish standards requiring simulation learning within initial training programs to decrease the potential for loss of human lives as a result of human error.

Subject Area

Paramedical education--Michigan, Paramedical education--Study and teaching--Simulation methods, Paramedical education--Study and teaching--Audio-visual aids, Allied health personnel--Training of

Files over 3MB may be slow to open. For best results, right-click and select "save as..."