Bachelor’s Degree as Entry-to-Practice A Literature Review of Paramedicine and Other Health Professions
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Abstract
Background: The evolving scope of paramedicine has prompted debate regarding the suitability of diploma programs as entry-to-practice, with increasing attention on transitioning to bachelor’s degree qualifications. Other health professions have undergone similar shifts, offering valuable insights for paramedicine.
Objective: To examine the reported outcomes of transitioning from diploma- to degree-level entry-to-practice in paramedicine and comparable health professions.
Methods: A narrative literature review was conducted in July 2025 using four academic databases and hand searches. Elements of the PRISMA framework were adapted to illustrate the search and screening process. As the review was a narrative review no risk of bias assessment tool was used. Inclusion criteria were full text academic articles on degree transition published from 1980-2025; exclusion criteria were non-English, non-peer reviewed, and non-healthcare professions. Eighteen peer-reviewed articles met inclusion criteria, encompassing nursing, dental hygiene, respiratory therapy, and paramedicine. Data were extracted and thematically analyzed to identify positive and negative impacts of degree-level entry.
Results: Positive outcomes included enhanced patient care, expanded career opportunities, improved cognitive and clinical competencies, and strengthened interpersonal attributes. Reported drawbacks included increased financial and geographic barriers, extended program duration, and perceptions of limited necessity for practice. Paramedicine-specific literature was scarce, though evidence from nursing and dental hygiene indicated significant professional and clinical advantages.
Conclusions: Transitioning to bachelor’s degree entry-to-practice offers potential benefits for paramedicine but may also restrict accessibility and exacerbate workforce challenges. Policymakers and educators should balance these factors, drawing on international and cross-disciplinary experiences, before adopting degree-based entry requirements.
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References
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623. https://doi.org/10.1001/jama.290.12.1617
Anderson, K.L., & Smith, B.S. (2009). Practicing dental hygienists’ perceptions about the Bachelor of Science in Dental Hygiene and the oral health practitioner. Journal of Dental Education, 73(10), 1222-1232. https://doi.org/10.1002/j.0022-0337.2009.73.10.tb04814.x
Becker, E.A, & Nguyen, X.T. (2014). The current impact of entry-level associate and baccalaureate degree education on the diversity of respiratory therapists. Respiratory Care, 59(12), 1817-1824. https://doi.org/10.4187/respcare.03106
Benbow, P., & Kanji, Z. (2019). Dental hygiene baccalaureate education: A national study of students’ perceived value and intentions. Canadian Journal of Dental Hygiene, 53(2), 89-99. https://www.cjdh.ca/
Berg, C., Philipp, R., & Taff, S.D. (2023). Scoping review of critical thinking literature in healthcare education. Occupational Therapy in Health Care, 37(1), 18-39. https://doi.org/10.1080/07380577.2021.1879411
Brooks, I.A., Grantham, H., Spencer, C., & Archer, F. (2018). A review of the literature: The transition of entry-level paramedic education in Australia from vocational to higher education (1961–2017). Australasian Journal of Paramedicine, 15, 1-11. https://doi.org/10.33151/ajp.15.2.584
Burke, L.M. (2018). Is higher education worth the cost? It depends. Counterpoints, 517, 361-374.
Caffrey, S.M., Barnes, L.C., & Olvera, D.J. (2019). Joint position statement on degree requirements for paramedics. Prehospital Emergency Care, 23(3), 434-437. https://doi.org/10.1080/10903127.2018.1519006
Canada Parliament House of Commons Standing Committee on Health. (2023). Addressing Canada’s health workforce crisis. https://publications.gc.ca/site/eng/9.921706/publication.html
Clinton, M., Murrells, T., & Robinson, S. (2005). Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmes. Journal of Clinical Nursing, 14(1), 82-94. https://doi.org/10.1111/j.1365-2702.2004.01015.x
Corporation for Digital Scholarship. (2025). Zotero (7.0.27) [Software]. https://www.zotero.org/
DeRosa Hays, R., & Moglia Willis, S. (2021). The baccalaureate as the minimum entry-level degree in dental hygiene. Journal of Dental Hygiene, 95(6), 46-53. https://pubmed.ncbi.nlm.nih.gov/34949682/
Dewey, J. (1997). Experience and education. Free Press. http://ebookcentral.proquest.com/lib/ualberta/detail.action?docID=4934956
Egnatovich, J. (2022). The perceived necessity by paramedics and paramedic employers for a college degree in the paramedic profession (Publication No. 29398834) [Doctoral dissertation, Caldwell University]. ProQuest Dissertations & Theses. https://dokumen.pub/the-perceived-necessity-by-paramedics-and-paramedic-employers-for-a-college-degree-in-the-paramedic-profession.html
Givati, A., Markham, C., & Street, K. (2018). The bargaining of professionalism in emergency care practice: NHS paramedics and higher education. Advances in Health Sciences Education, 23(2), 353-369. htps://doi.org/10.1007/s10459-017-9802-1
Graf, C.M. (2006). ADN to BSN: Lessons from human capital theory. Nursing Economic$, 24(3), 135-142. https://pubmed.ncbi.nlm.nih.gov/16786828/
Grant, M.J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Info Libraries Journal, 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
Haron, Y., Reicher, S., & Riba, S. (2014). Factors influencing nursing career choices and choice of study program. Health Marketing Quarterly, 31(2), 167-177. https://doi.org/10.1080/07359683.2014.907126
Jinks, A.M. (1994). Conceptualization of differing levels of educational attainment: What are the characteristics of nurses and midwives who have undertaken diploma and degree educational programmes? Journal of Nursing Management, 2(6), 279-285. https://doi.org/10.1111/j.1365-2834.1994.tb00169.x
Kanji, Z., & Laronde, D. (2018). Motivating influences and ability-based outcomes of dental hygiene baccalaureate education in Canada. International Journal of Dental Hygiene, 16(3), 329-339. https://doi.org/10.1111/idh.12330
Kanji, Z., Sunell, S., Boschma, G., Imai, P., & Craig, B.J. (2011). Outcomes of dental hygiene baccalaureate degree education in Canada. Journal of Dental Education, 75(3), 310-320. https://doi.org/10.1002/j.0022-0337.2011.75.3.tb05044.x
Katyal, S., & Kanji, Z. (2021). Students’ motivating influences for selecting dental hygiene and a 4-year degree: A retrospective study. International Journal of Dental Hygiene, 19(1), 114-120. https://doi.org/10.1111/idh.12472
Kim, N.Y., & Kwak, S.J. (2024). Relationship between nurses’ critical thinking disposition and patient safety incident reporting: The mediating role of patient safety culture in a comprehensive nursing service ward. PLOS ONE, 19(12), e0315679. https://doi.org/10.1371/journal.pone.0315679
Lane, S.H., & Kohlenberg, E. (2010). The future of baccalaureate degrees for nurses. Nursing Forum, 45(4), 218-227. https://doi.org/10.1111/j.1744-6198.2010.00194.x
Lasater, K.B., Sloane, D.M., McHugh, M.D., Porat-Dahlerbruch, J., & Aiken, L.H. (2021). Changes in proportion of bachelor’s nurses associated with improvements in patient outcomes. Research in Nursing & Health, 44(5), 787-795. https://doi.org/10.1002/nur.22163
Lawn, S., Roberts, L., Willis, E., Couzner, L., Mohammadi, L., & Goble, E. (2020). The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: A systematic review of qualitative research. BMC Psychiatry, 20(1), 348. https://doi.org/10.1186/s12888-020-02752-4
Makrides, T., Ross, L., Gosling, C., Acker, J., & O’Meara, P. (2022). From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system. Australasian Emergency Care, 25(4), 347-353. https://doi.org/10.1016/j.auec.2022.05.001
Maneval, R.E., & Teeter, M.M. (2010). The student perspective on RN-Plus-10 legislation: A survey of associate degree and diploma nursing program students. Nursing Education Perspectives, 31(6), 358-361. https://pubmed.ncbi.nlm.nih.gov/21280441/
Melnyk, B.M., Buck, J., & Gallagher-Ford, L. (2015). Transforming quality improvement into evidence-based quality improvement: A key solution to improve healthcare outcomes. Worldviews on Evidence-Based Nursing, 12(5), 251-252. https://doi.org/10.1111/wvn.12112
Moher, D., Liberati, A., Tetzlaff, J., Altman D.G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Murad, M.H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid. BMJ Evidence-Based Medicine, 21(4), 125-127. https://doi.org/10.1136/ebmed-2016-110401
O’Meara, P.F., Furness, S., & Gleeson, R. (2017). Educating paramedics for the future: A Holistic Approach. Journal of Health and Human Services Administration, 40(2), 219-251. https://doi.org/10.1177/107937391704000204
OpenAI. (2025). ChatGPT (July 28 version) [Large language model]. https://chatgpt.com
Reid, H.L., Boyd, L.D., & Vineyard, J. (2021). Dental hygiene student attitudes about benefits of baccalaureate degree and factors impacting entry-level program choice. Journal of Dental Education, 85(9), 1453-1461. https://doi.org/10.1002/jdd.12626
Roets, L., Botma, Y., & Grobler, C. (2016). Scholarship in nursing: Degree-prepared nurses versus diploma-prepared nurses. Health SA Gesondheid, 21, 422–430. https://doi.org/10.1016/j.hsag.2016.08.002
Scott, I.A., Hubbard, R.E., Crock, C., Campbell, T., & Perera, M. (2021). Developing critical thinking skills for delivering optimal care. Internal Medicine Journal, 51(4), 488-493. https://doi.org/10.1111/imj.15272
Simpson, P.M., Bendall, J.C., Patterson, J., & Middleton, P.M. (2012). Beliefs and expectations of paramedics towards evidence-based practice and research. International Journal of Evidence-Based Healthcare, 10(3), 197-203. https://doi.org/10.1111/j.1744-1609.2012.00273.x
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339. https://doi.org/10.1016/j.jbusres.2019.07.039
Sunell, S., McFarlane, R., & Biggar, H. (2017). Differences between diploma and baccalaureate dental hygiene education in British Columbia: A qualitative perspective. International Journal of Dental Hygiene, 15(3), 236-248. http://doi.org/10.1111/idh.12208
Swindells, C., & Willmott, S. (2003). Degree vs diploma education: Increased value to practice. British Journal of Nursing, 12(18), 1096-1104. https://doi.org/10.12968/bjon.2003.12.18.11774
Terenzini, P.T., Springer, L., Pascarella, E.T., & Nora, A. (1995). Influences affecting the development of students’ critical thinking skills. Research in Higher Education, 36(1), 23-39. https://doi.org/10.1007/BF02207765
Thielmann, B., Parker, K.K., Post, J.M., & Abraham, S.P. (2019). Factors influencing nurses’ perceptions of the baccalaureate degree in nursing as minimum requirement for professional practice. Nursing Education Perspectives, 40(1), 25. https://doi.org/10.1097/01.NEP.0000000000000391
Williams, B., Fielder, C., Strong, G., Acker, J., & Thompson, S. (2015). Are paramedic students ready to be professional? An international comparison study. International Emergency Nursing, 23(2), 120-126. https://doi.org/10.1016/j.ienj.2014.07.004
Williams, B., Lau,R., Thornton, E., & Olney, L.S. (2017). The relationship between empathy and burnout–Lessons for paramedics: A scoping review. Psychology Research and Behavior Management, 10, 329-337. https://doi.org/10.2147/PRBM.S145810
Wills, H.L., & Asbury, E.A. (2019). The incidence of anxiety among paramedic students. Australasian Journal of Paramedicine, 16, 1-6. https://doi.org/10.33151/ajp.16.649
Zhang, P., Xu, R., Cao, S., Mo, L., Liu, Y., Gao, C., Wu, Y., & Yu, G. (2025). Relationship between critical thinking ability and medication safety competence among clinical nurses: A multicenter cross-sectional study. Journal of Clinical Nursing, 34(6), 2107-2116. https://doi.org/10.1111/jocn.17361