Educating for the Paramedicine of Today Exploratory Findings Related to Primary Care Paramedic Training in Northern Ontario
Article Sidebar
Main Article Content
Abstract
Background: To ensure that largely rural and remote communities have access to medical care, both long distance ground and air transportation is often used in Canada. This, coupled with the increasing employment of community Paramedicine, positions Paramedics in an increasingly autonomous role. As such, it is important to consider how these professionals are being prepared to work in socially just and socially responsible ways with the diverse populations they serve. Scant literature examine health care provider (HCP) student’s preparedness to provide socially just and responsible care overall, and even less focuses specifically on paramedic students. This study explored HCP students’ relative preparation to enact social justice and social responsibility (SJSR) in practice.
Methods: Part of a larger qualitative case study, findings discussed in this article focus on paramedic students. Based in a constructivist ontology, semi-structured qualitative interviews were conducted with primary care paramedicine (PCP) students at one college in a northern region of Canada. Interviews utilized a go-along (Carpiano, 2009) methodology to follow students within their academic environment. Once transcribed, interviews were then analyzed using thematic analysis (Peel, 2020).
Results: Participants relayed a mixture of preparation and unease related to enacting SJSR. Students’ personal backgrounds, work and academic experiences, impacted their sense of preparation. Areas of concern listed by students included: potential devaluing of SJSR throughout their curriculum and marking structure; poor role-modelling; and a superficiality of SJSR-related content.
Conclusions: While efforts are in place to educate future paramedics on SJSR, enhancements and additional work may help to guide PCP curriculum and create more robust accreditation standards within Canada. Considerations include restructuring curriculum to incorporate SJSR longitudinally, connecting SJSR to the role of the paramedic; and in the long-term, expanding PCP diploma programs into undergraduate degrees and recruiting learners with previous post-secondary certifications.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
Adams, W. (2015). Conducting semi-structured interviews. In J. S. Wholey, H. P. Hatry, & K. E.
Allana, A., & Pinto, A.D. (2021). Paramedics have untapped potential to address social determinants of health in Canada. Healthcare Policy, 16(3):67-75. https://doi.org/10.12927/hcpol.2021.26432
Alshareef, M. H., & Flemban, A. F. (2025). How preceptor behaviour shapes the future of medical professionals. Advances in medical education and practice, 16, 135–144. https://doi.org/10.2147/AMEP.S481620
Banks, J. A. (2014). An Introduction to Multicultural Education (5th Ed.). Pearson Education Inc.
Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 12(4), 544-559. https://doi.org/10.46743/2160-3715/2008.1573
Beavis, A. S. W., Hojjati, A., Kassam, A., Choudhury, D., Fraser, M., Masching, R., & Nixon, S. A. (2015). What all students in healthcare training programs should learn to increase health equity: Perspectives on postcolonialism and the health of Aboriginal Peoples in Canada. BMC Medical Education, 15, Article 155. https://doi.org/10.1186/s12909-015-0442-y
Blackburn, M. (2022, September 16). Onigaming First Nation chief says paramedics refused to come into community while man overdosed. APTN News. https://www.aptnnews.ca/national-news/onigaming-first-nation-chief-says-paramedics-refused-to-come-into-community-while-man-overdosed
Blanchet Garneau, A., Browne, A. J., & Varcoe, C. (2018). Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing. Nursing inquiry, 25(1). https://doi.org/10.1111/nin.12211
Binagwaho, A., Ngarambe, B., & Mathewos, K. (2022). Eliminating the White supremacy mindset from global health education. Annals of global health, 88(1), 32. https://doi.org/10.5334/aogh.3578
Biswas, S., Douthit, N. T., Mazuz, K., Morrison, Z., Patchell, D., Ochion, M., Eidelman, L., Golan, A., Alkan, M., Dwolatzky, T., Norcini, J., Waksman, I., Solomonov, E., & Clarfield, A. M. (2020). Implementing a practical global health curriculum: The benefits and challenges of patient-based learning in the community. Frontiers in Public Health, 8, Article 283. https://doi.org/10.3389/fpubh.2020.00283
Boelen, C., & Heck, J. E. (1995). Defining and measuring the social accountability of medical schools. World Health Organization. https://apps.who.int/iris/handle/10665/59441
Butscher, M. (2025, July 14). From sirens to solutions: Guiding paramedics to a patient-centered mindset. EMS1. https://www.ems1.com/community-paramedicine/from-sirens-to-solutions-guiding-paramedics-to-a-patient-centered-mindset
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652–661. https://doi.org/10.1177/1744987120927206
Canadian Association of Schools of Nursing. (2020). CASN accreditation standards and framework. http://accred.casn.ca/content/user_files/2017/04/EN-CASN-AccreditationStandards-Feb-4-2022.pdf
Carpiano, R. M. (2009). Come take a walk with me: The “Go-Along” interview as a novel method for studying the implications of place for health and well-being. Health & Place, 15(1), 263-272. https://doi-org/10.1016/j.healthplace.2008.05.003
Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Nevile, A. J. (2014). The use of triangulation in qualitative research. Oncology nursing forum, 41(5), 545-547. https://doi.org/10.1188/14.ONF.545-547
Chan, J. T. (2020). Snowball sampling and sample selection in a social network. In A. de Paula, E. Tamer, & M. Voia (Eds.), Advances in econometrics: Vol. 42. The econometrics of networks (pp. 61-80). Emerald Publishing Limited.
Chooniedass, R., Reekie, M., Denison, J., Mercuri, A., Nawara, R., Purcell, N., Oelke, M., & Janke, R. (2025). Embedding cultural safety in nursing education: A scoping review of strategies and approaches. Journal of Professional Nursing, 56, 113-129. https://doi.org/10.1016/j.profnurs.2024.11.005
Colleges Ontario. (2025). Strengthening Ontario’s paramedicine talent pipeline: Transitioning to a three-year primary care paramedicine degree program across the public college system. [Issue Brief]. Colleges Ontario. https://www.nosda.net/images/NOSDA-Board-/2025/Board-Agenda-2025/colleges_ontario_oapc_briefing_note_june_12_2025.pdf
Committee on Accreditation of Canadian Medical Schools. (2023). CACMS 101: A primer on Accreditation of Canadian MD programs. Retrieved August 22, 2023, from https://cacms-cafmc.ca/wp-content/uploads/2023/03/CACMS101-A-Primer-on-CACMS-Accreditation.pdf
Confederation College. (n.d.). Paramedic courses. Retrieved January 12, 2026, from https://www.confederationcollege.ca/program/paramedic/courses
Confederation College. (2025). Primary care paramedic program manual – 2025/26 diploma certificate 0694. https://www.confederationcollege.ca/sites/default/files/2025-08/Paramedic%20Program%20Manual%202025-26%20-%20Version%206.0.pdf
Crampton, P., Hetherington, J., McLachlan, J., & Illing, J. (2016). Learning in underserved UK areas: A novel approach. The Clinical Teacher, 13(2), 102–106. https://doi.org/10.1111/tct.12385
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(1), Article 8. http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
Creswell, J. W., & Poth, C. N. (2017). Qualitative inquiry & research design: Choosing among five approaches (4th ed.). SAGE.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health, 18, Article 174. https://doi.org/10.1186/s12939-019-1082-3
Denizard-Thompson, N., Palakshappa, D., Vallevand, A., Kundu, D., Brooks, A., DiGiacobbe, G., Griffith, D., Joyner, J., Snavely, A. C., & Miller, D. P. (2021). Association of a health equity curriculum with medical students’ knowledge of social determinants of health and confidence in working with underserved populations. JAMA Network Open, 4(3), e210297. https://doi.org/10.1001/jamanetworkopen.2021.0297
Dickson, M., & Manalo, G. (2014). The beyond borders initiative: Aboriginal, Torres Strait Islander and international public health students: Engaging partners in cross-cultural learning. Education for Health, 27(2), 132–137. https://doi.org/10.4103/1357- 6283.143729
Dogra, N., Reitmanova, S., & Carter-Pokras, O. (2009). Teaching cultural diversity: Current status in U.K., U.S., and Canadian medical schools. Journal of General Internal Medicine, 25(2), 164-168. https://dx.doi.org/10.1007%2Fs11606-009-1202-7
Essa-Hadad, J., Murdoch-Eaton, D., & Rudolf, M. C. J. (2015). What impact does community service learning have on medical students’ appreciation of population health? Public Health, 129(11), 1444–1451. https://doi.org/10.1016/j.puhe.2015.05.009
Forsyth, C., Irving, M., Short, S., Tennant, M., & Gilroy, J. (2019). Strengthening Indigenous cultural competence in dentistry and oral health education: Academic perspectives. European Journal of Dental Education, 23(1), e37–e44. https://doi.org/10.1111/eje.12398
Gallegos, J., Tindall, C., & Gallegos, S. (2008). The need for advancement in the conceptualization of cultural competence. Advances in Social Work, 9(1), 51-62. https://doi.org/10.18060/214
Glazier R. H. (2023). Our role in making the Canadian health care system one of the world's best: How family medicine and primary care can transform-and bring the rest of the system with us. Canadian family physician Medecin de famille canadien, 69(1), 11–16. https://doi.org/10.46747/cfp.690111
Global consensus for social accountability of medical schools. (2010). Retrieved May 25, 2022, from https://healthsocialaccountability.sites.olt.ubc.ca/files/2011/06/11-06-07-GCSAEnglish-pdf-style.pdf
Grimaldi, J. (2021, February 9). Investigation underway at York Paramedics after ‘offensive’ tweets emerge. Toronto Star. https://www.thestar.com/news/gta/investigation-underway-at-york-paramedics-after-offensive-tweets-emerge/article_05b3aa4d-f6fa-56f3-8a74-8e19e3d82681.html
Harrison, S. G. D., Scheepers, J., Christopher, L. D., & Naidoo, N. (2020). Social determinants of health in emergency care: An analysis of student reflections on service-learning projects. African Journal of Health Professions Education, 12(1), 22–26. https://doi.org/10.7196/AJHPE.2020.v12i1.1152
Harvey, A. (2023). Student perspectives on preparation to be just and socially responsible providers: A northwestern Ontario qualitative case study [Master’s thesis, Lakehead University]. Lakehead University Knowledge Commons. https://knowledgecommons.lakeheadu.ca/items/6d66819d-1ec5-4bdb-8e27-4ef47520ac04
Hopkins, L., Saciragic, L., Kim, J., & Posner, G. (2016). The hidden curriculum: Exposing the unintended lessons of medical education. Cureus 8(10), e845. https://doi.org/10.7759/cureus.845
Kline, C., Godolphin, W., Chhina, G., & Towle, A. (2013). Community as teacher model: Health profession students learn cultural safety from an aboriginal community. Michigan Journal of Community Service Learning, 20(1), 5-17. http://hdl.handle.net/2027/spo.3239521.0020.101
Kuilanoff, E. (2021). Burnout and our professional identity crisis as clinical educators. Academic Medicine 96(5), 616-617. https://doi.org/10.1097/ACM.0000000000003994
Loriggio, P. (2022, January 18). Paramedics who treated fatally wounded teen receive 18 months’ conditional sentence. CP24. https://www.cp24.com/news/paramedics-who-treated-fatally-wounded-teen-receive-18-months-conditional-sentence-1.5744586
Lumivero (2023). NVivo (Version 14) [computer software]. Lumivero.
Mahood S. C. (2011). Medical education: Beware the hidden curriculum. Canadian Family Physician, 57(9), 983–985. https://www.cfp.ca/content/57/9/983
Mikkonen, J., & Dennis Raphael, D. (2010). Social determinants of health: The Canadian facts. York University School of Health Policy and Management, Toronto.
Mkandawire-Valhmu, L., Weitzel, J., Dressel, A., Neiman, T., Hafez, S., Olukotun, O., Kreuziger, S., Scheer, V., Washington, R., Hess, A., Morgan, S., & Stevens, P. (2019). Enhancing cultural safety among undergraduate nursing students through watching documentaries. Nursing inquiry, 26(1), e12270. https://doi.org/10.1111/nin.12270
Murray, R., Larkins, S., Russell, H., Ewen, S., & Prideaux, D. (2012). Medical schools as agents of change: Socially accountable medical education. Medical Journal of Australia, 196(10), 653–653. https://doi.org/10.5694/mja11.11473
O’Meara, O., Ruest, M., & Stirling, C. (2014). Community paramedicine: Higher education as an enabling factor. Australasian Journal of Paramedicine, 11(2). https://doi.org/10.33151/ajp.11.2.22
Ontario Paramedic Association. (n.d.-a). Becoming a paramedic. Retrieved September 1, 2024, from https://www.ontarioparamedic.ca/curriculum/become-a-paramedic
Ontario Paramedic Association. (n.d.-b). Frequently asked questions. Retrieved December 24, 2021, from https://www.ontarioparamedic.ca/self-regulation/faq
Ontario Paramedic Association. (n.d.-c). Paramedic self-regulation. Retrieved December 24, 2021, from https://www.ontarioparamedic.ca/self-regulation
Ontario. (2008). College program standard: Paramedic. https://www.ontario.ca/page/college-program-standard-paramedic
Ontario. (2014, January 21). Ontario expanding community role for paramedics. https://news.ontario.ca/en/release/28189/ontario-expanding-community-role-for-paramedics
Ontario. (2021, October 22). Ontario expands Community Paramedicine for Long-Term Care Program. https://news.ontario.ca/en/release/1001022/ontario-expands-community-paramedicine-for-long-term-care-program
Palis, A. G., & Quiros, P. A. (2014). Adult learning principles and presentation pearls. Middle East African Journal of Ophthalmology, 21(2), 114–122. https://doi.org/10.4103/0974-9233.129748
Paramedic Association of Canada. (2011). National occupational competency profile for paramedics. https://www.paramedic.ca/uploaded/web/documents/2011-10-31-Approved-NOCP-English-Master.pdf
Peel, K. L. (2020). A beginner's guide to applied educational research using thematic analysis. Practical Assessment, Research, and Evaluation, 25, Article 2. https://doi.org/10.7275/ryr5-k983
Ramsden, I. M. (2002). Cultural safety and nursing education in Aotearoa and Te Waipounamu. [Unpublished doctoral dissertation, Victoria University of Wellington, Wellington, NZ].
Reitmanova, S. (2011). Cross-cultural undergraduate medical education in North America: Theoretical concepts and educational approaches. Teaching and Learning in Medicine, 23, 197-203. https://doi.org/10.1080/10401334.2011.561761
Ross, B., Daynard, J., & Greenwood, D. (2014). Medicine for somewhere: The emergence of place in medical education. Educational Research and Reviews, 9(22), 1250-1265. https://doi.org/10.5897/ERR2014.1948
Ross, B. M., Cameron, E., & Greenwood, D. (2019). A qualitative investigation of the experiences of students and preceptors taking part in remote and rural community experiential placements during early medical training. Journal of Medical Education and Curricular Development, 6. https://doi.org/10.1177/2382120519859311
Rowland, E., & Brydges, M. (2023). Paramedics. Optometrists. In I. Bourgeault (Ed.), Introduction to Health Occupations in Canada. (pp. 295-310). Ottawa: Canadian Health Workforce Partners, Inc.
Ryder, C., Yarnold, D., Hayes, C., MacKean, L., Sjoberg, D., & Porter, M. (2013). Teaching and learning: Demonstrating cultural safety in communication through standardised role play. In C. Lochert (Ed.), LIME Good Practice Case Studies: Vol. 2. (pp. 19-23). Onemda VicHealth Koori Health Unit, The University of Melbourne. https://search.informit.org/doi/10.3316/informit.048922940559496
Shannon, B., Eaton, G., Lanos, C., Leyenaar, M., Nolan, M., Bowles, K. A., Williams, B., O'Meara, P., Wingrove, G., Heffern, J. D., & Batt, A. (2022). The development of community paramedicine; a restricted review. Health & Social Care in the Community, 30(6), e3547-e3561. https://doi.org/10.1111/hsc.13985
Snyman, S., & Geldenhuys, M. (2019). Exposing an interprofessional class of first years to an underserved community contributed to students’ contextualisation of the determinants of health. Journal of Interprofessional Care, 33(3), 280–290. https://doi.org/10.1080/13561820.2019.1566219
Stubbe D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus (American Psychiatric Publishing), 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041
University of Toronto Scarborough. (2023, June 8). Department of Health and Society to lead Paramedicine program. https://www.utsc.utoronto.ca/healthsociety/department-health-and-society-lead-paramedicine-program
Uy, T., & Dimaano, C. (2019). Lessons learned from “The Spirit Catches You and You Fall Down”: Student perspectives on how cultural differences can lead to health disparities. Health Education Journal, 79(1), 73-81. https://doi.org/10.1177/0017896919862592
van den Heuvel, M., Au, H., Levin, L., Bernstein, S., Ford-Jones, E., & Martimianakis, M. A. T. (2014). Evaluation of a social pediatrics elective: Transforming students’ perspective through reflection. Clinical Pediatrics, 53(6), 549–555. https://doi.org/10.1177/0009922814526974
Weber, A., Devenish, S., & Lam, L. (2024). Exploring the alignment between paramedicine's professional capabilities and competency frameworks for current and evolving scopes of practice: A literature review. BMC Medical Education, 24(1), Article 31. https://doi.org/10.1186/s12909-023-04992-w