The role of educational theory in the future development of paramedicine as a profession: An integrative review



How to Cite

Bell A, Hammer S, Seymour-Walsh A. The role of educational theory in the future development of paramedicine as a profession: An integrative review. Australasian Journal of Paramedicine [Internet]. 2021Aug.22 [cited 2023Feb.6];18. Available from:



Paramedicine is at a critical juncture in its history as a healthcare profession. The evolution of paramedic practice in Australia over recent decades has culminated in its inclusion as a nationally registered, accredited, healthcare profession, while similar development is also occurring worldwide. Although paramedic education has developed over time, it is now the moment to determine whether existing educational approaches can adequately support its ongoing evolution as a profession. This article shares findings of a systematic, integrative review of characteristics of professions, allied health education and paramedic education literature.


Due to too little current research on approaches to paramedic education, the review aimed to distil essential requirements of professional education in general, and paramedic education in particular. This distillation served as an initial point of comparison with existing educational approaches in paramedicine. Literature was iteratively searched using PubMed, ScienceDirect and EBSCOhost megafile ultimate search engines, and was complemented with manual searches via professional networks, reference searches and Google Scholar.


The literature review highlighted consistent themes relevant to paramedic education such as, the socio-political definition of a profession, methods for the identification of a profession, paramedicine as a distinct healthcare profession and the contemporary paramedic education framework.


Based on findings from this integrative review, we conclude that there is a potential misalignment between existing paramedic curricula and the educational scaffolding required to develop practicing paramedic professionals. We recommend further investigation of this potential misalignment as part of conceptualising an effective, quality, educational framework that is fit-for-purpose.


Williams B, Edlington T. Attitudes towards continuing professional development: a qualitative study of Australian paramedics. Australasian Journal of Paremedicine 2019;16.

First S, Tomlins L, Swinburn A. From trade to profession-the professionalisation of the paramedic workforce. Journal of Paramedic Practice 2012;4:378-81.

Williams B, Onsman A, Brown T. From stretcher-bearer to paramedic: the Australian paramedics’ move towards professionalisation. Australasian Journal of Paramedicine 2014;7.

Williams B, Fielder C, Strong G, Acker J, Thompson S. Are paramedic students ready to be professional? An international comparison study. Int Emerg Nurs 2015;23:120-6.

Bowen LM, Williams B, Stanke L. Professionalism among paramedic students: achieving the measure or missing the mark? Adv Med Educ Pract 2017;8:711-9.

Willis E, O’Meara P, Jensen AL, McCarthy C. Paramedic Education: developing depth through networks and evidence-based practice. Australasian Journal of Paramedicine 2009;7:1-4.

Lord B, Simpson P. Clinical decision making in paramedicine. 4th edn. Higgs J, Jensen G, Loftus S, Christensen N, editors. Edinburgh: Elsevier; 2019.

Reed B, Cowin L, O’Meara P, Wilson I. Professionalism and professionalisation in the discipline of paramedicine. Australasian Journal of Paramedicine 2019;16.

Acker JJ. Informing our Future: the development of a regulatory framework for registered paramedics in Australia. ibid. 2016;13.

McEwen C, Trede F. The academisation of emerging professions: Implications for universities, academics and students. Power and Education 2014;6:145-54.

Willis E. Paramedic education: developing depth through networks and evidence-based research-reflections twelve months on. Australasian Journal of Paramedicine 2009;7.

Higgs J. Deliberately owning my practice model: realising my professional practice. In: Trede F, McEwen C, editors. Educating the Deliberate Professional: Preparing for future practices. Cham: Springer International Publishing; 2016. p. 189-203.

Higgs J. Practice-based education: the practice-education-context-quality nexus. Practice-based education: Brill Sense; 2012. p. 1-12.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs 2005;52:546-53.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336-41.

Page MJ, McKenzie J, Bossuyt P, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol 2021;134:103-12.

Kelly KD, Travers A, Dorgan M, Slater L, Rowe BH. Evaluating the quality of systematic reviews in the emergency medicine literature. Ann Emerg Med 2001;38:518-26.

Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.

Silagy CA, Middleton P, Hopewell S. Publishing protocols of systematic reviews: comparing what was done to what was planned. JAMA 2002;287:2831-4.

Souza MTd, Silva MDd, Carvalho Rd. Integrative review: what is it? How to do it? Einstein (São Paulo) 2010;8:102-6.

Burford B, Morrow G, Rothwell C, Carter M, Illing J. Professionalism education should reflect reality: findings from three health professions. Med Educ 2014;48:361-74.

Hou X-Y, Rego J, Service M. Review article: paramedic education opportunities and challenges in Australia. Emerg Med Australas 2013;25:114-9.

Marshall H. Paramedic education: developing depth through networks and evidence-based research-Finding the ideal pedagogy. Australasian Journal of Paramedicine 2009;7.

Jackson D. Paramedic education: developing depth through networks and evidence-based research. Where from and where to? ibid. 2009;7.

O’Brien K, Moore A, Dawson D, Hartley P. An Australian story: paramedic education and practice in transition. ibid. 2014;11.

Williams B, Onsman A, Brown T. From stretcher-bearer to paramedic: the Australian paramedics’ move towards professionalisation. ibid. 2009;7.

Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000;75:612-6.

Joyce CM, Wainer J, Archer F, Wyatt A, Pitermann L. Trends in the paramedic workforce: a profession in transition. Aust Health Rev 2009;33:533-40.

Saks M. Defining a profession: The role of knowledge and expertise. Professions and Professionalism 2012;2.

Krishnan A. What are academic disciplines? Some observations on the disciplinarity vs. interdisciplinarity debate. 2009 Available at:

Hilton S, Southgate L. Professionalism in medical education. Teaching and Teacher Education 2007;23:265-79.

Cruess SR, Johnston S, Cruess RL. “Profession”: a working definition for medical educators. Teach Learn Med 2004;16:74-6.

Greenwood E. Attributes of a profession. Rockville, Maryland: Aspen; 1984.

Lynch DC, Surdyk PM, Eiser AR. Assessing professionalism: a review of the literature. Med Teach 2004;26:366-73.

Reynolds L. Is prehospital care really a profession? Australasian Journal of Paramedicine 2004;2.

Reynolds L, O’Donnell M. The professionalisation of paramedics: the development of pre-hospital care. Understanding the Australian health care system-e-book. Churchill Livingstone, 2012: p. 241.

Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Defining professionalism in medical education: a systematic review. Med Teach 2014;36:47-61.

Munro GG, O’Meara P, Mathisen B. Paramedic academics in Australia and New Zealand: the ‘no man’s land’ of professional identity. Nurse Educ Pract 2018;33:33-6.

O’Meara PF, Furness S, Gleeson RAY. Educating paramedics for the future: a holistic approach. J Health Hum Serv Adm 2017;40:219-51.

Loftus S, Gerzina T, Higgs J, Smith M, Duffy E. Educating health professionals: becoming a university teacher. Springer; 2013.

Kek MYCA, Hammer S. Theorising academic development as an academic discipline? Exploring academic developers’ ways of knowing, theorising and use of methods. Theory and Method in Higher Education Research 2015; p. 235-55.

Abbott P, Meerabeau L. Professionals, professionalization and the caring professions. In: The sociology of the caring professions. Editors: Abbott P, Meerabeau L. 1998; p. 2.

Higgs J. Practice-based education pedagogy. Practice-Based Education. Springer; 2012. p. 71-80.

Kilner T. Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: findings from a Delphi study. Emerg Med J 2004;21:374-8.

Williams B. The psychometric properties of the professionalism at work questionnaire for paramedicine students. International Journal of Emergency Services 2021.

Shulman LS. Signature pedagogies in the professions. Daedalus 2005;134:52-9.

Donaghy J. Continuing professional development: reflecting on our own professional values and behaviours as paramedics. Journal of Paramedic Practice 2018;10:1-4.

Bledsoe BE, Porter RS, Cherry RA, Armacost MR. Paramedic care: principles & practice. Pearson Upper Saddle River, NJ; 2013.

Vollmer HM, Mills DL. Professionalization. Stanford Research Inst, Menlo Park CA; 1966.

Cogan ML. The problem of defining a profession. Ann Am Acad Pol Soc Sci 1955;297:105-11.

Carr-Saunders A, Wilson P. Profession. In: Encyclopaedia of the Social Sciences 1944;12:476-80.

Freidson E, editor Knowledge and the practice of sociology. Sociological forum 1986; Springer.

Colby A, Sullivan WM. (2008). Formation of professionalism and purpose: Perspective from the preparation for the professions program. U. St. Thomas LJ, 5, 404. Available at:

Press N. Education for a profession: a phenomenological case study of professional practice preperation for nursing from a sociocultural perspective. University of Southern Queensland; 2017.

Willis E, Williams B, Brightwell R, O’Meara P, Pointon T. Road-ready paramedics and the supporting sciences curriculum. Focus on Health Professional Education 2010;11:1.

Kennedy S, Kenny A, O’Meara P. Student paramedic experience of transition into the workforce: a scoping review. Nurse Educ Today 2015;35:1037-43.

Williams B. Do undergraduate paramedic students embrace case based learning using a blended teaching approach? A 3-year review. Australasian Journal of Educational Technology 2009;25:421-39.

Williams B, Onsman A, Brown T. Australian paramedic graduate attributes: a pilot study using exploratory factor analysis. Emerg Med J 2010;27:794-9.

Ross L, Jennings P, Williams B. Experience, knowledge and attitudes: are paramedic students prepared to care for older patients? Educ Gerontol 2016;42:241-52.

Griffiths J, Speed S, Horne M, Keeley P. ‘A caring professional attitude’: what service users and carers seek in graduate nurses and the challenge for educators. Nurse Educ Today 2012;32:121-7.

Higgs J, Edwards H. Challenges facing health professional education in the changing context of university education. Br J Occup Ther 2002;65:315-20.

Tyler RW. Basic principles of curriculum and instruction. Curriculum Studies Reader E2: Routledge 2013; p. 60-8.

Genn JM. AMEE Medical Education Guide No. 23 (Part 2): curriculum, environment, climate, quality and change in medical education – a unifying perspective. Med Teach 2001;23:445-54.

Worley P, Prideaux D, Strasser R, Magarey A, March R. Empirical evidence for symbiotic medical education: a comparative analysis of community and tertiary‐based programmes. Med Educ 2006;40:109-16.

Prideaux D, Worley P, Bligh J. Symbiosis: a new model for clinical education. Clin Teach 2007;4:209-12.

Tight M. Discipline and theory in higher education research. Research Papers in Education 2014;29:93-110.

Brooks I, Grantham H, Spencer C, Archer F. 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 2018;15.

Tight M. Research into higher education: an a‐theoretical community of practice? Higher Education Research & Development 2004;23:395-411.

Brandon AF, All AC. Constructivism theory analysis and application to curricula. Nurs Educ Perspect 2010;31:89-92.