By Michael G. Miller, EdD, RN, NRP
Clinical and field experiences are a critical component of paramedic education. The Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) surveyed paramedic education programs to gauge levels of access to these key learning opportunities.
With participation from 573 programs (75% response rate) across 45 states, the resulting survey findings are clear: programs are struggling to maximize clinical and field learning experiences for paramedic education students.
The challenge 鈥� and opportunity 鈥� for the broader EMS community is to enhance strategies for ensuring access to these critical learning experiences. This will require coordinated engagement with national organizations representing clinical and field sites, as well as other key stakeholders.
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Scope and scale of paramedic programs
Surveys were emailed to 768 paramedic educational programs between March 4-April 4, 2025. The majority of surveyed paramedic programs operate with modest class sizes: 68% enroll fewer than 30 students annually, and over 84% offer only one or two cohorts per year. Programs also serve a wide range of populations. Roughly 39% are located in areas serving under 100,000 people, while 27% are based in larger metropolitan areas with populations exceeding 500,000.
Clinical site access: A growing concern
One of the most pressing issues identified in the survey is the decreasing availability of clinical education opportunities. Clinical education was defined as 鈥渉ospital, clinic or other location(s) or experience where students interact with patients that does not include an EMS response agency.鈥� More than half of the responding programs (55%) reported a decrease in access to clinical facilities. The most common contributing factors include:
- Increased competition from other health science programs (74%)
- Increased competition from other EMS programs (53%)
- Post-pandemic restrictions (50%)
- Lack of available preceptors (40%)
Programs require students to attend shifts in a variety of clinical units. Emergency departments (99%), obstetric units (82%), operating rooms (72%), critical care units (62%) and pediatric units (60%) remain the most commonly required clinical settings. However, many programs struggle to provide access to units like respiratory care services (38%), psychiatric care (37%), and neonatal intensive care units (20%).
When specialty rotations are not included, the reasons range from specialty units will not accept EMS students (45%) or there is limited availability due to other students (40%), to the units not existing in the program鈥檚 area (12%).
The most challenging patient populations to access include neonates (80%), infants (65%), toddlers (52%), preschoolers (41%), and school-aged children (30%). In contrast, geriatric patients are readily available with few programs (1%) reporting this as a challenging patient population to access.
Adding to the concern is the inconsistency of the student clinical experience. Some students complete rotations with little-to-no patient interaction, depending on shift schedules, facility volume and staff engagement. Nearly 70% of programs do not assign instructional faculty to oversee students at clinical sites, raising questions about supervision quality and educational consistency.
Field experience and capstone internships
Field internships, a cornerstone of paramedic education, present their own set of challenges and trends. About one-third of programs report reduced access to EMS agencies for both field experience and capstone field internships. This reduction is largely attributed to a lack of available preceptors to supervise students, onboarding of newly hired personnel, and requests for student placements that exceed operational availability.
Notably, 97% of programs use the same agencies for both early field experience and capstone internships. Seventy-three percent report collaborating with EMS agencies when selecting preceptors for the capstone experience. The remaining 27% either accept whatever staffing is available or lack formal processes for ensuring preceptor quality.
Preceptor training practices are varied:
- 78% distribute written materials
- 53% provide recorded video training
- 40% offer live classroom instruction
A majority of programs (56%) do not coordinate their preceptor training efforts with other local programs, missing opportunities to standardize expectations and reduce redundancy.
Programs overwhelmingly prefer a consistent preceptorship model during the capstone experience. Seventy-four percent assign students to a limited number of preceptors, supporting continuity and deeper mentorship. Yet variability remains in preceptor training, engagement and evaluation.
Supplementing gaps with innovation
Faced with inconsistent access and passive observational experiences, many programs are turning to simulation to reinforce or substitute clinical learning, particularly in high-risk, low-frequency scenarios, such as neonatal or obstetric emergencies.
Some educators report that high-quality simulation experiences may even surpass real-world clinical shifts in value. Emerging technologies, including virtual reality (VR) and augmented reality (AR), are also being explored to enhance skills development and replicate complex patient encounters.
These innovations are especially critical given the survey鈥檚 findings that neonate, infant and pediatric patient encounters are difficult to secure, followed by psychiatric and obstetric cases.
The role of collaboration and regulation
Underlying many of the issues are administrative and regulatory complexities. Programs report barriers including background checks, varying credentialing procedures, liability concerns and requirements for lengthy memoranda of understanding (MoUs). These logistical burdens can delay or prevent student access to essential education environments.
Strong relationships between programs and clinical or field partners were consistently identified as a key success factor. Programs that prioritize collaboration 鈥� by engaging with agency leadership, aligning on goals and ensuring open communication 鈥� tend to experience smoother onboarding and greater support.
However, not all hospitals and fire departments view EMS education as a priority, with some limiting access based on capacity, liability concerns or philosophical differences about paramedic roles. Programs located in more competitive or densely populated regions often struggle with 鈥渓ast-in-line鈥� status compared to nursing or other allied health programs.
Moving forward
The 2025 CoAEMSP survey underscores a critical need for systemic improvement in how paramedic education programs access and utilize clinical and field resources. As healthcare evolves, EMS educators must advocate for inclusion, foster robust partnerships, and invest in scalable solutions like simulation and cross-program preceptor development.
Ultimately, ensuring high-quality, supervised hands-on education for paramedic students is not only an educational imperative 鈥� it is essential to producing competent professionals who are ready to meet the urgent and diverse needs of prehospital care.
ABOUT THE AUTHOR
Michael G. Miller, EdD, RN, NRP, is an assistant director of the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP).
