Understanding how to maintain paramedic simulation-based education quality: a qualitative study

Abstract Background: Simulation-Based Education (SBE) is an essential component of paramedic training, offering a structured environment for students to develop clinical skills and decision-making capabilities. Despite the existence of SBE quality frameworks, such as those from the Association for Simulated Practice in Healthcare (ASPiH) and the International Nursing Association for Clinical Simulation and Learning (INACSL), the application of these frameworks in maintaining paramedic SBE quality remains inconsistent. This study explores paramedic educators' perceptions of SBE quality, the challenges in applying SBE quality frameworks, and potential strategies for improvement. Methods: An exploratory qualitative research design was employed, utilising semi-structured interviews with eight paramedic educators from five higher education institutions in the East Midlands, UK. Data were analysed using template analysis to identify key themes related to maintaining paramedic SBE quality. Results: Participants were aware of the importance of quality in SBE, yet demonstrated limited awareness and inconsistent application of formal quality frameworks, often relying more on informal, experience-driven approaches. Psychological safety and student engagement were emphasised as crucial to effective SBE, yet institutional constraints, including financial limitations, staffing shortages, inadequate faculty training, hindered quality assurance efforts. There were also challenges in standardising simulation scenarios and debriefing practices, with educators highlighting the need for greater institutional support and structured training in simulation pedagogy. Conclusions: The study highlights significant opportunities to enhance the integration of quality frameworks in paramedic SBE, emphasising the need for improved faculty training, increased institutional investment, and structured quality assurance mechanisms. Addressing these barriers is essential to ensure consistency, effectiveness, and sustainability in paramedic SBE.