ASSESSMENT OF EMERGENCY
MEDICAL SERVICES (EMS) TRAINING
CURRICULA IN KENYA
FINDINGS AND RECOMMENDATIONS
FROM AN EXPERT ASSESSMENT
ASSESSMENT OF EMERGENCY MEDICAL SERVICES (EMS) TRAINING CURRICULA IN KENYA
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ASSESSMENT AND REPORT BY:
Chelsea McCollough, MD
Department of Emergency Medicine,
Denver Health Medical Center – USA
Nee-Kofi Mould-Millman, MD FACEP
Department of Emergency Medicine,
University of Colorado, School of Medicine – USA
Benjamin Nicholson, MD
Department of Emergency Medicine
Boston Medical Center – USA
Benjamin Wachira, MD, FCEM
Accident & Emergency Department
The Aga Khan University, Nairobi
ASSESSMENT TEAM CONTACTS:
Nee-Kofi Mould-Millman, MD FACEP
12401 E. 17th Ave, Room 752, Aurora, Colorado – USA
E: Nee-Kofi.Mould-Millman@UCDenver.edu T: +1-720-848-6790
Benjamin Wachira, MD FCEM
The Aga Khan University, Nairobi – Kenya
E: benjamin.wachira@aku.edu T: +254 20 366 2603
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ACKNOWLEGEMENT
WE WOULD LIKE TO THANK ALL THE EMERGENCY MEDICAL SERVICES (EMS) PERSONNEL AND
ORGANISATIONS IN KENYA THAT SUPPORTED THE DEVELOPMENT OF THIS REPORT ON EMERGENCY
MEDICAL SERVICES (EMS) TRAINING CURRICULA IN KENYA.
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TABLE OF CONTENTS
Section I:
Executive Summary5
Section II:
Methodology6
Section III: Primary Findings And Recommendations
8
Section IV: Secondary Findings And Recommendations
12
Section V: Conclusions And Future Directions
13
References14
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SECTION I:
EXECUTIVE SUMMARY
Kenya has an undisputed and strong need for robust prehospital care. The high prevalence of natural
disasters (e.g. flooding), man-made disasters (e.g. terrorism), mass casualty incidents (e.g. multipassenger vehicle collisions), and referrals (e.g. inter-facility patient transfers) has placed an incredibly
large demand for a reliable, timely, integrated, and safe Emergency Medical Services (EMS) system.1
Several agencies across Kenya are working to provide both EMS response and training in order to meet
this demand for prehospital care. The training of EMS providers is an especially critical part of the
overall Kenyan EMS landscape with the need for quality training in order to produce quality providers
who are able to provide quality services and advance the profession. Notwithstanding, in Kenya to date,
no enabling national legislature exists to govern or oversee the safe practice of prehospital care, nor to
regulate training, certification, nor agency credentialing of EMS providers.
Consequently, Kenyan EMS training institutions have each made due by providing their own reference
standards, content, and processes for training providers to work in the challenging Kenyan prehospital
environment. This has resulted in considerable and confusing heterogeneity within providers and the
prehospital practice environment, which is likely resulting in sub-optimal care and service delivery.
Unfortunately, this is likely to dramatically worsen if it continues to be left unchecked.
This assessment, conducted by external EMS experts with expertise in African and international EMS
systems and EMS education, reports several key findings and offers important recommendations
to help standardize and enhance the quality of training in Kenyan prehospital care. In brief, the key
recommendations are as follows:
1.
2.
3.
4.
5.
6.
7.
A standard Kenyan EMS scope of practice (document and policy) is needed that defines
levels (i.e. tiers or cadres) of EMS providers, and delineates all knowledge and skills required
to practice as a prehospital provider at the given level.
A standard for EMS training should be developed and implemented to help ensure high
quality and uniformity in EMS training across institutions, and alignment with the Kenyan
EMS scope of practice.
There should be a transition from over-reliance on non-Kenyan curricula and training
content, to more Kenya-specific materials and content targeted to the local burden of
disease, healthcare system, and available resources. External reference texts/material can
function as a guide for initial training initiatives and provide coarse structure, but training
content should be edited as much as possible to reflect local needs.
The EMS training culture should shift away from diagnosis-based training to syndrome or
symptom based training.
EMS trainees could greatly benefit from stronger foundational didactic classroom-based
education (classroom education) at the basic (EMT) level with a specific focus in clinically
relevant basic anatomy and physiology. This should be limited to the knowledge and basics
directly relevant to their scope of practice.
To improve foundational clinical training in emergency care, all trainees should first
achieve competencies and attain adequate field experience at a basic (EMT) provider level,
before receiving additional training to higher qualifications (e.g. Intermediate Life Support
(ILS) or Advanced Life Support (ALS).
Higher-order and critical thinking skills need to be developed, by integrating basic
knowledge and skills into real-world clinical scenarios, which should be heavily woven into
all aspects of EMS training programs.
The following pages provide further details into the assessment methodology, the findings, and more
detailed explanation of the primary and secondary recommendations.
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SECTION II:
METHODOLOGY
Objectives:
Kenya has conducted prehospital training for nearly twenty years;2 a robust evaluation may augment the quality,
effectiveness, and efficiency of existing training efforts. The objective of this assessment is to provide expert external
opinion to appraise Kenyan EMS training programs and provide useful observations and recommendations. Further,
we aimed to assess EMS training programs in the context of the Kenyan burden of disease, healthcare system, existing
resources, and expected future of EMS in Kenya. It is our hope that findings from this assessment will serve to improve
EMS training in Kenya.
Approach:
Design: A mixed methods approach was undertaken to perform an educational assessment.
Period: The assessment was conducted in July and August 2016.
Setting: The assessment was primarily done in the Nairobi area, of EMS agencies and EMS training institutions
(intentionally de-identified for this report). The EMS organizations, although assessed locally in Nairobi, have a national
presence throughout Kenya.
Sources: There were three primary sources from which data were collected: key personnel interviews; structured
direct observations; and document review.
Data Collection:
•
•
•
Key personnel interviews were conducted with trainees, instructors, and senior staff within three EMS training
institutions. Interviews provided more detailed understanding of the thought process of all involved, each
party’s beliefs regarding strengths and weaknesses of the current approach, and improvements they believe are
necessary for the future.
The assessment team was given the opportunity to directly observe both the clinical and classroom training
environments as well as observe the delivery of prehospital care on board ambulances. The focus of observations
and interviews was to better appreciate the style of training and approach to instruction.
Training organizations provided documents for review that covered the training requirements, testing procedures,
and the instructional materials. Several ambulance companies provided equipment checklists. Together these
materials provided additional data to incorporate into the information obtain through both informal interviews
and direct observation of training and clinical care.
Analysis: The assessment team compiled all findings using an expert consensus approach, via ranking of
recommendations, which were sorted into primary (key) findings and recommendations, and a set of secondary
findings and recommendations.
Education Theories: Two internationally-accepted standard educational theories are used and referenced in this
report: Kirkpatrick and Bloom.3,4 Each is briefly explained below.
The Kirkpatrick Four-Level Training Evaluation Model is useful to objectively analyze the effectiveness and impact
of training programs. In this assessment, although we did not primarily assess Kirkpatrick outcomes, we assigned a
Kirkpatrick level to issues with training outcomes we identified. This may conceptually aide EMS educators in solutiongeneration. The four levels of evaluation are:
1.
2.
3.
4.
the reaction of the student and their thoughts about the training experience;
the student’s resulting learning and increase in knowledge from the training experience;
the student’s behavioral change and improvement after applying the skills on the job; and
the results or effects that the student’s performance has on patient care or service delivery.
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Bloom’s Taxonomy of Educational Objectives is a useful framework for categorizing educational goals into levels of
complexity and specificity. It is one of the most widely used methods of organizing levels of expertise. The Taxonomy
uses a multi-tiered scale to express the level of expertise required to achieve each measurable student outcome,
explained as:
1.
2.
3.
4.
5.
6.
Knowledge: “involves the recall of specifics and universals, the recall of methods and processes, or the
recall of a pattern, structure, or setting.”
Comprehension: “refers to a type of understanding or apprehension such that the individual knows what
is being communicated and can make use of the material or idea being communicated without necessarily
relating it to other material or seeing its fullest implications.”
Application: refers to the “use of abstractions in particular and concrete situations.”
Analysis represents the “breakdown of a communication into its constituent elements or parts such that
the relative hierarchy of ideas is made clear and/or the relations between ideas expressed are made
explicit.”
Synthesis: involves the “putting together of elements and parts so as to form a whole.”
Evaluation: engenders “judgments about the value of material and methods for given purposes.”
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SECTION III:
PRIMARY FINDINGS AND RECOMMENDATIONS
(I) Standardizing the Kenyan EMS scope of practice.
Key Findings:
•
Currently, the EMS scope of practice in Kenya is defined at the individual ambulance agency level. No national
or state-level policy exists that establishes or standardizes levels of EMS providers. Consequently, significant
heterogeneity exists amongst Kenyan EMS providers.
Key Recommendation:
•
A standard Kenyan EMS scope of practice (document and policy) is needed that clearly defines standard levels (i.e.
tiers or cadres) of EMS providers, and which delineates all knowledge, skills, and competencies required to practice
as a prehospital provider at that given level.
Discussion (brief):
•
•
•
•
Heterogeneity exists in ranks and training of Kenyan EMS providers – this is confusing to the medical and layperson
populations, and directly threats continued EMS professionalization.
Of note, countries that have adopted a strategy of a nationally-defined standardized scope of practice have
experienced efficiencies in EMS education and expanded career opportunities for EMS providers (e.g. through
career advancing opportunities).5
The national scope of practice document should explicitly define: (i) what the various levels of EMS providers
are, (ii) the training and/or qualifications required to attain those levels, and (iii) a standardized minimum and
maximum expected fund of knowledge and skills, and core competencies, for each provider level. This document
should be empowered by enabling legislature, policy, or written agreements such that EMS training institutions and
agencies will adhere to the standards within the scope of practice.
A standardized scope of practice will be even more important as EMS expands geographically in Kenya. Given
the wide range of populations, environments, and resources across Kenya, it is likely that even more variation in
training and certification will result if this heterogeneity is not standardized soon.
(II) Creating a national Kenyan standard for EMS training.
Key Findings:
•
•
Kenyan EMS training institutions have individually defined the breadth and depth of training content, and employed
their own training standards. This may directly stem from the lack of a standard scope of practice document and
national standards around EMS training.
Key Recommendation:
•
A standard for EMS training should be developed and implemented to help ensure high quality and uniformity in
EMS training across institutions, and alignment with the Kenyan EMS scope of practice.
Discussion (brief):
•
•
•
•
Standards for EMS training in Kenya can establish the minimum (“floor”) and maximum (“ceiling”) content of
training for each cadre/tier of EMS provider. Individual EMS training institutions can deliver content, with a given
tier, somewhere between the floor and ceiling.
Tightly aligning EMS training curricula and content to the respective providers’ scope of practice will be useful to
help minimize costly over-training, or dangerous under-training.
Once a scope of practice is defined, establish minimum knowledge, skills, and competencies for each item with
associated learning objectives. The frequency of specific skill and procedure utilization should be assessed regularly
to evaluate if the curriculum provides the necessary knowledge to perform the defined scope of practice.
EMS institutions should train learners receive all the corresponding knowledge, skills and attain all the competencies
at ta specific provider level defined by the scope of practice. If the scope of practice is well-written for the Kenyan
context, quality EMS training can produce a provider extremely well trained and prepared to function in the Kenyan
setting.
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(III) Adapting foreign training content to Kenya
Key Findings:
•
•
Currently, training materials and content, including slides, books, and practical simulations are from non-Kenyan
(mostly United States) sources. Local inapplicability subtly degrades the quality of EMS training and relevance of
content for EMS learners.
Testing materials cover non-Kenyan EMS system facts and issues, which is inappropriate for learners, and wasteful
on training resources.
Key Recommendation:
•
There should be a transition from over-reliance on non-Kenyan curricula and training content, to more Kenyaspecific materials and content targeted to the local burden of disease, healthcare system, and available resources.
External reference texts/material can function as a guide for initial training initiatives and provide coarse structure,
but training content should be edited as much as possible to reflect local needs (see secondary recommendation
(V).
Discussion (brief):
•
•
•
•
•
The Kenyan prehospital epidemiology can be elucidated by EMS service agencies collecting, analyzing, and
sharing/publishing these data as an integral part of their mission.
External reference texts and material can function as a guide for initial training initiatives and provide coarse
structure, but training content should be edited as much as possible to reflect local environment, burden of disease,
and health systems needs. Images of non-Kenyan EMS systems, for example, should be replaced with images of
African or local systems and equipment.
While creating a textbook is a large undertaking and unlikely to be locally created in the short-term, the slide bank
and testing material can be edited.
Presentation slides should be edited to be Kenyan focused and any material specific to the United States or any
other outside country should be removed.
Testing material should have a Kenyan focus (local patient complaints, local ambulance equipment, etc) and all
references to outside systems and standards should be removed and significantly downplayed (or omitted) in any
assessments.
(IV) Focus on symptom- or syndrome-based training.
Key Findings:
•
•
EMS students consistently reported discomfort with medical chief complaints, largely due to difficulty in formulating
simple symptom- or syndrome-based differential diagnoses.
Conversely, EMS trainees overestimated their knowledge and confidence in trauma care.
Key Recommendation:
•
We strongly urge a shift in EMS training culture away from diagnosis-based training to syndrome and/or symptom
based training.
Discussion (brief):
•
•
•
•
•
A focus on a strong basic (EMT) level course will strengthen all levels of prehospital care.6 Excellent ILS and ALS
providers depend on strong basic foundation. We found basic knowledge and skills amongst Kenyan EMS trainees
to be deficient. We propose the basic (EMT) course should be established as the initial course for all providers.
Globally, EMS providers are typically trained to recognize and manage patients based on constellation of complaints,
symptoms, or syndromes. We discourage approaching prehospital care and education from a diagnosis-based
perspective given the generally limited/short scope of training. We do appreciate that in Kenya, as in most of
Africa, EMS providers conduct a large volume of inter-facility transports, in which referring providers use diagnoses
– however, providers should be encouraged to refer/ascertain patients’ complaints and symptoms to continue their
prehospital care.
Trainees largely believed that they understood traumatic injuries but did not understand medical complaints. This
confusion around medical complaints was particularly evident when “abdominal emergencies” were discussed.
Providers stated that abdominal emergencies were difficult because there were such a large number of diseases
that could cause a single complaint. They focused on determining what the diagnosis was and not on managing
life threats associated with the complaint or symptomatic treatment.
Conversely, trainees believe that trauma is straightforward partly because the diagnosis is visible or “obvious”.
Unfortunately, the diagnosis that many trainees provided was stating the mechanism of injury, such as fall, and not
a broad injury category or anatomic complaint, such as long bone fracture or chest pain.
The basic (EMT) level course should increase the time spent on the general approach to medical symptoms and
decrease the number of distinct diseases covered.
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(V) Improve foundational didactic/classroom-based education.
Key Finding:
•
•
Students struggle with understanding basic anatomy and physiology (Bloom Lower-order).
This results in difficulty in applying this content to clinically (Bloom Middle- and High-order). For example, students
consistently expressed most discomfort with approaching medical complaints/conditions, of which “abdominal
complaints” appeared to create the most confusion and lack of confidence.
Key Recommendation:
•
•
•
EMS trainees could greatly benefit from stronger foundational didactic classroom-based education (classroom
education) at the basic (EMT) level with a specific focus in clinically relevant basic anatomy and physiology. This
should be limited to the knowledge and basics directly relevant to their scope of practice.
Increase the amount of time dedicated to basic anatomy and physiology, aligned to the Kenyan burden of disease
(Bloom Lower-order).
Increase time in course spent on general approach to medical symptoms and decrease the number of distinct
diseases covered because students inappropriately perseverate on linking diagnoses to complaints (Blood Middleand High-Order).
Discussion (brief):
•
•
Students arrived at the EMT course with a wide spectrum of prior education, from the most advanced students
who were former nurses, to those who had completed secondary education to some degree. Given this range of
backgrounds, the focus must be on ensuring that the least experienced and least proficient learner is brought to
the level necessary to perform the Kenyan EMT’s job. However, caution must be exercised to ensure that the course
does not inappropriately focus on advanced topics during the basic level course. For those providers with no prior
medical training, this advanced knowledge was too taxing and only served to complicate their understanding of
basic topics.
Anatomy and physiology are the foundation of medicine. The focus should be on ensuring that all providers
understand the basics of these topics and then repeatedly apply them throughout the training course. Students
currently have large gaps in their foundational knowledge and these gaps should be closed with reinforced
foundational training.
(VI) Improve foundational clinical training.
Key Findings:
•
•
•
•
•
Students had difficulty applying foundational classroom knowledge to patient simulations or practical stations (a
middle-order deficiency in Bloom’s taxonomy).
Further, students’ had limited opportunities to apply classroom knowledge to real clinical scenarios during their
ambulance clinical training (leads to middle- and high-order deficiencies in Bloom’s taxonomy).
Learning and behavior changes during the ambulance clinical experience are not assessed (Kirkpatrick levels 2
and 3).
Trainee’s opportunity to apply hospital-based care or practice skills learned in the classroom varies greatly (Bloom
Lower-order/Middle-order).
Knowledge and skill acquisition during the hospital clinical experience is not known (Level 2 of Kirkpatrick’s Model).
Key Recommendation:
•
•
•
To improve foundational clinical training in emergency care, we recommend all trainees first achieve competencies
and attain adequate field experience at a basic (EMT) provider level, before receiving additional training to higher
qualifications (e.g. ILS or ALS).
This effort should be guided and supported by the use of structured learning objectives, and the use of structured
feedback tools for formative and summative evaluations.
This should be applied to all learning experiences in the classroom, ambulance, and clinical setting.
Discussion (brief):
•
•
•
•
The EMS training institutions should assess learning outcomes at Kirkpatrick’s levels 1 (reaction), 2 (learning), and
3 (behavior).
The EMS service agencies should assess learning outcomes at Kirkpatrick’s level 4 (results) and feed these findings
back to EMS training institutions to influence EMS training.
The use of standardized feedback tools is important to ensure consistency and improve the overall clinical
education of providers. Feedback should inform students on their progress during the training program and help
trainers identify areas needing improvement.
Certifying agencies should ensure students have being formally assessed and satisfied the minimum necessary
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•
•
•
competencies at the end of each rotation. Students should have a means for providing the certifying agency with
feedback that is blinded/anonymous and used to continually improve the training experience.
Practical stations should use written checklists of the steps required of each skill with the expectation that student
will consistently perform each step. This will ensure skill consistency across providers and allow instructors to
consistently assess a student’s performance. There should be a heavy focus on performing generic trauma and
medical assessments as the core clinical skill.
During the ambulance-based clinical experience, trainees should be in an active role under a supervising senior EMT.
The trainee should perform all of the expected skills of an EMT. There should be consistent learning objectives for
trainees to accomplish during the ambulance experience and the supervising senior EMT senior should complete
an evaluation/feedback tool. The certifying agency should also establish a (formative) feedback tool that the
trainee completes in order to obtain regular feedback on the strengths and challenges of the current ambulance
clinical experience. The certifying agency should develop a tool to utilize at the end of the ambulance clinical
experience (summative tool) to ensure trainees have gained the appropriate knowledge and skills.
The hospital-based clinical experience should provide students with specific learning objectives including both
knowledge and skills to obtain at each unit within each facility. Hospital stakeholders at each institution at the
nurse and physician level should be identified and provided with key learning objectives that the students must
complete. These interested individuals should have maximized student interactions through efforts at clinical
scheduling. An evaluation/feedback tool should be created for the supervising provider to easily and frequently
provide feedback to the trainee. Each certifying agency should also establish a feedback tool to obtain regular
feedback on the strengths and challenges of the current hospital clinical experience. Trainees should be evaluated
at the end of the hospital clinical experience to ensure they have gained the appropriate knowledge and skills.
(VII) Improve (Bloom) high-order and critical thinking skills.
Key Finding:
•
•
There is limited emphasis on complex critical thinking skills beyond reciting facts and understanding basic concepts
(i.e. a current focus on Bloom lower-order thinking).
Consequently, we found that students struggle with applying classroom knowledge to practical clinical stations
(i.e. a deficit in Bloom Middle- and High-order thinking).
Key Recommendation:
•
•
•
•
Higher-order and critical thinking skills need to be developed, by integrating basic knowledge and skills into realworld clinical scenarios, which should be heavily woven into all aspects of EMS training and evaluation programs.
Increase the emphasis on applying basic anatomy and physiology knowledge to the pathophysiology of diseases
relative to symptoms or syndromes.
Increase the emphasis on and development of higher order/critical thinking skills through increased time dedicated
to knowledge application.
Increase the time spent on analyzing and evaluating clinical scenarios with students questioned as to how they
approach chief complaints and medical decision-making.
Discussion (brief):
•
•
•
Currently, Kenyan instructors use a mixed method (qualitative and quantitative) approach to assess learners in
small group sessions, lectures, homework, and student presentations. However, these assessment methods focus
primarily on simple facts and concepts (Krikpatrick level 1 and 2) without assessing higher-order thinking and more
integrated thought processes (Kirkpatrick level 3 and 4).
For example, in trauma care, many trainees indicated that the chief complaint of a traumatically injured patient is
the mechanism of injury, while failing to consider the relevant anatomy, physiology, the chief complaint, mechanism
of injury, and integrate all available data to formulate a care plan and determine how best to manage a trauma
patient (i.e. deficiency in Bloom’s Middle and High order thinking).
The overall quality of the EMS graduates would be greatly improved with more emphasis on developing higherorder and critical thinking consistently applied across all phases of learning. Ultimately, the responsibility falls on
the EMS trainers to include and assess higher order and critical thinking into the training program.
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SECTION IV:
SECONDARY FINDINGS AND RECOMMENDATIONS
(I) EMS training institutions: To ensure safe and responsible EMS provider training, EMS training institutions
should:
•
•
•
•
Provide adequate classroom and laboratory space to conduct training.
have EMS equipment that is used solely for training. The equipment must be in good working condition
and not be used for pre-hospital care.
maintain a written agreement with a licensed medical facility, licensed ambulance service, and physician
medical director at all times. It is recommended that the physician medical director have a good knowledge
of EMS and the function of a licensed training institution prior to signing an agreement.
Primary course instructors must be currently licensed as an instructor coordinator and hold a license at or
above the discipline that they are teaching. A primary instructor is defined as one that instructs at least
fifty percent of the entire course.
(II) EMS provider certification and re-certification: At the end of their training, and before entry into the
EMS workforce, EMS providers should be certified as ready-for-independent-practice as a practitioner. A
standardized process should be employed, which may consist of: producing a certificate of graduation
from a EMS training institution, and passing a standardized external exam (which assesses middle- and
high-order thinking per Bloom’s taxonomy). Re-certification should occur at a pre-defined interval, e.g.
every 5-10 years, and should include some maintenance of certification (e.g. completing several courses
annually, or receiving a certain number of Continuous Professional Development (CPD) credits).
(III) EMS provider credentialing and re-credentialing: Credentialing is a process by which an EMS service
agency prepares a certified EMS provider to enter their workforce. This should include a verification
of certificate, an on-boarding process (which includes orientation to the EMS agency’s equipment and
operating procedures), and a supervised or assessment period (by a medical director or field training
officer). Re-credentialing should occur every 1-2 years by the EMS agency.
(IV) Continuous medical education: Critical knowledge and skills, especially those that are not used
frequently in clinical practice, decay at 6 to 18 month intervals.7 It is imperative that EMS agencies provide
CME opportunities for their providers to minimize knowledge and skills decay. The content of CME
activities should be aligned to: (i) the most common patient conditions, (ii) the most frequent EMS causes
of morbidity and mortality, and (iii) particularly high-risk procedures (e.g. airway management). Refresher
trainings should be frequent and adult-learner friendly (i.e. minimize classroom didactics and maximize
case-based discussions and simulation training).
(V) Implement educational QA/QI processes: Providing quality assurance and quality improvement
processes and programs are helpful to ensure sustained high quality practices within EMS educational
institutions.
(VI) Prehospital burden of disease: The local Kenyan burden of disease, as it relates to the epidemiology
of prehospital emergency conditions, needs to be well-established to aide in adapting and tailoring training
to the Kenyan environment. EMS service agencies have an opportunity to collect this data and provide
reports to the EMS training institutions to help tailor the training
(VII) EMS service agencies should provide feedback to EMS training institutions. EMS service agencies
have an opportunity to assess how their providers are delivering care (Kirkpatrick level 4). Patterns or
repetitive issues noted should be fed back to the EMS training institutions to help improve training.
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SECTION V:
CONCLUSIONS AND FUTURE DIRECTIONS
Overall, the EMS environment in Kenya is thriving and expanding. Sustained high-quality training of
EMS providers will be critical to the continued bright future and professionalization of EMS in Kenya.
In this assessment, several recommendations have been offered to assist improve the quality of training
by EMS educational institutions, including focusing training to Kenyan epidemiology, improving critical
thinking skills, and focusing on symptom and syndrome based patient care. For EMS service agencies,
we recommend introducing continuous medical education/professional development and a process of
certifying and re-certifying providers. Recommendations are also offered that are more relevant to national
standards, including defining the scope of practice and EMS provider certification.
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Kirkpatrick, D. L. Evaluation of training. In R. L. Craig & L. R. Bittel (Eds.), Training and
Development Handbook (pp. 87-112). New York: McGraw Hill, 1967
4.
Bloom, BS (Ed.). Engelhart, MD, Furst, EJ, Hill, WH, Krathwohl, DR. Taxonomy of Educational
Objectives, Handbook I: The Cognitive Domain. New York, NY: David McKay Co Inc, 1956.
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National Highway Traffic Safety Administration. The EMS Education Agenda for the
Future: A Systems Approach. Prehosp Emerg Care 2000;4:365-6.
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National Highway Traffic Safety Administration. The National EMS Scope of Practice
Model. 2007.[ https://www.ems.gov/education/EMSScope.pdf]
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General Medical Council. Skills fade: A review of the evidence that clinical and professional
skills fade during time out of practice, and of how skills fade may be measured or remediated.
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