Upon writing this manuscript, the EMD Program training has not yet started and the first batch is expected to be enrolled in the program by the end of the year 2021. Trainees will be enrolled on a full-time, continuous basis for the entire fourteen-week duration of the EMD Program including examination weeks. After trainees complete graduation requirements, they will receive along with a certificate of graduation, a professional classification and registration as an EMD specialist by SCFHS and be licensed to work in dispatch centers in KSA. The admission criteria for applicants are detailed in Table 2 and were kept in mind when designing the curriculum based on the expected backroad competencies of the trainees . All dropout, postponement, and withdrawal requests during the EMD Program will follow HA guidelines and a service request should be applied accordingly . After written notification of acceptance into the EMD Program, the trainees responsibilities and rights will apply before and during the clinical experience as shown in Table 2.
Problem Identification and General Needs Assessment
The EMD system is growing in the healthcare sector and more functions are added constantly. Receiving emergency calls requires achieving competencies in knowledge, skills, and attitudes to enable the categorization of cases and the deployment of proper resources. Globally, a variety of dispatch systems exist and are built based on local demand, type of incidents, and terrain differences leading to a complex of operation services, hence standardizing international dispatch policies and procedures is impractical. Moreover, Emergency Medical Dispatchers (EMDs) are from different backgrounds and experiences and receive a variety of training programs to develop and maintain their fundamental dispatching skills throughout their career, adding more to the challenge of unifying dispatch language.
In KSA, EMDs receive vigorous dispatch-related training programs set by the SRCA to maintain daily operation services in EMD.
However, no dispatch program with targeted competencies and learning objectives according to which dispatcher trainees can be assessed regularly, currently exists. Building an EMD Program with a recognized SCFHS classification, in alignment with the national health sector transformation plan, would improve access to prehospital services through efficient and effective dispatch services and develop a clear career pathway for EMDs in KSA.
Targeted Needs Assessment
An international benchmarking of many EMD systems, curriculum, programs, and courses was set by the committee after reviewing several EMD books, relevant training manuals, and related scientific papers. This included: (1) National Emergency Communication Institute-USA (EMD National Certification Course); (2) National Highway Traffic Safety Administration-USA (NHTSA) (NHTSA EMD National Standard Curriculum); (3) the Association of Public Safety Communications Officials International; (4) Seneca College-Canada (911 & Emergency Services Communications); (5) the Principles of Emergency Medical Dispatch textbook 6th edition; and (6) many others [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Locally, the committee evaluated current dispatch systems, met with employees and experts in the field, and collected feedback evaluations from the local dispatch community, to set a group of learning outcomes covering the three learning domains knowledge, skills, and attitudes. The proposed targeted needs, therefore, were set to contain competencies in professionalism and communication, basic knowledge, and skills in interpreting various dispatch systems, prioritizing emergency calls, providing pre-arrival instruction, and dealing with special situations in EMD classified into four modules as shown in Table 1.
Goals and Objectives
The goal of the EMD Program is to improve the integration of current dispatch systems and unify the dispatch language as part of the national health sector transformation plan and Vision 2030 to accelerate the provision of efficient prehospital services and reinforce the role of the EMDs in receiving emergency and non-emergency calls, the dispatch of ambulances to the sites required according to the medical protocol, coordination with the concerned authorities, and directing callers on how to deal with emergency and non-emergency cases. The EMD Program objectives were identified and matched with competencies followed by further elaboration of specific learning outcomes for each module to guide the educational process and Bloom's Taxonomy of Educational Objectives was used as shown in Table 3 .
E-learning and simulation-based learning activities are evolving in health professions education and are being adopted to test different dispatch skills along with the program. In a well-equipped simulation environment (simulation lab), trainees will be exposed to a variety of pre-recorded scenarios to measure each competency by specialized expert simulation educators. A debriefing discussion after each session will take place to highlight passing points, lessons learned, and areas for improvement in every case. To ensure effective educational strategies and achieve educational objectives of the EMD Program, Kolb’s two levels experimental learning theory (four-stage cycle and four separate learning styles) was adopted . The experimental learning cycle includes: Concrete Experience (CE) (feeling); Reflective Observation (RO) (watching); Abstract Conceptualization (AC) (thinking); and Active Experimentation (AE) (doing). In his theory, learning styles are usually a product of two learning variables that include: Diverging (CE+RO); Assimilating (AC+RO); Converging (AC+AE); and Accommodating (CE+AE). He further elaborates in his matrix, the two continuum east-west axis also called Processing Continuum (how we approach a task by watching or doing) and the north-south axis also known as Perception Continuum (our emotional response to a task, or how we think or feel) and he believed that only one variable on a single axis can be achieved at a time. Based on that, a set of educational strategies were identified to be the most appropriate educational methods to achieve the desired learning outcomes in the EMD Program. A detailed tentative schedule and educational strategies of the program are illustrated in Table 4.
Considering KSA Vision 2030 and the health sector transformation plan, implementing this program on a national level would ease access to healthcare systems, provide efficient and effective prehospital services, and allow the integration of existing EMD systems in the country. The use of Kolb’s theory was crucial to implement the program's educational strategies and achieve educational objectives . Moreover, to implement this program, a set of formal proposals by higher authorities concerned with prehospital healthcare services and medical education for healthcare providers approved the launch and sponsorship of the program [2,7]. Nevertheless, setting specific criteria for faculty requirements and training sites was crucial for the program’s implantation . Having said that, the achievement of the desired learning outcomes of the EMD Program was facilitated by many elements. First, the national intention to transform the health sector and ease access to services was the driving energy to build this program. Second, the curriculum was developed by an experienced educational committee in the field of prehospital service, EMD systems, medical education, and curriculum development. This committee had specified the required personnel, time, facilities, and funding resources needed to develop this program. Finally, the partnership with SRCA, the national provider of prehospital services, empowered the implementation of the program outcomes in the actual dispatch operations services.
Evaluation and Feedback
The curriculum evaluation and feedback will be collected by the HA from different stakeholders (students, faculty, training sites) periodically by filling in electronic surveys for ongoing quality improvements during the program implementation and screening for rapidly reversible corrections related to curriculum faculty and training centers. By the end of the program, a comprehensive survey will be distributed among all stakeholders to revise and update any changes related to the curriculum content, modes of delivery, training facilities, tutors’ performance, and suggestions for further improvement in the program by a curriculum review committee. As part of the curriculum development of the EMD Program, trainees are evaluated constantly by formative and summative assessments to ensure the targeted learning outcomes are achieved . Overall, the assessment and evaluation of trainees are carried out in alignment with the SCFHS training and examination rules and regulations. This included every aspect of the trainee’s performance, whether in classrooms, simulation labs, or dispatch operations center. For each module, the assessment process enables those involved in the training process (i.e., faculty) to provide objective feedback to the trainees periodically (every month). For each module, the grading system will be 20% for attendance and punctuality, 40% for ongoing formative assessment (quizzes, presentations, or group activities), and 40% for the summative assessment (end of module exam). The final written exam (summative assessment) will be conducted centrally by the SCFHS, covering a detailed exam blueprint that is mapped to the competencies across all program modules. Exam format shall consist of no more than 120 multiple choice questions with a single best answer (one correct answer out of four options) covering basic concepts and clinical topics relevant to the EMD. The distribution of grades in the exam blueprint is different depending on formative and summative assessment, Kolb’s educational strategies, competency-based aspects, and various distribution of knowledge, skill, and attitude percentages in each module as shown in Table 4.
To obtain an EMD Program certificate, the trainee must fulfill the following requirements: successful completion of all modules, successful completion of the internship period, attendance: total absence percentage during the program is 10% or less, passing the final examination with no less than 60%, passing the Objective Structured Clinical Examination or Structured Oral Exam with no less than 60%, and passing the ETC and EMD courses.