Understanding Program Attrition: The Influence of Entry Requirements and Student Resources

Paramedic educational program attrition contributes to a loss of potential clinicians from the emergency medical services (EMS) workforce. Programs have developed entry requirements and resources to enhance retention, although their impact is unclear. Our objective is to evaluate program entry requirements and resources and their association with high educational program attrition.

We conducted a cross-sectional survey evaluating program entry requirements, benefits, resources, and attrition in paramedic educational programs using the 2023 Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP) annual report. Included are all paramedic programs that reported >4 enrolled students with at least 1 graduating cohort in 2021. Descriptive statistics were calculated (median and IQR), and proportional differences (PDs) were used to evaluate differences in prevalence between attrition groups.

We included 629 programs. The median attrition rate was 20% (10.6%-28.6%), with 148 programs (23.5%) reporting high attrition. Programs with high attrition were more likely to have open enrollment policies (PD, -10.9%; 95% CI, -20.0 to -1.7). In contrast, low-attrition programs more frequently required preadmission interviews (PD, 10.3%; 95% CI, 1.6 to 19.1), medical knowledge exams (PD, 11.5%; 95% CI, 3.2 to 19.8), and medical prescreens (PD, 11.6%; 95% CI, 2.7 to 20.5) and offered daycare (PD, 4.6%; 95% CI, 1.4 to 7.8).

We found substantial variability in baseline program entry requirements and the availability of common student resources. Paramedic educational programs should consider the combined impact of entry requirements and student support systems when developing strategies to improve retention.