Trends in CAPCE-accredited Emergency Medical Services Continuing Education Over the Past Decade

The COVID-19 pandemic disrupted traditional continuing education (CE) delivery methods, necessitating rapid adaptation to alternative educational formats. The pandemic led the National Registry of Emergency Medical Technicians (NREMT) to waive limitations on asynchronous online distributive learning (ADL) for emergency medical services (EMS) recertification. The Commission on Accreditation for Prehospital Continuing Education (CAPCE) maintains one of the largest EMS CE databases in the United States. The goal of this study was to examine trends in CAPCE-accredited EMS CE course formats over the past decade.

Five education formats were analyzed: live in-person, card-bearing courses, asynchronous online distributive learning, interactive gaming-style courses, and virtual instructor-led training. An observational retrospective interrupted time-series analysis was conducted using 19,289,785 EMS continuing education completions from the CAPCE database, from July 2014 through June 2024 (120 months). The COVID-19 intervention period was August 2020 through September 2022. Negative binomial regression and interrupted time-series models were used to estimate changes in course completions by CE format.

Comparing mean monthly course completions between the pre-pandemic and post-pandemic periods, course format use shifted significantly. Live in-person courses decreased by 8.1%, from 3,324 to 3,053, while card-bearing courses increased by 15.1%, from 7,469 to 8,598. In contrast, online formats all saw large increases: asynchronous online distributive learning courses increased by 209.4%, from 86,242 to 266,842, interactive gaming-style courses increased by 914.6%, from 98 to 992, and virtual instructor-led training increased by 218.9%, from 2,096 to 8,151.

In the post-pandemic period, NREMT's decision to permanently remove ADL restrictions, coupled with pandemic-related operational changes, was associated with significant, persistent shifts in CAPCE-accredited EMS CE format completions. This has resulted in sustained increases in completions of CAPCE-accredited online learning formats, including ADL, interactive gaming-style courses, and virtual instructor-led training, that persist well beyond the effects of the initial pandemic.