The subjects of this study were 42 second-year students enrolled in the Department of Emergency Medical Science, Faculty of Health Sciences, Suzuka University of Medical Science, who completed the newly established courses “Theory of Emergency Health and Daily Life Support Skills” and “Practice of Emergency Health and Daily Life Support Skills” in the 2023 academic year. Because this study aimed to verify the effectiveness of a novel educational program within the undergraduate paramedic curriculum, all students enrolled in these courses were included as the target population.

The survey was conducted in December 2023, following the completion of all lectures and practical exercises, allowing sufficient time for the students to consolidate the learning content. Upon the conclusion of the final class, the principal investigator provided the participants with detailed explanations—both verbally and in writing—regarding the purpose, significance, and methodology of the study, as well as the ethical considerations. To completely eliminate any potential influence on students’ academic grading, the survey was administered only after final grades had been determined and submitted to the Academic Affairs Office. This procedure was implemented to ensure a system devoid of any psychological coercion to participate.

The study utilized an anonymous, self-administered questionnaire. The survey forms were distributed simultaneously to all 42 target students. To prevent faculty members from directly accessing or identifying individual responses, students were instructed to submit their completed questionnaires by depositing them into a designated collection box installed on campus. This submission procedure ensured both the anonymity of the respondents and the voluntary nature of their participation throughout the collection process.

The questionnaire was designed systematically based on the course syllabus and its targeted learning objectives. Importantly, this curriculum and its syllabus were developed based on extensive prior research concerning practicing paramedics and paramedic training curricula in Japan [3][4][6][7]. To ensure content validity, the survey items were derived directly from these evidence-based course requirements and were consensus-validated through rigorous review by the authors, who are experts in emergency medical science and nursing education. While a formal pilot test was not conducted due to the exploratory nature of this newly introduced course sequence, the items were verified to accurately reflect the core competencies expected of the students. Participants were asked to evaluate their level of understanding and proficiency regarding the specific technical items using a 5-point Likert scale (5: Strongly agree; 4: Agree; 3: Neither agree nor disagree; 2: Disagree; 1: Strongly disagree).

The items were categorized into two main components. The first component evaluated the Understanding and Acquisition of Daily Life Support Skills, which included bed making, the handling of sterile materials, gown techniques, patient repositioning (including in emergency medical settings), assistance with wheelchair and stretcher transfers and mobility, the simulated elderly experience, and the handling of crutches and T-canes. The second component assessed Related Knowledge, which encompassed understanding patients through a nursing perspective, approaches to documentation in emergency medical settings, and communication in interprofessional collaboration.

2.4.1. Understanding and Acquisition of Daily Life Support Skills

This component includes bed making, the handling of sterile materials, gown techniques, patient repositioning (including in emergency medical settings), assistance with wheelchair and stretcher transfers and mobility, the simulated elderly experience, and the handling of crutches and T-canes.

2.4.2. Related Knowledge

Understanding patients through a nursing perspective, approaches to documentation in emergency medical settings, and communication in interprofessional collaboration.

For the multiple-choice items, responses were quantified on a 5-point scale, and quantitative analysis was performed using descriptive statistics (calculation of means and percentages). Throughout the analysis process, repeated discussions were held among the co-researchers to ensure the validity and objectivity of the results.

All statistical analyses in this study were conducted using Microsoft Excel 2024. To examine the relationship between “knowledge and understanding” and “skill acquisition” for each technical item, Pearson’s product-moment correlation coefficient (r) was calculated. Furthermore, to clarify the explanatory power of each indicator, the coefficient of determination (R²) was simultaneously calculated, enabling a structural analysis of the educational effects. Statistical significance was evaluated using Analysis of Variance (ANOVA) via regression analysis, with significance levels set at 5%, 1%, and 0.1% (two-tailed tests). Although the 5-point Likert scale data are ordinal, parametric tests (Pearson’s correlation and ANOVA) were applied because the intervals between the scale points were assumed to be approximately equal, which is a widely accepted approach in educational research. Additionally, a Spearman rank correlation analysis was performed as a sensitivity check, confirming that both parametric and non-parametric approaches yielded identical statistical interpretations and identical patterns of significance.

Table 2 shows the aggregate results for the four items (Questions 1, 8, 9, and 10) regarding the overall learning objectives and student awareness for this course. The mean scores for all items exceeded 4.0. The highest mean score was observed for “8. Understanding the necessity of communication with patients” at 4.67 (SD = 0.48). This was followed by “1. Understanding daily life support skills through nursing science” at 4.33 (SD = 0.48), “9. Self-reflection through portfolio creation” at 4.24 (SD = 0.70), and “10. Usefulness for future in-hospital activities and other endeavors” at 4.19 (SD = 0.68).

To clarify the relationships between each awareness item (Table 2) and the students’ knowledge and skills, Pearson’s product-moment correlation coefficients were calculated.

Table 2. Course-wide understanding and awareness (n = 21).

Table 3 presents the correlation coefficients among the items in Table 2. A significant positive correlation was observed between “Understanding through nursing science (Q1)” and “Usefulness for future in-hospital activities (Q10)” (r = 0.711, p < 0.001). Additionally, a significant positive correlation was also found between “Understanding through nursing science (Q1)” and “Reflection through portfolio creation (Q9)” (r = 0.640, p < 0.01).

Table 3. Correlation matrix among awareness items (n = 21).

Note. *p < 0.05, **p < 0.01, ***p < 0.001.

Table 4 shows the self-evaluation results of “knowledge and understanding” for each seminar item. Among all 12 items, the highest mean score was observed for “2-9. Senior experience simulation” at 4.62 (SD = 0.50). This was followed by “2-7. Wheelchair transfer and mobility” at 4.43 (SD = 0.60) and “2-4. Positioning and body mechanics” at 4.38 (SD = 0.59). Conversely, the item with the lowest mean score was “2-8. Stretcher transfer” at 4.05 (SD = 0.74).

Table 4. Self-evaluation of knowledge and understanding regarding individual support skills (n = 21)

Table 5 shows the self-evaluation results of the “level of mastery” for each seminar item. Among all 12 items, the highest mean score of 4.43 (SD = 0.60) was observed for both “3-2. Handling of sterile items” and “3-7. Wheelchair transfer and mobility.” This was followed by “3-9. Senior experience simulation” at 4.38 (SD = 0.74). Conversely, the items with the lowest mean score were “3-8. Stretcher transfer” (SD = 0.83) and “3-12. Documentation in the paramedic field” (SD = 0.77), both yielding a score of 4.10.

Table 5. Self-evaluation of the level of mastery for individual support skills (n = 21).

To examine the relationships between theoretical “knowledge and understanding (Question 2)” and practical “skill mastery (Question 3)” for each daily life support skill, Pearson’s product-moment correlation coefficients were computed on an item-by-item basis (Table 6). The analysis indicated that the vast majority of items exhibited statistically significant positive correlations. Notably, “Positioning and body mechanics (r = 0.930)”, “Patient positioning in the paramedic field (r = 0.927)”, “Documentation in the paramedic field (r = 0.922)”, “Single cane mobility (r = 0.904)”, and “Wheelchair transfer (r = 0.898)” exhibited exceptionally strong positive correlations (r ≥ 0.80). In contrast, the correlation for “Senior experience simulation” did not reach statistical significance (r = 0.414, p = 0.062).

Table 6. Correlation coefficients between “knowledge/understanding” and “skill mastery” (n = 21).

Note. **p < 0.01, ***p < 0.001, n.s. = not significant.

Furthermore, a calculation of the correlation between the overall mean of the 12 items for Question 2 (aggregate knowledge comprehension) and that of Question 3 (aggregate skill mastery) revealed a remarkably profound positive correlation (r = 0.940, p < 0.001).

To examine the linkage between “lectures (theory)” and “seminars (practice)” in this course, Pearson’s product-moment correlation coefficients were calculated between the question items sharing common themes: Questions 4 and 5 regarding “safety and comfort”, and Questions 6 and 7 regarding the “recovery process” (Table 7). The analysis revealed strong positive correlations across all pairs, with r > 0.70 (p < 0.001).

Table 7. Correlations between question items regarding “safety and comfort” and the “recovery process” (n = 21).

In the present survey, the finding that the mean scores for all awareness items exceeded 4.0 strongly suggests that this educational program had the potential to exert a profound impact on students’ perceived professional awareness. In particular, it is highly noteworthy that Question 10—“I recognized that the practice of paramedics confronting acute patient cases serves to support the ongoing convalescent life of patients, thereby enabling me to perceive medicine within a broader scope”—yielded an exceptionally high level of positive agreement, with a mean score of 4.19 (SD = 0.68).

This outcome substantiates that students possess an exceedingly positive sense of expectation and responsibility toward the emerging occupational role of “in-hospital paramedics.” This role was established following legislative amendments enacted in October 2021, which authorized paramedics to continue life-saving procedures for severely ill or injured patients within medical institutions under physician direction. Historically, since the inception of the paramedic system in Japan in 1991, conventional paramedic education has exclusively specialized in rapid clinical assessment and accurate emergency intervention within pre-hospital care settings.

Consequently, the educational curricula have been inherently structured with a predominant focus on acute-phase management. As a result of this paradigm, patients have historically tended to be perceived as isolated, “point-in-time” entities—essentially regarded merely as subjects for transport during the constrained timeframe from the incident scene to the receiving medical facility.

However, the integration of a nursing-based perspective through this course is suggested to expand the perceived role of paramedics beyond the mere execution of life-saving interventions, guiding them toward a longitudinal and linear perspective that supports the “patient as a person living their daily life” during the subsequent convalescent process.

Substantiating this conceptual shift, an exceptionally strong and significant positive correlation was observed between Question 1 (“I was able to understand support skills for patients’ healthy living through nursing science in ‘Emergency Health and Daily Living Support’”) and Question 10 (r = 0.711, p < 0.001). This clearly suggests that acquiring nursing-based daily living support skills does not merely represent the mastery of procedural techniques; rather, it serves as a robust foundation for reconstructing the professional identity of paramedics as integral members of the healthcare team. Furthermore, the highest mean score within the awareness survey (M = 4.67, SD = 0.48) was observed for Question 8: “I was able to understand that communication with the patient is necessary when practicing daily living support skills, including within the paramedic field.” In conventional emergency care settings, communication is predominantly centered on information gathering (assessment), such as identifying the chief complaint or taking a medical history.

Nordby and Nøhr et al. [8] reported that during the transport of patients with long-term medical conditions, paramedics experience difficulties in communicating under busy and unpredictable circumstances; thus, high-quality communication that incorporates empathy and ethical consideration—rather than mere information transfer—is indispensable. These findings suggest that through their learning experiences in this course, students profoundly internalized the significance of communication as an “interpersonal assistance skill” crucial for ensuring the safety and comfort of convalescent patients and for empathetically addressing their anxiety. This unique pedagogical challenge underscores the critical need for a comprehensive educational framework that addresses both ethical and interpersonal dimensions in undergraduate training. Indeed, as shown in previous curricular evaluations, structured courses focusing on paramedical ethics [3] and family support theory [4] are highly beneficial in fostering students’ holistic, longitudinal, and empathetic perspectives.

One of the most prominent findings of this study is the emergence of an exceptionally powerful positive correlation (r = 0.940, p < 0.001) between the mean scores of the 12 items in Question 2 (assessing theoretical knowledge) and those of the 12 items in Question 3 (assessing practical skill mastery). This clearly demonstrates that our institution’s lecture course, “Emergency Health and Daily Living Support”, and its corresponding seminar course, “Practice of Emergency Health and Daily Life Support Skills”, are delivered with a high degree of alignment, successfully integrating theory and practice without any fragmentation.

A closer inspection of the item-specific correlation analysis (Table 6) highlights remarkably robust associations within the following domains:

“Patient Positioning”: r = 0.930 (p < 0.001) between knowledge understanding in Q2-4 and skill mastery in Q3-4. “Patient Positioning in the Paramedic Field”: r = 0.927 (p < 0.001) between Q2-5 and Q3-5. “Documentation in the Paramedic Field”: (r = 0.922, p < 0.001) between Q2-12 and Q3-12. “T-shaped Cane”: r = 0.904 (p < 0.001) between Q2-11 and Q3-11.

In these items, it can be seen that a deep understanding of theoretical knowledge (such as body mechanics, the legal and ethical significance of documentation, and the correct use of assistive devices) directly led to high mastery and confidence in practical seminars. David De Jong et al. [9] suggest that for students aiming to become professionals, virtual simulated experiences of practicing leadership through simulation function as a foundational experience. It is inferred that teaching how to use a T-shaped cane was a meaningful class content for students who will become healthcare professionals in the future.

On the other hand, regarding the “simulated elderly experience”, the correlation between knowledge/understanding (Q2-9) and skill mastery (Q3-9) was not statistically significant (r = 0.414, p = 0.062). This lack of correlation suggests that the elderly experience is not a mere “fixed procedure to be mastered”, but rather an emotional and experiential learning component that involves simulating age-related physical decline and empathizing with the resulting psychological anxiety. Therefore, students’ theoretical knowledge and technical self-evaluations did not necessarily move in parallel. Crucially, while skill mastery did not show a linear correlation with knowledge, the knowledge evaluation for Q2-9 recorded the highest mean score of 4.62 (SD = 0.50) among all 12 items. This disparity highlights that while students did not perceive it as a technique to be mechanically mastered, they recognized the profound importance of understanding the physical characteristics of older adults extremely highly.

To verify how the lecture and seminar components contributed to students’ conceptual formation, this study analyzed the correlations between items addressing identical themes.

First, regarding the understanding of “safety and comfort”—a foundational philosophy of nursing science—a strong positive correlation was demonstrated between Question 4 (“I was able to understand safety and comfort in patients’ healthy lives, including the paramedic field, in ‘Emergency Health and Daily Living Support’”) and Question 5 (“I was able to understand daily living support skills to maintain patients’ safe and comfortable lives in the paramedic field, in ‘Emergency Health and Daily Living Support Seminars’”) (r = 0.715, p < 0.001). In the extraordinary and critical environments of pre-hospital emergency scenes, “safety” is a concept directly linked to immediate life preservation. However, in in-hospital operations and subsequent continuum care, the dimension of “comfort” must inherently be integrated. Comprehending these two concepts as an interconnected dyad directly contributes to the prevention of secondary complications and the mitigation of psychological distress in patients.

Next, concerning the comprehension of the “recovery process”, a robust positive correlation was obtained between Question 6 (“I was able to understand changes in activities of daily living [ADLs] caused by accidents or onset of illness based on the recovery process, in ‘Emergency Health and Daily Living Support’”) and Question 7 (“I was able to understand skills corresponding to the recovery process for changes in ADLs caused by accidents or onset of illness, in ‘Emergency Health and Daily Living Support Seminars’”) (r = 0.729, p < 0.001). For paramedic students, longitudinally learning both theoretically and practically how a patient progresses through clinical pathways following initial emergency stabilization, and tracing their rehabilitation to the stage of utilizing assistive devices (such as crutches or canes), proved highly effective in cultivating a comprehensive clinical vision required for modern emergency medical services.

On the other hand, the finding that certain items remained relatively lower in self-evaluation serves as a critical pedagogical indicator for subsequent curriculum development. The lowest self-assessment scores were observed in theoretical knowledge for Question 2-8, “stretcher transfer” (M = 4.05, SD = 0.74), and in practical skills for Question 3-8, “stretcher transfer” (M = 4.10, SD = 0.83), alongside Question 3-12, “Documentation in emergency medical settings” (M = 4.10, SD = 0.77).

6.4.1. Clinical Intricacies of Stretcher Transfer

Shifting from a pre-hospital mindset, where transfers are predominantly performed for immediate “transportation”, to an in-hospital context designed for “convalescence and diagnostic testing” demands a fundamental paradigm shift in risk management. In-hospital transfers inherently require sophisticated clinical reasoning, such as the meticulous management of intravenous lines and drainage catheters, as well as strict adherence to patient mobility and rest restrictions. These environment-specific complexities likely functioned as a cognitive barrier for paramedic students encountering in-hospital protocols for the first time.

6.4.2. Paradigm Shift in Documentation Competency

While conventional emergency medical service (EMS) documentation primarily focuses on the chronological listing of objective clinical facts and executed procedures, in-hospital documentation demands an advanced assessment capability to verbalize nuanced “patient responses” and “signs of recovery” for effective interprofessional information sharing. For paramedic students, synthesizing this nursing-based clinical reasoning into written records represented a profound departure from their traditional pre-hospital training. This discrepancy highlights the critical necessity for introducing longitudinal repetitive practice and targeted feedback mechanisms into the training program.

Furthermore, items such as Question 2-1 (“bed making/linen exchange”), Question 2-3 (“gowning technique”), Question 2-10 (“crutches”), and Question 2-11 (“T-shaped canes”) each yielded a theoretical knowledge mean score of 4.14, demonstrating a slight plateau compared to other domains. In teaching these fundamental skills, educators must transcend the repetitive mastery of mere procedural algorithms. Instead, there is a clear imperative to reinforce the pedagogical “meaning-making” or theoretical rationale, explicitly illuminating how these fundamental maneuvers directly intersect with and safeguard the patient’s daily “living environment” and comprehensive comfort.

Another prominent educational outcome of this study is the reinforcement of students’ self-reflection through the strategic utilization of portfolios. Question 9—“I was able to create a portfolio reflecting on daily living support skills, including their scientific rationales, for altered activities of daily living caused by accidents or onset of illness, while referencing my learning in ‘Emergency Health and Daily Living Support’ and its seminars”—yielded a high self-assessment score, with a mean of 4.24 (SD = 0.70).

H. Pandya et al. [10] noted that the implementation of portfolios empowers students to autonomously self-evaluate the fulfillment of their personal learning needs, professional trajectory, and competency acquisition. In the present survey, the depth of reflection achieved through portfolio creation demonstrated a significant positive correlation with the conceptual comprehension of patient care through nursing science (Question 1) (r = 0.640). This empirical linkage confirms that the portfolio effectively functioned as a cognitive vehicle through which students “reconstructed” the scientific rationales behind “why this support skill is necessary” in their own words, thereby facilitating the deep internalization and consolidation of knowledge.

Ultimately, cultivating this “ability to verbalize the clinical meaning of one’s learning” furnishes future practitioners with an unwavering professional foundation. It ensures seamless communication, mutual respect, and effective interprofessional collaboration (IPC) with physicians, nurses, and physical therapists within complex, modern in-hospital care ecosystems.