Reflections on Paramedicine Research: Part Three

For this year's #ParamedicServicesWeek, I'm reflecting on the evolving role research plays in improving the accessibility, safety, social responsiveness, and effectiveness of paramedic care; or, in short, the quality of the services we provide to our communities.

Part Three: the Ph.D. - Qualified Paramedic

We left off talking about research as a form of disciplined inquiry to systematically advance scientific knowledge. We also discussed the important role physician-scientists have played in advancing #paramedic practice in Ontario by leading clinical research and how medical school is one of two common pathways to acquire research training.

In this post, we'll dive into the other common career pathway for acquiring research skills: pursing a Ph.D.

A Doctor of Philosophy provides learners with a very advanced level of research training, necessary to prepare them to contribute to scholarship as an independent researcher or professor. Although requirements vary by discipline and institution, a typical Ph.D. path involves:

1. Undertaking two to three years of coursework in a relevant field of study.
2. Passing a comprehensive exam in the second or third year.
3. Proposing a program of research relevant to their field of study.
4. Preparing a written dissertation that reports the results of original research.
5. Publicly defending the dissertation before a panel of examiners.

Successfully completing a Ph.D. requires candidates to meaningfully advance the scientific knowledge in their field of study. Getting to this point, however, is an incredibly challenging endeavour that requires a lot of resilience, perseverance, and - very often - sacrifice.

Prospective students will usually need to have completed an undergraduate degree - often an honours degree - and a master's degree, preferably one that required the student to prepare and defend a master's thesis. An applicant to a Ph.D. program will need to identify a potential supervisor, outline a proposed program of research, and source funding before they can be admitted.

A Ph.D. student's progress is overseen by a supervisor who chairs an advisory committee that supports the student's professional development, supervises their research, and provides funding. Ph.D. students receive modest financial support through a combination of internal and external awards, scholarships, research funds, and employment income, which averages out to around $25,000 - $35,000 per year.

Pursuing a Ph.D. can be an enormous opportunity cost, pushing family planning, career development, and earnings potential back several years.

While Ph.D. programs are typically structured to last four to six years, data from Statistics Canada tell us that a little more than a third of doctoral students will have graduated after five years and about half after six. The overall completion rate in Canada hovers around 80% after 9 years. Most who do not finish their degree are in "ABD" - All But Dissertation - territory. This last step of preparing a dissertation for defence is often the most challenging. All told, about 1% of Canadians have a doctoral degree.

Something else to consider: Most doctoral students in Canada are aged 25 to 35, typically the years when people are establishing their careers or - read this one carefully - starting a family. Pursuing a Ph.D. can be an enormous opportunity cost, pushing family planning, career development, and earnings potential back several years.

My Ph.D. Path

If you're curious, my path looked like this: Honours BHSc (part-time; 4 years) --> MSc (thesis-based, full-time; 2 years)--> Ph.D. (full-time; 6 years, with a concurrent 1-year fellowship in education research). Because paramedic training in Ontario is a (typically) two year community college diploma, I was starting - almost - from scratch when I went back to university as a mature student after having worked clinically for 5 years. When I started my Ph.D. in 2016, I dropped to part-time in my paramedic work. Although some paramedics do continue to work full-time while completing their Ph.D., this is exceptionally difficult. A condition of my funding ($36,000/year in years 1 & 2, then $26,000/year in years 3 & 4, then zero in years 5 and 6) was that I limit my clinical time (and any work for pay) to less than 10 hours per week. I graduated at age 37.

So what are you getting out of a doctorate? Ph.D. students are simultaneously developing expert level knowledge in a specific discipline and research training, ultimately learning robust and transferable skills that shape how we think about and solve problems. Skills that, I argue, are incredibly valuable to the advancement of paramedicine in Ontario. But, they come with a high cost of admission, which is why having Ph.D.-qualified paramedics who are both actively pursuing paramedicine research and practicing clinically is rare.

Ph.D.-Qualified Paramedics in Ontario

Let's look at some Ontario paramedics who made the leap. Keep that high cost of admission in mind when you think about the scope of the work these scientists are doing:

• Dr. Walter Tavares deserves a shoutout as the 'OG' Paramedic-Ph.D. in Ontario. As an education scientist, Walter's work revolutionized how we think about, assess, and support the clinical competence of paramedics. Walter's latest work is creating a new vision for the future of paramedicine in Canada, reconceptualizing paramedic practice as existing along a health and social continuum.
• Dr. Ian Drennan is a resuscitation scientist whose research advances evidence-based paramedic practice in caring for patients with life-threatening illness. Ian practices clinically as an Advanced Care Paramedic with York Region. One of Ian's most recent studies developed a new way of predicting survival for patients who are resuscitated from cardiac arrest.
• Dr. Polly Ford-Jones brought more than a decade of clinical experience as a Primary Care Paramedic in Halton Region into her work developing a transformational research program on how paramedic services interact with people experiencing mental health crises. In partnership with Middlesex-London Paramedic Service, her latest work enabled the development of a new alternative disposition pathway within the 9-1-1 system for people with mental health concerns.
• Dr. Madison Brydges practiced as a Primary Care Paramedic in Halton Region for 12 years before transitioning to her current role at the National Institute of Ageing. Her research incorporated a social sciences perspective to shed light on the policy implications of the ongoing professionalization of paramedicine in Ontario. Madison's work is another useful example of how doctoral level training and research can shed new light on policy decisions to ensure that paramedic service delivery is collaborative, patient-centered, and equitable.
• Dr. Ryan Strum is a newly-minted Ph.D. graduate practicing clinically as an Advanced Care Paramedic and Superintendent with Toronto Paramedic Services . Ryan's work takes on the incredibly important job of developing alternate pathways and processes to divert suitable 9-1-1 patients away from the Emergency Department (ED). ED diversion strategies will not only improve the efficiency of paramedic service, but provide better, patient-centered care for our communities.

I'd be remiss if I didn't also mention Dr. Alan Batt , an Irish expat who has been an enormously influential and valuable addition to the paramedic research, education, and policy landscape in Canada. Alan brought decades of clinical experience as a Critical Care Paramedic to bear in shaping his research on bridging gaps between paramedic practice and educational curricula. Alan's latest work is setting the stage to revolutionize how we train paramedics across the country.

Lets also give a shoutout to Ph.D. Candidates Jason Buick and Rick Ferron , both of whom are in the final stretches of their studies in clinical epidemiology and health services research. Jason's work focuses on the development of clinical prediction rules to risk stratify patients receiving paramedic care, while Rick's latest research examined changes in paramedic service utilization during the COVID-19 pandemic.

An Under-Utilized Capacity

The number of Ph.D.-qualified paramedics in Ontario continues to grow and both the Paramedic Chiefs of Canada and the Ontario Association of Paramedic Chiefs have identified the value of supporting paramedic research in enabling evidence-informed decision making. And yet, of (soon to be) 9 Ph.D.-qualified paramedics in the province, less than half are clinically active. Why? Are we potentially missing an important opportunity to leverage a wealth of human capital? I would say yes.

Up next: What Ph.D.-qualified paramedics bring to the table, why paramedic leaders should hire them, thoughts on how to fund them, and... much more.

Stay tuned.