title: On the Assessment of Paramedic Competence: A Narrative Review with Practice Implications.
abstract: BACKGROUND
  Paramedicine is experiencing significant growth in scope of practice, autonomy, and role in the health care system. Despite clinical governance models, the degree to which paramedicine ultimately can be safe and effective will be dependent on the individuals the profession deems suited to practice. This creates an imperative for those responsible for these decisions to ensure that assessments of paramedic competence are indeed accurate, trustworthy, and defensible.
  
  
  OBJECTIVE
  The purpose of this study was to explore and synthesize relevant theoretical foundations and literature informing best practices in performance-based assessment (PBA) of competence, as it might be applied to paramedicine, for design or evaluation of assessment programs.
  
  
  METHODS
  A narrative review methodology was applied to focus intentionally, but broadly, on purpose relevant, theoretically derived research that could inform assessment protocols in paramedicine. Primary and secondary studies from a number of health professions that contributed to and informed best practices related to the assessment of paramedic clinical competence were included and synthesized.
  
  
  RESULTS
  Multiple conceptual frameworks, psychometric requirements, and emerging lines of research are forwarded. Seventeen practice implications are derived to promote understanding as well as best practices and evaluation criteria for educators, employers, and/or licensing/certifying bodies when considering the assessment of paramedic competence.
  
  
  CONCLUSIONS
  The assessment of paramedic competence is a complex process requiring an understanding, appreciation for, and integration of conceptual and psychometric principles. The field of PBA is advancing rapidly with numerous opportunities for research.
authors.affiliation: 1Centennial College,Paramedic Program,Toronto,Ontario,Canada.
authors.forename: W
authors.initials: W
authors.lastname: Tavares
authors.affiliation: 6University of Ottawa,Skills and Simulation Centre and Department of Anesthesiology,Ottawa Hospital,Ottawa,Ontario,Canada.
authors.forename: S
authors.initials: S
authors.lastname: Boet
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D006801:Humans
keywords: ECG electrocardiogram; Emergency Medical Services; Emergency Medical Technicians; GRS global rating scale; OSCE objective structured clinical examination; PBA performance-based assessment; RBA rater-based assessment; SBA simulation-based assessment; WBA workplace-based assessment; clinical competence; educational measurement