Cultural Competency in Paramedic Education

· Professional,Research

Words by Oskar Loughlin


The modern paramedic’s enate ability to positively engage with an increasingly diverse patient cohort illustrates a respect for cultural competence as a foundational skill. Australian Health Practitioner Agency Regulation Agency (AHPRA) standards reflect this view, with a key capability outlining that all paramedics must have the ability to “provide culturally safe care for all patients”. To achieve this, cultural competence is being brought to attention at the university level.

Simulation based learning is a central pillar of paramedic education, with mannikins, fake limbs, and props often utilised to create a more immersive environment for the learner (1,2). The use of culturally diverse training equipment in simulations can assist in the development of cultural safety as they visually prompt learners to consider cultural aspects of their practice which are specific to the scenario or patient presented to them (3). This consideration for cultural diversity in the simulation allows for real-world cultural competence to be practiced early on. This creates an environment where cultural competence is nurtured as a foundational skill of paramedicine, rather than an afterthought. Furthermore, the presence of culturally diverse equipment during training has shown to promote feelings of inclusiveness for students who identify as “coloured” (1,4).

A recent cross-sectional analysis by Lam et al., surveyed 16 total Australasian undergraduate paramedicine universities (including 14 from Australia and 2 from New Zealand) to assess cultural competence in paramedic teaching. Using adapted inventory surveying, the Head of Department at each accredited institution relayed information relating culturally diverse simulation equipment. While qualitative questions to the Heads of Department, gauged opinion on their existing program’s ability to educate cultural competence.

Across all institutions there were a total of 140 ALS manikins acknowledged, only twelve were identified as as a skin colour other than white. Furthermore, out of a total of at least 145 cannulation arms, only 27 were identified as a skin colour other than white. Qualitative questions highlighted a mix of responses. When asked “In your opinion, does your university teach students how to appropriately treat and build rapport with patients of culturally diverse backgrounds?” five respondents simply answered “Yes”, while one other answered “No”. Two respondents explained cultural competence was a part of theoretical teachings but remained absent from practical simulated scenarios. Three respondents implied that cultural competence teachings were in place but had room to improve. While only one response identified that cultural competence is a point of continual review and development, going on to say that there was a plan to fund the purchase of manikins with skin other than white.

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Several respondents expressed that their current curriculum only addressed cultural competence at a basic level, acknowledging more needs to be done in the space of simulation-based training utilising culturally diverse training equipment. A reason for this may be that teaching staff often hold no formal education or training specifically relating to cultural diversity (6). Furthermore, studies show that feelings of inclusiveness can be further promoted by the presence of culturally diverse teaching staff, leading to a more enriched learning experience (4). This shows that improvements in staff training and workplace inclusivity/incentivisation could positively affect the outcome of cultural competence at the student level.

Lam et al., study responses suggest that there are difficulties with translating principles of culturally safe practice into the practical space (7). Respondents from universities who expressed low cultural safety training also had no ALS manikins or cannulation arms that reflect people of colour. This may suggest a relationship between possessing culturally diverse equipment and a university’s ability to incorporate cultural safety and cultural competence into curriculum. Additionally, universities that utilised coloured ALS manikins and cannulation arms were more likely to believe that they had a curriculum that developed a student’s ability to practice culturally competent care.

Overall, access to culturally diverse training equipment across universities providing undergraduate paramedicine education in Australia and New Zealand is limited (7). Lam et al. identify a possible link between access to culturally diverse training equipment and a university’s ability to embed curriculum that addresses culturally safe paramedic care skills. However, future research is needed to assess whether access to culturally diverse training equipment has an impact on how students view their ability to provide culturally safe paramedic care. This study also opens the door for cultural competency research relating to other social dimensions of paramedic simulation, including but not limited to, gender, religion, and sexual orientation. Indeed, there is much to unpack relating to the representation of these specific populations in theoretical and practical paramedicine education.

You can find the orginal article here 


1. Fuselier, J., Baldwin, D., & Townsend-Chambers, C. (2016). Nursing students' perspectives on manikins of colorin simulation laboratories. Clinical Simulation in Nursing, 12(6), 197-201.

2. Williams, B., Abel, C., Khasawneh, E., Ross, L., & Levett-Jones, T. (2016). Simulation experiences of paramedic students: a cross-cultural examination. Advances in Medical Education and Practice, 7, 181–186.

3. Buchanan, D. T., & O'Connor, M. R. (2020). Integrating Diversity, Equity, and Inclusion into a Simulation Program. Clinical Simulation in Nursing, 49, 58-65.

4. Foronda, C. L., Baptiste, D. L., & Ockimey, J. (2017). As simple as black and white: The presence of racial diversity in simulation product advertisements. Clinical Simulation in Nursing, 13(1), 24-27.

5. Foronda, C., Prather, S. L., Baptiste, D., Townsend-Chambers, C., Mays, L., & Graham, C. (2020). Underrepresentation of racial diversity in simulation: An international study. Nursing Education Perspectives, 41(3), 152-156.

6. Greenberg, M. R., & Pierog, J. E. (2009). Evaluation of race and gender sensitivity in the American Heart Association materials for Advanced Cardiac Life Support. Gender Medicine, 6(4), 604-613.

7. Lam, R., Hillsley, R., Steele, J., & Whitfield, S. (2022). Developing Cultural Competence In Paramedic Education: An Analysis of Culturally Diverse Training Equipment Amongst Universities In Australia And New Zealand. Australian Journal of Clinical Education, 11(2).