Threading the PhD journey through collaboration, balance and belonging among Middle Eastern paramedics’. A reflexive thematic analysis

Paramedics from the Middle East are enrolling in overseas Doctor of Philosophy (PhD) programs in growing numbers, yet their experiences remain under-explored. This study sought to explore the lived experiences, challenges and supports that shape their PhD. Paramedics with a primary residence in the Middle East who had either completed or were undertaking their PhD study internationally were eligible to be included. Participants were purposively recruited. We conducted a qualitative reflexive thematic analysis through an inductive process at the semantic/explicit level with theme development informed by a critical-realist lens. Data was constructed from nine participants, leading to the development of four inter-locking themes. Theme 1: Importance of collaboration captured how PhD projects surged forward when students secured early alliances with university, ambulance-service and industry decision makers and paramedic mentors, yet drifted when those links were missing, leaving ethics applications and data requests languishing. Theme 2: A balancing act portrayed the daily tightrope of deciphering new academic norms while relocating families, making finances work amid soaring costs, and, for some, absorbing overt racism, pressures that often felt harder than the study itself. Theme 3: Having a reason highlighted the inner motivation from participants: ambitions to influence and contribute to elevating care provided by paramedics, gain academic seniority, or honour employer sponsorships that had staked faith in their success to undertake the study. Finally, Theme 4: Lack of paramedicine expertise revealed limitations participants paced with few paramedic supervisors and scant discipline-specific doctoral pathways being available, meant participants felt they were left translating their efforts to well-meaning but unfamiliar advisors. Middle Eastern paramedics negotiate complex academic, personal and cultural landscapes to complete overseas PhDs. Culturally responsive onboarding, structured mentorship by experienced paramedic researchers, and expansion of paramedicine-specific doctoral programs could ease this journey, improve experiences and better harness this cohort's capacity to advance global paramedic practice.