From Stakeholder Expectations to Curriculum Gaps in EMS Education: Implications for Learning-to-Practice Alignment

Background: Preparing emergency medical services (EMS) graduates for real-world practice remains a challenge, particularly in low- and middle-income country settings. Although stakeholder engagement is increasingly used to define desired graduate attributes, how these expectations are translated into curriculum implementation is often unclear. Methods: This study employed a secondary qualitative content analysis of stakeholder-derived graduate attributes for bachelor-level EMS programs. Identified attributes were mapped against existing curriculum structures, including course learning outcomes and assessment practices, using national qualification and quality assurance frameworks to examine alignment and gaps. A secondary qualitative content analysis was conducted using data from 24 stakeholders, including EMS employers, alumni, and professional representatives. Results: Stakeholders emphasized attributes related to clinical decision-making under pressure, communication, teamwork, ethical judgment, adaptability, leadership, and handover skills. While several attributes were formally acknowledged in curriculum documents, many were only partially addressed or remained implicit and insufficiently assessed. Non-technical and context-dependent competencies were particularly underrepresented in practice-oriented learning. Discussion: The persistence of these gaps reflects structural prioritization of easily documented competencies, misalignment between accreditation frameworks and field realities, limited experiential learning opportunities, and assessment practices that undervalue non-technical attributes. Conclusion: Addressing learning-to-practice misalignment in EMS education requires moving beyond competency documentation toward intentional, practice-oriented curriculum design and assessment. Stakeholder-informed approaches may support educators in strengthening graduate preparedness for real-world EMS practice.