Graduate paramedics’ clinical transition support mechanisms: a modified delphi consensus study from South Africa

Graduate paramedics frequently experience transition shock upon entering professional practice, with consequences for patient safety, retention, and early-career well-being. While structured transition support programmes are well established for graduate nurses and medical doctors, comparable support mechanisms for graduate paramedics in resource-constrained African Emergency Medical Services (EMS) remain undefined. This study aimed to develop expert consensus on the clinical transition support mechanisms required for graduate paramedics entering professional practice in South Africa. A two-round modified Delphi study was conducted in 2023 with a purposively recruited panel of fifteen South African EMS experts drawn from public and private EMS providers, higher education institutions, the statutory regulator, and national policy structures. Panellists rated 31 pre-developed items derived from prior qualitative work using a seven-point Likert scale. Consensus was predefined as a median ≥ 6, an interquartile range ≤ 2, and an average panel agreement ≥ 60%. Descriptive statistics informed iterative analysis between rounds. After two rounds, consensus was reached on eleven statements, clustering into eight support mechanisms: a structured graduate internship, workplace clinical mentorship, non-clinical workplace orientation, compulsory clinical case review, clinical consultation, psychological and emotional support, restructuring of the bachelor’s degree programme toward greater experiential learning, and capacitation of EMS managers. Psychological support and clearly defined internship objectives achieved 100% panel agreement. This study provides the first expert-derived, African-contextualised framework of clinical transition support mechanisms for graduate paramedics. The eight mechanisms address an evidence gap in prehospital workforce development from low- and middle-income countries and provide a basis for national policy reform and feasibility testing of structured transition programmes in South Africa and comparable African EMS systems.