Abstract
This is a letter in response to Corman et al. We frame this letter in the spirit of scholarly discourse around four areas in which we would like to challenge Corman et al. These are 1) that there is insufficient empirical evidence and overstated claims of sociological absence in paramedic curricula, 2) the notion of the so-called ‘translucent curriculum’ – where high-acuity care is prioritised at the expense of low-acuity and socially complex care – is misrepresentative and outdated, 3) the critique of the biopsychosocial model is overstated, reductive, and unrepresentative of current practice, and 4) that the relationship between paramedic education and problematic aspects of ambulance culture is far more complex than the paper suggests.
Introduction
Corman et al. offer a critical examination of paramedic education, drawing attention to the risk of dominance of biomedical paradigms and the undervaluing of sociological insight. While their call for a more socially informed curriculum is welcome – we agree that socially informed curricular are essential – their analysis would benefit from stronger empirical grounding, greater recognition of existing curricular innovations, and a more constructive framing that advances practical solutions.
To position the authors of this response: we create curricula, teach, assess, and lead on paramedic programmes, are qualitative researchers exploring paramedic identity and ethical issues in paramedic practice, and work on development of national paramedic curricula and associated accreditation processes in the UK. This response comes through discussion with our respective teams at the University of East Anglia, the University of the West of England, and the College of Paramedics UK.
We frame this letter in the spirit of scholarly discourse around four areas in which we would like to challenge Corman et al., (2025). These are 1) that there is insufficient empirical evidence and overstated claims of sociological absence in paramedic curricula, 2) the notion of the so-called ‘translucent curriculum’ – where high-acuity care is prioritised at the expense of low-acuity and socially complex care – is misrepresentative and outdated, 3) the critique of the biopsychosocial model is overstated, reductive, and unrepresentative of current practice, and 4) that the relationship between paramedic education and problematic aspects of ambulance culture is far more complex than the paper suggests.
Insufficient empirical evidence and overstated claims of sociological absence
At the risk of being accused of centring a positivist approach to knowledge (which would be a first for us), we believe this paper would benefit from greater empirical grounding. The paper relies heavily on anecdotal accounts and reflective narratives without triangulating these with comparative curriculum audits or robust studies across diverse paramedic education programmes and/or systems. While this provides a compelling, if partial, depiction of a sociologically limited educational landscape, it undermines the validity of broader claims, particularly the assertion of a near-total absence of sociological and structural content. An example from the work is the suggestion that the education an author experienced 20 years ago could be representative of what is being taught now. We note that this author currently teaches on a UK paramedic programme, are we to assume that in his programme, sociology is deemphasised or entirely absent? And if not, why does he give an example from his education rather than from his experiences as an educator?
In reality, we know that at least two UK programmes (UWE and UEA) already embed teaching on sociological themes, aligned with national standards and frameworks – and we imagine that many others also do. While the extent and depth of integration may vary, suggesting widespread absence risks obscuring ongoing and meaningful educational developments. Viewed through the translucent – cataractic – lens of this paper, paramedic education appears to be a sociologically barren ‘bio-bio-bio’ landscape devoid of ‘sociological imagination’. We have not seen any evidence that this is the case.
We suggest that the authors have highlighted a need for future study and that paramedic education may benefit from more systematic content analyses of curricula, and qualitative exploration of student and educator experiences, to uncover the extent of sociological integration across institutions.
The translucent curriculum
This paper purports that there is a translucent curriculum where students’ paramedic identity is modelled by language of their lecturers, and the emphasis of the curriculum which make them believe low-acuity and high social needs clinical cases are not worthy of a paramedic. Furthermore, the authors claim that paramedics are taught high-acuity care to the point where lower acuity presentations are deemphasised and that there are ‘noted gaps in supporting paramedics in “assessing and managing low-acuity clinical conditions”’. We reject these claims and invite the authors to come to our institutions and see what our students are taught, where a greater part of the curricula is community paramedicine taught by advanced practitioners in primary and urgent care, with much less time spent on trauma or critical care.
In April 2024, the College of paramedics published the 6th ed of their Paramedic Curriculum which explicitly sets out a broad sociological curriculum that accounts for an equivalent amount of the curriculum as research and evidence-informed practice. The arguments put forward in this paper just do not resonate with contemporary paramedic education in the UK.
The paper purports to concern ‘the future of paramedic education’ despite being nested in archaic stereotypes of paramedic practice and identity. These arguments therefore become a strawman – they are right, yet they are meaningless – but worse than that, with them the paper appears to degrade the work of paramedic educators globally who endeavour to educate socially and culturally competent paramedics, rather than advocate for better practice.
Dismissal of the biopsychosocial model
The critique of the biopsychosocial model as biologically dominated (reduced to ‘bio-bio-bio’ and then further to ‘bio-psycho-medico’) is a provocative but ultimately a reductive argument. In practice, many paramedic educators (like us) who already strive to deliver holistic education that integrates psychological and social perspectives through theoretical foundations, simulation and case-based learning, and practice education are likely to have read this paper open mouthed (as we did) at the sweeping generalisations and unsubstantiated claims the paper made about our community of practice.
The authors claim that positivist ways of knowing are privileged within paramedicine and that there is a lack of ‘sociological imagination’ and a need for ‘curricular transformation’. There are even claims that where health sociology is taught this is done so only in a deterministic way, a mere add-on to our education rather than woven throughout. Although this might describe some global paramedic education, this feels alien to us and does not describe the education which our students receive.
We suggest that rather than appearing to reject the biopsychosocial model outright (as Corman et al. appear to have done), paramedic scholars might engage with it in its current form and consider how it can be rehabilitated and/or enhanced through stronger pedagogical approaches, interdisciplinary teaching teams, and longitudinal studies exploring its impact on paramedic understanding of sociological aspects of practice.
Ambulance culture and educational causality
The authors imply a linear relationship between the ‘translucent curriculum’ and problematic aspects of ambulance culture (e.g. machismo, trauma-focus, stigma). In fact, the authors appear to broadly conflate paramedic practice with ambulance work, a position we would suggest is out-of-date. However, the sociological literature acknowledges that professional identity formation is complex, shaped by practice environments, mentorship, regulation, and broader societal values – not solely education.
We agree with Corman and colleagues, that ambulance culture requires change, and we also believed that increased sociology teaching would help make that change. Unfortunately, thus far, this has not been enough, and we do not know the reason behind this, but we can attest that we are also constantly battling classical ambulance attitudes after students return from placement. The influence of ambulance work and paramedic identity over ambulance service culture is poorly understood – precisely how paramedic education feeds into this translucent miasma of sociological experience is a potentially fertile area for future enquiry. Understanding why ambulance work appears to be a hegemonic pedagogy would be an avenue of enquiry that might be fruitful in terms of shifting cultural narratives.
Paramedic scholars may wish to consider how cultural change is already being driven from within services and universities and explore the extent to which a deeper sociological understanding may influence these complex processes.
Summary
Although we have issues with the paper, it does make a valuable contribution by reigniting critical conversations around the philosophical underpinnings of paramedic education. However, its impact would be amplified by integrating empirical evidence, showcasing positive examples of sociological pedagogy, and inviting collaborative dialogue across academic and clinical domains – rather than adopting an antagonistic and cynical attitude towards a profession striving for higher levels of professionalisation.
As such, it is hoped the authors might engage directly with programmes already implementing sociologically informed teaching and join efforts to broaden and deepen paramedic education scholarship in a way that is intellectually rigorous, practically grounded, and aligned with the evolving needs of the profession and public.
We extend a warm and genuine welcome to any of the authors to come to our programmes and see where we have attempted to weave healthcare sociology throughout our curricula for them to understand better how this is currently done in modern UK paramedic degree programmes. Furthermore, we invite them to undertake a critique of our actual pedagogical practices in this area and collaborate on a future publication, so that we all might grow stronger together.
