Impact of practical-based education on paramedic students’ confidence and competence in assessing and managing mental health conditions

BACKGROUND: Mental health presentations are an increasing component of out-of-hospital care, requiring paramedics to develop confidence and skills in assessment and management. Practical-based education (PBE) and Objective Structured Clinical Examinations (OSCEs) have been proposed as effective approaches to support this development. AIM: To evaluate the impact of mental health-focused PBE and OSCEs on paramedic students' self-perceived confidence, and to examine the relationship between confidence and performance in a simulated assessment context. METHODS: A retrospective pre-post survey design was used to assess changes in self-perceived confidence among second-year paramedic students enrolled in a mental health unit at an Australian university. Confidence was measured across assessment, communication, and management domains using a 10-point Likert scale. OSCE performance scores were also collected. Changes in confidence were analysed using Wilcoxon signed-rank tests, and the relationship between confidence and performance was examined using Spearman's correlation. RESULTS: Ninety-four students participated. Statistically significant increases in self-perceived confidence were observed across all domains (p < 0.01), with the largest gains in assessment and management skills, including mental status assessment, suicide risk assessment, and pharmacological interventions. Small to moderate positive correlations were identified between confidence and OSCE performance, particularly in communication and interpersonal domains such as rapport and patient-centred interviewing. CONCLUSION: PBE and OSCEs were associated with increased self-perceived confidence and improved performance in simulated assessment contexts. These findings support the use of experiential learning approaches in paramedic mental health education. Future research should explore long-term skill development and the mechanisms underlying simulation-based learning.