Between the ambulance and academia: rethinking identity and competence in paramedics with reduced clinical exposure

The evolution of paramedicine into a diverse and academically grounded profession has expanded career pathways well beyond frontline clinical practice in operational ambulance settings. Paramedics now commonly work as researchers, lecturers, clinical academics and educators, as well as in specialist advisory or project roles, both within and outside ambulance services. These developments reflect both the maturation of the profession and the appeal of portfolio careers that combine operational shifts with roles in higher education, research and leadership. Dual- or multi-role clinicians often bring with them enhanced critical thinking, deeper engagement with evidence and the ability to identify research questions directly arising from frontline clinical problems. By translating practice-based challenges into focused inquiry, clinical academics help generate new knowledge and improve patient care. Their own knowledge and experiences from clinical practice can be shared with student paramedics and other colleagues to facilitate greater learning opportunities, to support research supervision and to create valuable case studies for discussion. Such diversification strengthens the discipline’s academic foundations and supports professional longevity, but it also provokes an enduring question: how can paramedics maintain clinical competence and confidence when practising clinically less than full time?

This editorial initially sought to reflect on the specific experiences of research and academic paramedics, who frequently report challenges in sustaining operational practice. However, through discussion and engagement with wider evidence, it became clear that reduced clinical exposure affects a much broader group. Paramedics in rural settings often encounter fewer patients: a median of seven patients per week, compared to 10 patients for their urban-based counterparts (Pilbery, 2025). Those on specialist secondments or development pathways may experience prolonged periods with limited clinical shifts. Clinicians returning from sickness, injury or parental leave face the well-recognised difficulty of rebuilding confidence and familiarity with evolving practice (Dod & Lansdown, 2025). Even full-time clinicians may experience reduced exposure due to extended hospital handover delays limiting the number of patients they attend.