Evaluating Practice-Based Education and OSCEs in Paramedic Mental Health Training: Effects on Confidence and Simulated Performance

Background: Mental health conditions are a growing concern in out-of-hospital care, requiring paramedics to develop confidence and competence in assessing and managing mental health presentations. Historical paramedic education has primarily focused on physical health emergencies, with limited emphasis on mental health training. Practical-based education (PBE) and Objective Structured Clinical Examinations (OSCEs) have been proposed as effective methods to bridge this gap. Aim: This study aimed to evaluate the impact of PBE and OSCEs on paramedic students' self-perceived confidence and competence in assessing and managing mental health conditions. Methods: A retrospective pre-post survey design was used to assess changes in confidence levels among second-year paramedic students enrolled in a mental health unit at an Australian university. Self-reported confidence was measured after engagement in PBE and OSCEs in addition to the collection of final OSCE scores. Statistical analyses, including paired-sample t-tests and Spearman correlation, were conducted to evaluate changes in confidence and the relationship between confidence and competence. Results: Ninety-four students participated in the study. Statistically significant increases in self-perceived confidence were observed across all assessment, communication, and management domains. The strongest confidence gains were in Mental Status Assessment, Suicide Risk Assessment, and Pharmacological and Non-pharmacological management. A positive correlation was found between confidence and OSCE performance, suggesting that students who reported higher confidence levels also demonstrated stronger clinical performance in key areas. Conclusion: These findings support the integration of structured, experiential learning approaches into healthcare education to improve learner preparedness and performance. This study contributes to evidence on simulation and practice-based strategies for addressing gaps in paramedic mental health training.