Method for assessing self-evaluation of professional effectiveness among paramedics

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In today's healthcare environment, improving the professional effectiveness of medical specialists, particularly paramedics working in rural areas, is particularly important. Russia remains a predominantly agricultural country, with a significant portion of the population living in rural areas where access to qualified medical care is limited. Currently, paramedics are becoming a key player in the primary health care system, and the quality of the entire rural healthcare system directly depends on the quality of their work. At the same time, rural healthcare is experiencing a steady increase in the average age of its workforce: according to Latyshova A.A., Nesvetailo N.Ya., Lyutsko V.V., and Ivanova M.A. (2025), the age structure of rural healthcare workers is shifting toward more mature age groups [1]. Combined with the limited influx of young specialists, this complicates the timely acquisition of new competencies, particularly in the area of ​​healthcare digitalization and the implementation of innovative forms of care. As noted by Esauenko I.E., Petrova T.N., Sychev E.V., and Petrov I.S. (2024), the aging of the workforce and the shortage of young specialists are key barriers to the modernization of rural medicine and require systemic measures to attract and retain young personnel [2].

The study was also motivated by the steady increase in the number of patients with CHF. According to international estimates, its prevalence reaches 64.3 million cases, and the total costs associated with the disease amount to $346.2 billion [3]. In Russia, the situation is comparable: the prevalence of CHF is 7-10% of the adult population, and the annual economic losses exceed 81.86 billion rubles, with almost half of these costs attributable to direct non-medical expenses [4, 5].
In recent years, there has been an expansion of the professional competencies of paramedics, which in some areas brings their work closer to that of physicians. However, the current professional standard for paramedics, approved by Order No. 470n of the Russian Ministry of Labor dated July 31, 2020, primarily covers traditional job functions related to providing primary pre-hospital medical care, including patient examination, treatment prescription, preventive and rehabilitative measures, medical record keeping, and emergency care. The standard mentions the use of healthcare information systems, but lacks detailed regulations on the digital competencies required for telemedicine, remote patient monitoring, and digital document management. Furthermore, the current document does not reflect new initiatives to expand paramedics' responsibilities, such as participation in providing specialized care and the use of a wider range of medical technologies.
The relevance of managing rural patients with CHF in the new digital environment is confirmed by the lack of adequate digital readiness for nursing staff. This highlights the need to discuss new tools for developing and assessing the competence of paramedic personnel in a digital environment, as well as updating regulatory and qualification requirements to reflect modern conditions for providing care.
The developed structural-level model of social efficiency for managing rural patients with CHF demonstrates the cyclical interrelationship between the micro-, meso-, and macro-levels of medical care. The presented model is based on Academician A.V. Reshetnikov's conceptual framework for the social efficiency of healthcare as an integrative characteristic reflecting the degree to which the structure, processes, and performance of a medical organization meet the expectations of the population and the requirements of the social environment [6]. The effectiveness of medical care is formed at the intersection of organizational mechanisms, the quality of medical services, and patient reactions, which allows us to consider feedback (including complaints) as an indicator of the functionality and sustainability of primary care [7] (Fig. 1).
Unlike the general concept of social efficiency, which focuses on the compliance of a medical organization's performance with public expectations, our structural-level model complements the theory with operational mechanisms for achieving this effectiveness. The model introduces two fundamentally new analytical components:
1. Digital tools for remote monitoring of rural patients with CHF as a system-forming channel for receiving feedback, ensuring continuity of monitoring and clinical decisions;
2. Self-assessment of paramedic professional effectiveness as a central condition for the quality of medical care in rural areas, influencing the sustainability of interactions between the micro-, meso-, and macro-levels.
Thus, the model not only reveals the multi-level structure of the social effectiveness of managing rural patients with CHF but also offers a specific instrumental framework for its implementation—through digital patient support and assessment of paramedic professional self-efficacy.
Within the structural-level model for managing rural patients with CHF, the various levels of the model are represented through a set of indicators that allow for assessing effectiveness both at the level of the individual healthcare worker's activity and at the level of institutional processes and the social effectiveness of medical care.
The central agent of the model is the paramedic, whose professional self-assessment and digital readiness determine the accuracy of remote monitoring, the sustainability of inter-level routing, and the quality of clinical decisions. Important functional components of the model include digital tools, such as the DI-MOZAIK app and the "Regional Heart Health" chatbot.
Of particular importance is the vertical structure of institutional forms of medical care delivery, represented by the following stages: feldsher-midwife station → district hospital → level III medical facilities. This routing demonstrates that digital monitoring results are transmitted between the levels of our model, ensuring the consistency of medical decisions and the possibility of timely specialized care.
The paramedic's professional training and confidence determine the quality of remote monitoring procedures.

 

About the authors

Tatyana Bogdanova

ФГБОУ ВО СГМУ им.В.И.Разумовского Минздрава РФ

Author for correspondence.
Email: bogtanmih@mail.ru
ORCID iD: 0000-0002-9203-451X

Кандидат медицинских наук, доцент, заведующий кафедрой пропедевтики внутренних болезней

Russian Federation

Elena Andriyanova

Ministry of Health and Social Development of the Russian Federation State Educational Institution of Higher Professional Education Saratov State Medical University named after V. I. Razumovsky

Email: elena-angriyanova@yandex.ru
ORCID iD: 0000-0002-6250-8331
SPIN-code: 8378-3460

Doctor of Social Sciences, Professor, Head of the Department of Philosophy and Humanities

Russian Federation, Saratov, Russia, 410012, 112 Bolshaya Kazachya Street

Rustam Raskaliyev

Ministry of Health and Social Development of the Russian Federation State Educational Institution of Higher Professional Education Saratov State Medical University named after V. I. Razumovsky

Email: rustamrask@mail.ru
ORCID iD: 0000-0002-1110-5276
SPIN-code: 2655-7175

Head of the Laboratory of Ethics and Psychology

Saratov, Russia, 410012, 112 Bolshaya Kazachya Street

Irina Krom

Ministry of Health and Social Development of the Russian Federation State Educational Institution of Higher Professional Education Saratov State Medical University named after V. I. Razumovsky

Email: irina.crom@yandex.ru
ORCID iD: 0000-0003-1355-5163
SPIN-code: 4854-1094

д-р мед. наук, профессор;

Russian Federation, Saratov, Russia, 410012, 112 Bolshaya Kazachya Street

Alexander Fedonnikov

Ministry of Health and Social Development of the Russian Federation State Educational Institution of Higher Professional Education Saratov State Medical University named after V. I. Razumovsky,

Email: fedonnikov@mail.ru
ORCID iD: 0000-0003-0344-4419
SPIN-code: 2248-5246

Doctor of Medical Sciences, Associate Professor

Russian Federation, Saratov, Russia, 410012, 112 Bolshaya Kazachya Street

References

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