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Paramedics and EMTs play a crucial role in the emergency response system. Despite this, there is little research on the challenges faced in emergency medicine education. Through a series of seven interviews and a community-engaged approach, the present study identifies and defines the most essential skills and educational challenges for EMS. Three critical skills are identified and defined: Interpersonal Communication, Relational Conceptual Knowledge, and Critical Thinking. Challenges facing the instruction of these skills include the artificial nature of simulated practice, lack of instructional tools, and lack of guidelines or rubrics to provide feedback to students. These results lay the necessary foundation to develop instructional interventions and measures that address the needs of EMS instructors.