Introduction: In Ontario, Advanced Care Paramedics (ACPs) are required to perform a minimum of 24 educational credits per year of Continuing Medical Education (CME). Of these 24 credits, 12 are chosen by the paramedic, while 12 credits are mandated by the Base Hospital. The combined mandatory and optional CME frame is used so paramedics can target their personal needs appropriately, while ensuring new medical directives and global knowledge deficits identified by Quality Assurance (QA) means can be addressed by the Base Hospital. Objective: To determine if there is a difference between what ACPs identify as their knowledge deficits and what CME they complete. Methods: Methods: Request for participation in a written survey was delivered to all ACPs in an Ontario Base Hospital, prior to the CME cycle for the year. Respondents were asked to identify deficits from a 37-point, organ systems-based list, with free-text option for any deficits not itemized. Following the annual cycle, CME credits were evaluated by the Regional Base Hospital education coordinator, and Base Hospital medical directors for content. The deficits identified prior to the CME cycle were then compared to the CME attended for each respondent. In order to best represent the individual ACP response to their perceived deficits, a percentage of deficits identified and addressed was chosen. Respondents were not aware that their responses would be compared to the credits obtained for the year, to minimize bias in CME selection. Results: Of the 140 ACPs in the region, 42 (30%) completed the survey. From the 37-point list, the median number of perceived deficits identified was 7.00 (IQR 3.00-10.00). The median number of CME events that addressed perceived deficits was 2.00 (IQR 1.00-3.00). The median number of perceived deficits addressed by either paramedic-chosen or mandatory CME were identical at 1.00 (IQR 0.00-2.00). The percentage of perceived deficits identified and addressed via CME was 35.07% (range 0-100%). Paramedic-chosen CME covered 22.48% (range 0-100%) of perceived deficits, while mandatory CME covered 20.14% (range 0-100%) of perceived deficits. Conclusion: In the current system, only 35.07% of perceived deficits were addressed through mandatory and paramedic-chosen CME. Further information regarding barriers to paramedics obtaining CME that meets their perceived deficits needs to be elucidated.