Are We Preparing Students For NREMT EXAM?

Why do so many people fail NREMT? This is a frequent question by students, difficult to answer and it depends on where you live. In 2020 the national pass rate for EMTs on the first attempt was 70%. Mississippi was at 49% and Hawaii boasted a 91% pass rate, another reason to live on an island 🌴. While the paramedics held a 72%, for first attempts, North Dakota at 53%, and Hawaii and Vermont tied at 100% pass rate. The NREMT national average is below the 85-93% range for professional examinations. For example, Nurse Practitioners ranged between 83-87% and physicians (internal medicine) at 91%. So why are we struggling, shouldn’t our rates be higher? It starts with primary EMS education.


EMT Programs

Experience is priceless. Talk to anyone who has been on the street for a while and they will tell you experience outweighs exam grades. These days you can find an EMT or paramedic program anywhere. Technical colleges, hospitals, private education, and universities all offer these programs. For EMT’s many programs have little if any requirements, beyond a high school diploma. I barely passed my EMT program. Anatomy, physiology, medical terminology, and human growth and development were not required prior to entering the program. I did not know the difference between aorta and atria. I struggled without a base of knowledge, in a program that moved fast. This was over 20 years ago, and we still have not learned our lesson.

Quality education starts with a solid foundation. This means EMT’s should be required to complete Anatomy and physiology, medical terminology, and Human growth and development, before starting. Does this need to be at the level of a physician, No! All three of these courses can be geared to what an EMT (future paramedic) is expected to know. This allows the EMT instructor to focus on the core elements of the program. Does this mean you may need to repeat A&P? Maybe, but this is not a bad thing, in fact, this positions the EMT to grow his or her knowledge base with the next A&P course.


Quality Instruction

I belong to several Facebook groups that lift up members to help them pass the course. One group has >15,000 members. This tells us that students are proactive in seeking help, and we have issues with students, instructors, and or programs. Some students who enter an EMT course do not have solid academic skills. While it is not the job of EMS instructors to teach these skills, it is their job to recognize deficiencies. Another reason EMT programs should require a semester of prerequisites allows time to identify and correct these problems.

A great clinician does not equal an excellent instructor. We have a habit of hiring people who are qualified but lack the “teaching gene”. Programs that have rigorous instructor requirements, identify this gene and tend to be highly successful in first pass attempts.  Finally, programs vary in quality, based on administration, funding, and instructor quality. The program chair requires knowledge in instruction and academics, not EMS necessarily. This person should ensure instructors have the tools to do their job and improve efficiency, based on pass rates. Schools that focus on the profit of the program may cut corners or may be financially out of reach for some. Instructor quality in cash-strapped programs tends to be lower than those who received grants and or have higher tuition.


Test Preparation For EMT’s

Most EMT programs are completed in one or two college semesters and include ride/clinical time. This hands-on experience is valuable and allows prospective employers to gauge potential employees. What’s missing? Test prep and critical thinking skills. EMT education focuses on a cookbook methodology that narrows the students’ view. Chest pain equals heart attack, always. We know this is not the case and tell EMTs not to worry because “you don’t need to know that”. This is not only a disservice to the EMT but patients as well. We should always strive to advance the education of everyone in the profession. Critical thinking skills should start in high school; however, we need to develop them in EMT school.

Test-taking skills are a lifelong skillset and missing from EMS education. We can start EMT programs by gauging students learning styles, adapting the flow of information, and improving study habits. Students may not know how to take a test, surprise! Educators cannot assume that students entering have the academic foundation necessary to pass the course. Incorporate test-taking strategies with each review session.


EMT Refresher

Zero To Hero Programs

When I completed paramedic school, it was 4 months of Monday-Friday 0800-1700, followed by 500 hours of ride time and clinical hours. It was brutal, I was working a 36-hour shift every weekend and was scraping by each month. Looking back, I’m thankful for the instructor and the design of the course. None of us had time for anything else, this made us better students. Before entering the program, 3 years of EMT experience was required. Why? The school found that students with experience were more likely to succeed. Makes sense, right?

Not all schools feel the same way and many paramedics opted for the zero to hero program. These programs take a student with a high school diploma from no experience and certification to Paramedic in 12-18 months. Do some students succeed in these programs? Yes, but what is the quality of the provider without experience? The best experience is being wrong or to have a patient humble you. When a call goes terribly wrong, we learn from that experience. Perfect example. My partner and I were out on a call for a sick male on a hot day, likely heat exhaustion. The patient was sitting under a tree, we elected to stand up this 6’3 230lb gentleman…did not end well. While no one was hurt, a lesson learned for both. Experience is priceless and irreplaceable.

Paramedic Examination

We have the same issues in paramedic programs as EMT, lack of critical thinking education, and test-taking proficiencies. The absence of these abilities reduces test scores and quality of care. While this should start in high school, many students do not have this benefit when entering a program. MedEdNow EMT/AEMT/Paramedic refresher includes Pediatric Arrest and Cockpit CPR. This course was developed by Dr. Jake, Chief Learning Officer, and explores critical thinking during a code. Mental map, assumptions, memory, experience, and fight or flight are some of the concepts discussed. Feedback from students is universally positive. Comments such as, “I was never taught to think like that “or “I know how my memory and experience worked against me on calls” are common. This translates directly to test-taking, picking apart, and understanding how our mind works against us allows clarity during exams. Lastly, test-taking competencies should be taught within paramedic modules, same as EMT.

The Road Ahead

We have a long road to improve first-time pass rates for EMT and paramedic programs. This starts with mandatory perquisites and experience. Next, test-taking and critical thinking should be assessed and taught in both programs. Finally, improving the quality of instruction and administration sets up students for success. None of this is possible without the financial support of students, reducing their cost burden. Alternatively, programs may be supported by state/federal funds to reduce the cost of tuition. Changes in EMS are impending, it’s time we focus some attention on where people start.

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