NREMT-P Written Exam

[usmc_chris]

So, I took the NREMT-P written test yesterday, and found out this morning that I passed (pass/fail results posted on the website). Now, let me preface what I am about to say with the following disclaimer: I completely understand for individuals going through Paramedic school (or EMT school, for that matter) that the final written test can be nerve-wracking. 15 months ago, when I took the New York State written, I was confident I could pass, but was still scared about it, because it was the "moment of truth" so to say.

My thoughts on the matter.

I went in, with almost no pressure at all. My wife and I would like to move, which is why I am obtaining my Registry certification. However, as I'm already a State certified Paramedic, and NYS doesn't require the NR, I really had no big "pressure" to pass. That probably helped.

I did find the test somewhat harder than the NYS written, but not much. It was shorter, however. The CBT cut me off after 80 questions. I finished in about 25 minutes. Now, I COMPLETELY agree with Dwayne, Dust, Lone Star, et. al. on the topic of increased educational standards in EMS. That being said, is the NR (or state written that I took just over a year ago), really the minimum standard that needs to be passed? I, for one, don't really think it truly assesses what Paramedics need to know - it doesn't even begin to assess that, IMHO.

Now, I would hope that most Paramedic schools would teach far above and beyond what is required to pass the NR, but the sad fact is, they don't. Many of the Patch mills out there teach to pass the test, and that's it. I am reasonably certain that my basic partner could pass the written test without ever having set foot in a Paramedic classroom (admittedly, he's one of the best BLS technicians I've met, but I digress).

I remember after taking the state written exam, my nervousness about passing was over. To be honest, I almost felt insulted by the content on the exam. I truly think it's scary to think that there are medics out there that are ONLY taught the MINIMUM to pass this test. That, coupled with a lack of an adequate QA program in many agencies... it's scary to think about how many patients we could be seriously harming through a lack of knowledge, through just being a "skills monkey."

I seriously hope that certifying bodies such as the NR and various state Offices of EMS wake up and "smell the coffee" and raise the bar. They don't even have to make the classes harder! Based on what is supposed to be taught in the curriculum, the tests could be much more in depth. We talk about raising educational standards, but it makes me wonder whether the "standards," such as they are; are even being fully explored in class, or whether many programs are simply "teaching the test" and teaching the bare minimum that will allow their students to pass the NR. And by some reported first-attempt pass rates, it makes me wonder whether the they are even teaching that much!

Excuse my ramblings, but after being through both the state and NR written tests, I really am kind of scared at exactly what the competence level of some of the people that could be showing up at my door step if I ever had my own medical emergency.

Your thoughts and inputs are appreciated.

[Ridryder 911]

As a test writer for the NREMT, let me attempt to explain some things. First, NREMT is simply a testing agency... not a certifying agency or licensing agency per state, although many choose to utilize the NREMT as the test to offer. Unfortunately, EMS is so fragmented and so out of touch with professional and educational standards it is ridiculous!

The sole basis for any certifying and professional tests is to assure that they meet the minimal and safe practices as a beginner practitioner. This is NOT based upon a 5 year experienced Paramedic, or one with a high academic science degree. Unfortunately, NREMT can only test what is based upon the current NHTSA curriculum , AHA ACLS/BLS standards, PHTLS and that's it ! Nothing else... no State protocols (as each state and areas vary) no specific manufacture book (i.e. Mosby, AOOS, etcas the ONLY reference material is as I mentioned (NHTSA, AHA, PHTLS) for test questions.

So one should look at the source if that is where the material is coming from.. i.e. Don't blame the testing agency, if the curriculum is faulty! So, the new curriculum is out and guess what? Major anger and head bleeds from those that want to resist and fail to understand professional standards. NREMT has been at the forefront encouraging increasing educational standards and better evaluation tools from true academic and scientific research (as true professional testing agencies have to do) and they have met resistance along the way from professional, state EMS groups due to their demands of requiring educational institutions to be accredited to have students test. (Really, why would should a healthcare education be held accountable?.. satire)

So the problem is much more than what is on the surface. As well, majority of the personal in EMS do not understand professional standards, testing procedures (blind studies, question writing and values) that are required by academic and professional standards (why most states opt to NREMT due to costs).

Simply, don't blame the messenger ... change the system

R/r 911

[usmc_chris]

NREMT can only test what is based upon the current NHTSA curriculum , AHA ACLS/BLS standards, PHTLS and that's it ! Nothing else...

Simply, don't blame the messenger ... change the system

R/r 911

I fully agree with your last statement, Ridryder. However, I guess what I was getting at was what you state, that I quoted above. Are they even testing these standards/curricula? I truly believe that the bar is set a little low. I don't recall a single question about ACLS. There were only two cardiology questions! I understand the idea of CBT testing, but I'm not really sure if I buy the idea that with CBT, the computer can be 95% sure that you are going to pass based on your answers to 80 questions, when the full test is 150 questions or so. And while I understand that on any such certifying test, only a representative sample of questions is going to be asked, it seems that the test could have been much more in depth.

What's even scarier, is the abysmal first-pass rate of even this, at least from my perspective, seemingly low standard.

Of course, as has been mentioned hundreds of times in these forums, the answer is to get everybody on the same page (or at least reading the same book would be a good start), and vastly increase educational standards. And then hold students to those standards in the test that formally certifies them.

[Dustdevil]

I have nothing to add that I haven't already said thousands of times. But I just want to recognise the awesomeness of your observation, usmc_chris. It is the exact same feeling I got the first time I took any EMS exam, NR or otherwise.

Unfortunately, we as providers have to set our own bar. The IAFC and NAEMT won't allow it any higher than it already is. And I honestly don't think that things will ever get any better.

[MetalMedic]

Thanks for the thoughts, I felt the same way.

I'm also wondering about the practicals as well... I think it would've been better to test us on taking the BP, writing PCR's and daily stuff... but I digress.

Thank you for that information!

Oh and where are you now? I'm another in the North East.

-MetalMedic

Edited June 1, 2011 by MetalMedic

[m0nster986]

I'm also wondering about the practicals as well... I think it would've been better to test us on taking the BP, writing PCR's and daily stuff... but I digress.

-MetalMedic

Are you being sarcastic? Those skills are those you should have mastered as an EMT-B.

But yes! The bar in education need to be raised!

[island emt]

The national registry as a whole is nothing more than a sad joke.

From the basic level on up all test are written to the eighth grade level of comprehension'

.'NR is a money making venture for providing a standardized test and nothing more.

The current DOT curriculum at all levels is so inept as to make the courses a rush to teach just enough to pass the test.

My wife adds 35 hours to her basic courses on top of the required minimum 150 hours and it's still hard to get all the needed information to the students above the minimum DOT standard materials.

[usmc_chris]

Oh and where are you now? I'm another in the North East.

-MetalMedic

I'm in upstate New York. NY isn't a Registry state, but I'm getting mine because my wife and I plan on relocating, most likely to Virginia, so we're closer to her mother, and we like the area, etc.

The national registry as a whole is nothing more than a sad joke.

From the basic level on up all test are written to the eighth grade level of comprehension'

.'NR is a money making venture for providing a standardized test and nothing more.

The current DOT curriculum at all levels is so inept as to make the courses a rush to teach just enough to pass the test.

My wife adds 35 hours to her basic courses on top of the required minimum 150 hours and it's still hard to get all the needed information to the students above the minimum DOT standard materials.

Now, I completely agree that more education should be required! That being said, even with EMS education as it stands today, the test could have been a lot more thorough! As I said in my OP, I seriously think a trained monkey could have passed it. Another poster stated that they can test on the DOT curriculum, current ACLS and current PHTLS standards. Most of that wasn't in there! If it was, there were an average of less than 3 questions per subject, and even those seemed similar to one another. Now, it probably doesn't need to be 1000 questions, but I seriously question the validity of a test that can even come to predict competency over a broad range of subjects with a grand total of 80 questions, and no more than about two per subject.

I suppose I wouldn't object to the difficulty level of the test if I knew that all areas of the country were closely supervised by medical directors, with strict standards and QA processes. It is, after all, easier and more thorough to manage competency at the local level, IMO. Unfortunately, there's too many systems that are "a patch and a pulse." You have the patch, and a pulse, you go on the road, with all your toys, and little to no oversight in how you use them, until you screw up big time. Or perhaps until you screw up big time multiple times. And by then it's too late for your patients that you screwed up on. (I understand, everybody screws up. But most of us recognize when we do, and report it, and correct the deficiency. The above comments are directed to those services/areas where the level is set so low providers may not realize they even did mess up.)

If more people fail, so what? (IMHO) That makes the schools actually teach the curriculum! Of course, the curriculum standards need to be increased too, but I'm honestly of the opinion that schools could be seriously shortchanging their students, even given the current standards, and still have a high pass rate. The curriculum standards will NEVER change until what's already being "taught" is ADEQUATELY taught!

[DwayneEMTP]

Are you being sarcastic? Those skills are those you should have mastered as an EMT-B...

Yeah, but still, most of the basics AND medics I know are unable to do 'the basic daily stuff' in a competent, professional manner.

I think that she has an awesome idea! Not to mention that doing so would either raise professionalism in the field to increase the fail rates of the test...both good things.

Dwayne

Edited June 3, 2011 by DwayneEMTP

[MetalMedic]

Are you being sarcastic? Those skills are those you should have mastered as an EMT-B.

But yes! The bar in education need to be raised!

No I'm not being sarcastic at all. I think that KED was kind of a joke. I've never met an EMT who uses one for the initial purpose of it. I think that some of the stations should've included actually taking a BP, doing a patch, actually contacting med control. Not that all of the stations were a waste of time, but when all is said and done, we'll be doing those things daily, and not necessary doing a CPR in progress daily. I think it's good for us to think on our feet and know those situations as well, but I just think that others need to be added to the certification.

Because honestly, I couldn't do a patch to save my life (or anyone else's). And I'm not going to pretend to either... I'm green and ready for all the knowledge I can get.

If I run across a trauma or a medical situation, we're golden. Don't get me wrong, our instructor did go over how they are supposed to go, theoretically. But putting it into use is a totally different story. Which is why I think it needs to be a test station for us EMT-B's.

Does that clarify?

-MetalMedic

Edited June 9, 2011 by MetalMedic