Oh how I despise the NREMT CBT...

[P_Instructor]

I basically think it not what you know, but if you can read a question. I practice with students on how to read a question and then respond. Tell the medics to always treat first as a basic (like you did) and then go onto the advanced crap. Seems to be effective with good results.

As for me, being old, still do the arse way (paper trail) recertifying. With the Alzheimer's setting it, the only thing I have to worry about is where I put all the documentation.

[Steve Whitehead]

Some great information here, and some common misconceptions about the NREMT CBT. Thanks for posting the video. I think it explains a bunch of stuff very well.

I created a fairly popular NREMT basic study guide that's available on the internet. While I've never written questions for the NREMT, I worked with a bunch of people who have been on development commitees while I was developing my products. (I couldn't work for the NREMT and publish the stuff I publish online. It wouldn't be premitted.)

I'd like to speak to a few ideas I found in the thread:

Regarding the test questions seeming like they aren't applicable to your certification level. If you are answering questions correctly, they will get more and more dificult until the test finds the upper level of your ability. (And it will find it.) If your knowldge level is advanced, the questions that appear at the upper level of your ability may be far outside of your typical scope of knowledge. Keep answering questions correctly and you'll eventually see physician level questions.

Regarding the test "finding your knowldge weaknessess" and then exploiting them. The degree of question difficulty will adapt and change, but the subject matter does not adapt or adjust based on which questions you got correct or incorrect.

Regarding the registry spending more money on developing good questions, they currently spend around $1,100 dollars per question from development to pilot testing to test integration. You may not agree that the money is well spent, but I don't think investing more money in question development is at issue.

I haven't heard that the test wording is targeted to tenth grade comprehension but it's possible. However, the knowledge assessment is targeted to an entry level EMT or Paramedic, not a tenth grader, so I'm not seeing how this correlates to anything that has to do with test quality.

Each question that you find on the test is created by a single question author. It is then placed in front of a review panel made up of various certification and education levels from physician down through EMT basic. Most of the question reviewers are involved in EMS education except for the grammar and statistician specialists. The original question author is present, though they are not required to identify themselves as the author of the current question under review. Each question needs to be validated using multiple medical references. The process is extremely rigorous. Some folks may dismiss the test questions as ridiculous but I think you'd be hard pressed to design a better system for question development.

Thanks for the discussion ya'll,

Steve

[Kiwiology]

Keep answering questions correctly and you'll eventually see physician level questions.

LOL I'd like to see some of those because they probably aren't "physician" level questions but rather make use of knowledge not taught to ambo's in your part of the world

I haven't heard that the test wording is targeted to tenth grade comprehension but it's possible. However, the knowledge assessment is targeted to an entry level EMT or Paramedic, not a tenth grader, so I'm not seeing how this correlates to anything that has to do with test quality.

It is commonly held that your paramedic books are written to a 10th grade reading level and for that to be the comprehension level for a profession let alone a profession in charge of medical decisions and powerful drugs is a bit concerning ...

Each question needs to be validated using multiple medical references. The process is extremely rigorous

Awesome, I'd love to see all the references supporting spinal immobilisation and high flow oxygen!

Edited April 2, 2012 by Kiwiology

[runswithneedles]

Like anything "done by committee" , it is a compilation of what a large group of folks think you should be tested on.

It saddens me that this test is written by pencil pushers who havent seen the back of a box or a aircraft in 20 years. Correct me if im wrong.

It is commonly held that your paramedic books are written to a 10th grade reading level and for that to be the comprehension level for a profession let alone a profession in charge of medical decisions and powerful drugs is a bit concerning ...

Thats scary. And quite insulting if thats true.

[Steve Whitehead]

It saddens me that this test is written by pencil pushers who havent seen the back of a box or a aircraft in 20 years. Correct me if im wrong.

I'm sure that there are a few of those in there, but all the test authors I know are active duty paramedics who are involved in EMS education.

It is commonly held that your paramedic books are written to a 10th grade reading level and for that to be the comprehension level for a profession let alone a profession in charge of medical decisions and powerful drugs is a bit concerning

I guess I'm just not seeing the problem with this. Why not make the writing style in your EMT or paramedic textbook clear and uncomplicated? The textbook I teach from includes an extensive glossary of words that I could not comprehend in 10th grade. Learning medicine is like learning a new language. It makes sense to not complicate the matter. I'd prefer the author lay out the information in the least complicated manner. (But no less.)

Awesome, I'd love to see all the references supporting spinal immobilisation and high flow oxygen!

And while we may wish it weren't so, there are currently many, many references for the use of both of these interventions. (In our textbooks and in national standard curriculum and in our protocols.) And, until that changes, both of these interventions will be represented (in quantity) on the test. It's only fair to test students on their understanding of where medicine is, not where it's going.

[runswithneedles]

my apologies. it seems like portions of the stuff we learn is so left field its hard to find it applicable in emergency care

[Kiwiology]

I guess I'm just not seeing the problem with this. Why not make the writing style in your EMT or paramedic textbook clear and uncomplicated?

I think the overall concept is that the material in the book is equivalent to a tenth grade level in terms of complexity of cognition required to understand and apply it; and if true is pretty damn worrying for a profession which makes medical decisions and has access to powerful drugs for administration ....

I am not a formally qualified educator but let's get one of those Paramedic books (which we threw out here because they were not in-depth enough (to reach ALS Level in New Zealand and Australia you require 2/3 of Masters Degree)) and something like Guyton and Hall or Rosen or Harrison and compare how the two fare for educational complexity?

Most of the concepts at least in Guyton and Hall are things Paramedics should have to understand ...

And while we may wish it weren't so, there are currently many, many references for the use of both of these interventions. (In our textbooks and in national standard curriculum and in our protocols.) And, until that changes, both of these interventions will be represented (in quantity) on the test. It's only fair to test students on their understanding of where medicine is, not where it's going.

I'm not talking about that, you said each question must have medical evidence supporting it, so if that is true, there must be some literature supporting spinal boards and high flow oxygen because many nations have abandoned at least one or both of these practices (NZ, AU, UK)

Not sure if a curriculum which has not been updated in fifteen years (1998) written by firefighters and nurses (oh and one or two physicians where necessary) is a legitimate medical reference

[Steve Whitehead]

You said each question must have medical evidence supporting it, so if that is true, there must be some literature supporting spinal boards and high flow oxygen because many nations have abandoned at least one or both of these practices (NZ, AU, UK)

Ummm, nope. That's not what I said. But you're a smart guy. I think you understand what I said. (For the record, I'd love to see spinal immobilization go away and more research on hyperoxemia)

I think the overall concept is that the material in the book is equivalent to a tenth grade level in terms of complexity of cognition required to understand and apply it.

I think you're reaching. I'm glad your educational standards are so high. Americas educational standards should be higher. I haven't experienced this tenth grade cognitive cap that you're describing. I've never heard reference to it even when working with educators developing the content we're discussing. I'm having a hard time imagining the physicians who authored the EMT-Basic textbook that I teach from, sitting around a table and saying, "Well yes, it's important to teach them about recognizing and treating congestive heart failure, but isn't the concept a little too difficult for a high school sophomore to understand?"

Of course, I can't get the questions right on that "Are you smarter than a fifth grader" show. So perhaps I'm evidence of this EMS cognitive affliction that you're describing.

Not sure if a curriculum which has not been updated in fifteen years (1998) written by firefighters and nurses (oh and one or two physicians where necessary) is a legitimate medical reference.

Last year I taught American EMT's to use tournequets sparingly. This year I'm teaching them to use them liberally. This is one of hundreds of curriculum changes I've made since 1998. We update textbooks and teaching content frequently. I'm not sure where you got the idea that our EMS curriculum froze 13 years ago.

[BillKaneEMT]

Really? No more long boards and KEDs? Well, if they're not needed then fair enough. They're certainly not so much fun that I'd support their use if it's been determined they're unhelpful. What about c-collars, can we dispense with those as well? How bout if I roll up to a 4 car collision on the interstate and just give everybody a damn good shake? Anyone who's head starts flopping around like a tetherball gets a lift to the ER? I'm only kiddin with ya, though of course if protocols get changed then so be it. Til then I have to stick with mah long board and KED. And even my high flow O2. Though I understand the arguments against the O2 (as opposed to spinal immobilization).

And what's this about tourniquets? Those are suddenly back in favor? They issue us with the friggin inflatable shock pants I'm gonna be pissed. Ah well, time to audit some classes I spose. I do see why they make us do that every year now. I'll get to hassle some students which will be fun. Good Old Evil George and his Psychotic Scenarios of Doom. Where kidnapping, dismemberment, cannibalism and human sacrifice of emt students who aren't observant or quick witted enough is the norm. And that's on a basic trauma call. You don't want to know what happens on a psych call. Oooh, now I'm excited! *evil chuckle*

[BillKaneEMT]

Ok, I found the article in Trauma journal about the study in which spinal immobilization was proven to be useless and harmful to patients by the docs. Good for them. I'll be happy to stop doing it provided that every single patient that sues for back and neck pain (which will be every single trauma patient, bar none) sues the docs instead of us. While I freely admit that in cases of penetrating trauma it can do more harm than good the idea that as soon as any patient is rolled into an ER the c-collar is ripped off and tossed is idiotic and probably harmful to innocent readers who haven't worked in ER. The first patient I treated in an ER setting was an accident victim who hadn't been wearing his seat belt. His jaw was dislocated by the steering wheel, he was basically scalped by the windshield(the entire crown of his head was connected by a 3 inch scrap of skin at the back). The doctor kept the c-collar on him til after the xrays and ct scan were complete. The doc who wrote the article was full of it. He acted like that here and he'd have some trouble finding a job the emergency medical field. Not because us lowly non doctor types would disapprove but because he'd be sued every damn patient he saw.

Still, in the case of penetrating trauma or internal trauma I understand what they mean. I simply feel the article overstated their case somewhat. And if you think the chosen cases couldn't have been chosen specifically to skew their findings I'll have to surmise a lack of experience in the field of academic experimentation. I'm not accusing the testers of dishonesty, not as such. I'm simply stating the fact that researchers are perfectly capable of deciding what their tests will discover before they're made. You may find this difficult to believe but when, as an example, a certain brand of health food commissions a 3 year study, at the cost of 5 million a year in funding, to determine who has the healthiest type of health food..... let's just say that their competitor is unlikely to benefit from that study. I'm not saying that's what happened here. The article I read was far too strong against it though. The implication was "If you immobilize the spine, you might as well put a 12 gauge shotgun to your patients head and pull the trigger!!! DAMN YOU SPINAL IMMOBILIZERS!!!! DAMN YOU TO HELLLLLLL!!!" It struck me as a case of certain research folks wanting to make a name for themselves. Supporting the status quo is obviously not the way to do that. If you want to write a historical reference book about George Washington which states that he was a talented general, the father of our country, and wore a wig and wooden teeth; publishers will flick rubber bands at you til you leave their office. If you want to write a book in which Washington is portrayed as a communist vampire who consumes the souls of clergymen to sustain his power and has secretly been possessing every president since the revolution.... well. Publishers will literally try to run over with dump trucks full of cash. Because they want to sell books. Again, I have no proof that that's the case here. I simply have a deep suspicion of... well. Of damn near everyone I don't personally know.