No NR test??

[ladyfirefighter36]

Recently heard, thru the grapevine, that the state is looking into doing away with National Registry. (How lucky could we be). The test really only tests you on if you know how to take a test, not very good at testing practicals, in my opinion. What we are hearing is that, if you take all the training (ems or medic), satisfactorily complete all ride-alongs, and practicals, attend class, the instructor can sign off and you will get your certification. What do you think? I'm not a fan of the test to begin with. I want someone who, yes, knows what they are doing, and why, but I also want someone who is proficient in hands-on-care. I want to work with someone who can step in and give good patient care, and know why they are doing what they do.

What are your thoughts? Do you think it would work, or would instructors be signing off just to get them thru the class?

Will be interesting to see if this happens.

[JakeEMTP]

North Carolina is also non-NR. That being said, we still have to take the practicals as set forth be the state and are very similar to the NR. There is also a State written exam and oral boards before I can work in my particular County, I'm not to sure about everywhere else, my bad. IMHO, Ohio should still have a State written exam. Allowing instructors to just sign off and " Bob's your Uncle", you're an EMT/Medic, sounds like a major step backwards.

[AnatomyChick]

I think that there has to be some type of "governing body" that tests the ability of the students... Just having them pass the class may not be enough, due to the fact that Instructors are biased about their own students (this is the same reason that I am not allowed to test my own students at the State Practical Exams here in Missouri)....

I would LOVE to see us go back to State testing here, I think the test(s) were more effectiveand the process to hold a class was more thorough.... with that said, budget cuts are definitely affecting most states EMS Bureaus/ Departments/ Units... and the NR is a solution to some of those issues.

[Nate]

There weren't a whole lot of ALS questions on my NR test, most of them were basic level questions. I know it is important to test the basic level of most; but I think that 180 questions isn't enough to see if someone is capable of being a paramedic.

[Arachne]

It seems to me as if there are a few different issues here:

1) Should there be a national test and national standards defining what is an EMT-B/I/P and what each can do?

2) Should states be able to not use that national standard/test, such as NC and MA?*

3) How good/valid/useful is the National Registry's test? I've taken NR and the MA state test, and found both to be fairly inadequate at assessing knowledge and ability (And ridiculous - if you're going to make me answer via multiple choice, at least give me enough information in the question to figure out what you're looking for!)

4) How much of making someone a "good" EMT is the job of a test/course, and how much of it is the job of preceptors/ambulance services?

*Which are the other non-NR states, anyways?

[JakeEMTP]

It seems to me as if there are a few different issues here:

1) Should there be a national test and national standards defining what is an EMT-B/I/P and what each can do?

2) Should states be able to not use that national standard/test, such as NC and MA?*

3) How good/valid/useful is the National Registry's test? I've taken NR and the MA state test, and found both to be fairly inadequate at assessing knowledge and ability (And ridiculous - if you're going to make me answer via multiple choice, at least give me enough information in the question to figure out what you're looking for!)

4) How much of making someone a "good" EMT is the job of a test/course, and how much of it is the job of preceptors/ambulance services?

*Which are the other non-NR states, anyways?

I think the non- NR States are NC, MA, NY and UT.

The NR is just a test. If individual States don't want to participate that is fine. What NR does is make it easier to move from State to State ie: Reciprocity. I had the option when writing my Basic of NC or the NR exam. Since I hadn't any intention of leaving the Tarheel in the near future, I opted to not write the NR. When it comes time to write the Medic exam, I will write NR since I have more employment opportunities as well as reciprocity is easier if you have it.

As far as how good a provider a test makes you is irrelevant. A test will hopefully show you have the minimum knowledge to enter the field. A good preceptor will teach you the job.

Just my .02 cents.

[SSG G-man]

Maryland has its own state exam. The state practical qualified for my NR when I took it. I only took it because I am in the military and might have to move. MD has a state run EMS system. MIEMS- Maryland Institute of Emergency Medical Services (Someone from MD correct me if I got the acronym wrong). The set our protocols, we send all our patient reports through them, they run the testing. Seems to be a pretty good system. I have always heard that MD is a leader in Emergency Medicine. I know the R.A Crawley shock trauma center in Baltimore is one of the best.

[Dustdevil]

It would be pretty funny for the state that is home to the National Registry were to withdraw from it.

But, as funny as it would be, it would also be a nightmare on many levels for your state to do it as you are outlining. Most other states would quickly cross Ohio off their list of approved states for reciprocity. Then we would start getting daily post from newbies in Cincinnati crying and whining about how unfair it is that their certification is no good across the highway in Kentucky. Then would come the outcry from those Ohio registrants who challenge the NR and fail miserably talking -- just like you -- about how that "book learnin'" isn't important and the only thing that matters is their "skills." Eventually, the State would be so inundated with complaints from schools and registrants that they would have to either go through the enormous hassle and expense of establishing their own exam process (more of a hassle and expense than you think!), or go back to NR, which they wouldn't do strictly out of stubbornness.

Not only will other states shun Ohio graduates once word circulates of the lack of impartial review and standards, but regions across the state will begin to shun graduates from other regions that they believe are inadequate. Once the community college in Cleveland gets a reputation for cranking out functionally illiterate morons who can't even spell EMT, those people will find themselves unable to get a job outside of the big city. And, of course, even more of the better, more progressive employers will begin to require NR for employment simply to establish a standard because they know none exists there. And, since the educational standards will be dropping in Ohio, even fewer people will pass NR, meaning even fewer grads will be able to get jobs, resulting in even more whining.

If Ohio's educational (using the term loosely) process is so horribly inadequate that a significant percentage of people are incapable of passing NR, then things will obviously only go downhill from there. Yes, people will get passed for showing up. It already happens in many locations. That's why "refresher" classes are packed full of people going back for their fourth shot at the NR written. The occurrence of such practise will increase exponentially. Fire departments already put a lot of pressure on many institutions to railroad their hosemonkeys in and out of schools as quickly as possible with little concern for anything other than the quantity of people they can show are certified on paper. The fastest, easiest school is always the most popular school in any given region. This move would lower that bar significantly, and more schools will dumb down even more in order to be competitive, as well as passing even more idiots to avoid upsetting fire chiefs who send all their people there.

This whole thing seems to be the result of an attitude of entitlement that I see in EMS, but not any other profession I have been involved in. Every idiot that pays his money seems to think that he is the smartest guy in the class. And worse yet, they all seem to think that his instructor (the only instructor he's ever even met) is the best instructor in the world at the best school in the state. So when one of them fails out of class, all we hear is a bunch of self-serving crap about how smart they are, how the test is bogus, how great their "skills" are, and how all that "book learnin'" ain't important anyways, and therefore are entitled to graduate and get that patch for showing up. Similarly, the ones who pass the class but fail the State or NR exam whine about how good they did in class and how awesome their "skills" are, and how if their wonderful school and instructor passed them, then it must just be the test that is bad because they could not possibly have been inadequately educated. If I had a dime for every EMT or Paramedic student over the last thirty years who honestly accepted his failure as a sign of inadequacy, learned a lesson about how to do better next time, and humbly walked away to fight another day without blaming everybody but themselves, I would still be working on my first dollar.

This focus on "hands-on care" skills, and seeming lack of concern for a solid foundation of knowledge, is troubling. Why is it that so many people simply can't understand that "skills" are completely without value if the provider lacks the intellectual capacity to make the sound clinical judgements necessary to determine what "skills" are needed for their patient? How can anybody be so stupid as to suggest in one breath that all that "book learnin'" isn't important, yet in the next breath whine about all the extra "skills" and drugs they ought to have at their disposal, like we see here everyday? Would you want your doctor to be the guy who was the best cutter in his class, but never mastered the process of figuring out what was wrong with the patient? Would you want your hairdresser to be the most artistic person in the class, but the one who failed to understand the important concepts of microbiology and hygienic practise that keep you from getting her last customer's bugs? Would you want your bug exterminator to be a pro at spraying deadly chemicals in the house your children live in, but have an inadequate understanding of toxicology?

Good "hands-on" skills don't come from education. They come from practise. They aren't knowledge. They are skills. Consequently, ANYBODY -- even the average fireman or monkey -- can become quite good at bandaging, splinting, bagging, and taking vital signs. Big deal. It's simple repetition. The more you do it, the better you get at it. It doesn't require any intelligence. They are nothing to be particularly proud of. And, since everybody who does them long enough will eventually get better at them, they are the very last thing that anybody needs to concentrate their focus upon. Especially considering that over ninety-percent of all our patients don't need bandaging, splinting, backboarding, bagging, OPA's, or any of that other simple first aid crap.

There is only one "skill" that is required by one-hundred percent of our patients. That skill is patient assessment. And, contrary to popular belief, patient assessment is more than reading down the checklist you were supposed to memorise in EMT school. In fact, patient assessment is not a "skill" at all. Patient assessment is an cognitive process that requires a specific aptitude and intellect. And, unfortunately, not every person who can pay their thousand-dollars and learn to perform CPR has the aptitude and intellect to become proficient at patient assessment. Consequently, all of those repetitive "skills" they learned are all but useless to any employer. If you cannot accurately diagnose the problem (yes, I said DIAGNOSE! Don't give me no $hit about it!), or at least narrow it down to the most relevant possibilities, then you have no business calling yourself an EMT or Paramedic. And that is exactly what the National Registry -- despite it's faults -- effectively measures in those candidates who take it.

Do I have faith in ANY individual school to assure that its students leave their school with both monkey skills AND the medical foundation necessary for good clinical judgement and patient assessment without independent oversight and validation? Hell no! If you know of, or have ever even heard of one school with a bad reputation, or one EMT graduate who had poor "skills," then be honest. There is no way you can intelligently argue that allowing each school to establish its own criteria is a good idea.

I am certainly no defender of the quality of the NR or their exam. They have problems on several levels. But the remedy to those problems is to either participate in the process to have them improve, or for your state to simply write a better test. Poor standards are not cured by more poor standards.

No good can come from this idea. And Ohio will become the laughing stock of the already pitiful U.S. EMS community.

[ladyfirefighter36]

I am for "book learnin". I just feel that practice, as stated, is where you gain your knowledge and that needs to be looked at. Hands on skills are great, book learnin is great. There has to be a better way of testing those coming out of the classroom. I don't think the instructor signing off is the way either. Like commented, some have class favorites, they should not be allowed.

Dust, I agree the most important thing we have to do is patient assessment. Some people, know matter how much they read in a book, just don't get it. They have to have the hands on practice. I don't necessarily feel, that the NR, effectively tests this. Yes, it does make you think on your feet, it makes you come up with a diagnosis, but as stated in an earlier post, it really doesn't give you enough information, most of the time, to make the type of conclusion that they are looking for.

I hope that Ohio does not do this. I think we still need the testing. They are also talking about going back to just the state test. Who knows. Something needs to happen. Not sure what.

[Dustdevil]

I am for "book learnin". I just feel that practice, as stated, is where you gain your knowledge and that needs to be looked at.

I disagree. Practice is not where you gain your knowledge. Practice is where you increase your understanding. The scientific knowledge base cannot -- and should not -- be taught in the field. It's book knowledge. It comes from a text and must be learned in a controlled and programmed fashion. The haphazard process of picking up pearls of wisdom in the field does not give you your medical foundation. It only gives you understanding about how to utilise that knowledge base.

I do, however, think that our disagreement is really not much more than semantics. What you are talking about is about the same as what I have long been advocating -- a mandated, and significantly lengthy internship process after the classroom process is over. Unfortunately, it won't happen. The fire chiefs won't let it happen. And too many students would not support schools that increased their course length from 110 hours to upwards of 300 hours when they can get the same patch in a month at another school. Not to mention the problem of finding a service to host your interns that has both the quantity and quality of runs and preceptors to make the experience effective. It just does not exist across much of the country.

There simply is no way to increase a student's clinical and practical competency without increasing their experience. And, unless you start eliminating even more classroom time and required knowledge from the curriculum, there simply is no way to increase their experience without significantly lengthening the course.