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During my twenty five years as Executive Director of the NREMT, I’ve counseled hundreds, if not thousands, of aspiring EMTs on how to pass the NREMT. Every telephone call was unique. Every unsuccessful candidate provided a different “reason” why he or she failed. Over the years the reasons seemed to fall into groups.
I am going to explain to you the reasons for failure and provide input regarding how to avoid failing the NREMT exam. Not every reason, however, will apply to every student.
Study throughout the course. I first asked, “How many classes did you miss?” If the answer was more than 25%, I then asked about the depth of studying the content that was missed due to missing classes. Most students would change the tone of their voice and say something like, “Well that could be part of the problem.”
So, if you did not read and study throughout the course, your “Swiss Cheese” (solid in some areas but missing information in others) learning model will likely be exposed when you take the test.
If you failed the exam, your results letter will tell you where you fell below the standard. Before you re-test, you will need to read chapters related to those topics. Do not fail to also study your notes if you came in “at the standard” because on your next exam you could end up below the standard. “Swiss cheese” education can only be resolved by reading the text and working with a mentor.
Read the book. I could detect that a student hadn’t read the course book by asking, “Who was the author of your textbook?” When the answer was something like, “I don’t know, but the color was red,” I would then ask, “How many hours per night did you spend reading the book?” Often the answer was, “Well I didn’t read the book.”
Every EMT textbook varies in depth and breadth.
But a person who reads the book and highlights what he or she thinks was important to remember, can pass the NREMT exam even when he or she uses a poorly written EMT book.
When the failing student never even read the book, he or she received the outcome expected based upon their effort.
There are few facts in education but one stands out to be accurate in all educational situations: the more time students spend engaged with the material (class and studying) the more they learn. The more they learn the better they perform on standardized tests.
Look around you. Many of failing students I spoke to came from classes in which a high percentage of fellow classmates also failed. If I asked, “What percent of your class also failed?” and the answer was, “More than half of my class failed,” I surmised that the problem was a poor education.
I recall one EMT candidate who failed the exam fifteen times before calling me. Because the EMT course has to be repeated after failing it six times, I asked, “Where did you take your second EMT course?” When the answer was that the student took the course at the same location with the same instructor, I replied, “Did you expect a different outcome when you did the same thing over again?” If you attended a course with a poor outcome you will have to make up for the loss on your own via independent study.
Study what is going to be on the test. Many candidates who lack confidence in their knowledge base spend an unusual amount of time studying areas that would not appear on the test. In my experience, students who failed the exam concentrated on remembering knowledge that was difficult to learn. These same students, however, could not recite the signs and symptoms of anaphylactic shock, which is an essential piece of knowledge. These students failed to study what the National Registry says will be on the test: how to figure out what is wrong with a patient and what to do to treat that disease or injury. Complicated and difficult content is not the focus of the test.
Know the “right stuff.” The NREMT exam tests the important functions of the job: 1) determine what is wrong with a patient, and 2) administer treatment. In order to be competent to do this, an EMT has to have an understanding of the various diseases and injuries, and how to treat them. The NREMT exam will test your knowledge of the diseases and injuries you are expected to know as an entry-level EMT. The exam will test your knowledge of the signs and symptoms of these diseases, correct diagnosis of the diseases, and their proper treatments.
Be Test-wise. The most comprehensive review books available on the market are EMT PASS and AEMT PASS. No other review books teaches students how to be “test wise,” except EMT PASS and AEMT PASS.
Test wisdom is not taught in any course or at any educational level. I feel rather strongly your teacher doesn’t teach you how to have test wisdom. As stated in other parts of this website, test wisdom takes time to acquire, requires practice over well developed test items, and requires a verbal or written debrief so students can see for themselves how test wisdom can improve test performance. Test wisdom alone will not result in passing the NREMT. Students must also have knowledge. When a student’s knowledge base is wavering on the edge, however, test wisdom can be a huge help in exam success. To acquire any knowledge regarding test wisdom you must learn it via some method that demonstrates what test wisdom is. Test wisdom can be acquired via using EMT PASS and AEMT PASS.
Understand how a CAT test works. Although not completely necessary, a good understanding of how a computer adaptive test (CAT) works can be helpful. More information about CAT testing can be found on the NREMT website. Because of how CAT tests are structured, you will do best if you 1) answer one question at a time to the best of your ability, 2) concentrate only on the current question on the screen. Don’t worry about past questions or what questions might be coming up, 3) when you’ve selected your answer to a questions, move on and forget that question because you will never see it again even if you fail and 4) don’t lose your composure when faced with a difficult question. If you do, you are most likely to also lose your composure when you are on an EMS call. Someone who can’t hold it together under stress does not make a good EMT.
Find a mentor. An experienced EMT who passed the NREMT exam on his/her first attempt can be a very valuable study partner. Seek him or her out. Even if you have to pay them to be a tutor, do so, as it will be more cost effective than paying to retest! Keep in mind that the EMT test is the most difficult of the NREMT exams. Even though the Paramedic exam has more difficult questions, the EMT test itself is more difficult because the course length is so short, and the exam covers knowledge that is new to the student coupled with the student’s lack of EMS experience.
Read each question carefully. This is a problem that happens to me! I read the stem (problem) of the question, think I know the answer, find what I think is the answer, and quickly answer it. Then I learn I am wrong for one of either two reasons: 1) I didn’t read all of the choices and there was actually a better answer that I would have chosen if I hadn’t been so impulsive. 2) I thought I knew the answer, and later when I looked it up in a text, I didn’t really know the answer. “Thinking” I knew the answer didn’t make it correct.
All National Registry tests are set up to give the test candidate one minute per question. While that might seem like a short time period, it really isn’t. Most candidates answer each question in about forty-five seconds. Therefore you really don’t have to rush through the test or read the questions too fast—which will just make you more likely to answer the questions incorrectly.
Read each question carefully, and be sure to read all of the possible answers.
Know the AHA Guidelines. Over the course of my career, I came in contact with numerous NREMT exam candidates who took CPR (Lifesaver Course) but never integrated that knowledge with the EMT skills and interventions they learned. Doing so would have significantly enhanced their CPR skills.
The American Heart Association (AHA) Guidelines include information on oxygen delivery, use of the AED, child and infant CPR, and obstructive airway. While having taken a CPR course is good, it’s not enough. To be effective, a person needs to know how to deliver adult, child and infant CPR; use oxygen; and use an automatic defibrillator as part of the EMT scope of practice. Since the AHA changes its guidelines every five years, much of the specifics regarding integration of AHA guidelines in EMT practice are not in the textbook. But the test candidate needs to know it, because it will be on the exam. Even though instructors should have taught this, it’s often not the case. The National Registry has informed the EMS community in many publications and at conferences that the highest number of missed questions comes directly from the AHA guidelines within the context of EMT practice. Exam candidates should make sure they know this information, as it will be very helpful in passing the test and in taking care of patients.
Don’t be a sucker for strong distractors. Every answer on the test is within the domain of knowledge of an EMT or AEMT depending upon the test you are taking. That does not mean a distractor is within the domain. Often it can be outside of your knowledge base and when you see that distractor, you might think, “Well I never heard of that information, so it must be right!” Exam candidates often fall into this trap, as illogical as it seems. If you’ve never heard of something, don’t think it’s right! Pick what you know. This is a good example of test wisdom, a skill you will learn by taking the practice questions that are part of EMT PASS and AEMT PASS.
Avoid the testing “myths”. The NREMT does not want EMT or AEMT candidates to fail. Many times, weak instructors tell their students the NREMT is “out to fail you.” This is a myth! In a CAT test (the type of testing platform used for the NREMT exam) every question answered correctly will cause the CAT test to pick a more difficult question. This is how a student’s knowledge is measured, and how the CAT test determines if you are “at” or “above the entry-level standard.” Once a test candidate gets to this point, he or she is likely to stay above the entry-level standard and will pass the exam at the minimum length. Once the test determines this, it will end the exam because it knows the student is above the entry-level standard. A candidate can “pass” the test by being “at” the entry level of competency. These candidates receive the maximum number of questions, are so close to the line of entry-level competency and may “pass” just because they got the last question on the test correct. It should be a goal of every student to exceed the minimum standard.
Remember that you are not competing against anyone other than yourself, so do your best by answering every question to the best of your ability.
Ignore the rumors you may have heard about the exam. If you are nervous about the test, that’s good! In fact, nervousness causes you to study, and those who study do well.
The NREMT is not “out to get you,” but it IS requiring you to get to the entry-level of competency. If you have followed EMT PASS or AEMT PASS in their entirety to prepare for your exam, you can be confident that you’ve done everything possible to get the best possible score! EMT PASS and AEMT PASS will test your knowledge with difficult practice test questions that will arm you with knowledge that is beyond entry-level. And when you forget whatever you’ve learned, the outcome will still be that you pass, because you have received a comprehensive review of the entire knowledge base. Having the knowledge you’ve gained from using EMT PASS or AEMT PASS, remaining calm regardless of the question the computer presents to you, and having confidence that you can pass gives you the best possible ammunition needed to pass your exam
Study before retaking the test. The computer remembers your test questions given on previous tests and will not ask you the same questions again.
This means a candidate can’t just take the test again and hope to do better. Candidates who need to re-test need to spend more time preparing for the exam:
- Study diseases and injuries and how to treat them
- Know the AHA guidelines within the context of EMT practice
- Find and use a mentor
- Review the questions you missed in EMT PASS and AEMT PASS
- Be aware of any “Swiss cheese” knowledge gaps and fill them
- Take your time answering questions
- Most importantly, don’t waste your time and money taking the test again without spending considerable time studying!