The dreaded National Registry of EMTs (NREMT) cognitive test.

The NREMT test commonly acts as a stumbling block to a lot of careers. Is it really as tough in reality? I guess that would depend on how you are as a test taker. Greg Applegate, NREMT’s Chief Science Officer, recently published an article in the Journal of Emergency Medicine (JEMS) to counter the false information that has been spread over the years.

Myth #1 – Non-practicing professionals write the questions

This could not be further from the truth. A committee of experienced professionals,  brought into the NREMT main office with the goal of writing fair and appropriate questions, write every question. The committee members undergo training where they learn the best practices of question writing. Additionally, officials highly encourage clear, concise questions and ensure no trick questions make the final draft.

The NREMT staff is only present to facilitate the question writing process while remaining neutral to ensure the questions are not biased. If you would like to get involved in this process, apply! You can see how things really work from the inside.

Myth #2 – There is more than one correct answer

The second myth Applegate is trying to dispel is that there is more than one correct answer for each NREMT test question. This myth will take some time to get past because tests did used to contain more than one true answer. This only changed a couple of years ago.

Th industry eliminated this style of questioning because “high-stakes testing” has evolved and developed a set of “best practices” regarding test questions. And providing more than one correct answer simply is not a fair practice.

NREMT also hired a psychometrician, someone who specializes in ensuring that the tests are fair and accurate. This role will continuously review the data from the cognitive exams and new test questions to ensure every candidate receives a fair testing experience. This change should put all of the instructors and students at ease, one answer for every question. This has been a huge issue for students. Too many students washed out of the training programs because they were unable to wrap their minds around picking the “most” correct answer.

Myth #3 – The NREMT test questions are not reflective of the field

Teaching students to pass the NREMT test is different than teaching students the way things are done in the prehospital setting. It is true that NREMT test questions avoid being specific to protocols as protocols can and do vary by community.

This mindset also helps to test the student’s knowledge of “principle and practice.”

Before entry into the test bank, questions have to undergo a review by the NREMT’s program managers. Each of these managers has a different background and level of experience to ensure that the questions fit the “best practices” model. But keep in mind, this process is not perfect because we practice medicine, which means medicine is constantly changing.

A question deemed appropriate five years ago may prove controversial by today’s standards. When this occurs, officials remove the question from the test bank. To minimize the possibility of receiving a controversial question the NREMT only uses active EMS professionals to “develop, review and approve content.”

Myth #4 – Out-of-scope NREMT test questions

Myth four, the student received content meant for a paramedic.

The NREMT test does not ask questions considered ‘out-of-scope,’ as it would be unfair to hold the EMT student to skills and knowledge of an Advanced EMT or Paramedic. This myth came to fruition because of adaptive testing. With every correct answer the candidate is presented with a more challenging question, and if the candidate is truly performing well, he or she will see the hardest questions in the test bank.

The second reason for this mindset is the instructor. Applegate’s explanation for this is that the instructor failed to teach a given subject, so the student was never exposed to it. All of the test questions for a given level are based on the National Scope of Practice. As a student, keep in mind, you are responsible for all of the information between the front and back covers. We sometimes just run out of time for a given subject. I do it all the time in my EMT and my CME classes.

Myth #5 – I randomly received the maximum number of NREMT test questions

The last myth is that students randomly received the maximum number of questions on his or her test. The only students who see the maximum number of questions intentionally are the AEMT candidates. The NREMT is still testing the adaptive testing algorithm for the AEMT test bank. If you hit the maximum number of questions on an EMT or paramedic cognitive exam it is because you were waffling back-and-forth between correct and incorrect answers and the testing algorithm was trying to determine if you actually understood the information or if you need to spend more time studying a given subject.

If you are struggling with the NREMT cognitive exam, Distance CME can help! Enroll in a Paramedic or EMT Test Prep program and you will be partnered with a mentor that can help you be successful.