You don’t have to look far to find an online discussion where students are talking about feeling unprepared for the NREMT exam—especially at the EMT level. Many are saying the tests they took in class are nothing like the NREMT—and they’re right.
When updated education standards were released seven years ago, EMS education was supposed to change and improve. It didn’t. Now we seem to be faced with the realities of a non-EMT-Basic world. Solid, scenario-based, comprehensive testing has become increasingly important in this world, but that doesn’t matter if students’ classroom training doesn’t hit the mark.
For those of us who are educators, the days of linear chapter-by-chapter PowerPoint presentations are over—at least if we want our students to pass the NREMT. Classes that use the chapter-by-chapter approach also miss the opportunity to teach the decision-making and clinical thinking skills that are critically important in the real world.
Here are five examples of things students must know for the NREMT but frequently leave class without.
1. How to handle a patient with more than one problem
We teach about stroke, and then we teach about diabetes. Rarely do we teach what to do when a diabetic patient has a stroke. Students hear that glucose is bad for stroke patients but fail to realize that hypoglycemia is bad in any patient. They don’t always hear that diabetic patients (as well as seizure and migraine patients) sometimes present like stroke patients—and PowerPoint-based classes offer no opportunity to integrate such learning through exercises or scenarios. The result is an inaccurate, one-size-fits-all approach to patient care. This doesn’t work in the field, and it doesn’t work on the NREMT.
2. How to differentiate early versus late signs of shock in a scenario
Our students memorize the signs and symptoms of shock. Some classes provide enough pathophysiology for students to understand shock, but few provide exercises or scenarios that familiarize students with different patient presentations and give them practice in applying conceptual knowledge to determine criticality or make decisions about transport. Application is key to both clinical practice and exam prep.
3. How to identify critical subtleties in assessment and care
Let’s say a student taking the NREMT gets a question where the scenario involves a male patient with chest pain. The patient is holding his fist to his chest like a cardiac patient and is sweaty and ashen like a cardiac patient—but instead of crushing pain, the patient has tearing or ripping pain. Would the student recognize the difference in presentation between an infarction and an ascending aortic dissection? The student’s ability to identify subtleties in a NREMT question makes a big difference in his or her ability to choose the best answer.
Continuing on the theme of subtleties, students must be able to consider a patient’s presentation—in an exam scenario and in real life —and determine what’s important and what isn’t. Many times a slightly elevated respiratory rate, a narrowed pulse pressure, or pale skin might seem like a small detail, but such details can be the key to understanding the situation and choosing the best course of action.
4. How to differentiate among different causes of a complaint
In situations where an EMT must choose among multiple treatments that are available to administer, differential diagnosis is important—primarily because treatment decisions are based on choosing the right protocol. How is that choice made? By knowing what’s wrong with the patient.
Being able to tell the difference between a crashing 16-year-old asthmatic patient who is no longer wheezing and an 18-year-old patient with an opiate overdose is important. The ability to distinguish a sick and borderline-septic pneumonia patient from a heart failure patient is important. Our students’ classroom training should at least provide them with the practical tools they need to recognize key differences, even if we don’t expect them to make an iron-clad diagnosis.
5. How to choose a medication based on patient presentation
Our textbooks all have pharmacology chapters. They all have patient care chapters that discuss appropriate pharmacological interventions for many conditions. But do our EMT students get classroom training that includes exercises or scenarios to help them learn to link the two in practice? The NREMT expects students to be able to do this (and with only minimal information provided), but most classes provide little experience of this kind.
Limmer Education and our co-founder, Dan Limmer, have been long-time advocates of this type of EMS education. We provide many resources for educators and students, from our high-quality exam prep apps (which include the types of practice questions students need to be prepared) to our dynamic learning exercises for the classroom.