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By Dan Limmer

A recent announcement from the NREMT about the implementation of Technology Enhanced Items (TEIs) on their certification exams caused educators and students alike to wonder what this means for the exam experience.

Here is my take on it in a nutshell: It means little. And it also means a lot.

If that isn’t clear, let me expand a bit. The exam questions the NREMT is considering adding are used in other examinations (NCLEX, radiologic technology, and others). They really aren’t new or controversial. They are different. The downside? We don’t do well with different in EMS.

What Are the NREMT TEI Questions?

One item type is the multiple response (MR) questions (see samples below). These will be the first to appear. In this format, the NREMT will pose a question that has multiple correct answers. There may be six choices and three of those are correct. According to the NREMT, candidates will always be told how many correct answers there are. The question is all-or-nothing as far as grading. If you don’t choose all three correct answers, you will get the question wrong.

The other question types include images and videos. There are currently some basic images in items on the NREMT now. We believe these will gradually expand to having more clinical relevance and depth as these question types mature. We don’t believe students testing in late fall and in January 2021 will see significant numbers of multimedia questions.

Sample NREMT TEI Question
Sample NREMT TEI Question

What Does TEI Mean for Educators?

First, the NREMT has been very open and forward-facing about any issues or events. Executive Director Bill Seifarth and his team are approachable, and I don’t expect any surprises. Their press release now, before these items are seen on the NREMT, is evidence of this.

The plan for TEIs was actually announced and voted on in their June 2019 Board meeting.

The new items will be created in item writing workshops like prior items. We should start seeing them sometime later this year, beginning with the multiple response questions.

If you are teaching a course this fall, your students may see some of these questions. Even though they will be pilot questions for validation, it could scramble an already stressed brain even more. I recommend:

  1. Adding multiple response items to your exams immediately so students are familiar with them before they get to the NREMT test site.
  2. Be very careful about how you message this to students. Some love to make the NREMT the bad guy. An evil, unfair force standing between each student and their dreams. If you have NREMT baggage, keep it in check. Tell your students that they will see several types of questions. Explain the questions and note how you include these types of questions on your exams to help prepare students.
  3. This may be #3 but it is a big one: Make sure your class teaches the depth necessary to answer these questions. Taking a guess at 1 of 4 choices is one thing. Picking three of 6 is a bit more in-depth. Do you need to up your game this semester? In 2005 – 2009 as the original education standards were developed, we heard how we needed to teach in greater depth and include pathophysiology. To a great extent, that never happened. Now more than ever it is time to switch from memorization-based learning and testing to an educational philosophy based on understanding.

Rollout and Test Times for NREMT TEI

The NREMT has told program directors that they will announce when a question type will begin to appear. It won’t be a surprise. They have also indicated that the time for the completion of the exam will not be expanded based on these new questions—at least yet. If we do get to an item with 4 video clips students must watch (sometimes more than once), I suspect more time will be needed. For now, the time limits and the number of questions appear to be remaining the same.

So, there it is. A little and a lot. Please keep in touch. Let us know your experiences with these questions and how you are preparing your students.

You can be assured that Limmer Education will have you and your students covered with high-quality questions in whatever style the NREMT puts forth. That’s what we do. We are in the process of writing and reviewing multiple response items and tweaking technology to add these questions to our exams at all levels.


More like this: How Much Difference Will “One Correct Answer” and TEIs Make on the NREMT?

Join the discussion 5 Comments

  • Rod VanOrsdol says:

    Thank you, Dan and Team Limmer, for keeping us updated on these changes, their impact, and suggestions on how to respond. Are TEIs going to be included in all levels of exams?

    • Stephanie Limmer says:

      Hi Rod- the NREMT hasn’t specified that it would only be at certain levels so we will assume at all levels. They will release more information as the time draws closer. We will do our best to keep you informed!

  • Got says:

    I agree that standards regarding EMS education should be high. If indeed our students will be faced with this type of questioning or cognitive ecxercise as part of their preparation and subsequent certification, then the NREMT needs to give Program Directors guidance in the scope and type of questions to be presented. If not, the only thing that this type of “innovation” may accomplish is to frustrate candidates with mainly HS level education and of course decrease the number of first time pass rates (which I believe to be the intent).

  • Cullen McGee says:

    When will these start going into affect?

    • Stephanie Limmer says:

      These are already starting to appear in the exams as questions for validation purposes. They are not being scored.

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