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By Dan Limmer

Many have been posting and writing about the upcoming changes to the NREMT exams at the advanced level, but few have gone into any detail on the how, why, and what it will mean for candidates beginning on July 1, 2024. This post will give my interpretation of the changes and how they will affect AEMT and paramedic candidates sitting for the exam.

July 1, 2024, will see two significant changes: elimination of the psychomotor exam and the new questions styles will go live.

chart comparing current nremt exam to july 2024 nremt exam changes

Elimination of the Psychomotor Exam

While many believe that the psychomotor is necessary, it isn’t. An end-test for skills can be performed in several ways in class. The NREMT is accredited as a testing agency, but the psychomotor wasn’t reliable. It has to be dropped for the NREMT to maintain this accreditation. We all know that students shop exam sites because they know who was easiest—and two different examiners testing the same station on the same day could have completely different results. Let it go.

A student minimum competency (SMC) validation will now be required for AEMT students, but the details are still pretty fuzzy. States are required to create the SMC, but not all have—and may not by July. Stay tuned for more on how this will work.

New Question Styles Going Live

Many have focused on the new exam items called technology-enhanced items (TEI). Here’s an overview of the new questions and how to practice them. They’re new to EMS (although not to other health professions), and they’re not evil. I do think they are a bit more challenging and require higher level thinking. The issue that many people aren’t looking at is how will this affect pass rates?

I predict pass rates will drop slightly.

This is normal when an exam changes. It takes some time for EMS to get used to these—and to teach better and more deeply to prepare students. The NREMT writes very challenging questions. Now, take NREMT questions based on a scenario with multiple responses and in the drag-and-drop format looking for ordering and prioritization. The challenge is real!

In 2023, the national pass rate for the AEMT exam (first sitting) was 58%. We are struggling already. The exam will now ask questions in a different and more challenging format.

The NREMT initially stated that there would be no partial credit for these TEI questions. More recent documents have stated that they haven’t decided on partial credit. For reference, the NCLEX (nursing exam) does offer partial credit on multiple response items.

Not allowing partial credit will drop pass rates even more.

What would I do if I were a paramedic student graduating in May 2024?

I’d wait to take the exam until July 2, 2024, and skip the stress and expense of the paramedic psychomotor examination. If your program requires the psychomotor, you may not have a choice. But if it isn’t required, don’t go through that gauntlet. If you wait until July to take your exam, you’ll be taking the new format anyway.

I’d recommend this, especially for those who did well in class. Yes, the exam may be a little bit tougher with the new questions counting toward your score, but I still think that beats having to do a full psychomotor exam. Don’t wait much longer than early July. Knowledge degrades over time.

AEMT students may have to complete a skills minimum competency (SMC) verification. If this was done as part of your AEMT course, you would be able to avoid the practical examination as well.

In 2024, the NREMT will expand the paramedic exam.

In a recent webinar, the NREMT announced that the NREMT paramedic cognitive examination will increase to a minimum of 110 questions (it is 80 now) with an extended time of 3 hours for completion.

The AEMT exam will remain a computer-based, linear exam for the foreseeable future.

What does this all mean?

  1. This means that the NREMT is bringing the exam into the present day for psychometric theory and is in line with cognitive exams for other health professions.
  2. It means we will have an adjustment period where pass rates for AEMT and paramedic cognitive exams will likely waver a bit beginning in July.
  3. It means educators will need to up their game to make sure students are prepared—especially at the AEMT level where the pass rate is already low. Practice tests will help students prepare for the exam (Limmer is here for you), but they won’t make up for a class that doesn’t teach the depth required to succeed.
  4. It means that this is a change that will happen. Don’t spend time being angry or confused. Study and pass the test!

The NREMT has published answers to FAQs about these changes here.

Join the discussion 8 Comments

  • Nicole says:

    So if I am reading this correctly the NREMT test will be more advanced and harder? I surely hope not! I have been in a volunteer Fire/EMS personal for 15 years now. I only used to drive ambulance for the longest time. The members finally convinced me to take the NREMT course with the little time I had to spare being a single mother if 2 kids, working full time. I made it possible. Mind you I went into this class knowing more than average already. Helping other students in fact and our instructor. Passed every hands on, chapter test with flying colors. It was basically nothing for me. I didn’t even have to study. It was during covid so our class didn’t have to do the final hands on exam but we all certainly had to do the NR final exam. What a joke! 6 out of 26 students passed it and earned their NREMT, however I was not one of them. How? Why? Because the questions are beyond the “need to know” ACTUALLY scenario. This is WHY there is such a deteriorating, high demand for EMTs today because of the NR test! Vet paramedics and EMTs even admit that they would never be able to pass that test today. It’s very sad! I would much rather see hands on then answering “trick” questions. Just my opinion

    • Michael Winey says:

      It does NOT say tougher, it says different.
      It’s NOT advanced, it’s all BLS in your book.
      There are NO trick questions, they are critical thinking.
      When things change, people have trouble.
      Real life patients don’t say I’m having an Acute Myocardial Infavrctiin in page 586, and the treatment and PCI is on page 587.
      This is MINIMAL entrant level competency.
      Practical gauntlets of tests are stressful, not psychometricslly sound, NO other Healthcare does it, and EXTREMELY subjective.
      Written tests are objective.
      NREMT FIRST attemot pass rate is 70% for decades. MY TCs are in the mid 90s first attempt.
      Your TC had 23% that was THEIR failure and should be reported to the state.
      Do you think a pass rate of less than 70 is good or everyone should get 100% pass?
      Did your class recommend read NREMT Candudate Handbook, Resources, and CAT Testing, along with book objectives?
      I’m sorry about your program. You have 6 total attempts.

  • Joshua Carroll says:

    As a current EMT I believe my passing the knowledge test was of pure luck. There were very few questions in my exam that were actually related to being an EMT. I had questions that were asking me about diagnosing a disease. Most EMT’s will tell we do not diagnose diseases nor do we spend more than 20-30 minutes with a patient. We stabilize and get them to the hospital. That’s it. You really need to reevaluate the questions on the test.

    • Michael Winey says:

      The test is ALL BLS, from your book and other National Resources clearly listed on NREMT.
      It’s MINIMAL entry level competency.
      Absolutely we diagnose.
      How can you treat if you don’t diagnose.
      That’s OLD First Aid thinking.
      Your local area may be 20-30 minutes to the hospital, it’s a NATIONAL curriculum and exam, but look at ANY state not on the Atlantic, Pacific, or Gulf of Mexico.
      One of my EMTS has 3 HOURS to the NEAREST hospital.
      If you have concerns read NREMT Candidate Handbook & CAT Testing, and contact them if you still believe it’s not basic level.

  • Art Hsieh says:

    Hi Dan,

    If paramedic programs are doing what they should be doing, their students should be well prepared for the new exam. It is focused on clinical judgment – the ability for the provider to make key decisions in caring for their patients. I agree that the pass rates may dip slightly as the new exam ramps up, but it should recover within a relatively short period of time.

  • Bill Seifarth says:

    If education programs prepare their students to function in the field as EMS clinicians, their students will do fine with this exam. When the NCLEX (nursing exam) implemented similar types of questions, their pass rates did NOT see any significant changes. Based on our pilot testing of similar items, we anticipate there to be a similar response to our change (NREMT’s new exam), as with the NCLEX change. The take-away message to EMS educators: prepare your students to function in the field and they will do fine with our new (and IMPROVED) examination process.

    • Dan Limmer says:

      Bill–Thanks for reading this post and taking the time to reply.

      I am in full agreement about the need for EMS programs to step up to the plate in preparing students for not only the NREMT, but for adequate entry-level knowledge and skills to function at their certification level. I wholeheartedly believe we can and should do better.

      It is good to hear your beliefs about the pass rates. I not only hope that is true, but I want to be clear I am not blaming the NREMT if they do waver. The new test plans seem to put increased prominence on the clinical judgment portion of the exam (about 1/3) which appears to be more than we are seeing now in the pilot based on anecdotal reports of those who have taken the exams recently. The preponderance of medical emergency material in the AEMT test plan is valid based on how AEMTs practice, but it is a change. As Art noted above, EMS takes time to react to change.

      I personally support the NREMT and believe it is moving in the right direction with the elimination of the psychomotor exams and updated exam formats. While EMS is relatively young, we are resilient. We will get through this like many other evolutions we have experienced and grow.

  • M Patrick says:

    I have taken EMT classes and NREMT tests and I can never seem to pass the NREMT and it feels like a money grab not a test to see if your prepared. I agree with what I have read in regards to the testing is seems like to is medical driven but not toward what you were taught in some cases. I did call a while back a spoke to a person about the questions and they told me that some of the questions where experimental and you didn’t not again or lose any points they just wanted to see how the questions did. I feel like that can be very confusing when you under stress to pass the test. It would be good if there was a test for EMT and a test for paramedic in my humble opinion. I have experienced medical runs and what to do and I can pass the class and the skills I could just never get passed the NREMT. I haven’t went back and I am sure I am one of many that has feels this way. You have many EMT and or Paramedic courses that are given and the NREMT questions are different. The questions should be here is the answer not what is the best answer and of course in the field things are not certain however that is learned and experienced in time and or course can and should be discussed in the class room but not be used has a hurdle in a test. I hope I make sense and my thoughts. I am sure Michael Winey will have a lot to say about my comments because he seems to about everyone elses.

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