# Trouble with class/instructors



## wannabeemtb (Mar 10, 2010)

Hi all, I'm a first time poster, so if this in the wrong place, I'm sorry.  Also, if this question has been answered elsewhere, sorry for the double post, I searched, I really did.

My names Ben, I'm 30 years old, and I recently started an EMT-B class.

I'm having a problem with the class/instructors.  We're studying Prehospital Emergency Care, Ninth Edition by Mistovich/Karren published by Pearson.  We've got the main book, a workbook, and access to a website with practice tests and games.  We're taking a test at the end of each module.  We're told that 70% is a passing grade, that we can take a test again if we fail the first time, but if we fail twice, we're dropped from the class, and that these are DOT standards.  We're also told that we must pass one module before being allowed to continue on with the next module.  We're usually given a 10% bonus for correctly labeling a diagram, so far of the heart, skeleton, etc...

My issue is that text seems to bear little relation to the test.  The rules seem to be against giving specific examples in this forum, so I'll refrain.  I've taken 3 module tests so far, and passed all three.  The first I got a 94 (104 with bonus), the second 78 (88 with bonus), and the most recent 76 (most likely 86 with bonus).

I study for a minimum of eight hours before every test.  I'm present for every class.  I fill out my workbook.  I take the practice test online multiple times.  I've spoken with two instructors so far about my performance on the test.  I've voiced my concern that the text bears little relation to the test.  I've been told their's nothing they can do, it's just the way that it is.  When I asked for additional resources to study to improve my grade, I was referred to Barnes and Noble to read guides they had there.

I'm very frustrated with this advice from my instructors.  Being told that's just the way it is doesn't offer any sort of actionable information that I can glean, perhaps it's just some inside EMS code that I've not been taught yet?  The Barnes and Noble advice, while actionable, is a dead end.  The study guides are designed for the entire test, and I'd really need something that was targeted toward the module test I was taking.

My question to any of you who've read this far is what would you do in my situation?  I want to be an EMT.  I want to pass my module test.  I'm willing to whatever work is required to do that, I just have no idea where to start.  I don't know what I don't know.

Thanks for reading all this, felt good just to get it out there if nothing else.


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## JPINFV (Mar 10, 2010)

Could you describe what you mean by little resemblance to the material? There are numerous ways to legitimately ask a question that may not resemble necessarilly how the materal was taught, but expect students to connect the dots. For example, first degree vs 2nd degree vs 3rd degree questions (I'm having trouble thinking up examples from the EMT-B curriculum) vs scenario questions.

Also reevaluate how you're studying. Just because you spend 8 hours studying doesn't mean it's effective. For example, for me if I'm trying to learn concepts, I study best by just rereading the material ad nauseum until I can essentially predict what's on the next slide. If it's something like anatomy or drugs, then I make flash cards of the main points and go over those ad nauseum. If the problem is something like assessments, practice doing assessments on friends and family. Alternatively, see if you can shadow someone at a local clinic or do some ride alongs outside of class. If the problem is performing interventions, practice them on someone.


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## wannabeemtb (Mar 10, 2010)

A recent example would be a question about the most common threat to females in the 40-60 age range.  The text clearly states that menopause and osteoporosis are common occurrences for females of that age range.  It also states a list of other common occurrences, cancer among them, for all members of that age range.  The test question asked for the most common threat to females in that age range.  Choices were cancer, menopause, accidental drug overdose, and one other I can't remember.  Cancer was the correct answer, but menopause was what I answered based on the text, as did every other member of my class.

I study best in the exact ways that you mention.  I'm a little leery of field experience at this point, as we're still in the classroom and I know how often and how wildly those two can differ from one another.  But, I suppose I could give it a shot.  I was reading about EMT Attendants (CPR certified, enrolled in EMT-B class).  That sounded interesting to me, and something I plan to look into further.


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## JPINFV (Mar 10, 2010)

Serious question. Why do you view menopause as a threat?  If I said that suicidal ideation  and puberty were common themes of preteens, would you list puberty as a threat? They might be related, but I find it hard to argue that a normal physiological change is a threat over a disease or disorder.


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## wannabeemtb (Mar 10, 2010)

Serious answer, I don't view it as a threat.  I gave the answer I did based on the text I read and the choices I had for answers.  That's only one example, I thought the best one being how clearly the text and test differed from one another, also the fact that everyone in my class missed that question and gave the same exact answer I did.

My last test was 25 questions.  I counted 11 questions I was sure of the answer on, the remaining 14 I made the best guess I could.


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## feldy (Mar 10, 2010)

something that helped me is that i re-wrote my notes by hand. Muscle memory works for me for both written and especially practical tests. Study with other people in your class and quiz each other during your breaks and outside of class. I found this to help a lot. I ended up meeting someone in my class and carpooled with them and we just went over the material. This will help you from both sides of the spectrum, learning from others and strengthening what you know when you teach it to others. I would urge you to do clinicals and ride alongs (im strongly believe in hands on experience as a way of learning) but be VERY careful relating them back to your tests becuase things may be different from when your "mentor" went through training and also somethings may come second nature to them that as a student you may think that they missed something where they didnt. 

I hope this helps and good luck. Dont get down on yourself. It seems like you are not doing that poorly. If you really want it then you will do fine.


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## wannabeemtb (Mar 10, 2010)

I take notes by hand as well, my handwriting is atrocious, and the private company that I want to work for still uses written PCR's, so I use that as a way to practice my handwriting as well.  However, I'm failing to see how getting muscle memory from text that differs from the test will help me when taking the test.

I don't feel that I'm doing all that well.  My second and third test scores were within 10% of failing without a bonus.  That's not doing well by any common standard.

I'll look into getting a study group together, but again, with text that differs so much from the test, I'm not confident of that being a viable solution.


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## feldy (Mar 11, 2010)

sorry i didnt think that through when i was writing that. If possible, see if you can get a hold of maybe another text book. I used the Brady 11th ed. which i think is the newest version, it was very helpful in study...im not really sure if i can provide anymore advice but just ask around to your classmates get their opinions on the tests and utilize what they have to offer...or give another instructor a call (if possible even if it is at a different institution and see if they could help out). That is what i am doing now to retrain for my NREMT test (b.c. i am certified in a non NR state. I called a local hospital and I actually am training with the head medic there this weekend.

if you have any other questions feel free to send me a private msg or post here.


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## feldy (Mar 11, 2010)

sorry i didnt think that through when i was writing that. If possible, see if you can get a hold of maybe another text book. I used the Brady 11th ed. which i think is the newest version, it was very helpful in study...im not really sure if i can provide anymore advice but just ask around to your classmates get their opinions on the tests and utilize what they have to offer...or give another instructor a call (if possible even if it is at a different institution and see if they could help out). That is what i am doing now to retrain for my NREMT test (b.c. i am certified in a non NR state. I called a local hospital and I actually am training with the head medic there this weekend.

if you have any other questions feel free to send me a private msg or post here.


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## wannabeemtb (Mar 11, 2010)

Okay, good advice, thank you.

I've got a friend who works for Pearson, I'll see what he can do about getting me a copy of the book.

I'll call around to the local hospital and the other training location that I know of and see what I kind in the way of alternate instruction.

Thanks again.


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## MusicMedic (Mar 12, 2010)

as JPINV said, they usually want students to think out side the box and connect the dots, because sure the text might be right when it comes to facts but it might not be the right answer for the scenario, have you guys taken any Scenario Tests yet?
Try not to read too much into the answer, because once you do you start 2nd guessing everything

For Ex: You find a 34 year old male who is unconscious and is making a gurgling sound what do you do first? 
A : Suction Airway
B: Head-Tilt Chin Lift
C: BSI/Scene Safety
D: Splint his left arm

Answer is: C  
A few people who read into the question might think B because oh the scene should be safe if we are already next to the patient.

If it doesn't say that it happened in the question IT DIDN'T HAPPEN!!

How far along class are you? 

another tip: Listen to the Lectures, and ask questions during the lectures if it says something different in the book and contradicts it

do you remember anymore of the questions that you had trouble with?


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## wannabeemtb (Mar 12, 2010)

I don't know what a Scenario Test is, so I assume no, we haven't taken any yet.

Thinking outside the box and connecting the dots are all well and good, except, what does that actually mean?  In my experience, those things are products of experience, not a tool used to gain experience.  Perhaps EMS is different, but since it exist in the same physical world as all other knowledge, I doubt this is the case.  I realize that I'll need to critically assess a scene/patient and make the correct determination based on my training and experience.  I don't have any trouble with that expectation.  If that's what you meant by thinking outside the box and connecting the dots, fine, and if you add adapt and overcome to that list, you'll get exactly what my instructors have told me.

The only trouble is that NONE of that will help me pass the module tests.  If I don't pass those, nothing else really matters.

We've just completed a month of classes.

Almost every question I've asked in class that deals with a difference between the text and the lecture is met with the same sort of obstinacy that asking questions dealing with the difference between the text and the test.  At my class last night, while giving a lecture on blood pressure, my instructor printed Systolic on the board, and then followed it by printing Dystolic on the board.  I said nothing, and neither did anyone else in the class, we've all pretty much given up attempting to get a correct answer.

No, I don't have any other examples of questions I had trouble with.


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## JPINFV (Mar 12, 2010)

wannabeemtb said:


> I don't know what a Scenario Test is, so I assume no, we haven't taken any yet.
> 
> Thinking outside the box and connecting the dots are all well and good, except, what does that actually mean?



I'll give you two examples of test questions that I've gotten on recent test (note: I'm in medical school, so take that as you will). 

Scenario/clinical integration example:
1. You're patient had an organ transplant 3 months ago and recently developed hyperglycemia, HTN, and tremors and has an elevated BUN and creatinine levels. Which drug is the patient on?
Choice A, B, C, D, E.  

Connecting the dots:
2. A patient has been started on antibiotics for a gram negative rod and has developed a [set of side effects including unique one]. What is the mechanism of action for an antibiotic that you can switch to to avoid X side effect.
Choice A, B, C, D, E. 

Question 1 is a fancy way of asking, "Which immunosuppressive has the following side effects?" 

Question 2 is basically asking multiple questions with 2 pathways: "What antibiotic for gram negative rods has a unique side effect?" "what's the alternative to this drug?" and "What is the mechanism of action for the alternative?"

Alternatively, "Which antibiotic for gram negative rods doesn't have a common side effect?" "What is the MOA of said drug?"


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## wannabeemtb (Mar 12, 2010)

For all those examples I'm assuming that you've learned the correct answer to the questions.  My issue isn't getting to the question from the problem, my issue is actually getting the correct answer.  Again, the text and the test differ.


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## ExpatMedic0 (Mar 12, 2010)

Are you sure the answers to the test are not in the book? I would ask the instructor to point out the  answer in the book for the question you got wrong  about the greatest threat to females. If your instructor is unable to find the answer in the book that was on the test, than I would look into if someone is not following the DOT objectives you should be covering on either the test or the text. Text or Test...
Either way if thats the case it would be your instructors fault.
With all that said I bet your instructor can find the answer to your test question in the your text if you ask.... but you never know


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## Angel (Mar 12, 2010)

why is menopause a greater threat to women than cancer?
i think your thinking the wrong way...what is the question asking? of all those things, as an emt, what should you be most concerned about? I think this is another reason why people fail the NREMT so often.
you have to stop and read the question to know which answer is best. sometimes theres more than one RIGHT answer...but which one is best for the question asked.

id love to help you if i can...just post somemore (similar) questions either here or PM me.


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## cdnosilla (Mar 13, 2010)

I just finished my EMT-B course and just received national and state certification.  I was surprised with the tests we were given and, as stated before, had to think outside the box.  I must say at this point that I noticed several students in my class begin dropping after the first few tests, some dropped toward the middle of semester.  By that time, the serious students were still there. 

With that said, here is how I did my course-work.  (American Academy of Orthopaedic Surgeons 9th Edition Care & Transportation of the Sick & Injured)  First, I read all of the chapters regarding what we were studying.  Second, I answered all of the questions in the workbook (look up the answers in your text to match the workbook if you question them).  Third, I typed out all the questions with just the correct answers from the workbook after I answered the set of questions.  And, finally, I printed out the questions with the correct answers and that was my study guide.  It worked for me.  A lot of work, but well worth it.

Also, the NREMT exam is more difficult than any test we were given in our class.  You have to think outside of the box and really know your stuff.  You can't memorize study guides to pass it, you have to know it.  Just keep studying your text and think about why it says what is said.  Good luck and I hope this helps.


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## Euclidus (Mar 13, 2010)

When you take registry, you are going to have questions like the one you listed about the greatest threat to females age 40 to 60. Think about the question. As a previous poster stated, you have to think about it as it relates to your job as an EMT. Menopause may be listed in your text as the most common "occurrence," but it's something that every woman will go through and for all intents and purposes, not really a threat. Also, not something you are as likely to deal with as an EMT as some of the other choices. I know this doesn't affect your original issue (with the tests being so different than the textbook) but you are going to have to train your brain to seek out the answer that is "most right" for registry. And many of the questions aren't going to be verbatim from a textbook, you'll have to pull the facts together and form your own conclusion. Sometimes you will have four right answers and you'll sit there scratching your head wondering how you're going to narrow it down to one.

Now, about your class situation. The worst part about it, in my opinion, is that your instructors aren't really coaching you about why which answer was right after you take the quizzes. There was a learning curve during the first few modules in my class too, but our instructors went over the quizzes with us, answered our questions until we were satisfied, and trained us to understand that questions weren't necessarily always going to have textbook answers. It is a fault of your program that your instructors aren't willing to do that with you, especially if so many in your class are getting the same things wrong.

My EMT class ended up being like a tight little family. We made an email list the first day, formed study groups, and we still keep in contact with each other. I don't think this is a rare occurrence with EMT class groups. Do you think your instructor would give you contact info for someone from a previous class that successfully completed the class and registry? Or pass your contact info on to them? That could potentially be a very valuable resource for you, even if it's just exchanging a couple of emails about what worked and what didn't. I know that I would be glad to talk to a current student from the program I went through, if it could help them be successful. Also, try to get a study group going. It really helped me to go over the test questions that I thought had crazy answers. For your situation, if nothing else, it might help you all to discuss the situation and come up with a unified front so that when you (as a group) talk to your instructor about the issue, you're all on the same page.

Another suggestion I have would be to visit your instructor one-on-one during office hours. Sometimes it's easier to work with instructors about specific issues outside of the classroom. 

I hope that something works out for you, I wish you the best of luck with it.


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## mycrofft (Mar 13, 2010)

*I'm swearing off commenting on these, (after this one).*

Brushing aside all other maybes and could bes:
1. Can you get some experience before you take the NREMT?
2. Challenging the instructor is dicey, challenging the quality of the instructor's class is best done as you drop it at the business office. Instructors put lots of work into their presentations (even if sometmes it is wasted effort) and can be very defensive.
3. I keep saying regurgitate then get through the course, but that presumes some ability to get past the concrete and to recognize the principles illustrated by them.

So, don't start knife fights with the teacher, think, maybe get another book to triangulate (and don't waste time looking for a deal, go get it done), and see if you can get some hands on with a mentor.


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## rescue99 (Mar 13, 2010)

Test questions should be written to draw out the depth of a student's understanding. Measuring understanding by using the levels (Bloom's levels of learning) of learning as a guide for writing tests helps students know where they're at IMO. The proper use of distractors and playing on words is about the only way to achieve that in a multiple choice setting. The more distractors, the more challenging the question. It requires one to understand what the question wants based on how much understanding of the material a student actually has. It is equally vital that the material being used be validated (ie.DOT objectives) and measured annnnnnd....cross checked to the text in use. Even more vital, it requires a decent educator to know what tests are supposed to do. They aren't meant to confuse. They're meant to measure!

Hint: The closest I have come to a NR test generator has been Platinum Testing.


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## mct601 (Mar 13, 2010)

I read the first post, and a few of the replies - but I think  I can see the problem (dunno if its been mentioned)


The book is the academic portion of your class.  It presents how to do your job, and why.  Its all the technical aspects of being an EMT (well not all, but you get my point)

When you are given a test, not only do they want you to answer questions like "What is a pneumothorax?" or "What dressing what you apply to an open chest wound", but they will present questions like 

"You have been dispatched to a house in a bad neighborhood of town. Police have secured the scene. You find an unconscious 22 y/o male with a stab wound to the the third intercostal space. Vital signs are <insert set of vitals>. What would be your immediate intervention

A Manual Inline Stabilization
B Open airway with jaw-thrust
C Apply gloved hand to chest wound
D Retrieve SAMPLE history"

They want you to take what you learn and APPLY it.  To correctly do this, you must know your material like the backside of your hand to be able to properly apply it to any scenario given to you. Many students in my class were pissed that the tests were like this (not directly related to the book).


If this doesn't answer your question- sorry, I tried. But as mentioned they want you to think outside, above, under, and around 'the box'.  It's just how these classes are taught/tested.  When you take national registry, it will be like the tests you are given now but more confusing.


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## feldy (Mar 13, 2010)

Im not sure how far in the course ( material wise) you are but if you have not yet learned medical and trauma assessments then I would start looking at the NR sheets on the NREMT website and read those sections in the book. Many questions whether it be on the NR test which i am studying for reciprocity, or in my case the MA EMT-B test follow the basic prinicple as followsl

BSI
scene safety
MOI
number of pts.
C-Spine
ALS

then go through your ABCs. there will be a great number of questions that relate back to those these things. 

for example: You arrive on scene to find 22 y.o. male unconcious and bleeding from a laceration on the head. What do you do first to initial treatment?
A. Apply direct pressure to the wound.
B. Open his Airway with an OPA.
C. Begin IV therapy
D. Scene Safety.

The answer is D because personal safety takes precedent over pt. treatment.
(an i know Basics generally cannot give IV fluids i was just making a point)

Or You arrive on scene to find a pt. laying in bed not breathing. What is your first action in treating the pt?

A. Prepare for immediate Transport w. ALS intercept.
B. Remove the pillow from under his head.
C. Apply O2 at 15 lpm via BVM
D.Check his pulse.

The answer is B. Because although you need to do all of these, the rule of ABCs, airway comes first.

If you can learn these assessments to the point that they are second nature to you, then you will start to understand scenario questions with more ease.


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## Sodapop (Mar 14, 2010)

Ok I will likely take some heat for this response but as people will find out about me I really do not worry about that.  Also to the OP I mean no disrespect to you and your questions and I think questions are good and that you need to get this worked out and get your head around it.

There have been some very good suggestions posted for you.  If I recall correctly you have passed all the tests so far but you do not seem happy with you scores and are concerned that you will not keep them up.

As a previous teacher I would tell you that your becoming to engrossed in this. You are passing and if you are learning from each module that is the goal, correct?  What I found when I first took the EMT class is that at fist much of the material although I was memorizing it really did not make lots of sense to me. Then there came a time when something was taught or something heppened in a lab that tied things together and made the light bulb snap on.

So what I would say is number one relax. It sounds like this is really stressing you out and that stress will do more damage to your ability to learn the material. Second, if your still passing I would make less effort on trying to prove why you feel your right and more on learning why the answer is what it is.  When you complete the EMT class you are still really just scratching the surface of trying to learn. You may know the material to get through the class and become licensed however you will still have a great deal to learn and likely you will learn every shift you work. I worked 6 years as an EMT-B and I was still learning when I left. I worked IFT's and a county 911 system. I worked in 2 different states. I worked Transport ambulances and non transport first response FD units. And every call was an opportunity to learn more.

Again, hope I have to offend you but it sounds to me like your progressing just fine and that if you see that and relax a little and learn why your answer was not what they were looking for that you will be just fine.


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## MusicMedic (Mar 14, 2010)

Sodapop said:


> Ok I will likely take some heat for this response but as people will find out about me I really do not worry about that.  Also to the OP I mean no disrespect to you and your questions and I think questions are good and that you need to get this worked out and get your head around it.
> 
> There have been some very good suggestions posted for you.  If I recall correctly you have passed all the tests so far but you do not seem happy with you scores and are concerned that you will not keep them up.
> 
> ...



I agree


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## 8jimi8 (Mar 14, 2010)

wannabeemtb said:


> Hi all, I'm a first time poster, so if this in the wrong place, I'm sorry.  Also, if this question has been answered elsewhere, sorry for the double post, I searched, I really did.
> 
> My names Ben, I'm 30 years old, and I recently started an EMT-B class.
> 
> ...



You need to read and reread your cognitive and psychomotor objectives.  If you can say that you know the information, inside and out, covering all of the pre-chapter objectives AND the post chapter summary, then you will see an improvement in your testing.

the REASON that the text is different from the test questions is because the correct answer to any question on any EMS test is:  Whatever will kill the emt or his patient first, ABC's, stabilization, and rapid transport.  *None of the test is rote memory, it is all application*.  The text is a _BASELINE_ of knowledge.  If you don't have the didactic information down, you will miss out on important signs and symptoms.  If you have the knowledge hardwired, assessment, reason and logic guide you to the correct intervention.


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## EMTBWannabe (Mar 16, 2010)

I am also a very recent (3 weeks) EMT-B student - I can definitely understand where WannabeEMTB is - yes it's while each emergency will not be the same and each situation calls upon interpretation and application of the skills learned as a student we are looking for something concrete (althought some situations are not) - we need to build a foundation of concrete knowledge in order to apply it in situations.  

as with the martial arts we must learn to punch and kick before we put them together to defend against an attacker.

if the text books states one thing as a health concern to females and then on the test that is not the answer - i think that's a problem.

it's like some text books say the air we exhale is 16% oxygen - i think the AHA CPR handbook says 17% oxygen - and if this is on the test which one should we go with?

As a student we need that concrete information and within that we need to apply it - i think getting our EMT-B certification is a beginning not an end to education.

it's like martial arts (yup again martial arts) it's only after you get your black belt do you begin to learn - anything before the black belt is just building your foundation.

but i had hoped my class would be a little more challenging than it is.


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## EMT_TIFFANY (Mar 16, 2010)

I'm currently halfway through my Paramedic program. Our text book goes into GREATER (like M.D. level) detail than what our program requires. It's a great resource for information but if you are struggling with the exams/tests... My advice is to take notes based upon the material your instructor reviews during lecture. Learning this technique has significantly improved my test taking skills vs. the test taking skills I had going through my basic. The information your instructor reviews during lecture whether it be via PowerPoint, Handouts, etc. is more than likely going to be on your exam/test. Try not to sweat the textbook to much. Refer to it to clarify information you don't understand. I hope this helps and good luck!


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## EMTBWannabe (Mar 16, 2010)

EMT_TIFFANY said:


> I'm currently halfway through my Paramedic program. Our text book goes into GREATER (like M.D. level) detail than what our program requires. It's a great resource for information but if you are struggling with the exams/tests... My advice is to take notes based upon the material your instructor reviews during lecture. Learning this technique has significantly improved my test taking skills vs. the test taking skills I had going through my basic. The information your instructor reviews during lecture whether it be via PowerPoint, Handouts, etc. is more than likely going to be on your exam/test. Try not to sweat the textbook to much. Refer to it to clarify information you don't understand. I hope this helps and good luck!



it's weird how each class differs.  the exams my class takes are straight from the textbook - although they give us handouts to grow our knowledge.  you would think across the country there should be one standard curriculum along with your local protocols.


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## Radioactive (Mar 17, 2010)

Doesn't look like Wannabe has checked this thread in a bit, but I'll throw in my spare change.

I'm also an EMT-B student.  My class seems a lot like yours (except that we must be >80% to pass, and no 'extra credit')  Our tests also seem very similar.  I am with you in thinking "that's just how it is" is not an appropriate answer to your concerns.

The difference between us, however, is that I actually appreciate how the tests here are run.  Many of the questions presented in the test seem to be 'trick questions,' but my instructor told us right up front that they were going to do that.  The point it to make you think (sometimes pretty damn hard) about the best answer.  

I havent had any 'field time' per say, but from what I understand, our teachers are doing this in order to help you get in to the appropriate mindset.  When you are on a rig responding to a call, there will likely be ALOT of diffrent things that you _could _do, and you need to be able to know which one you _should _be doing.

Does that make it harder?  Darn right.  Should it be harder?  Heck yes.  Think about if I were the one to show up at your house during a medical emergency.  You would want to be sure that I knew wth I was doing.  But I digress.

I think it is awesome that you are looking for other sources of information, but everything on your test is very likely to be in your book.  Other sources, while valuable for practical experience, are only likely to confuse you when the answer that you are looking for was in your book (even if it's not the answer you though it was.)  

I guess my point here is that, IMO, the goal is to make you a decent EMT and not just for you to be able to pass an EMT-B class.  There are many Medics on these boards that can likely attest to the difference.


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## EMTBWannabe (Mar 17, 2010)

Radioactive said:


> Doesn't look like Wannabe has checked this thread in a bit, but I'll throw in my spare change.
> 
> I'm also an EMT-B student.  My class seems a lot like yours (except that we must be >80% to pass, and no 'extra credit')  Our tests also seem very similar.  I am with you in thinking "that's just how it is" is not an appropriate answer to your concerns.
> 
> ...



i agree with you 100%.. i wish my class was more thought provoking.


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## rescue99 (Mar 17, 2010)

EMTBWannabe said:


> it's weird how each class differs.  the exams my class takes are straight from the textbook - although they give us handouts to grow our knowledge.  you would think across the country there should be one standard curriculum along with your local protocols.



There is a standard. Albiet, the guideline portions leave room to flex, it is up to the institution and / state to use them right.


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## JPINFV (Mar 17, 2010)

EMTBWannabe said:


> it's weird how each class differs.  the exams my class takes are straight from the textbook - although they give us handouts to grow our knowledge.  you would think across the country there should be one standard curriculum along with your local protocols.




Why should there be one specific curriculum for EMT-B courses? One set of minimum standards? Sure, but for example, there are at least 3 styles of curriculum (traditional, systems based, problem based) for medical school, not counting hybrid designs. Yet all medical students either take USMLE or COMLEX (or both) depending on their school's philosophy (MD v DO). If there was one standard curriculum that all programs must adhere to, does that mean that if a program has extra resources to incorporate additional materials or work for other learning styles that they shouldn't or couldn't without a wavier?


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## bstone (Mar 17, 2010)

What the gentleman is asking for is consistency. This is not unreasonable or exceptional in any situation. Are your instructors writing the tests themselves or using the ones that come with the book?


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## rescue99 (Mar 17, 2010)

bstone said:


> What the gentleman is asking for is consistency. This is not unreasonable or exceptional in any situation. Are your instructors writing the tests themselves or using the ones that come with the book?



Creating a bank of test questions isn't easy when considering objectives, subject materials, levels of learning, validation and cross checking. Validating a question alone, can take months. The time it takes to create a good test sure makes generators a blessing!


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## EMS84 (Mar 21, 2010)

study the states protocols,and compentencies. Know everything you can possibly know about EMTB and I would say go as far as knowing even some EMTI material for the sake of knowledge. Know your critical failure points in any exams,know your medications well. And finally,remember finally exams,questions,scenarios aren't all "knowledge" you really have to read questions and interpet,analyze and pick the "best" answer. goodluck.

cheers


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## NepoZnati (Mar 21, 2010)

bstone said:


> Are your instructors writing the tests themselves or using the ones that come with the book?


Have no idea where they get questions but my instructors used to type they own, ending up with heavy typos (spell-check anyone?) and then wrong test results and messy review sessions. :wacko:


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## Aidey (Mar 21, 2010)

EMTBWannabe said:


> if the text books states one thing as a health concern to females and then on the test that is not the answer - i think that's a problem.



Without knowing the exact wording it's hard to gauge, but chances are the test question tricked him. The book presented an extra piece of information, and he and everyone else in the class focused on it rather than the answer to the question. 

The "what do you do first" examples above are good illustrations of how that happens. 

The idea is to develop critical thinking skills, not just regurgitate memorized information.


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## leftysoftball (Mar 25, 2010)

We are using the same book but the 11th edition in my class. The workbook quizzes seem to jive with the text but the test questions are not. We were told that the tests questions are randomly generated by the the Brady software.

When our asst. instructor looked at the mid-term, she agreed the test was crap and agreed to hand select each of the 200 questions for the final, by hand, assuring more relativity.


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## EMTBWannabe (Apr 9, 2010)

JPINFV said:


> Why should there be one specific curriculum for EMT-B courses? One set of minimum standards? Sure, but for example, there are at least 3 styles of curriculum (traditional, systems based, problem based) for medical school, not counting hybrid designs. Yet all medical students either take USMLE or COMLEX (or both) depending on their school's philosophy (MD v DO). If there was one standard curriculum that all programs must adhere to, does that mean that if a program has extra resources to incorporate additional materials or work for other learning styles that they shouldn't or couldn't without a wavier?



There is a National Registry of EMTs isn't there?  That's one specific set of standard of knowledge for those who decide to take the national registry.  the national registry isn't studying all 50 states protocols - it's a non-state non-regional set of standards.

don't you think?

each state, even down to the city level has their own set of protocols.  i think it's weird.


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## MrBrown (Apr 9, 2010)

EMTBWannabe said:


> There is a National Registry of EMTs isn't there?  That's one specific set of standard of knowledge for those who decide to take the national registry.  the national registry isn't studying all 50 states protocols - it's a non-state non-regional set of standards.
> 
> don't you think?
> 
> each state, even down to the city level has their own set of protocols.  i think it's weird.



It's not weird.

There is a difference (and it is a big difference) between the modality of treatment and the knowledge required to treat.

Guidelines, protocols or standing orders whatever you work to or from are fairly generic and cross jurisdictionally nonspecific.  A seizure is a seizure and will respond to midazolam the same down the street or on the other side of world just like if you zap somebody in VF the effect of cardioversion is no different wherever you are.

Legislatory and regulatory frameworks differ from one jurisdiction to another; California is quite tightly legislated and each EMSA has thier own standing orders whereas in the UK the Joint Royal Colleges Ambulance Liason Committee has establishes the guidelines UK Paramedics work from.  There is also disagreement between medical directors as to the objectivity and validity of evidence and as such you get variation between protocol, guideline or standing order.

The modality of treatment is very narrow requiring little knowledge and a high degree of dexterious skill e.g. draw up midazolam and administer, how to size a hard collar while the cognitive knowledge required to make good functional linkages and use the modalities of treatment is somewhat more substantive.

A good example is chest pain and GTN; sure you can be a protocol monkey and give everybody with chest pain some sublingual GTN but if you have are a thinking and well educated Paramedic you know to check for signs of a right ventricular infarct first.

The National Registry is attemtping to ensure that people have the knowledge to be proficent, thinking, clinically sound Paramedics and not just protocol monkeys.

If you have the right knowledge the specifics of a modality of treatment is really fairly benign and should not be an issue if your guideline changes because you moved from jurisdiction A to jurisdiction B.


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## EMTBWannabe (Apr 9, 2010)

MrBrown said:


> It's not weird.
> 
> There is a difference (and it is a big difference) between the modality of treatment and the knowledge required to treat.
> 
> ...



agreed on your point concerning modality and knowledge to treat.  but when you're a student and a complete novice you'd want some consistency in reading materials while also presenting the material in some logical sense. 

an example in my class would be the following - we're learning pt assessment currently- so you have your scene size up, initial assessment, rapid/focused assessment, baseline, sample, ongoing -

we have the orange book and some sheets full of acronyms (presumably from the NYS protocols) - the steps are somewhat different in sequence.  

i asked the instructor do we have to follow the pt assessment step by step - he said yes and no - you have to following the main points.. that is in ABC, the B need needs to fall in between A and C - but within B you can perform OIPASS or IPASSO doesn't matter as long as you get it performed.

specific example on the recent test for ongoing assessment.. what should you do first for ongoing assessment?  repeat vitals or repeat initial assessment.  

i asked the instructor that's an unfair question because he said if it was within that framework the steps doesn't really matter as long as it gets done.

in ongoing assessment you have to repeat initial and vitals so according to him it doesn't matter what i do first.. but the test specifically asks what should be done first in the ongoing assessment.

that's the consistency i'm looking for. sure, nothing goes textbook but as a student i need the consistency first.


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## Shishkabob (Apr 9, 2010)

Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment. 

Vitals aren't part if the primary survey, initial assessment or what ever you call it.


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## Veneficus (Apr 9, 2010)

EMTBWannabe said:


> you can perform OIPASS or IPASSO doesn't matter as long as you get it performed.



Can somebody tell me what that even means?


Afterword, might I suggest not trying to dumb medicine down to a series of acronyms and memory aids without learning the why behind it or at the very least what you are using memory aids for?

Otherwise you get idiots looking for DCAPBTLS but have no idea what the significance of any of it is.


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## EMTBWannabe (Apr 9, 2010)

Linuss said:


> Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.
> 
> Vitals aren't part if the primary survey, initial assessment or what ever you call it.



funny you should say that... after the exam the instructor said he would have picked repeat vitals before repeating initial.. however i did choose repeat initial.

it's a fair question if he said we must adhere to the steps not as long as we perform it within that frame.

i'm gonna fail now... cuz he's probably monitoring this forum. haha.


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## EMTBWannabe (Apr 9, 2010)

Linuss said:


> Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.
> 
> Vitals aren't part if the primary survey, initial assessment or what ever you call it.



no it's part of the ongoing assessment.  my question was based on ongoing not initial...


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## EMTBWannabe (Apr 9, 2010)

Veneficus said:


> Can somebody tell me what that even means?
> 
> 
> Afterword, might I suggest not trying to dumb medicine down to a series of acronyms and memory aids without learning the why behind it or at the very least what you are using memory aids for?
> ...



i need to memorize it in the "B" section - IPASSO = inspect, palpate, auscultate, seal, stablize, Oxygen (administration) - sorry.. i'm a NOOBIE.


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## EMTBWannabe (Apr 9, 2010)

Linuss said:


> Actuslly it was a fair question and the answer is in the question. There's a reason it's called the INITIAL assessment.
> 
> Vitals aren't part if the primary survey, initial assessment or what ever you call it.



here's another thing why do we have to call initial assessment by a few different names.. initial assessment aka primary assessment aka primary survey... ah well i guess there's always going to be multiple names for the same thing.


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## JPINFV (Apr 9, 2010)

EMTBWannabe said:


> There is a National Registry of EMTs isn't there?  That's one specific set of standard of knowledge for those who decide to take the national registry.  the national registry isn't studying all 50 states protocols - it's a non-state non-regional set of standards.
> 
> don't you think?
> 
> each state, even down to the city level has their own set of protocols.  i think it's weird.



Your confusing curriculum with standards. There's only 1 US Medical Licensing Exam (USMLE) and only 1 Comprehensive Osteopathic Medical Licensing Exam, but there's currently 130 ways to make an MD and 28 ways to make a DO since there is no set curriculum for teaching medical students. 

Should EMS have a set standard for what each EMT and paramedic needs to know? Yes.

Should anyone be dictating how a school takes a student and makes them meet that standard? No.


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## MrBrown (Apr 9, 2010)

JPINFV said:


> Should EMS have a set standard for what each EMT and paramedic needs to know? Yes.
> 
> Should anyone be dictating how a school takes a student and makes them meet that standard? No.



That is what the National EMS Education Standards go aways to fixing since they are replacing the National Standard Cirricula


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## John E (Apr 9, 2010)

*Getting back to your original question...*

you, and the rest of the class apparently, failed to differentiate between a condition that "occurs" and a "threat" if the test question was worded the way you relayed it.

Menopause isn't a threat to anyone other than the people living with the woman undergoing it. It's part of the natural path of life.

Cancer on the other hand, is a disease which kills people, it's a threat. 

What would have been even more interesting would have been having heart disease in the list of potential threats, it kills more women than men but there are more forms of cancer and the odds of contracting one or more of them is higher than the odds of contracting heart disease. 

If you think about what the test question is really asking you, you'll usually find that the correct answer will jump off the page. Don't get tied up with facts not in evidence or thinking beyond the scope of the questions asked.

Now back to modalities...

John E


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## joeshmoe (Apr 9, 2010)

emtwannabe....I think you should spend time thinking logically about WHY you do certain things and WHY you should do them in a certain order, instead of just robotically memorizing x comes before y. 

For instance take the ongoing assessment. Think of WHY it makes sense to repeat the initial assessment before retaking vitals...rechecking a pt's mental status, airway,  breathing and circulation is something that can be done quickly and as you have learned by now, the ABC's, especially airway, take priority. So it makes sense to do that BEFORE, say, rechecking someones BP and temp.

You cant reduce everything to some cookbook recipe, there has to be some critical thinking and decision making involved which requires some understanding of what is happening and why. This can take some time and thought to develope. You may not learn everything you need to know in class, reading and studying on your own is required.


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## EMTBWannabe (Apr 9, 2010)

joeshmoe said:


> emtwannabe....I think you should spend time thinking logically about WHY you do certain things and WHY you should do them in a certain order, instead of just robotically memorizing x comes before y.
> 
> For instance take the ongoing assessment. Think of WHY it makes sense to repeat the initial assessment before retaking vitals...rechecking a pt's mental status, airway,  breathing and circulation is something that can be done quickly and as you have learned by now, the ABC's, especially airway, take priority. So it makes sense to do that BEFORE, say, rechecking someones BP and temp.
> 
> You cant reduce everything to some cookbook recipe, there has to be some critical thinking and decision making involved which requires some understanding of what is happening and why. This can take some time and thought to develope. You may not learn everything you need to know in class, reading and studying on your own is required.



i agree with you 100%.


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## Veneficus (Apr 9, 2010)

EMTBWannabe said:


> i need to memorize it in the "B" section - IPASSO = inspect, palpate, auscultate, seal, stablize, Oxygen (administration) - sorry.. i'm a NOOBIE.



Whoever came up with that should be beaten prior to being permanently barred from EMS or any educational undertaking.


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## wannabeemtb (May 14, 2010)

Apologies for not checking the thread in some time, for some reason it stopped emailing me replies.

I've got things more or less worked out at this point, I was mostly stressed over my scores because I believed (at the time) that they had a direct correlation to the level of patient care I would be able to provide.  I've since spoken to a half dozen Basic's and Paramedic's who assure me this is not the case.  Passing is passing, and that's good enough for me, I don't really even look at my score on the tests anymore.

I completed my first mandatory rideout earlier this week, and scheduled another in a couple weeks just to get more field experience.  Class is over in a month or so.

Thanks for all the replies, they were a big help.


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## Fox (May 25, 2010)

Veneficus said:


> Whoever came up with that should be beaten prior to being permanently barred from EMS or any educational undertaking.



I have to agree with this.

Sounds like this instructor is just teaching memorization to me. Making up acronyms to assist with memorization.


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## Cohn (May 25, 2010)

wannabeemtb said:


> Hi all, I'm a first time poster, so if this in the wrong place, I'm sorry.  Also, if this question has been answered elsewhere, sorry for the double post, I searched, I really did.
> 
> My names Ben, I'm 30 years old, and I recently started an EMT-B class.
> 
> ...



you got it good buddy... 80% and lower is a fail when I went to school.


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## mycrofft (May 25, 2010)

*NOTHING personal to the OP, but...*

...generically, when I read these posts, I get this question in the back of my mind as to whether they are just trainees complaining due to their not cutting it, or not understanding the process, or are these factual events of stupid, crazy or macho instructors?
Maybe a FAQ needs to be drawn up. Same issues time and again.

My stock answer: you paid for it, if it sucks get your money back or stop payment on your credit card and get another class. If enough people do that the trainers will go out of business or figure it out and straighten up.


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## Focallength (Jun 5, 2010)

70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.

I have a question why would you think menopause is a threat as opposed to cancer? Cancer is a disease, menopause is something every woman of a certain age goes through, its a biological function. You cant die from menopause


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## Fox (Jun 5, 2010)

Focallength said:


> 70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.



we had to have an 84 or higher on everything.


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## rescue99 (Jun 5, 2010)

Focallength said:


> 70%, wow I wish we had that much leeway. We had to maintain 80% at all times, fall below 80 and your gone, thanks for playing. But I guess thats why our school has a 96% NREMT first time pass rate.
> 
> Yeah, they all say how amazing their pass rates are. What you will never see is any school proving it. I can hardly wait until the day NR and my state starts showing those amazing pass rates on line!
> 
> I have a question why would you think menopause is a threat as opposed to cancer? Cancer is a disease, menopause is something every woman of a certain age goes through, its a biological function. You cant die from menopause



Many cancers are fueled by hormones, male and female alike. Take away the fuel and cancer may  be curable or put into remission. And, while one may not die from menopause, the negative hormone state increases disease potential. Same goes for men.


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## Rabbit86 (Jul 1, 2010)

I know this is late response but I just joined.  The best thing to do is get together with other people from your class.  And based off my experience and training in Indiana, they taught us the basics, then we had to interrupt what we thought was best from that.  (I don't know if that makes sense) Your example was menopause, cancer and something else I can't remember.  You can rule out menopause because in general there is no life threatening issues with menopause.  Cancer can cause life threatening issues that would require your immediate help in the field.  I hope all is going well with your training and experiences.


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## wijjiam (Jul 2, 2010)

wannabeemtb said:


> 70% is a passing grade, that we can take a test again if we fail the first time, but if we fail twice, we're dropped from the class, and that these are DOT standards.  We're also told that we must pass one module before being allowed to continue on with the next module.
> QUOTE]
> 
> wow we have to get an 80 or we get droped


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