# It's about time! NREMT to require accreditation



## Ridryder911 (Nov 27, 2007)

WOW! It's about time! Only schools that offer real education, and have approved clinical sites, and have their act together, only their students will be able to test for the NREMT!! Of course all schools have the chance to prove themselves in the next 5 yrs... I bet we will see a lot less shady, piss poor training centers, and who knows maybe... yes, maybe truly educated EMT's and Paramedics...

The following press release explains it all.

NREMT Board Votes to Require Paramedic Accreditation

On November 13-14, 2007, the National Registry of EMTs Board of Directors
voted to require that applicants for national Paramedic certification
graduate from a nationally accredited educational program after December 31,
2012. 

The motion was introduced in June 2007 and tabled to enable consultation
with other members of the EMS community. Following discussions with other
national EMS organizations, the board passed the motion unanimously on
November 14, 2007. The rationale for the change is based on the
recommendations in the EMS Education Agenda for the Future: A Systems
Approach as well as the Institute of Medicine (IOM) Report titled Emergency
Medical Services at the Crossroads. These two publications call for a
linkage of paramedic educational program accreditation with eligibility for
certification. 

Currently, fourteen states require national accreditation of paramedic
education programs and, there are over 240 nationally accredited programs.
Most experts believe that this represents about one-half to one-third of the
active paramedic education programs in the country. The CoAEMSP is
committed to helping programs understand and meet the standards and
guidelines for accreditation, stated Randy Kuykendall, the current Chairman
of the Committee on Accreditation for EMS Educational Programs (CoAEMSP).

William E. Brown, Jr., NREMT Executive Director said We believe that the
major barrier to achieving accreditation will be institutional support. We
hope that this policy provides paramedic program directors with the leverage
to get the same resources as other allied health education programs. There
is simply no reason why any quality program cannot achieve accreditation in
the next five years. 

Another concern is the number of paramedic programs that are in
"non-traditional" educational settings. Dr. George Hatch, CoAEMSP Executive
Director, stated We currently have accredited programs in all types of
locations and institutions. The CoAEMSP has a variety of mechanisms to meet
the sponsorship requirements. Virtually any type program, including
proprietary and agency based, can meet the sponsorship standard through
seeking independent institutional accreditation or collaborating with other
organizations to form a consortium.

While the EMS Education Agenda for the Future calls for educational
accreditation for all levels of EMS personnel, the IOM report recommends
requiring accreditation only at the paramedic level. The NREMT motion
affects only paramedic eligibility. Jimm Murray, NREMT Vice-Chairman (of
the Board of Directors) concludes that the current evidence supports
requiring accreditation at the paramedic level. We may revisit the issue of
accreditation at other levels at a later date. 

This is an important step forward for the discipline of paramedicine,
concluded Sandy Bogucki, MD, PhD and Chairman of the NREMT Board of
Directors. Every occupational group that has evolved and gained credibility
as a profession has done so through strengthening their educational and
credentialing systems. We know that this change will be a challenge, but the
Board feels confident that accreditation will improve paramedic education
and ultimately the quality of care that patients receive in the out of
hospital setting


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## triemal04 (Nov 28, 2007)

Allow me to repeat myself:  :beerchug:

Best thing to happen to EMS in awhile.  Now all they need to do is up the standards for accreditation.  :beerchug:


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## reaper (Nov 28, 2007)

Good Deal.

 Now they just need to fix the joke of a system they have and all will fine in the universe!


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## Alexakat (Nov 28, 2007)

This is a good first step in the right direction!


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## bstone (Nov 28, 2007)

Interesting. Good step.


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## Asclepius (Nov 28, 2007)

Here's what I don't get. I've only recently discovered this in our relocation process. I went to a very well known university to obtain my paramedic education. I have several quantifiable years as an EMT-Intermediate. I graduated from the paramedic class and I challenged and passed the NREMT-P practical and written exam on my first attempt. NREMTP is supposed to be the gold standard of measurement, yet in everyone of my application processes for agencies around where we live now I have had to take a written exam and in one case a practical station. 

Didn't I already prove myself when I took and passed the NREMTP and also graduated from a collegiate program? Why do I need to take and pass someone elses exam...already been there and done that.


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## triemal04 (Nov 28, 2007)

Asclepius said:


> Here's what I don't get. I've only recently discovered this in our relocation process. I went to a very well known university to obtain my paramedic education. I have several quantifiable years as an EMT-Intermediate. I graduated from the paramedic class and I challenged and passed the NREMT-P practical and written exam on my first attempt. NREMTP is supposed to be the gold standard of measurement, yet in everyone of my application processes for agencies around where we live now I have had to take a written exam and in one case a practical station.
> 
> Didn't I already prove myself when I took and passed the NREMTP and also graduated from a collegiate program? Why do I need to take and pass someone elses exam...already been there and done that.


Well... let's count the ways.
1.  NREMT-P is not a hard written test to pass.
2.  NREMT-P is not a hard practical test to pass.
3.  Many schools do a horrible job at teaching people to be paramedics; see 1&2.
4.  People will (often) forget what they learned in paramedic school if they aren't using that knowledge.
5.  Occasionally places only want to hire the best possible people; thus multiple tests and interviews to determine that person.
6.  Passing a couple of dinky written tests does not make someone a good paramedic.

Maybe this is a topic for another thread, but did you really expect to just walk in to a place, toss an app' on the table and get the job?  Come on, really?  Generally most agencies/services aren't going to want to hire someone and then have to fire them 2 weeks later because they're an idiot with zero knowledge; testing is a way to help filter out the morons.  This is especially true if they normally are hiring brand-new paramedics.

Edit:  Sorry, nothing personal against you, but this pisses me off.  It's part of the reason that EMS is so screwed up now; we've got these crappy tests for determining if someone is qualified to be a medic and that's it.  And when a service tries to make sure that someone really is qualified and the right paramedic for them, it get's questioned?  Are you kidding me?  EMS is not (should not be anyway) another McJob that any bonehead can get; getting certified is only the first step towards actually working in an ambulance; the sooner that we realize that and start to embrace places that are actively trying to weed out those who have no buisness on an ambulance the better.  Look at police departments, fire departments, both have an EXTENSIVE testing process because both only want the BEST people for the job.  It doesn't matter what your background is, if you want to work in those areas, you better be ready to show that you really are good.  The sooner we realize that and apply it to EMS the better.  If you have to actually test for one service or agency, don't question it, be glad that they only want good people working for them.  And don't ever think for a second that just because you have a piece of paper from the National Registry that nobody will ever question your abilities or qualifications or that you are above having to prove what kind of medic you are.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> Well... let's count the ways.
> Maybe this is a topic for another thread, but did you really expect to just walk in to a place, toss an app' on the table and get the job?


Yeah, actually I did. I didn't JUST pass the NREMT test, I also graduated from a university program. It's just silly, really. What good is the NREMTP if, as you say, it doesn't count for anything? I've proven that I know being a paramedic by testing and graduating.

Also, PD and FD, doesn't have an equivalent to the NREMT. At least not that I know of. When there is no national standard, then I would better appreciate being tested by each agency.


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## triemal04 (Nov 28, 2007)

Asclepius said:


> Yeah, actually I did. I didn't JUST pass the NREMT test, I also graduated from a university program. It's just silly, really. What good is the NREMTP if, as you say, it doesn't count for anything? I've proven that I know being a paramedic by testing and graduating.


See #1, #2, and #5.  And the edit as well.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> See #1, #2, and #5.  And the edit as well.


I saw them...I just disagree with you.


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## triemal04 (Nov 28, 2007)

Asclepius said:


> I saw them...I just disagree with you.


Can you explain why?  National Registry is not that hard a test to pass.  Going to one school are another does not gaurentee that you actually learned anything, or retained any of that knowledge.  And neither ensures that you'll be a good medic on the street.  (course a test doesn't either, but it can help a bit)

Do you honestly think that it's a good thing for a brand new paramedic to be able to walk in and then head out to the street without ever having his ability/knowledge tested?  Do you really think that's good for our profession?

EDIT:  And the fire service has lots and lots of certifications that are recognized nationally.  Police also.  Still doesn't matter; you could be a Lieutenant with his Fire Officer 3 from Dept A, but if you apply at Dept B, you're still going to test with everyone else.  If you're a police Sergeant from A and go to B, same thing.

DOUBLE EDIT:  You really don't think a service should be looking for the best people and weeding out the idiots who should never be on the street?  Sheeeeeit.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> Can you explain why?


Yes, I can. I believe I did. Having adequately passed the requirements of the university, which also certifies that I have met requirements of the NREMT, I believe I have proven myself.



> National Registry is not that hard a test to pass.  Going to one school are another does not gaurentee that you actually learned anything, or retained any of that knowledge.  And neither ensures that you'll be a good medic on the street.  (course a test doesn't either, but it can help a bit)


I don't know why you think this test is so petty. Nearly every state in the country including the military recognizes it's achievement.



> Do you honestly think that it's a good thing for a brand new paramedic to be able to walk in and then head out to the street without ever having his ability/knowledge tested?  Do you really think that's good for our profession?


Yes, I think it is good for our profession. It's good enough to become a doctor or RN. They go to school for their predetermined amount of time. They put in their hours of clinical time. They take their tests and then apply for their licenses. 

I think what is bad for our profession is making the process hostile. I considered it a great achievement each time I advanced through the ranks in EMS. First a basic, then an Intermediate, then a paramedic. One of the proudest moments of my life was learning that I was good enough to be certified by the NREMT. I felt so good about it, because I know it will basically take me to any state that I choose to go.



> You really don't think a service should be looking for the best people and weeding out the idiots who should never be on the street?  Sheeeeeit.


Yes, I think any company should look for the best people. That's what reference checks are for. That's what judging the applicants experience is for. That's what looking at the applicants educational background is for. Things like that. Not adding on more tests that demonstrate the applicant already knows his profession.


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## wolfwyndd (Nov 28, 2007)

This is just my personal opinion (so take it for what it is), but until we have a NATIONAL standard that's accepted by ALL 50 states in the US, it's all just one big feel good jerk off.


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## triemal04 (Nov 28, 2007)

Asclepius said:


> Yes, I can. I believe I did. Having adequately passed the requirements of the university, which also certifies that I have met requirements of the NREMT, I believe I have proven myself.
> Say it again; NREMT is an easy test.  Passing the course at your school doesn't ensure that you learned and retained the material.  Sorry, but just doing that is NOT "proving yourself."
> 
> 
> ...


How are you supposed to demonstrate that you know your profession then?  Little secret, nobody likes to hire someone, train them, and then have to fire them because they don't know their stuff; waste of time and money.  Reference checks are great, but only can go so far.

I still can't understand why you think that this is a bad thing.  In any way, shape or form.  It makes no sense.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> How are you supposed to demonstrate that you know your profession then?  Little secret, nobody likes to hire someone, train them, and then have to fire them because they don't know their stuff; waste of time and money.  Reference checks are great, but only can go so far.


You're right. The whole system sucks. My nearly 10 years in EMS has taught me nothing and I have no reason to be proud of my accomplishments.

Nationally accredited collegiate programs that require a signficant demonstration of education, clinical hours and proficiency of skills is not worth the paper it's written on.

No employer should judge or verify for themselves the applicants experience, education, and/or certifications.

btw, I am not debating the hours that MDs and RNs have to put in. I am merely comparing that the system is similar. Sure they do more hours, but the also have a much broader scope of practice.

btw, are you NREMT?


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## triemal04 (Nov 28, 2007)

Asclepius said:


> You're right. The whole system sucks. My nearly 10 years in EMS has taught me nothing and I have no reason to be proud of my accomplishments.
> 
> Nationally accredited collegiate programs that require a signficant demonstration of education, clinical hours and proficiency of skills is not worth the paper it's written on.
> 
> ...


Wow.  That's just really sad.  You say you've been in EMS for this long and 1-don't understand why this has to be done, and 2-don't want something to be done that could easily help to improve EMS.  Not my problem I suppose; making someone show that they can perform proficiently is perfectly acceptable to me, especially when you consider the :censored::censored::censored::censored:e state of EMS today.  But that's ok, you can be sarcastic and feel sorry for yourself all you want.  Again, not my problem.  What is my problem is exactly what I said in the "edit" in my first (second really) post in this thread.  And I'm sorry, but the more you perpetuate the mentality of "I did this so you can't ever ask me to show that I know what I'm doing" the more you help to drag the system further down.  Nice one.

RN's and Doc's are still apples and oranges when compared with EMS.  The only similarity is that we are all involved in mediciene.  

I've got nothing more to say that I haven't allready.  Ensuring that people are qualified and live up to the standard for your service/agency...why is that wrong?  How is it detrimental?  How is it beneficial?  Ahh...you don't want these answers anyway.

Cheers.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> Nice one.


Thanks, I'm glad you approve.



> RN's and Doc's are still apples and oranges when compared with EMS.  The only similarity is that we are all involved in mediciene.


I don't see it that way.



> I've got nothing more to say that I haven't allready.  Ensuring that people are qualified and live up to the standard for your service/agency...why is that wrong?  How is it detrimental?  How is it beneficial?  Ahh...you don't want these answers anyway.


On the contrary...I already answered these questions. You and I don't see eye to eye on this and I am not interested in arguing or making this personal. 

I am still curious, though, did you say you were NREMT or not?


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## VentMedic (Nov 28, 2007)

Asclepius,
Are you in the California system?


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## Asclepius (Nov 28, 2007)

VentMedic said:


> Asclepius,
> Are you in the California system?



No, we recently relocated from Cincinnati area to the St. Louis area. I work, however, in Illinois. Why do you ask?


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## VentMedic (Nov 28, 2007)

California has a county system that even if the paramedic has a state license, each county and/or municipality establishes its own way of doing things by powers granted to them by the state of California. 

For EMTs it gets even more complicated as they must apply for certification with each county even if they are state certified.


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## triemal04 (Nov 28, 2007)

Whoops, knew I forgot something.  No, currently I am not a NREMT-Paramedic; I let it lapse this last go around, mostly because I don't plan on going out of state anytime soon.  Course if I do I know I'll have to jump through some hoops to get it back.  Why do you ask?

Oh, and despite my state having some of the tougher requirements for paramedic certification, it is still required here that initially you become a dual state certified/NREMT certified medic.  And pretty much every ambulance service here gives some form of test before making a job offer.

Guess that's what happens when the system works and places only want good, qualified people working for them.


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## Asclepius (Nov 28, 2007)

VentMedic said:


> California has a county system that even if the paramedic has a state license, each county and/or municipality establishes its own way of doing things by powers granted to them by the state of California.
> 
> For EMTs it gets even more complicated as they must apply for certification with each county even if they are state certified.



I don't know how that works in St. Louis, but where I work in Illinois the same is true. We have an "area wide" EMS system. You must take a protocol test to function, but that is different. The protocol tests your knowledge on what the protocols for the system are. That is way different then having to prove to an employer that you can pass their testing of something you've already demonstrated that you can pass.


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## Asclepius (Nov 28, 2007)

triemal04 said:


> Whoops, knew I forgot something.  No, currently I am not a NREMT-Paramedic; I let it lapse this last go around, mostly because I don't plan on going out of state anytime soon.  Course if I do I know I'll have to jump through some hoops to get it back.  Why do you ask?
> 
> Oh, and despite my state having some of the tougher requirements for paramedic certification, it is still required here that initially you become a dual state certified/NREMT certified medic.  And pretty much every ambulance service here gives some form of test before making a job offer.
> 
> Guess that's what happens when the system works and places only want good, qualified people working for them.



I just wondered. You seem really down on NREMT. I have no objection to only wanting good candidates, but redundant testing does not insure that. The way to insure good candidates is to look at the employees training, education, and experience. Just because a person can not pass a written test doesn't mean they would be a poor candidate.


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## triemal04 (Nov 28, 2007)

Asclepius said:


> I just wondered. You seem really down on NREMT. I have no objection to only wanting good candidates, but redundant testing does not insure that. The way to insure good candidates is to look at the employees training, education, and experience. Just because a person can not pass a written test doesn't mean they would be a poor candidate.


I agree somewhat actually, there's a lot that goes into it, including how they perform during what ever probationary/entry-level/whatever you call it period they have (assuming they have one).  That's more important than everything that either of us has listed so far, because, let's face it, you can do great in school and be a complete and utter f&ck-up on the street.  But, a written test, or scenario based test or both that tests someones minimum knowledge level (or just knowledge level period if that service doesn't want someone with only the bare minimum) isn't wrong either; like I said it's going to help weed out the people who shouldn't be there in the first place.  Hopefully.  Guess my final word on that is:  with what you're saying, it's the same as saying that you don't think we should have to recertify in ACLS, PALS, PEPP, PHTLS, BTLS, the rest of the alphabet soup, and even recertify as medics.  After all, we allready proved we could do it once.

Far as NREMT...it's not that I'm down on it.  I would like to see a system in place in which there was one and only one paramedic certification for all 50 states, and this isn't to far off.  (it'd have to be a lot more advanced than the current minimum standards and the requirements would also have to be really jacked up to make me happy too...I'm so needy )  I really like the accreditation deal they're doing now; long as the minimum requirements to get that accreditation are adequate...I like, I like.  Hopefully it'll get rid of medic mills.  I'd like it even more if all 50 states passed a requirement that you had to get your NREMT cert initially; that way nobody can bypass this.

What I don't like about NREMT is that the test is so damned easy to pass.  70% and you're good.  With a lot of the questions being BLS (think scene safety/BSI)...swing and a miss.  Same goes for the practical portion, though I'm not sure how that can be fixed.


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## VentMedic (Nov 28, 2007)

Florida has its own state Paramedic exam. The argument has been its passing score is higher than the NR, 80 vs 70. However, Florida adds questions about its state trauma regulations which is state specific and not so much medicine specific.  

There were a couple of counties in Florida that wanted their paramedics to be dual certified with the state and the NR. That has since been challenged unfortunately.  

Florida also has many PDQ Medic Marts where Florida believes they are adequate if the students take the state exam.  If someone from out of state seeks retroprocity with the NR but is a graduate of an unaccredited PDQ Mart, they must also take the NR.  At least the EMT-B is NR in Florida.    

Attempts to make the NR the state test have been tried many times with various trial offerings. The last one was about 3 years ago.  I may try to find the data in the Florida system to see what the pass rate was.  That had been the problem in previous years when the NR came to town. 

Florida has many community colleges that offer the 2 year degree but have allowed for the certificate program to develop within the program.  The number of private tech schools are exceeding the colleges.  Thus, many students choose the shortest route because they can. 

I think Florida will continue to hold off the NR at the paramedic level for awhile. Florida just changed testing vendors again also. It is expensive for a state to do its own testing. 

Other medical professions have required graduation from accredited schools with established minimum educational standards for many years to sit for the boards.  Even physicians from other countries or the Americans that choose to get their M.D. at "alternative" locations may have difficulty with the boards.


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## Ridryder911 (Nov 28, 2007)

Remember, all boards are only asking for the minimum allowable requirements on what ever they are testing. Although, I do agree NREMT is appearantly too easy, it is at least a start. To contrary beliefs there are "national standards" and all states has to go with them as a minmum or loose federal funding. They are the National Curriculum, again out of date and poor, but they are scheduled to change within the next 1-2 years. 

One has to understand that most health care professions started out this way, to change training into education base level. The license/ board /certification has to have some weight (teeth) to be able to validate itself. Requiring education and training facilities to have accreditation to meet rigorous standardsto ensure patient safety and provide the student with at least then minimum educational programs. 

Just because someone has attended a specific University, Medical School, Hospital, Trade School, does not ensure that student or person is qualified; hence the reason for board examinations. Rather an accreditation does mean that the school has met its obligations providing students quality instructions per accreditated instructors, quality clinical sites to meet the objectives, and the institution will be held upon those standards. Hence, they will be reviewed like other professions in many things, such as board pass rates, employment rates, instructors level of education and professional development. 

Hopefully, this will remove the so called back-room fire station schools, fly by night programs and programs that fail to offer quality clinicals (no more cofee clinicals!) by having the ability to place instructional systems on probation or even removing their ability to teach at all. Just like other medical programs such as nursing, respiratory therapy, physical therapy, etc. 

Wow! Professional standards and requirements for schools ! What could be next? 

R/r 911


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## Asclepius (Nov 28, 2007)

triemal04 said:


> Guess my final word on that is:  with what you're saying, it's the same as saying that you don't think we should have to recertify in ACLS, PALS, PEPP, PHTLS, BTLS, the rest of the alphabet soup, and even recertify as medics.  After all, we allready proved we could do it once.


See, I don't agree with that line of thinking. We recertify by a process of CONTINUING education, which again are measurable. You shouldn't have to prove something you've already proven you know. Receiving CE, refreshers, etc. is all a necessary part of EMS and any employer can check to insure that a person has kept up on those aspects. The rest is a matter of determining if they have good experience, if they have had discipline issues, and if they've had any QA issues. Oh yeah, and determining if they're behind on child-support (maybe that's just a local thing).

I agree that we need to strengthen our base. I just don't think it needs to be done in a redundant manner. We tend to eat our young in EMS and I have seen people enter EMS being, at best, a mental, but turning out a leader after some fine tuning. I have also seen people that can ace any test you put in front of them, but clinical skills suck or the have the bedside manner and professionalism of Marilyn Manson. It's our job to help educate and strengthen our colleagues. After all, we all started some place.

Vent -

I've never really worked anywhere but Illinois. I can only speak for my experience there. Illinois used to offer a state test. I am not really sure how it compared to the NREMT, but recently they have switched or are switching the the NREMT.

Wouldn't the equivalent to an MDs boards be the NREMT or a state test? We receive our training by passing the educational institutions requirements. At least that is how I look at it.


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## VentMedic (Nov 28, 2007)

Asclepius said:


> Wouldn't the equivalent to an MDs boards be the NREMT or a state test? We receive our training by passing the educational institutions requirements. At least that is how I look at it.



If the school is not accredited, they may not be able to sit for the boards.  Hence, we have several foreign trained M.D.s working in other professions.  The other factor concerns if they still need to do their residency. This is a very competitive part of their training and if they again are not graduates from an accredited school, even if they were allowed to take the boards, they may not get a residency position.


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## Asclepius (Nov 28, 2007)

VentMedic said:


> If the school is not accredited, they may not be able to sit for the boards.


I'm sorry,  I mentioned being in an accredited institution earlier and just assumed that we were all talking about them.


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## triemal04 (Nov 28, 2007)

Sorry, you can't have it both ways.  Refreshers for the alphabet soup include a test.  And recertifying as a medic requires a test at various times (for some places, not all I know).  What's good for one is good for the other in this case.

CE hours are not measurable, beyond the actual amount of time spent on it; that's why many states require a written test to be taken.  You can spend 8 hours on cardiology, but if you didn't pay attention you won't learn anything.  But you still get 8 hours of CE in cardiology.

I'm sorry that you think that you can take one test and never have to do it again, but that's not the way it works.  Maybe someday (a long, long, LONG time) in the future the educational requirements, standards and testing process will be advanced and strict enough that it won't be as neccasary.  (though even then I'd be ok if various places still did it)  But right now it most definetly is.  You don't like it...start working on fixing the problems with education that we have in EMS.  That's the root problem here.


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