# "Nothing prepared me for it..."



## NomadicMedic (Sep 3, 2013)

I am always amazed when I read posted statements like this, "I took the test on Friday. I felt like I totally failed. Nothing prepared me for this test. Got the results today. Passed in 70 questions."

Obviously something prepared you for the test if you were able to demonstrate competency in 70 questions. And here's a tip, everybody feels as though they failed.

This test is designed to delve into your base knowledge. It doesn't ask simple questions, instead requiring you to look at several answers and choose the one that is best based on the knowledge you obtained during your EMT or paramedic training.

If you studied during class, the only preparation you need is some sort of computer-based test taking prep, simply to make you comfortable with answering multiple-choice questions on the computer.


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## medicdan (Sep 3, 2013)

DEmedic said:


> I am always amazed when I read posted statements like this, "I took the test on Friday. I felt like I totally failed. Nothing prepared me for this test. Got the results today. Passed in 70 questions."
> 
> Obviously something prepared you for the test if you were able to demonstrate competency in 70 questions. And here's a tip, everybody feels as though they failed.
> 
> ...



I couldn't agree more. I've been teaching EMT students for a few years, and recently took the medic exam, but never understood that statement until taking it. 
The exam is built to challenge students, adjusting questions to measure maximum competence, so that each student is measured on their own. With each question, the software gains more insight into their abilities, building a confidence interval in fewer questions. The software and algorithms behind it are truly fascinating, but so is all of psychometrics. 

There is no better way to prepare than to be a good student and a good provider. The questions don't come from left field, all undergo a strenuous review, approval and testing process, and are written by providers based on field and best practices. The test is not out to get you, its there to measure competence, and has been verified as a legitimate tool.


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## Wayfaring Man (Sep 4, 2013)

I think a lot of people don't "get" the way the test works.  I had read it was adaptive but in my prep leading up to the test I was focusing a lot on EMS and not a lot on the ins and outs of the actual testing procedure.  When it stopped suddenly after a question, I had been in my "test taking groove" so I honestly cannot even recall what the last question I answered was, which is one of the better ways to know if you passed or not (because of how it tests, if you fail the last question that means you dipped below its ~95% competent threshold, so if you know you missed the last one, you can read the writing on the wall).  Also it's pretty ambiguous.  It leads with hard questions that one could easily see themselves missing, so a person "keeping score" with how confident they feel on answers will always feel like they've missed more than they'd like to.  And the abrupt sudden short finish can be very startling, so if you don't know you're solid, it's easy to think "oh man I missed like half of those 70 questions, I must have failed hard."

When I took the thing all the test takers told me was it was a timed test and I would not likely use all my time.  It cut me off after about 25 minutes (I test fast), which really surprised me given how long my time limit was, but shouldn't have.  I passed but I too had the anxiety that I was sure I'd failed.  Made the mistake of taking it July 3rd, so didn't get results until 2 days later.  Spent the whole time putting my psychology degree to work on why I was stressing when I knew I knew my stuff, and welp, here's a post.

Basically I think giving people a better idea of how the test moves and how the questions ebb and flow would be the only way to solve the anxiety, but there's an NDA and anyhow, I guess that anxiety is a test in and of itself!  haha


Edit: All of this applies for me to the EMT-B test.  Paramedic I assume is even more stressful for the same reasons but because it includes a much more expansive breadth of information.


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## Anonymous (Sep 4, 2013)

It can become confusing when in EMT school you are taught what your book says, then your instructor goes off on a "but in the field tangent," then you have local protocols you are taught that differ from national, so on and so forth. 

Suddenly your thinking, "Is it a systolic of 90 or 100 for Nitro? Crap, both are possible answers."

That and I had questions like "What do you do with this persons dog." I can say with absolute certainty that I was not taught that. So what does common sense say? It says  3 of the 4 are all viable options depending on the particular situation...


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## AtlasFlyer (Sep 4, 2013)

That's where it comes down to picking the BEST answer. More than one answer may be technically _correct_, but one is probably _best_.


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## medicdan (Sep 4, 2013)

Anonymous said:


> It can become confusing when in EMT school you are taught what your book says, then your instructor goes off on a "but in the field tangent," then you have local protocols you are taught that differ from national, so on and so forth.
> 
> Suddenly your thinking, "Is it a systolic of 90 or 100 for Nitro? Crap, both are possible answers."
> 
> That and I had questions like "What do you do with this persons dog." I can say with absolute certainty that I was not taught that. So what does common sense say? It says  3 of the 4 are all viable options depending on the particular situation...



The NR exam shies away from specific protocols--- they will never ask you a systolic cut off for nitro (for the EMT exam), or exactly what to do with a dog, but they want to see good decision making, and above all, common sense... This is not an exam to cram for from the textbook...


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## Tigger (Sep 4, 2013)

I really do not get the fear of the "adaptive testing model."

You show up, you answer questions, you leave. Same as any other test. The only difference being that you don't know how many questions you answer. I don't see how this is a big deal at all. You can only answer the question you are currently being asked. You answer it and move on to the next one, which again is just like any other test. Maybe you feel uncertain when you leave, but that's not a flaw in the model and doesn't affect whether or not you were well prepared. Even if you know how many questions you'll see, odds are most test takers are not going to walk out of any exam with 100% certainty that they passed. That's just part of taking a test. 

Some people also argue that it isn't fair that the questions don't necessarily increase in difficultly in a linear manner, or that the topic matter jumps around. That is an absurd complaint in my eyes. If you properly learned the material, the order you are tested in should make no difference. The relative difficulty in questions shouldn't be throwing you off. If you know your stuff, you know the answers and that's the end of it. Not to mention that in the rest of the academic world you won't find a test that holds your hand like some EMT tests do. 

The other thing that bothers me is that the NR test has the rep of being some boogeyman of a test that you can't prepare for (because it's adaptive) and that since it's a "national test" it must have questions that are out of your scope. I don't know why these rumors exist but they do and are also downright absurd. We get posters on here freaking out because they heard there were a bunch of "medic questions" on it, so how can they cram in some EKG knowledge real quick?!?! 

Why in the world would there be medic questions on an EMT level test? Who propagates that? For whatever reason we have people are out there basically fear mongering and scaring people away from it when they probably haven't even taken it. I firmly believe in a degree of national standardization in EMS certification so that one can move states and at least have a relatively easy time becoming certified there. Many of the people that are against this that I have talked too (personal anecdotes are not data but still) are opposed to a national test because of crap reasons like that, which are so far from true that you have to wonder where it all started. 

The bottom line is that it's a test. It's not supposed to be a breeze.

I'll get off my soapbox now, I think I feel better?


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## IslandTime (Sep 4, 2013)

AtlasFlyer said:


> That's where it comes down to picking the BEST answer. More than one answer may be technically _correct_, but one is probably _best_.



There in lies the rub. Frequently the "best" is an opinion, or the result of thinking carefully through all the various options and discussing it with your peers to see which would be the best solution. But the reality is that when you encounter an unexpected situation you do what you think is best at the moment, in that setting, and without the benefit of extended consultation with others. As an example, see the "Just for fun..." thread http://www.emtlife.com/showpost.php?p=500209


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## Wayfaring Man (Sep 4, 2013)

Tigger said:


> The other thing that bothers me is that the NR test has the rep of being some boogeyman of a test that you can't prepare for (because it's adaptive) and that since it's a "national test" it must have questions that are out of your scope. I don't know why these rumors exist but they do and are also downright absurd. We get posters on here freaking out because they heard there were a bunch of "medic questions" on it, so how can they cram in some EKG knowledge real quick?!?!
> 
> Why in the world would there be medic questions on an EMT level test? Who propagates that?



The primer on the cognitive test says as much on the NREMT website.  The theory is that if you can answer questions above your scope, you probably know your scope.  The thing people don't realize is the questions it does this with aren't questions about reading echos or medic-only drug protocols or so on.  It asks questions about what some things do, for example it may ask about equipment medics have.  It may ask A&P questions that are way above anything an EMT needs to know about, because if you can answer questions about the receptor types found in the liver, it can safely assume you know what quadrant the liver is in as well.  So it's not that it asks "medic-level" questions, but on the EMT-B test it does ask questions that an EMT-B is not likely to have encountered about things that an EMT-B isn't likely to need to know.

I also recall me asking something about BIADs at some point, but it wasn't about how to use them, just generally what one is.  And I recall it using bizarre trade names for things that I'd never heard of but could use common sense to figure out, like it asked how to treat a sucking chest wound or something and the answer was some kind of brand name burp dressing and not "plastic and some tape."  

But yeah generally I think the rumors about "it asks medic level :censored::censored::censored::censored:!" is people who got asked questions about either specific pieces of anatomy that EMT-Bs don't necessarily learn, or questions about what things _are_ that medics have to do but that EMTs should know, like what nebulization is and so on.  Then they panic afterwards, sure they failed, and they tell everyone they know "oh god it is so hard it asks medic level :censored::censored::censored::censored:!," then those folks tell their friends, and next thing you know people are trying to learn to read echos.

But yeah I think your advice about the kind of test it is is spot on.  It's not a test you can really study for by just cramming the textbook.  It's very much the kind of test that does a really good job of determining if you know your stuff or not, and so the only way to take it and succeed is to just know your stuff.  If you're confident that you could practice in the field, then you should be confident to take the test.  If you're not confident to take the test, how can you be confident to treat patients?


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