Test taking skills are subjective from one person to another, and by now you should know what works for you. If you can pass your practicals ,t he written will be nothing.
As far as real world, this is coming from someone who just got off trainee status not long ago himself:
Ask questions. Don't be afraid to ask questions. I and every other person out there would rather you ask than try to fake it.
Admit if you don't know something. Yes, it sounds like I'm repeating myself. But already I've had at least three trainees tell me the pt. BP was "122/80" or some such number, only to check it myself and have it well below 100/palp. DO NOT FAKE STUFF LIKE THIS. Respirations, pulse, BP... All very important, don't just make it up. If you can't get a BP or another vital, or you're not confident in it, let them know and ask them to verify.
Be assertive. You will have a lot of crap you need to get signed off in your training book, and some EMT's don't want to let a trainee to anything. Others just want to keep them doing vitals and never do anything important or new, like setting up an IV for an ALS or doing a Cincinnati stroke test. You may need to ask "Hey, you mind if I do that?" I had to do so with Nitro administration, oral glucose, and setting up a monitor. Sometimes, the people you are working with just do it automatically and don't think about it. Once you saw something a couple times and think you're comfortable to try it, ask them and go for it. Keep in mind that if they don't think you're ready, well, maybe you're not.
If you get a team that DOESN'T want you to do anything, talk to your field training officer. Don't wait until after the shift either. There is no reason to treat you like grunt labor or an unwanted element.
Most of all, stay open. Things are HUGELY different on the street than it was in training. Like someone else said, first few shifts just shut up, watch, listen, and take vitals while you do so. See how different people get assessments or give radio reports. Watch how they navigate around traffic in a priority call.
ALWAYS VERIFY THE ADDRESS BEFORE YOU GO GANGBUSTERS. My second call, we punched the wrong address into the GPS (forgot to add "South" to the road name) and it took us to the wrong side of the damn city, and the person involved almost crashed before we realized our mistake and radioed for an engine company to get out there with O2 and a drug box until we got there ourselves. Some lessons are learned hard.
Incidentally, always check an entire limb for a trauma. If they say their knee hurts, cut the pants all the way up to the hip. During training, I had an old guy that fell down the stairs and said that his left thigh, directly above his knee and no higher than mid-thigh, felt like he pulled a muscle. We checked out the effected area, compared it bilaterally, and everything seemed fine. Did not want to go the hospital, and so he wanted us to pick him up and put in a chair. It wasn't until we picked him up and noticed his leg bending kind of weird. Cut higher up on the left leg, up by his hip, and you saw a nice bump sticking out the side where his femur broke and was making the skin distend almost two inches out. Again, some mistakes are learned hard...
And that's all just off the top of my head!
