Does Size Matter?: Paramedic program class size may predict success - Research - @

Does Size Matter?: Paramedic program class size may predict success


Antonio R. Fernandez, MS, EMT-P | Melissa A. Bentley, BS, EMT-P | From the December 2009 Issue | Tuesday, December 8, 2009

How many paramedic programs are there in the U.S.? Sounds like an easy question, right? Until now there was no solid answer. Also, no one has a good idea of the average number of paramedic candidates in these programs. Well, have no fear, the EMS Mythbusters are here.

Myth: The Size of a Paramedica Programs is Associated with Program Success.

What We Know

First, we wanted to get a good estimate of how many paramedic programs there are in the U.S. Starting in 2007, paramedic programs with graduates requesting to take the National Registry of Emergency Medical Technicians (NREMT) exam were required to register with the NREMT.

But answering our first question is not as easy as just pulling up the number of programs in the database because, just like the weather, it can change almost daily.

We needed to specify the study period, or beginning and end dates, to be used. Because most paramedic programs are about a year long, we chose a study period of one yearƒspecifically, from Oct.1, 2007, through Sept. 30, 2008. During the study period, 1,111 paramedic programs were registered in the NREMT database.

Next, we wanted to know the average number of paramedic candidates in these programs. It turns out that 379 of those programs didn_t have any candidates attempt the NREMT cognitive exam during our study period. Because these programs wouldn_t help us answer the rest of our questions, we dropped them for this question. (We_ll revisit them later.)

So, 732 programs in the U.S. had at least one student attempt the NREMT exam during our study period. To find the average number of candidates, we simply added up all the candidates who tested during the study period (10,289) and divided that number by 732. The average number of candidates was just about 14, and program sizes ranged from one student all the way to 253 candidates.

To determine if class size is associated with program success, we needed to have something to compare. So, like we_ve done in past articles, we made some categories: small, medium and large.

Because we_re not educators, we needed to proceed with caution. We needed to consult experts in EMS education to determine appropriate category cutoff points. Luckily, we know a few EMS educators with 20 or more years of experience.

After speaking with them, we determined reasonable category cutoff points would be: ten candidates or less for small programs, 11Ï20 candidates for medium-sized programs and 20 or more candidates for large programs. Based on our categorization scheme, the majority of programs were "small" (see Figure 1).

We had our categories in place, but how were we going to measure success? In other words, what was our outcome measure? The success of educational institutions often is judged by the success of their graduates, so we_ll measure success by how paramedic candidates in each category of program size performed on the NREMT exam.

However, we couldn_t just see which programs had the most candidates pass the NREMT exam because that wouldn_t be a fair comparison. It_s very likely that large programs would account for the most candidates who passed, followed by medium programs and then small programs. Therefore, we decided to assess thepercentage of paramedic program graduates who passed their first attempt on the NREMT exam and see if there_s a difference based on our program size categories (see Figure 2).

What We Don't Know

We should mention that this is a national study and that our results may differ from what one might find at the community or state level.

Next, let_s talk about those programs that had no candidates during our study period. In order to register a paramedic program with the NREMT, that program must be approved by the state. It_s likely that these programs were functioning in some capacity. Some that had no candidates take the exam might take longer than a year to finish. (Here_s another good topic for you budding EMS researchers out there: At this time, there_s no good estimate of the average length of paramedic programs in the U.S. or what the appropriate length of a program should be.)

Another explanation for these programs may be that some might provide only continuing education, like a refresher class. Finally, some of them may be authorized to teach at the paramedic level but don_t run classes every year and didn_t have a class during our study period. So, if someone were to repeat this study, it would be a good idea to lengthen the study period.

There_s something else that we just don_t know: Was our categorization scheme adequate? For example, although at least 44 states require the NREMT certification to obtain a state license, others don_t require paramedics to pass the NREMT exam. So a program in one of these states may have had 40 students but only five or six that chose to take the NREMT exam. We would have misclassified that program as small when in fact it was large. This may account for some of those programs that had only one candidate.

Further, in this project we looked only at class size. Many other important variables impact a candidate_s success. Research has shown that such variables as national accreditation, the academic and clinical credentials of the instructors, and numerous other student variables impact the success of a candidate taking the NREMT exam.

If we were to look at all of these variables and include class size, it might show that class size is not a driving factor of success. We also didn_t look at resources, and it may be the case that large programs get more money and therefore have more faculty, admin support, training equipment, etc.

Finally, we presented this information at a national EMS conference and received comments such as, "Why don_t you like small programs?" It_s important to understand that, as researchers, we_re impartial reporters. Unlike those cable news stations, ethical researchers do not choose sides. We didn_t care which program had the better results, we simply used all the information we had to identify them.


It appears from these results that size does matter. Programs identified as "large" using our methods had more graduates pass the NREMT exam on their first attempt, followed by "medium" and then "small" programs.JEMS

Melissa Bentley,BS, NREMT-P, is a research fellow at the National Registry of EMTs and is pursuing her master_s in public health. She_s been involved in EMS for three years.

Antonio R. Fernandez,MS, NREMT-P, is a research fellow for the National Registry of EMTs. He_s currently pursuing a PhD in public health. Fernandez also has experience providing prehospital as well as in-hospital patient care as an EMT-B and a paramedic in urban settings.

Greg Gibson,PhD, PRC, Dr. Gibson is the new research director for NREMT. Greg is an applied sociologist by trade and specializes in survey research, social psychology and gender.\

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Antonio R. Fernandez, MS, EMT-PAntonio R. Fernandez, MS, NREMT-P, is a research fellow for the National Registry of EMTs. He's currently pursuing a PhD in public health. Fernandez also has experience providing prehospital as well as in-hospital patient care as an EMT-B and a paramedic in urban settings.


Melissa A. Bentley, BS, EMT-PMelissa Bentley, BS, NREMT-P, is a research fellow at the National Registry of EMTs and is pursuing her master's in public health. She’s been involved in EMS for three years.


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