Refresher Courses vs. CME

Dear Professor Werfel;

My state has been offering refresher training for many years. They have recently added the option of maintaining the EMT or paramedic credential by way of continuing medical education. I am a new EMT and have only had my card for about a year. What is your opinion of refreshers and continuing education? This will help me make a decision as to which method I will use to refresh.


T. A. Smith


Thanks for taking the time to write. Congratulations on receiving your EMT certification. I m glad you asked this question because many of us have been wrestling with this for a while. Before I give you my opinion on the subject, let s take a look at the advantages and disadvantages of each of these training models.

Refresher Training


  1. The information is delivered to the students immediately before the recertification exam.
  2. It s a quick way of bringing students to a level of minimum competency.
  3. The instructor can be assured that all curriculum items have been covered.
  4. The ability (in some states) to challenge the refresher course. A pretest is given and is scored and perhaps subscored. If the candidate has very high scores in specific areas, the candidate would not be required to attend those sessions in the refresher.
  5. Consistency. (alleged)
  6. Quick and dirty
  7. It allows measurements of all cognitive domains
  8. It produces income for training sites


  1. Very difficult for the instructor to make it an interesting educational experience.
  2. Expensive in both money and time.
  3. Does not demonstrate behavior on actual calls.
  4. Does not require self discipline.
  5. Administered at the level of the slowest student.
  6. Delivers large amount of information in a very short time.
  7. High stress for the student- Must pass or possibility of loosing job.
  8. Tends not to lend itself to case-based education

Continuing Medical Education


  1. Great for self motivated people.
  2. Varied, interesting topics, great for the instructor.
  3. Better long term recall of information, trickling info, rather than dumping in on the student.
  4. More academic based learning.
  5. Allows interested students to pursue other topics of EMS interest/research.
  6. Life long learning.


  1. Requires dedicated physician support.
  2. Requires dedicated employer support.
  3. Requires students and sponsors to be organized (sometimes a very tall order).
  4. Students need a prior knowledge base.
  5. Can be easy to avoid and get credit for attending (honor system).
  6. In undirected CME students tend to gravitate to their interest and not their educational needs.

Mr. Smith, to be honest, that the way that most professions recalibrate individuals is via the CME model. In order to work, the CME model needs specific structure. The requirements need to be topic specific. Dedicated oversight is key. Administrators, physicians and the EMS providers need to be dedicated to the process. There should be mandatory attendance policies (including departments paying their personnel to attend), with flexibility in the topics and times/shifts that they are offered.

I m an unrepentant supporter of the CME model; no other profession I m aware of forces member of that profession to retake their original credentialing exam every three years. The reason why it s hard for EMS to make up its mind on this CME vs. refresher discussion is that EMS — with its predilection for home rule — may not qualify as a profession. While I know this is provocative, look at the Wikipedia definition of the word profession.

A profession is an occupation, vocation or career where specialized knowledge of a subject, field, or science is applied. It is usually applied to occupations that involve prolonged academic training and a formal qualification. It is axiomatic that “professional activity involves systematic knowledge and proficiency.” Professions are usually regulated by professional bodies that may set examinations of competence, act as an licensing authority for practitioners, and enforce adherence to an ethical code of practice.

While I believe that prehospital providers are professionals and that EMS is a profession, it clearly lacks some of the markings of other professions. We can not say EMS is regulated by professional bodies that license or credential the practitioners. Our major problem is that we have 50 states, each with its own ideas of not only how to test and credential EMS personnel, but also how to educate those providers and for how long. Imagine this being true for the aviation industry or for medical doctors. Imagine if commercial aviation pilots were certified by their state of residence instead of industry standards. In New York you could fly an airbus 320 after only 200 hours of training, while in Illinois it took three years of training and an apprenticeship to get to that same point. Who do you want flying the plane you re gonna be on?

It s time for the establishment of a nationwide industry standard in EMS education and once that is done and we know how to train the providers, the question of how to maintain their competence will be obvious.