Airway & Respiratory, Cardiac & Resuscitation, Columns, Patient Care

How to Prepare for the Big One

JEMS.com Editor’s Note: This is the second article of a two-part series on studying to become an EMS provider. For more general study tips, read the first article entitled: “How to Study for Success in EMS.”

For most EMS students, the exam with the highest stakes is the final registration examination — and for most EMS students in the U.S. that means the National Registry of EMTs (NREMT) computer adaptive test.

For this exam — as for any test — the key to success is to know and to understand the material. Period. But you can take certain steps to prepare for this “mother” of all exams.

Review the materials provided on the NREMT Web site. This will give you specific information related to the test.

Practice taking tests in a similar format. Instructors can deliver tests that will only allow you to see one question at a time. These tests often also have a running timer clock on the screen. Adapting to these seemingly small things can help to diminish unnecessary anxiety the day of the test. Tests available for a fee can help to predict your success on the registry examination and help you target weak areas so you can focus your study time.

The NREMT exams cover airway, medical, trauma, OB/pediatrics, cardiovascular and operations. Prepare for all sections of the test. Failing to study for the operations section so you can spend extra time studying cardiovascular could be a critical error.

Make your first attempt your best. Taking the test “just so you can see how you do” is never a sound strategy. The test will be different each time, and the personal cost in terms of time, money and anxiety will be greater with each subsequent attempt.

Keep your eye on the prize: Remind yourself why this is important to you. Your motivation will be critical to ensure adequate preparation.

Develop a study plan: A schedule allows you to devote sufficient time to prepare. Cramming is NOT effective. Divide your time into manageable blocks so you can study properly. Set goals and include “rewards,” such as exercise, if you meet your goal.

Identify effective study strategies: These will vary depending on whether the material requires memorization, application or problem solving. Study skills will vary by student. See part I of this article to review more specific general study strategies.

Focus on understanding: The licensure exam has many questions that require you to apply your knowledge or to solve problems. You must understand what you’re doing, why you’re doing it, when to do it and how. In addition, you must understand the pathophysiology behind each sign, symptom and intervention.

Monitor your study effectiveness: At the end of each section ask yourself, “Did I really get it?” If the answer is no, you may be in the wrong place to study or you might be using the wrong strategy. Just because you’ve spent time studying doesn’t mean you know the material. Don’t waste your time; study effectively!

Control the environment: Get enough sleep the night before the exam. Take the test at the time of day when you know you’ll be at your best. Take care of your physical needs before the exam. Eat a small meal and go to the restroom before testing. You don’t want to be distracted by little things.

During the test: Treat each question as if it’s the last. Don’t rush. Read each word in the stem (introduction) of the question carefully. Professionally written examinations avoid using unnecessary words. If the word is in the question, it’s there for a reason. For example, the patient’s age is often an important clue. Difficulty breathing in a 6-month-old patient has very different causes than in a 72-year-old patient. Pay careful attention to words that can modify the meaning or priority of the answers. Words such as “best”, “first” or “most important” can help you distinguish between two or three choices (distractors) that look correct but aren’t so you can pick the “best” answer.

Try to read the question (stem) first to see if you can think of the answer before you read the distractors. If none of the answer choices presented in the question match the one that you thought of, or if you have no idea what the answer is, go back and reread the question. Break the problem (stem) into small pieces and be sure you understand what the question’s asking. For example, when you carefully reread, you may notice that you missed the fact that your patient’s heart rate was very slow. That could be the clue you need to solve this problem! If you carefully reread the question and still can’t pick out the right answer, try to rule out answers that you know for sure are wrong. That may at least increase your odds of getting the question right.

Don’t forget the priorities of care when you choose an answer. If two answers one that involves treating airway and the other breathing — are attractive, the former may be correct if the question asks you to choose the intervention that you should perform first. That said, don’t just blindly choose answers that include airway. Answer the specific question being asked.

For many EMTs, AEMTs and paramedics, the registry examination is the final stop on the journey to a new career. Current research shows factors related to your EMS program, your instructors, and your field and clinical experience play critical roles in your success on the final exam. However, you play the final — and most important — role in preparing for this test. Give it the attention it deserves. Your future depends on it.