PCRF 2012 Educational Abstracts

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2012 Educational Abstracts (PDF) 203.44 KB

Clinical/Field Experience and Cognitive Exam Success: What Matters for EMT Students?
Author: Elloit Carhart, EdD(c), MHS, RRT, NREMT-P
Associate Authors: Kim D. McKenna, MEd, RN, EMT-P, Greg Cliburn, MA, NREMT-P, Jeff Pollakoff, Louise Briguglio, BA, EMT-B, Josh Salzman, MA, EMT-B, Chris Anderson, MPH, Scott McIntyre, BA

Introduction: The 2009 National EMS Education Standards require EMT students to perform 10  patient assessments during their internships. The FisdapEMT Readiness Exam has a high positive predictive value when evaluated against student success on the National Registry exam. It is not known if EMT clinical/field experience impacts the likelihood of passing cognitive exams.

Hypothesis: Greater frequency of clinical/field skills will improve the likelihood of success on a summative EMT exam.

Methods: EMT clinical/field skills records and student results from the EMT Readiness Exam were retrospectively collected from Fisdap, a national online EMS student tracking system for clinical/field and testing experiences. Study inclusion criteria were: 1) records completely filled out;, 2) student consent; 3) an indication of institutional audit; and 4) cognitive exam attempted within three months of completing internship. The primary outcome in the study was pass/fail on the EMT Readiness Exam. The following predictor variables were examined: total runs, total ALS runs, total skills, total field skills, total clinic skills, observed field skills, observed clinic skills, performed field skills, performed clinic skills, the ratio of observed to performed clinic skills, the ratio of observed to performed field skills, and the ratio of all observed to all performed skills. Within each variable, observations greater than 3 standard deviations above the mean were removed from the analysis. Univariate logistic regression was used to measure the usefulness of each variable as an independent predictor of passing the EMT Readiness Exam, followed by 5 multivariate logistic regression models using various combinations of the associated and noncollinear variables.

Results: For the study, 405 students met inclusion criteria. The total number of skills (observed and performed combined) was the only independent predictor of summative exam success (OR 1.015; 95% CI: 1.002 — 1.028; p = 0.0193). However, ROC analysis showed that total skills provided only a 5% increase in ability to discriminate between student success and failure when compared to random guessing. The remaining variables were less useful in predicting summative exam success.

Discussion: In this sample, clinical/field experience did not drive EMT success on a summative exam. However, requiring completion of these skills might contribute to other areas (e.g. affective domain, employability) important to EMT students and educators.

Is EMS Colorblind?
Author: Heather Davis, MS, NREMT-P
Assoicate Authors: Melisa Martin, MHS, Allen Borck, Education Operations Manager, Franciscan St. Elizabethan Health, Antonio Fernandez, PhD, Mike Bowen

Introduction: A documented achievement gap exists in kindergarten through 12th grade and higher education among minority students, but no data exist to describe how minority students perform in paramedic education programs.

Hypothesis: Paramedic student demographics affect attrition.

Methods: The study included demographic data from paramedic students who opened and maintained accounts in Fisdap, a a national online EMS student tracking system for clinica/field and testing experiences. The data set began in the didactic phase of their program through clinical, internship, and graduation and included data that were verified by faculty between 2001 and 2011.. The outcome variable was graduation status. Independent variables included age, gender, and ethnicity. Any “unspecified” data were excluded since “unspecified” is the default for each category. Ethnic categories of African American, Native American, Hispanic, Asian and Other were combined to create a category called “minority” as only 11% of all respondents identified themselves as any ethnicity other than Caucasian.

Given that a large sample size was expected, alpha was set at 0.01. A chi square was used to determine if the proportion of students who did not graduate differed based on minority status. Logistic regression modeling was used to determine the measure of effect.

Results: Of 4,940 paramedic students included in the study, only 5% did not graduate. Of the 273 who did not graduate, there was no statistically significant difference between minority groups and nonminorities in the categories of age, gender and ethnicity. While not statistically significant because alpha was set at 0.01, the data show that p=0.047 for ethnicity with an odds ratio of 1.44, indicating that nonwhites are 1.4 times more likely not to graduate than Caucasian students.

Conclusion and Discussion: This study failed to reject the null hypothesis. Course completion does not differ with minority status. Previous studies have demonstrated that minority students perform more poorly on the national licensing exam. Entrance into paramedic school often requires successful completion of a standardized test. The EMS workforce is 88% Caucasian male. Further research should be conducted to determine if the low number of minority students in paramedic programs is an access barrier created by the entrance exam or if it might be a recruitment issue based on lack of representation in the workforce.

The Association Between Class Size and the Cognitive Knowledge of EMT Students Assessed Using EMT Readiness Exam 2
Author: Kelly Wanzek, NREMT-P
Associate Authors: Charles Foat, M.Ed, EMT-P, Scott Tomek, MA EMT-P, Earl Neal, BA, EMT-P, Ghengis Philip, MA, Alexander Stevenson, BS, Jonathan Studnek, PhD, NREMT-P

Introduction: Decreasing financial support from state government has created an environment in which academic institutions need to increase class size. These changes might impact the ability of students to successfully obtain and maintain knowledge. Currently there is limited research assessing the impact class size might have on EMT education.

Hypothesis: There is an association between the number of students enrolled in an EMT section and cognitive performance as measured by the EMT Readiness Exam 2 (ERE-2).

Methods: ERE-2 results from a retrospective cohort were collected from Fisdap a national online EMS student tracking system for clinica/field and testing experiences, between Jan. 1, 2011, and Feb. 10, 2012. Participants were included in this analysis if they completed a first attempt at the ERE-2 and were assigned to a unique class section. The outcome variable was score on the ERE-2, dichotomized as pass (>72%) or fail (<72%) as determined by Angoff standard setting. The main independent variable was EMT section size categorized as 1-16, 17-23, and greater than 23 students as determined by a cut point analysis. Other independent variables considered included program accreditation status, race and gender.

Results: A total of 1,289 students from 36 different programs met the inclusion criteria. Section size ranged from 1 to 67 students with a mean of 19. The mean test score was 66%. Frequency of passing the ERE-2 was significantly associated with section size (1-16 students = 23.9%, 17-23 students = 35.9%, and greater than 23 students = 43.9%; p<0.001). Additionally, EMT programs affiliated with nationally accredited paramedic programs were associated with a higher pass rate (accredited 36.9% vs. non-accredited 27.9%; p<0.001). When controlling for race, gender and accreditation status; the likelihood of passing the ERE-2 was 2.5 (95% CI 1.8 -3.4) times greater for students in a section size greater than 23 when compared to those in a section of 1-16 students.

Conclusion: There was an association between section size and students”˜ cognitive performance on the ERE-2 based on class size. Specifically, the highest pass rate was found among students in a class section greater than 23.

When Is a Paramedic Student a Competent Team Leader?
Author: Keith Widmeier, NREMT-P, CCEMT-P, BA
Associate Authors: Marchal Washick, NREMT-P, James Dinsch, MS, NREMT-P, Mike Mayne, BS, NREMT(c), Steve Asche, MA, Todd M. Cage, M.Ed., NREMT-P

Introduction: The 1998 Paramedic National Standard Curriculum recommended students serve as a team leader at least 50 times. As EMS education transitions to a competency-based approach, it becomes imperative to identify the point at which paramedic students have demonstrated competency. The National Registry of EMTs Paramedic Psychomotor Competency Portfolio Package Project defined team leadership competency as student success in 18 out of their last 20 attempts.

Hypothesis: Student success as a team leader on 18 out of the last 20 eligible runs is a reliable predictor of continued team leadership competency.

Methods: Five paramedic programs that used Fisdap, a national online EMS student tracking system for clinica/field and testing experiences Fisdap  and participated in the NREMT Paramedic Psychomotor Compentency Portfolio Package Project were identified. Deidentified data from all students who had team lead records completed by both the student and preceptor were collected. IRB approval was obtained from Inver Hills Community College [location?]. The data weres placed in contingency tables and association was tested using a Pearson chi-square test.

Results: The initial sample consisted of 439 paramedic students who operated as a team leader. Of those, 126 (28.7%) students with fewer than 20 attempts were excluded leaving 313 eligible students who had completed 20 or more team leads. Of the remaining students, 96.2% (301/313) were deemed successful by their preceptor in 18 out of their last 20 attempts. Of those, 100 (33.3%) met this goal in their first 20 attempts, while 181 (60.1)% of students achieved competency by their 50th attempt. Analysis of students who attempted team leads after reaching initial competency showed students maintained the minimum 90% competency 87% of the time. [double check all the numbers; I had to back into some of them but the standard is number with % to one decimal point in parenthesis.)

Conclusion: The standard of success in 18 out of the last 20 attempted team leads is a reliable predictor of continued student competency. Students may need more than the previously recommended 50 attempts to reach competency so programs should provide for sufficient team leadership opportunities.

Development and Critical Appraisal of a Global Rating Scale for the Assessment of Paramedic Clinical Competence
Author: Walter Tavares, EMT-P, BSc., PhD(c)
Associate Authors: Walter Tavares, EMT-P, BSc, PhD (c), Sylvain Boet, MD, MEd., Rob Theriault, CCP, B.HSc., Tony Mallete, EMT-P, BSc, Kevin Eva, W. PhD

Introduction: The assessment of paramedic clinical competence in simulation and work-based settings often requires the use of global rating scales. However, evidence supporting construct validity of a paramedic specific global rating scales is lacking. The aim of this study was to develop and critically appraise a scale for the assessment of individual paramedic clinical competence from entry to practice level.

Methods: This study involved a development phase and a critical appraisal phase. The development phase involved task analysis by experts, contributions from a focus group and a modified Delphi process using a national expert panel to establish evidence of content validity and create a global rating scale. The critical appraisal phase had two raters independently apply the global rating scale developed in the first phase  to a series sample performances from three groups: novice (G1), entry to practice (G2), and experienced paramedics (G3). Using data from this process, content validity, discriminant validity and reliability were tested as evidence of construct validity.

Results: The development phase resulted in a 7-dimension, 7-point adjectival global rating scale. Eighty-one recorded sample performances (n = 25 in G1, n = 33 in G2, n = 23 in G3) were scored by two independent blinded raters using the scale. Overall reliability, inter-rater and test-retest reliability calculated using generalizability theory reached 0.87 and 0.92 and 0.95, respectively. Inter-rater-reliability ranged from 0.69 to 0.88 across dimensions. Inter-item correlations ranged from 0.62 to 0.93. Item-total correlations ranged from 0.74 to 0.92. Rater contributed less than 1% of the total variance. Global rating scale scores assigned to each group were significantly different (F = 29.483, 2df, p = < 0.001). Applying a borderline group method, 80% of G1, 36% of G2 and 30% of G3 scored below the cut score on one or more dimensions.

Conclusions: The results of this study provide evidence of construct validity for this global rating scale. In the proper context, this scale could be used for the assessment of paramedic clinical competence.

Paramedics Cognitive ACLS Skills Might Not Require Practice
Author: Rodney Brouhard, BBA, EMT-P
Assoicate Authors: Scott Bourn, PhD, Suzan Kardong-Edgren, PhD, Tamara Odom-Maryon, PhD, Lena Rohrbaugh

Introduction: Limited research addressing cognitive knowledge and retention of ACLS by medically trained professionals is available. Retention of ACLS skills may differ between professionals such as paramedics who use ACLS regularly and health care providers who infrequently perform ACLS. Reported here are the preliminary findings from a study looking at the effects of brief monthly practice on ACLS skills in paramedics.

Methods: Paramedics were recruitedand then completed a refresher ACLS course, followed by a baseline assessment of skills using a digitally recorded and scored modified ventricular fibrillation megacode pretest scenario. Participants were then randomized to one of two groups: monthly practice (10 minutes per month for 10 months) or no practice. Practice scenarios were created using Laerdal ACLS Microsim modules gaming software and were completed by the monthly practice group only in their ambulances during down time between calls. Both groups returned for a digitally recorded post-test bradycardia Megacode scenario in month 12.

Results: Immediately following the refresher course, 52 (77%) of the monthly practice group (n=67) and 54 (89%) of the control group (n=61) satisfactorily completed the post-test. Of the 128 participants, 53 (41.4%) completed the post-test 12 months later. Of the 53, 34 (64.1% were in the practice group and 19 (35.9%) were in the no-practice group. Despite not having monthly practice sessions, the percentage of participants in the no-practice group that satisfactorily completed the 12 month posttest Megacodes was similar to the practice group (79% vs. 82%, respectively). Participants satisfactorily completing the pretest, but failing the post-test megacode included 4 (11,7%) practice group and 3 (15.8%) no-practice group participants. Five (14.7%) in the practice group failed the pretest megacode, but with monthly practice were able to pass the post-test megacode.

Conclusions: Monthly cognitive practices of ACLS cognitive knowledge does not improve paramedic performance on megacode performance. Further study is required to understand the relationship between regular clinical practice and education on paramedic cognitive knowledge retention.

The Importance of Factors Related to Selection of Continued Education in EMS
Author: Jennifer Eggerichs-Purcell, MS, CHES, NREMT-P
Associate Author: Melissa A. Bentley, MS, NREMT-P

Introduction: As stated in the Education Agenda for the Future: A Systems Approach, sponsored by the National Highway Traffic Safety Administration,  EMS continuing education  and continued competency assurance are integral parts of a comprehensive educational system. The objective of this study was to describe the importance of factors related to the selection of continuing educationamong a national cohort of training officers.

Methods: In 2011, an online questionnaire was sent to all training officers in the National Registry of EMTs’ database. Respondents were asked to rate the importance of 10 items with respect to the selection of continuing education on a 10-point Likert Scale (very unimportant=1 to fery important=10). The distribution of continuous variables was assessed with the Shapiro-Wilk test. Descriptive statistics were used to summarize each item.

Results: Of the 4,956 people who received the survey, 2,528 (51.0%) responses were obtained. All continuous variables were found not to be normally distributed (Shapiro-Wilk, p-value>0.05). When comparing the importance of factors related to the selection of continuing education topics, errors in patient care found during run reviews, new protocol implementations, and new standards such as American Heart Association changes were considered the greatest factors in the selection of CE topics (Table 1).

Table 1: Importance of Factors Related to the Selection of CE in EMS Continuing Education Programs




Std. Dev.

Errors in patient care found during run reviews




New protocols




New standards such as AHA changes




Topics in state requirements




Topics in national requirements




New technology




Readily available materials




Low cost educational materials




Low frequency type calls




Other materials




Conclusion: Continuing education is the cornerstone of EMS progression (NAEMSE, 2003). This study shows training officers are taking steps to ensure that EMS professionals are informed of current and up-to-date practice changes. Further studies should focus on understanding how topic selection impacts continuing education.

Training Officer use of Continuing Education
Author: Jennifer Eggerichs-Purcell, MS, CHES, NREMT-P
Associate Author: Melissa A. Bentley, MS, NREMT-P

Introduction: Currently, little evidence exists that describes continuing education  on a national level. The objectives of this study were to describe the state of continuing education throughout the United States and to estimate the association between the number of hours training officers spend developing, delivering and accounting for continuing education and the amount offered and required by EMS services.

Hypothesis: There is an association between the amount of hours spent developing, delivering and accounting for continuing education and the offered and required amount of hours in EMS education.

Methods: In 2011, an online questionnaire was sent to all training offices in the National Registry of EMTs’ database. Specific items assessed the amount of CE hours offered monthly, CE hours required annually, pay status for providers who attended continuing education, and amount of hours training officers spent on the creation and utilization of continuing education. The distribution of continuous variables was assessed with the Shapiro-Wilk test. Descriptive statistics and Spearman correlations were calculated.

Results: In all, 51.0% of the people contacted responded to the survey (2,528 out of 4,956). All continuous variables were found not to be normally distributed (Shapiro-Wilk p-value>0.05). The median hours of continuing education offered monthly was 6 (SD=31.81, range=0-600). The median hours of continuing education required annually as set by individual services was 24 (SD=36.49, range=0-720). The majority of individuals received continuing education while paid on duty (42.0%), followed by personal time without pay (23.7%), other status (15.4%), outside of regular hours on over-time (10.4%) and outside of regular hours being paid straight time (8.5%). There were small but significant correlations between the amount of time used in developing and implementing continuing education produced and the amount of EMS education offered monthly (r=0.250, p-value<0.001) and the annual required hours set by individual services (r=0.167, p-value<0.001).

Conclusion: The National Association of EMS Educators states that continuing education is a valuable and essential component of assuring competent, efficacious, and contemporary patient care (2003). Monthly [?] paramedic CE standards proposed by the National Highway Traffic Safety Administration and the NREMT recommend 24 to 36 hours and 72 hours respectively. This study estimates that a minimal amount of continuing education is being offered. Further studies should focus on understanding this relationship [what relationship?].

A Novel Technique for Analyzing Paramedic Students’ Concept Maps
Author: Laura A Carhcart, MA, BS, EMT-B

Introduction: Concept mapping is a technique for graphically expressing relationships between ideas or objects, known as concepts, using linking lines or arrows that are labeled, known as propositions.

Objective: This study examines the use of knowledge space theory (Folmagne & Doignon, 1988) as a novel method of analyzing paramedic students’ concept maps.

Methods: The students studied were participating in an accelerated one year paramedic program at a community college. The researcher trained the students on the use of IHMC CmapTools (http://cmap.ihmc.us/), a free concept mapping software. The researcher and instructor selected two topic areas for the students to draw concept maps: (the autonomic nervous system and diabetes) and generated lists of concepts for students to include in each of these maps. The students were assigned two concept maps, one each semester. The researcher and the instructor used knowledge space theory (Folmagne & Doignon, 1988) to systematically analyze and compare the concept maps drawn by the students to the instructor’s predicted concept map for each topic.

Results: Using this analysis method, the study revealed students’ level of understanding of course material, and identified students’ alternative conceptions. The analysis method produces a composite concept map that graphically depicts both qualitative and quantitative data.

Conclusion: Surveys indicated the students found concept mapping assignments helpful as a study tool. When interviewed, the instructor felt that using this technique to analyze students’ concept maps was a valuable pedagogical tool because it informed his teaching practice.

Graduate Research in Emergency Medical Services Education
Author: Kim McKenna, M.Ed., RN, EMT-P

Introduction: As early as 1997, authors noted the lack of Emergency Medical Services (EMS) research. This study sought to describe the quantity and nature of dissertation and thesis research related to EMS education. The findings may contribute knowledge to the scanty research in this field and provide an anthropological analysis of key issues that emerged during its development.

Methods: A search of ProQuest Dissertations & Theses A&I was conducted to identify EMS education dissertation research. Dissertations and theses were selected only if they related to education and either the abstract or the posted sample contained the term emergency medical services, prehospital, paramedic, ambulance or emergency medical technician (EMT). Search terms that yielded fire and education were not included if it was not explicit in the abstract that the fire agency, research subjects or population target included EMTs, paramedics or EMS. The abstracts identified were searched to determine the earned degree; educational institution conferring the degree; topic and type of research methodology. When the abstract failed to provide sufficient information, the preview was also reviewed. The full papers were not available.

Results: Ninety-four dissertations and theses published from 1974 to 2011 were identified from 61 colleges and universities in the United States and Canada. The authors included 20 who earned masters and 64 doctoral degrees. No school published greater than two doctoral dissertations in the targeted area. Of this sample, research methodology involved literature review (2), model development (1), case study (3), qualitative (25), quantitative (44) or mixed methods (14). In 18 cases, an experimental or quasi-experimental study was apparent, although sampling procedures were rarely available.

Discussion: Given the broad nature of EMS education, ninety-four EMS education theses dissertations spanning 37 years is sparse. More detailed investigation is needed to elaborate on this information. Of interest is the lack of concentrated EMS education research at any one institution. Perhaps as more doctoral researchers in EMS education emerge, mentorship in this area will increase and a center of research excellence in EMS Education will evolve.

Childlike Wonder: The Current State of Paramedic Student Pediatric Clinical Education
Author: Gordon Kokx, MS, NREMT-P
Assoicate Authors: Sandi Wewerka, MPH, Thomas Brazelton, III MD, MPH, Gabe Romero, MBA, NREMT-P, Kate Hanson, BA, NREMT-P, Laura Holyoke, PhD, Sherman Syverson, MS, NREMT-P

Introduction: The 1998 DOT NSC recommends 30 pediatric patient encounters of various age groups. The NEMSE Standards require “competency” in caring for pediatric patients. No research exists evaluating the current state of paramedic student pediatric clinical experiences.

Methods: This study was designed as a retrospective review of student records from FISDAPâ„¢, a national database of prospectively reported internship experiences. 313,211 pediatric encounters, submitted from 9,152 students between 2001-2011 met the inclusion criteria: 1) graduated from paramedic program, 2) verification of reported data, and 3) student provided consent for research. Pediatric encounters were evaluated based on age, location (rural, urban, suburban), and pathology (medical, trauma).

Results: Descriptive statistics and chi square tests revealed significant differences in the types (clinical, field, lab), locations, and pathology of pediatric patients being experienced during their encounters. Our results indicate that as the age of the pediatric patient increases, paramedics report more encounters regardless of specific setting or pathology. (See Table 1).

Conclusion: Paramedic students average 33 pediatric patient contacts with highly variable settings, ages, and pathologies. Creative methods appear needed to increase access in all categories of pediatric clinical encounters in order to ensure student competencies

Table 1:                                                Settings                                                                                               Pathology






% of Total Settings



% of Total Pathologies




























School Age






























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