Authors: Mark Malonzo, MA, NRP; Leah Tilden MA AEMT; Felix Marquez BA NRP; Sara Walker, MS, EMT-P; Jonathan Willoughby, PhD(c), NRP; Nancy Hoffmann, MSW; Tiffany Sliter, BS; Michael Shoulders, AS, NRP; Jose Palma, PhD(c)

Research Questions: Is there a difference in NREMT cognitive pass rates between traditional and flipped classrooms within the institution?  Is there a difference in NREMT cognitive pass rates between national and individual programs?  Is there a difference in exam scores between flipped classrooms and the national Fisdap scores in 2017?

Introduction: A flipped classroom model is based on out-of-class learning for core content followed by in-class application-level activities.  Flipped classrooms are thought to enhance learning through interactive activities among instructors and peers.  Data from a 2016 pilot study found a marginal increase in NREMT cognitive exam scores in a flipped OB module.

Hypothesis: Flipped classroom students will score higher on cognitive exams than traditional EMT students.

Methods: Four geographically different EMT programs self-identified to utilize a flipped classroom delivery for the entire EMT class. Students took the unit exams and ERE2. Upon completion of the course, students also took the NREMT cognitive exam. Nonparametric bootstrap tests were used to determine differences in the mean achievement scores between students from flipped classrooms and traditional using different measures. For each measure, a Monte Carlo p-value was computed using 4999 bootstrap duplicates from the data. Each p-value computed is a corrected p-value using the suggestion by Davison Hinkley (1997).

Results: Data from 51 students were included in the study. Nonparametric bootstrap tests found pvalues were statistically significant all unit exams and the ERE2. For each of the measures, this is evidence against the null hypothesis of no mean differences, and suggests that students from flipped and non-flipped classrooms may differ in each measure. EMT students in the flipped classroom also had higher cognitive scores than national averages on the NREMT cognitive exam.

Conclusion: Flipped classroom students had higher scores than the national NREMT cognitive exam average. These flipped classroom students also had significantly higher scores on all 6 unit exams and the ERE2. While further research with a larger geographic distribution and number of participants is needed to generalize these findings, these results align with evidence from other disciplines suggesting that EMT students have higher cognitive competency in a flipped classroom setting.