The following abstract was developed during the 2012 Research Summit and presented at the 2012 NAEMSE Symposium in Orlando, FL.

The Association between Class Size and Cognitive Knowledge of EMT Students Assessed Using EMT Readiness Exam 2

Kelly Wanzek, AAS, Paramedic; Charles Foat, M.Ed., Paramedic; Scott Tomek, MA, Paramedic; Earl Neal, BA Paramedic; Genghis Philip, MA; Alexander Stevenson, BS; Jonathan Studnek, PhD, Paramedic

Introduction: Decreasing financial support from state government has created an environment where academic institutions have seen a need to increase class size. These changes may impact the ability of students to successfully obtain and maintain knowledge. Currently there is limited research assessing the impact class size may have on Emergency Medical Technician (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, an online emergency medical services (EMS) tracking system, between January 1, 2011 and February 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 1-67 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; the likelihood of passing the ERE2 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.