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

Clinical / Field Experience and Cognitive Exam Success: What Matters for EMT Students?

Elliot Carhart; 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 ten patient assessments during their internship. The Fisdap EMT Readiness Exam (ERE) 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 ERE were retrospectively collected from Fisdap, a national, online emergency medical services student tracking system. Inclusion criteria were:  1) complete records, 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 ERE. 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 ERE, followed by five multivariate logistic regression models using various combinations of the associated and noncollinear variables.

Results: 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.