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Assessing the Competency of EMS Educators

Assessing the Competency of EMS Educators

For many years, it has been a given that it is the job of the EMS educator to evaluate and verify the competency of his or her students. This came to the forefront when EMS stakeholders across the nation moved from an hours based educational system to one that was based upon competency or not. It fell to the instructors to determine competency prior to being sent to the NREMT for testing. With first time pass rates lower than what might be considered adequate and an ever increasing job shortage of paramedics in certain parts of the country, it is imperative that educators are doing the best job that is possible in ensuring that their students are success on the state and/or national certifying exam. This research study, completed as part of my doctoral program looks at whether this is indeed true or not, at least from the evaluation of psychomotor skill evaluation.

According to Limmer (2009a), the education of EMS providers has undergone a dramatic transformation from its inception in the late 1960s until today.  In the past, the determination of whether a paramedic student was competent or not had been based upon the completion of approximately 1200-1600 hours of didactic, clinical, and field internships while taking a formal emergency medical technician (EMT) or paramedic course (Dawson & Brown, 2003).  Again, Limmer (2009b) observed that the required number of hours ranged from approximately 120 hours for the EMT to well over 1200 hours for the paramedic.  Beginning in the mid-1990s, there was a call for a change in the method of prehospital provider education.  This change initiated the transition of the competency criteria from required completion of a class to performance-based skill verification confirmed by an EMS instructor (O’Meara et al., 2012).  That is, the basis for competency changed from hours in the classroom to verification of skill competency. 

It was not until January of 2013 that this transition was achieved, as the National Registry of Emergency Medical Technicians (NREMT) began to mandate that schools that provide any level of EMS instruction that resulted in initial certification and verification of competency determined by the completion of an identified set of skills.  This determination of competency was opposite to the previous method that called for a prescribed number of hours in class (NREMT, 2012).  Along with the change in determining student competency, EMS education transitioned to alignment with the educational standards and guidelines.  Students must be evaluated as competent in order to complete the program successfully and sit for the national licensing exam.  This method of evaluation was new to the vast majority of EMS educators.  As a result, many have resisted this change.  One theory for the resistance is that many educators did not take the time to understand the scope and meaning of this change (Limmer, 2009b).  To add to this resistance, there has been little to no documentation published and a lack of published, peer- reviewed studies on this topic regarding the quantifiable evidence that EMS educators use to identify competency in their students.  This study will examine the ability of EMS educators to identify the competency level of EMT and paramedic students.

The EMS Education Agenda for the future standards are the foundation upon which paramedic education currently exits.  “The Standards define the competencies, clinical behaviors, and judgments that must be met by entry-level EMS personnel to meet practice guidelines defined in the National EMS Scope of Practice Model" (National Highway Traffic Safety Administration,  2009).  These new standards are made up of four distinct, interactive modules: competencies, competency knowledge, clinical behaviors/judgments, and educational infrastructure. The standards offer a general framework so that individual EMS educational programs will be able to develop specific curricula to meet the customized training and educational needs in particular regions of the country.  In addition, the fluid nature of this format allows for alterations when research supports changes in the scope of practice based on new medical evidence or when standards of care change.

These new standards required educators to identify competency in new EMS students.  In the past, educators have been seen as central to the delivery and verification of this competency.  However, in today’s educational arena, the principles of andragogy (Knowles, Holton, & Swanson, 2015) and the success that the implementation of these principles with the adult learner results in is paramount.  This emphasis on the role of andragogy is seen in that adult EMS learners want to know, explicitly how their education will lead to the accomplishment of their goal of becoming a paramedic. In other words, the adult paramedic students wants to ensure that he or she is not wasting time on items that they may consider irrelevant to their education.  The important aspect of the educator here is the role that they play in ensuring that the student understands the importance of all EMS educational content that is being delivered.  Failure to provide this explanation to the student may result in students who are disengaged and who will, often unnecessarily, struggle with the content.   As a result, it is necessary to develop quality controls to ensure the identification of the EMS skills of students as they progress towards more complicated competencies. 

One of the greatest challenges facing EMS education is the teaching of the critical thinking skills necessary to apply EMS skills in the field.  In addition, as EMS educators continue to be asked to do more in the area of competency assurance, many are unprepared by failing to utilize the latest teaching methods of competency verification (Salzman et al., 2007).  Prior to 2013, EMS instruction had been more focused upon rote memorization, the regurgitation of facts and figures, as well as the successful completion of multiple-choice exams that assessed the lowest level of Bloom’s Taxonomy of Educational Objectives—knowledge.   These training methods are not adequate to ensure adequate prehospital care (Salzman et al., 2007).  It has not been clearly established how best to deliver and assess students’ critical thinking skills, a competency that is essential for prehospital care (McManus & Darrin, 1976).  As a result, many, if not most, EMS educators have a weak grasp of adult education theory and process.  This statement is not to be viewed as derogatory, but rather a fact (Russ-Eft, Dickison, & Levine, 2005).  There are many EMS educators who became highly-skilled through trial and error rather than by an organized design following adult educational theory.  That is, they were self-taught (Lorenzo & Abbott 2004).

It is the responsibility of the EMS educator to ensure that prehospital emergency medical services providers can competently assess, diagnose, and treat patient illness and trauma.  As a result, it is imperative that EMS educators teach competent medical practice and understand the critical degree of importance of their competency in the delivery of EMS education to the adult student. Failure to deliver effective EMS instruction is detrimental to the student and requires them to complete additional hours of education to obtain their licensure at additional personal expense of time and money.  In addition, failure to provide consistent and effective EMS training causes a breech in the public trust among the EMS professions (Pollock et al., 2014).

I completed a study that addressed a gap in the literature regarding the ability and effectiveness of EMS educators to evaluate student competency.  This measure sought to assure quality treatment standards which are essential regardless of location.  Quality treatment controls were established by a consistent nationwide curriculum for all states (Katzer et al., 2012). As a result, all EMS providers who have had the correct training in emergency medicine were deemed competent by instructors who have been identified by their respective state boards of oversight as proficient in the identification of student competency. 

In part two of this blog posting, we will take a look at the results that determined whether EMS educators are competent or not in evaluating psychomotor skills. 

About the author:

Bill Young began his EMS career in 1975 with a small fire department near Williamsburg, KY. They began running first responder calls long before the phrase ever existed. In addition to Kentucky, his career has taken him to Tennessee, Colorado, Georgia, and Kansas. He has served as a street medic, training officer, supervisor, state regulator, and educator. He is enrolled in the University of the Cumberlands where he is seeking a doctorate degree in education. Currently, he is an Assistant Professor and the Program Director at Eastern Kentucky University in the Fire and Paramedicine Science Department.



Dawson, D., & Brown, B. (2003). Assessment of nationally registered emergency medical technician training in the United States: the LEADS project. Prehosital Emergency Care Journal, 7(1), 114-119.


Knowles, M. S., Holton, E. F., & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development. Abingdon: Routledge.


Limmer, D. (2009a, September). Charting a new course; an introduction to the new EMS education standards; Part 1. EMS World, 9(9), 27-32.


Limmer, D. (2009b, October). Getting down to details; an introduction to the new EMS education standards; Part 2. EMS World, 9(10), 47-51.

Lorenzo, R. A., & Abbott, C. A. (2004). Effectiveness of an adult-learning, self-directed model compared with traditional lecture-based teaching in out-of-hospital training. Academic Emergency Medicine, 11(1), 33-37.  

Mcmanus, W., & Darin, J. (1976). Can the well trained EMT-paramedic maintain skills and knowledge?  Journal of the American College of Emergency Physicians, 5(12), 984-986

National Highway Traffic Safety Administration (2009a). The National EMS Education Standards. (DOT Publication No. DOT HS 811 077E). Washington, DC: U.S. Government Printing Office.

National Registry of Medical Technicians (NREMT).  (2012). About NREMT examinations. Retrieved from

O'Meara, P., Acker, J., Munro, G., Menzies, N., Rae, J., & Woolard, M. (2012). Enhancing the leadership and management competency of paramedics. Journal of Paramedic Practice, 2(6), 22-35.

Pollock, M. J., Brown, L. H., & Dunn, K. A. (2014).  The perceived importance of paramedic skills and the emphasis they receive during ems education programs. Prehospital Emergency Care, 1(4), 263-268.

Russ-Eft, D. F., Dickison, P. D., & Levine, R. (2005). Instructor quality affecting emergency medical technician (EMT) preparedness: a LEADS project. International Journal of Training and Development, 9(4), 256-270. 

Salzman, J. G., Page, D. I., Kaye, K., & Stetham, N. (2007). Paramedic student adherence to the national standard curriculum recommendations. Prehospital      Emergency Care, 11(4), 448-452.

Published on February 28, 2017

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