The
Exam Committee, which was formed in 1987 by the Board of Maine
EMS, consists of nine members: a representative from each
of Maine's six regions, a Board member, a Lead Instructor-BLS
representative, and a Lead Instructor-Paramedic representative.
The Committee is assisted by a MEMS staff member. We meet
monthly, and look at all issues relating to EMS licensure testing
in the state of Maine. The Committee thought EMS providers in the
state might be interested in reading about some of the work we do
and who we are.
After
many, many months of work on the Exam Administrators
Manual, we were very excited in April of 2003, when we finally
finished a full revision. (The Manual had been first published in
1990, and had only received minor updates since.) We then
distributed a CD version of the revised Manual to each of the
state's six regions, who are responsible for licensure testing,
and we also had it uploaded to the MEMS Web site.
The
revision of the Exam Administrators Manual contains not only
instructions for Exam Administrators themselves, but also
valuable information for instructors who want to prepare their
students well for the testing experience, and students who want
to know what to expect during their licensure testing. In
addition to the body of the manual, there are several appendices
such as the current MEMS Functional Position Description, ADA
policy, the Maine EMS licensure application form, some of the
National Registry applications, and a whole host of other
valuable resources.
We
also placed on the MEMS Web site downloadable, printable
copies of the MEMS practical exam skill sheets. This means
that anyone can, at any time, have access to the most current
skill sheets for all licensure levels.
In
October of 2003, the Exam Committee hosted a day-long meeting
with Bill Brown and Greg Margolis of the National Registry of
EMTs. The purpose of this meeting was to update us on the
Registry's plans for the future, as well as to answer our
questions about how the Registry's exams are generated and
scored, and the philosophy of the Registry.
Brown
began his presentation with an explanation of the NREMT's
history, accreditation, and mission. He then described how
Registry exams are developed, covering, among other things, how
the decision is made about the number of questions to include
from each curriculum area, how each question is written and
evaluated, how the tests are piloted and reviewed, and how scores
are determined. He finished his formal presentation by describing
some of the possibilities under consideration for the future,
with quite a lengthy discussion of Computer Adaptive Testing. He
concluded with a question and answer session.
Eighteen
people, including the Exam Committee, members of the Education
Committee, MEMS, regional offices, and other interested parties,
attended. Based on this meeting and discussions which followed,
the Exam Committee brought to the MEMS Board the recommendation
that Maine EMS should continue to use National Registry testing
for licensure at the EMT-B and First Responder levels.
As
an interesting side note, in March Bob Hawkes, one of our
Committee's members, went to Columbus, Ohio to participate in an
EMT-B test-item writing session run by the National Registry. He
shared information about this process not only with Exam
Committee members but also with Maine's Instructor/Coordinators
in an article in the Spring issue of the Maine EMS I/C News.
Bob was the second Maine instructor to go to an item writing
session; Jacky Vaniotis went for a similar session in 1995, when
the National Registry was developing its first bank of questions
for the First Responder National Registry exam.
A
question that came to the attention of the Committee some months
ago was whether successful completion of the National Registry of
EMTs Intermediate exam (I-99) should be accepted as meeting state
testing requirements for persons seeking licensure as EMT-Intermediates
in Maine. After reviewing Maine's EMT-Intermediate curriculum,
MEMS' EMT-I exam, the DOT's EMT-I curriculum and the National
Registry's EMT-I (1999) exam, and after much discussion, the
Committee at its January 2004 meeting accepted the National
Registry I-99 exam as meeting state licensure testing
requirements at the Intermediate level. This allows essentially
two pathways to intermediate licensure: the state exam and the
National Registry exam. This change will, as a side effect, also
streamline the process for nationally registered candidates from
out of state who are seeking reciprocity.
Ask
anyone in EMS how to control bleeding, and you will get the
standard answer: direct pressure, elevation, and pressure points.
In the spring of this year it was brought to our attention that
the DOT 1994 EMT-Basic National Standard Curriculum includes
another step. In the event of continued bleeding after direct
pressure and elevation, the NSC directs the removal of the
dressing, assessing for a bleeding point, and applying direct
fingertip pressure specifically to the bleeding site. Because not
all textbooks mention the removal of the dressing once it is
placed, and in fact some go so far as to discourage that
practice, the question was asked whether there was a discrepancy
between the state test and the nationally recognized curriculum.
The
Committee reviewed the National Standard Curriculum, the MEMS
Examination Skill Sheet, and the instruction sheets for testers
in the Exam Administrators Manual. We came to the conclusion that
the language in the testing sheet is general enough that it does
not need changes. We did feel, however, that it was worth adding
instructions to testers that some candidates may add this
additional step, and that this shall be accepted as an
appropriate method of bleeding control. The Committee also
reminded instructors via the MEMS I/C News that MEMS
follows the NSC in all areas, especially those in which there is
a discrepancy among other published sources.
At
its May 2004 meeting the Committee studied five years' worth of
EMT-Basic practical exam scores in an effort to calculate pass/retest/fail
rates. The Committee's thinking was that if it turned out that,
as is popularly believed, "nobody fails the MEMS practical
exam," then we would need to consider the value of
continuing this process.
What
the Committee found was that, while approximately 94 percent of
candidates do pass the practical exam, between five and
six percent do not, and approximately 20 percent of those
who do pass do so only after retesting on one station. Our
study found that the highest station failure rates came from
splinting, spinal immobilization, and assessment, but that there
were failures in all stations.
The
Committee decided to use this study as an opportunity to begin
doing quality improvement monitoring on our practical exams on a
regular basis. We will begin by looking at the spinal
immobilization station, which was the station that had the
highest number of retests. During our first review, which we will
begin this fall, we will monitor all spinal immobilization
results, pass and fail; later in the year we will look at all
assessment stations, and continue going through the exam, looking
at a different station during each review. We will use this data
to make improvements in our exams in the future.
The
Exam Committee is spearheading an effort to put together a web-based
student handbook which will consist initially of a letter from
the MEMS director, the MEMS mission statement, ADA paperwork,
Clinical Behavioral Objectives, criminal conviction statement,
EMS functional position descriptions, written and practical exam
information and applications, preceptor guidelines, and a
statement of understanding for students to sign. This handbook,
once it is completed, will be easily updated, so that it will
always be current, and will be available on the MEMS web site.
Another
issue the Exam Committee is looking at is the options available
for replacing or updating Maine EMS's Paramedic exam. This
discussion is quite likely to be a long and involved one.
Included for consideration will be an analysis of data from
recent tests, a look at procedures used by other states and other
entities, a look at computer capabilities, availability of
testing sites statewide, and so on. All possibilities are
currently on the table, including having the Exam Committee write
its own test, having the state hire a writer, purchasing the exam
from an already-existing test-generating company, using the
National Registry exam, not making any changes at all, and other
options. This will be an ongoing discussion, one that will
require much research and which will take many months to complete.
We
hope this overview of the work of the Exam Committee has provided
you with an understanding of what our Committee does. As you can
see, our work extends far beyond simply writing and implementing
licensure exams. If you have any questions about the Exam
Committee, MEMS' exams, or any other licensure issues, please
contact your region's Exam Committee representative or anyone
else on the committee.
Our
committee members include Board representative: Rick Doughty;
Region 1 (SMEMS) representative: Jacky Vaniotis (Chairman);
Region 2 (TCEMS) representative: Joanne LeBrun; Region 3 (KVEMS)
representative: Kelly Roderick; Region 4 (NEEMS) representative:
Trisha Coleman; Region 5 (AEMS) representative: Travis
Norsworthy; Region 6 (MCEMS) representative: Darrell Gilman; Lead
Instructor-BLS: Gary Utgard; Lead Instructor-ALS: Bob Hawkes. Our
MEMS staff representative is Drexell White. We meet every month
on the third Tuesday of the month at 9:30 a.m. These meetings are
open to the public, and anyone is welcome to attend. I do,
however, suggest that you contact the MEMS office beforehand to
confirm the meeting date and time, as we occasionally need to
cancel or reschedule a meeting.
© 2004 by Jacqueline B. Vaniotis