Testing for EMT

As Emergency Medical Technician (EMT) is a profession regulated under the Virginia Office of EMS there are rules and regulations when it comes to testing. There are two tests that must be completed at the end of the program: the psychomotor exam and the National Registry of EMTs (NREMT) cognitive exam.

Psychomotor Exam

As of March 2020, due to the COVID19 pandemic, the Virginia Office of EMS (OEMS) has suspended all state psychomotor test sites indefinitely. It was mandated that the individual courses should create and test their own students at the end of their program. Frontline Educators approached this with enthusiasm as we had a vision for how our test should run.

Currently our exam consists of testing two Integrated Out of Hospital (IOOH) stations: a medical and a trauma. An IOOH station is a comprehensive physical station that the student runs with a partner (another student). They will have a stretcher and a full set of equipment including but not limited to a stocked response bag, oxygen bag, AED or simulated heart monitor, splinting bag, c-collar bag, traction splint, and suction unit. The student will be dispatched to the call and will be expected to perform all skills needed to care for their patient in a simulated environment including preparing the patient for transport. This means that the student will physically complete the skills and not just verbalize them such as actually setting up nebulizer treatment instead of just saying, “I will give a nebulizer”.

NREMT Cognitive Exam

The National Registry uses the Computer Adaptive Tests (CAT) format for Emergency Medical Technician (EMT) examinations. CAT examinations allow shorter, more precise tests individualized to each candidate’s level of knowledge and skills. A passing standard, identical for all candidates at their level of certification, is used to determine whether a candidate is successful or unsuccessful on the cognitive examination.

After the candidate gets a short series of items correct, the computer will choose items of a higher ability, perhaps near entry-level competency. The examination selects these items from a variety of content areas of the test plan. If the candidate answers most of these questions correctly, the computer will choose new items at an even higher ability level. Again, if the candidate answers many of these items correctly, the computer will present the candidate with more items of an even higher ability level. Eventually, every candidate will reach their maximum ability level and begin to answer items incorrectly. Thus, the computer evaluates a candidate’s ability level in real-time. The examination ends when there is enough confidence the candidate is above or below the passing standard once the candidate responds to a minimum number of items.

A 95% Confidence is Necessary to Pass or Fail a CAT Exam

The computer stops the exam at the minimum number of items in the following situations:

  • There is a 95% confidence the candidate is at or above the passing standard
  • There is a 95% confidence the candidate is below the passing standard
  • The candidate has reached the maximum allotted time

The length of a CAT exam is variable. A candidate can demonstrate a level of competency in as few as 60 test items. Candidates closer to entry-level competency need to provide the computer with more data to determine with 95% confidence that they are above or below the passing standard. The examination continues to administer items in these cases. Each item provides more information to determine if a candidate meets the passing standard. Test items will vary over the content domains regardless of the length of the examination.

For more information on the NREMT cognitive exam or their ADA Policies please see their website.


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