Introduction: The 1998 DOT NSC recommends that paramedic students complete 30 pediatric patient encounters with various age groups of children. Previous data have shown that the average US paramedic student will encounter an average of 33 pediatric patients in their clinical and field experiences. 1 The majority (66%) are school-aged and adolescents. The National EMS Education Standards require "competency" in caring for pediatrics patients of all ages but the current measures of competency are limited to testing metrics. No research exists examining the number of pediatric field encounters and performance of paramedic students on the pediatric section of the Field Internship Data Acquisition Project (Fisdap™) Paramedic BLUE Examination. We sought to better understand the association between paramedic students' quantity of pediatric encounters, their role during those encounters, and their outcome on standardized testing given after the clinical rotations and field internship.
Methods: This is a retrospective and descriptive database review of prospectively identified data from the web-based Fisdap™ system. Paramedic graduates consented to their anonymous data being prospectively gathered and used for research. Verification of data was audited and validated by instructors and designated "good" if it was accurate and complete. We defined performance by paramedic students on test items with a logit score model where the average item difficulty logit score centered at 0. The logit score becomes a reflection of the student's ability to answer the question compared to the average question in that exam.
Results: A total of 2,182 paramedic student examinees participated in the Paramedic BLUE examination. For the exam's pediatric-specific questions, the average student logit score was 2.1 ± 0.9, meaning students were likely to get the answer correct 88% of the time. Paramedic students saw an average of 24.6 ± 16.6 pediatric patients in their clinical rotations and 5.6 ± 4.6 pediatric encounters in the field internship. Paramedic participation in a field encounter contributes more to the logit score than does a clinical encounter. Over an average of 33 pediatric patient encounters, the overall effect will be an additional 6.6-13.2% improvement in paramedic student scoring on the pediatric- specific test questions of the Fisdap ™ Paramedic BLUE exam. In addition, prior to a paramedic student ever having any pediatric encounters, the effect of a non-white ethnic background was strongly but negatively associated with paramedic student success answering pediatric-specific test questions on the Fisdap™ Paramedic BLUE exam.
Table 1.
Sample size by ethnic background.
African American42
Table 2.
Mean and standard deviation for pediatric scale
score, pediatric clinical encounters, and pediatric
field encounters.
BLUE Pediatric Scale Score2.050.90
Pediatric Clinical Encounters24.6216.61
Pediatric Field Encounters5.574.65
Table 3.
Regression estimates, probability improvement, standard error, p-values, and confidence
interval for the effects in the model.
 Estimate1+exp(β)SEp-value95% CI
Intercept1.92---0.041< 0.001[1.841, 2.001]
Pediatric Field Encounters0.0090.4%**0.0040.028[0.001, 0.017]
Pediatric Clinical Encounters0.0040.2%**0.001< 0.001[0.002, 0.006]
African American-0.358-17.7%0.1390.010[-0.631, -0.085]
Hispanic-0.317-15.7%0.086< 0.001[-0.484, -0.149]
All Other Ethnicities*0.000------------
*Not estimated ** Reference is zero encounters R2 = 0.016

Conclusions: Pediatric test questions are relatively easy for paramedic students and may not adequately
assess cognitive competency. Field encounters contribute more to success than clinical
encounters. Ethnic differences should be investigated further.