The following abstract was developed during the 2010 Research Summit and won the award for Best Research at the 2010 NAEMSE Symposium in Chicago.

Right Dose? An Examination of a Prescription to Enhance Critical Thinking in Paramedic Students

Ron Lawler, AAS, NREMT-P; Kyle Chambers, AAS, EMT-P

Introduction: Moving from the Department of Transportation “hours-based” standards to the new “competency based” National Standard Curriculum, program directors will benefit from evidence-based guidance when setting internship requirements. Previous research has shown a positive correlation between the advanced life support (ALS) team leads in which paramedic interns participate, their critical thinking scores, and their eventual success on the National Registry of Emergency Medical Technicians (NREMT) examination. The purpose of this study was to determine whether the presence of ALS team leads on medical calls specifically leads to better critical thinking outcomes than the presence of nonmedical ALS team leads.

Hypothesis: A greater number of medical ALS team lead calls is a positive predictor of critical-thinking ability as measured by the critical thinking portion of the CPE examination.

Methods: Clinical internship data and CPE results between 2001and 2009 were collected from consenting paramedic students participating in FISDAP, a national, online emergency medical services (EMS) student tracking system. Students prospectively self-report internship data during their field experiences. Data queried from FISDAP included ALS team leads, team leads on medical and nonmedical calls, and scores on the critical-thinking questions of the CPE examinations. Medical calls were further divided into five categories: abdominal, cardiac, neurological, obstetric, and respiratory. FISDAP defines critical-thinking questions as “application and problem-solving test items as defined by Bloom’s taxonomy.”

Results: The data set (N = 1,350 students) included 35,732 ALS team leads, with 30,534 of those beingALS medical team leads. FISDAP recommends a cutoff score of 73% on its CPE examination as an indicator of success on the NREMT examination. Linear regression analyses indicate that to achieve a cutoff score of 73%, the paramedic student should participate in at least 45 medical ALS team leads (p < 0.001). Our results indicate that type of call is also significant, with cardiac (p < 0.001) and abdominal (p < 0.0503) calls related to improved critical-thinking skills.

Conclusion: Program directors can use these findings to guide ALS team lead requirements during field internships to increase critical-thinking scores and ultimate success on the NREMT examination.