As the field of emergency medical services (EMS) evolves over time, the standards for certification must adapt. The National Registry of Emergency Medical Technicians (NREMT) took that step on July 1, 2024, when it implemented a new computer-based certification exam for advanced EMTs (AEMTs) and paramedics. If you’re a candidate for either NREMT certification, this article explains what’s different and how you should prepare.

The previous NREMT exam format, which included separate cognitive and psychomotor examinations, has been phased out. The new exams consolidate these assessments into a single comprehensive exam.

In addition, the NREMT has made a few changes in test fees, time limits, and the number of questions:

• AEMT exam: $159.00, 135 items, 3 hours
• Paramedic exam: $175.00, 110 minimum items, 3.5 hours

Exam Format and Content

First and foremost, candidates should know that the complexity of the exams has not increased. The key change, the NREMT states, is that the new tests incorporate a different way to assess knowledge and clinical judgment.

The new exams are designed to more accurately assess entry-level competence and measure clinical judgment through a variety of technology-enhanced items (TEIs), explained Stephen J. Rahm, NRP, a paramedic who is cochair of the Centre for Emergency Health Sciences. Rahm is the author of the Navigate 2 TestPrep series for AEMTs and paramedics and numerous other books and resources published by Public Safety Group.

Rahm emphasized that the TEIs are not intended to increase the complexity of the exam but to offer a different approach to evaluating a candidate's knowledge and decision-making skills,

On the new exams, candidates will encounter the following item types and TEIs:

1. Multiple choice: This traditional format presents a question followed by four options. Candidates must select the one correct or most appropriate answer. This type of question assesses a candidate's ability to recall and apply knowledge to a given scenario.
2. Multiple response: These questions require candidates to select two or three correct responses from five or six options. The number of options provided correlates with the number of correct responses required. This format tests a candidate's ability to identify multiple aspects of a complex situation.
3. Build list: In these questions, candidates must arrange a list of options in a specified order. For example, they might be asked to prioritize medical conditions from most to least likely to cause a patient's symptoms. This type of question evaluates a candidate's ability to prioritize actions or assessments based on clinical relevance.
4. Drag and drop: Candidates will be asked to categorize or classify options by dragging them into the appropriate area. For instance, they might need to drag treatments into "indicated" or "not indicated" categories. This format assesses a candidate's understanding of treatment protocols and decision-making.
5. Options box: Similar to drag and drop, this format requires candidates to classify, categorize, or identify options presented in a table according to specified criteria. It challenges a candidate's ability to organize information logically and make decisions based on that organization.
6. Graphical items: These questions involve interpreting graphical information, such as ECG rhythm strips, images, or photos, and may be combined with any of the other item types. Graphical items test a candidate's ability to analyze visual data and apply it to their clinical decision making.
7. Scenario-based items: These questions are based on a passage describing a clinical scenario. Candidates must use the information provided to answer questions that may involve any of the item types mentioned above. This format evaluates a candidate's ability to synthesize information and make decisions in a simulated real-world context.

Candidates should review exam specifications for deeper understanding

The NRMT has published key documents that candidates should review for a deeper understanding of how the new exams are constructed. As with all professions that require certification, candidates should organize their study to reflect the exam test plan.

The following documents provide a blueprint of the knowledge and skills the exams are designed to measure:

• National Registry Advanced Emergency Medical Technician Examination Specifications
• National Registry Paramedic Examination Specifications

Expert Advice for Exam Preparation

Rahm, who has been a paramedic for 40 years, recommends that instructors and candidates not panic about the new exam. He said no significant change in preparation is warranted because the new exams have the same goal as the prior versions: to determine entry-level knowledge, skills and abilities. He said taking a structured approach to studying is still the most effective way to prepare.

"Create a realistic, practical study schedule," Rahm said. “Be self-aware and honest about strengths and weaknesses, and integrate practice questions from TestPrep products into daily study routines.”

Rahm noted that the Navigate 2 TestPrep materials provide complete annotated rationales that explain why each correct answer is correct and why the distractors are incorrect. This level of explanation adds an important educational component that helps build critical thinking and understanding required for clinical judgment. Therefore, Rahm said, it is important for students to read the accompanying rationales, even if they answered the item correctly.

Group study sessions, simulation exercises, and review courses can also be beneficial in preparing for the scenario-based and graphical items on the exam, the NREMT states.

Rahm emphasized that the new exam format is not designed to be more difficult. Rather, it is designed to assess knowledge and clinical judgment differently.

"This is still an entry-level competence exam," he said. "The registry is simply using new item types as a different way of assessing this knowledge and clinical judgment."

The core objectives of the exams remain

The new NREMT exams mark a significant transition in the certification process for emergency responders. While the format has been updated, the core objective of ensuring that AEMTs and paramedics possess the necessary entry-level competence remains unchanged.

By approaching the new exam with a clear understanding of the changes, a well-structured study plan, and the right resources, candidates can confidently navigate the new certification landscape. Preparation is the key to success, Rahm said.

Learn more about the new NREMT exams as Rahm walks you through sample items that illustrate the various question types:

Preparing for the New NREMT Exam from Ascend Learning on Vimeo.