Characteristics Associated with Examination Persistence After an Unsuccessful First Attempt at the National EMT Cognitive Examination

Introduction—Recruiting EMS professionals is essential to meet increasing demands for emergency care. EMT certification is often the entry point for EMS as well as firefighting careers. A prerequisite for obtaining licensure to practice in most states is successful completion of the National EMT certification (National Registry) cognitive examination (NREMT-C). Candidates who are unsuccessful at their first NREMT-C attempt and never return for any of the five remaining attempts represent a loss of potential EMS providers. Identifying factors related to a candidate’s decision to reattempt is important for informing future interventions to improve retesting behaviors.

Objective—To identify characteristics associated with reattempting the NREMT-C following an unsuccessful first attempt.

Methods—Using NREMT test data from 2007–2014, this investigation employed descriptive statistics and multivariable logistic regression analyses to evaluate the relationship between examination reattempts and previous NREMT-C cognitive ability score, examination payer type, candidate demographic characteristics, and program characteristics.

Results—Sixty-three percent (70,661/112,213) of eligible candidates reattempted the exam at least once. Increased age category (25+) was associated with reduced odds of reattempting the exam compared to those aged 18–25 years. (e.g., 36+ years, OR 0.85; 95% CI, 0.82–0.89). Males had 38% greater odds of making a second exam attempt (OR 1.38; 95% CI, 1.34–1.42). Candidates who identified as Hispanic had 12% lower odds of making a second attempt compared to those who identified as white, non-Hispanic (OR 0.88; 95% CI, 0.85–0.91). Candidates who paid for the first attempt themselves had reduced odds of retesting (OR 0.90; 95% CI, 0.86–0.93). EMT candidates whose programs were affiliated with an accredited paramedic program had increased odds of making a second exam attempt (OR 1.10; 95% CI, 1.07–1.13).

Conclusions—More than one-third of eligible EMT candidates never reattempted the exam. Candidates who were female, had a high school education, had self-pay status, attended a school not affiliated with an accredited paramedic program, or identified as Hispanic had reduced odds of making a second exam attempt. Further research is needed to identify underlying causes for the differences observed in this study and identify additional factors associated with the decision to persist after an unsuccessful NREMT-C EMT examination attempt.