New NREMT psychomotor begins in 2017
Beginning January 2017, candidates attempting the National Registry of EMTs paramedic certification will see
a new and improved psychomotor exam. In the
first phase of implementation, candidates will
test at six stations, including an
integrated out-of-hospital scenario, instead of the current 12
discrete skills. Preparations for
these changes have been carefully planned and piloted in
consultation and support from
a robust group of stakeholders.
Candidates will continue
to perform the current trauma
assessment, two oral stations
(A and B), and cardiology
(dynamic and static). These
stations won’t change.
Subject matter experts representing EMS edu-
cators, medical directors, state officials, training
officers, field clinicians and supervisors have
all been involved in dozens of planning meet-
ings, review sessions and focus groups since
2008 to update the exam.
One of the biggest changes is the addition of
a paramedic psychomotor competency portfolio
requirement. Students beginning a paramedic
program on or after August 2016 are required
to document their psychomotor practice and
proficiency with a portfolio that’s designed to
show progression in learning and competence.
Students start by documenting sufficient
progress with individual skill repetitions on
task trainers, progressing to skills performed
during scenarios in classroom labs. The port-
folio includes recommendations for hospital
clinical rotations and a cap-
stone field internship.
Thirty-three new detailed
formative skill sheets are
guides for novices to learn
each step of a skill. Evalua-
tion forms for scenarios and
field clinical rotations are also
available. More importantly,
the portfolio has incorporated
concepts of crew resource
management (CRM) and
EMS culture of safety.
Although completing a
portfolio is required, both the NREMT and
the Committee on Accreditation of Educa-
tional Programs for the EMS Professions
(CoAEMSP) are allowing programs flexibil-
ity in the types of forms, tracking methods
and outcome goals. Each program director
will be required to provide attestation of the
completed portfolio of their students.
An example of a portfolio and skills sheets
are provided on the NREMT website and
can be used or modified by programs; however, instructors should be mindful of how and
how much they modify. After all, the portfolio
was piloted and revised yearly since 2009 until
being implemented by programs nationwide.
Suggested minimum repetitions for individual
skills and types of patient complaints are based
on findings from more than 100 pilot schools
with data collected for more than five years.
The process of review, consensus building and revision based on these pilots gives
the NREMT-developed portfolio internal
and external validity. Inventing different
goals or editing steps in skills should ideally be re-validated and based on evidence,
not just personal preferences. Programs are
encouraged to set their own target goals in
consultation with their advisory groups and
Each program director will be required to provide attestation of the completed portfolio of their students.
Photos courtesy David Page
Students beginning a
paramedic program on or after
August 2016 are required to
document their psychomotor
practice & proficiency.