By John Spencer, Platinum Educational Group
In the dynamic fields of Emergency Medical Services (EMS) and nursing, we must accurately evaluate our students' clinical decision-making skills. While valid, the traditional single-response multiple-choice questions that our students are familiar with often fail to assess the complex thought processes required in emergency and acute care scenarios (Smith et al., 2022). Technology Enhanced Items (TEIs) are changing how we assess the clinical competence of EMS and nursing students, offering a more authentic representation of real-world patient care challenges.
The National Registry of Emergency Medical Technicians (NREMT) has been at the forefront of implementing TEIs in their examinations, recognizing their value in assessing critical EMS skills (NREMT, 2024). Similarly, the National Council Licensure Examination (NCLEX) for nurses has incorporated TEIs to better evaluate nursing competencies (NCSBN, 2023).
Let us explore some of the TEI formats used by the NREMT and their applications in EMS and nursing education:
1. Multiple Select Items: These questions allow candidates to choose more than one correct answer from a list of options. For example, a question might ask, "Which of the following signs and symptoms are consistent with a tension pneumothorax?" and provide a list of clinical findings. This format assesses a student's ability to recognize multiple relevant factors in a clinical presentation, mirroring the complexity of authentic patient assessments (Johnson, 2023).
2. Drag and Drop Items: These interactive questions require candidates to move objects on the screen to appropriate locations. In an EMS context, students might be asked to drag medication names to the correct corresponding doses or indications. This format tests knowledge organization and association skills crucial in emergency care (Williams & Brown, 2022).
3. Ordering Items: These questions present a list of steps or events that candidates must place in the correct sequence. For instance, students might be asked to order the steps of a basic life support (BLS) algorithm. This type of item assesses a candidate's understanding of procedural sequences, which is critical in both EMS and nursing protocols (Chen et al., 2023).
4. Build List Items: In these questions, candidates create a list by selecting items from a larger pool of options. An example might be, "Build a list of equipment needed for endotracheal intubation." This format evaluates a student's ability to identify necessary components for a specific procedure or intervention, reflecting the preparation skills required in emergency and acute care settings (Garcia et al., 2022).
5. Option/Check Box Items: Option/Check Box items present a question with multiple options, each accompanied by a checkbox. Candidates must select all correct options for the given scenario or question. For example, a question might ask, "Which of the following interventions are appropriate for a patient with signs of anaphylaxis?" followed by a list of potential treatments, each with a checkbox. The candidate must check all the correct interventions. This format allows for a more nuanced assessment of a candidate's knowledge, as it can evaluate their ability to identify multiple correct answers in complex clinical situations. It is particularly useful for assessing a student's understanding of multi-step protocols or situations where various interventions are necessary (NREMT, 2024; Anderson & Lee, 2023).
The benefits of incorporating these TEIs into EMS and nursing education assessments are significant:
1. Enhanced Realism: TEIs provide a closer approximation to real-world emergency and acute care scenarios, preparing students for actual practice (Johnson, 2023).
2. Improved Assessment of Critical Thinking: Complex, multi-step items allow for a more thorough evaluation of clinical reasoning and decision-making processes crucial in EMS and nursing (Smith et al., 2022).
3. Increased Engagement: Interactive elements make the assessment process more engaging for students, potentially reducing test anxiety and improving performance (Williams & Brown, 2022).
4. Broader Skill Evaluation: TEIs can assess a more comprehensive range of skills and competencies than traditional multiple-choice questions, including the psychomotor skills and information synthesis required in emergency and acute care settings (Chen et al., 2023).
5. Adaptive Testing Potential: When combined with computerized adaptive testing, as used in the NREMT examinations, TEIs can provide a more precise measurement of a student's abilities across the spectrum of emergency care competencies (Taylor, 2024).
As educators and program directors in EMS and nursing, embracing TEIs in your assessment strategies can enhance the quality and effectiveness of your evaluation processes. By assessing clinical decision-making skills more accurately, we can better ensure that our graduates are truly prepared for the complexities of modern emergency and acute care practice (Anderson & Lee, 2023).
The future of EMS and nursing education assessment lies in the innovative use of technology to create more authentic, comprehensive, and engaging evaluations. Technology-enhanced Items are not just a trend—they are a vital tool in our mission to produce highly competent and confident emergency medical technicians, paramedics, and nurses ready to face the challenges of 21st-century healthcare (Garcia et al., 2022).
Note: AI provided research assistance for this article (Anthropic, 2024).
References:
Anthropic. (2024). Claude [AI model]. https://www.anthropic.com
Anderson, K., & Lee, S. (2023). Simulating electronic health records in nursing education: The impact on clinical decision-making skills. Journal of Nursing Education, 62(4), 145-152.
Chen, Y., Wang, X., Li, Z., & Brown, T. (2023). The effectiveness of hot spot items in assessing diagnostic skills among medical students. Medical Teacher, 45(2), 210-218.
Garcia, R., Martinez, L., & Thompson, K. (2022). Beyond multiple choice: The role of technology-enhanced items in allied health education. Journal of Allied Health, 51(3), 178-185.
Johnson, P. (2023). Technology Enhanced Items in healthcare education: A comprehensive review. Medical Education, 57(6), 623-635.
National Council of State Boards of Nursing (NCSBN). (2023). NCLEX-RN and NCLEX-PN test plans. https://www.ncsbn.org/nclex.htm
National Registry of Emergency Medical Technicians (NREMT). (2024). Cognitive exam content. https://www.nremt.org/cognitive-exams
Smith, J., Davis, A., & Wilson, M. (2022). Evaluating clinical decision-making: The limitations of traditional multiple-choice questions. Advances in Health Sciences Education, 27(2), 415-427.
Taylor, R. (2024). Multimedia-enhanced assessment in paramedic education: A pilot study. Prehospital Emergency Care, 28(1), 45-53.
Williams, E., & Brown, N. (2022). Drag-and-drop items in nursing examinations: Impact on student engagement and performance. Nurse Education Today, 110, 105267.
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