Paramedic Student Performance on the Paramedic Readiness Exam 4 (PRE4) Improves With Exposure to Higher-Acuity Patients

Introduction: Paramedic program directors struggle with balancing limited time available in clinical and field learning experiences with accomplishing required objectives and allowing for a broad exposure to differing patient types. The purpose of this study was to examine how the students’ exposure to perceived high-acuity patients relates to cognitive performance.

Methods: A retrospective review of 554,546 student records from Fisdap was conducted from 2014 to 2018. Participants were included in this analysis if they completed a first attempt at the PRE4 and had completed clinical and field patient contacts prior to their exam attempt. The outcome variable was pass/fail on the PRE4. The dichotomized pass/fail was determined by Angoff standard-setting. The cut score for the PRE4 is 73%, with a 97% positive predictive value for passing the NREMT paramedic examination. The primary independent variable was exposure to patients by perceived criticality as a proxy for patient acuity.

Results: A logistic regression model estimated the likelihood of passing the PRE4 was 1.07 (95% CI, 1.02–1.12, p=0.003) for perceived red criticality when compared to all other levels of criticality. Further analysis explored the differences observed between this association in the clinical and field settings. The likelihood of passing the PRE4 was 1.18 (95% CI, 1.17–1.19, p=0.000) for perceived red criticality patients in the field setting, and the likelihood of passing the PRE4 was 0.84 (95% CI, 0.83–0.85, p=0.000) for perceived red criticality patients in the clinical setting.

Conclusions: This study suggests there is a positive correlation between exposure to high-acuity patients in field placements and performance on the PRE4. Conversely, this study suggests a negative correlation between exposure to high-acuity patients in clinical placements and performance on the PRE4. These findings suggest paramedic programs should place greater emphasis on field placements with reduced emphasis on clinical placements for paramedic students.