I recorded this video interview with Chris Montera at Pinnacle EMS 2010 in Miami for EMS1.com. In our conversation we discuss cheating in fire and EMS education, the responsibilities of students and educators, and the implications on content developers. Developing more engaging and interesting educational content often comes at the expense of time and energy I am expending to build the wall higher against cheating and fraud.

Is cheating happening in your organization? And more importantly what are you doing about it?

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I use Articulate e-learning software to create quiz questions for online EMT and paramedic continuing education. The software makes the process easy.  The real difficulty is writing quiz questions that engage the learner and assess their new knowledge based on the lesson objectives. Determining the type and difficulty of quiz questions as well as actually writing usable questions is a challenge for many subject matter experts (SMEs). These are five of the tips I share with SMEs.

1. Determine the format for questions. I generally only use multiple choice questions. True/False or Yes/No questions are essentially guessing and provide little meaningful information about student retention or comprehension of the material presented. Unless I specifically tell SME’s I want multiple choice questions I usually receive 50% or more True/False questions.

2. Question construction. A multiple choice question has three parts – the stem, the answer, and multiple distracters. Write question stems based on the objectives of the lesson. Make sure to review the lesson objectives before writing questions. I usually have the source PowerPoint file on the screen in front of me as I begin writing questions – a great use for a dual monitor set-up. As I build a bank of questions I try to write three to ten questions per objective.

3. Present only the essential information in the question stem. Extraneous material does not likely add any educational value to the assessment. A multiple paragraph stem only assesses the student’s ability and determination to actually find the question you are asking. If there is a long scenario present it first and then ask the actual question.

Don’t teach in the stem. Explaining a process that was part of the lesson and then asking a question is unnecessarily redundant.

All of the following, except, none of the above, and all of the above are universally despised by students because it is confusing to determine what is actually being asked. As an educator you don’t know if the student got the question wrong because they didn’t know the material or they couldn’t determine what the question was actually asking. Help me rid the world of these question types.

4. Consistent formatting of the answer and distractors. I recommend these general guidelines for the one correct and three wrong answers:

• All answers should be approximately the same length. Since a visibly shorter or obviously longer answer is usually right make sure all answers have about the same number of words or one to three word answers or same number of characters for longer answers.
• Use plausible answers for the distractors. Obviously wrong answers increase the odds of guessing correctly.
• Any words or phrases repeated in every answer should be part of the stem. Keep the answers as short as possible.
• Write with a consistent verb tense for every answer. If only one answer is active tense it is likely the right answer.
• If the answers are numbers, order the numbers sequentially. For example, if a question is to calculate a medication dose order the answers 2, 5, 10, 15 instead of 5, 15, 2, 10.

5. Ask questions to determine comprehension. Student retention of lesson content is merely interesting. At least half of the questions should assess comprehension – the ability to apply information. Use short scenarios for students to apply what they have learned.

Finally, consider other ways to assess student use of e-learning content. If you are only using a quiz to prove they completed the lesson the only question you might need is “I completed this lesson” with the answers Yes or No.

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Paramedic Review, a new iPhone App from Limmer Creative, is a sophisticated exam prep app that can be used anywhere at anytime. Much like its counter part EMT Review, a veteran Paramedic or a new medic will benefit from this application. This app is a tool for education, and in my opinion in a world were there is lots of education with a lack of motivation, this tool is a breath of fresh air. The app challenges the experienced and the new EMS professional to answer questions from these categories:

• Preparatory
• Airway
• Patient assessment
• Medical emergencies
• Trauma emergencies
• Special populations
• Operations

An app user is able to test, train and review at anytime. Within the Paramedic Review App, the user is able to create specific questions to test certain areas of knowledge. If you feel like an area of your knowledge is weak, you can design lists of 5, 10, or 20 questions to brush up in that area.

The developers continued with what works, by using the “challenge me” section. Much like the EMT Review app, the user is able to access randomized questions from any of the above mentioned topics.

The tool continued to be fun and engaging as I was sitting around the station. It forced me to think about treatments and patient conditions globally. This is a tool that reminds us not to put blinders on during patient assessment.

Finally, with each question you receive a rationale of why the answer was wrong or correct. This is a great feature in my opinion because I was able to learn from my mistakes.

Paramedic Review is available on ITunes and is well worth the $3.99 purchase price. I hope the Paramedic Review app creators will create a download of more questions. Again, an upgrade of more questions will make the app adaptable.

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I just finished my National Registry re-registration application … nothing like waiting until the absolute last minute. Fortunately I have enough CE and have met the refresher requirements through regular training sessions. Now I just need to track down my training director for the official letter and my medical director for a suggestion. Two weeks and counting …

If you need a few more hours of CE check out the great training sessions available at EMSBootCamp.com. The Boot Camp is a collaboration between me and Jim Hoffman. We have a library of archived sessions on topics like:

• Trauma in pregnancy
• Childbirth emergencies
• Medical math
• Test taking
• Pediatric assessment
• MCI response
• Diabetic emergencies

The one area I am always touch and go for my renewal is OB and Peds. If you need a few more hours of OB and Peds visit the archived sessions page to register for Trauma for Two or Pediatric Assessment Essentials.

Note: Archived sessions include certificate to present to your medical director.

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Multiple choice exams are an inevitable part of initial and ongoing EMS training. Good exam questions are based on the course objectives and content. Question writers attempt to assess your recall of information, but often more importantly, your comprehension and ability to apply knowledge. If you want to get better at taking EMS examinations follow these Everyday EMS Tips:

1. Read my EMS1.com column on taking multiple choice exams.

2. Enroll in EMS Boot Camp session 1. Jim Hoffman and I deliver a 1.5 hour training program with lots of bonus learning content on taking EMS examinations. We are getting great feedback from students using this program.

3. Become a member of the Medic Cast Extra. Everyday EMS Tips friend Jamie Davis has assembled a huge amount of content, study guides, test preparation materials, and more for EMT and Paramedic students.

4. Take lots of test questions using test preparation books. Check out the selection of test preparation books and review guides in the Everyday EMS Tips book store.

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Last weekend I ran my first half marathon. As race day approached, it felt similar to preparing for a final exam. During the months prior, I trained in various conditions and venues. I researched nutrition, apparel, footwear, and other logistical details. My final training runs took place on the course, and I drove the complete route. I knew where water stations would be located, and I knew where to line up at the start. The night before I pinned my bib to my shirt, organized my gear, and was ready for an early morning. Had I trained enough? Would I be able to keep up with the other runners? Was I prepared for this final exam?

Preparing for a final exam, whether running a race or taking a written test, is best done by following a systematic approach. Read 5 Everyday EMS Tips contributed by Martha Bonnie for final exam preparation.

1. Plan ahead. At least a week before your exam, begin to plan how, when and what you will study for your exam.

2. Ask questions. Ask your instructors and peers questions you have as you review your material. Use your available resources, such as textbooks and the Internet, to look for information.

3. Take care of yourself. Try to obtain at least 8 hours of sleep. Eat a well balanced diet with regular meals. Exercise your body and your brain regularly. Avoid excessive caffeine consumption or the use of supplements or stimulants that are intended to keep you alert and awake.

4. Believe that you will do well. You have studied, practiced and know the material. You are ready for your exam and will pass.

5. Stay calm when taking the exam. Begin by scanning through the entire exam. Answer the questions you know first. Anticipate challenges. Take your time.

Elated, I crossed the finish line to the half marathon knowing I had followed this systematic approach. Use the same steps to successfully prepare for your own final exams.

Martha Bonnie is a 911 telecommunicator, author, and teacher in northeast Wisconsin.

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