1. National Registry Exam Registration and Testing Process and State Certification Process

2. Introduction
Since Texas is a part of the NREMT exam process, you MUST initially certify at the NR level
In Texas, you do NOT have to maintain the NR after initial certification
Understanding the computer adaptive testing system will help to eliminate some of the fear associated with NR testing

3. Resources to Help with NR Registration
Brochure is available on the NR website at
Video is available with step by step instructions located at:

4. NR Registration Process
Create an account on the NR’s website
If you already have an account, you should NOT create a second account.
If you forgot your log in information, contact the NR at or reset your password
Log in to the account
Manage account information
Name, DL, etc.

5. Registration Process Create a new application Select level (EMT)
You must pay close attention to select the correct training center.
These are listed by state and then by name
Select “Texas”, then select “Olton EMS Training Program”

6. Registration Process Pay application fee
Fee applies for initial test and each retest
Check for coordinator approval
All candidates in Texas must be approved (authorized) to test by the coordinator
This will occur AFTER you meet with the lead instructor to verify that ALL requirements are met
The candidate MUST have an NR application that is PAID for before the candidate can be authorized

7. Registration Process Once approved Print ATT letter to schedule exam
You will get an authorization to test (ATT) letter
Print ATT letter to schedule exam
Letter will have a unique ATT number
Call VUE to schedule exam
Can also use the Pearson Vue website
Tests are administered through Pearson Vue Company with testing sites throughout the US
Number is on ATT letter

8. The Application
Click Here
To begin the application process, go to the NREMT website at and click on login.

9. The Application
And set up a new account
Click Here

10. The Application Fill out remainder of application
Fill out Info
Fill out Info
Select Registrants and Candidates and follow the remainder of the screen prompts
Fill out remainder of application

11. Taking the Exam You must have 2 forms of ID
No electronic devices allowed in testing area
Testing area monitored through windows
Dry erase board is furnished
If you leave for any reason (bathroom, break, etc.) VUE will use a fingerprint scanner to assure the same person returns

12. Retesting
If you are unsuccessful, on the first or second attempt, you may retest after 14 days.
This waiting period is to provide you with time to study prior to retesting.

13. Things to Remember
NR allows you to test up to 2 years from course completion
Course completion is when the you finish ALL requirements AND turn everything in to instructor.
Course completion CANNOT be after course completion date as approved by state
Example: a student has 60 days from last day of class to complete all rotations. He turns in all documents 70 days after the last date of class. His course completion date will the on the 60th day NOT the 70th day

14. Skills Verification
For basic courses, the coordinator verifies skills proficiency at the same time he/she authorizes a student to test
The skills proficiency date is the month and year of final skills exam which can create different deadline dates for skills and written exams

15. Skills Verification
If a basic level student does not pass the NR written exam within one year, he/she will have to retest skills
The coordinator must send a skills verification letter to the NR
Your skills verification date will be the month of the final skills exams

16. Things to Remember
You can test the NR up to 3 times. If you fail all three attempts, you will have to take a refresher course (if you can find one) and then you would have 3 more attempts
After 2 years from course completion date or 6 failed attempts, the candidate will have to repeat all requirements

17. Things to Remember
The student will get results by logging back in to their NR application and checking application status
If passed and skills proficiency has been verified or skills exams passed, the NR will assign a certification number
Test results are normally posted within one business day

18. State Certification
After gaining NR certification, the candidate MUST apply for state certification in order to be certified in Texas
If new applicant (not currently certified at any EMS level), applicants must obtain and submit fingerprints

19. State Fingerprint Requirements
Should be submitted as EARLY as possible
Conducted at the IdentoGO Company
Sites available throughout State (including Plainview)
Must use correct fingerprint form with TDSHS service code
Form found at:
Click on “Texas Fingerprint Service Code Form”

20. State Application
Most are done online but paper forms are available on State’s website:
Online application found at:

21. Online State Application
Click on “Online Licensing System”
Select “Emergency Medical Services”
Select “Choose Application”
Select “EMS Personnel Initial Online Application”
Select appropriate level
Fill out online application

22. Information for State Certification
Applicants must have TDSHS course approval number
Obtained from instructor (on syllabus cover and in handout)
Students must have NR certification number
Obtained from NR website after logging in

23. What You Need to Know About the Computer Adaptive NREMT Exam

24. NR Testing
The NR uses Computer Adaptive Testing (CAT) that includes Item Response Theory (IRT) to customize each test to the individual that is taking the exam
A complicated process that has used hundreds of thousands of questions to classify each question and assign it a level

25. Computer Adaptive Testing
An “adaptive test” presents you with items that will be most informative for measuring your ability.
Each test is tailored to the individual.

26. What is Item Response Theory (IRT)?
A very precise way to determine ability
Roughly based on the fact that
If a student has a high ability he/she will have a high likelihood of answering an easy question correctly.
If a student has a low ability, he/she will have a low likelihood of answering a hard question correctly.
Since questions are targeted right at a student’s ability, the accuracy of the measurement gets very high.

27. Combining CAT and IRT
Results in test that is MUCH more precise, accurate, and fair
Every question has maximum measurement value
The state-of-the-art in psychometrics
In terms of the testing modalities considered by the NREMT we looked at these three:
Staying the course with a paper-pencil exam. [Elaborate on what the NREMT does today with scheduling, exam materials shipping and management and test delivery.]
Changing to utilize a Computer-based form of the examination that basically computerizes the paper exam and delivers it in a linear, question by question, fashion to the test taker. High-stakes computer-based exams, like the NREMT exam, are delivered in formal computer testing centers by computer testing delivery providers.
The third modality examined is the Computer-adaptive form of the exam which basically ‘adapts’ the way in which questions are delivered to the candidate based upon his or her ability. The same formal computer testing centers are used in this type of testing modality.
We will talk in more detail about each modality later on in the presentation.

28. Questions on NR Exam (1 of 2)
Each question is given a difficulty level from 0 to 10 but there is normally no questions with a difficulty level less than 3
Based on thousands of exams given
The pass fail line is adjusted periodically based on a statistical analysis
The test is designed to miss every other question

29. Questions on NR Exam (2 of 2)
The questions will be over specific content area (pediatrics, trauma, medical, OB/GYN, operations, special considerations, etc.)
Many questions will be in multiple content area
Example: a pediatric trauma question will be considered pediatric and trauma
Your results will indicate your proficiency in each content area (pass, near pass, below passing)

30. An Adaptive Test Ability Question 10 8 6 4 2
Ability
A computer adaptive test involves questions delivered to the candidate one at a time, however the questions are not randomly selected, but rather are rated along the same ability scale as the individuals. If a question is asked that is below the candidate’s ability, they have a high probability of answering that question correctly. If a question is asked above an individuals ability, they have a high probability of missing it.
Question

31. The “Perfect Candidate”10 8 6 4 2
Ability
Exam begins
The initial questions are generally just below the passing standard. If the candidate answers the question correctly, a slightly more difficult question is presented. As the difficulty increases, eventually the candidate will be begin to miss questions. The questions then become slightly easier and the candidate will begin to answer correctly.
Question

32. The “Perfect Candidate”10 8 6 4 2
Evaluation begins
Ability
At this point the computer algorythm calculates an ability estimate for this individual candidate and targets questions to be sligthly harder and slightly easier than the their ability.
Question

33. The “Perfect Candidate”10 8 6 4 2
Evaluation begins
Ability
As the exam progresses, the abiliy estimate gets more and more precise as the right/wrong pattern stabilizes around the candidates true ability.
Question

34. The Ability Estimate Ability Question 10 8 6 4 2
Ability
The precision of a CAT/IRT exam is illustrated by the slide. The ability estimate can be expressed statistically as a confidence interval. Initially the confidence interval is broad, but as the exam progresses…
Question

35. The Ability Estimate 10 8 6 4 2 ↑
Ability
Ability level determined as the line becomes consistent
it narrows. The candidate passes if their calculated ability is above the passing standard, and fails if the calculated ability is below the passing standard.
Question

36. When is the test over?
The computer determines with at least 95% certainty that the candidate’s ability is either above or below the passing standard, OR
The candidate receives a maximum number of items*, OR
The candidate runs-out-of-time*.
*=infrequent

37. Computer Adaptive Testing
Every time the candidate answers a question, the computer re-estimates his or her ability.
With every additional answer, the ability estimate gets more precise.
Based upon the most recent, revised ability estimate, the computer selects the next item to be presented, such that the candidate will find it challenging.

38. Important Concepts
There is no minimum percentage of items correct to pass.
Student’s will test varying number of questions in each content area
You will be challenged to the limit of your ability.
You may miss up to 50% (every other question) of the questions and still pass
It all depends on the difficulty level of the questions
It is very common that candidates finish the exam confident that they were unsuccessful. This is because we are not used to taking exams were every question is targeted directly at our ability level. The best strategy for success is to answer every question to the best of your ability and not to jump to conclusions regarding whether you passed or failed.

39. Passing V. Failing
Missing every other question in this difficulty range would most likely result in passing 10 8 6 4 2 ↓
__________________________________
Ability
__________________________________ ↑
Missing every other question in this difficulty range will most likely result in failing
A computer adaptive test involves questions delivered to the candidate one at a time, however the questions are not randomly selected, but rather are rated along the same ability scale as the individuals. If a question is asked that is below the candidate’s ability, they have a high probability of answering that question correctly. If a question is asked above an individuals ability, they have a high probability of missing it.
Question

40. More Fair and Accurate Evaluation
Every candidate is measured against predetermined competency level (difficulty level of questions)
CAT combined with IRT, is the most precise method of evaluation
Examination is individualized according to candidate performance
Exam matches question difficulty to candidate ability
Limited question exposure increases validity

41. Conclusion
The NR testing system is designed for a candidate to miss up to every other question
It is all dependent on the level of questions marked correct or incorrect
Prepare your students to feel that they will have no idea if they passed or not
Many students have to retest at least once