title: Assessing continued cognitive competence among rural emergency medical technicians.
abstract: BACKGROUND
  In emergency medical services (EMS), it has been accepted that continued cognitive competency can be impacted through continuing education (CE).
  
  
  OBJECTIVE
  The objective of this study was to assess the continued cognitive competence of emergency medical technicians-basic (EMT-Basics) practicing in low-frequency environments. It was hypothesized that an individual's continued cognitive competence would be associated with hours of continuing education and frequency of patient encounters.
  
  
  METHODS
  Data collection occurred at two state EMS conferences. These states were selected because they were closely matched on many demographic characteristics. Selection criteria required that participants be currently state-licensed/certified EMT-Basics and in attendance at their respective state conference. Individuals were asked to complete a demographic survey and the National Registry of Emergency Medical Technicians' (NREMT's) computer-adaptive EMT-Basic cognitive examination. The outcome variable for this study was an individual's pass or fail of the cognitive portion of the NREMT-Basic certification examination. Independent variables assessed included number of continuing education hours in the preceding 12 months, call volume in a typical week, gender, and level of education. Multivariable logistic regression was used to identify variables significantly associated with the outcome.
  
  
  RESULTS
  There were 127 (53.1%) participants from state A and 112 (46.9%) participants from state B. Overall, 151 (63.2%) individuals met or exceeded the passing standard of the NREMT-Basic cognitive examination, with 90 (70.9%) passing in state A and 61 (54.5%) passing in state B. Individuals reported an average of 48.6 continuing education hours. A clear majority of individuals reported responding to 0 or 1 call in a typical week. A logistic regression model was constructed in which level of education and volunteer status were significantly associated with passing the examination. After adjustment, amount of continuing education and call volume were not significantly associated with passing the NREMT-Basic certification examination.
  
  
  CONCLUSIONS
  This study assessed the cognitive competency of currently state-certified EMT-Basics in a low-frequency practice environment using the current NREMT-Basic cognitive examination. Variables commonly assumed to be associated with continued cognitive competence, hours of CE and practice frequency, were not significantly associated with success on the cognitive examination.
authors.affiliation: The Center for Prehospital Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232, USA. jonst@medic911.com
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Studnek
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Fernandez
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Margolis
mesh_terms: D002568:Certification; D002983:Clinical Competence / Q000592:standards*; D004496:Education, Continuing; D004521:Educational Measurement / Q000379:methods*; D004634:Emergency Medical Technicians / Q000523:psychology / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012424:Rural Population