title: The attrition condition: use of a preparatory course to reduce EMT course attrition and improve performance on North Carolina certification exams.
abstract: BACKGROUND
  A growing concern in emergency medical services (EMS) education is student attrition. Perchance, there is a population of nonmatriculate students lacking prerequisite academic skills or who are otherwise ill prepared for the unique requirements of the EMS profession. Consequently, addressing these issues could promote academic and occupational preparedness, thereby reducing emergency medical technician (EMT) course attrition.
  
  
  OBJECTIVE
  To measure the impact of a preparatory course designed to address academic and psychosocial skills affecting EMT course completion.
  
  
  METHODS
  We conducted a retrospective analysis of a 24-hour preparatory course using a before-and-after nonexperimental design. The course included the EMT preparatory curriculum, program orientation, work-force-preparedness skills, and an academic skills assessment. All students who were enrolled in an EMT course at a single study site between July 2008 and December 2011 were included. Chi-square analysis was performed on attrition categories defined by CoAEMSP (Academic, Disciplinary, Attendance, Health, Financial, Personal, Never Attended) and state exam categories (Airway, Medical, Trauma, Operations, Pediatrics, Preparatory, Assessment). A logistic regression model calculated the odds ratio (OR) of course completion as a function of preparatory course completion while controlling for demography.
  
  
  RESULTS
  The historical control group consisted of 117 (58.5%) students enrolled prior to implementation of the preparatory course, while the remaining 83 (41.5%) students in the intervention group completed the course. Overall attrition was 115 (57.5%) students, with lower rates observed in the intervention group (32.5 vs. 75.2%, p < 0.01). Among noncompleters, the majority originated from the control groups in attrition categories of Academic (4.8 vs. 39.3%, p < 0.01) and Never Attended (1.2 vs. 14.5%, p < 0.01). Students who took the preparatory course were more likely to achieve course completion (OR = 5.17, p < 0.01). The use of the preparatory course produced a higher first-time test-taker pass rate despite showing little difference in individual categories.
  
  
  CONCLUSIONS
  Students who participated in an EMS preparatory course were 5 times more likely to achieve course completion and perform higher on most portions of the state exam; and the proportion of students that enrolled but never attended an EMT course was reduced. Unlike prior studies, we did not observe a paradoxical increase in other attrition categories after addressing academic preparedness. These findings may prove useful for EMS educators tasked with program planning.
authors.forename: Ginny K
authors.initials: GK
authors.lastname: Renkiewicz
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hubble
mesh_terms: D002568:Certification; D002983:Clinical Competence; D004521:Educational Measurement; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D016015:Logistic Models; D009657:North Carolina; D012189:Retrospective Studies
keywords: attrition; certification; education; emergency medical services; emergency medical technician; nonmatriculate; retention; workforce development