National Registry Announces Update to Advanced Level Skill Sheets Effective March 17, 2021

March 09, 2021

National Registry Announces Update to Advanced Level Skill Sheets Effective March 17, 2021 

March 9, 2021 - Experienced providers sometimes interpret EKGs differently from one another. It is also true that paramedics, emergency physicians, cardiologists and primary care physicians have many different approaches to assessment and care that still leads to a positive outcome for the patient. For these reasons, the National Registry has revised the Advanced Level Psychomotor Examination Skill Sheets.  

We are providing this information to help you prepare for the implementation of the revised Skill Sheets on March 17, 2021.  

The “What”  

Skill Sheets for the National Registry Advanced Level Psychomotor Examinations will have fewer critical criteria. In addition, the Static Cardiology skill will now allow candidates to receive points for the appropriate treatment of the patient, even if the rhythm interpretation is incorrect. This is a change from the previous “all or nothing” score for this skill station.  

The “Why”  

The National Registry continuously reviews its examinations to be certain that content is accurate, relevant and reflects current practice.  Best practice in test development encourages judicious use of critical criteria to eliminate “trap doors” which potentially cause a candidate to fail based on a simple error when they were otherwise demonstrating good performance. Critical criteria also cause candidates to focus too much on “what not to do” instead of focusing on appropriately managing the patient.  

The National Registry recognizes that there is  variance in the way different healthcare providers assess and treat patients which all fall within nationally acceptable standards, hence the changes. 

The “How”  

The National Registry reviews its examinations with the help of Subject Matter Experts (SMEs), who are guided by accurate content, and current and relevant practice  to make recommendations to the National Registry. Critical criteria were reviewed by working EMS providers and have been simplified to more accurately reflect a focus on good patient care. Skill examiners still have the opportunity to report major clinical errors or behavioral issues to the National Registry Representatives who are responsible for scoring the candidate’s examination.   

 The “When”  

This change impacts Advanced Level Psychomotor Examination candidates testing on or after March 17, 2021. Any candidate testing on or before March 16, 2021 will be evaluated using the current Skill Sheets. Both versions of the skill sheets are available on our website. Please review the ones pertinent to your examination.   

Frequently Asked Questions (FAQs)  

Q: Do the changes to the skill sheets mean that the skill examiner has more power, or is the candidate’s pass/fail status more reliant now on the skill examiner?  

Skill examiners time the skill, provide the necessary information to candidates when prompted, and document candidate performance.  

  • Skill examiners do not determine whether the candidate passed or failed the skill.  

  • When critical criteria are marked, the National Registry Representative reviews them for documentation and accuracy.  

  • In some instances, the exam’s Medical Director may also weigh in on decisions related to critical criteria.   

Q: Is this a change to the passing standard?  

  • The passing standard remains unchanged. The National Registry Representative will still assign a pass or fail to a candidate based on the scoring rubric, which was not modified.  

  • The removal of critical criteria simply removes trap doors for candidates who otherwise demonstrated acceptable performance.  

Q: Why is unprofessional behavior a critical failure?  

  • Unprofessional behavior is a critical failure based on the input of SMEs and the expectations of the profession.  

  • This criterion allows the skill examiner a formal tool to alert National Registry Representative to inappropriate behavior.  

Q: Do these changes impact the BLS skill sheets for EMR and EMT?  

  • No, only Advanced Level Psychomotor Examinations are impacted by this change.  

  • EMR and EMT psychomotor examinations are regulated by state EMS offices.  

Q: Has anything other than the critical criteria changed on the skill sheets?  

  • There are a handful of very minor editorial changes to help skill examiners more efficiently assign points to a candidate.  

  • The American Heart Association update in 2020 published revised ventilatory rates. In response, the National Registry adopted the AHA 2020 ventilatory rate guidelines. Candidates are expected to adjust ventilations to patient response such as skin color, oximetry, and capnography.   

Q: What if I have a concern about my evaluation?  

  • Immediately notify the National Registry Representative onsite during or after the occurrence.  

  • Complaints are not accepted after unofficial results are reported to the candidate.  

On YouTube

A video further explaining the Skill Sheet Revisions is available on the National Registry's YouTube channel