Background: Paramedic programs use formative assessments to determine cognitive competency. Understanding the number of failed formative units as a probability of passing the summative exam will allow programs to set additional benchmarks. The purpose of this study was to determine whether failure in formative exams determines success on a summative exam.

Methods: Formative and summative scores from 2011 – 2016 for paramedic students with accounts in Fisdap™, an Internet-based administrative database, were retrospectively reviewed for the following criteria: provided consent for research, completed all six formative (unit) examinations, and completed a summative (comprehensive) examination. Analyses were performed with Pearson correlations and linear regression. Results: A total of 1,406 student records were included based on inclusion criteria. Correlation with each formative and the summative examination were all significant, p < 0.001: Cardiology 0.597; Airway 0.571; Medical 0.571; Trauma 0.566; Ob/Pediatrics 0.549; Operations 0.495. The cardiology exam was shown to have a moderate correlation on summative performance, whereas the operations exam had the weakest correlation. The number of formative examination failures was a significant predictor of the probability of passing the summative examination, t(1405) = –31.02, p < 0.001. Zero failed unit examinations yielded a 100% probability of passing. Three failed formative exams yielded a 60.4% probability. Four failed attempts yielded a 44.8% probability. Failure of all six formative exams yielded a 13.4% probability of passing the Paramedic Readiness Exam Version 3. Conclusion: Not all formative examinations hold the same predictive power on the probability of passing a summative examination. Each had their own correlation value. Students who did not fail formative examinations have a 100% likelihood of passing the summative examination.

Author Bio(s)

William Leggio, EdD, NRP is assistant professor and paramedic program coordinator at Creighton University in Omaha, Nebraska.

Alan Batt, MSc, CCP, is faculty in the paramedic programs at Fanshawe College, Ontario, Canada

Jennifer C. Berry, BA, NREMT is a Product Owner at Fisdap in St. Paul, Minnesota.

Tom Fentress, BS, NRP is EMS Coordinator at Methodist Hospitals in Gary, Indiana.

Marilee L. Vosper, M.Ed., NRP is Community Education Manager at American Ambulance in Fresno, California

Kelly Walsh, BSN, RN is EMS Academy Program Director at Advance Medical Transport of Central Illinois in Peoria, Illinois.

James Dinsch, MS, NRP is Department Chair and Program Director of Emergency Medical Services Academy at Indian River State College in Fort Pierce, Florida


1. This study was conducted during the Fisdap Research Summit in February, 2016. 2. The findings of this study were presented as an abstract poster and oral presentation during the annual Prehpospital Care Research Forum at the National Association of EMS Educators conference in August, 2016.




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