Admissions and Expectations

"This will be the hardest thing you have ever done."  

For the third time in my life I have been told that what I am about to undertake will far and away be more difficult than anything else I have ever attempted.  Prior to USAF Basic Training, the beginning of paramedic school, and now, I have had to build an accurate assessment of the task and compare it to what I have accomplished previously. 

To be fair to the intent of this blog, I am going to have to look at not only paramedic school as I knew it when I attended in 1998, but paramedic schools as they exist today and my involvement in assisting establishing the groundlings of a program in 2011 in Northern California as the Director of Academics for the School.  The assessment will be a comparison of what I undertook in paramedic school alongside the research I conducted to most efficiently start a paramedic program against my real-time experiences in a private postsecondary nursing school in Southern California.

This post’s intent is to look at the admissions process and requirements through acceptance and orientation for the program.  Now that I am admitted to, and have finished the orientation for nursing school, I am not convinced that this journey will be more difficult than other ones I have completed, but I do believe that it will be challenging.  After all, there are a whole new set of medical theories to be learned and a whole new way of thinking about medicine top adopt.  I attempt to gain something from any schooling I attend; I believe that if an individual sits through any type of class and learns nothing from it, the only excuse is that he must have been sleeping.

A few things to point out before we start:

1. This assessment is of generally like-institutions.  They are private postsecondary schools in the State of California, both governed by the CA Department of Consumer Affairs’ Bureau of Private Postsecondary Education, and both requiring accreditation for a continuance of their programs.
2. A major difference between these programs is that while the nursing school delivers an Associate’s degree at its completion, the paramedic school is a certificate program.  This is not uncommon for paramedic schools – RN schools are required to furnish a degree.
3. Graduates for either program are required to take a national examination in order to be licensed in the State to practice under the protocols or physician’s orders which direct them.  The paramedic examination is governed by the National Registry of Emergency Medical Technicians (NREMT) while the nursing examination is governed by The National Council of State Boards of Nursing (NCSBN). Both of these national examinations have a cognitive component; the paramedic graduate, however, must also complete a battery of psychomotor examinations.

Contact:

Getting in touch with any private postsecondary school is generally not incredibly difficult.  They are, in spite of everything, for-profit businesses and without your money, they don’t exist.  Even institutions that are not-for-profit have to earn your business somehow, be it by loans and grants, or your hard-earned green and believe me when I say that they work just as diligently to recruit and retain a student body as their for profit counterparts.

Admissions Requirements:

General – Both programs required the minimally accepted standards, such as a HS Diploma or GED, background check, and drug screening.  Both programs required immunizations and a Healthcare Provider CPR Certification from the American Heart Association.  An informational meeting with an Admissions Representative and, after acceptance, meeting with a Financial Aid Representative or Student Financial Assistance occurs to square away loans and grants if applicable, and any repayment plans. 

Application and Prerequisites – One of the major differences in this category is the length and requirements of the application process for the nursing and paramedic schools.  You will see by the chart below that some of the content is dispersed throughout the course, respective of the educational program.

	EMT-P	RN
Time in Field – Employer Verification Required	2080 Hours (EMS)	1040 Hours (Any)
Preparatory Course	Yes – 48 Hours	16 Hours “Academic Success”
Anatomy & Physiology Pre-Course	Yes – 72 Hours, then throughout course	2 Semesters of A&P required in school
Oral Board	Yes	No
Application Essay	Yes	No
References	3	No

If the student has not completed collegiate-level Anatomy and Physiology with lab, the nursing school will deliver it Anatomy and Physiology during its education model as stand-alone classes, formatted to meet the standard expectations of A&P in the community college.  Paramedic school requires a very brief brush with A&P prior to starting (or collegiate level A&P).  For those required to take this course, it was honestly intended to be used as a tool to determine whether or not an individual would be able to handle the pace of A&P covered during paramedic school where it is delivered in relation to a topic.  For example, when discussing cardiovascular emergencies, in addition to assessment patterns and treatment modalities, it is expected that the student would receive an immersion course in cardiovascular Anatomy and Physiology.  The reality is that paramedic education understandably concentrates on the assessment and treatment of emergent patients.  The problem with that is that the paramedic is potentially left without a firm understanding of anatomy and physiology in everything related to anything non-emergent.  It will be interesting to see how in-depth nursing school addresses A&P and whether it delivers a more solid base of understanding of the fundamental workings of the human body.

Testing – Almost every private postsecondary institution requires similar items to be considered for acceptance to their program because it is a field standard.  Often times, however, the entrance requirements are shockingly minimal.  For most programs, an assessment test is administered.  The Wonderlic Cognitive Ability Test is a common examination and is used to assess an individual’s problem-solving capacity over a range of occupations.  This examination a 50-question multiple choice test and is given over 12 minutes with instructions to the candidate to answer as many as possible in that time.  After a great deal of research, Wonderlic, Inc. claims a score of at least 10 points suggests a person is literate.  A warehouse worker should score 15, clerical worker should score 21, a journalist should place at 26, and a chemist comes in at 31.  http://en.wikipedia.org/wiki/Wonderlic_Test.

The Wonderlic was used by my former employer as well as the nursing school I am attending.  With programs such as Phlebotomy Technician, Emergency Medical Technician (Basic), and Medical Assistant, the bar is set around 16.  When applying for longer, more intense programs, the minimal score allowed increases, as it should.  There was an established a minimum of 21 for our paramedic school; my nursing school required 24.  I scored a 32.  After experiencing both the administration of, and taking the exam (a version I had never seen), I believe this exam is not an accurate portrayal of the probability of one’s success in educational programs.  Simple literacy does not equate to learning aptitude.  The true use at my school up north was as a tool to weed out individuals that would likely have difficulty with simple reasoning or the English language.

Additional examinations are required for both nursing and paramedic schools.  Paramedic school consideration required a field-specific examination at the EMT level to ensure the candidate had a firm handle on prehospital medicine at the basic life support level.  This examination was a 100 question 2-hour test of a randomized sampling of our reviewed and approved test bank for our EMT program.  The questions were evenly distributed across all required knowledge fields (medical, trauma, pediatric, etc.), and an 80% was required to continue in the evaluation process.  Noting that these questions come from an approved bank, it is important to also state that they are modeled after the NREMT test questions which, in my opinion, do not always ask questions with the intent to see if you have content knowledge.  Rather, some NREMT questions are written to specifically see if you are a critical thinker and will lead an answer series with “which is the most correct” or “which is the least correct”.  In my opinion, critical thinking is “critical” to being a successful practitioner, but it is not necessary to pose questions where there are arguably more than one correct action to take, or where no action is truly appropriate.

For nursing, however, a more well-rounded examination was administered.  My nursing school administered the Test of Essential Academic Skills (TEAS) which is a 170 question, untimed evaluation covering Math, English, Science, and Language.  http://en.wikipedia.org/wiki/TEAS_test.  We were required to score no less than 75% overall to continue in the admissions process.  I scored an 84% (which ranked me in the 96^th percentile nationally).  That said, a number of paramedic schools utilize the Health Occupations Basic Entrance Examination (HOBET) which will test the candidate’s knowledge of math and reading comprehension.  It does not, however, score any sciences or a language component, so while it is far more comprehensive than the Wonderlic, it does not come close to the TEAS examination.

Objectively, the nursing school admissions examination would is more useful in gauging a generalized academic knowledge base, and I believe, an individual’s overall readiness for school.  It gave me a clear understanding of the areas that I was weak in (physical sciences – I did well in life sciences) and I will be sure to keep that in the forefront as I progress in my education.  I believe the EMT examination for paramedic school entrance is useful as another tool to weed candidates out and ensure that those accepted to the program have a handle on the basics prior to moving to into advanced practice.  It does not, however, produce a global picture of the individual’s knowledge.

Interview/Oral Boards – While both the paramedic and nursing programs require some form of interview with the program head(s), I found that the intention of the interview for each program could not have been different from each other.

I attended the nursing program interview on 04-Jan-2012 with the School’s Director of Nursing along with approximately 10 other accepted or wait-listed individuals.  This interview was more of an informational session and a time to ask any questions we had of the Director.  Schedules were delivered and it was an overall pleasant experience.  The Director reviewed a few items in the nursing orientation handbook which we could have read ourselves, but I understand the necessity to cover it – not everyone would read it on their own.  This interview ended up being more of a meet and greet with a few possible classmates than an interview for admission.  We had already all been admitted prior to ever having our personalities being assessed.

Paramedic Oral Boards, on the other hand, are intended to act as an interview.  They are designed to see how an individual will react under the pressure of being questioned by 3-5 experienced providers and administrators.  The oral board is nerve-wracking, to say the least, and is designed to test an individual’s composure.  Points are awarded based on the board’s assessment of the candidate’s punctuality, answers to questions on attitude and teamwork, verbal communication skills, appropriateness of answers, and medical knowledge.  Once the candidate has answered pre-designated questions, they are required to complete a basic life support assessment of a simple patient and treat them appropriately; they earn points for both assessment and treatment.  The boards are intended to be neither supportive nor degrading – they are intended to objectively judge a candidate’s character and current medical knowledge.

Finances:

Unless a school is a “Title IV” school, they are not eligible for federal funding.  Accreditation does not automatically qualify a school for Title IV eligibility, and a school must have Title IV for the student to use funds received after completing a FAFSA, be them by grants or loans.  As the size of a paramedic school is generally quite smaller than that of a school offering an Associate’s Degree in Nursing, you would be hard-pressed to find a private institution that was able to offer federal loans and grants.

But… it’s a really good thing that the nursing school can offer such assistance because when all the finances are tallied and the bill is mailed home, after tuition, uniform, texts, cost of internship (paramedics have to pay additional), and all other incidentals, the damage is:

Paramedic – Approximately $14,000.00.

AS Nursing – Approximately $57,000.00.

So – Thank God for student loans for nursing students!  The backside is, upon graduation, a nurse has a far higher probability of paying off loans, as they can make easily 3-4 times what a paramedic can make, unless they are hired in the public sector or as a firefighter.  (Refer back to one of my initial posts stating that I was going to be making $11.00-$12.00 per hour in San Diego as a paramedic.  Nursing jobs are STARTING at $34.00-$38.00 here and can get up to $50.00-$60.00 in the SF Bay Area where medics don’t make much more than here.)

Orientation:

Orientation is a necessary component to both the nursing and paramedic programs.  Neither is significantly different, covering the School’s attendance policy, dress code for the program, parking situation, and other demographic incidentals.  Both programs tout the degree of support available for the student, something that I must say is rare to find in the public institutions.  Tutoring and additional assistance is commonplace with private postsecondary schools because it is vitally important to ensure a decent retention and graduation rate.

The research resources available to students seem to be more abundant with nursing school.  Their library has an actual librarian and their computer lab has indexed videos and resources available for the student.  While paramedic schools are required under accreditation to have some form of a library, most choose to opt for a virtual library like www.freelibrary.com, and they may or may not have a computer lab available.  I do hope, however, that we will see this change in the near future with the increase in focus on research for paramedic programs.

I think the thing that stood out most between the two programs during orientation was that for paramedic school, it is not uncommon to advise the student that for the next year and half, they can expect that they “will not have a life”; paramedic school is an absolute time commitment, sitting in the classroom up to 24 hours per week and an expectation of at least that much, if not double or triple in homework.  Beyond that, the paramedic student will often times find themselves working up to 72 hours per week (I did three 24-hour shifts during my schooling) because like paramedics, EMT’s make a dismal living.  The nice thing about working on an ambulance, however, is that any time you are not running a call, you can study.

During the nursing orientation, it was stated quite a few times that this program is incredibly fast and that a great deal of studying was to be expected, but when the student body representative spoke (beginning his second year now), he said to expect about an hour of homework for every hour spent in class.  I am scheduled for 10 hours per week for my first semester.  Further, the Director stated that she expected we take the program seriously and make a definitive commitment to it, but that “…for the next two years, I want you to have a life in addition to school.”  It was stressed that working part-time might be stretching one’s limitations, but it could be done.

Conclusion…

Prior to starting nursing school, I have found far more support in the process of getting started than is designed in the admissions process for paramedic school.  Paramedic schools have been designed to utilize many different tools to weed out individuals and scrutinize every component of the individual prior to being allowed to start.  In the field of Paramedicine, I find that attitude carried over onto our ambulances.  Our support system is a “sink or swim” environment and it is not uncommon to lose educational opportunities because we’re so busy defending ourselves.  I feel that because we are paramilitary, we intentionally look to best each other, and not in a way that is productive and supportive.  As a USAF Veteran, I can say that paramedic school resembles boot camp, minus the military campaign DI hats.

Nursing school has proven to be a gentler ride thus far than paramedic school or military basic training ever was.  Whether or not that will continue is yet to be seen.  I have my first day of class tomorrow at 0800.  My sister is a nurse and I’ve heard the stories about how nurses eat their own.  It may prove to be that the kindness I have seen so far from the School is secondary to the nature of the private postsecondary educational institution - $$$.

Off to bed for now.  My next post will be after the completion of the “Academic Success” class which I believe will be akin to the Paramedic Preparatory course and a preamble to the actual academics.