The psychomotor exam tests your “hands-on” knowledge and skills. A trained Registry representative gives the exam, and the exam is the same across the country. All candidates complete the same exam in the same format. We only accept results from official, scheduled exams given by Registry representatives.

To pass the psychomotor exam, you must demonstrate proficiency in the following skill stations:

1. Patient Assessment – Trauma
2. Dynamic Cardiology
3. Static Cardiology
4. Oral Station – Case A
5. Oral Station – Case B
6. Integrated Out-of-Hospital Scenario

Patient Assessment – Trauma

You perform a “hands-on” head-to-toe physical assessment and state how you would treat a patient in a given scenario. This station must be completed in a maximum of 10 minutes. The scenarios include:

• Scene Size-Up
• Primary Survey/Resuscitation
• History Taking
• Secondary Assessment

Dynamic Cardiology

You need to show you can manage a cardiac arrest situation. You need to be able to deliver electrical therapy and state all interpretations and treatments in a given scenario. The presentation of this exam station will be similar to a “megacode.” This station must be completed in a maximum of 8 minutes.

Static Cardiology

You review 4 prepared ECG tracings with associated patient information. You identify and state the name of each rhythm. You state all treatments associated with that rhythm. This station must be completed in a maximum of 6 minutes.

Oral Station—Cases A & B

You need to state how you would manage all aspects of an out-of-hospital call in two separate cases: Oral A and Oral B. The person giving you the exam will provide the information verbally. There will not be a simulated patient and no physical assessment or skills will be demonstrated. This station must be completed in a maximum of 15 minutes. The person giving you the exam will evaluate you in the following categories:

• Scene Management
• Patient Assessment
• Patient Management
• Interpersonal Relations
• Integration (verbal report, field impression, and transport decision)

Integrated Out-of-Hospital Scenario

The Integrated Out-of-Hospital Scenario may involve a pediatric, geriatric, or adult patient. You will have a simulated patient encounter. We will provide you with a Professional Paramedic Partner. You need to show you can manage a call, lead a team, effectively communicate, and maintain professionalism. You or the Professional Paramedic Partner must perform all interventions just as you would in the field. This station will last for exactly 20 minutes.

Skill Station Check Sheets

We publish electronic copies of the skill station check sheets we use as evaluation instruments. They can be accessed, downloaded, and printed at: nremt.org/paramedic/certification

To register for the psychomotor exam, you need a Psychomotor Authorization to Test (PATT) number. When you schedule your exam, you will need to give the PATT number to the reservation coordinator. We recommend bringing a copy of your PATT with you on the day of the exam.

We recommend that you do the following at least six to eight weeks before you take the psychomotor exam.

FAQ: Do I have to take my cognitive exam prior to my psychomotor exam?

The Registry does not have a set order for the exams. Check with your program director or state office for local requirements.

Submit your paramedic application if you have not yet. For the application to be complete, your program director must confirm that you have Early Eligibility or Course Completion. You can consult with your Program Director for questions related to Early Eligibility or Course Completion. Once your application is complete, you can get your PATT.

A PATT number will post to your Registry account on the “Psychomotor ATTs” page. Find your PATT using these steps:

1. Log into your Registry Account
2. Select “CBT Candidate” role
3. Click on “My Applications” on the left-hand side
4. Click on “Psychomotor ATTs”
5. Click the blue button “Generate PATT” to create the needed number
6. Print your PATT

Important PATT Reminders:

• Check your account for your PATT number and psychomotor results
• You need to produce your PATT number on the day of the exam, so we recommend you bring a copy of your PATT
• You must bring a government-issued form of identification with you to the exam site
• If you cannot make the exam, you will be unable to reschedule for another exam until the original exam you signed up for has been processed and all official scores released. This can take four to six weeks. You can only register for one exam at a time
• You can cancel the exam. The deadline for cancellations is in the exam details on your account. After this deadline, you may no longer cancel your reservation.

To take your exam, you need to find a place that gives the exam and see if their dates work with your schedule. Ask your Program Director about where to take the exam or go to the regularly updated “Locate A Psychomotor Exam” page:
nremt.org/locate-exam

FAQ: Why is my PATT on hold?

Your PATT number is on hold because the results from your previous exam have not been processed.

Some states offer the exam as part of their licensure process. The state may allow only residents of that state to take the exam. Also, for initial licensure, some states only accept psychomotor exams given in their states. If an exam is given by the state, call the State EMS Office and ask when and where you can take the next psychomotor exam.

Once you know where and when you would like to take your exam, make a reservation. Contact the Exam or Reservation Coordinator by the registration deadline. When you make your reservation, you may be asked to provide some basic demographic information (name, address, phone number, email contact) as well as your PATT number. Please note: An exam may fill up. Register early to make sure you get a spot in the exam you want.

Check with the Exam or Reservation Coordinator to see if the site charges any psychomotor exam fees. We do not charge or collect fees for the psychomotor exam, but the site may. The site will also inform you of any other local considerations (directions, maps, specific equipment issues, food and beverage availability, etc.).

Cancellation/No Show

You can cancel your reservation as long as you do it before the cancellation deadline. The deadline is listed in the exam details. If you cannot make the exam, you will not be able to schedule another exam until the original exam has been processed.

Processing exams takes time. After candidates take the exam, the Registry Representative sends the candidates’ exams in to the Registry office where they are reviewed and scored. The process can take 4-6 weeks.

You can only register for one exam at a time. If you do not attend an exam, it does not count as an attempt.

Before the Exam Begins

When you check in at the psychomotor exam site, you must produce a current government-issued form of identification (e.g. driver’s license). Photocopies of any ID will not be accepted. The ID must contain a permanently affixed photo and your signature (not required for military IDs). As part of checking in, you will need to provide your PATT number. We recommend bringing a copy of your PATT with you on the day of the exam.

Before the exam, the official Reistry Representative will read a specific orientation script to you. After the orientation, you complete the Registry Advanced Level Psychomotor Report Form. Then you will need to sign the attestation. If you do not sign the attestation, you cannot take the exam.

The Registry Representative will collect your completed Advanced Level Psychomotor Report Form and confirm your identity. You will need to provide your official form of government-issued photo identification, such as your driver’s license, and your PATT number.

If you do not provide an accepted form of ID or if you do not have a valid PATT number, you cannot take the exam. You may also forfeit any exam site fees.

During the Exam

You cannot bring electronic devices in to the exam. Lock all cell phones, smart watches, pagers, and similar devices in your vehicle.

You cannot bring any calipers, calculators, or any other electronic or mechanical devices into the exam site. You may not use reference material for any skill station except the Integrated Out-of-Hospital Scenario.

You may use non-electronic reference materials in the Integrated Out-of-Hospital Scenario (e.g. field guides, medication cards, protocol, length/weight tape).

You may make calculations or notes, but only on the scratch paper provided. You must leave the scratch paper in the room when you complete the skill station.

The Exam Coordinator or Staging Officer will tell you which skill station to go to. Go quickly to the skill station as soon as your name is called. Return to the staging area as soon as you finish at your skill station. Do not discuss any specific details of any skill station with anyone at any time. If you discuss exam content, your certification can be denied or revoked (See Denial or Revocation of Certification policy).

Please be courteous to everyone by keeping noise to a minimum. If you leave the site before you complete the required portion(s) of your psychomotor exam, you will not be allowed back into the exam that day.

The skill stations have several types of equipment available. You will have time at the beginning of each skill station to look at and choose the equipment you want to. You do not need to use all the equipment.

If you do not know how to use a device, ask the Skill Examiners about it. They can tell you about any specific features of the equipment. If you bring your own equipment, the National Registry Representative needs to inspect and approve your equipment before it can be used.

You must state what you are doing as you complete each skill station. If the skill station has an overall time limit, the Skill Examiner will let you know during the instructions. When you reach the time limit, the Skill Examiner will tell you to stop. You may be asked to remove equipment from the Simulated Patient before leaving a skill station.

The following skill stations have a time limit:

Patient Assessment—Trauma: 10 minutes maximum
Dynamic Cardiology: 4 rhythms within 8 minutes maximum
Static Cardiology: 4 rhythms within 6 minutes maximum
Oral Case A & B: 15 minutes maximum
Integrated Out-of-Hospital: 20 minutes required

The Registry Representative is responsible for ensuring that fair, objective, and impartial evaluations occur in accordance with Registry policy. If you have any complaints, notify the Registry Representative immediately to discuss your complaint. The Registry Representative will be visiting all skill stations throughout the exam to verify that Skills Examiners conduct evaluations according to Registry guidelines.

Testing Environment

The testing site will have enough room to accommodate the candidates who are scheduled to attend. All facilities meet National Registry and acceptable educational standards. The facilities will have all required equipment for each skill station. The Exam Coordinator will make sure the equipment is clean and that it works.

If an unexpected event, such as a fire alarm or power outage, interrupts the exam, the Registry Representative, Exam Coordinator, and Medical Director will decide whether to nullify skill stations in process. They will also decide when to restart the exam. Their final decision(s) will be based on making sure that all candidates are able to complete the Registry psychomotor exam in the same standardized format as all other candidates.

Complaint Process

If you have a complaint concerning the psychomotor exam, make your complaint before you leave the testing site on the day you take the exam. Complaints will not be valid after the day of the scheduled exam. We will not accept complaints if you make the complaint(s) after you get unofficial results or leave the exam site.

If either of these two things occurred, contact the Registry Representative immediately to initiate the complaint process. The Registry Representative will give you the necessary complaint form, which you must complete in writing. The Quality Assurance Committee, made up of the Registry Representative, Exam Coordinator, and Medical Director, will review your concerns and make a final decision about your complaint.

Reasons for Dismissal

You may be dismissed from an exam if any of the following happen:

• If your identification does not match the official exam roster or information that you enter on the Registry Psychomotor Report Form
• If you cannot produce your PATT number
• If you attempt to impersonate a candidate identified on the official exam roster. All exam materials handed-in by the impersonator will be marked and withheld from processing. The incident will be communicated to the appropriate agencies. Additional actions may also result
• If you attempt to use any communication or recording device during the exam for any reason whatsoever, attempt to make any copies or recordings of any skill station at any time, or remove any notes you made in any skill station
• If you possess any injury or condition that may be aggravated by the exam conditions, or the exam conditions may cause further harm.
• If you become boisterous, unruly, and hostile upon learning of your results. The incident will be communicated to the appropriate agencies. Additional actions may also result
• If you are found to be discussing scenario information or attempting to illicit scenario information

How Candidates are Evaluated

The Skill Examiners are experts in their assigned skill station. The Skill Examiner watches you and records your actions. Each Skill Examiner documents your performance based on pre-created standards for each skill station that follow the U.S. National EMS Education Standards and the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The Skill Examiner may ask you questions in order to better understand what you are doing. The questions are only for clarification and understanding. Answer the questions if you are asked. They do not indicate that you are doing well or poorly. Do not let a question or the fact that the examiner is documenting your work influence your actions.

The Skill Examiners do not decide what the pass/fail criteria are. We have told all Skill Examiners to avoid any casual conversation with candidates to help ensure fair and equal treatment of all candidates throughout the exam. We do not allow Skill Examiners to tell you anything about your performance in any skill station.

Scoring Exam Results

The Registry Representative will review and score all unofficial results. The Representative will record your unofficial results onto your completed National Registry Advanced Level Psychomotor Report Form.

The Registry Representative will then ask you if you have any complaints concerning equipment or discrimination. If you have any complaints that have not been disclosed yet, the Registry Representative must address your concerns before telling you your unofficial score. The Registry Representative will privately tell you your unofficial psychomotor exam results only.

If you do not pass, neither the Registry Representative, nor any other person, is allowed to tell you any specific reason(s) for failure. The purpose of certification by the National Registry is to verify the achievement of minimal competency for safe and effective practice. The exam is pass/fail and is not designed to analyze errors.

We give the Registry Representative up to three weeks to return the exams to us. When your exam arrives at the Registry, we begin a quality control process. We may discover errors that change the unofficial results given to you the day of testing. We will post your official results; you will see each skill station listed as passed or failed.

We will post the official results to your Registry account within 3-8 business days after they arrive at Registry, assuming they are in an acceptable condition.

Appealing a Psychomotor Exam

If you believe that the psychomotor exam was administered in an inaccurate or unfair manner for any reason, including, but not limited to, an equipment malfunction or discrimination or bias of an examiner, you must immediately discuss your complaint with the Registry Representative to start the complaint process.

The request must be made to the Registry Representative on the complaint form provided. You can only make a complaint/ appeal the exam result on the day you take the exam.

As soon as you make a complaint, a Quality Assurance Committee made up of the Registry Representative, Exam Coordinator, and Medical Director will gather at the testing site. The Committee may discuss the matter with you and the involved skill station examiner(s), if necessary. They may also make other investigations they decide are needed.

There are two outcomes for the Complaint Process: one is to nullify the results and retest the skill station, and the other is to have the results stand. If you retest, the first exam will be voided and only your performance on the retest will count toward your score.

The determination of the Quality Assurance Committee is final and binding. There will be no further appeal from a failure on the psychomotor exam.

If you fail the psychomotor exam, you may be able to retest that same day. We do not guarantee that there will be a same-day retest at any scheduled exam site. The Registry Representative, Exam Coordinator, and Medical Director for that exam decide if there will be a same-day retest.

If a same-day retest is offered, you may complete only one retest attempt that day. The Registry cannot score or report incomplete psychomotor exam attempts. As a result, if you retest, you must complete all the skill stations you did not pass. You are not permitted to complete only a portion of the skill stations that need to be retested.

If same-day retests are offered, you cannot be retested by the same Skill Examiner or over the same scenario for the same skill station.

You are allowed two full attempts to pass the psychomotor exam. If you fail up to three skill stations, you may be allowed to retest in those skill stations as part of your first full attempt. One “full attempt” is defined as completing all six skill stations and up to two retesting opportunities. If you fail four or more skill stations during the first attempt, that exam also counts as “full attempt.” You are allowed the two full attempts only if all other requirements for National Registry certification are fulfilled.

You must take remedial training if you fail a full attempt or any part of a second retest. The remedial training must cover all skill stations. Once you have completed remedial training, you will need to provide documentation of the training (a letter) before you make another full attempt. The letter must be signed by the Exam Coordinator, Training Officer, Program Director, or Medical Director who verifies remedial training. It has to say that you have completed remedial training over all skill stations since the last unsuccessful attempt. It also has to say that you have demonstrated competence in all skill stations.

Send the signed letter on letterhead to the Registry Exams Department at exams@nremt.org. Once we have verified your remedial training, we will post a new PATT number to your account.

Your exam results are valid for 24 months. If you are eligible to retest any skill stations, complete the retest within 24 months while the parts you passed are still valid. Provided all other entry requirements are met.

For candidates with a course completion date prior to November 1, 2018, passed portions of each examination are valid for 12 months. If you are eligible to retest any skill stations, complete the retest within 12 months while the parts you passed are still valid. Provided all other entry requirements are met.

You will not be able to schedule yourself for another exam until your official results are posted to your Registry account. It may take 4-6 weeks for the results to post to your account.

Should you fail the second full and final attempt of the Paramedic psychomotor exam, you must start the process over. You will need to:

• Complete another approved Paramedic program
• Meet all other requirements for Registry certification in effect at that time
• Begin the certification process again

Rescheduling

If additional retesting is required, visit the Registry website for a list of Advanced Level exam sites: nremt.org/locate-exam

After you find a scheduled Registry psychomotor exam that works for you, contact the designated Exam or Reservation Coordinator by the reservation deadline listed for that exam. You will not be able to schedule yourself for another exam until your official results are posted to your Registry account. It may take 4-6 weeks for the results to post to your account.

If you need to retest on your first attempt, you will register with your existing PATT number.