The Michigan EMSCC has decided to revisit the CoAEMSP accreditation requirement and the use of the NREMT for testing. It is expected, at the September 30, 2011 EMSCC meeting, a motion will be made to require CoAEMSP accreditation and to continue using the NREMT as the testing organization for State licensure. This motion, if passed, will overturn the previous recommendation made in January of 2009. The reason for the revisit is new information has been discovered, and confirmed, in regards to CoAEMSP and NREMT policies and procedures.
As many will recall there was heated debate on the issues and although the initial recommendation, by the EMSCC, was passed with a unanimous vote we have to also acknowledge there was, and continues to be, strong opposition to the recommendation amongst the constituents that are represented by EMSCC.
I am sharing with you information that I have gathered hope you may find it helpful as you discuss this with your peers. I also suggest you do your own “fact finding mission”
Disclosure
The author discloses no commercial, financial or relevant financial interest exist with the entities mentioned in this article and is not involved in coordinating or offering initial EMS education programs.
Q: How did this all start?
A: In the year 2000 the Education Agenda for the Future: A Systems Approach was published by NHTSA and it specifically stated there should be a single agency that provides national EMS program accreditation and a single agency that provides national EMS certification (http://www.nhtsa.gov/people/injury/ems/FinalEducationAgenda.pdf). The Institute of Medicine’s (IOM) EMS At the Crossroads (2006) also recommended a single national EMS accrediting agency for the country as part of a process of standardization in EMS education (http://www.iom.edu/Reports/2006/Emergency-Medical-Services-At-the-Crossroads.aspx)
Q: Is there a difference between institutional and programmatic accreditation?
A: Yes. The terms both refer to accreditation however INSTITUTIONAL refers to the institution that holds accreditation of the university, community college, or hospital where various allied health care programs are taught. Organizations that provide institutional accreditation include the Southern Association of Colleges and Schools, the Western Association of Colleges and Schools as well as many others. These accrediting agencies are interested in the entire institution and its educational offerings. PROGRAMMATIC accreditation refers specifically to the profession, in this case, the Paramedic educational program.
Q: Is CoAEMSP the accrediting agency?
A: Yes and No. CoAEMSP actually reviews and makes recommendations to their parent organization The Commission on Accreditation of Allied Health Education Programs (CAAHEP) who accredits over 2,000 education programs in about 20 health science programs to include Paramedic education (www.caahep.org)
Q: Is CAAHEP recognized by the United States Department of Education (ED) so programs may be eligible for federal funding/grants?
A: No. In speaking with the Executive Director, Kathleen Megivern, she stated prior to 1998 they were recognized by ED however in a review of programs they accredited there was a “handful” of programs who were not part of an institution that was accredited by another organization that was recognized by ED. Hence, to save time and money they decided to eliminate the redundancy.
Q; May CoAEMSP recommend accreditation for programs that offer distant learning?
A: Yes. In a conversation with CoAEMSP’s Executive Director, Dr. George Hatch, he stated they have two programs that are accredited that use Distance Education, one in Louisiana and the other in Oklahoma. He also stated they have received an application for a complete “Distance Education Program” and the site visit has yet to be done. In their Policy and Procedure manual (revised July 2011) they differentiate “Distance Education – Method of Instruction” and “Distance Education Program” (www.coaemsp.org)
Distance Education – Method of Instruction
A formal educational process in which the majority of synchronous and asynchronous instruction occurs when student and instructor are not in the same place. Distance education includes, but is not limited to, correspondence study or audio, video and/or computer/internet technologies.
Distance Education Program
Delivery of the complete program that allows the completion of the entire curriculum without the need to attend any instruction on a campus location. (Note: this delivery is not hybrid or partial e-learning delivery.)
Q: If I have satellite programs would I need each satellite site accredited?
A: It depends on if you are truly a “Program Satellite” then yes however if you it is a “Program Section” then no. These are defined in the CoAEMSP Policy and Procedure manual (www.coaemsp.org).
Main-campus: the location designated by the sponsor as the primary location of the program and where students attend to complete the laboratory (or similar hands-on skills) professional courses of the curriculum.
Program Section: the delivery of the program to a distinct cohort of students who attend the main-campus for one or more of the laboratory (or similar hands-on skills) professional course(s) of the curriculum. A cohort may be distinguished by time of day for primary completion of the curriculum (e.g., day vs evening), by day of the week for primary completion of the curriculum (e.g. weekday vs weekend), or by contract with a third party for a specified group of students (e.g. employees of a municipal fire service). Each section is reported as a separate enrolled class in the Annual Report.
The section would have the same curriculum and same graduation requirements.
Program Satellite: off-campus location(s) that are advertised or otherwise made known to individuals outside the sponsor where students can complete the laboratory (or similar hands-on skills) professional course(s) without attending the main campus. A satellite does not pertain to sites used by a completely on-line/distance education program for individual students. Satellite(s) are included in the CAAHEP accreditation of the sponsor and function under the direction of the Key Personnel of the program.
Q: What is the cost to obtain CoAEMSP accreditation?
A: CoAEMSP has fixed costs for the application, review etcetera and provides an estimation of total cost over a 5-year accreditation period (www.coaemsp.org).
Q: The dollar amount for accreditation, per student that CoAEMSP states does not accurately reflect the total cost for the process. What is a real number?
A: This will vary from program to program depending on what they currently have in place versus what they are deficient in.
Q: Are there any studies that show program accreditation, positively, effects credentialing examination success rates?
A: Yes. According to CoAEMSP “several current research articles published in peer-review academic journals indicate an increased success rate on national certification exams from graduates of nationally accredited Paramedic programs”. One study, “Program Accreditation Effect on Paramedic Credentialing Examination Rate “ Dickison et al PEC 2006 10:2, 224-228 states:
RESULTS
Data were available for 12,773 cases. The majority of subjects were male (74.6%) with a mean age of 31™}8 years. The overall pass rate was 55.4% (Table 1). Univariate associations are listed in the Table. Attendance at an accredited program was associatedwith passing the examination (OR 1.65, 95% CI: 1.51– 1.81). Increasing education was most strongly associated with successfully completing the examination. Individuals who made repeated attempts at the exam were less likely to pass. Compared with fire department personnel, test takers indicating their primary affiliation was private EMS or municipal “third service” EMS were less likely to successfully complete the exam. Black candidates were less likely and Asian candidates more likely to pass the exam than whites. Multivariate logistic egression verified that attendance at an accredited program was independently associated with passing the examination, even after accounting for the confounding effects of age, sex, race, education, experience level, and total number of examination attempts (OR 1.58; 95% CI 1.43–1.74). Goodness-of-fit of the multivariate model was satisfactory (Hosmer–Lemeshow p = 0.14). Repeating the multivariate analysis excluding education level 1 (<12 years) resulted in the same inferences.
Conclusion
Students who completed an accredited paramedic program were more likely to pass the national paramedic examination. National accreditation should be required for all EMT-Paramedic education programs.
Q: Will States be able to use National Registry of EMT’s (NREMT) for testing, at the paramedic level, after January 1, 2013 if their paramedic programs are not CoAEMSP accredited?
A: Yes, but only if the State agrees they will require their paramedic programs to be CoAEMSP accredited by 2018. If a State agrees to this, after January 1, 2013 any candidate that does not attend a CoAEMSP accredited program but takes the assessment test for licensure will NOT be eligible for National Registry Certification.
Editorial Comments
Some may say “moving the chairs on the deck of the Titanic would not have prevented the disaster” I do not disagree with that but if the Titanic had more accurate, updated, information or acted differently with the information they had they could have changed course and prevented the disaster.
The fact still remains, to continue to use the National Registry as the testing organization, for Michigan EMS licensure, they will only accept (at the paramedic level) candidates who graduate from a CoAEMSP accredited paramedic program. I believe most stakeholders are not opposed to “national accreditation” in fact many have or promote some form of a national accreditation (e.g. CAAS, CAMTS, etc.). I also believe most stakeholders do not have an issue with the products the National Registry offers. The issue is the mandate
We (Michigan) have accepted the National EMS Education Standards, as a minimum, for all levels of licensure in Michigan. We did not oppose the Education Agenda for the Future: A Systems Approach. We are in-line with the national initiatives for everything but the CoAEMSP accreditation. Michigan is still the only State that has declared they were withdrawing from the National Registry. How is this going to impact our industry and reciprocity with other States? Are decisions being made for selfish reasons or are we basing them on the student’s and patients’ best interests?
I am confidant there will be some lively discussions over these issues and we can only hope people remember, “The mind is like a parachute, it works best when it is open”.
