Trending Topics

Using pre-tests in the online EMS classroom

Pre-tests can enable individualized instruction based on students’ knowledge, skills, abilities and needs


The sudden shift to online learning has been a shock to both EMS students and instructors.

Photo/Getty Images

The EMS1 Academy features “Module 14: Critical Thinking and Clinical Decision Making,” a one-hour accredited course for emergency services personnel. Visit the EMS1 Academy for more information.

A sudden shift to online learning blind-sided many EMS instructors, especially those who have never taught outside the traditional brick-and-mortar environment. These instructors are now tasked with figuring out how to give their time online with students the most value.

Some have simply resorted to recording a voiceover of their PowerPoints or requiring all students to attend a virtual classroom at the same time they would usually have class, while other instructors have taken to splitting students into groups when they interact with them online to help give more individualized instruction. This is a great idea for some, but this technique could be capitalized on even further by implementing constructive alignment when deciding how to group students for these smaller sessions.

Constructive alignment

Henning et al. (2017) explain constructive alignment as “an organizing principle used to ensure that each teaching and learning activity in a course corresponds to a specific element of assessment, and in turn, a specific intended learning outcome” – a combination of “constructivist learning theory and instructional design.”

By working backward from the learning outcomes when developing curricula for a course, all elements of the course are likely to be aligned, without tangents to unrelated topics and irrelevant activities being added in. A course instructor can use this approach to further refine the learning activities through implementation of pre-tests.

Often, we think of pre-tests as a large bank of questions to be answered at the beginning of a course to determine the baseline for our students’ knowledge (i.e., pre = before). In this way, we’re giving students a formal assessment, but it doesn’t always have to be formal. If you’ve ever asked your students at the beginning of a class to tell you about a topic before you start the lecture about it, you’re testing their knowledge of the subject. This tends to inform changes in your lesson for the period as you find that students are well-versed in one concept, but perhaps need extra attention in another.

Implementing pre-tests in EMS education

Instead of administering one test at the beginning of the course, create smaller pre-tests based on the learning outcomes or objectives for that unit, which you can then administer throughout the semester. This is going to involve some extra work and planning for you, but you can choose how these pre-tests best fit into your course schedule, perhaps also adding a couple completion points to make it a low-stakes quiz.

You could work this in by assigning students the pre-test after they complete the assigned reading or even just before each week of lecture, as long as you have enough time to look at their scores and advise them on which group they are meeting with you in.

After looking at their scores for the assessment, divide them into groups based on their score. For example, if the unit is cardiac emergencies, maybe some students struggled more with rhythms while others more with electrical conduction. So now, instead of arbitrarily dividing your class into groups that meet at specific times so that you are not faced with 20 students on a Zoom meeting at once, you have divided them based on their ability and where they fall in the zone of proximal development for this subject, allowing you to structure and tailor your lectures or student interactions based on the results of your pre-test.

Houston and Thompson purport in a 2017 study that “if assessment events are positioned as components of complex communication processes for learning, then the focus of attention can be shifted from the tools of the assessment to considerations of the qualities and utility of the judgments and information these events produce, and of the communication that flows from them.”

Formative assessments, such as pre-tests, provide rich information sources about students, including a roadmap of what to teach next. You can explain these pre-tests to students as a way for you to help better guide their instruction and give them more individualized help where they need it.

Tools for pre-testing

Many of the schools that are still holding EMS courses, even though they are online, have moved to teaching through a learning management system (LMS) or platform, such as Google classroom, Moodle or Blackboard. An LMS allows you to control the content that you are presenting to students, and many, if not all, LMS platforms come with some sort of quiz software. You can use this quizzing software to create to your pre-test, assign a due date and generally receive metrics about how students did on the test, whether you’re analyzing by question or student.

You may already be doing this and not realizing it, such as when you administered your last exam and looked at how the students performed by question to see if you perhaps had a faulty question or just needed to reinforce understanding of the topic. Even if you do not have access to an LMS, there are other free tools you can implement, such as Kahoot, but the list is endless.

EMS students are adults, and they understand the challenges involved in teaching and learning online, especially for the first time. If we spend valuable time on a concept that they already know, especially when we have thrust them into a learning environment they are not necessarily comfortable with, we are violating the principles of andragogy and Malcolm Knowles: get learners involved in their own learning path, make learning relevant, and take into consideration their prior experiences.

Doing so helps us keep their attention and better explain the “Why who we have to cover this?” question. You now have a simple answer: you’ve assessed the needs of your students and are now providing more individualized attention based on their knowledge, skills, abilities and needs.

Listen for more: How to continue EMT, paramedic course instruction during COVID-19 pandemic


The Journal of University Teaching and Learning Practice.

Does Progress Testing Violate the Principles of Constructive Alignment?

Melissa Meyers, NRP, combines her experience as a firefighter, paramedic and educator to bring dynamic, thought-provoking, and experiential learning to all of her classes. Melissa is ALS program manager at the Maryland Institute for Emergency Medical Services Systems. She holds a Master of Education degree from Liberty University with a concentration in teaching and learning English, and certification as a National Registry Paramedic.