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In the Fall of 2020, the NREMT began introducing TEIs, or technology enhanced items, into the national registry exam. At this time, the change you will see this year in your exams is a move to “multiple response” questions. These questions will be posed in a way that indicates to the participant to “select x correct responses” among a list of choices. While there may be additional changes within the theme of technology enhanced items, your primary adjustment for tests this year should be preparing for the possibility of being asked multiple response questions. In August, the NREMT sent out a memo to provide clarity on what this change in question format will look like in the test. 

The NREMT will be specific about the number of correct answers in the provided options. Test takers will NOT be asked to select multiple correct answers without being provided the number of correct selections within a question. For example, you should expect to see a question similar to the following example. 


“Which of the following are part of the primary survey? Select two correct answers.”

A. Determine LOC

B. Physical exam

C. Assess airway and breathing

D. History of present illness

E. Determine scene safety

F. Request additional resources


In this example, the correct answers would be A and C. As demonstrated, you will be prompted to select a specific number of correct answers. Additionally, you should anticipate the possibility of having a larger field of options than the traditional four available. 

It is also important to note that these items will be scored as right or wrong. There will be no partial credit given or taken away, and the responses will only be marked as correct if all of the right answers are selected. You will also not receive any additional time for these questions. Having said this, you should not change your process. Read all of the question and available options before attempting to answer. 

For now, there is no guarantee on the specific number of multiple response questions a candidate will receive. Some examinees may see more TEIs than others. If you see multiple TEIs, do not assume you are answering them incorrectly. Candidates should also prepare for the possibility of receiving no multiple response questions during their examination. 

The NREMT has done extensive research on the validity of TEIs and the use of multiple response questions in their testing. NREMT is confident that TEIs provide a dynamic test which more accurately assesses a candidate’s ability to practice as an EMT. The presence of TEIs should not change your confidence going into the test, you have probably experienced questions like these during your EMT program examinations. 

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