TEI Questions and the NREMT

EMTprep Staff Updated Dec 18, 2021

Introduction to TEIs

A Technology Enhanced Item (TEI) is, for the purposes of the National Registry of Emergency Medical Technicians (NREMT), an additional type of test question other than multiple choice. Since 2020 the NREMT has started using TEI’s in the form of a multiple response question. A TEI could also be formatted in other ways such as an image, fill in the blank, etc. The NREMT has started using TEI’s in order to continue to develop fair and accurate testing measures for emergency medical service (EMS) certification.

Example of a TEI (Multiple Answer Type)

Which of the following are colors? Select the two answer options that are correct.¹

a. Blue

b. Apple

c. Chair

d. Red

e. Sky

Only options A and D are colors, so selecting both options would be correct.

How TEIs Work

The purpose of TEIs is for the NREMT to be able to accurately evaluate individuals for medical knowledge. The better the testing, the more confident the NREMT can be that they are certifying individuals with the ability to do the job safely and correctly. Many other healthcare examinations already incorporate TEIs including the American Registry of Radiologic Technologists (ARRT), the National Center for Competency Testing (NCCT), and the National Council of State Boards of Nursing (NCSBN) to name a few. Research has shown that multiple answer options can reduce luck and be stronger indicators of a test-taker’s grasp of the martial relative to a single answer multiple-choice questions.² According to the same research by Thayn (2010), these increases in testing accuracy are only found when TEI test questions are graded right or wrong and giving partial credit reduces the effectiveness of the questions. The NREMT will grade questions right or wrong, and not offer any partial credit on multiple response questions. TEI questions for NREMT exams at any EMS level will have the same weight for the exam as every other question on the exam. The NREMT has also stated they will not increase the testing time as TEIs take approximately the same amount of time to complete as a traditional multiple-choice question. The focus of the testing is still on the material rather than the question type so with the randomized draw from relevant topics a test-taker could see multiple TEI-style questions or none at all.¹

How to Prepare for TEI questions

The best way to prepare for TEI questions is to practice and practice some more. It comes down to becoming familiar with the question type, as the material is the exact same as the material on a regular multiple-choice question. EMTprep has all the resources needed to build and review the knowledge base for any NREMT exam, EMT, or Paramedic. These resources are for all learning types and include memory-building flashcards, study guides, interactive worksheets, and videos. Additionally, EMTprep has practice exams that include both multiple-choice questions and multiple answer questions (TEIs) to help prepare students for the NREMT exams.


TEIs are a new type of question being implemented by the NREMT for EMS exams. Currently, the NREMT is phasing in multiple answer option TEIs but has stated they could implement more TEIs in the future as they evaluate the success of their initial TEIs. As TEIs have been present in many other health professional exams for years, it seems likely TEIs are here to stay in NREMT exams. EMTprep is the leading test prep for NREMT exams and implements TEI questions in their test prep material and practice tests. Over 200,000 students have passed their EMR, EMT, AEMT, or Paramedic exams using EMTprep and EMTprep has a 100% pass guarantee, continuing to support students until they reach their goals. From TEIs to whatever else the NREMT throws at students, EMTprep has the resources to prepare students to pass their exams.


1) Technology enhanced items: Sample multiple response items. National Registry of Emergency Medical Technicians. (n.d.). Retrieved December 16, 2021, from https://www.nremt.org/Document/technologyenhanceditems

2) Thayn, S. (n.d.). An evaluation of multiple-choice test questions ... Retrieved December 16, 2021, from https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=3449&context=etd