How to overcome the stages of grief over the NREMT exam

By Dan Limmer

Recently, I posted about the stages of grieving over the NREMT exam. People certainly seemed to agree. We received quite a bit of feedback about the stages—and how it is harmful for students to fight the NREMT style question.

In this post I’d like to continue the discussion with ways to deal with each of the steps. I’ve listed the stages and how I deal with students in each stage.

Denial – the exam isn’t really like that. I had a 91% average in class!

We must educate students about the NREMT exam. Go over a few questions and discuss the NREMT style. Limmer Creative has videos that break down questions and can help your discussion.

Anger – This is bull$#@! Why do I have to learn how to take their test? It is nothing like the street or my class.

As you begin to discuss the questions, students may become a bit angry. (OK, sometimes very angry.) Acknowledge those feelings and explain that the NREMT isn’t that far from the street and the things they were taught in class. Put up another exam question and discuss it. Explain the best answer concept positively and with examples. This is a bit of a defense mechanism that breaks down more quickly in some students than others.

Bargaining – I talked to three paramedics I know and they say these questions are nothing like the NREMT. It can’t be that bad.

As students get close to their NREMT exam they tend to get a bit crazy. They’ll search for sources that agree with them in order to build up the wall they have put between them and the NREMT exam. This is a good time to again explain that the material they learned in class is valid and will help them on the exam. Tell them that people who are advising them mean well but as their instructor, you have prepared students successfully for the NREMT before and you will continue with this course.

Depression – I don’t have a friggin’ snowball’s chance in hell of passing this test. Was I even awake in class?

This is a pivotal point. If students don’t break out of this phase they’ll have no confidence going into the exam. They’ll be more prone to discouragement when tougher questions come up and it can throw them off—and result in failure for a student who may have otherwise been able to pass. Work with these students. Go over some questions and offer to review problem material with them. I find a lot of students in this mode coming to the office hours I host weekly on When this occurs I do two things, provide them with some positive exam experiences and (perhaps even more importantly) help them get their mojo back.

Acceptance – OK. I’m going to take a few more practice tests and study some stuff I found I didn’t know.

If the students get here, they are on their way to success. No student ever feels fully ready for the NREMT (those who do may actually be over confident). When a student gets to this point you know they’ve been through the steps and are going to hunker down for some effective study.

I’d like you to know that Limmer Creative is your partner in helping your students through the steps and to success on the NREMT exam. From our site which helps EMT students learn about the exam in a variety of ways—not just test questions—and including my live office hours, to our apps and audios available at, we are here for educators and students alike.

How do you help students through the stages? Do you find students in one stage more—or longer—than another? We’d love to hear some of your stories.