Category: Medical

Topic: Quick and Dirty Tips For Passing National Registry

Level: EMT

Next Unit: NREMT Test Anxiety

19 minute read

The National Registry Test Prep Guide Tests Taking Tips

Of all of the worries that I hear from medic students about the licensure process, taking the National Registry test is by far the most common.  It is odd that the style of the test causes more anxiety than the actual content but unfortunately that's the nature of the game here in the US.  In this quick and dirty guide, I'm going to cover three basic topics: how the National Registry is structured, how to formulate a study schedule, and how to become a master tester.


How the National Registry is Structured

The Pass / Fail System

As most of you know, the National Registry is an adaptive test that gets progressively harder as you do better and progressively easier as you do worse.  The test is looking for you to maintain a level of difficulty that is above a certain threshold rather than a minimum percentage of correct answers.  In fact, one can theoretically pass the National Registry with a percentage score that would be failing in a traditional class!  Because of this, it is difficult to gauge how you're doing mid-test.  If you've been killing it, you will be getting insanely hard questions and may feel like you were unprepared.  Conversely, if you've been answering everything incorrectly, you will get very easy questions which may lead you to believe that you came in overly prepared.

As you answer questions correctly your line moves towards the pass region and as you get questions wrong you will be pushed into the fail zone. Your goal as the student is to get your line into the passing zone and, at the very least, straddle that line.  Unfortunately, the information as to where those zones lie is proprietary information.  Understanding the basic structure of the test is extremely useful, though.

Question Format

The question format of this test is fairly standard.  You will have a question that can range from scenarios to basic knowledge to EKG interpretation that will be accompanied by four choices. The choices will generally have two obviously wrong answers and two answers that are very close.  You may not go back to questions and you may not skip questions.

Test length

As if the changing difficulty of the test isn't stressful enough, the number of questions you get is unpredictable.  Some people will get 70 and some will get 150.  Generally, the test will cut you off when it "decides" that it has enough information about you to judge your competency.  That is to say, if you consistently do very well (or very poorly for that matter) then you will get cut off early.  If you straddle the "passing line" then you will get a very long test.  In some cases, though, students will be selected on a random basis to take the entire test regardless of their performance.  It is assumed that these are calibration tests that are used to keep the content relevant.  As with most things, there is always an exception to the rule so don't get hung up on your test length.  As I said, it is pretty unpredictable.


How to Formulate a Study Schedule

The key to doing well in any testing situation is proper time management and adequate preparation.

Like any successful financial investment portfolio, diversity is the key to success in passing your test. uses a combination of 3 learning environments to maximize your retention of the material.

  1. The MedicTests library has hundreds of detailed EMS units written in plain English and organized by topic.
  2. Strengthen Skills, Work on Weaknesses, and Study Suggestions are part of our new adaptive tutoring system that senses what you know and what you need to learn. Then, it pushes content and questions to your dashboard based on the topics you need.  
  3. We have over 600 units on every topic in EMS. Simply pick a unit, such as Acid-Base Balance, soak in the knowledge, then take an open book quiz to test yourself on what you just learned. 
  4. The National Registry Simulator™ software was designed to recreate the testing pattern and experience of the actual National Registry Exam. It is recommended that you do this twice a week when you have about 2 hours to go through the entire program. Its primary function is to build your test endurance and to get you used to NOT KNOWING WHERE YOU STAND, in the middle of a test, and it gives you the opportunity to practice focusing on ONE question at a time, independently of how you feel you are doing on the exam. Test endurance is a very hard thing to build. Your mind will want to GET IT OVER WITH AND JUST HOPE! You have to fight the desire to have it over with and focus on the desire to answer this ONE NEXT QUESTION correctly. 

After you obtain your tools you will be ready to formulate a schedule.  As you will notice, creating a study schedule is not unlike a workout or training schedule.  Medic Tests suggests that you begin preparation 90 days prior to your test day.  In the interest of saving space, I will outline a 30-day plan.  This can be easily extended to a 90-day plan.


  Week 1 Week 2 Week 3 Week 4
Monday Strengthen Skills Strengthen Skills Strengthen Skills National Registry Simulator
Tuesday Work on Weaknesses Work on Weaknesses Study Suggestions NR Simulator Review
Wednesday Study Suggestions National Registry Simulator Work on Weaknesses Group Study
Thursday National Registry Simulator NR Simulator Review Focus Study  Work on Weaknesses
Friday Rest Mentor meeting National Registry Simulator National Registry Simulator
Saturday NR Simulator Review Group Study NR Simulator Review Rest
Sunday Rest Rest Rest Test Day


You will notice that this plan has three major characteristics:

  1. Consistency
  2. Variety
  3. Rest days


How to Become a Master Tester

Ultimately, the only way to become a great tester is to test often.  Like anything else, practice makes perfect.  Aside from keeping a consistent testing schedule (see above), here are some tips that you can employ during your test.

  • Take your time!  As the old EMS adage goes "When on scene, walk.  When you feel the urge to run, walk slower."  Getting carried away will stress you out and ultimately cause you to fail.  There is no previous question, there is no next question, there is only the present question.
  • Identify the oddballs.  More often than not, there will be two ridiculous answers and two plausible answers.  Identifying the ridiculous will increase your chances by 100%!
  • Write things down.  Pearson VUE is required to give you a dry erase board and a marker.  Use it to sketch ideas, write down concepts, and do the math.  Sometimes seeing your thoughts can help.
  • Learn to accept defeat.  Now, don't misunderstand me... I'm not saying give up at the slightest hint of difficulty.  I'm saying if you're absolutely sure that you do not know the answer then Identify the oddballs, make an educated guess and move on.  If you stress and stress and stress over a question then you are going to psych yourself out.



For more test tips check out  

Top 5 Tips for the NREMT Written Exam

Test Anxiety