Research and Evidence-based Practice Practice Questions

42 multiple-choice questions on Research and evidence-based practice for paramedic and EMT students, from Chapter 1 (EMS Systems). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

42 practice questions

1. Evidence-based practice combines:

   1. A. Research, clinical expertise, and patient values
   2. B. Instructor preference, habit, and local custom
   3. C. Tradition, experience, and expert consensus
   4. D. Protocols, hospital policy, and legal standards
   Show answer

   Answer: A. Research, clinical expertise, and patient values

   It combines the best available research, the provider's clinical expertise, and the patient's values and circumstances. All three legs are needed; research alone doesn't decide a case.

2. Peer-reviewed literature is:

   1. A. A textbook chapter written by a recognized expert
   2. B. Any article published in an online journal
   3. C. An agency newsletter summarizing recent studies
   4. D. Research vetted by experts before publication
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   Answer: D. Research vetted by experts before publication

   Peer review filters out much, though not all, weak work.

3. Which is the usual order of the evidence-based process?

   1. A. Search, ask, apply, appraise, then evaluate
   2. B. Adopt the practice, then search for support
   3. C. Ask, search, appraise, apply, then evaluate
   4. D. Evaluate outcomes, ask, search, then apply
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   Answer: C. Ask, search, appraise, apply, then evaluate

   The process is: ask a question, search the literature, appraise the evidence, apply it, then evaluate the result. It starts with a clear, answerable clinical question.

4. A study that follows patients forward in time after enrollment is:

   1. A. Retrospective
   2. B. Prospective
   3. C. A case report
   4. D. A meta-analysis
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   Answer: B. Prospective

   Prospective studies plan data collection in advance, so the data tend to be cleaner.

5. A study that reviews patient care reports from the past two years is:

   1. A. Randomized controlled
   2. B. Retrospective
   3. C. Double-blinded
   4. D. Prospective
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   Answer: B. Retrospective

   Retrospective work is faster and cheaper but limited by what was recorded.

6. The strongest single study design for showing that a treatment works is:

   1. A. A large retrospective case series
   2. B. An expert consensus opinion paper
   3. C. A cross-sectional provider survey
   4. D. A randomized controlled trial
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   Answer: D. A randomized controlled trial

   Randomization spreads unknown differences evenly between groups.

7. In a double-blind study:

   1. A. Only the subjects are unaware of their assignment
   2. B. Only the outcome assessors are unaware of assignments
   3. C. Only the researchers are unaware of assignments
   4. D. Neither subjects nor researchers know assignments
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   Answer: D. Neither subjects nor researchers know assignments

   Neither the subjects nor the researchers know who receives the treatment. Blinding limits bias in how treatment is given and outcomes are judged.

8. A descriptive study differs from an experimental study because it:

   1. A. Describes care without changing it
   2. B. Always randomizes subjects into groups
   3. C. Tests an intervention against usual care
   4. D. Requires a control group for comparison
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   Answer: A. Describes care without changing it

   It observes and reports what is happening without changing care. Descriptive work is often the first step that raises the question worth testing.

9. A meta-analysis:

   1. A. Surveys providers about their practice patterns
   2. B. Pools results of multiple studies
   3. C. Reports one unusual case in detail
   4. D. Describes the structure of a single EMS system
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   Answer: B. Pools results of multiple studies

   It combines the results of multiple studies to reach a stronger overall conclusion. Pooling studies increases the effective sample size.

10. A convenience sample is a concern because it:

    1. A. Is unethical without separate IRB approval
    2. B. Is too expensive for most EMS agencies
    3. C. May not represent the target population
    4. D. Requires randomization to analyze properly
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    Answer: C. May not represent the target population

    A convenience sample may not represent the population you want to draw conclusions about. Who gets included shapes what the numbers can tell you.

11. A p value of less than 0.05 generally means:

    1. A. The sample size was large enough to be valid
    2. B. The treatment effect is clinically important
    3. C. The study design is free of meaningful bias
    4. D. The result is unlikely due to chance alone
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    Answer: D. The result is unlikely due to chance alone

    Statistical significance and clinical significance are not the same thing.

12. Research involving human subjects requires:

    1. A. IRB approval and informed consent
    2. B. Only the medical director's written approval
    3. C. Nothing, provided the data are anonymous
    4. D. Approval from the state EMS office only
    Show answer

    Answer: A. IRB approval and informed consent

    Human subjects research requires institutional review board approval and informed consent, with subject confidentiality protected. Protecting subjects comes before the value of the data.

13. Evidence-based practice in EMS matters because:

    1. A. It reliably lowers the cost of EMS care
    2. B. It always simplifies agency protocols
    3. C. Some long-standing practices proved harmful
    4. D. Federal law requires research-based protocols
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    Answer: C. Some long-standing practices proved harmful

    Tradition is unreliable, and several once-standard interventions have been abandoned after research showed harm or no benefit.

14. A well-formed clinical question generally includes:

    1. A. The intervention and its expected cost
    2. B. The outcome and the needed sample size
    3. C. Population, intervention, comparison, outcome
    4. D. The author's opinion and the clinical care setting
    Show answer

    Answer: C. Population, intervention, comparison, outcome

    This is the PICO format.

15. Peer review before publication is intended to:

    1. A. Speed the publication of important findings
    2. B. Evaluate methods and conclusions first
    3. C. Protect authors from outside criticism
    4. D. Guarantee that published findings are correct
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    Answer: B. Evaluate methods and conclusions first

    Peer review evaluates methods and conclusions before the work is published. It filters but does not eliminate flawed work.

16. A predatory journal is one that:

    1. A. Charges fees with little real peer review
    2. B. Publishes only studies with negative results
    3. C. Requires authors to register their trials
    4. D. Publishes accepted papers very quickly
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    Answer: A. Charges fees with little real peer review

    It charges publication fees while providing little or no genuine peer review. Its presence complicates literature searches.

17. An abstract is useful for:

    1. A. Making practice decisions on its own
    2. B. Replacing the full paper when time is short
    3. C. Citing the study's conclusions in protocols
    4. D. Screening whether to read the full study
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    Answer: D. Screening whether to read the full study

    Decisions require reading the methods.

18. The methods section of a study tells you:

    1. A. The authors' conclusions and recommendations
    2. B. How the study was actually conducted
    3. C. A brief summary of the entire paper
    4. D. Only the sources of the study's funding
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    Answer: B. How the study was actually conducted

    Methods describe how the study was conducted, which determines how much weight to give the results. Weak methods undermine strong conclusions.

19. A control group exists to:

    1. A. Reduce the overall cost of the study
    2. B. Isolate the effect of the intervention
    3. C. Increase the total sample size
    4. D. Satisfy institutional review board rules
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    Answer: B. Isolate the effect of the intervention

    It provides a comparison so the effect of the intervention can be isolated. Without it, improvement may reflect other factors.

20. Randomization serves to:

    1. A. Balance known and unknown differences
    2. B. Simplify the statistical analysis needed
    3. C. Increase the number of subjects who enroll
    4. D. Guarantee the groups are perfectly identical
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    Answer: A. Balance known and unknown differences

    It distributes known and unknown differences evenly between groups. It is the strongest protection against bias.

21. A placebo is used to:

    1. A. Control for the effect of being treated
    2. B. Reduce the number of subject dropouts
    3. C. Shorten the overall length of the study
    4. D. Give the control group active treatment
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    Answer: A. Control for the effect of being treated

    A placebo controls for the effect of receiving treatment itself. Blinding relies on it.

22. Single blinding means:

    1. A. Only the researchers are unaware
    2. B. Results stay hidden until the study ends
    3. C. Neither party knows the assignment
    4. D. The subject does not know the assignment
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    Answer: D. The subject does not know the assignment

    Double blinding hides it from both.

23. A cohort study follows:

    1. A. Following a single patient over a long period
    2. B. Groups with different exposures over time
    3. C. Hospital records from a single past year
    4. D. Randomly assigned treatment and control groups
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    Answer: B. Groups with different exposures over time

    It follows groups with different exposures over time to compare outcomes. It is observational, not experimental.

24. A case-control study:

    1. A. Follows exposed subjects forward in time
    2. B. Randomly assigns subjects to an exposure
    3. C. Starts with outcome, looks back for exposure
    4. D. Uses no comparison group at all
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    Answer: C. Starts with outcome, looks back for exposure

    It is efficient for rare outcomes.

25. A case report describes:

    1. A. A large multicenter randomized clinical trial
    2. B. A pooled statistical analysis of several studies
    3. C. A survey of a whole regional population
    4. D. One patient's presentation and course
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    Answer: D. One patient's presentation and course

    It generates hypotheses rather than proving them.

26. A systematic review differs from a narrative review because it:

    1. A. Is shorter and easier to read
    2. B. Covers a broader range of topics
    3. C. Includes the authors' expert opinion
    4. D. Uses a defined search and appraisal method
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    Answer: D. Uses a defined search and appraisal method

    It uses a defined search and appraisal method to reduce bias. A meta-analysis may combine the results statistically.

27. Qualitative research is used to:

    1. A. Calculate risk ratios for an exposure
    2. B. Randomize patients to treatment groups
    3. C. Explore experiences and perceptions
    4. D. Measure the size of a treatment effect
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    Answer: C. Explore experiences and perceptions

    It explores experiences, perceptions, and reasons that numbers do not capture. Provider and patient perspectives matter.

28. Selection bias occurs when:

    1. A. Subjects drop out of the study at random
    2. B. How subjects are chosen skews the groups
    3. C. The sample is too large to manage
    4. D. Data are analyzed with the wrong test
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    Answer: B. How subjects are chosen skews the groups

    The way subjects are chosen makes the groups systematically different. Convenience samples are vulnerable to it.

29. Confounding occurs when:

    1. A. Measurements are recorded inaccurately
    2. B. A third variable distorts the link
    3. C. The outcome is too rare to study well
    4. D. Randomization balances the two groups
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    Answer: B. A third variable distorts the link

    Another variable related to both exposure and outcome distorts the apparent relationship. Age and severity are common confounders.

30. A prehospital study of 12,000 intubations found that a new device raised first-pass success from 82% to 84% (p = 0.03). Which interpretation is best?

    1. A. The difference is unlikely to be chance but may be too small to matter
    2. B. The device has been shown to improve patient survival
    3. C. The result must be clinically important because p is below 0.05
    4. D. The difference is probably chance because it is only 2 points
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    Answer: A. The difference is unlikely to be chance but may be too small to matter

    A p value below 0.05 means a difference this large would be unlikely if the device had no real effect. It says nothing about whether the effect is large enough to matter, and large studies can make tiny differences significant. First-pass success is a process outcome, not survival, so survival cannot be claimed. Calling it chance ignores the p value.

31. A confidence interval tells you:

    1. A. How much bias is present in the study
    2. B. The sample size the study should have used
    3. C. The p value associated with the main result
    4. D. The range likely holding the true value
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    Answer: D. The range likely holding the true value

    Wide intervals reflect uncertainty.

32. Sensitivity of a test refers to its ability to:

    1. A. Correctly identify those with the condition
    2. B. Confirm disease when the result is positive
    3. C. Measure the severity of the condition
    4. D. Predict the patient's eventual outcome
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    Answer: A. Correctly identify those with the condition

    High sensitivity helps rule out disease when negative.

33. Specificity refers to a test's ability to:

    1. A. Measure how severe the condition is
    2. B. Detect every patient who has the condition
    3. C. Reduce the cost of diagnostic testing
    4. D. Correctly identify those without it
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    Answer: D. Correctly identify those without it

    Specificity is the ability to correctly identify those without the condition. High specificity helps rule in disease when positive.

34. Number needed to treat describes:

    1. A. The number of subjects a study needs
    2. B. The percentage of subjects who drop out
    3. C. The cost of the treatment per patient
    4. D. How many must be treated for one to benefit
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    Answer: D. How many must be treated for one to benefit

    It helps translate statistics into practice.

35. Generalizability refers to:

    1. A. Whether the sample size was adequate
    2. B. Whether the funding source was disclosed
    3. C. Whether results apply to your patients
    4. D. The statistical power of the study
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    Answer: C. Whether results apply to your patients

    Generalizability is whether results apply to your patients and system. Urban trial results may not fit a rural system.

36. Informed consent in research requires that subjects:

    1. A. Sign a waiver of liability for any injury
    2. B. Be paid fairly for their time and travel
    3. C. Understand risks and the right to withdraw
    4. D. Agree in advance to complete the whole study
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    Answer: C. Understand risks and the right to withdraw

    Subjects must understand the purpose, risks, benefits, and their right to withdraw. Exception from informed consent has strict requirements.

37. An institutional review board exists to:

    1. A. Protect human research subjects
    2. B. Recruit subjects for approved studies
    3. C. Publish approved studies in journals
    4. D. Fund promising research projects
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    Answer: A. Protect human research subjects

    It protects human subjects by reviewing study ethics and design. Approval is required before enrollment.

38. Conflicts of interest in research should be:

    1. A. Prohibited entirely in published research
    2. B. Disclosed so readers can weigh them
    3. C. Handled privately between author and editor
    4. D. Ignored if the study is well designed
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    Answer: B. Disclosed so readers can weigh them

    Funding source can influence design and reporting.

39. A study showing association between two variables:

    1. A. Proves that one variable causes the other
    2. B. Is worthless without a control group
    3. C. Does not alone establish causation
    4. D. Is valid only if randomization was used
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    Answer: C. Does not alone establish causation

    Causation requires more evidence.

40. Publication bias refers to the tendency for:

    1. A. Journals to reject long or complex papers
    2. B. All completed studies to be published
    3. C. Positive results to be published more often
    4. D. Authors to overstate the strength of methods
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    Answer: C. Positive results to be published more often

    Positive results are published more often than negative ones. It skews the apparent weight of evidence.

41. Which factor most affects whether research changes prehospital practice?

    1. A. Translation into protocols and training
    2. B. The reputation of the study's authors
    3. C. How long the study took to complete
    4. D. The prestige of the journal publishing it
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    Answer: A. Translation into protocols and training

    Evidence changes care only when it is translated into protocols, training, and quality measures. Translation is often the slow step.

42. A paramedic reading a study should first consider:

    1. A. Who funded the study and why
    2. B. Whether the methods support the conclusion
    3. C. The abstract, since it summarizes everything
    4. D. The conclusion stated by the authors
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    Answer: B. Whether the methods support the conclusion

    Check whether the methods support the conclusion and whether the study population resembles your own. Conclusions can outrun the data.