Summary Evaluation: The Process is Evolving

December 2025

The CAAHEP 2023 Standards and Guidelines for the Accreditation of Educational Programs in the Emergency Medical Services Professions require that

“Achievement of the program competencies required for graduation must be assessed by criterion referenced, summative, comprehensive final evaluations in all learning domains at the completion of the program.” 

The interpretation of this standard is that the evaluation occurs at or near completion of the capstone experience. Latitude is provided since not all students complete their capstone rotations on the same date. What does this all mean, and how is the process operationalized?

The process has evolved; it has not changed. 

The evolution has been accelerated with the transition to the current student minimum competency philosophy, which delineates the formative and summative evaluation processes. The CoAEMSP Student Minimum Competency Recommendations (SMC) were developed in collaboration with the National Registry of EMTs and were effective January 1, 2023. The document emphasizes differentiating between the formative and summative skill acquisition processes. The introduction to the document specifies that “reasonable evidence of competency is built on the concept that competent performance must be demonstrated over time in a variety of conditions.” Further, “the educational program can attest that the student has amassed a portfolio of demonstrated performance of skills and abilities necessary for safe and effective care.” Students are evaluated through the various skill stations, scenarios, simulations, experiences during clinical and field experience rotations, and the capstone field internship.

As stated in the CAAHEP Standards, programs have a responsibility to conduct a final evaluation of competency before graduation. So, what is the process?

Cognitive Domain Evaluation

The best practice for the cognitive domain evaluation remains a graded ‘written exam’ in whatever format is appropriate, i.e., written or electronic items with questions and responses. The content should be representative of the overall depth and breadth of the curriculum, and the program determines the length of the exam.

Affective Domain Evaluation

For the affective domain, there should be a final evaluation, developed by the faculty, that summarizes observations throughout the program. The Affective Behavior Evaluation Form in the CoAEMSP Resource Library is an optional tool evaluating behavior across 12 dimensions. 

Psychomotor Domain Evaluation

For psychomotor evaluations, common program formats have historically been a skills rodeo or one or more complex out-of-hospital scenarios. Other options used occasionally are an oral station with the medical director, a scheduled clinical shift with the medical director, or a final sign-off by the capstone field internship preceptor. Some of these options involve evaluating purely cognitive information, while others involve a mixture of cognitive and psychomotor abilities. 

What is Changing? 

With the operationalization of the SMC, meeting all the program-established minimum competency requirements will now be evidence of a comprehensive final evaluation in the psychomotor domain. Programs are responsible for reviewing and evaluating all components/tables of the SMC before approving graduation for each student. The tables in the SMC document include instructions and comments, and instructional faculty are responsible for reviewing them to appropriately evaluate student progression and attainment of the required competencies. 

In Summary: Dealers’ Choice. 

All students are required to meet the program-established minimum competencies to graduate, which will now satisfy the summative, comprehensive final psychomotor evaluation. A program may continue with additional psychomotor evaluation if desired; however, CoAEMSP will not require it. In addition, your state may have requirements for final evaluation.

Have questions? Please reach out to any of the following:

Patricia Tritt, pat@coaemsp.org

JC Cook, jc@coaemsp.org

Mike Miller, mike@coaemsp.org

What is Required for a Summative Evaluation?

View the FAQ here.