BACKGROUND: Paramedic students are exposed to numerous patient contacts during their required internship experience. There is no current research examining paramedic student internship experience in relation to performance on the written portion of the National Registry Exam (NRE-W). METHODS. A retrospective review from 2001 to 2006 of student records from FISDAP was completed. Three hundred ninety-six students met the inclusion criteria: 1) graduate of a paramedic program, 2) consent to access data, 3) internship data previously verified, and 4) NRE-W results available. Pearson correlation coefficients were used to determine if the number of advanced life support (ALS) runs (run with an i.v. and ECG, or one medication administered), hospital patient contacts (PCs), field PCs, total PCs (hospital PCs + field PCs), student team lead runs (TLs), in-hospital clinical hours, field internship hours, or total hours (in-hospital clinical hours + field internship hours) were associated with passing the NRE-W. Logistic regression was used to determine predictors of success on the NRE-W. RESULTS: The number of ALS runs and total PCs were the only variables associated with passing the NRE-W (p=0.003, 95% CI 0.05-0.24; p=0.047, 95% CI=0.00-0.20, respectively). These variables were also predictors for passing the NRE-W (OR = 1.015, 95% CI 1.005-1.025; OR=0.003, 95% CI 1.000-1.006, respectively). CONCLUSIONS: In this sample, the number of ALS runs students completed was the strongest clinical and field internship predictor of passing the NRE-W. The number of ALS runs and total PCs paramedic students complete need to be evaluated by paramedic programs.