Introduction: To accomplish the goal of producing competent paramedics, paramedic programs strive to optimize clinical opportunities in settings where clinical hours are limited and competitively shared with other allied health programs. Previous research has shown positive correlations between the number of field experiences and examination success up to the National Registry of Emergency Medical Technicians (NREMT) level. The current literature does not discuss the optimal learning environments (whether field or hospital) for success on specific sections of the summative paramedic examination. Hypothesis: Each section of the paramedic summative examination has an optimal training environment, whether in the field or in the hospital, that will predict success with the critical-thinking questions on that portion of the examination. Methods: A retrospective review of student records from FISDAP, a national database of prospectively reported internship experiences, was completed. In all, 1,515 students’ data met the inclusion criteria for analysis: 1) graduated from paramedic program; 2) valid comprehensive paramedic exam (CPE) and critical-thinking scores; 3) clinical data from field and hospital experiences; and 4) student provided consent for research. Students prospectively self-reported internship data during their field and hospital experiences. Data queried from FISDAP included all patient assessments, team leads, and scores on the critical-thinking questions of the CPE. The CPE sections analyzed included cardiology, airway, medical, obstetrics/pediatrics, and trauma. FISDAP defines critical thinking questions as “application and problem-solving test items as defined by Bloom’s taxonomy.” Results: Linear regression analyses indicate that in every category, field assessments led to statistically significant increases in criticalthinking scores (range = 0.2%–0.4% increase per field assessment). Team leads increased the score even more (range = 0.2–0.5% increase per team lead). Hospital experiences had no effect on critical-thinking scores in any section, regardless of the number of hospital experiences completed. Conclusion: The initial hypothesis that the hospital environment might have a benefit in some sections of the CPE was not supported by the data. Program directors interested in increasing student critical thinking need to plan a higher ratio of field experiences rather than hospital-based experiences.