PresentsThe Jimmy A Young

Memorial LectureSunday, July 15, 2012

7:30 to 9:00 AMSante Fe, NM

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The NBRC has sponsored this lecture series in honor of Jimmy A. Young since 1978. The NBRC honors his memory and many contributions he made to respiratory care through this annual program.

Jimmy Albert Young, MS, RRT1935 –1975

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• Jimmy Albert Young, MS, RRT was one of the profession’s most outstanding and dedicated leaders– 1935 – born in South Carolina– 1960 – 1966 – served as Chief Inhalation Therapist at the Peter

Bent Brigham Hospital in Boston– 1965 – earned the RRT credential, Registry #263– 1966 – 1970 – served in many roles including Director of the

Program in Respiratory Therapy at Northeastern University in Boston

– 1970 – became Director of the Respiratory Therapy Department at Massachusetts General Hospital

– 1973 – became the 22nd President of the American Association of Respiratory Care

– 1975 – was serving as an NBRC Trustee and Member-at-Large of the Executive Committee when he passed away unexpectedly

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Credentialing Evolution Continues

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Presenters• Kerry E George MEd RRT FAARC

– NBRC President• Robert C Shaw Jr PhD RRT FAARC

– NBRC Assistant Executive Director and Psychometrician

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Conflict of InterestWe have no real or perceived conflicts of interest that relate to this presentation. Any use of brand names is not meant to endorse a specific product, but to merely illustrate a point of emphasis.

Summer Meetings 2012

ObjectivesLearning objectives for this presentation about

credentialing of respiratory therapists• Describe historical milestones through which NBRC

credentialing systems have transitioned• Compare current and future concepts that underlie

credentialing programs• Explain details about changes that are planned for

examinations associated with CRT and RRT credentials

Summer Meetings 2012

HISTORICAL MILESTONES

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In the beginning• Early 1940s

– Innovations in cardiopulmonary support accelerated during and after World War II

• 1947– Professional association began

• 1960– Credentialing board was incorporated

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First Credentialing Requirements 1961

• A multiple-choice examination for broad content coverage– Therapist Written Examination

• An oral examination to assess depth of content mastery and ability to critically react in patient scenarios

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RRT Was a High Standard• The demand for respiratory care personnel

outstripped the supply in the 1960s and early 1970s

• The professional association started a program to certify technicians in 1969– For a few years, the AARC certified

technicians and the NBRC registered therapists

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Very Few Schools at First• Competence acquired through individual

effort, particularly in the early years– On the job– Short courses– Technical schools– Community college programs– Bachelors programs

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Formal Education is Required Today

• Competence acquired through formalized programs– On the job– Short courses– Technical schools– Community college programs (395 – 87%)– Bachelors programs (55 – 12%)– Masters programs (2 – less than 1%)

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A lawsuit in the 1970s crystallized potential conflicts of interest

• Membership in a professional association is not required for competence

• There is a risk– Members can be motivated to manipulate the

credentialing system to serve their own interests

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Consolidation of credentialing activities

• The NBRC agreed to take over the certification program in 1975– Affirmed how vital it is for the credentialing

system to be independent of opportunities for undue influence

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Additional milestones in history• 1979

– The Clinical Simulation Examination replaced the Oral Examination

• 1983– RRT candidates required to demonstrate

competence at the entry level before attempting Written and Simulation Examinations

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Additional milestones in history• 1988

– Certification Examination length reduced from 200 to 140 items

• 1994– Number of options reduced from 5 to 4 within

items on the Certification and Therapist Written Examinations

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Additional milestones in history• 1999

– CRTT transitioned to CRT– “Therapist” replaced “Technician” in the title

• 2000– Computer administrations – Results on the day of testing

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Additional milestones in history• From the 1980s through the 2000s, 49

states passed legislation relying on results from the Certification Examination as a central component in the regulation of respiratory therapists

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CONCEPTUAL TRANSITION

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Current Concept

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Trending EvidenceOver the last 4 job analysis studies, the subset of RRT-only content shown in red has shrunk

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Future Concept

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CHANGES TO MULTIPLE-CHOICE EXAMINATIONS

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New Therapist Multiple-Choice Examination

• Examination length remains at 140 scored items and 20 items that do not contribute to scores– Legal counsel advised against increasing test

length so as to hold the licensure burden constant

– Psychometric properties of an examination of this length have been strong and candidates’ characteristics will change slowly

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New Therapist Multiple-Choice Examination

• There will be two cut scores– Test scores equal to or greater than the low

cut score will be associated with CRT– Test scores equal to or greater than the high

cut score will permit candidates to take the Clinical Simulation Examination

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New Therapist Multiple-Choice Examination• Implementation planned for January 2015• Studies between now and 2015

– Determine content that items can cover and test specifications• 2012 job analysis

– Relate examination outcomes to job performance• 2013-2014 criterion validation and test bias

– Determine cut scores• 2014 passing point

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Expect a Shift Toward Higher Cognition than on the Current CRT Examination

Cognitive LevelsPercentages of Items on Multiple-Choice Tests

CRT RRT

Recall 25 6

Application 53 15

Analysis 22 79

Total 100 100

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CHANGES TO CLINICAL SIMULATION EXAMINATION

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Rationale for Changing the Simulation Examination

• Instant scoring demands selection of problems for new test forms that have not changed– After a decade, keeping examination content

current became an increasing challenge

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Solution• Give the examination committee smaller

content elements from which test forms are assembled– Halve the length of problems– Double the number of problems

• Hold testing time the same at 4 hours

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ENHANCE PSYCHOMETRIC PROPERTIES

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Standardize Test Forms More Thoroughly

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Type of ProblemSpecifications

Current 10-Problem Future 20-ProblemA1. COPD Conservative Care 1 or 2 2A2. COPD Critical Care 1 or 2 2B. Trauma 1 or 2 3C. Cardiovascular 1 or 2 3D. Neurological / Neurosurgical 1 or 2 2E. Pediatric 1 2F. Neonatal 1 2G. General Medical / Surgical optional 4

Score Accuracy• Simulation test scores have been sufficiently accurate,

but have the potential to be enhanced– Increasing items or measurement units will increase

accuracy– IG and DM scores will be combined into one total test

score to which one cut score will be applied• From the psychometric perspective, there will be

one long test instead of two short tests

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Address Unwanted Compensation Effect

• Cut for DM has been near the mean score• Cut for IG has been well below the mean

score– A cross-validation study in the late 1970s

showed that successful oral examinees could make effective decisions after collecting minimal information

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Address Unwanted Compensation Effect

• Combining IG and DM scores shifts the area of concern– Some candidates could compensate for low

DM scores when IG scores are added– The board has directed the examination

committee to increase IG section pass levels– Successful candidates will have to score near

the average for DM and IG

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NET EFFECTS OF THE MOST RECENT CHANGES

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CRT

• Content mastery will deepen among candidates who succeed on an examination with more items at high levels of cognition

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Access to Testing for RRT• RRTs of the future need only take

examinations with two titles– Therapist Multiple-Choice, while equaling or

exceeding the high cut score– Clinical Simulation

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Clinical Simulation Examination• RRTs of the future will demonstrate

strength while making decisions and gathering information

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QUESTIONS WE COULD ANTICIPATE

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Applying• Will a candidate declare whether he or she

intends to become an RRT candidate when applying for the Therapist Multiple-Choice Examination?– No

• Some candidates who are surprised to equal the high cut score may be encouraged to go on

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Scheduling• Will a candidate be able to take the

multiple-choice and simulation examinations on the same day?– No

• As before, RRT candidates must first establish competence as a CRT

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Retesting Impact• If a CRT reattempts the multiple-choice

examination (while attempting to recredential or become eligible for the simulation examination), but he or she achieves a score below the low cut, should he or she expect to lose the use of the CRT credential?– No

• The current policy will continue44

Therapist Multiple-Choice Examination

• Can you tell us what the low and high cut scores will be?– No, a few activities must be completed

• Finish the job analysis– Identify competencies the examination should assess– Specify item weights by content domain and cognitive

level• Approve and pretest items• Conduct a passing point study

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Your Questions

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Contact Information

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Question from moderator• Do you expect that changes you have described

will strengthen the credentialing system?– Yes

• CRT will imply deeper mastery of content• RRT gateway decisions become more precise• CSE test forms standardized more thoroughly• RRT outcomes (CSE pass/fail) become more precise• RRT will imply strong mastery of information gathering in

addition to strong mastery of decision making

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