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Presents The Jimmy A Young Memorial Lecture Sunday, July 15, 2012 7:30 to 9:00 AM Sante Fe, NM 1.

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Presentation on theme: "Presents The Jimmy A Young Memorial Lecture Sunday, July 15, 2012 7:30 to 9:00 AM Sante Fe, NM 1."— Presentation transcript:

1 Presents The Jimmy A Young Memorial Lecture Sunday, July 15, 2012 7:30 to 9:00 AM Sante Fe, NM 1

2 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, RRT 1935 –1975 2

3 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 22 nd 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 3

4 Credentialing Evolution Continues 4

5 Presenters Kerry E George MEd RRT FAARC –NBRC President Robert C Shaw Jr PhD RRT FAARC –NBRC Assistant Executive Director and Psychometrician 5

6 Conflict of Interest We 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

7 Objectives Learning 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


9 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 9

10 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 10

11 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 11

12 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 12

13 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%) 13

14 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 14

15 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 15

16 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 16

17 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 17

18 Additional milestones in history 1999 –CRTT transitioned to CRT –“Therapist” replaced “Technician” in the title 2000 –Computer administrations –Results on the day of testing 18

19 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 19


21 Current Concept 21

22 Trending Evidence Over the last 4 job analysis studies, the subset of RRT-only content shown in red has shrunk 22

23 Future Concept 23


25 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 25

26 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 26

27 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 27

28 Expect a Shift Toward Higher Cognition than on the Current CRT Examination Cognitive Levels Percentages of Items on Multiple-Choice Tests CRTRRT Recall256 Application5315 Analysis2279 Total100 28 78


30 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 30

31 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 31


33 Standardize Test Forms More Thoroughly 33 Type of Problem Specifications Current 10-ProblemFuture 20-Problem A1. COPD Conservative Care1 or 22 A2. COPD Critical Care1 or 22 B. Trauma1 or 23 C. Cardiovascular1 or 23 D. Neurological / Neurosurgical1 or 22 E. Pediatric12 F. Neonatal12 G. General Medical / Surgicaloptional4

34 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 34

35 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 35

36 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 36


38 CRT Content mastery will deepen among candidates who succeed on an examination with more items at high levels of cognition 38

39 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 39

40 Clinical Simulation Examination RRTs of the future will demonstrate strength while making decisions and gathering information 40


42 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 42

43 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 43

44 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 continue 44

45 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 45

46 Your Questions 46

47 18000 W 105 th St Olathe, KS 66061-7543 Phone (913) 895 4900 FAX (913) 895 4650 Contact Information 47

48 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 48

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