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Presents The Jimmy A Young Memorial Lecture. Sunday, July 15, 2012 7:30 to 9:00 AM Sante Fe, NM. Jimmy Albert Young, MS, RRT 1935 –1975.

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presents the jimmy a young memorial lecture
PresentsThe Jimmy A Young Memorial Lecture

Sunday, July 15, 2012

7:30 to 9:00 AM

Sante Fe, NM

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Jimmy Albert Young, MS, RRT1935 –1975

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.

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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
presenters
Presenters
  • Kerry E George MEd RRT FAARC
    • NBRC President
  • Robert C Shaw Jr PhD RRT FAARC
    • NBRC Assistant Executive Director and Psychometrician
conflict of interest
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

objectives
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

in the beginning
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
first credentialing requirements 1961
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
rrt was a high s tandard
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
very few schools at first
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
formal education is required today
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%)
a lawsuit in the 1970s crystallized potential conflicts of interest
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
consolidation of credentialing activities
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
additional milestones in history
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
additional milestones in history1
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
additional milestones in history2
Additional milestones in history
  • 1999
    • CRTT transitioned to CRT
    • “Therapist” replaced “Technician” in the title
  • 2000
    • Computer administrations
    • Results on the day of testing
additional milestones in history3
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
trending evidence
Trending Evidence

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

new therapist multiple choice examination
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
new therapist multiple choice examination1
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
new therapist multiple choice examination2
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
rationale for changing the simulation examination
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
solution
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
score accuracy
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
address unwanted compensation effect
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
address unwanted compensation effect1
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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CRT
  • Content mastery will deepen among candidates who succeed on an examination with more items at high levels of cognition
access to testing for rrt
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
clinical simulation examination
Clinical Simulation Examination
  • RRTs of the future will demonstrate strength while making decisions and gathering information
applying
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
scheduling
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
retesting impact
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
therapist multiple choice examination
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
contact information
Contact Information

18000 W 105th St

Olathe, KS 66061-7543

Phone (913) 895 4900FAX (913) 895 4650

www.nbrc.org

question from moderator
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