Presents
The 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, RRT
1935 –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
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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 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
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
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 Evidence
Over 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 MULTIPLECHOICE 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
Percentages of Items on Multiple-Choice Tests
Cognitive Levels
CRT
RRT
Recall
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Application
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Analysis
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79
100
100
Total
78
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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
Type of Problem
A1. COPD Conservative Care
A2. COPD Critical Care
B. Trauma
C. Cardiovascular
D. Neurological / Neurosurgical
E. Pediatric
F. Neonatal
G. General Medical / Surgical
Specifications
Current 10-Problem
Future 20-Problem
1 or 2
2
1 or 2
2
1 or 2
3
1 or 2
3
1 or 2
2
1
2
1
2
optional
4
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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 MultipleChoice 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 continue
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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
18000 W 105th St
Olathe, KS 66061-7543
Phone (913) 895 4900
FAX (913) 895 4650
www.nbrc.org
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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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