Respiratory Care Annual Assessment Report Bachelor of Science Program (On Campus)

2015-16 Respiratory Care Annual Assessment Report Bachelor of Science Program (On Campus). ntroduction This Respiratory Care program is one of only three BS degree programs in the states of Oregon, Washington, Alaska, Hawaii and California. n the fall of 2009 Oregon Tech enrolled the first class of bachelor s degree students. The first three cohorts graduated March of 2012, March of 2013 and June of 2014. Oregon Tech celebrates pass rates of 100% for these three classes on the Registered Respiratory Therapist (RRT) examinations. The program experienced a 100% first time pass rate on the RRT Clinical Simulation examination with the June 2014 graduating class. During 2016 our first time pass rate on the RRT Clinical Simulation examination has fallen to 0%.. Program Purpose, Objectives and Student Learning Outcomes During the March, 2016 advisory board meeting and the September 2016 the program purpose, objectives and outcomes were reviewed and affirmed, as described below. Respiratory Care Program Purpose The purpose of the Respiratory Care Program, a Bachelor of Science degree, is to provide for the regional needs for respiratory care practitioners prepared at the advanced level of Registered Respiratory Therapist. t is a unique opportunity to build leaders that promote this profession. Program ducational Objectives Graduates will demonstrate professional behaviors consistent with employer expectations as advancedlevel respiratory therapists (affective domain). Graduates will demonstrate the ability to comprehend, apply, and evaluate clinical information relevant to their roles as advanced-level respiratory therapists (cognitive domain). Graduates will demonstrate technical proficiency in all the skills necessary to fulfill their roles as advanced-level respiratory therapists (psychomotor domain). Graduates will demonstrate knowledge in Management, ducation, Research and Advanced Clinical Practice. (Faculty decided to add this educational objective September of 2014, Advisory board voted this March 11, 2016). xpected Program Learning Outcomes Students in the program will demonstrate: 1. The ability to communicate effectively in oral, written and visual forms. 2. Knowledge of the respiratory care code of ethics and ethical and professional conduct. 3. The ability to function effectively in the health care setting as a member of the healthcare team. 4. Knowledge and application of mechanical ventilation and therapeutics. 5. Knowledge and application of cardiopulmonary diagnosis and monitoring. 6. Knowledge and application of cardiopulmonary pharmacology and pathophysiology. 7. Management of respiratory care plans for adult, neonatal and pediatric patients. 1

. Three-Year Cycle for Assessment of Student Learning Outcomes The following table shows the three-year plan for assessing individual student learning outcomes. Student Learning Outcome 2014-15 2015-16 2016-17 1. the ability to communicate effectively in oral, written and visual forms. 2. knowledge of the respiratory care code of ethics and ethical and professional conduct. 3. the ability to function effectively in the health care setting as a member of the healthcare team. 4. knowledge and application of mechanical ventilation and therapeutics. 5. knowledge and application of cardiopulmonary diagnosis and monitoring. 6. knowledge and application of cardiopulmonary pharmacology and pathophysiology. 7. management of respiratory care plans for adult, neonatal and pediatric patients. Table 1. Respiratory Therapy ducation Assessment Cycle V. Summary of 2014-15 Assessment Activities The respiratory care faculty met on in fall 2014 to discuss assessment for the academic year. The Student Learning Outcomes (SLOs) for the year were discussed and multiple places where these are taught and measured in the curriculum were identified, as shown in Appendix A. #2 PSLO Knowledge of thics and Professional Conduct Assessment #2 The faculty conducted an assessment using assignments in connection with in interdisciplinary team course consisting of OHSU nursing students and OT imaging and OT respiratory care students. Results: 12/15 students met the standard in thics and Professional Conduct required for course completion. Students meeting the standard: 12 Student not completing the course and meeting the standard: 2 2

Analysis: The students not completing the course were unable to due to work obligations. Faculty feel that we are meeting our standard in this area. Plan: No remediation needed. #3 PSLO the ability to function effectively in the healthcare setting as a member of the healthcare team The faculty conducted an assessment using assignments in connection with in interdisciplinary team course consisting of OHSU nursing students and OT imaging and OT respiratory care students. Results: 12/15 students met the standard in thics and Professional Conduct required for course completion. Students meeting the standard: 12 Student not completing the course and meeting the standard: 2 Analysis: The students not completing the course were unable to due to work obligations. Faculty feel that we are meeting our standard in this area. Plan: No remediation needed. SLO #2. Diverse Perspectives Assessment #1 The faculty conducted an assessment of this SLO using an Objective Skills Clinical Assessment at the completion of the Helping Mothers Survive Bleeding After Birth Course. The passing score was 10/12 n this course students must demonstrate the ability to talk to and evaluate a mother from a foreign country after giving birth to a baby. 2/24/2016 HMS OSC 1 Post Test Student PvC02 12 Student PaC02 12 12 3

Student Pa02 10 Student Sa02 12 Student Pv02 11 Student Sv02 11 Student Sp02 12 Student Vt 10 Student RV 12 Student RV 11 Student RV 12 Student C 11 Student VC 11 Student FRC 11 Student FV 12 Student FVC 10 Student Ptc02 12 Student PtcC02 10 Student Ve 12 Student RR 11 Student Pb 12 Student VA 12 SLO Critical Thinking (ngage in a process of inquiry and analysis) ach year faculty measure the critical thinking abilities of students by evaluating their performance on the Registered Respiratory Therapist Clinical Simulation examination. Credentialing xam Performance: STUATON: Clinical Simulation First-Time xamination Performance (NBRC Annual School Summary 9/19/16) Total Passing Passing First time Passing Repeaters 2013 13 13 100% 13 100% 0 0% 2014 14 14 100% 10 71.4% 4 28.6% 2015 6 6 100% 6 100% 0, 0% 2016 5 2 40% 0 0% 2, 40% 4

n 2013 13 students took the clinical simulation examinations and all 13 passed the first time. They also passed the CRT and RRT examinations the first time they took them. n 2016 5 students took the clinical simulation examination and none of them passed it the first time. The two that retested and passed had to take the examination 3 times to pass. Worse yet One student took the examination and failed 3 times. One student retook the examination twice and failed. Some students just did not retest. BACKGROUND: Since 2013 the instructor teaching Critical Care and Mechanical Ventilation has changed. Since 2013 giving students C&S Solutions assignments in Critical Care and Mechanical Ventilation has been greatly reduced or eliminated. Since 2013 the timing of the Clinical Simulation course moved from Spring to Summer Term. Since 2013 there have not been graded assignments to complete clinical simulations in the fall, winter or spring terms of the senior year. Since 2013 the Certified Respiratory Therapist xamination, and the Registered Respiratory Therapy xaminations have been eliminated and replaced with a new Therapist Multiple Choice xamination. The matrix and content of the Therapist Multiple Choice xamination have been updated to reflect current evidence-based practices. Since 2013 the Clinical Simulation xamination changed from about 12 long simulations to 20 short simulations. The new Clinical Simulation xamination now has a new matrix and it is graded differently it is definitely different. Since 2013 students are not longer able to take credentialing examinations while enrolled in the program and must wait until they are graduates to take the examination. Data: See Microsoft xcel file: NBRC Outcomes and grades study Record of graduates taking the exam. 1. The first time pass rates on the clinical simulation examination has gone from 100% in 2013 to 0 % in 2016. 2. Six students took and passed the Clinical Simulation xamination the first time. 3. Two students took the examination 3 times in order to pass. 4. Two students took the examination multiple times, one student took it three times and the second student took it twice and they never passed the examination. 5. One student took the examination once and never took it again. 6. Four student never elected to take the examination. Two of these students are not qualified as they have never taken the therapist multiple choice examination. The nature of the grades of students as relates to taking the examination. 1. There is no correlation between the CH 360, 336 courses and higher scores in 351 and good performance on the credentialing examinations. n fact the students who took the credentialing examination the most times and never passed had the highest scores in CH 360, 336 and 351. There appears to be an inverse correlation. 5

2. There is only very slight correlation between GPA and the decision to take the credentialing examinations. 3. There is a high correlation between 352 C grades and those who elect to not take credentialing examinations later. However high grades in 352 do not predict CS credentialing examination success. Some students with the high score of a B in 352 fail the credentialing examination. 4. There is a high correlation between students who obtain a C grade in 366 and those who later elect not to take the CS credentialing examinations. 5. There is no correlation between the grades that students receive in Most courses and CS credentialing examination success. 6. C grades in 442 and 450 correlate with poor performance on the credentialing examinations. 7. Most courses have routine high GPA and these courses also do not predict Clinical Simulation examination passage or demonstrate who will not pass the CSs. The nature of first time student preparation for elements of the NBRC CS examination. 1. 3F, Graduates perform the worst on 3F ndependently Modify Therapeutic Procedures Based on the Patient s Response. Our percentage of the National Mean in this area is -110 2. 3A Maintain records and communicate information we are at 24% of the national mean. 3. 3D Achieve Respiratory Support we are at 28% of the national mean. 4. 1A lower than national mean - Review data in the patient record 5. 1B lower than national mean Collect and valuate Additional Pertinent Clinical nformation 6. 1 lower than national mean Recommend diagnostic procedures 7. 2B lower than national mean nsure infection control 8. 3B lower than national mean Perform airway clearance and lung expansion techniques 9. 3G lower than national mean Provide respiratory care techniques in high risk situations ANALYSS FROM TH DATA: 1. 336 Pathophysiology, CH 360 Pharmacology and 351 appear to be inversely related to success on credentialing examinations. 2. 352, 360 correlated with students who choose not to take the credentialing examinations after graduation. 3. 442 and 450 low grades correlate with students who did not pass the credentialing after multiple attempts. 6

4. Passing respiratory care courses does not predict success on the credentialing examinations. DSCUSSON: 1. There are courses in the respiratory care program namely 366 and 352 which identify student who are weak and assign a C grade but these courses do not remedy the situation. Student who attain C grade in these course are less confident and never gain the confidence in any subsequent coursework. 2. There are courses in the respiratory care program namely 442 and 450 which identify students who will actually not pass the clinical simulation examination after multiple attempts and assign a C grade to these students. But these courses and subsequent courses do not remedy the situation. 3. The 336 and CH 360 courses cause great consternation to our students and difficulty to the program as some students have to take these courses over and over. n fact outcomes in these courses are inversely correlated with success on the credentialing examinations. This fact calls into question the unquestioning reverence for these courses demonstrated by the fact that respiratory care faculty expel students from the program based on their not passing these courses. These courses routinely assign C grades and D grades to student who find success on the credentialing examinations. They also have assigned higher B grades to students who fail the credentialing examinations multiple times. This suggests that these courses are mainly memorization courses that push large quantities of information out and then have tedious rules for grading that evidently do not develop the high levels of critical thinking that our students need to pass clinical simulation examinations. Clinical simulation examinations have been highly correlated with critical thinking and yet these courses tend to only test memorized facts and that in large quantity. Testing large amounts of facts and then moving on two additionally large amounts of facts does not provide the time for reflection that is needed to understand and apply critical thinking. 4. To my knowledge there are very few courses that assign and grade a substantial quantity of clinical simulations. These courses include 388 and 389 and 366. This was not the case in 2013 when 388 and 366 and 352. 353 and 386 and 440 all included assigned clinical simulations. A lack of exposure and success in any activity will result in less skill and less confidence. 5. Since the Clinical Simulation examination has changed it is doubtful that any respiratory care faculty are sufficiently familiar with the new content to be teaching it in their courses. The Respiratory Care faculty at Oregon nstitute of Technology need to seek out this information and include it in their respective courses. ach faculty member should become familiar with how the subject area that they teach is being tested. 6. Some faculty have added and are testing information that is not tested on the credentialing examinations and may not be common knowledge among practicing respiratory therapists. While students may struggle to learn this peripheral information they are not be taught or tested on information that they need to pass their examinations. 7

7. Program outcomes that are systemic and demonstrated in this way are the responsibility of those who design the curriculum and design the classes. 8. The drop in first time pass rates is not the result of less capable students. 9. The drop in the first time pass rate is not the result of changes of when the students can take the examinations. Our last batch of students had more time than the 2013 students to prepare and they have done far worse. 10. The drop in first time pass rates is something that faculty can reverse by good planning of the curriculum, by purposefully inserting well informed clinical simulation activities into every respiratory therapy course from the sophomore class through to the end of the senior year. The students borrow money to pay for a good education it is the responsibility of the faculty to design the courses and the curriculum to ensure student success. t is the responsibility of the faculty to carefully implement changes in every course that will support and test the ongoing development of the ability to pass the credential examinations. 11. Passing our difficult science courses such as CH 360 and 336 have had nothing to do with our pass rates on the clinical simulation examinations. Action Plans: During a Department Assessment Meeting on September 21, 2016 the faculty discussed the above findings and decided upon the following remedial actions. 1. Beginning Winter Term 2017 Sophomores, Juniors and Seniors will be required to purchase Kettering Seminar Simulations. 2. The Program Director was directed by the Department Chair to make a policy that would require all faculty to have components in each class that will increase the exposure and experience of students in actually taking clinical simulations. Faculty should not only have clinical simulations assignments but spend some time in mentoring students in how to take clinical simulations. Sometime should be spent in each class actually going through a clinical simulations. 8

Appendix A-1 Student Learning Outcomes-Course Matrix 2015-2016 PSLO #. Courses that are shaded below indicate that the SLO above is taught in the course, students demonstrate skills or knowledge in the SLO, and students receive feedback on their performance on the SLO. Fall 231 CH 101/4 MATH 111/243 WR 121 = ntroduced R = Reinforced = mphasized Freshman Sophomore Junior Senior Human ntro to Resp Adv. Case A&P 100 Care 388 Neonatal 440 Mgmt/Credential (summer) lem Pathophys Mechanical ntro to Clinical Chem Coll Alg/Stats ng Comp 336 231 CH 360 Pulm. Phys. Pharmacology 351 337 Vent. Pulmonary Pathology 350 R 366 (Summer) Clinical Simulation R Wn 232 Human A&P 105 Microbiology 389 nternational Neonatal R 441 Case Mgmt/Credential (fall) 9

Spr PSY Psy 201/2/3 Hum lec 236 WR ng 122 Comp 241 WR 122 200 233 ng Comp Med Term Human A&P 235 223 221 SP 111 Fund of Speech 252 Hum lec 336 Soc Sci lec SP 321 Dynamics Resp Gas Therapeutics Arterial Blood Gas mergent CXRay nterp. Patient Assessment Pharmacology Hyperinflation Therapy Small team communicat. 352 386 326 335 353 345 387 Mech Vent Critical Care Disaster Preparedness xercise Phys & ducation Mech Vent Diagnosis/M onitoring Critical Care R 450 442 451 452 Clinical Care (fall) Case Mgmt/Credential (winter) Clinical Care Clinical Care Appendix A-2 Student Learning Outcomes-Course Matrix 2015-2016 PSLO #. Courses that are shaded below indicate that the SLO above is taught in the course, students demonstrate skills or knowledge in the SLO, and students receive feedback on their performance on the SLO. = ntroduced R = Reinforced = mphasized Freshman Sophomore Junior Senior Fall 231 CH 101/4 MATH 111/243 WR 121 Human A&P lem Chem Coll Alg/Stats ng Comp 100 336 231 CH 360 ntro to Resp Care Pathophys Pulm. Phys. Pharmacology 388 351 337 Adv. Neonatal Mechanical Vent. Pulmonary Pathology R 440 350 R 366 Case Mgmt/Credential (summer) ntro to Clinical (Summer) Clinical Simulation Wn 232 Human A&P 105 Microbiology 389 nternational Neonatal R 441 Case Mgmt/Credential (fall) PSY Psy Mech Vent Clinical Care 10

Spr 201/2/3 352 450 (fall) Hum lec 236 Dynamics 386 Critical Care R WR 122 ng Comp 241 Resp Gas Therapeutics 442 Case Mgmt/Credential (winter) WR ng Arterial Blood Clinical Care 122 200 233 Comp Med Term Human A&P 235 223 221 SP 111 Fund of Speech 252 Hum lec 336 Soc Sci lec SP 321 Gas mergent CXRay nterp. Patient Assessment Pharmacology Hyperinflation Therapy Small team communicat. R 326 335 353 345 387 Disaster Preparedness xercise Phys & ducation Mech Vent Diagnosis/M onitoring Critical Care R R 451 452 Clinical Care 11