Coalition Chronicle Coalition for Baccalaureate and Graduate Respiratory Therapy Education August 14, 2012 Volume 1 (8) Respiratory Care Board Issues Open Letter On July 19, 2012 the North Carolina Respiratory Care Board approved the following open letter to the North Carolina respiratory care community concerning baccalaureate and graduate respiratory care education. http://www.ncrcb.org/index.asp (Accessed August 8, 2012). The North Carolina Respiratory Care Board has been charged by the General Assembly with responsibility to ensure the competency of respiratory care in this state and to protect the citizens of North Carolina from the unqualified practice of respiratory care. In keeping with this responsibility, the Board is issuing this letter to address the need for more intensive educational programs for Respiratory Care Practitioners (RCP's). The increasing demands on the practice of Respiratory Care require careful attention to the clinical skills that will be necessary for future practice. There are over four thousand practitioners in North Carolina who have been nationally credentialed and have become licensed by the Board. Like the 100,000 RCP's across the United States, North Carolina RCP's work with patients of all ages and in many different care settings. RCP's work in hospitals where they perform intensive care procedures in the adult, pediatric and neonatal critical care units, and are typically a vital part of the hospital's lifesaving response team that handles patient emergencies. They also are a vital part of the health care team that provides respiratory care for patients with heart and lung disorders in many non-institutional settings. Wherever they practice, RCPs are expected to participate in the development, modification and evaluation of care plans, protocol administration, disease management and patient education. The continued growth and advancement of the profession, and the expectations placed on RCP's will require that every RCP demonstrate an advanced level of critical thinking, assessment and problem solving skills. These skills are essential in today's health care environment not only to improve the quality of care, but also to reduce inappropriate care and control costs. The associate degree programs have been the foundation for the respiratory care profession and do an outstanding job in providing the initial training of many practitioners in the field, but there is an increasing need for RCP's with advanced credentials and education who can take on leadership roles, including research, education, management, as well as advanced clinical diagnostic skills. Therefore, the Board supports the development of baccalaureate and masters level education in respiratory care. There is currently one baccalaureate level education program in 1
respiratory care at the University of North Carolina at Charlotte. In order to meet the current and future need for RCP's with advanced credentials and education, the Board supports the establishment of at least two more similar programs in the state to accommodate selected graduates of the 14 associate degree programs in the state. The Board also supports the establishment of a Clinical Masters Respiratory Care program in the state to provide a midlevel Clinical Respiratory Care Practitioner who can function as a clinical assistant to physicians such as Pulmonologists, Anesthesiologists, Hospitalists and Intensivists. The Board also plans to explore several amendments to the Respiratory Care Practice Act which would: allow for the associate level respiratory care graduate who has passed the Certified Respiratory Therapist (CRT) exam to practice with a basic / provisional license under the direct supervision of an active / advanced licensed RCP. The provisional licensee would be limited in the procedures that he/she may perform. require the associate level graduate to successfully pass the Registered Respiratory Therapist (RRT) exam and complete a baccalaureate degree in respiratory care or other health services related degree within a set period of time, such as 5 years. allow RCP's who have passed the RRT exam and completed a baccalaureate degree in respiratory care or other degree program approved by the Board to practice advanced procedures such as ECMO, protocol development, respiratory care consult, ventilation management, and advanced medication administration such as moderate sedation, nitric oxide administration, and prostaglandin administration. grandfather those individuals that are currently licensed as RCP's on the effective date of the statute. In conclusion, the Board believes that the establishment of baccalaureate level education programs in respiratory care and the requirement of a baccalaureate degree in respiratory care as the minimum entry level for advanced practice is needed to advance the respiratory care profession and improve patient outcomes. The Board also supports the development of masters level respiratory care education programs for clinical practice, education and management. The Board is issuing this letter to start a dialogue within the respiratory care community about these critical issues for the future of our profession. On behalf of The North Carolina Respiratory Care Board: Floyd E. Boyer, RCP Executive Director 2
Director Election to be Held in September Four CoBGRTE members will be on the ballot in September for three CoBGRTE Board of Directors positions with terms of 2013-2017. Active members are eligible to vote in the election and will be sent a link to the online election ballot during the first week of September. The election ballot must be completed by September 30, 2012. Information and a vision statement for each candidate follow below: Donna D Gardner, MS, RRT-NPS, Associate Professor and Department Chair, University of Texas Health Science Center at San Antonio, Department of Respiratory Care. Vision Statement: My vision for CoBGRTE is to develop a strategic plan in alignment with the 2015 recommendations to make bachelor s degree education the primary method of obtaining a degree in respiratory care. The vision would continue to ensure the competencies outlined in the 2015 conferences be woven into respiratory care education as these are essential for the respiratory care profession, especially with the changes in health care and adoption of the Affordable Care Act. My continued vision for CoBGRTE is to create and share curriculum, matrices for higher education and research opportunities for students, faculty and programs. This would encompass bridging respiratory therapists that graduate from an associate degree to bachelor's degree programs and bachelor s degree to master degree program. CoBGRTE is THE one voice to make a change in the perception of respiratory care from technician to professional. Shane Keene, D.H.Sc., MBA, RRT-NPS, CPFT, RPSGT, RST, Program Director/Associate Professor, Respiratory Care Program, University of Cincinnati. Vision Statement: The field of healthcare is constantly evolving with new innovations and technology. Consequently, the education and scope of practice of all healthcare disciplines must constantly be updated to insure best clinical practices and quality outcomes. The field of respiratory care is at a pivotal point in its history where the opportunity to do great things for the future has presented itself. The Coalition for Baccalaureate and Graduate Respiratory Therapy Education (CoBGRTE) has played a vital role in promoting awareness of the need for enhanced education in respiratory therapy to keep pace with other allied health fields and facilitate the highest level of training to all respiratory therapy graduates. The CoBGRTE will play an even more important role in the future molding of respiratory therapy education as most stakeholders are now demanding the highest qualified graduates in the clinical, research and management areas of respiratory care. The future growth for respiratory therapy largely resides within the educational process. The curriculum of the profession must promote graduates who are not only clinically 3
sound, but who can function in research and management roles without huge learning curves. The associate level programs will still play a vital role in respiratory education; however, an associate s degree should no longer be viewed as an end point for respiratory therapy education, but simply as a point of transition. The CoBGRTE should broker relationships with the schools that that have degree completion programs in order to facilitate articulation agreements among all associate level programs. In addition, schools that are not regionally accredited should no longer be eligible to be accredited through the Commission on Accreditation for Respiratory Care (COARC). Otherwise, students who do not graduate from regionally accredited programs will have a much more difficult time continuing their undergraduate or graduate degrees. The CoBGRTE should be actively involved in working with all respiratory schools to bring about synergy within the education community, to promote awareness of the need for enhanced degrees within the profession, and to serve an instrument to facilitate seamless transitions. Another change that most stakeholders in the respiratory arena would like to see is a mid-level provided in the respiratory profession. There has been a steady increase in the number of nurse practitioners and physician assistants entering the work force. In addition, Radiology Practitioner Assistants (RPA) has been recognized as mid-level providers since 1998. Once the availability of advanced respiratory education improves at the undergraduate level then graduate programs leading to advanced credentialing for the profession as mid-level providers are the next logical step. The CoBGRTE has done an excellent job, but there are still difficult times ahead. Although change is never easy, I feel as though I would be well suited to tactfully help others within the coalition facilitate positive outcomes for the profession. I am a lifelong proponent of education and love the profession of respiratory therapy and I am very excited to see what the future holds! Shawna Leigh Strickland, PhD, RRT-NPS, AE-C, FAARC, Clinical Associate Professor University of Missouri (Columbia, MO). Vision statement: The Coalition for Baccalaureate and Graduate Respiratory Care Education (CoBGRTE) is an organization developed for faculty, students and other stakeholders to learn more about advanced degrees in respiratory therapy. As such, the CoBGRTE leadership is vital to the effective planning and maintenance of higher education for the respiratory care profession. Future directions of the CoBGRTE may be heavily influenced by the leadership s ability to foster new relationships with colleges and universities, the faculty at these institutions and the students who choose to earn higher degrees in respiratory care. 4
Providing a network for faculty to discuss increasing levels of education and for developing new advanced degrees in the profession may impact not only the increased availability of advanced degrees in respiratory care but also impact the success of these programs and the quality of the therapists who provide patient care. The sharing of best practices can reduce anxiety in the development of new programs and possibly help the educational institution in streamlining the process of expansion. By providing opportunities to help with curriculum design and development, the CoBGRTE can help the college or university in developing a program that not only prepares students to become respiratory therapists but also mentor those students to become future researchers, managers and educators. As the profession considers the necessary degree for entry-level to practice, many barriers will arise. One of those barriers is the location of programs preparing new respiratory care practitioners. As universities and colleges that grant four-year degrees may not be geographically accessible to all demographics, fostering collaboration between community colleges and the four-year degree-granting institution may allow the community college to remain a vital part of the community s growth while also providing the community with a well-prepared respiratory care practitioner. The future of the profession lies not in alienating any one group of respiratory care educators and degreegranting institutions; rather, the future of the profession lies in the sustained and meaningful collaboration of all educators, students, and respiratory care practitioners. Jonathan B. Waugh, Ph.D., RRT, RPFT, FAARC, Professor, Respiratory Therapy Program, Dept. of Critical and Diagnostic Care, University of Alabama at Birmingham, Birmingham, Alabama. Vision statement: I believe the respiratory care profession is approaching a crossroads and the path taken will determine if we continue to grow and mature or diminish into a technical specialty. A health professional is more defined by the ability to independently assess patients, plan and revise care, using critical thinking and evidence-based decisions than by specialized technical knowledge. Baccalaureate and graduate programs must take the lead in moving the profession on this trajectory. As much as possible we need to speak to our peers and other professionals in a unified voice with a consistent, clear message for what must happen and the steps that will accomplish the goal. A "national" curriculum model for emerging advanced practice graduate programs is needed so that potential employers of this new type of graduate will have confidence in the abilities and fit of this new practitioner. If we do not chart our course for the future now, other powerful groups will do it for us. These are the priorities I see for us to work on. 5
Using Highwire to Search Medical Literature Robert L. Joyner, Jr., PhD, RRT, FAARC Vice President for Research - CoBGRTE I have been encouraged recently by what I perceive as in increase in practitioner interest in finding peer-reviewed evidence to support proclamations made in the clinical setting and the academic challenges these proclamations cause. This interest can be found in numerous LISTSERVs devoted to respiratory care and in e-mails I have received asking me for advice in finding literature discussing a particular topic of interest. This has led me to believe that readers of this Coalition Chronicle would be interested in a free webbased resource search engine that I have used for the past 15 years. Don t get me wrong, Academic discussions, even when they are boisterous, can be valuable learning tools and are likely to result in increasing the knowledge of all that are involved. For my own practice, one of the tools I use is the web-based search engine Highwire. This search engine allows me to easily find biomedical articles and to identify whether the articles are available for free (legally) on the internet or at a minimum as a way to obtain all of the information required to obtain the article through my university s interlibrary loan system. In order to understand the usefulness of Highwire, the user must have a basic understanding of the largest and most comprehensive biomedical database available today, MEDLINE. MEDLINE is a bibliographic database containing more that 19 million references to journal articles in the life sciences with a concentration in biomedicine. The database is maintained by the National Library of Medicine (NLM) and is indexed with the NLM s unique topic identifiers called Medical Subject Headings, also referred to as MESH terms. These topic identifiers allow articles with various similarities (e.g., similar content, similar experimental setup, etc.) to be found using a systematic search strategy. The database itself contains citations for virtually every perceptibly important biomedical journal from 1946 to present day. In addition, the database grows continuously with approximately 2000 4000 references added every day. 1 6
Users of MEDLINE need to understand that MEDLINE is just a database containing data we are interested in. To access the data there are a number of web-based front ends that can be used to interrogate the database. Some of these front ends can be quite expensive and complicated to use. When I was in graduate school I used a UNIX based system to access MEDLINE, but more recently elaborate web-based systems have been developed to make access easier for the average user. For example Ovid provides a fantastic web-based solution for searching MEDLINE, but is usually only available are large research institutions because of the cost. Other free web-based front ends are available (e.g., PubMed, Highwire, etc.), and I have chosen to review Highwire here because it is the one I have found most useful in my career. Highwire is a free, state of the art online content delivery system operated by a non-profit division of the Stanford Universities Libraries. Although Highwire has many more capabilities than I will discuss here (e.g., journal hosting, etc.), this article is focused narrowly on the ability of Highwire to search MEDLINE and provide either direct access to the articles discovered during the user s search or the information necessary to get the articles from your own library s interlibrary loan system. The first step is to go to the Highwire website: http://highwire.stanford.edu/ Once there, you will notice on the front page there is an area to insert in your search terms, but I suggest first registering with Highwire. I don t register with internet services frivolously and actually rarely do I make the suggestion that anyone register with a service because of the resulting spam mail and other worries that can happen when registering with an unknown service. With that said Highwire is free and comes with some very useful benefits discussed a little later. I have been a registered user with Highwire for about 15 years and have never received an unsolicited e-mail from them. I don t usually search from this front page and suggest you click where it says more search options. The next page contains many ways of refining what you are searching for. There are options for searching within the text of an article, within the abstract, or even the title directly. You also have the ability to search an author s name specifically and even limit the search to a particular publication date. These options are available on other web-based MEDLINE search engines, but Highwire just makes it very easy. When deciding how you are going to search the most 7
important aspect is feeling confident that the results you receive are correct and complete. You don t want to miss an important article that was exactly what you are looking for. Highwire allows you to feel comfortable that you did a comprehensive search and received a complete set of results. You will notice that there are a couple of options must be minded to before initiating your search. Looking at the column on the right, Highwire can be set to search hosted content alone or include PubMed (i.e., MEDLINE) in the search. I never advise searching without including PubMed as you would eliminate a large portion of the MEDLINE database and your results would be missing articles from that would likely be important to you. Again, one of the more important aspects of a search is feeling confident that you found everything possible. Try a simple search. Enter the term Atelectasis in the Title Only Field and select Include PubMed, and then click on Search. In my search this resulted in 1,846 results. You may have slightly different results because there are additions to MEDLINE every day. In the left column you will article citations and information on whether the full-text article can be obtain free of charge. The column on the right contains links to the article abstract, the PDF of the article itself, and links related to refining your search based on the contents of the particular article of interest. Assuming you took my advice and registered with Highwire, now scroll down to the bottom of the screen and look for the link Create Alert. This will take you to a screen that describes a service Highwire offers in which it will automatically notify you by e-mail when a new article is published based on the criteria that you set up in the Create Alert page. Whether it s by author s name or a particular key term(s) you will now know when something is published as soon as it is published. This is quite useful when developing new presentations, keeping up on the latest research, or even knowing when a colleague publishes an article. There are many other useful attributes of Highwire and if there is one thing I have learned about searching a topic is that it takes time, practice, and cultivated thought. One important I have learned over the years is that nothing replaces a good medical librarian. 8
If you have any questions or comments related to this article or other topics related to research, please contact me on the COBGRTE Research Forum, which can be found on the COBGRTE website http://www.cobgrte.org/home.html. I look forward to hearing from you there. 1. Vanhecke TE, Barnes MA, Zimmerman J, Shoichet S. PubMed vs. HighWire Press: A head-to-head comparison of two medical literature search engines. Computers in biology and medicine 2007;37(9):1252-1258. Texas State University Graduates with Faculty Members Texas State University San Marcos will graduate 32 students in two cohorts in 2012, eighteen in May (see below) and fourteen in August. Scholarships Available from ASAHP Scholarship of Excellence awards are granted by the Association of Schools of Allied Health Professions (ASAHP). ASAHP sponsors a scholarship program for allied health students enrolled in its member schools. The purpose of the scholarship program is to recognize outstanding students in the allied health professions who are achieving excellence in their academic programs and have significant potential to assume future leadership roles in the allied health professions. The selected students will receive a $1,000 scholarship. Full details and the nomination form are available at the ASAHP web 9
site: http://www.asahp.org/excellence_award.htm. Check with your dean to determine if your institution is an ASAHP member. The due date for nominations is May 15 of each year of the competition. Brooke Yeager Helps with CoBGRTE Research Study Brooke Yeager BSRT, Director of Cardiopulmonary Rehabilitation at the Medical University of South Carolina and a graduate student in the Northeastern University Master of Science in Respiratory Care Leadership Program, has provided information needed on directors of respiratory care in acute care hospitals in South Carolina. A CoBGRTE research priority is to survey directors/managers of RT departments for acute care hospitals in the United States not including critical access hospitals. The names for all the directors/managers have been obtained, however e-mail addresses for each director are needed. The Board of Directors hopes all CoBGRTE members will participate in this study by helping to gather e-mail addresses for one or more states. Help is needed with the following states: Alaska, Arizona, Hawaii, Iowa, Kansas, Missouri, Nebraska, New Mexico, Oklahoma, Oregon, West Virginia and Wisconsin. If you can help, contact CoBGRTE using the form on the Contact Us page at www.cobgrte.org. Coalition Chronicle Archive Back issues of the Coalition Chronicle can be viewed by CoBGRTE members by signing into the Forum/Chronicle Archive Page at www.cobgrte.org Come to New Orleans Early November 9-13 AARC Meeting November 9 1:00p-5:00p CoBGRTE Seminar at Louisiana State University November 9 10:00a-11:30a CoBGRTE Scholarship Cemetery Tour University of Cincinnati and the University of Kansas Medical Center have become Institutional Members The University of Cincinnati will become the fifth baccalaureate respiratory therapist program in Ohio. The new Program Director, Dr. Shane Keene, plans to start an online BSRT completion program soon followed later by a masters degree in respiratory care. University of Kansas Medical Center Program, a long established program, offers a traditional baccalaureate degree program and online ASRT to BSRT option. Both universities have decided to become Institutional Members of CoBGRTE to help support the development of baccalaureate and graduate respiratory therapist education. Thirty- 10
one Universities now hold CoBGRTE institutional membership and have unlimited free faculty position postings on the Career Opportunity Page at www.cobgrte.org. Add your university to the list of Institutional Members below: Indiana Respiratory Therapy Consortium Georgia State University Weber State University Boise State University Bellarmine University Rush University Salisbury University University of Toledo The Ohio State University State University of New York Upstate Medical University Northeastern University University of Texas Medical Branch - Galveston Wheeling Jesuit University Texas State University - San Marcos University of South Alabama Long Island University University of North Carolina Charlotte Louisiana State University New Orleans Midwestern State University University of Missouri Jefferson College of Health Sciences Youngstown State University University of Medicine and Dentistry of New Jersey Nova Southeastern University Loma Linda University University of Arkansas for Medical Sciences State University of New York at Stony Brook University of Texas Health Science Center San Antonio University of Hartford University of Cincinnati University of Kansas Medical Center 11
Ten Reasons Why You Should Become a CoBGRTE Member If you haven t already decided to become a CoBGRTE member after visiting www.cobgrte.org, the following are 10 reasons why you should join the coalition. 1. Collectively work towards the day when all respiratory therapists enter the profession with a baccalaureate or graduate degree in respiratory care. 2. Support a national association, representing the 55 colleges/universities awarding baccalaureate and graduate degrees in respiratory care, to move forward the recommendations of the third 2015 conference. 3. Help start new baccalaureate and graduate RT programs thus leading to a higher quality of respiratory therapist entering the workforce. 4. Work to change the image of the RT profession from technical-vocationalassociate degree education to professional education at the baccalaureate and graduate degree level. 5. Join colleagues to collectively develop standards for baccalaureate and graduate respiratory therapist education. 6. Develop public relations programs to make potential students aware of baccalaureate and graduate respiratory therapist programs. 7. Develop and promote wage standards for respiratory therapy faculty members. 8. Find answers to the flooding of the market place with under-educated respiratory therapists. 9. Help to publicize, among department directors/managers, the differences between respiratory therapists with associate, baccalaureate and graduate degrees. 10. Help to support maintaining a roster and web site for all baccalaureate and graduate respiratory therapist programs. To become a CoBGRTE member complete the application on the Membership Page on the web site www.cobgrte.org. www.cobgrte.org 12