American Association for Respiratory Care's

Spring 2004

Editor
Dennis R. Wissing, PhD, RRT
LSU Health Sciences Center
Dept. of Clinical Sciences
School of Allied Health Professions
PO Box 33932
Shreveport, LA 71130
(318) 675-6814
dwissi@lsuhsc.edu

Chair
Thomas V. Hill, PhD, RRT
1206 Captains Brg.
Dayton, OH 45458-5710
(937) 298-3399 x5645
Fax (937) 296-7235
thill@athenstech.edu

Past Chair
Susan P. Pilbeam, MS, RRT, FAARC
9 Althea St.
St. Augustine, FL 32084
pilbeamsue@aol.com

 

In This Issue...

COLUMNS
Notes from the Editor: No Units, No Credit! Dennis R. Wissing, PhD, RRT
Notes from the Chair Thomas V. Hill, PhD, RRT-NPS
Minutes of the Education Section Business Meeting, December 9, 2004, Las Vegas, NV Thomas V. Hill, PhD, RRT-NPS
ARTICLES
Reflections on a New Career in RC Education Wendy W. Ayscue, BS, RRT
The High Price We Pay for Low Health Literacy Donna Timm, MLS
Making the Most of PowerPoint: Use of Color in a Slide Presentation Sandra Partain, BS, RRT-NPS
Resource Review: “WinSim” Susan P. Pilbeam, MS, RRT, FAARC

AARC Education Section Bulletin
AARC Education Section Bulletin

Notes from the Editor: No Units No Credit!

by Dennis R. Wissing, PhD, RRT

I have a hard and fast rule when it comes to exams in my courses. It is very simple: if the student uses a numerical number to respond to a question, it must be followed with a unit of measurement (e.g., torr, mg, L). If the student fails to include a unit of measurement, the entire answer is wrong. Generally, a semester passes before all students are in the habit of including units of measurement in their test responses. Despite awareness of this rule, students are often frustrated when points are deducted for not following it.

I explain to my students that units of measurement tell me a lot about how well they understand the concept being tested. For example, if a student uses incorrect units of measurement in test responses it alerts me to concepts that are poorly understood or content that needs remediation.

Although the use of inappropriate units of measurement is widespread across the three levels of RC education provided at our university, I will use one of my current classes and the concept of stroke volume to illustrate my point. My students take three sequential courses covering cardiac output and stroke volume: human physiology, cardiopulmonary physiology, and critical care concepts. In each of these courses, stroke volume is discussed, problems are worked, and the concept tested.
On a recent final exam in critical care concepts the following problem was given:

A patient has a cardiac output of 5L/min and a heart rate of 100 BPM. Calculate stroke volume.

Out of 15 students, seven responded with the correct answer of 50 mL/beat. The other eight responded:

  • 500 mls
  • 50 mls per beat per minute
  • 50 L/min/beat
  • 500,000 ml/beat
  • 50 L/min
  • 20 L/beat
  • 50 ml/beat/min
  • 50 L/min

These incorrect units illustrate students’ misunderstanding of stroke volume. It is obvious from these incorrect units of measurement that the students do not have a good reference point for what normal stroke volume should be, much less what it actually is. This list of erroneous units reveals gaps in their understanding of stroke volume and perhaps related concepts (e.g., cardiac flows, volumes, and pressures). I am considering that this may be one of those concepts best learned at the bedside with a patient with a PA catheter, where you can work with the student one-on-one to master this and related concepts.

Students were also required to hand calculate the stroke volume problem on my exam. This brings up an issue of performing math using paper and pencil, which, for many college students, is a challenge. Several students worked the problem correctly but put the decimal in the wrong place and recorded the incorrect answer. These students did not seem to recognize that their incorrect unit of measurement was not plausible.

By holding students accountable to reporting correct units of measurement, respiratory care faculty can assess their understanding of a variety of concepts.


I welcome comments at dwissi@lsuhsc.edu.

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AARC education Section Bulletin
AARC Education Section Bulletin

Notes from the Chair

by Thomas V. Hill, PhD, RRT

As section chair, the majority of my recent activity has been working with the Section Program Committee on the program for the Summer Forum and International Respiratory Congress. We forwarded a comprehensive list of program proposals to the AARC Program Committee, based primarily upon the topics identified in the questionnaire many of you completed last year. Bill Galvin, our liaison to the AARC Program Committee, has done a wonderful job of promoting our needs to the Committee, and I take this opportunity to thank him for all his efforts. The Summer Forum Program contains a wealth of information pertinent to educators, and I think you will be pleased with the quality, value and variety of the presentations. I hope to see many of you in Vail, CO, in June.

I recently received the 2004 Charges to the Education Section. They include developing a review course to assist graduates in their preparation for the advanced practitioner (RRT) exams and proposing strategies to encourage graduates to participate in the advanced practitioner exams. I have been soliciting your thoughts and suggestions on these two charges via the Education Section e-mail list, and we will discuss our next steps at the section meeting in Vail. If you have not yet shared your ideas, please take a few moments to do so, either via the e-mail list or by sending me your comments directly at: thill@athenstech.edu.

Our section web site on AARC Online has been updated recently, thanks to the AARC staff. Be sure to review the site and forward your comments and suggestions to me at: thill@athenstech.edu. Our e-mail list has provided wonderful opportunities for sharing information recently, and I am proud to see how quickly requests for assistance or information receive helpful responses. Please continue to utilize this valuable communication tool.

Your participation in section activities is encouraged and appreciated. Please let us know how we can continue to serve you.

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AARC education Section Bulletin
AARC Education Section Bulletin

Minutes of the Education Section Business Meeting, December 9, 2004, Las Vegas, NV

Thomas V. Hill, PhD, RRT-NPS

Section Chair Sue Pilbeam called the meeting to order at 11:20 a.m.

Committee Reports

1. Program Committee: Sue Pilbeam gave a report on behalf of Committee Chair James Cairo. Sue thanked committee members for the excellent job they did in providing suggestions for topics and speakers for the 2003 Summer Forum and International Congress. The feedback on the quality of the Summer Forum Program was very positive.

2. Abstract Committee: Chair William Pruitt reported on the successful poster session held at the Summer Forum and thanked everyone who volunteered to review abstracts. Bill reminded the members of the deadline for submitting abstracts for presentation at the 2004 Summer Forum.

3. Long Range Planning Committee: Chair Tim Op't Holt reported that the committee met on Monday to identify topics to consider. Topics for discussion include:
•  Development of “ready-to-teach” curricula on asthma and COPD
•  AS to BS articulation agreements
•  Possibility of a Critical Care Specialty Exam and the implications for respiratory care curricula
•  Handling less-prepared students
•  The need for faculty recruitment efforts to fill future demand for respiratory care educator

4. Educator of the Year Committee: Carol Hopper reported that Sue Pilbeam was recognized as the Educator of the Year at the AARC Awards Ceremony.

5. Publication Committee: Sue Pilbeam reported on behalf of Dennis Wissing, thanking everyone who submitted articles for the Section Bulletin in 2003 and noting that the electronic format has been well received by the membership. Sue said Dennis is seeking authors for 2004, and welcomes submissions at dwissi@lsuhsc.edu.

Sue Pilbeam introduced Tom Hill, who was taking over as section chair. Tom thanked Sue for all her hard work and accomplishments on behalf of the Education Section and her guidance and advice.

Old Business: None

New Business:

1. Bill Dubbs, AARC director of education and management, announced a new mechanism for reporting CEU credits online and asked members to try using the new process.

2. Nancy Colletti, president of Lambda Beta National Honor Society, urged educators to consider starting a Lambda Beta chapter at their colleges. This is an excellent way to recognize outstanding graduates and an opportunity to draw attention to the respiratory care program during commencement and honors activities.

3. Tom Hill urged members to check their AARC profile on the web site to make certain that their section membership is up-to-date.

4. Tom Hill announced the Request for Proposals for presentations at the 2004 Summer Forum and International Respiratory Congress, noting that forms were available at the Congress and also on the AARC web site.

The meeting was adjourned at 12:00 p.m.

The next meeting of the Education Section will be at the Summer Forum in Vail, CO, in June.

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AARC Education Section Bulletin
AARC Education Section Bulletin

Reflections on a New Career in RC Education

by Wendy W. Ayscue, BS, RRT, Director of Clinical Education, Respiratory Therapy,
Pitt Community College, Greenville, NC

Becoming an educator after working in the clinical setting as a respiratory therapist for about seven years was a tremendous change. Fortunately, as director of clinical education, I am still able to be in the clinical area a great deal of the time.

But as I made the transition, I was still very nervous about how I would handle the change from peer to instructor. While the transition has been smooth, I have found myself not wanting to be as stringent with my second year students as I am with the first year students. I suppose this is because I was only a clinician when I first became acquainted with this set of students; now I am their instructor.

Changing careers, in a manner of speaking, has been a wonderful lifestyle change. Although my patients varied daily when I worked as a clinician, the job itself had become monotonous. I did not feel as if I was being challenged as much as I had been when I was a new graduate. That is not to say I was never challenged, it was just not as often.

Now that I am teaching, I am challenged everyday by students asking questions I have not thought about for years. I find myself doing more research now than when I was a student. Because of these questions I strive to relearn things I've forgotten while acquiring new information.

My goal as an instructor is to always keep the students well informed of new therapies, procedures, and other changes in the field of respiratory care. As for myself, continuing my education is also at the forefront. If I do not continue my education, then I will not have fulfilled my potential to be an excellent instructor. I want my students to strive for excellence, and I must set the standard.

Would I recommend this line of work to other clinicians? Yes, there is always room for growth.

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AARC Education Section Bulletin
AARC Education Section Bulletin

The High Price We Pay for Low Health Literacy

by Donna Timm, MLS, Head, User Education,
LSU Health Sciences Center Library, Shreveport, LA

In September 2003, the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) library hosted a Medical Library Association (MLA) teleconference, “Reading Between the Lines: Focusing on Health Information Literacy.” The target audience for the MLA teleconference was librarians, but since this issue also affects those in the health professions, the library marketed the teleconference to the staff, students, and faculty on the LSUHSC-S campus and at Northwestern State University (NSU) in Shreveport. One NSU professor asked clinical students to participate in this event so they could become familiar with how low health literacy could adversely affect the quality of patient care. These issues were addressed during the teleconference.

What is health literacy?

Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health care decisions.” (1) A patient's level of health literacy affects his ability to read, understand, and act upon health information, as well as the ability to take advantage of health care services.

Have studies been done to raise awareness of low health literacy?

Numerous studies have been conducted to make people aware of the problems that result from low health literacy in this country — problems affecting both the quality and cost of patient care. According to the Council of State Governments (CSG), “Inadequate health literacy costs the U.S. health care system an estimated $30 billion to $73 billion annually.”(2) These figures are based on a 1998 study conducted by the National Academy on Aging Society. (3)

Terry C. Davis, PhD, a professor in the department of medicine at LSUHSC-S who has conducted extensive research on the impact of low health literacy, notes, “literacy is related to multiple aspects of health, including health knowledge, health status, and the use of health services.”(4)

Davis goes on to point out that patients may experience difficulties reading the educational brochures that are supposed to prepare them for various procedures or the consent forms they must sign prior to undergoing surgical procedures. Studies have shown that approximately 20% of Americans -- about 40 million people — read below a fifth-grade level, (5) with these rates doubling for people over age 65 and those living in poverty. (6)

What is the impact of low health literacy on the patient?

The impact on the patient’s health is significant when you consider that a patient’s level of health literacy can affect her ability to: (1) arrive on time for a medical appointment, (2) read the label on a prescription bottle, (3) comprehend how to correctly administer medication, (4) comply with the physician's oral instructions, or (5) complete consent forms. And the list goes on. Obviously, these problems can adversely affect the outcome of patient care, with millions of Americans struggling needlessly due to low health literacy.

What is the impact of low health literacy on the health professional?

Presumably, every health professional seeks the best possible outcome for the patient. It’s pretty difficult to achieve the best possible outcome without the patient’s cooperation or compliance. The efforts of health professionals are impeded when patients fail to arrive for appointments on time, don’'t take medications as prescribed, and cannot comprehend oral instructions. Such problems can lead to medical errors and unnecessary hospitalizations. In such a scenario, there can be no winners, no “best” outcomes.

What are public libraries doing to address health literacy issues?

The MLA teleconference provided several possible approaches to solving the problem:

  • Improve reading skills of American adults.
  • Improve health providers’ ability to communicate in plain language.
  • Improve the readability of health information materials.

Public libraries already play a significant role in adult literacy education in many communities, and they are now expanding this role by helping librarians understand the implications of low health literacy. In a number of public libraries, the librarians attend workshops on how to design and choose easy-to-read materials for library users, as well as how to design web sites that lead the users to reliable consumer-health information.

What are the states doing to address health literacy issues?

The CSG has published the State Official’s Guide to Health Literacy, an overview of how the states might address this issue. For more information about the work of the CSG in analyzing the states' role in improving low health literacy, please visit www.csg.org (keywords: Health Literacy).

What is Louisiana doing to address health literacy issues?

The state of Louisiana has created the Interagency Task Force on Health Literacy; the first legislatively mandated task force of its kind in the nation. LSUHSC-S’s Dr. Davis has been appointed to chair the task force. Its mission is to “study and evaluate the health literacy of the residents of this state.”(7) The task force will focus on a number of issues:

  • The ability of residents to access health care services.
  • The ability of residents to communicate with health care providers.
  • Barriers preventing residents with low health literacy from receiving health care.
  • Identification of groups at risk for low health literacy.
  • Examination of the impact of health literacy on the quality and cost of health care.
After studying these issues, the task force will report to the legislature, making recommendations on strategies for improving the health literacy of the residents of Louisiana. The task force will also be expected to make funding recommendations to provide programs and resources to increase health literacy in the state.

Conclusion

Many studies have been conducted to raise awareness of the problems associated with low health literacy, but there is much to be done in terms of identifying and implementing strategies that solve those problems. Simplifying reading materials alone is not the answer. Funding will be necessary to conduct further research and to initiate demonstration projects that identify strategies that work.
Through its Interagency Task Force on Health Literacy, the state of Louisiana hopes to lead the way in identifying workable solutions to: (1) reduce the financial burden of low health literacy in the state of Louisiana, (2) improve patients' access to health care, and (3) enhance the quality of that care.

References

Healthy People 2010. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.
  1. Fact Sheet: Health Literacy. Council of State Governments (www.csg.org/CSG/Policy/health/health+literacy.htm).
  2. Fact Sheet: Low Health Literacy Skills Increase Annual Health Care Expenditures. National Academy on Aging Society (www.agingsociety.org/agingsociety/publications/fact/fact_low.html).
  3. Davis, TC, et al. The Role of Inadequate Health Literacy Skills in Colorectal Cancer Screening. Cancer Investigation 2001, 19(2):195.
  4. Doak, CC; Doak, LG; Root, JH. Teaching Patients with Low Literacy Skills, 2nd ed.; J.B. Lippincott: Philadelphia, 1996.
  5. Kirsch, I, et al. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey; National Center for Education Statistics, U.S. Department of Education, Washington, DC, 1993.
  6. Louisiana House Bill No. 2019, Regular Session, 2003.

AARC Education Section Bulletin
AARC Education Section Bulletin

Making the Most of PowerPoint:
Use of Color in a Slide Presentation

by Sandra Partain, BS, RRT-NPS

Editor’s Note: This article is the first in a series of articles that will explore the effective development of PowerPoint slides for respiratory care education.

Conscious color placement in a slide presentation is under-appreciated and under-performed. The appropriate use of color serves more than an aesthetic purpose. When infused into a presentation effectively, color lends emphasis and organization to the information presented.

Color selection should be guided by basic principles of functionality and consistency. A functional color choice provides contrast between the font color and slide background, which allows for optimal “readability” of the text. Equally important is the consistency of the color integration, such as when all slide titles are the same color or each level of information is the same color. This assists the learner in the organization and development of patterns in the presented material.

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AARC Education Section Bulletin
AARC Education Section Bulletin

Resource Review: ‘WinSim’

by Susan P. Pilbeam, MS, RRT, FAARC

Most of us in teaching are well aware of the books and software materials available from publishers, but we often miss good resources created by our own peers. The purpose of this column will be to review available instructional materials you won't see reviewed in Respiratory Care or Chest, but may find worth looking at for your program.

To get things started, let’s review a software program titled, “WinSim: A Computer-Based Clinical Simulation Authoring and Testing System,” created by Louis Sinopoli, EdD, RRT.

WinSim is a computer program for Windows systems that lets the user create tests for any topic area or cognitive skill. It allows the instructor to create custom tests to match specific course content. Students can take the tests at any time and in any location.

Tests created in WinSim can be simple true and false, multiple choice, or complex branching-logic clinical simulations. You can paste in x-rays, ventilator control panels, waveforms, lab results, close-ups of real equipment, and any drawings or illustrations you would like to include in an exam question.
The difference between off-the-shelf exam software and texts and the WinSim program is, obviously, that you create your own questions to match your own course content and teaching style rather than using someone else's test items. Test development becomes a progressive and ongoing process that allows you and your faculty to build tests and edit them as technology changes.

We are all aware that one of the major stumbling blocks for graduates is passing the NBRC advanced practitioner clinical simulation exam. Having a tool that allows you to start small and simple and progressively build to a more advanced level of case difficulty is a handy tool to have, and one reason why you might find WinSim beneficial to your students and your program. The WinSim software also allows the author to create a branch to remedial content areas or easier content, based on the student’s previous selection or choice. It is a method instructors can use to create immediate remedial feedback to the student based on the selections they make.

Of course, like any paper and pencil test, the test is still only as good as the author’s ability to create it, so WinSim will not make a good test writer out of a bad one. It does, however, make the process of creating an operational computer version of a test easier than I expected. I’m only familiar with one other test-authoring program, although I’m sure there are many. So, I’m not an expert in this area. However, I did find WinSim easy to use in creating a clinical simulation question.

Most of us have adopted PowerPoint and are producing instructional resources using it or something similar. Some of us have even ventured into using the web to teach respiratory care courses. A part of this continuum is, I believe, building evaluation into the process. WinSim's format seems to lend itself to online courses, although I haven’t personally tried it for that purpose.

In addition to the authoring version of WinSim, there is another version students can use that allows testing, but not authoring or editing. Installation uses Microsoft’s Windows Wizard, so it is basically self-installing, with no complicated settings, drivers, or special commands required. Those of you who were fortunate enough to hear Dr. Sinopoli’s presentation about WinSim at a recent Summer Forum (2002, 2003) probably received a free copy of the program, as I did.

Here are a few illustrations showing what the program looks like. The student is presented with a sign-in screen that requires minimal computer skills. Then the test screen is presented:

The author screen looks like this and demonstrates how you would fill in the blanks.

The Student Score Report

A summative score report appears at the end of the exam. It can be printed or saved digitally for the student’s record. WinSim provides subdivisions in the summary report for major skills like decision-making and information gathering, and content areas, such as ventilatory settings or blood gas interpretation.

The time you, as the author, put into test development with WinSim comes back to you semester after semester. Your current exams can, of course, be computerized by entering them into the WinSim program. You do not have to retype them, if they are already in digital form, such as a Word document. You can receive a limited-use demo version of the WinSim authoring system by contacting Dr. Sinopoli.

WinSim is one example of some of the resources available to us from our peers. If you have experience using WinSim, we would appreciate your comments. Perhaps faculty may wish to share clinical simulation questions they have created with this software. If you would like to share information, please post your comments on the section e-mail list.

In future editions of “Resource Review” we hope to provide you with a summary of a polysomnography technician training program notebook and a software program (DataArc) for tracking student progress in the clinical setting. If you know of similar resources, please contact section chair, Tom Hill.

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