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

A year ago, at the section meeting held during the AARC Congress in Tampa Bay, I strongly recommended that program faculty be required to regularly re-take the NBRC exams that correspond to the programs they teach. Much discussion followed, and a survey was eventually distributed to all members of the section with e-mail access. The survey asked the following question: "Do you think that respiratory therapy program faculty should be required to take and pass the NBRC credentialing examination appropriate to the level of the program in which they teach, once every 3-4 years? Please respond with a yes, no, or maybe, and please add your comment."

Below is a summary of the results and some sample responses from participants. For a copy of the entire list of responses, contact me at pilbeamsue@aol.com.

The questionnaire:

* Distributed electronically on January 14, 2003 to members of the Education Section.
* 812 -- Total number of section members.
* 682 -- Members of the section who have e-mail addresses posted with the AARC.

Overview of responses:

* 322 of 682 responded (47% response rate).
* 80 members responded "maybe"(25% of responders).
* 100 members responded "no" (31% of responders).
* 142 members responded "yes" (44% of responders).
* There were many pages of comments!

General consensus of those responding "No":

* Should not be "required," but recommended.
* Should not harm a faculty member's position if they fail.
* NBRC should offer at a lower fee rate.
* CEUs are an adequate substitute for taking the test, so the test should not be required.

General consensus of those responding: "Yes".

* Exam should be taken every 5 years, when there is a new exam matrix following job analysis.
* Improves faculty "legitimacy" for teaching students when they model behavior.
* Heightens faculty awareness of the reality of the exam and its contents.
* Cost is a concern.

Sample Responses

The following comments were selected because they represent either frequently stated opinions or because of their uniqueness. All comments are presented anonymously and have been edited for spelling and grammar.

Responses regarding the professional organizations:

1. I swear that the AARC is going to KILL the profession with initiatives like this.
2. This proposal is probably floated by friends of Steve Bryant and the rest of the syndicate at the NBRC, which already charges exorbitant fees for its examination, offers little in support of programs to determine exactly what information is most important, and is unwilling to release information (on) who finalizes the content of the exams and the validity of its process of supposed validation. I don't need to support anymore than necessary such organizations that are so insensitive to their constituents (i.e., programs).
3. What Idiot Thought of This Idea? Author's Note: It wasn't the NBRC. It wasn't the AARC. It wasn't CoARC. I (Sue Pilbeam) would be that idiot.

Responses regarding how other organizations are not required to be retested:

1. No, not until it is required of all individuals holding the CRT or RRT credential.
2. No retesting. No other profession requires it, why us?
3. Yes, they should. If they know the material they teach it should be a "no brainer." They need to be aware of the questions that are being asked.
4. As an educator myself, although it is a pain, I must retest for all my certs every two years, BLS, ACLS, PALS, etc. It keeps you current.
5. I do think that the faculty should take the exam on a regular basis. That way they can both stay current with what the NBRC is testing and they can also give the NBRC feedback on whether the exam is testing current practice.
6. If any testing should be considered, it should be for hospital RT directors. These people lead our students as they enter the workforce and should be knowledgeable of new procedures and equipment.

Responses saying, Please, No!

1. Absolutely not! After 20 years of teaching full time, I can almost recite most of the questions.
2. I believe what is really important is that we keep up with our CEUs and keep students abreast of current trends as well as the basics (the board exams).
3. It is the type of fix meant to address the weakest among us because of poor policing by programs themselves. What outsider thought of this one?
4. No - except for those who are not required to acquire CEUs for state licensure. I think that they should be required to take it.
5. No. They should not have to take the test every 3 to 5 years. I think it would be very difficult for someone who only teaches to be able to pass such a test.
6. Maybe. Maintaining the competency/quality/knowledge base of faculty is very important. A requirement, however, might be distressing/threatening to many. If the exam results in remediation/upgrade of information - great! If exam results cause a punitive reaction or dismissal from employment - it could be problematic.

Responses regarding issues of trust:

1. I feel as professional educators we must be trusted to maintain our currency within the field in which we have chosen to work and teach. The mandating of a recredentialing exam is indicating a lack of trust in professional educators' ability to accomplish this task.
2. Educators probably keep up more with CEU/new techniques than any other group.
3. I would think that it would not need to be required, as educators should want to do this.

Other interesting responses:

* Yes. I am strongly in favor of this requirement. This has been my personal belief and action since becoming an educator 30 years ago, and look at how much the content and testing methods have changed. How else are the faculty going to personally know what their graduates are facing and begin to prepare them for the ordeal? Why do you suppose so few of the therapist grads take the RRT exam -- learned avoidance and fear of the NBRC tests? Nothing is more credible to me than to have my instructor tell me of her or his experiences doing what the instructor is trying to teach me to do. Modeling is still a valid mode of teaching. If there is any consideration that practitioners be required to recredential at any regular interval, educators must be required to do the same. Thank you for letting me voice my opinion.
* Yes. We see so many graduates who struggle with the exams, and when doing site visits it was easy to see why! So many faculty are writing program exam questions at the recall and application level only, and grads are caught so unaware when they sit the actual exam. This is further exacerbated when program faculty are still teaching the same content they taught 10-15 years ago!
* Yes, I do. This should be a requirement of the accreditation body. This will force all faculty to get up-to-date. Some of my former colleagues were so far behind in the content of their classes because they just didn't keep up. It made it difficult for junior faculty to function appropriately.
* No, retaking the NBRC examinations is not necessary! There are other more efficient and less expensive ways for faculty to keep abreast of the changes on the NBRC examinations.
* Yes, I do. I think it is important to keep current. How can we expect to prepare students if we cannot pass it ourselves? Also, since practitioners will have recredentialing, it only makes sense that educators should also. It is something I always tried to do on my own anyway.
* No. Program performance on CoARC standards is adequate to evaluate faculty effectiveness.
* Not without research. Throwing regulations at a problem that someone feels they have identified by unsubstantiated reasoning is a naive approach at best.
* Maybe. I do this already, but don't feel it should be "required."
* Maybe. I am a big believer in credentialing (I have them all) and recredentialing. Our faculty took the CRT last year and the CSE this year. Every 5-7 years faculty should recredential, but "required" is too strong. It should be a "highly recommended."
* No. I do not think program directors should be required to retake the test every 3-4 years because my budget -- both college and personal -- will not support the cost. If I use college money I will not be able to attend ANY conferences.
* Reluctantly, yes. Now that graduate RCPs are required to recredential it seems reasonable to expect RT faculty to sit the exam at the same interval. This will become a cost (prohibitive) issue for many programs and, therefore, the NBRC should offer this at no cost or a low cost.
* I think this is good idea . . . there are probably many faculty who would like to do this but don't have the support from their institution, and so have to bear the burden alone . . . this might not sound like a big deal to some but those in rural areas may have travel expenses and need time off in addition to the cost of the test.
* Yes. Absolutely essential every time NBRC changes the exam content outline.
* A resounding YES! It would also have the benefit of informing educators about exam content (from a medical director).
* Yes. But it is a scary thought!
* Pardon me for being "condescending," but I can't imagine an educator not wanting to retake the credentialing exams to maintain awareness of the exam content and to demonstrate ongoing competency. To me it's a moot issue . . . it would be the educator's professional responsibility to take the exam, and every 3-5 years sounds good to me.
* I have had the opportunity to do a lot of site visits to respiratory therapy programs. It is disheartening to see how many faculty are not current in their teaching. MA-1 questions? Please!
* Some have not taken the exams their own students have to take in 20 or more years. They may be competent in some ways, but they are doing a disservice to their students.
* Make it less expensive.
* I think they need clinical practice at least 1-2 days/month, too.

Based on these results, I would like to suggest that the Education Section recommend the following: That all full-time faculty members of accredited respiratory care programs voluntarily take the credentialing examination for which they teach every 5 years (when a new job analysis has been completed). This recommendation would not require that faculty pass the exam or reveal their scores, only that they participate. Many survey respondents said cost was an issue. I believe if this is an organizational recommendation, institutions might offer to pay all or part of this expense. What's more, recredentialing by the NBRC is much less expensive than taking the examination for the first time. Interested individuals can contact the NBRC (http://www.nbrc.org) for actual cost of each test and location of the testing sites..[Top]

Editor's Note:The following article is being reprinted from the Management Section Bulletin.

Respiratory therapists must have "spunk" to survive in our modern health care and educational environments. Educators across the nation realize respiratory care is not a high profile, widely recognized health career which attracts abundant numbers of applicants like nursing, physical therapy, and radiography. Respiratory therapists have to work harder to lure individuals into the profession. Therapists have to be "Respiratory Care Ambassadors," constantly educating the public about who we are and the valuable services we perform. Career presentations have to go beyond the usual "you can help people breathe easier" maxim. Pitches for our profession must be innovative and dazzling, emphasizing the easy availability of jobs, the national credentialing, the gender equity, and the opportunity to work with some really cool technology.

To read more, click to the story: http://www.aarc.org/sections/mgmt_section/bulletins/07.08.09.2003.asp#02[Top]

Editor's Note: The following article is from the November 1999 issue of RESPIRATORY CARE Journal.

Distance education, particularly the current emphasis on instructional technology, is being examined, utilized, and debated throughout the world at an increasing rate. There are mixed views toward distance education within the respiratory care profession and across disciplines. Like many educators today, my faculty and I are experiencing increased pressure to offer various types of programs to learners at a distance. There are many questions whenever an educational innovation such as distance education is introduced:

* Is it as good as traditional education?
* Do students receive a comparable learning experience?
* What does it cost?
* What variables determine instructional effectiveness?
* What are the outcomes?
* Which learners can benefit?
* Does the learning transfer to the work place?
* Do instructors have to teach differently?

Read the rest of Dr. Mishoe's editorial at: http://www.rcjournal.com/contents/11.99/11.99.1332.asp[Top]

The Education Section distributed a Program Planning Questionnaire to educators attending the Summer Forum in Orlando and also shared it with those participating in the section e-mail list. We received 107 completed questionnaires at the Summer Forum, and 12 were submitted by e-mail. According to the respondents, the top ten areas of interest are:

1. Evaluation of student clinical performance by instructors (consistency, reliability).
2. Teaching and evaluating affective behavior.
3. Improving graduate participation in the Advanced Practitioner (RRT) Exam.
4. Training clinical instructors.
5. Using unpaid hospital staff as clinical instructors.
6. Improving graduate performance on the NBRC exams.
7. Clinical education techniques.
8. Education and the Law.
9. Teaching and evaluating psychomotor skills.
10. Curriculum design/multiple program entry points.

Other areas of high interest included alternative clinical sites, RC faculty teaching RC staff, classroom technology/web-based learning/PowerPoint, student evaluation techniques, and the role of the director of clinical education.

The results of the survey will be forwarded to the Education Section Program Planning Committee for consideration in the selection of topics and speakers for the 2004 Summer Forum and International Congress. If you have comments about these topics, or would like to submit a proposal for a presentation, please contact me as soon as possible at thill@athenstech.edu.

In their responses, many educators also mentioned the need to re-examine the credentialing process for respiratory therapists. Suggestions for beginning this examination included brainstorming sessions, panel discussions, and an open hearing. I'm interested in your thoughts about how the Education Section should go about addressing this important issue. How and where should the initial discussions take place? And who should be invited to participate? Please e-mail your comments and suggestions to me, again at thill@athenstech.edu. I look forward to your responses.[Top]

Listed below are web sites catering to students seeking financial aid information. Educators are encouraged to share this information with their students.

Access Group
http://www.accessgrp.org

Association of American Medical Colleges
http://www.aamc.org

American Association of College Registrars & Admissions Officers
http://aacrao.com

Citibank
http://www.citibank.com/student

The College Board
http://www.collegeboard.com

Educaid
http://www.educaid.com

FAFSA Instructions
http://www.ed.gov/prog_info/SFA/FAFSA

Fastweb Scholarship Search
http://www.fastweb.com

NASFAA
http://www.finaid.org

Peterson's Education Center
http://www.petersons.com/finaid

Project EASI Scholarship Search
http://www.easi.ed.gov

Sallie Mae
http://www.ed.gov/prog_info/SFA/StudentGuide

U.S. Department of Education
http://www.ed.gov[Top]

Editor's Note: The following article is being reprinted from the January-February-March 2003 issue of the Management Section Bulletin. While it speaks specifically to managers in respiratory care, the program described by Gaebler should be of interest to educators as well.

Many RTs would argue that recruitment activities aimed at the procurement of prospective students is the responsibility of respiratory care program directors and their staff. Others look at the role as a joint activity, with responsibilities on both sides. Still others might agree managers should play a role, but feel they can't get involved because of heavy workloads. Yet managers remain frustrated with the difficulties the profession has encountered over the last several years.

Click here for the complete story: http://www.aarc.org/sections/mgmt_section/bulletins/01.02.03.2003.asp#02[Top]

Editor's Note: The following report was summarized from a recent Institute of Medicine report by AARC Director of Education and Management Bill Dubbs, MEd., MHA, FAARC.

The Institute of Medicine's newly released report, "Health Professions Education: A Bridge To Quality," is the third phase of the IOM's quality initiative, which was launched in 1996. The 2001 IOM report, "Crossing the Quality Chasm: A New Health System for the 21st Century," recommended that an interdisciplinary summit be held to develop the next steps for reforming health professions education to enhance patient care quality and safety. In June 2002, the IOM convened this summit, which included 150 participants across disciplines and occupations. This follow-up report, published this year, focuses on integrating a core set of competencies - patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics - into health professions education. The report's recommendations include a mix of approaches related to oversight processes, the training environment, research, public reporting, and leadership. The recommendations targeting oversight organizations include integrating core competencies into accreditation and credentialing processes across the professions. The goal is an outcome-based education system that better prepares clinicians to meet both the needs of patients and the requirements of a changing health system.

"Education for the health professions is in need of a major overhaul" is the first sentence in this report, and it clearly sets its tone. Health professionals are not adequately prepared in either academic or continuing education venues to address (1) shifts in the nation's patient demographics and desires, (2) changing health care system expectations, (3) evolving practice requirements and staffing arrangements, (4) new information, and (5) a focus on improving quality or new technologies. The following bullet points detail concerns and the rationale for change:

* Patients in America are becoming more diverse, are aging, and are increasingly afflicted by one or more chronic illnesses, while at the same time being more likely to seek out health information. This changing landscape requires that clinicians be skilled in responding to varying patient expectations and values; provide ongoing patient management; deliver and coordinate care across teams, settings, and time frames; and support patients' endeavors to change behavior and offer lifestyle training, which is in short supply in today's clinical education settings.
* Once in practice, health professionals are asked to work in interdisciplinary teams, often to support those with chronic conditions, yet they are not educated together or trained in team-based skills.
* These same clinicians are confronted with a rapidly expanding evidence base upon which health care decisions should ideally be made but are not consistently schooled in how to search and evaluate this evidence base and apply it to practice.
* Although there is a spotlight on the serious mismatch between what we know to be good quality care and the care that is actually delivered, students and health professionals have few opportunities to avail themselves of coursework and other educational interventions that would aid them in analyzing the root causes of errors and other quality problems and in designing system wide fixes.
* While clinicians are trained to use an array of cutting-edge technologies related to care delivery, they often are not provided a basic foundation in informatics. Training in this area would, for example, enable clinicians to easily access the latest literature on a baffling illness faced by one of their patients or to use computerized order entry systems that automatically flag pharmaceutical contraindications and errors.

While there are notable pockets of innovation where clinicians are being trained for a 21st century health care system, these are by and large exceptions to the rule. Therefore, the committee suggests the following overarching vision for all programs and institutions engaged in the clinical education of health professionals and believes organizations should develop operating principals that will allow this vision to be achieved: "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics."

What foundational competencies are needed?

The following are the five recommended core competencies all patient care clinicians should possess, regardless of their discipline, to meet the needs of the 21st century health system:

1. Provide patient-centered care: Identify, respect, and care about patient differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision-making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.
2. Work in interdisciplinary teams: Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable.
3. Employ evidence-based practice: Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible.
4. Apply quality improvement: Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality.
5. Utilize informatics: Communicate, manage knowledge, mitigate error, and support decision-making using information technology.

How can we get there?

To actualize these five core competencies, the committee made ten recommendations:

* Recommendation 1: The Department of Health and Human Services (DHHS) and leading foundations should support an interdisciplinary effort focused on developing a common language, with the ultimate aim of achieving consensus across the health professions on a core set of competencies that includes patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics.
* Recommendation 2: DHHS should provide a forum and support for a series of meetings involving the spectrum of oversight organizations across and within the disciplines. Participants in these meetings would be charged with developing strategies for incorporating a core set of competencies into oversight activities, based on definitions shared across the professions. These meetings would actively solicit the input of health professions associations and the education community.
* Recommendation 3: Building upon previous efforts, accreditation bodies should move forward expeditiously to revise their standards so that programs are required to demonstrate through process and outcome measures that they educate students in both academic and continuing education programs in how to deliver patient care using a core set of competencies. In so doing, these bodies should coordinate their efforts.
* Recommendation 4: All health professions boards should move toward requiring licensed health professionals to demonstrate periodically their ability to deliver patient care as defined by the five competencies identified by the committee through direct measures of technical competence, patient assessment, evaluation of patient outcomes, and other evidence-based assessment methods. These boards should simultaneously evaluate the different assessment methods.
* Recommendation 5: Certification bodies should require their certificate holders to maintain their competence throughout the course of their careers by periodically demonstrating their ability to deliver patient care that reflects the five competencies, among other requirements.
* Recommendation 6: Foundations, with support from education and practice organizations, should take the lead in developing and funding regional demonstration learning centers, representing partnerships between practice and education. These centers should leverage existing innovative organizations and be state-of-the art training settings focused on teaching and assessing the five core competencies.
* Recommendation 7: Through Medicare demonstration projects, the Centers for Medicare and Medicaid Services (CMS) should take the lead in funding experiments that will enable and create incentives for health professionals to integrate interdisciplinary approaches into educational or practice settings, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies.
* Recommendation 8: The Agency for Healthcare Research and Quality (AHRQ) and private foundations should support ongoing research projects addressing the five core competencies and their association with individual and population health, as well as research related to the link between the competencies and evidence-based education. Such projects should involve researchers across two or more disciplines.
* Recommendation 9: AHRQ should work with a representative group of health care leaders to develop measures reflecting the core set of competencies, set national goals for improvement, and issue a report to the public evaluating progress toward these goals. AHRQ should issue the first report, focused on clinical educational institutions, in 2005 and produce annual reports thereafter.
* Recommendation 10: Beginning in 2004, a biennial interdisciplinary summit should be held involving health care leaders in education, oversight processes, practice, and other areas. This summit should focus on both reviewing progress against explicit targets and setting goals for the next phase with regard to the five competencies and other areas necessary to prepare professionals for the 21st-century health system.

What are the next recommended steps?

* Articulate common terms (by 2004) so shared definitions can provide the foundation for interdisciplinary discussions about the development of core competencies. These competencies must then be incorporated into curriculums and required by accrediting agencies.
* Regional demonstration learning centers and Medicare demonstration projects will provide a venue to showcase the integration of the core competencies into care delivery. Simultaneously, a set of measures reflecting the core set of competencies, along with the national goals for improvement, should be developed by AHRQ and private foundations.
* Biennial summits of health care leaders who control and shape education should be held starting in 2004. This will provide important guidance in integrating and furthering the efforts of those developing measures, practice and education innovators, researchers, and leaders from oversight organizations.

Where to get the complete report

"Health Professions Education: A Bridge to Quality" can be ordered from the National Academy Press at http://www.nap.edu/catalog/10681.html. Internet pricing is $28 for the paperback (192 pages-8 1/2 x 11), $21 for the PDF file version, or $34 if you purchase both together. If you have the patience, you can read it online at no charge at http://www.nap.edu/books/0309087236/html/.[Top]

The Education Section would like to offer a special thanks to Nellcor for donating nearly 100 of its N-395 Pulse Oximeters to respiratory care educational programs, half of which were specially earmarked for members of the Education Section. Check out the AARC News story and the list of recipients here: http://www.aarc.org/headlines/nellcoroximeters.asp[Top]

Are you an educator who prides himself on being on the cutting edge of technology? Do you get butterflies in your stomach as you walk down the computer software isle? Do you feel like a kid on Christmas morning when you find a web site with a free software download? If you squealed "yes" to any of the above, then it's likely you've already been dreaming of receiving a copy of Microsoft PowerPoint 2003(r). But if you chuckled "no," you probably have no idea how Microsoft PowerPoint 2003 can change your presentation experience.

Like most things in life, PowerPoint 2003 is not perfect. In order upgrade to Office 2003(r) (the software necessary to use PowerPoint 2003) you must have Windows XP(r) (2003). Office 2003 is unable to "install under Windows 95, 98, or ME" (Mendelson, p. 1). However, if you plan on investing in Windows XP or already have it, you are just 15 CDs away from your installation of PowerPoint 2003. If you did not quite catch that, Office 2003 is a 15-disc install (Coursey, 2003). Aside from the technical aspects of obtaining Office 2003, the new and improved PowerPoint has some exciting updates and practical features that will not require specific software versions or add-ins to operate (Microsoft, 2003).

Highlighted are a few features that will simplify the creation of your educational masterpieces and impress your students. The incredible Research task pane is the first of these improvements to come to your rescue. It is equipped with a dictionary and thesaurus. The most amazing aspect of this feature is that it will allow you to search the Internet while you are building a presentation without ever having to leave your slide (Microsoft, 2003).

With the new PowerPoint, you also have an option to Autocorrect. If enabled, this feature will automatically correct commonly misspelled words. Another undeniable must-have for the RT educator is Rights Management. This feature allows the individual creating the presentation to "set policies on the reading, copying, or printing of documents created" (Mendelson, 2003, p. 1). In other words, Rights Management will allow content creators to set passwords for viewing of their slideshows, to prevent viewers from unauthorized copying of a presentation, and to restrict printing of certain aspects of the presentation or the presentation as a whole (Mendelson).

If these features have yet to put a smile on your face, this next feature should get you to reveal your pearly whites. You and your students will no longer have to try to decipher the activity on a movie clip crammed into a small box, because the updated PowerPoint has the capability to play movies in full-screen mode. Other technical improvements include an expansion of the play list formats, increased ease in playing media files, and improvement of the audio and video quality while playing within a presentation (Microsoft, 2003).

Now are you ready to run out and get copy of PowerPoint 2003? Try to contain your enthusiasm, because Microsoft Office System Beta 2 Kit 2003(r) is not yet available in stores. As of this writing in early fall, an official release date is not yet available. But keep PowerPoint 2003's potential for presentation Nirvana in the back of your mind, so that when you are considering a software purchase you will know the power that is PowerPoint 2003.

References

* Coursey, D. (2003, March 10). Office 2003: Should you upgrade? Yes, if... [On-line]. Anchordesk, March, 1-4. Retrieved June 18, 2003, http://www.zdnet.com/anchordesk/stories/story/0,10738,2912398,00.html.
* Mendelson, E. (2003, March 10). Microsoft Office 2003: Beta shows promise of this major overhaul [On-line]. PC Magazine, March, 1-4. Retrieved June 16, 2003, http://www.pcmag.com/print_article/0,3048,a=38196,00.as.
* Microsoft (2003). Microsoft Office 2003: Reviewer's guide [Electronic]. Retrieved June 17, 2003, http:///www.microsft.com.[Top]

Editor's Note: The following article is being reprinted with permission of the National Staff Development Council, 2003. All rights reserved. The article appeared in the Dec./Jan. 2000 issue of Tools for Schools, a Council publication.

Much has been written about planning effective workshops and staff development sessions. Many of these articles provide specific ways to increase the effectiveness of the session. These articles have generally suggested "what works" in workshops.

Experience and research also indicate certain things that a facilitator should never do during a workshop. I have gleaned these "never evers" from observing other presenters, conducting my own workshops, consulting with experts, and reading the literature. As a thoughtful reminder, place this list of "never evers" near your other workshop materials.

Never ever forget that individuals at the workshop are unique, with needs, interests, and experiences particular to them. Adults have a strong sense of self and bring all life experiences -- past and present, personal and professional -- to bear on new learning (Brookfield, 1986). Each adult in the session has a different reason for attending and will be pleased and inspired by and learn from different activities and workshop experiences (Merriam, 1989). Accommodate various learning styles by using a variety of instructional strategies such as small group discussions, lectures, simulations, reading, writing, and using media.
Never ever require individuals to participate in an activity. Many participants are eager to share and try new ideas in a workshop, but some are uncomfortable and feel foolish. When suggesting activities, make it clear that participation is optional; those who prefer to watch will learn from the activity in their own way.
Never ever talk to participants as if they are children. Adults are not second graders and should not be treated as such. Incorporate specific adult-oriented presentation, communication, and facilitation skills into the workshop and consider the particular needs of participants (Seaman &Fellenz, 1989).
Never ever ridicule participants or their experiences. Acknowledge the expertise and experience of the participants. It is inappropriate to put people in the position of feeling uncomfortable about what they do not know or something they have or have not done.
Never ever neglect the participants' personal needs. Participants have basic physical needs that need to be met if learning is to occur (Knowles, 1980). Give participants ample breaks and make it clear that you understand they may need to get up at times other than the break. Provide appropriate refreshments for breaks and tables and chairs appropriately sized for adults.
Never ever say that you are going to rush through and compress material in order to complete what is usually a longer workshop in a shorter length of time. Develop a plan for the workshop. Cut it thoughtfully so the workshop stands on its own. Participants deserve to attend a session developed just for them (Brookfield, 1986). Give participants all you can in the time provided without referring to what they're missing.
Never ever say that you would have brought more materials if it had been possible. Participants need to know that you are ready for them and that they are getting all that they deserve. They are not interested in excuses about materials that were too heavy, took up too much space, or that you lacked time to produce the materials.
Never ever tell participants what you've forgotten. Participants have no idea what you intended to bring or intended to say, so they will have no idea of what you've forgotten. Appearing disorganized is a sure reason for participants to think something is wrong with the workshop (Pike, 1989). If they know you've forgotten something, they may feel cheated.
Never ever give excuses. Participants don't like to know what could be better; they want to spend time at something that is the best it can be. If you've made a mistake and it's a mistake that is obvious to everyone, don't hesitate admitting that (Pike, 1989).
Never ever read from a lengthy prepared text. Reading excerpts from a paper or book is appropriate, but never read an extended paper or lengthy selection from a book. Reading from a paper can give the impression that the participants are irrelevant (Brookfield, 1990). If the participants need to have the information verbatim, then provide a copy.
Never ever share illegible handouts. Use high-quality originals for photocopying. As adults age, it becomes more difficult for them to read small print, so it's especially important to have clear copies with adequate sized print (Bee, 1987).
Never ever share a disorganized "mishmash" for a handout. Participants want to leave with materials that reflect the content of the workshop. Each handout should include the workshop title and identify the content of the session. Number pages to help people locate information during the workshop and after they leave the session. Provide information that allows for follow-up after the workshop.
Never ever give participants something to read and then read it to them. Most participants are capable of reading on their own and would prefer that the workshop include information and activities that supplement what they can read independently. Adults are active participants in their learning and can take responsibility for their own learning (Brookfield, 1986).
Never ever share overhead transparencies that participants cannot see or read. If people in the back row cannot see the words on an overhead transparency, they are too small or too low. If you can't read the original for the transparency from eight feet away, then the words are too small. Letters on a transparency should be at least one quarter of an inch. Use the top third of a transparency for the most significant information and limit your transparencies to a single idea. The appropriate use of colors and symbols can enhance your transparencies (Satterthwaite, 1990). Ask someone in the back of the room to signal you if there is a transparency that is not plainly visible so that you can make appropriate adjustments.
Never ever share with participants a workshop schedule that is impossible to follow. Tell participants the general structure of the day. Identify broad subject areas and general time frames rather than specific topics for specific time periods. Be organized, but allow yourself some flexibility and opportunity to respond to participants' needs and unexpected events of the day (Pike, 1989).
Never ever go past the scheduled time. Participants want a full workshop, but they want it to end on time. Going beyond the scheduled time creates anxiety, and participants will spend more time worrying about when the facilitator will close than considering what is being shared (Pike, 1989). Stop at or a few moments before the scheduled ending time even if you were unable to share all that you wanted. Those who are truly interested can talk with you privately after the session.
Never ever forget that you have an audience. Workshop facilitation is collaborative in that the facilitator and participants work together during the workshop (Brookfield, 1986). Walk among and talk with the participants. Standing at the front for too long creates an artificial boundary between you and the participants and makes an atmosphere of collegial collaboration difficult to attain.
Never ever take the workshop so seriously that everyone (including the facilitator) cannot have fun. While the content of the workshop is important, don't forget to "lighten up" and insert some humor and levity into the day (Pike, 1989). Use humor that fits naturally and logically into the workshop to make a point and help everyone feel at ease.
Never ever plan a workshop without considering this list of never evers. Use these suggestions to help make your next workshop one that participants would "never ever" want to miss.[Top]

As respiratory therapy educators, we focus on providing didactic and clinical education. We prepare students to be competent, critical thinking therapists who assess patients, perform diagnostic tests, recommend therapeutic procedures, and function as effective members of the health care team. Educational programs also provide instructional guidance in the psychosocial aspects of health care, ethics, and communication skills.

Indeed, the value of communicating with patients cannot be overstated. When patients and health care professionals work together to achieve a mutual goal, the outcome is generally more positive. Unfortunately, some older patients who receive respiratory care cannot communicate with their therapists. Older patients may have sensory impairment, dementia, aphasia, depression, or an artificial airway, all of which can preclude efforts to communicate. Other older patients may communicate, but not in an appropriate or positive manner.

Each particular patient situation requires a different adaptation or intervention. Even seasoned therapists spend years developing these skills. It would be impossible to foresee and/or prepare students for every eventuality they may encounter in trying to communicate with their patients. Perhaps a more realistic approach might be to give students a few scenarios, let them respond to the choices, and then discuss the pros and cons of each potential answer.

Consider the following two situations:

The angry patient

Mr. Harrington, an 82-year-old patient with COPD, is angry most of the time. Staff members have come to accept him as a person who cannot be pleased. Today when you enter his room to give him a treatment he snarls, "I don't need that and I don't need you coming in here and bothering me." How will you respond?

The choices:

A. "Yes, you do need this medicine, and if I don't give it to you, who will?"
B. "What's the matter?"
C. "I am just following the physician's orders. He wants you to take this treatment."
D. Leave the room without even responding -- show Mr. Harrington that you will not tolerate such behavior.

While choice D would not be appropriate under any circumstances, either A or C, if said in a kindly manner, might be reasonable, but not correct. Asking Mr. Harrington "what's the matter" is the best response because it's the only response that comes close to determining why Mr. Harrington in angry. While asking a disarming question will not change the patient's personality, it demonstrates caring and concern and is less threatening. Ask students if they have encountered angry patients, and if so, how did they respond?

The second scenario is a little different.

The verbally abusive patient

You are delivering therapy to an elderly COPD patient with Alzheimer's disease who is continually cursing at you. How can you make him stop?

The choices:

A. Curse right back at him and let him know how it feels.
B. Respond by saying, "You really need to change your swearing behavior. Let's work on it together."
C. Tell the patient, "I'm sorry you feel like that, but I don't care to be spoken to in that way."

Again, poll the students. They will all recognize that choice A is inappropriate, but may need some help deciding between B and C. If students have treated patients with Alzheimer's before, they will understand the futility of trying to change behavior and will select C as being the most appropriate choice.

Asking students to share some of the problems they have encountered gives faculty an opportunity to discuss a variety of compensatory mechanisms, some of which will work and some of which might not. Open, honest communication with students about the potential for, and probability of, encountering communication dilemmas with patients may not solve all their problems, but it will give them more potential solutions.

Communication tips

Here's a general checklist we all can use to better communicate with our elderly patients:

* Be accessible.
* Listen and try to understand.
* Invite rapport by exhibiting a smile and a friendly manner.
* Give the patient your full attention - show them they are important.
* Provide privacy if possible when talking about personal health.
* Express an interest in their comments, both by facial and verbal expression.
* Use a reassuring, non-threatening, non-authoritarian tone of voice.
* If talking to someone with a hearing impairment, keep lips visible; try to talk to them at their eye level.
* If patients have visual impairment, verbal instructions are imperative.
* Maintain eye contact to see if the patient appears puzzled or confused.
* Avoid talking in "medical speak" language.
* Repeat instructions, using different and short explanations to reinforce your message.
* Reinforce what you are saying with written instructions - 14 font, double-spaced, black print on white paper.
* Give the patient the opportunity to ask and re-ask the same question.
* Ask if there is a family member who can be contacted if the patient appears confused.
* Empathize - and treat every patient as if they were your elderly loved one.[Top]

Debbie, from Kansas City, writes, "How should we teach students to assess lung mechanics on patients on pressure-oriented ventilator modes?"

This discussion assumes that lung mechanics are to be measured on mechanical breaths delivered in a standard pressure mode of constant pressure with decelerating flow.

Assessing the compliance of the lung/chest wall and airways resistance is best accomplished through the analysis of a pressure-volume curve. The slope represents compliance and the width of the sigmoid curve reflects airway resistance. Further analysis can be performed by dividing the curve into its inspiratory and expiratory segments, thereby assessing airway resistance during both phases of ventilation.

Due to the nature of pressure ventilation, plateau pressures are not available. Peak pressure is substituted for plateau pressure and divided into delivered tidal volume to measure dynamic compliance. Without the presence of a proximal flow measuring sensor (heated wire or pressure differential), measurement of airway resistance, independent of compliance, is difficult due to the deceleration flow inherent to pressure ventilation. When flow can be measured and compared to proximal pressures, an accurate measurement of airway resistance is possible.

Although no longer popular, several free-standing pulmonary mechanics monitors can provide these measurements using proximal pressure and flow signals with esophageal pressure measurements. Although labor intensive, many practitioners feel these devices provide the "most accurate" measurements of lung mechanics.

References

1. Hess DR, MacIntyre NR, Mishoe SC, Galvin WF, Adams AB, Saposnick AB, Respiratory Care: Principles and Practices W.B. Saunders, Philadelphia, 2002.
2. Levitzky M., et al. Introduction To Respiratory Care W.B. Saunders, Philadelphia, 1990.
3. Pilbeam S. Mechanical Ventilation: Physiological and Clinical Application, Mosby, St. Louis, 1998.[Top]

Editor's Note: The following abstracts were presented at the Summer Forum held last July in Lake Buena Vista, FL.

LEARNING STYLE PREFERENCES OF RESPIRATORY THERAPY STUDENTS IN A BACCALAUREATE DEGREE PROGRAM

Tom Smalling, MS, RRT, RPFT, RPSGT
State University of New York at Stony Brook

BACKGROUND: There is a dearth of research in the area of learning style preferences of respiratory therapy students, thus complicating the ability of educators to improve teaching strategies in an increasingly diverse study body.

METHOD: This study profiled the preferred learning style of students for four consecutive years based on Kolb's Learning Style Inventory (LSI) (Kolb, 1985). In addition, a comparative analysis was performed to ascertain gender and race-related differences in learning style preferences. Sixty-nine third- and fourth-year respiratory therapy students accurately completed a 1-page demographic questionnaire along with 12 questions on learning style preferences from the Kolb LSI. The data were collected and descriptive analysis performed. The 12 ranked questions of the LSI were translated into four cycles of learning: Concrete Experience (CE), Reflective Observation (RO), Abstract Conceptualization (AC), and Active Experimentation (AE). The CE, RO, AC, and AE values were then used to determine the predominant learning style of diverger, assimilator, converger, and accommodator.

RESULTS: 58 students were female (84%) and 11 were male (16%). There were 21 Asian-Americans (30%), 17 Caucasians (25%), 17 African-Americans (25%), 10 Hispanics (14%), 2 Indian-Americans (3%), and 2 Middle Eastern-Americans (3%). The average age of the cohort was 22 (SD=3.29) years. The average age of males was 25.4 (SD=6.64) years. The average age of females was 21.9 (SD=1.81) years. The oldest was 42 (male) and the youngest was 19 (female). The results showed that learning occurred in all four learning cycles. The order of learning modes from highest to lowest preference was CE (76%), RO (50%), AC (46%), and AE (32%). The dominant learning modes were then subcategorized according to gender and race. The dominant learning mode remained CE for both females (76%) and males (73%). In addition, the dominant learning mode also remained CE for Asian-Americans (73%), Caucasians (77%), African-Americans (78%), Hispanics (75%), Indian-Americans (86%), and Middle Eastern-Americans (83%). The dominant learning styles from highest to lowest ranking were Diverger (52%), Accomodator (22%), Assimilator (20%), and Converger (6%). The majority of learning style preferences for males was split between Diverger (45%) and Accomodator (45%), while the distribution for females and minorities mimicked that of the entire cohort.

CONCLUSIONS: The majority of the cohort characterized themselves as concrete learners. According to Kolb, (1976) students scoring high in concrete experience (CE) represent a receptive, experience-based approach to learning that relies on feelings-based judgments. High CE people tend to be empathetic. They learn best in cooperative learning environments. These learners tend to relate better to peers, not authority. The data coincide with Belenky et al. (1997) and MacKeracher (1994) studies which suggest that female students place emphasis on relationships, are empathetic in nature, prefer to work in groups, and prefer to learn in an environment where cooperation is stressed rather than competition. The results also coincide with studies by Enns (1993) and Cavanaugh et al. (1995) showing females to be more likely to exhibit concrete experience and active experimentation preferences. It is important for educators to be aware of student learning styles and adjust their instruction accordingly. In light of these findings, it is suggested that respiratory therapy educators design a curriculum and devise teaching strategies that coincide with the dominant learning styles of its students. Respiratory therapy educators need to adapt their teaching strategies to the different cognitive styles and diverse cultural backgrounds of students.

A COMPARISON OF A TRADITIONAL VERSUS ONLINE ETHICS COURSE

Kathleen Hernlen, RRT, MBA
Medical College of Georgia

Problem based learning (PBL) incorporates active learning that can result in more effective teaching. An interdisciplinary ethics course was developed consisting of reading assignments, lectures, class discussions, and a PBL component with faculty facilitated discussions of ethical cases for groups of eight to ten students. Because of the difficulty in obtaining faculty facilitators, a PBL online course utilizing one instructor was developed. The online course consisted of both individual and group synchronous and asynchronous assignments. Content was presented in reading assignments followed by activities that required students to make choices about ethical dilemmas and contemplate the consequences of their choices. Students in the traditional and online courses were required to write a discipline-specific paper. Grading rubrics were provided and identical final exams were administered. The instructor documented the time spent in preparation, teaching, and class management for both the traditional and online courses for two consecutive semesters. The design of the online class was not taken into consideration. In the fall semester 102 students were enrolled: 73 traditional, 29 online. The instructor time was: 2,101 minutes (traditional) compared to 1,439 minutes (online). In the spring semester 37 students were enrolled: 20 traditional, 17 online. Faculty time was 1,383 minutes (traditional) and 898 minutes (online). On average the instructor spent 38 minutes per student with the traditional class and 50 minutes per student with the online class over the two semesters. The design of the courses yielded different degrees of participation from the students. All online students participated in numerous active learning activities, whereas traditional students' participation varied depending on their involvement in the discussions. A higher degree of active learning was achieved with the online course, with fewer faculty members.

USE OF VIDEO CLIPS TO SUPPLEMENT ARTIFICIAL AIRWAYS INSTRUCTION

Ellen A. Becker, PhD, RRT-NPS, AE-C
Academic Coordinator, Respiratory Care Long Island University Brooklyn, NY

PURPOSE: This study examined whether a series of video clips viewed from a CD-ROM would enhance artificial airway written exam scores and the first-time pass rates for laboratory exams.

METHODOLOGY: Procedures related to artificial airways were videotaped with digital video, edited, compressed, and burned into a CD-ROM which was given to each student. The written exam scores and first-time pass rates for the artificial airway laboratory exams were compared with a control group. Experimental and control groups were compared using Fisher's Exact Test on first semester GPA, the written exam scores, and the first-time pass rates for four separate laboratory skills. Median GPA and written exam scores were used to split groups into performance levels. Students in the experimental group rated the ease of learning from lecture, laboratory, written materials, and video clips on a 5-point scale with endpoints of 1 = very difficult and 5 = very easy. The Sign Test was used to compare learning through video clips with each of the other methods. A family-wise alpha level of 0.05 was considered as significant for all tests.

RESULTS: There was no difference in first semester GPA (p = .510) for the control (n=19) and experimental (n = 15) groups nor in the first-time pass rates for the laboratory exams (p = .219). However, members of the experimental group scored higher on the written exam than the control group (p = .005). Sign Test ratings revealed that students (n = 9) found learning through video clips easier than learning through lecture (p = <.001), laboratory work (p = <.001), or written materials (p <.001).

CONCLUSIONS: Academic backgrounds for both groups were similar. Use of video clips did not change first-time pass rates on laboratory exams, however use of video clips improved written exam scores. Faculty should consider supplementing learning with video for students who find it more difficult to learn through written materials.

FACULTY INTERVENTIONS TO IMPROVE LEARNING OUTCOMES THROUGH COMPUTER CONFERENCING

Ellen A. Becker, PhD, RRT-NPS, AE-C
Academic Coordinator, Respiratory Care Long Island University Brooklyn, NY

PURPOSE: This study evaluated the impact of enhanced student support and feedback on health profession students' learning through an interdisciplinary computer conferencing module.

METHODS: Interdisciplinary teams comprised of occupational therapy, physical therapy, and respiratory care students participated in a computer conferencing module that contained all instructions and resources on the Internet. Several faculty monitored teams of 4-5 students and provided weekly written feedback. Outcomes from the first module were compared to an enhanced module that added more student technical support, weekly grades, and a print-based study guide that repeated instructions and resources. Two researchers independently recorded the number of messages each student posted for each lesson's time frame and assigned codes for faculty message content: introductory, reinforcement, technical information, restate assignment, vague feedback, professional expertise, give direction, and response to question. The researchers compared their codes and established a consensus. A t-test compared the difference in students' pre- and post-Interdisciplinary Education Perception Scale (IEPS) beliefs between modules. Fisher's Exact Test was used to compare the total student postings, total faculty postings/team, and faculty message content between modules using the aggregate median to determine categories. An a = 0.05 was considered significant.

RESULTS: Compared to the first, the enhanced module had greater IEPS belief changes, more faculty messages/team, however no difference in total student postings. Students in the enhanced module showed greater changes in beliefs that their profession was positive about their contributions, needed to cooperate with others, had good relations with other professions, was well-trained, and did not have a higher status than other professions. Faculty messages in the enhanced module contained fewer vague messages and more messages containing introductions, re-stated assignments, reinforcement, and technical information.

CONCLUSIONS: Providing students with more technical support, weekly grades, a print-based study guide, and enhanced written feedback positively impacted students' online interdisciplinary learning experience. Written feedback that restates assignments and contains reinforcement, introductions, and technical information improved online learning outcomes.

RELIABILITY OF AND CORRELATION BETWEEN THE RESPIRATORY THERAPIST WRITTEN REGISTRY AND CLINICAL SIMULATION SELF-ASSESSMENT EXAMINATIONS

Deborah L. Cullen, EdD, RRT; Linda I. Van Scoder, EdD, RRT;
Krzysztof Podgorski, PhD; and Derek Elmerick, MS

STUDY OBJECTIVES: The purpose of this study was to determine the reliability of two respiratory therapy self-assessment examinations: the written registry examination (WR), and the clinical simulation examination (CSE). We then used reliability coefficients to test the true correlation between the WR and CSE by employing the Spearman-Brown formula to attenuate for unreliability.

DESIGN: This was a nonexperimental correlational study.

SETTING: The study was conducted at respiratory therapy education programs located in four states.

PARTICIPANTS: Sixty advanced-level respiratory therapy students enrolled in the final semester of their programs.

MEASUREMENTS AND RESULTS: Fifty-eight students completed the WR, and 56 students completed the CSE. The reliability coefficient for the WR was 0.79. The reliability coefficient for the CSE when taken as a whole was 0.76. However, the CSE is separated into two sections, information gathering and decision making, which are scored separately. Cronbach a computed for the information-gathering section was 0.72, while the a coefficient for the decision-making section was only 0.64. The correlation between the WR and CSE was 0.86 after attenuation for reliability.

CONCLUSIONS: The estimate of the reliability for the CSE is less than that for the WR, and the two examinations are strongly correlated. This leads us to question whether the CSE adds to the validity or reliability in the testing of respiratory therapists.

(CHEST 2003; 123:1284-1288)

RECRUITMENT IN RESPIRATORY CARE PROGRAMS

Debra K. Kasel, MEd, RRT
Northern Kentucky University

Recruitment is vital for the survival of respiratory care programs. The purpose of this study was to evaluate the success of a recruitment plan utilized in an advanced practitioner program. All inquires from December 2001-February 2003 (N = 166) were recorded in a database and analyzed for point of contact (POC), follow-up, and enrollment in the program. POC or follow-up included: web-based inquiry, phone calls, career fairs, program open houses, walk-ins, and a career exploration course in allied health professions. The most frequent point of entry was web-based inquiry (n = 105). From the 166 potential applicants, 30 followed through with applications. The 30 applicants had 66 POC, averaging 2.2 POC/applicant. Three applicants (10%) completed the career exploration course. In summary, the more POC we had with a potential applicant, the more likely they were to apply to the program.

General resources

Excellent resource for respiratory care related web sites dealing with professional societies, AARC related pages, medical societies and organizations: http://www.xmission.com/~gastown/herpmed/respi.htm

Continuing Education for RTs on the web: http://classes.kumc.edu/cahe/respcared/

Excellent online tutorials and labs in pulmonary physiology and other related topics for RC students and faculty to use: http://oac.med.jhmi.edu/res_phys/, http://www.acbrown.com/lung/ http://www.medicine.mcgill.ca/physio/resp-web/OUTLINE.htm

PowerPoint templates

Animation Factory has created another batch of templates for Microsoft PowerPoint that includes more than 500 new designs. Templates to the Go features business, educational, and other themes appropriate for the RC educator to use. Several templates have more than one title master and up to four backgrounds. Price: $90. Contact http://www.animationfactory.com or call 1-800-525-2474.

Ideas for alternative teaching strategies and interactive exercises: A fresh look at doing things differently in the RC classroom

Check out two books by Michele L. Deck at Barnes and Noble (http://www.bn.com): Instant Teaching Tools for Health Educators, 1995 Mosby-Yearbook, Inc ISBN 0815123795; and More Instant Teaching Tools, 1997 Mosby ISBN 0-323-00085-1. Both are full of good resources aimed at the health educator, including creative ideas and tools that offer positive reinforcement and raise confidence levels of both student and teacher. The books feature over 100 field-tested teaching and learning interactive exercises that make classes much more effective and interesting, along with many ready-to-use exercises that can be copied and used in class. Both books are softbound and reasonably priced.

CoARC News

At the Summer Forum in Orlando, FL, CoARC Executive Director Rich Walker announced that programs will not have to submit annual reports in 2004 until October. The normal report date is in April of each year. Sounds like good news!

CAAHEP has recommend that the "participation" portion of threshold analysis be eliminated from RC program requirements and that the focus be placed on "success." In other words, pass rates on exams should be used for Thresholds, not the number of graduates taking the exams. For more details, go to the CoARC web site (http://www.coarc.com) and submit your questions.

Teaching Tidbits

From Program Director Brad Leidich in Harrisburg, PA: Brad does not buy ventilators for his RC program. He borrows ventilators from the local hospitals instead. If a hospital needs the ventilator during the time it is borrowed, the hospital calls the local ventilator rental company and gets one from them. The school covers the cost of the rental. Brad says in the many years he has been doing this, he has only had to cover the cost of rented ventilators twice.

From Program Director Faye Mathis, at Okefenokee Technical Institute: When a student misses an exam question, Faye makes the student look up the correct answer in a text and write out the answer, with page number, etc. and submit it to her. She finds this helps her students focus more on the concept they missed rather than the "question" they missed.

Watch future issues of the Education Section Bulletin for a new column: "Before and After: How To Improve Your PowerPoint Slides" This column will be co-edited by Sandra Partain, BS, RRT, Bossier Parish Community College, and me (Dennis Wissing). Using principles of visual literacy and science, neurobiology, and cognitive science, poor examples of slides will be presented and then edited to show how changes can make them more effective tools for teaching. A discussion as to why changes were made will be provided.[Top]