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

Many of you have probably already seen the article posted on the section e-mail list last fall by Greg Paulauskis, the director of clinical education for the RT program at Montana State University in Great Falls. However, it contained such nice news that it bears repeating for those who missed it.

The Billings Gazette in Billings, MT, assigned a reporter, James Hagengruber, to an article on the nursing shortage in the local area. After he talked to various directors of human resources, it became apparent to him that respiratory therapy had a greater personnel shortage than nursing. According to the article, "Respiratory therapists aren't stars in emergency room soap operas - most people don't even know what they do. But they're beginning to play major roles in a national health care worker shortage."

He goes on to describe some of the functions of the respiratory therapist and note some of the RT shortages in his area. For example, St. Vincent's Hospital employs 23 respiratory therapists, but was looking for six additional people -- more than double the hospital's nursing vacancy rate. The article goes on to quote salaries of $19.50/hour in Portland, OR, and $20/hour in Dallas, TX.

The article also featured a discussion of local school enrollments. Hagengruber reported a starting class at Missoula of 22 (out of 25 openings), and said Great Falls had filled 14 of 15 slots. That's good news compared to how things have been going over the past few years for most RT programs.

Now the progress noted in Montana is beginning to be echoed around the country as well. Here in Florida, Edison Community College is up to 18 students from 6 graduating two years ago. Enrollment at the Florida Junior College at Jacksonville has risen to 19, compared to a last year's graduating class of 9.

Of course, this doesn't mean that our problems with recruiting and retaining students are over. Still, it's hard not to be optimistic after at least three years of lean times. And if more communities would generate interest in RT through local articles such as the one featured in the Billings Gazette, that optimism might spread even faster. [Top]

The editors encourage original reviews of software programs, computer-related technology, and multimedia for respiratory care educators. In addition, articles about effective teaching strategies, novel approaches to instructing the science of respiratory care, and educational-related research articles are also welcomed.

We recognize that it's not easy for educators to stay abreast of the growing number of Internet and software resources for respiratory therapy and other areas of health care. So, we've developed this initial column to provide you with pertinent links. The sites listed provide information on basic sciences and general and critical care medicine.

Core Science Software

Mathematics, Chemistry, Physics
"Study Works!" (http://www.mathsoft.com)
"How Things Work: The Physics of Everyday Life" - L. Bloomfield, PhD (University of Virginia) (http://howthingswork.virginia.edu)
Interactive Learning Systems (http://www.highergrades.com)

Anatomy and Physiology
The Virtual Human Gallery (http://www.vhgallery.gsm.com)
The Visible Human Project (http://www.nlm.nih.gov/research/visible/visible_human.html)

Pharmacology
Drug Information Online
USP Drug Guide at Mayo
The Merck Manual Online Resources (http://www.merckmedicus.com)

Pathophysiology
Introduction to Cardiothoracic Imaging (http://www.info.med.yale.edu/intmed/cardio/imaging/)
Heart Disease (http://www.pathguy.com/lectures/heart.htm)

General Therapeutics
JL Enterprises - Respiratory Therapy Modalities (http://www.jlenterprise.com)
RC-Web University of Missouri Respiratory Therapy Program (Lung Sounds) (http://www.muhealth.org/~shrp/rtwww/rcweb/docs/rcweb.html)
Healthcare Provider Resources (http://www.lungdoc.md/LinksPearls/RespTx.htm)

Electronic Education Bulletin

If you know fellow section members who aren't getting this electronic Bulletin, please ask them to supply the AARC with a current e-mail address. Addresses may be e-mailed to: mendoza@aarc.org.

Section E-Mail Lists

Start networking with your colleagues via the section e-mail list. Click http://www.aarc.org/sections/education_section/mailing_lists/ to sign up now! It's the best way to stay on top of current events, trends, and issues in respiratory care education.

Bulletin Submission Guidelines

If you would like to receive a set of guidelines for the submission of articles to the Bulletin, e-mail your request to DebBunch@aol.com.

AARC Addresses Polysomnography Issues

In the September 2002 issue of AARC Times, you may have read that the respiratory care program at Vincennes University was slated for closure in May of 2001. The announcement was made to the program chair, Everett T. Wood, Jr., on Friday, May 11. At that time, he was told the program would be closed Wednesday, May 15. Because this was the first indication that the program was in serious trouble and because first-year students had no warning that this was about to happen, many people responded to the president and provost of the university, expressing their displeasure at the news.

After several hundred e-mail messages from alumni, local physicians, department managers, AARC Executive Director Sam Giordano, human resource personnel, and hospital administrators from around the state - not to mention a front-page story in the local newspaper - a decision was made to modify the closure date. The administration agreed to allow the returning second-year students to finish the degrees they had begun in good faith at the university.

This overwhelming show of support for the program also resulted in the administration offering to reconsider the decision to close - if the many folks clamoring for the program to remain open would join in partnership with the university to support it. A number of meetings were held between the program faculty, university administration, and others in the community of interest to discuss what needed to happen in order for the university to sustain the program.

The crux of the problem was that enrollment was down, and the administration believed it would not go back up. Declining enrollments had resulted in six-figure financial losses annually. The university essentially told the community of interest that it would not support the continuation of a program that generated such losses. The only way the program could possibly continue was if local hospitals would share in the financial liability and further work to recruit students into the program. The threshold established by the administration for continuation of the program was an annual contribution by the hospitals of $100,000 and an enrollment of 24 freshman students for the 2002-03 academic year. The administration gave us until March 1, 2002 to achieve these goals.

As a result of these meetings, by February 15, 2002, a coalition of supporting hospitals had been formed, and a total of $60,000 per year was pledged. At that time, 12 students had been accepted for Fall 2002, and 19 scholarships had been pledged. The scholarships were to be awarded by the hospitals to students in return for an employment agreement. The faculty made an all-out blitz of area high schools to make counselors aware of the opportunities for scholarships. Alumni were also contacted and asked to contribute to the cause, and by February 15, a total of $5,000 had been pledged.

Unfortunately, the administration announced on February 15 that the efforts to reach the stated goals were in all likelihood going to fall short. On that date, they announced finally that the program would close with the August graduation of the class of 2002.

The question remains, how did we arrive at this point? I believe the answer lies in the fact that historically, recruitment of students into the respiratory care program was left entirely to the university. The admissions department and the faculty were responsible for attracting the next generation of students. Neither the admissions counselors nor the program faculty had sufficient time and resources to mount an effective, sustained, consistent effort. The hospitals did not see that it was their responsibility to assist in the recruitment of the next class . . . or the next . . . or the next. The hospitals only focused on their IMMEDIATE needs. THEIR recruitment activities were targeted at the respiratory care programs. In other words, they were only interested in recruiting the finished product. They did not see it as their role to recruit the raw material.

How can we keep this from happening in the future? I believe the PROFESSION must be proactive in maintaining a pipeline of students entering RT programs around the country. The state societies must get involved in an ongoing, aggressive, coordinated effort to market the profession to high school, middle school, and even elementary school students. And the hospitals must establish a budget for recruitment - not just to recruit graduate RTs but also to recruit students into the programs. In order to accomplish this, they must allocate monetary scholarships to entice young people to enter the profession. They must do this consistently and persistently. They must award scholarships even in those years when they believe themselves to be at full staff. They must look at the long run, not just focus on immediate needs.

Sign-on bonuses and escalating salary scales do not get at the root of the problem. These recruitment tools may work in the short run, but fail miserably in the long run, because sign-on bonuses and ever-increasing salaries do not increase the number of graduating RTs. They merely reallocate those who already exist.

To prevent other RT programs from closing, strategic alliances need to be formed between schools and those who depend on them as a source of new employees. Coordinated efforts need to be put into place so that all efforts are aimed at increasing the base - the number of students enrolling in the programs each year. Unfortunately, it took the Vincennes University respiratory care program closure for the respiratory care leaders in Indiana to begin to develop such an alliance. I hope other programs in other states won't have to close for the professionals in those states to realize what needs to be done. [Top]

Last November, John Hiser, MEd, RRT, CPFT, FAARC, from Tarrant County College, Hurst, TX, posted a question on the section e-mail list asking other educators how their students are graded during clinical rotations. Respondents provided considerable insight into how student clinical experiences are evaluated by different respiratory care programs.

Here's a summary of these responses:

Features of the pass/fail or credit/no credit system

* Ultimately students are either clinically competent or they are not, so use of the pass/fail system seems philosophically reasonable.
* Students are hopefully motivated to a higher level by more than grades alone.
* May eliminate competition and anxiety associated with assignment of a letter grade, permitting students to concentrate on achieving an acceptable level of performance.
* Statistically, the majority of the students would receive a grade of "C" anyway.
* Students may slide by with minimal effort and still receive a passing grade.
* Works well when the bulk of clinical evaluation consists of checklists.

Features of a graded (A-F) system

* Students who excel are rewarded with an "A" or "B" grade, so there is incentive for students to go above and beyond the minimum level of required performance.
* Supports the suggestion that there are multiple levels of clinical competency.
* Letter grades are easily figured into a grade point average, allowing for matriculation into other educational settings.
* Allows an instructor to differentiate levels of performance among students. A grade of "C" means students are safe and minimally competent. Higher grades are earned through efficient and meticulous practice, ability to communicate, and quality patient care plans.
* One program uses a contract system for letter grades. A grade of "C" comes from completing a certain number of hours, competencies, and other requirements. Students can earn a grade of "B" or "A" by completing successively higher requirements.

Some hybrid systems

* Task performance is graded by a checklist and receives a satisfactory/unsatisfactory grade, while letter grades for the clinical course are derived from case study presentations, rating scales of problem solving ability and professional attributes, written and clinical oral exams, and the like.
* One program recently merged lecture, lab, and clinical components into a single course. The psychomotor portion of lab and clinical is competency based and students must receive a passing grade in these portions before enrolling in a subsequent course.

Evaluation of students by clinical instructors

* DCE spends considerable time with the students, and his/her evaluations are weighted heavier than those of non-paid clinical instructors.
* Many clinical instructors want to be kind to students and consistently give good evaluations. Their evaluations are primarily used for feedback, borderline grades, and counseling.

Following this online discussion, John reported that while the program at Tarrant County College is waiting for feedback from faculty and its advisory committee before making a final decision on grading during clinical rotations, faculty are leaning toward continuing with their letter grade system with some modification. The change would be to establish more strict criteria for each letter grade. For example, to earn an "A", a student would have to complete all check offs, have no excessive absences, present an exceptional case study, earn a score of greater than 80% on the final exam. Other grades would be assigned based upon lower levels of performance in each of these categories.

Respiratory care educators face the challenge of developing and implementing clinical evaluation systems that meet the requirements for continued accreditation and are also acceptable to their faculty, advisory committee, and college or university. Comments from students and alumni can provide valuable input, as can those from colleagues from around the country. The comments listed in this article represent different educational institutions with varying experiences. Their ideas could provide an excellent basis for discussion of a program's clinical evaluation policies and practices. [Top]

As an educator in the respiratory therapy profession, I have faced some of my greatest challenges in the assessment of the student when evaluating the affective domain. Something so simple in my mind often becomes one of the biggest headaches of the semester. I have encountered little or no problem in the evaluation of the cognitive and psychomotor domains. Is this because the objectives are clearly stated and the learner knows what to expect? While the student is aware of the areas that will be assessed for the affective component of the clinical grade, does the student really understand what is required? Who is the ultimate authority guru responsible for defining this area for the students?

Krathwohl's taxonomy of the affective domain begins with the learner's awareness of a phenomenon and progresses to a level where the development of a value system will guide the individual's behavior. Krathwohl's hierarchy includes the following levels: receiving, responding, valuing, organization, and characterization by value. The problem lies in the fact that the student enters the professional component of instruction with a set of values in place, and any attempt to alter or adjust these views or values leads to disharmony between the instructor and the student. The student needs to understand that the role of the instructor is to assist in the development of a consistent value system that promotes the respiratory care profession, and this can only be accomplished by evaluating the affective domain and providing constructive comments.

The AARC and the Committee on Accreditation of Respiratory Care (CoARC) have set guidelines that can be used to assist the instructor and student in developing a value system that promotes the profession. The AARC Statement of Ethics and Professional Conduct and CoARC's Employer Survey for Graduates list areas of expectations for respiratory care personnel. CoARC's assessment of behavioral skills for the graduate who has obtained employment include:

(1) Communicating effectively within the health care setting,
(2) Conducting oneself in an ethical and professional manner,
(3) Functioning effectively as a member of the health care team,
(4) Accepting supervision and working effectively with supervisory personnel,
(5) Possessing self-direction and being responsible for his/her actions,
(6) Arriving on time and ready to work, and
(7) Contributing to a positive environment.

In addition to utilizing these published items, maybe I need to put into writing my expectations of the student, which are nothing more than the common courtesy practices I was taught as a child. During lectures, labs, and clinical experiences, I have expressed verbally and demonstrated personally many of the aspects that are evaluated for the student in the affective domain. I have focused a great deal on the respiratory therapist being a "team" member, which means one needs to be able to interact with other individuals on a daily basis. A student who only acknowledges other health care professionals during crisis situations, in my opinion, is not acting as a team player. On a daily basis you can hear me tell students, "say what you mean and mean what you say" and "be responsible for all your actions." I have stressed to the students the need to "make a difference" and give 110% daily in the didactic and clinical settings. The bottom line is the student must come to me with a desire to make a contribution to the profession, whether this is in the delivery of care to patients or the promotion of the profession by having a positive, friendly attitude in the workplace.

While I have never failed an individual student from the program for their behavioral skills assessed with the affective domain, you would have thought I had committed a serious atrocity by assessing a 6, 7, or 8 on a likert scale of 10 for an individual who did not demonstrate what I believe to be "perfect 10" behavior. With 18 years of experience in the profession and wonderful guidelines set by the AARC and CoARC, you would think this would not bother me, but if I hear one more person tell me "you are penalizing me for my natural personality," I am going to scream.

Is there a personality test I can give these students that will eliminate them from the interviewing process, thus saving them and myself any suffering during the affective domain evaluation process? If you have suggestions or comments, email me at dmeren@lsuhsc.edu. [Top]

Educators continue to be confused and disturbed by the fact that obviously intelligent and capable individuals fail to persist to graduation. Despite our best efforts at selecting the brightest and best applicants through carefully constructed admissions programs, approximately one out of four students drop out of respiratory care programs.

Student attrition is disconcerting to educators and society alike. Douce and Coates (1984) reported national attrition rates in respiratory care programs (two- and four-year colleges) of 26%. Gupta's analysis of 1991 CAHEA data reaffirms this substantial student attrition problem, finding a 20% overall attrition rate in therapist programs and 29.4% overall attrition rate in technician programs.
According to Gupta (1991), allied health education programs are challenged to support the integrity of their curricula and at the same time maintain their enrollment levels. In order to meet this challenge, the strategic planning process must include examination of student persistence issues. Due to the changing demographics and increased diversity of the student body at most institutions of higher education, this challenge is even more appropriate. Gupta stated, "In the past, when enrollments in postsecondary education were high, retention was viewed as an ethical issue related to equal opportunity, equal access, and the maximization of human resources. Now that the traditional pool of students (18 to 20 years of age) has diminished, retention has also."

Students frequently cite financial difficulties, home responsibilities, lack of time for school, and job responsibilities as reasons for failure (Hedl, 1987). Because these involve motivational and commitment variables, there is a need for further study in these areas. The major theoretical perspectives on college attrition have suggested the importance of social and academic integration. What happens to students after they enter an allied health institution may be more important than their' prior characteristics.

The overall effects of attrition are far-reaching because attrition implies a waste of time, money, and resources for both students and educational institutions (Mayville, 1992). In addition, there is a concern that in limited access programs, each place occupied by an unsuccessful student eliminates the admission of a potentially successful applicant.

Because research does suggest that there is a shortage of respiratory therapists, special attention must be given to the problem of retaining students who are enrolled in our programs. If the specific variables that influence students to persist in allied health programs can be found, programs can possibly decrease attrition rates. By increasing the retention rates in our programs, we will be able to produce more highly qualified personnel, thus helping to alleviate a shortage of trained personnel in the field. A national study of respiratory care student persistence is needed to expand the current body of research on persistence behaviors of students enrolled in respiratory care programs.

Perhaps a starting point is to look at the implications reported by Rye (2001) in a national study, which examined characteristics that influenced within-year persistence decisions of allied health professional students enrolled in four-year institutions in the United States and Puerto Rico between July 1, 1995 and June 30, 1996. The sample included 1,086 four-year allied health students from the 1996 National Postsecondary Aid Study (NPSAS:96). The allied health professional subsample was 4.8% of the total NPSAS:96 population. The percentage of persisters pursuing a baccalaureate degree was 42.4% compared to 15.7% nonpersisters. The study did not clearly delineate how many of the allied health students were respiratory therapy majors. However, during this same period the American Medical Association (AMA) reported a 16.6% attrition rate in accredited registry (RRT) programs.

Rye's findings suggest several important observations related to within-year persistence for allied health professional students. In the 1996 four-year logistic regression analysis (Table 1) , three background, no aspiration, one high school achievement, and four college experience variables were significant. Of the background variables significant in the 1996 model, three were negatively associated with persistence of four-year allied health students. Hispanic students were 21.4% less likely to persist than white students. Students with disabilities were 27.5% less likely to persist than students who had no disabilities. Students whose mothers had attained a bachelor's degree were 17.4% less likely to persist than those whose mother had no degree.

Four college experience variables were significant. Students who were classified as seniors were 8.7% more likely to persist than freshmen. Full-time students were 13.2% more likely to persist than part-time students. Those students enrolled in associate degree programs at four-year institutions were 11.4% more likely to persist than those enrolled in baccalaureate programs. Four-year college students who worked full-time were 14% less likely to persist than students who worked less than 35 hours per week. With regard to the influence of financial variables, only the current-year loan value was significant in the four-year allied health student sample. Students were 1.9% more likely to persist for every $1,000 of student loans received. Neither tuition amounts nor accumulated debt was significantly associated with persistence behaviors of four-year allied health students.

The pseudo R² for the model was 0.2523. It correctly predicted 96.82% of the persisters and 48.23% of the nonpersisters for an overall prediction rate of 90.15%. Gender, age, income level, educational aspirations, earning a high school degree or GED prior to college enrollment, classification as a junior, living on campus, having a high GPA, receiving remedial instruction, being enrolled in a certification program, or being enrolled in a public institution had no significant influence on this sample of allied health professional students.

Attrition of respiratory care students has been identified as a crucial problem. In our attempt to reduce attrition, we must examine methods for promoting student persistence. This includes identification of variables that increase the probability of either student failure or student success in allied health programs. Educational leaders must strengthen their efforts to identify those respiratory care students who are at risk for failure and the factors that contribute to student failure.

References

* American Medical Association. (1997). Health professions education directory 1997-1998 (25th ed.). Chicago, IL: Author.
* Douce, F.H. & Coates, M.A. (1984). Attrition in respiratory education: Causes and relationship to admissions criteria. Respiratory Care, 29 (8), p. 823-828.
* Gupta, G.D. (1992). Student attrition from CAHEA-accredited programs: Perspectives on respiratory care. AARC Times, 16 (11), p. 54-59.
* Gupta, G.C. (1991). Student attrition: A challenge for allied health education programs. Journal American Medical Association, 266 (7), p. 963-967.
* Hedl, J.J. (1987). Attrition in an undergraduate program in allied health education. Journal of Allied Health, 16 (3), p. 219-228.
* Mayville, J.A. (1992). The Relationship Between Social Support and Persistence Among Female Hispanic Students in an Associate Degree Nursing Program. Unpublished Doctoral Dissertation, Texas A & M University. College Station, Texas.
* Rye, K.J. (2001). Promoting persistence: Allied health professional students at risk. Unpublished doctoral dissertation, University of Arkansas Little Rock, Little Rock, AR.[Top]