New Developments for the RST Credentialing Exam


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Presentation given by Anglee Leviner at the 2012 Carolina Sleep Society Fall Meeting.

Page 26 note:
"I have heard countless times the point driven home that the RST isn’t ‘real’ or isn’t ‘legitimate’ or other similar phrasings because it’s not NCCA accredited. I’m going to go ahead and remind you guys that the BRPT exam gained NCCA accreditation in 2002, and many, many technologists were credentialed by the BRPT 2 years prior to that and the years they were still within the APT, and to continue insisting the passing of an unaccredited examination is somehow less or unacceptable is to say that a large number of very qualified and experienced sleep professionals have an RPSGT credential that is somehow less than everyone credentialed after 2002. As the time table it took the BRPT to gain NCCA accreditation hasn’t passed yet, it’s only fair to give the ABSM an equal amount of time to accomplish this task."

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  • I do not work for the ABSM or AASM and cannot answer all questions.
  • Reminder that our technologist organization has always supported multiple credentialing pathways – RRT-SDS wasn’t boycotted by the AAST.
  • So in 2006 the ABSM ceased being the sole provider of the physician’s sleep certification examination. This freed up time and resources to begin working on new projects, such as the RST.
  • According to IRS 990 forms, the members of this board are completely uncompensated and averaged no more than an hour of work per week in 2011. Do you really think they could single-handedly design an exam, an all physician written exam in that little of time spent doing board obligations? Obviously the board of directors sticks to the paper pushing and procedures that all nonprofits have to keep up with – not test writing. (RE: the conspiracy of identical board members) The current active members of the AASM BoD ran the skeleton operation that was the ABSM from 2007 through 2010 because they were offering no exams after giving the physician certification over to the ABMS. They had little upkeep and no reason to employ or throw away money on what amounted to less than an hour a week of effort. Now that the ABSM is offering exams once again - they have a new board, who can provide the time and efforts required that folks spending terms on the AASM board cannot spare. Current list of BoD for ABSM - Bradley Vaughn, Carol Rosen, Madeleine Grigg-Damberger, Andrew Jamieson, Susan Harding, Thomas Hurwitz, Nancy Collop, David White, Sigrid Veasey, A. Clete Kushida RPSGT
  • So the exam is written by technologists and doctors. Yes physicians are involved, by proxy, and you could even say they’re supervising the exam development, but they are not in any technical or figurative way – solely writing the exam.
  • We’re going to touch on inspiration for the exam, as well as goals in mind during it’s development. And perhaps touch on some of the core differences between it an the RPSGT exam – though I’d like to avoid comparing the two for any continued length of time -Hiring managers decide what they expect their technologists to know and be capable of. Some more skeptical organizations may even quiz their candidates to ensure they retain the knowledge required to perform the job well. If you cannot get hired, what good is the credential? -Our education programs design curriculums based on what we have claimed and carved out as our scope of practice within polysomnography. We have defined our jobs, our jobs do not define themselves. So the exam was designed to test applicants on the knowledge instructed to them in our educational programs. However the field evolves from here: We define it, we teach it, and we test understanding of it.
  • This is a decidedly very different way of determining test composition. BRPT – We’re going to test on topics that you might not be learning about in school at all, but since surveyed techs out there are doing it, we think you should know it. This inherently offers the problem of an exam being based on the actions and work habits of techs who’ve had years of continued education and advanced training. Everything should start with education, and I believe that exams should be based on that education, and not education be based on exams.
  • I’m not hear to say which test is better, just to inform those that are confused, frustrated, or curious about the details of the new exam.
  • Practical: this is a word and concept that is at the core of everything that brought about the RST exam.
  • It’s important to note – the BRPT has made it very clear that they do NOT and will NOT test based on sleep technologist program curriculums. They are explicitly of a different mind on this subject, and from this derives the biggest difference between the RPSGT and the RST. I asked Dr. Watson a question along these lines in Boston, and what he means to say is – exam takers are not expected to have the in depth theoretical sleep medicine knowledge a physician is expected to have. While that knowledge is great, and a fantastic addition for continued education which improves the skills and knowledge of all technologists, should it really be expected to pass the exam? For those on Binarysleep, do we really need to be Somnonaut to perform night-time study acquisition?
  • Two words that describe a person's competence are, knowledge and skills. Knowledge refers to learning concepts, principles and information regarding a particular subject through books, media, encyclopedias, academic institutions and other sources. -A skill refers to the ability to use that information and apply it in a context. But, which is more important, Theoretical Knowledge or Practical Skills? It is a question that has lead to the subjective need for a second credentialing style. -Obesity Hypoventilation Syndrome -It is great to know that if your patient has consumed alcohol that they may have increased N3, but is that necessary to know to perform the task of polysomnography acquisition?
  • A real-world example of theory vs. practical that we can all relate to…who had to take the written driving test more than one time? This is their online practice exam, I failed on the first try. And yet – I have a license!
  • Should someone be required to understand extraneous theory to be employed? Some people are better at answering questions on theory than proving practical functions. And others are better at showing how something is done rather than explaining the theory behind it. And some here took an exam that had both! –Dinosaurs. Unfortunately, no one seems interested in moving back towards that model.
  • So who’s allowed to sit for this new exam? The BRPT recently changed from paid experience requirements to this style of completion requirements for exam eligibility.
  • Grandfathering is a concept used all over the medical field. In fact, some of you currently see doctors who may have a lifetime credential. Very scary that they were grandfathered into their specialty’s credentialing, and never have to prove CME’s to retain their licensing. But people of the world can rest easy with the knowledge that every sleep technologist in the world has to prove their CEC’s to remain credentialed, *whew*.
  • This requirement has been used as a means to insinuate that the AASM is using the new exam as a means to take over the field, and squash all other competition on all fronts that they control. Unsubstantiated conspiracy theories aside, this is why they have the good sense to require their completions be done in a lab that can be monitored for correct procedures. And I don’t know if Pandas would necessarily fail an accreditation visit, but it does serve to prove that we can’t really know what’s going on inside labs where the AASM isn’t checking in regularly – there really could be pandas for all we know! We know that other accrediting organizations do not focus as much on study procedure so much as patient safety and sanitation. It’s important to make sure the studies are being adhered to according to AASM guidelines to confirm the experience expected to sit for the exam.
  • Now on to the long awaited results of the first exam window! (That’s an 84% pass rate, though a small sampling isn’t accurate enough to give any real merit or meaning to that statistic yet) The first nation-wide offering of the exam is going on right now, and I can’t wait to see the full results from the first widely available testing window.
  • Now this 90% thing is super interesting and exciting to me, I was blown away while hearing about it in Boston. I find it to be genius, and a great way to keep the test objectively the appropriate difficulty, rather than comparing it’s difficulty to exterior objects. In the space vacuum that is the RST exam, statistically difficult or easy questions (regardless of why they’re too hard or too easy) will be thrown out. So with every testing window the test becomes more and more targeted, narrowed to the line of perfect balance in which students who have studied and learned the information can answer the questions appropriately and pass.
  • We touched on this earlier when discussing the structure of the ABSM, this is an elaboration and reminder that there isn’t a room full of just doctors somewhere writing out a test for technologists to take. It’s just not that simple.
  • That’s right, the ABSM is going to launch it’s own version of the CPSGT, an entry-level training exam. I have heard the question asked “Why bother with the CPSGT already in existence?” Well, as we’ve gone over already – the testing style and pathway of the RST is a bit different than the RPSGT, so it stands to reason that they would need an entry exam tailored to the RST’s specific testing/education requirements.
  • This was in the future when I wrote it, obviously this has already come to pass, and some folks are taking the RST as we speak. Of note is the test questions count, which is also different from the RPSGT. This testing window will be the first wide-spread offer of the RST exam, the results of which will be exciting to see.
  • Now this is a hot topic, we are hearing about it everywhere. All our BRPT legislation updates focus on preventing states who are working on their practice acts from making the grave mistake of allowing a registry exam which is not certified by the NCCA count for state licensing. So will the RST get NCCA accreditation? I have heard countless times the point driven home that the RST isn’t ‘real’ or isn’t ‘legitimate’ or other similar phrasings because it’s not NCCA accredited. I’m going to go ahead and remind you guys that the BRPT exam gained NCCA accreditation in 2002, and many, many technologists were credentialed by them 2 years prior to that and the years they were still within the APT, and to continue insisting the passing of an unaccredited examination is somehow less or unacceptable is to say that a large number of very qualified and experienced sleep professionals have an RPSGT credential that is somehow less than everyone credentialed after 2002. As the time table it took the BRPT to gain NCCA accreditation hasn’t passed yet, it’s only fair to give the ABSM an equal amount of time to accomplish this feat. I don’t see any reason how or why the ABSM would fail to get accredited. This isn’t their first exam rodeo.
  • This is another question I’ve heard, someone asked Dr. Watson this in Boston. It’s kind of funny, because if the accusation were true, as unlikely as that is – would he really say yes anyways? An entry level technologist should be able to follow a policy and procedure to successfully complete NPSGs, titrations, etc… they know how to do their job, not always why. Management, educators, those who spend time in extensive continued education, training, or even our 4 year degree over at UNC chapel hill, should know the WHY’S of the job. We cannot expect entry-level night-time technologists to pass an extensive test on theory that they do not need to perform their initial job tasks.
  • It seems to me a lot of people are still focusing on the RST only as it pertains to the RPSGT, instead of just taking the RST at face value and forming opinions about just it.
  • New Developments for the RST Credentialing Exam

    1. 1. New Developments Forthe RST Credentialing Exam Information for the Sleep Technologist, and answers to pressing questions. Presented by: Anglee Leviner, RPSGT, RST September 6th, 2012
    2. 2. AAST Mission & Vision Mission To promote and advance the sleep technology profession through the continued development of educational, technical and clinical excellence in sleep disorders Vision To preserve the autonomy and future of the sleep technology profession by providing educational and professional pathways with innovative approaches that promote professional growth and development Values Make a difference in the quality of care provided by our members Respond to our members needs with service programs founded with integrity Provide quality products and services Conduct business in an ethical and professional manner Be accessible and accountable to our members Treat individuals with compassion, respect, dignity and fairness Value individual contribution in an atmosphere of teamwork and collaboration Encourage open communication and welcome diversity of opinions
    3. 3. History of the American Board ofSleep Medicine Began in 1978 as a committee of the American Academy of Sleep Medicine. (Just like the BRPT was once an APT committee) First examination for sleep medicine specialists given under the direction of Mary Carskadon, Ph.D., Christian Guilleminault, M.D., Peter Hauri, Ph.D., Milton Kramer, M.D. and Tom Roth, Ph.D. (Pioneers of the industry and field we have the pleasure of working in) Twenty one sleep medicine specialists sat for the first examination window.
    4. 4. History of the American Board ofSleep Medicine ABSM was established as an independent entity in 1991. As a self-designated board the ABSM was unable to attain Medicare and private insurer recognition of sleep medicine in many states. There was a designed effort to transition fellowship training programs to the Accreditation Council for Graduate Medical Education and certification to the American Board of Medical Specialties. The ABMS (American Board of Medical Specialties) examination in sleep medicine reflects maturation of the field and has led to enhanced recognition of sleep specialists by insurers and the public as well as financial support from the medical establishment.
    5. 5. ABSM Organization
    6. 6. Executive Board The 10-member Executive Board of the ABSM consists of distinguished sleep medicine physicians in education, research and clinical practice; behavioral sleep medicine specialists in research and clinical practice; and sleep technologists active in the profession.
    7. 7. Board of Directors Nathaniel F.Watson, MD  Sam A. Fleishman, MD (President) (Member-at-Large) Timothy I. Morgenthaler, MD  Susan Redline, MD (Secretary-Treasurer) (Member-at-Large) Amy Aronsky, DO  Ilene Rosen, MD (Member-at-Large) (Member-at-Large) M. Safwan Badr, MD  Steven A. Shea, PhD (Member-at-Large) (Member-at-Large) Ronald Chervin, MD  Patrick J, Strollo Jr., MD (Member-at-Large) (Member-at-Large) Nancy A. Collop, MD  Merrill Wise, MD (Member-at-Large) (Member-at-Large)**Per 2011 990 IRS form
    8. 8. RST Exam Committee The American Board of Sleep Medicine’s (ABSM) Sleep Technologist Registry Examination was developed by a Sleep Technologist Examination Committee comprised of senior members of the sleep technology profession and the sleep medicine field.
    9. 9. Examination Development Labs hire technologists based on a set of specific criteria and competencies. These may vary from organization to organization. Ultimately, those doing the hiring decide what competencies they expect from their potential staff choices. CAAHEP programs and other educational sources devise programs which instruct students on these required competencies. Exam writing committee drafts questions which verify the successful understanding and application of these required competencies. (You’ve all seen the dog diagram?)
    10. 10. More than one way to skin a cat?BRPT Samples technologists ABSM surveys management tovia a job task analysis, which determine what competenciesis used to determine the they expect technologists tomost relevant topics to test possess in order to bethe competency of employed. Then ensure theseexamination applicants. competencies are being covered in course curriculums, and draft examination(This may have an inherent hindrance of stagnating change and preventing questions to test those the evolution of the field.) competencies. (Some are concerned with the efficacy behind contacting an appropriate cross-section of employers in this method.)
    11. 11. Subjectivity Opinions are not always mutually exclusive!
    12. 12. What’s different about theRST exam? “The blueprint of the ABSM exam will reflect the skills that are taught by CAAHEP-accredited sleep technology programs, focusing uniquely on the day-to-day professional responsibilities of sleep technologists in the sleep center setting. Written by an expert examination committee, the exam questions will place a strong emphasis on practical clinical relevance, which will make the exam an effective gauge of a candidates immediate readiness to assist in the education, evaluation, treatment, and follow-up of sleep disorders patients.” --Nathaniel F. Watson, MD, MSc (Full article found on
    13. 13. What’s different about theRST exam? “The Sleep Technologist Certification Examination was created because the ABSM had a desire to align the educational offerings of CAAHEP-accredited sleep technologist training programs with the material thats tested, and have those two things dovetail with the real world job description of a sleep technologist. Were trying to marry these three things: the technologists job, the sleep technologists education that is currently being offered to train these individuals to perform the job, and to have the test be on material thats consistent with those two entities. Were astutely interested in making sure that our test is consistent with the job that the technologists do and with the training that they get. For a technologist who is interested in getting a credential that is just representative of those aspects of their career, then our credential would be the one for them. Were not interested in testing things that are outside the scope of work of a technologist. We dont have expectations for technologists to understand aspects of sleep medicine that are outside the scope of their job.” -Nathaniel Watson, MD
    14. 14. Practical VS TheoryExamples of Practical Examples of Theory Electrode placement  CO2 retention in OHS patients Correct filter settings  Use of dead space to improve Titration protocols gas exchange Patient education  Normal ranges of blood gases Trouble-shooting low-quality  Hypercapnic/Hypocapnic signals  Optimal tidal volumes Stage identification  Thalamic functions Scoring per AASM guidelines  Effects of Bi-polar disorder on Application of O2 per doctor’s sleep orders.  Pharmaceutical effects on sleep
    15. 15. I failed the NC DMV practice theorytest… I can’t pass the written, but I can nail a K-turn and parallel park (barely) on the road test, so HA!
    16. 16. Why should we have twoexams?“When we reflect, we are guided by our knowledgeof truths about the world. By contrast, when weact, we are guided by our knowledge of how toperform various actions. If these are distinctcognitive capacities, then knowing how to dosomething is not knowledge of a fact — that is,there is a distinction between practical andtheoretical knowledge.” -Jason Stanley, “The Practical and theTheoretical”“I can’t explain to you how or why it works, but Ican perform the task correctly every time.” Saysthe employee.
    17. 17. RST Pathways Graduates of CAAHEP or CoARC programs. A-STEP introductory program and modules with on-the-job training. Minimum experience in an AASM-accredited sleep center includes:  1. Independent performance of 50 overnight sleep studies  2. Of the 50 overnight sleep studies, a minimum of 20 must include CPAP titration  3. Performance of one Multiple Sleep Latency Test (The experience must be obtained over a minimum of 6 months and a maximum of 3 years.) Health Professionals Medical degree, Doctoral level degree, Physician Assistants (Pas), Nursing degree (RN or LPN); Allied health credential including Respiratory Care (RRT, CRT), Electroneurodiagnostics (R.EEG.T., R. EP.T, CNIM); Paramedic (EMT-P); or Radiology (RT, RT(R), RT(CT), RT(BD)) Minimum experience in an AASM-accredited sleep center includes:  1. Independent performance of 25 overnight sleep studies  2. Of the 25 overnight sleep studies, a minimum of 10 must include CPAP titration  3. Performance of one Multiple Sleep Latency Test  4. Participation in one quarter (3 months) of the center’s inter-scorer reliability meeting the center’s minimal standards for concordance with the gold standard scorer
    18. 18. Why Grandfathering?Grandfather Clause:“Any policy or rule that exempts a group ofindividuals, organizations, or drugs frommeeting new standards or regulations—e.g., when a new subspecialty board ininternal medicine is created, the physicianspracticing in that area may be‘grandfathered’ into the subspecialty andnot required to meet residency or othereducational requirements.”(‘Concise Dictionary of Modern Medicine’ by Joseph Segen)
    19. 19. Why AASM-accredited sleepcenters?Quality control!How else can the properapplication of AASMstandards be proven?Requiring experience fromlabs already monitored bythe AASM preventscontinued spread ofimproper practices andincorrect training. Are panda bears part of the recommended Standards and Guidelines?!
    20. 20. Examination Statistics The first RST examination was offered on November 11, 2011 Nineteen applicants met the eligibility criteria and sat for the examination Sixteen candidates passed the examination and earned the RST credential
    21. 21. The Testing ScienceThe ABSM is utilizing an independent statistician fromthe University of Illinois at Chicago to reviewexaminations for data integrity and to determine thecut point (passing score) for exams and questionreliability.A point by serial formula to determine questions withpoor reliability is being used. Questions where examtakers are either correct or wrong 90% of the time areremoved from the exam question bank.The ABSM discarded 7 questions from the 2011 RSTexamination due to this formula. This will keepquestions which are both too easy and too difficult outof the examination permanently, providing perpetualimprovement of the exam content.
    22. 22. Who is involved? A broad representation of stakeholders is included in the examination process. The Sleep Technologist Examination Committee is composed of senior members in the fields of Sleep Technology and Sleep Medicine. An Advisory Committee reviews the content of the examination and the statistical analyses used to determine cut points and retention of questions. The Advisory Committee includes trainees, active Sleep Technologists, Sleep Technology educators, employers of Sleep Technologists, Sleep Medicine specialists and patient representation. The examination process is constantly under review in order to insure a fair and balanced outcome. (ABSM Candidate Handbook)
    23. 23. What’s next for the RST?
    24. 24. Future Planning In 2011 the ABSM convened the Sleep Technologist Examination Committee to develop examinations that certify:  That successful candidates are prepared to begin training for a career in Sleep Technology and;  At the conclusion of the training are qualified to serve as Sleep Technologists. These examinations are the Certified Sleep Technologist Trainee Examination and the Sleep Technologist Registry Examination.
    25. 25. Test Planning Question writing session this summer to evaluate examination and write new questions. The next RST examination window will be offered August 11 – September 7, 2012. Examination will be 150 questions over 4 hours. The examination will be web-based and offered at a host site of their testing partner, Kryterion.
    26. 26. Will the RST be a real boy?NCCA Accreditation! The ABSM is a member of the Institute for Credentialing Excellence (ICE). The ABSM has stated their plans to apply to ICE for NCCA certification. The ABSM states they will submit a letter of intention.  ***
    27. 27. RST Replacing the RPSGT?How does the development of the new examimpact my RPSGT credential?-It does not. The RPSGT credential is held by over 17,000technologists in 32 countries. It is recognized in statelegislative and regulatory language in a number of states; itis incorporated into a range of CMS reimbursementguidelines. It is widely recognized and respected in thebroader sleep community, accredited by NCCA, and fullysupported by BRPT. -(BRPT FAQ)We need a practical-oriented exam beside a theory-orientedexam, this allows those who are abnormally weak on one orthe other a second option to gain their credential.So, let us credential people who know how to do their job,and let us promote people who know why they do their job.
    28. 28. Who’s right, or who’s wrong?Is the wrong question.This isn’t a competition.Let go of a natural fear of change; block outyour predispositions; and assess the actions,quality and efficiency of the ABSMexamination on it’s own merit.