The Board of Registered Polysomnographic Technologists becomes accredited by the National Commission for Certifying Agencies

Although the credentialing agency for sleep technologists—the New York City-based Board of Registered Polysomnographic Technologists (BRPT)—has been an agency independent of the Association of Polysomnographic Technologists (APT) for only 2 years, the nonprofit corporation has worked quickly to implement changes designed to promote the acceptance of the Registered Polysomnographic Technologist (RPSGT) credential as the professional standard for polysomnographic technologists.

According to BRPT’s past president Cameron Harris, RPSGT, operations coordinator of the Sleep Disorders Center and assistant professor of medicine at the Mayo Clinic in Rochester, Minn, the rationale behind making the BRPT a separate organization from the APT was the first step toward attaining the BRPT’s goal of accreditation by the National Commission for Certifying Agencies (NCCA). The NCCA requires organizations like the BRPT to be independent from their professional organizations so that the examination and credentialing process is objective and credible.

NCCA accreditation criteria and standards are the only voluntary standards for certification agencies. These principles were developed after years of research and discussion and they are nationally recognized concepts, which have been used by a variety of certification organizations in many disciplines. Currently, the NCCA accredits 48 personnel certification programs including allied health organizations such as the American Academy of Nurse Practitioners, American Registry of Diagnostic Medical Sonographers, and National Board for Respiratory Care.

“NCCA accreditation is very important to us because it’s an acknowledgment by the certification community that what we’re doing meets the standards endorsed by national experts involved in professional testing and certification,” Harris explains. “In other words, this accreditation will be our sign of approval.”

Marietta Bellamy Bibbs, RPSGT, president of BRPT and technical director of the Sleep Disorders Clinic and Research Center at Baylor College of Medicine and the Veteran Affairs Medical Center in Houston, stresses that NCCA accreditation will provide more job security to sleep technologists. Specifically, she notes that BRPT accreditation by NCCA will help sleep technologists to document their competency to perform polysomnography in states that have scope of practice issues related to respiratory care licensure. “With accreditation of our exam, it will then be recognized just as highly as the respiratory care credential,” she says.

The BRPT’s application was reviewed by the NCCA this summer and notification of accreditation was received in late August. Several administrative and organizational changes were made during the past 2 years to move the organization closer toward receiving NCCA accreditation. These changes included implementation of a recertification program, the establishment of standards of conduct, and the appointment of a public member on the BRPT’s board of directors.

Recertification
The BRPT recertification program became effective with the June 2002 comprehensive registry examination (CRE). Candidates who pass this examination in 2002 and beyond will be issued a time-limited credential that will expire after 10 years if recertification is not completed. Technologists with time-limited credentials will be required to recertify prior to expiration of the RPSGT credential. Failure to recertify will result in expiration of the credential.

The new program also requires certificants to participate in continuing education. Eligibility for the recertification examination will require proof of continuing education units (CEUs). “The primary goal of the BRPT recertification program is to ensure that RPSGT certificants maintain current knowledge of standards and practices within the discipline of polysomnographic technology,” Bibbs stresses. Harris concurs that the rapidly evolving nature of sleep medicine requires that sleep technologists stay current with these developments. “The basic underlying message of recertification is that people seeking the credential need to participate in continuing education,” Harris says.

The BRPT supports educational programs that enhance the field of polysomnographic technology and accepts continuing education credits from programs accredited by the APT. Bibbs notes that this emphasis on continuing education has also caused the APT to strengthen its own infrastructure to develop professional education programs to guarantee the ongoing maintenance of competencies. “Sleep technologists have been asking for continuing education over the years, and until now it’s been difficult to find the resources,” she says. “Now there will be a lot more opportunities for technologists in this area.”

Not only will recertification demonstrate continued competence for individuals, it will also provide a basis for employers, clinicians, and the public to have confidence that those who hold the RPSGT credential have current competencies. According to Bibbs, physicians and owners of accredited sleep laboratories have been very positive about the BRPT’s new recertification program. The American Academy of Sleep Medicine (AASM), the Chicago-based physician group, has been advocating continuing education for sleep technologists for many years. In fact, the AASM recently established a policy that accredited sleep laboratories must require technologists to receive at least 10 hours of continuing education each year. “It’s important for labs and technologists to realize that this does not have to be a time-consuming and costly activity on their part,” Bibbs says. “They can earn continuing education credits by going to classes in their hospitals or by participating in case conferences or presentations.”

Technologists who have earned the RPSGT credential prior to June 2002 will not be required to recertify as their credentials will have been issued without an expiration date. Harris, however, points out that these “grandfathered” sleep technologists will be eligible to voluntarily recertify. To do so, they must meet the CEU requirements, but will take the recertification examination without peril. In other words, their credential will not be invalidated if they are unsuccessful at passing the examination. “Even if they do not choose to take the exam again, we strongly encourage them to participate in continuing education,” Harris says.

A New Examination
One of the BRPT’s major tasks is to conduct periodic nationwide job analysis studies to determine the role of sleep technologists in terms of the tasks required for competent job performance. The results of these studies provide current information to determine the appropriate content, scope, and complexity for the CRE. To ensure that the CRE covers current material and applications, an examination development committee is responsible for writing and refining test items. Chaired by Harris, the committee meets twice a year in February and August to assemble an examination that matches the content outline published in the BRPT Candidate Handbook. Each item on the examination is reviewed by the committee to ensure that it is pertinent to the content category to which it is assigned, has a clearly written question, has appropriate distracters (incorrect answer choices) and is keyed correctly (the correct answer is in fact correct).

Bibbs stresses that the examination development committee has played an important role in enhancing the CRE. “Our goal is to strengthen the CRE by continuing to review and facilitate new content in future revisions,” she says. The BRPT used a revised content outline for the December 2001 CRE after conducting a role delineation survey in 2000. A routine part of revising the examination is the establishment of the passing score. The minimum passing score on the CRE is set by a committee of content experts using a variation of Angoff standard-setting methodology.¹

Committee members received training in standard-setting methodology and were then asked to define and continually reflect upon the “minimally acceptable for certification” candidate as each item was considered. The group then gave independent estimations of the proportion of minimally acceptable candidates who would answer the item correctly. These estimates were averaged across all subject matter experts for each of the 200 items and summed to determine the minimum passing score. “Intra-class correlation of the panelists’ estimates exceeded 0.98, indicating a very high degree of consistency and agreement among expert judgments,” Bibbs explains. The December 2001 examination and its associated minimum passing score serve as the standard to which subsequent versions of the examination are compared to determine the passing point for each administration. The BRPT uses an equating methodology that takes into consideration the relative difficulty of each version of the CRE to determine what adjustment, if any, is required to the passing score.

More than 700 individuals sat for the June 2002 examination at 26 sites, including sites in Japan and China. Bibbs notes that the turnout was much larger than expected. “We had thought that the numbers would have been down since so many took the test last December and June in order to avoid the recertification policy,” she says.

Another change in the examination process was the elimination of the need for a separate record section as part of the materials. Since all the examination materials were consolidated into a single booklet, administration of the CRE was much more efficient in June 2002.

Even though the passing rate for the examination is relatively low—of the 1,285 candidates who took the examination in December 2001, 537 passed and 748 failed—Bibbs points out that this is due to an increasing number of less experienced technologists who are taking the examination and the lack of standardized education.

In order for candidates to sit for the CRE, they must satisfy the following eligibility criteria including compliance with the BRPT Standards of Conduct:

• Completing a minimum of 18 months of clinical experience where duties are primarily polysomnography; or

• Completing a minimum of 12 months of clinical experience where the duties performed are primarily polysomnography and provide proof of credentialing in a health-related field accepted by the BRPT (nursing, respiratory care, and electroneurodiagnostics); or

• Completing a minimum of 6 months of clinical experience where duties performed are primarily polysomnography after graduation from a program accredited by the Commission on Accreditation of Allied Health Education Programs with special recognition in polysomnography; and

• Being currently certified in basic cardiac life support, cardiopulmonary resuscitation, or its equivalent in other countries.

Standards of Conduct
The other major accomplishment of the BRPT has been the enactment of standards of conduct. Recognizing that the NCCA requires these guidelines for organizations seeking accreditation, the BRPT board of directors worked hard throughout 2001 to develop a comprehensive listing of professional and ethical standards. “Individuals wishing to take the examination need to understand these standards of conduct and must sign an agreement that they will comply with them,” Harris says. The BRPT has also established a judiciary process to handle complaints, and credentials can be revoked if needed. The following statements are standards to guide those individuals holding the RPSGT credential in their professional activities.

RPSGTs shall:²
• Do everything within their scope of authority to ensure that the currently accepted professional standards are complied within the department in which they work.

• Provide care without discrimination on any basis, respecting the rights and dignity of all individuals.

• Respect and protect the legal and personal rights of the patients they treat.

• Comply with governmental rules and regulations that relate to and govern their scope and standards of practice. Divulge no confidential information regarding any patient or family unless disclosure is required for responsible performance of duty or required by law.

• Refuse to participate in unethical or illegal acts and refuse to conceal illegal, unethical, or incompetent acts of others.

• Avoid any form of conduct that creates an impermissible conflict of interest, following the principles of ethical business behavior.

• Refuse primary responsibility for interpretation of polysomnographic procedures, provided, however, that individuals who are licensed or otherwise authorized by practice standards to provide interpretation are excluded from this standard.

• Maintain RPSGT registration as defined by the BRPT.

Public Board Member
In its effort to comply with the accreditation guidelines of the NCCA, the BRPT revised the structure of its board of directors and established new policies and procedures. One of its most notable accomplishments in this area was to include a public member on its board of directors. “It became clear that we needed to have a director who was not a sleep technologist or derived income from sleep medicine and yet still represents the people we serve,” Harris says. “This person would bring objectivity and a new perspective to our organization.”

The BRPT received assistance from the American Sleep Apnea Association in identifying William Peters as an individual qualified to serve as the BRPT public member. Peters began a 4-year term as a voting member of the BRPT board of directors last January.

The current directors have been selected from among individuals nominated by the American Society of Electroneurodiagnostic Technologists, the AASM, and the APT. Besides the public member and a physician, the other board members are all RPSGTs.

Future of Profession
Bibbs stresses that the recent changes made in the credentialing process, not to mention those organizational changes within BRPT, will be effective in supporting the profession of polysomnography as it continues to evolve. According to Bibbs, an emphasis on standardization and education is having the greatest impact on the field. “In the past, sleep labs would use methods dictated by medical directors without relying on any specific standardized procedures,” Bibbs says. “Now the AASM has standards of practice and recommended guidelines for the use of polysomnography.”

As the sleep field has boomed in recent years, the need for qualified, and credentialed, sleep technologists continues to increase. The newly created standards of conduct and recertification process should help employers identify experienced and skilled sleep technologists.

Harris is excited about the changes in the profession and the steps organizations like the BRPT and APT have taken to support the educational and career goals of polysomnographers. At the same time, he believes professional organizations need to continue to work together to ensure that there is an adequate supply of qualified sleep technologists. “Currently there is a strong need for entry-level education as well as a means for bringing new technologists into the field,” Harris says. “The continued growth in sleep medicine will also create the need for more technologists with advanced skills who can provide ongoing care and therapeutic modalities.”

Bibbs is confident that the proactive steps of the BRPT—such as changes to the CRE, development of standards of conduct, and NCCA accreditation—will raise the professional status of sleep technologists in hospitals and sleep laboratories. “It’s an exciting time for our profession,” she says. “With more than 4,500 technologists on the registry and increasing numbers of individuals wanting to take the CRE, our profession will continue to see competencies increase, which will raise our status within the health care community.”

Carol Daus is a contributing writer for Sleep Review.

References
1. Angoff WH. Scales, norms, and equivalent scores. In: Thorndike RL, ed. Educational Measurement. Washington, DC: American Council on Education; 1971.
2. BRPT Standards of Conduct of Registered Polysomnographic Technologists, 2001.