Leave aside, for a moment, the question of whether the sleep profession needs a competing credential exam for technologists. Four months after the physician-led American Academy of Sleep Medicine (AASM) announced its decision to create just such a test, one point ought to be clear to all of us who have committed our careers to the advancement of sleep technology: the goal of a new exam can’t be simply to make the exam easier.

Unfortunately, the passing rate for the current Registered Polysomnographic Technologist (RPSGT) exam, which has been the gold standard in our profession for 32 years, is precisely what has created friction between BRPT and the physician group. In recent years, AASM has expressed concern, repeatedly and explicitly, about the RPSGT pass rate. AASM has pressed BRPT to address the issue through a change in exam development methodology or scoring, or simply by adjusting the passing standard downward, to allow more candidates to become credentialed. As politely as possible, BRPT has declined.

The reason is simple. We don’t want to devalue registered technologists or diminish their growing professional stature within allied health.

AN EVOLVING EXAM

Since its first administration nearly 32 years ago, the RPSGT exam has served as one of the cornerstones of the field of polysomnographic technology. The delivery of a strong, respected credentialing exam—developed by a group of subject matter experts according to best credentialing practices, independent of the undue influence of a controlling parent organization—has been instrumental in placing our field on equal footing with the leading allied health disciplines.

The RPSGT exam blueprint is developed against the results of a job task analysis, which is central to a valid credentialing program. Essentially, the job task analysis is conducted to ensure that an exam is testing what it is intended to test: the knowledge, skills, and abilities actually needed in a specific professional role. The blueprint is not a guess; it is not based on anecdotal comments; it is not dictated by a parent organization. It is built against the results of a validated survey of the field of sleep technology, reviewed by a carefully selected team of subject matter experts, and updated as changes in the field warrant.

Throughout its history, the RPSGT exam has responded to the changing realities of a dynamic field. In 2002, the RPSGT exam was accredited by the National Commission for Certifying Agencies (NCCA); the exam won reaccreditation in 2007. NCCA accreditation underscores a commitment to the development, delivery, and maintenance of the RPSGT credentialing program in accordance with the highest professional standards. NCCA accreditation for the RPSGT exam has been instrumental in positioning the field of sleep technology before legislative and regulatory bodies at the state and federal levels. It has made the RPSGT credential a symbol of skill and accomplishment in a distinct and growing allied health discipline, and a source of great pride for those who have earned it.

The rate at which technologists pass the exam, which was 62% in 2010, is a valid concern. But it is a symptom, not a cause. Yes, the RPSGT exam is not an easy exam. But the pass rate reflects the overall quality of on-the-job training, bearing in mind that more than 70% of exam candidates have a minimum of 18 months of experience. It reflects the level of overall candidate preparation. And it reflects the quality of the educational resources available to exam candidates.

NEED FOR STANDARDIZED EDUCATIONAL CURRICULUM

The truth is that the biggest challenge to exam candidates is the absence of a strong, readily available, standardized educational curriculum in sleep technology. BRPT has long provided financial support to the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Committee on Accreditation for Polysomnographic Technologist Education (CoA PSG). That combined support—totaling more than $15,000 annually—has been offered for many years, including the years during which the CoA PSG was managed through AASM. We share with our colleagues at AASM the frustration with the slow pace of the expansion of CAAHEP-accredited programs. We are eager to see the number of CAAHEP-accredited PSG programs (now 32) increase, and we will remain committed to active support of CAAHEP and the CoA PSG. In addition, BRPT accepts nine respiratory programs with a PSG add-on, accredited by the Commission on Accreditation for Respiratory Care (CoARC). Graduates of these programs are also eligible to take the RPSGT exam under Pathway #3.

Better education is certainly the ultimate answer, but current employment pressures do present a challenge for technologists not prepared to sit for the RPSGT exam. That’s precisely why BRPT collaborated with AASM and the American Association of Sleep Technologists (AAST) to launch the certificate-level Certified Polysomnographic Technician (CPSGT) exam in March 2010. The CPSGT exam was built to test against a subset of the AASM-owned A-STEP online learning modules and was developed with input and review by both AASM and AAST. Its mission is to position technicians with limited experience in a tiered progression toward the RPSGT exam. The current passing rate for the CPSGT exam is 86%.

AASM CHARTS NEW COURSE

Just 9 months after the launch of the CPSGT exam, however, AASM decided to strike out on its own. The letter BRPT received in December from Nathaniel Watson, MD, AASM Board member and president of the American Board of Sleep Medicine (ABSM), never really explained the change of heart. He did level a familiar criticism: “The pass rate for the Registered Polysomnographic Technologists examination indicates that a majority of otherwise qualified sleep technologists currently employed at sleep centers are unable to obtain the necessary credentials required to stay in the profession.” Strangely enough, he also asserted for the first time that: “Sleep physicians who are medical directors of sleep centers have expressed concern that certification by the BRPT does not ensure professional readiness.” That assertion was made with no supporting data.

BRPT recognizes the valuable role played by each of the key organizations representing the field of sleep medicine. As a strong, physician-driven professional organization, AASM offers the reach, the resources, and the influence critical to navigating the challenging legislative, regulatory, and political landscape that each of the medical specialties and allied health disciplines must confront. AASM has functioned with considerable success as an advocate for the interests of the AASM membership and, by extension, the business and professional interests of the broader sleep field.

Similarly, the technologist members of AAST look to their professional organization to work collaboratively with AASM, while ensuring that sleep technologists have a strong, autonomous voice in matters that impact their field, their careers, and their patients. Technologists look to AAST to function as the independent voice for the concerns of the field of sleep technology, taking direction from and making decisions based on the best interests of the members.

BRPT is not a membership organization. Rather, it has the fundamental responsibility to provide the field of sleep medicine with a credentialing program for sleep technologists that is developed, delivered, and maintained, at every point, according to best practices in professional credentialing.

While the roles of each organization are distinct, the potential for cooperative collaboration is enormous. That’s why the unilateral nature of the AASM decision has been so disappointing to us. BRPT has made a consistent effort over the past several years to communicate proactively and consistently with both AASM and AAST, providing regular, detailed information not only about the performance of the RPSGT candidate pool but also about the areas of exam content proving to be challenging for RPSGT candidates. In fact, just 2 months before we received the surprise announcement of the new exam, BRPT held what we perceived as a productive, collegial joint meeting of the technologist members of our board and the full board of AAST and the executive director of AASM.

None of us at BRPT really understands why AASM decided to change course on the mutually developed CPSGT exam, an exam in which BRPT has to date invested well over $100,000. We do know that the total number of BRPT-credentialed RPSGTs will soon surpass 18,000, and this is no time to be pulling technologists in two different professional directions.

PLEDGE TO MAINTAIN HIGH STANDARDS

No matter what happens with this competing exam—and let’s hope it is not fashioned so that everyone gets a passing grade—we will not change our standards at BRPT. We resisted the pressure to make credentialing into our field easy, and we’re not about to diminish the standards that have helped sleep technologists to gain respect as a strong, distinct allied health field.

We commit to you that the RPSGT credential is—and will remain—the gold standard in sleep technology. The RPSGT exam itself will continue to evolve to reflect the realities of our changing field. It will continue to be developed, delivered, and maintained according to best practices in professional credentialing. BRPT will move aggressively to become an active player in the education arena, partnering with educational providers as appropriate to bring alternative educational pathways to the BRPT exams, developing a variety of educational resources to assist candidates in preparing for the BRPT exam and a range of educational opportunities for BRPT credential holders to earn the CECs needed to retain their certification.

At BRPT, we will continue to work to position the quality, integrity, and value of the RPSGT exam and credential with legislative and regulatory bodies, with patients, and with our colleagues in the allied health disciplines. And we will always look to our credential holders to serve as our strongest advocates.


Janice East, RPSGT, R. EEG T., is president of the Board of Registered Polysomnographic Technologists (BRPT). East is also the director of sleep disorders, neurodiagnostics, and rehabilitation services for Morton Plant Mease Health Care. The author can be reached at [email protected]