Curricular Designs for Sleep Programs

1. Curricular Designs forSleep Programs Tom Smalling, MS, RRT, RPFT, RPSGT

2. Overview • How do I get started? • PSG Program Goals and Strategies • CoARC PSG accreditation standards • Sample program outlines • Sample instructional units • What resources are at my disposal? • Question and answers

3. How do I get started? • Go to www.coarc.com, download and review the self, study, curriculum guide and its associated documents. • Obtain support/feedback from program director, dean, advisory committee, and medical director. • http://www.absm.org/diplomates/listing.htm • Network with colleagues. • Perform a needs assessment: • Assess your resources

4. Resource Assessment • ADVISORY COMMITTEE • Develops, promotes, supports and evaluates the goals of the Program. • MEDICAL DIRECTOR (S) • Effective medical direction/administration for the program to ensure that current standards of medical practice are met. • FACULTY • Effective laboratory, classroom and clinical instruction; effective examples for students in all three domains. • SUPPORT PERSONNEL • Appropriate and effective clerical support for the program. • FACILITIES • Adequate classroom, laboratory, office space and accommodations.

5. Resource Assessment • LABORATORY EQUIPMENT AND SUPPLIES • Provide students with the equipment and supplies sufficient to prepare them for clinical practice. • LEARNING RESOURCES • Support student needs for supplemental reading, electronic and print reference materials, research and computing resources. • FINANCIAL RESOURCES • Adequate fiscal support for the retention of personnel and the acquisition and maintenance of equipment and supplies • CLINICAL RESOURCES • Provide a sufficient variety of clinical tasks and procedures to allow for student mastery of the program's required clinical competencies. • PHYSICIAN INPUT (Instructional) • Assure that program graduates can communicate and work with physicians in a confident and professional manner.

6. PSG Program Goals • Facilitate the entry of working therapists wishing to cross-train into this specialty. • Provide graduates with the opportunity to obtain specialized training and be eligible to take the national credentialing exam upon completion of the certificate. • Offer a means for non-matriculated allied health professionals the ability to cross-train into the field of polysomnography [bridge curriculum].

7. Curricular Strategies • Instructional units, curriculum content and length, and documentation of student progress must be designed to enable achievement of program goals and objectives. • Instructional units must be based on a structured curriculum which includes learning goals, course objectives, and competencies required for completion of the program. • Curricular content must be designed to supplement as well as take advantage of the comprehensive didactic, laboratory, and clinical instruction already established in a respiratory care curriculum. • For instance, while respiratory care program curricula provide significant instruction on positive airway pressure (PAP) therapy, respiratory therapy students enrolled in an optional polysomnography program would learn about the distinct application of PAP devices within the context of the sleep laboratory.

8. Curricular Strategies • Course content should be periodically reviewed and revised to reflect both the work performed by sleep technologists as assessed by job analysis surveys and the material covered in national credentialing examinations. • Faculty teaching polysomnographic-specific course content should be appropriately credentialed (e.g., RPSGT or REEGT) and should utilize continuing education and other educational opportunities to maintain and upgrade their professional, instructional and administrative abilities. • Both material and personnel resources must be adequate to fulfill the needs of the program.

9. Curricular Strategies • Learning and clinical resources must be appropriate to the program’s goals and should be available to students outside of regular classroom hours. • Physician input, preferably from American Board of Sleep Medicine (ABSM) Diplomates, should also be adequate. • Program competencies should provide the basis for deriving the objectives and activities constituting the program's curriculum.  • The competencies stated and the curriculum objectives derived should be consistent with the level of practitioner preparation delineated in the program's goals, and should encompass the knowledge, technical expertise and behavior expected of graduates.

10. Curricular Strategies • The curriculum must include an appropriate sequence of learning experiences consisting of classroom and laboratory presentations, discussions, demonstrations, and supervised laboratory and clinical practice that progresses in sequence from entry-level cognitive, psychomotor, and affective components of instruction to more advanced levels. • Clearly written course syllabi which describe learning objectives and competencies must be developed for each of the didactic, laboratory, and clinical components. • Clinical affiliates should conform to professional standards, such as those established by the AASM and by other health care accrediting entities where appropriate.

11. Curricular Strategies • The above strategies are not meant to be all-inclusive, but are attentive and consistent with current accreditation standards and practices. • The polysomnography curriculum should be designed in such a way as to addresses the unique characteristics and constraints of each respiratory therapy program. • What works well for a university-based, baccalaureate respiratory therapy program with 10-week modular curricula, for example, will not necessarily work for a semester-based, associate degree community college program.

12. CoARC PSG Accreditation 2003 Standards • “For those programs providing a Polysomnography “specialty” option, curricular content should be periodically reviewed and revised to reflect both what is being done by Polysomnographic Technologists in the workplace (the Board of Registered Polysomnographic Technologists, Inc. (BRPT) Job Analysis) and the material covered in the appropriate national credentialing examination (BRPT Examination Matrix), which are nationally accepted standards of roles and functions in Polysomnography.” • In meeting the requirements of state and institutional accreditation, the following units, modules, and courses of instruction may be included:

13. CoARC Focused PSG Instructional Units • Clinical Polysomnography-Sleep Staging & Pattern Recognition • Electroneurodiagnostic Electronics & Instrumentation • Electroneurodiagnostic Recording Techniques • Electrographic and Clinical Correlations • Pharmacology for Treatment of Sleep/Wake Disorders • Neuroanatomy and Physiology • Anatomy and Physiology related to sleep and sleep disorders • Sleep disorders classifications • Patient and equipment preparation for Polysomnography • Fundamentals of Polysomnographic instrumentation • Polysomnographic monitoring techniques • Multiple Sleep Latency Testing/Maintenance of Wakefulness Testing • Scoring of sleep, sleep related events and report generation • Fundamentals of therapeutic intervention during Polysomnography • -Supplemental 02 • -PAP titration (continuous or bi-level) • Other surgical, non-surgical and behavioral treatment modalities

14. CoARC PSG Curriculum Guide • It is acknowledged that there are variations in academic calendars as well as other curricular constraints among respiratory therapy programs. As such, the following are minimum curricular requirements for completion of the certificate program: • A 2-credit (50 contact hours) lecture/lab course, followed by a 2-credit (80 contact hours) clinical rotation in the first semester. • The second semester will consist of a 2-credit (50 contact hours) lecture/lab course, followed by a 2-credit (80 contact hours) clinical rotation.

15. SAMPLE PROGRAM OUTLINE FOROPTIONAL POLYSOMNOGRAPHIC TECHNOLOGY CURRICULUM • LAST SEMESTER (YEAR 1) • OBSERVATIONAL CLINICAL IN A SLEEP LABORATORY • FIRST SEMESTER (YEAR 2) • PSG LECTURE I -------------------------- 20 contact hoursPSG LAB I ----------------------------------- 30 contact hours • PSG CLINICAL I --------------------------- 80 contact hours • SECOND SEMESTER (YEAR 2) • PSG LECTURE II -------------------------- 20 contact hours • PSG LAB II ----------------------------------- 30 contact hours • PSG CLINICAL II --------------------------- 80 contact hours TOTAL PROPOSED “MINIMUM” CONTACT HOURS: 260

16. SAMPLE PROGRAM OUTLINE FOROPTIONAL POLYSOMNOGRAPHIC TECHNOLOGY CURRICULUM Course No. Course Title Semester Hours • First Semester • MATH-1140 Applied Algebra 02 • *BIO-1100 Introduction to Biological Chemistry 03 • ENG-1010 English Composition I 03 • *BIO-1430 Anatomy and Physiology-I 04 • RESP-1310 Cardiopulmonary Physiology 03 • RESP-1410 Beginning Polysomnography 02 • Subtotal 17 • Second Semester • BIO-1440 Anatomy and Physiology - II 04 • RESP-1420 Intermediate Polysomnography-I 03 • RESP-1934 Directed Practice-I 03 • Subtotal 10 • Third Semester • RESP-1440 Neurophysiology of Sleep 02 • RESP-1430 Intermediate Polysomnography-II 03 • RESP-2934 Directed Practice-II 03 • Subtotal 08 PROGRAM TOTAL 35 • * = Core courses required for application • Adapted from David Lucas, MS, RRT-NPS, AE-C, Program Manager.

17. TYPICAL SEQUENCE OF INSTRUCTIONAL UNITS FOR PSG PROGRAM • Overview/Medical Terminology • Patient and Laboratory Safety Issues • Procedures/Documentation for Initiating Sleep Studies • Electrode Theory/Instrumentation • Patient Preparation Procedures/International 10-20 System • Neuroanatomy and Physiology • Intro to sleep architecture/sleep stages • Ancillary equipment application • Signal processing • Montage selection/Equipment calibration • Physiologic Calibrations/Lights Out Procedures • Sleep disorders pathophysiology • Monitoring procedures

18. TYPICAL SEQUENCE OF INSTRUCTIONAL UNITS FOR PSG PROGRAM • Sleep microanatomy and architecture • PSG record staging (R&K/AASM) • Event recognition • Limb movement • Respiratory • Cardiac • Neuro • Sleep Pharmacology • Sleep Calculations • Pediatric PSG • MSLT/MWT • Therapeutic Interventions (PAP, surgical, non-surgical) • Report generation

19. BRIDGE CURRICULUM FOR “NON-RT” CREDENTIALED HEALTH PROFESSIONALS • The program should evaluate the applicant’s educational background and content areas covered on the respective credentialing exam for which they have demonstrated minimal competency. • Applicants that have completed prior coursework in the Focused Polysomnographic Technology instructional units outlined in the CoARC 2003 Standards and Guidelines (p. 7) should demonstrate minimal competency in such instructional units via challenge examination.

20. What resources are at my disposal??? • www.coarc.com • Accreditation and curriculum • Sample list of typical equipment and supplies • www.aarc.org • Specialty sections in polysomnography/education (sleep@aarc.org) • Smalling, T. (2003). Education resources for the respiratory therapist interested in sleep technology. AARC Times 27(5). pp 14-18. • www.brpt.org • Credentialing • www.aasmnet.org • Educational resources

21. Contact Info • tsmalli@notes.cc.sunysb.edu • 631-444-3241 office • Respiratory Care Program • Stony Brook University • HSC Level 2 Room 410 • Stony Brook, NY 11794-8203