National Exam Certification for Certified Asthma Educators (AE-C)

1. National Exam Certificationfor Certified Asthma Educators (AE-C) • Presented by: • Kathleen Moseley RN MS AE-C

2. Tips for studying for the Exam 1.) Organize material into topics 2.) Set up a study schedule, e.g. , 4 week, 6 week or 8 week plan 3.) Identify your weak areas and strong areas, studying the strong ones last

3. Information to Memorize Severity tables, start with the far left column, then middle column, then remaining. Middle age first Control tables List of Medications-Inhaled Steroids, Leukotriene modifiers, etc… use flashcards if helpful, Mother’s of Asthmatics poster

4. Information to Memorize Stepwise Diagram-treatment table Drug-Drug Interactions Safe Drugs during pregnancy Herbal Supplement Interactions Referral Criteria for specialist

5. Information to Memorize Calculating and reading Spirometry Results Co-morbid conditions Asthma Predictive Index

6. Reading Exam Items 1.)Question 2.)Options or distracters 3.)Key or answer

7. Reading the Exam Question The introductory statement-the scenario The Stem-poses the question The options; the key and distracters

8. Anatomy of an Exam Item Each item has three main parts:

9. Anatomy of an Exam Item Stem: Statement or question to which candidate responds (may be an incomplete sentence). The amount of detail depends on the cognitive level of the item.

10. Anatomy of an Exam Item Key: The right answer as defined by the committee and content experts. In some cases the key will the BEST answer. Other choices may also be correct, but they would not be the first thing to do or they would not be the best choice for the situation presented.

11. Anatomy of an Exam Item Distracters: Wrong answers that are meant to be plausible but wrong and will distinguish able candidates from weak candidates.

12. Anatomy of an Exam Item There are 3 forms of questions defined by the “cognitive level”: • Recall • Application • Analysis

13. Anatomy of an Exam Item Recall items: Typically depend on rote memorization and the answer is true for all situations (19%). EXAMPLE: A useful tool for a person with asthma to assess their asthma control is a: • Small-volume spacer • Spirometer • Pulse oximeter • Peak flow meter

14. Anatomy of an Exam Item Application items: More situation-dependent or involve some calculation or manipulation of information (44%). EXAMPLE: A 40-year old male presents to the primary care doctor with wheezing, cough and shortness of breath after exercise. Which of the following best describes these symptoms? • Bronchospasm • Airway inflammation • Mucous production • Foreign body aspiration

15. Anatomy of an Exam Item Analysis items: More complex item usually presenting three or more pieces of info. Often focus on what asthma educators should do rather than just what they should know (37%). EXAMPLE: A person with dust mite sensitivity has been using a LTC med (compliance, technique are not issues). The individual’s symptoms persist. Which of the following should an asthma educator verify? • Use of a HEPA filter in the living room • Installment of a room ionizer • Encasement of individual’s mattress and pillow • Installment of new carpet in the bedroom

16. Test-Taking Tips • Read everything carefully. • Don’t second-guess yourself. • Put questions in context with things that are familiar to you. • Remind yourself that you have the benefits of experience and knowledge. • Use the process of elimination (POE) on difficult questions. • Manage your energy level. • Use the scrap paper provided.

17. Use POE on Questions You Find Difficult • Every time you eliminate an incorrect choice on a question, you improve your odds of finding the best answer. • The more incorrect choices you eliminate, the better your odds.

18. Energy Management • It is often difficult, psychologically, to let go of a problem once you have spent time on it. The more time you invest, the harder it is to let go. • Learn when it’s time to guess and move on to other questions on which your energy (and perhaps time) will be better spent.

19. Scratch Paper, Computerized Testing & POE • For POE to work, its crucial to keep track of choices you eliminate. By crossing out a clearly incorrect answer, you permanently eliminate it from consideration. • If you don’t cross it out, you may continually consider it or be distracted by it. • But how do you cross out anything on a computer screen?

20. Scratch Paper

21. Bookmarking IMPORTANT: If an item is left bookmarked, it is not counted, even if the correct answer is checked.

22. Case Study #1: Exaggerated Case Study Fred is a 56-year-old African American male with a history of asthma. He presents today, with his wife at his side, reporting daily daytime symptoms and frequent nighttime symptoms. He said this is an increase from his usual symptoms, which were reported to occur daily more than 2/week but less than 1/day and nighttime 2 nights/month.

23. Fred says he and his wife are having marital problems related to her refusal to remove her cat (one of his triggers) from their bedroom. His job is being restructured and he feels his position may be cut. His 16-year-old daughter recently moved back into the home with her 1-½ year old child and a dog.

24. Fred’s current signs and symptoms include at FEV1 80%, pulse 80 and a respiratory rate of 18/minute. His current meds include a rescue inhaler with spacer.

25. Your Best Action(s) Would Be: • Ask Fred how often he checks his peak-flow meter. • Have Fred demonstrate the use of an MDI with a spacer. • Set Fred up with a job skills class. • Suggest to the physician that Fred needs a long acting corticosteroid.

26. Sample Question #1 An adolescent male with moderate persistent asthma tells his asthma educator that his current medications are not controlling his symptoms. He is using pirbuterol four times daily using a valved holding chamber, but stopped using budesonide because he did not any feel better after using it. Which of the following actions by the asthma educator would be most likely to improve his asthma control over the short term? • Verify the adequacy of his inhaler technique with a valved holding chamber. • Recommend changing budesonide to a different medication. • Discuss the differences between the use of quick relief and controller medications. • Advise him regarding environmental modifications to avoid asthma triggers. NAECB Candidate Handbook, 2007

27. This came from the candidate handbook – it’s an example of an Analysis question • answer: C

28. Sample Question #2: For the best effect, adults with asthma should use nedocromil: • two to four times per day until discontinued by the asthma care provider • once daily in the morning until the asthma exacerbation has resolved. • for quick relief of exercise induced asthma symptoms. • daily at bedtime to prevent nocturnal asthma symptoms. NAECB Candidate Handbook, 2007

29. “Nedocromil oral inhalation U.S. after June 14, 2010. If you are currently using nedocromil, you should call your doctor to discuss switching to another treatment” Old question, but you can see that it is a recall question using medication names. This is from the Candidate handbook – it’s an example of a Recall question about medication dosages answer: A

30. Sample Question #3: Which of the following would be the best method for an asthma educator to assist an adolescent boy to integrate his asthma action plan into his normal routine? The asthma educator should: • Give him a written action plan listing medication times to post in his bedroom. • Suggest he check peak flow readings around activities he does most days. • Encourage him to use the inhaled corticosteroid before brushing his teeth. • Recommend completing his symptom diary before going to bed each night. NAECB Candidate Handbook, 2007

31. Answer This is from the candidate handbook – it’s an example of an Application question Answer: B one that best implies an assessment of his activities

32. Preparing for the Exam Days/weeks before: • Apply for the exam (www.naecb.org). • Schedule a testing appointment (application valid for 1 year). • Review and prepare. • Take a practice test on web. (www.naecb.org) • Find test site (H&R Block), look for parking etc.

33. Preparing for the Exam Night/morning before: • Make a final review of the materials. • Get plenty of rest. • Eat breakfast. • Arrive early (no admittance if you are more than 15 minutes late). • Have ID ready – 2 forms, one with photo. • Don’t take anything else to testing center.

34. During the Exam

35. During the Exam

36. Test-Taking Tips • Enter the exam rested and ready to think. • Read the instructions and questions carefully. • Don’t second-guess yourself. • Put questions in context with things that are familiar to you. • Remind yourself that you have experience and knowledge to help you. Think positively!

37. After the Exam • Congratulate yourself on giving it your best effort! • Please contact us with feedback. • What did you think of the test? • How well did this course help you prepare? • What could we have done to make the course more helpful? • How did you do on the test?

38. CPT Codes and Reimbursement • 2006 CPT codebook includes: • 98960 Education and training for patient self-management by a qualified, non-physician healthcare professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes, individual patient • 98961 2-4 patients • 98962 5-8 patients

39. CPT Codes and Reimbursement • Purpose of these codes is to teach self-management of a patient’s illness or disease or delay disease co-morbidity. • Curriculum used in patient education must be recognized by a physician society or by a non-physician healthcare professional society/association.

40. CPT Codes and Reimbursement • It is unclear at this point how the codes will be used and what the specific reimbursement will be. • Submission of these codes on a regular basis will help more third-party payers accept and reimburse using these new codes.

41. Good Luck! Your Asthma Educator Institute Faculty

42. Acknowledgements David DeBiasi American Lung Association in Virginia Michelle Mercure, CHES American Lung Association in Wisconsin