Notes from the Chair

Joseph G. Sorbello, MSEd, RT, RRT

In the Summer edition of the Bulletin I wrote about hyperconnectivity possibly being the kudzu of the 21st Century. Months later I am still witnessing our students and people everywhere using their iPads and smartphones as they walk the streets, the halls, and everywhere else. I do note, however, that my students are using more apps for school-related activities, so I’m encouraged by their judicial use of the software and hardware.

In this issue, I address two topics that most of us deal with at the beginning of every school year: adjusting to the workload and creating successful study groups. Many of our students get off to a strong start and maintain that level of performance, but others will struggle, and it’s up to us as faculty to help them gain the foothold they need to do well and graduate.

We also have an interesting look at home care in the RT curriculum from AARC Home Care Section Chair Kim Wiles and educator Lindsay Fox. While adding topics and information to the curriculum can be a challenge, they make a good case for the need for more education in home respiratory care in this era of health care reform.

As I write this column in early September, AARC Congress 2014 is only a few months away—Dec. 9–12—and I hope everyone is busy planning their trips to Las Vegas. The program is packed with cutting edge sessions on a wide range of topics in the profession, as well as lectures and symposiums specifically targeting RT education. We’ll be holding our annual section meeting during the conference as well, and I hope to see many of you there.

Adjusting to the Workload

Joe Sorbello, MEd, RRT

First year students can have a difficult time adjusting to the workload that you and I present to them each fall as they begin their journey in our profession. Study habits and strategies that worked previously somehow do not work when presented with expectations of not only memorization but problem-solving, application, and synthesis. This is a challenge to both students and faculty each year, and I know that all of you are faced with at least some students who are not meeting expectations academically.

As with other institutions, we offer professional as well as peer-tutoring here at SUNY Upstate. But as faculty, we also meet with students to see if we can help them work and achieve to their potential. One thing that some students have found helpful is a compendium of small booklets I’ve compiled into a three-ring binder. I keep this resource readily available in our department’s conference room where the students regularly meet for both individual and group study sessions.

The binder contains the following booklets, all from The Channing Bete Company*, and are loaded with all sorts of study and organizing tips, hints, and strategies—

About Academic Survival Skills
Learn about Getting Organized
What Every Student Should Know about Time Management
Put Time on Your Side—Time Management for Students
Take Time to Make Time—Time Management Skills for Students
Time for Everything: Tips to Help You Manage Time Well and Stay Organized—Skill Book
Successful Studying—It’s All Academic
Study Skills for Academic Success
How to Study
Studying for Success: Tips to Help Build Effective Study Habits—Skill Book
Test Anxiety—Tips for Success
How to Beat Test Anxiety
Learn about Beating Test Anxiety
Be Your Best on Tests—Tips to Help You Improve Test Scores

Although some students have found these helpful, I have found that working closely with students as they try these different strategies helps the student gain confidence and hopefully improve his or her academic performance. It also assists the faculty member in keeping track of the student’s progress and growth. Having the booklets is one thing but making sure they are really helping the students is quite another. We, as faculty, still have to be monitoring their progress through various means and I have found that periodic and regular meetings with all students, particularly those who are struggling, is one of the keys to everyone’s success.

*I have no relationship with The Channing Bete Company and no conflict of interest to report regarding the same.

Creating Successful Study Groups

Joseph G. Sorbello, MSEd, RT, RRT

As we start the Fall semester, particularly with our first year students, the faculty strongly encourages the use of study groups as a study strategy. In a recent email to my first year students I encouraged them to try some specific strategies when organizing their groups to make them more effective. I’m sure that many of you have said many of these same things to your students to not only improve their academic performance but also to help them learn and develop tolerance, group dynamics, and team building skills, among other things.

In essence, this is how I phrased it to them:

First, try what those in other professional schools (e.g. law, medicine, dentistry) do in their groups. More often than not, a leader (formal or informal) will emerge in a group and will be the first to speak up to help the group organize.

This is normal for what we call “group behavior.” Let the leader rise in your group as a person who is the helper. Don’t look upon this person as being bossy but recognize that this is a normal phenomenon in any organization and/or group of people. This is part of a huge area labeled “group dynamics” and “organizational behavior” that you will someday come to understand more intimately.

Second, recognize that each member of the group has a task or tasks for which he or she needs to take ownership. These can and probably should be rotated among group members in a cooperative way as you become more adept at the group study thing and learn each other’s ways, strengths, weaknesses, etc.

For instance, have someone be the “researcher” who looks up background info and more specifics on the more difficult topics (like stuff that puzzles everyone). Have someone else be the “definer of terms.” There are key terms, many of which are new to everyone, in each chapter in your required texts. Another person can be “the questioner,” the person who asks others in the group to explain specific areas within a topic. Someone else can be the “labs/diagnostic tests” person, while another can be the “signs/symptoms” person and another can be the “disease management” person who defines/lays out how patients with a particular disorder are managed/treated.

The important thing is that all have their own area to contribute. Of course, copies of anything you research should be shared with the rest of the group. All should be good group members. Part of that is asking others if they REALLY understand something or if they have more questions.

How do know if you really do know something? You can teach it correctly and others understand what you taught.

Third, study often, use analogies, and notice the purposeful crossover/integration in the curriculum. Most people are visual learners, so take advantage of that fact and use the Internet to capture/copy/paste pictures and diagrams to illustrate what is being learned. The mind is a huge storage unit that will attach words, knowledge, and concepts to pictures. The mind will recall pictures WAY MORE often than words. Remember the ancient Chinese saying: “One picture is worth a thousand words.”

Fourth, be kind and helpful to each other and help everyone achieve to his or her highest potential. Remember that you will learn even more if you become “the teacher.” So, when you really get into it, the teaching and learning become a lot easier, it all goes faster, you’ll actually have some fun (sometimes), and you’ll all have much to gain since your ultimate goal is to be great therapists who will give excellent care to your patients. Of course, there is nothing more valuable than that!

Here’s hoping that this helps you, and especially, your students. As always, I’d love to hear your comments on anything I’ve written. Comments and suggestions are always welcome!

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Home Care Competencies: Are We Doing Enough for Our Students?

Kimberly S. Wiles, BS, RRT, CPFT, Home Care Section Chair, and Lindsay Fox, MEd, RRT-NPS, Program Coordinator, Southwestern Illinois College/St. Elizabeth Hospital, Belleville, IL

As we enter into the future and an era of change, we have to evaluate our care at all levels and ask ourselves, is the graduate respiratory therapist prepared to enter the unchartered, uncontrollable environment of the home?

Many health care treatments and diagnostics that were once offered only in a hospital or a physician’s office can now be safely, effectively, and efficiently provided in patients’ homes by skilled clinicians. Home health care is generally less expensive, more convenient, and as effective as care provided in a hospital or skilled nursing facility.1 Many patients are being discharged sooner and in a more critical state requiring multiple treatment modalities. Are our students prepared to handle these patients in an uncontrolled environment that requires critical thinking skills?

Home care lacking in the curriculum

So what does the current curriculum look like for the respiratory student as it relates to home care? According to one instructor who taught in two associate degree programs and two baccalaureate programs, the time allotted in the didactic and/or lab portion of the program varies greatly. In some programs, the only discussion of home care comes in the context of other courses. For example, the students may learn about oxygen delivery devices used in the home during a basic respiratory care lecture. They may learn about home ventilation (invasive and noninvasive) in the mechanical ventilation course. Is this enough to adequately prepare the student for the home care environment? Equipment used in the home is vastly different than equipment used in the acute care setting, not to mention that it is being utilized in an uncontrolled environment and various adaptations need to be made in order to accommodate some of the equipment.

Associate degree programs have to satisfy general education requirements as well as the necessary respiratory care coursework in a set number of credit hours, which is dependent upon their state. This can be challenging due to the fact that some community colleges set the maximum credit hours at 60–70 hours. A bachelor of respiratory therapy program may have more flexibility to fit in a course that is specific to home care. However, after researching a few websites of bachelor’s programs it appears that there is more of an emphasis on pulmonary rehabilitation, research, management, community/patient health education, and pulmonary function testing than on home care.

What the standards say

The Commission on Accreditation for Respiratory Care (CoARC) lists the standards and the evidence of compliance for the curriculum of a respiratory care program in section 4.0 of the 2010 CoARC Accreditation Standards Manual.2 Standard 4.01 states, “The program must prepare students to meet the recognized competencies for registered respiratory therapists identified in these standards.” The standards do not list the competencies, but programs must show that there is documentation of competencies that demonstrate the student’s knowledge, technical skills, proficiency, and behaviors.

Standard 4.06 discusses the requirements of the respiratory care content in a respiratory program. According to this standard, “Respiratory Care content must include respiratory care of the adult, pediatric and newborn patient; health promotion, education, and disease management; fundamental principles of healthcare reimbursement; fundamental principles of evaluating current scientific literature; medical ethics; provision of health care services to patients with transmissible diseases; provision of services for and management of patients with special needs; community respiratory health; medical emergencies; and legal and ethical aspects of respiratory care practice.” There is nothing in this standard that states that home care is required.

Brief rotations fall short

The respiratory therapist’s role in the home setting will inevitably be changing and it will be important to understand that this means a possible shift of clinical experience in this setting. Currently, many programs treat home care rotations as a specialty along with areas such as pulmonary rehabilitation, polysomnography, and pulmonary function testing. These specialty rotations may include a one or two day home care rotation that allows the student to tour the facility, handle the equipment used in home care, and observe the therapists in the home.

With only a one or two day rotation in the home, how can programs deliver a quality clinical experience for their students? Such a short rotation provides only a glimpse of the challenges that occur in the home. Perhaps it is time to evaluate students in this setting as they provide care and make decisions regarding the patient’s care plan. This would help to build the independent thinking skills that are essential for home care RTs to possess.

Of course, even if programs are able to add extra clinical time for the student to spend in the home care rotation, there are clinical obstacles that the director of clinical education may encounter—

• Adequate number of sites for the number of students willing to take rotations.
• Home care companies refusing to take students due to the recent changes to reimbursement and the lack of time their RTs have to work with students.
• Liability—some companies will not allow students to ride with the RT. This adds an extra financial burden for a student.
• Lack of standardization of RT protocols in the home.

One of the key home care competencies that should be included in the RT curriculum is the ability to assess the environment of care. This is essential in establishing the plan of care as it relates to the equipment being provided, as well as the disease state. In order to decrease health care costs, problem identification must occur in the patient’s home. The home environment may pose new problems for the patient when he goes home from the hospital. This is only one unique competency that exists, but if not carried out appropriately it can be a “game changer” when it comes to managing the patient in the home.

Now is the time

As we prepare for the future, now is the time to address the unique competencies required for the respiratory therapist to work in the home environment. Due to major changes and reductions in reimbursement for home medical equipment, many companies are decreasing and/or eliminating RT positions. The payers have made it clear that they are paying for the equipment and not the service, including the RT. But if the patient cannot or will not use the equipment provided due to lack of education or follow up, the patient will be admitted back to the hospital.

When there is not an RT in the home, the hospital RT will need to be well-versed in the competencies needed to help solve the problems encountered by the patient at home. Most home care RTs have worked in the hospital at some point, but very few hospital RTs have worked in the home. Their only home care experience might have been a rotation through a home care company that only provided a peak into the home environment without any “hands on” training. It is time for us to contemplate if a brief rotation is enough to provide what is needed for the future RT student.

Education is our passport to the future, for tomorrow belongs to the people who prepare for it today.―Malcolm X

References

1. Centers for Medicare and Medicaid Services. Medicare and You. 2011.

2010 CoARC Standards for the Profession of Respiratory Care.

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Section Connection

Recruit a new member: Know an AARC member who could benefit from Education section membership? Direct him/her to the AARC website. It’s the easiest way to add section membership to his/her overall membership package.

Section discussion list: Go to the section website and click on “Discussion List” to start networking with your peers via the AARC’s social networking site, AARConnect.

Bulletin deadlines: Winter Issue: December 1; Spring Issue: March 1; Summer Issue: June 1; Fall Issue: September 1.

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