A New Path to Polysomnography

Sleep technologists’ road to certification is gaining a new fork. The American Board of Sleep Medicine is developing a sleep tech exam and certification, upping to three the number of paths to professional practice.

New legislation requiring sleep techs to be credentialed to practice in many states has caused a boom of choices in the past two years. The ABSM credential will join the Board of Registered Polysomnographic Technologists’ RPSGT and newly developed CPSGT credentials, and the National Board for Respiratory Care’s RRT-SDS and CRT-SDS, which launched in early 2009.

Announcement of the new exam in December launched a flurry of speculation and backlash from already credentialed sleep techs. Of utmost concern is that the new exam will flood the market with credentialed professionals and reduce sleep tech salaries.

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“This has the potential to bring down the field,” cautioned Randy Townsend, RPSGT, who runs the 1,975-member group “RPSGT/CPSGT/Sleep Tech” on the social media site Facebook.

Comments on ADVANCE’s Facebook page suggested the new test was a “money grab” or attempt to dummy down the field. Townsend suggested “with health care reform, they’re looking to cut the biggest cost in the lab: Me.”

Some technologists have threatened to withdraw membership from the American Association of Sleep Technologists, which supports “all pathways to certification.”

“Because the ABSM is highly regarded in both the sleep field and broader medical community, having this new credential means even greater recognition for sleep technology as a separate and distinct allied health profession,” said AAST president Cindy Kistner, RPSGT, R EEG T, in a written statement to ADVANCE.

Closely aligned

Backers say the new ABSM credential will strengthen the profession by more closely aligning the exam with sleep physicians’ expectations of techs’ job duties and testing the basic knowledge needed to perform a sleep study.

“We are going to create a blueprint for this examination that is really based on education and training,” said Nathanial F. Watson, MD, ABSM president. Physicians, sleep specialists, and RPSGTs are writing exam questions on key topics such as study performance, record scoring, and sleep disorders encountered in daily practice.

The test also will cover techs’ ability to perform pediatric polysomnography and multiple sleep latency testing. Questions on both topics were eliminated from the RPSGT exam last year after the BRPT undertook a job task analysis of existing RPSGTs and found that only a small portion of techs reported performing these functions.

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“It was a difficult decision for us,” said Janice East, R EEG T, RPSGT, president of the BRPT. MSLTs did not reach criteria to be included on the exam because most are conducted by scoring techs, who are much smaller in number than night techs. But most RPSGTs can learn how to perform MSLT on the job in a few days. “It doesn’t mean that you don’t perform them in your lab, just that you’re not tested on them.

“It’s a little bit frustrating,” East continued, “but we can’t just add things back on to the (exam) blueprint because what would be the point of doing the job task analysis?”

Passing grade

Another point of contention: Only 62 percent of RPSGT test-takers passed the exam last year, according to BRPT data. With new laws requiring all professionals to be credentialed to practice, “a majority of otherwise qualified sleep technologists currently employed at sleep centers are unable to obtain the necessary credentials to stay in the profession,” Dr. Watson said. Overall, the goal of this new exam is to be fair to those techs.

But the BRPT says that the field needs better education, not a new exam. Techs with the lowest pass rate for the RPSGT exam were trained on the job – and nearly 70 percent of exam takers fall into that category.

Requiring techs to complete Accredited Sleep Technology Education Program (A-STEP) modules beginning in 2008 was a stop-gap measure to improve basic knowledge. But it has not improved the pass rate. “Really we need about 200 schools to meet the needs of sleep centers around the country,” East said.

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By introducing the CPSGT exam in March 2010, the BRPT hoped to help new techs meet state requirements for polysomnography practice while they are studying for the more advanced RPSGT exam. More than 300 people have passed the CPSGT exam. The certificate is time-limited and valid for three years, within which time a certificate holder must earn the RPSGT credential. Each year, CPSGT holders also have to complete 10 continuing education credits, which helps broaden their understanding of the field.

East initially was stunned when the ABSM revealed its plans for the new exam and credentials in a December letter expressing the agency’s concern that BRPT certification does not ensure professional readiness.

Her reaction has since become tempered. “If it is a carefully developed exam that offers technologists a reliable, valid testing option, then it becomes simply a competing exam,” East said. “While that is not ideal in professional credentialing, it is not unusual. As long as people are educated about the differences in the exam, that is the most important part.”

NBRC Associate Executive Director Lori Tinkler also is uneasy about the new credential further fragmenting the field. “It is probably not a good thing to have so many credentials in the field,” she said. New techs, for example, might not know which credentials they must earn to qualify to work in a sleep facility.

Her agency has concerns about how the introduction of the new credential will affect its forthcoming application to have the AASM recognize the RRT-SDS and CRT-SDS as equivalent to the RPSGT and CPSGT credentials, which would allow sleep centers employing only respiratory therapists holding the NBRC’s specialty credentials to apply for AASM facility accreditation.

More than 17,000 sleep technologists currently hold the RPSGT credential and about 160 respiratory therapists have added the RRT-SDS or CRT-SDS credential to their resumes.

The ABSM expects to announce more details on its exam within the next six to 12 months.

Kristen Ziegler can be reached at [email protected].