Vol. 14 •Issue 9 • Page 12
Choosing the Right Polysomnography Program
Are you tired of the 3 a.m. ventilator checks? Don’t think you can suction out even one more trach? Working double shifts and need a break? Well, if that’s the case, here’s something you should do: Go to sleep!
No, not literally — but taking your respiratory skills to the sleep lab may be just the boost your career needs. Sleep medicine is exploding in popularity, and many respiratory therapists are making the career change.
Of course, one would think that this should be a simple transfer from the respiratory department to the sleep department, right? Not necessarily.
Once you decide to make the move to sleep, choosing the right polysomnography training program can be confusing. Because of the high demand for trained sleep techs, coupled with relatively loose regulations on the profession, fly-by-night PSG courses are rampant.
Even legitimate courses vary widely in quality and content. Training courses may range from three-day weekender courses to community college programs leading to an associate’s degree.
I recently hired a new employee that had completed a “comprehensive 10-day course in PSG.” The excitement of having a “ready-made” employee quickly faded as the failings of the training course became evident in the first week. Apparently, the course consisted entirely of PowerPoint lectures and didn’t include any hands-on experience with patients or even equipment. The employee required four more weeks of training in our facility before being able to run studies on patients.
A FIELD IN TRANSITION
Sleep medicine has transformed from an obscure, academia-type research field into a high-demand branch of practical medicine. Across the nation, large-scale, multi-bed sleep centers are cropping up to meet the ever-increasing demand for sleep studies. In some areas of the country, a patient may wait up to two months or longer for an overnight PSG appointment. Well-qualified technologists are in critically short supply to meet the growing need.
In the past, PSG as a profession has grown haphazardly, responding to the immediate needs of the field. Many technologists were trained on the job, often with little or no previous experience in patient care. RTs enjoyed a relatively easy transition from cardiopulmonary services to sleep medicine. Respiratory knowledge sufficiently translated into sleep knowledge, with perhaps a small amount of coaching from a senior PSG tech on the side.
Today, respiratory knowledge, while providing a solid basis to start from, is only one piece of the complex puzzle that makes up sleep medicine. Board-certified sleep physicians not only diagnose and treat sleep apnea patients, but also investigate psychologically and neurologically based sleep complaints such as insomnia, narcolepsy, parasomnias and limb movement disorders.
Pediatric sleep is fast becoming a hot topic as the attention deficit disorder/attention deficit hyperactivity disorder epidemic swells.
In the public health and safety arena, sleep centers routinely screen workers in safety-sensitive jobs such as commercial airline pilots, school bus drivers and nuclear power plant operators to ensure they’re able to perform at peak alertness.
Formal training in PSG should be undertaken by any RT intending to expand his or her career to include sleep medicine. So, what kind of PSG course will best prepare an RT for a career in sleep? Several attributes of a program need to be considered before enrolling: accreditation, curriculum, course structure and length, quality of instructors, participant competency evaluation, and measure of graduate’s success.
Accreditation is clearly the most important factor to consider when choosing a program. Any program accredited by the Commission on Accreditation of Allied Health Education Programs has been closely scrutinized with regards to course content, evaluation of participants, qualification of instructors, classroom environment, and post-course success rate of participants.
An accredited course will be affiliated with a post-secondary education facility or an American Academy of Sleep Medicine (AASM) accredited sleep center. Accreditation assures that the course is properly structured, covering all relevant material, and taught by qualified personnel. A course may still be quite good without being accredited if it’s structured well, taught by qualified instructors, and affiliated with an AASM-accredited sleep facility.
An accredited course must be taught by qualified personnel. Instructors should be licensed in good standing in their respective fields. Normally, a PSG course will be taught by a mixture of registered PSG techs, respiratory care providers, physician assistants or physicians. Polysomnographers and RTs teaching a course should have at least five years experience running patient studies and scoring PSGs in the lab setting.
If an accredited program is chosen, the curriculum already has been evaluated for completeness and relevancy. For an RT, however, many aspects of the curriculum will be redundant.
Consider a program offered as a compilation of several courses such as a degree program. Much of the redundant material, especially the prerequisites, may be waived if your respiratory courses are transferable between institutions. This will greatly reduce the time and money spent on the program. Prerequisite courses for PSG should include cardiopulmonary resuscitation (basic cardiac life support for the health care provider), algebra, basic PC literacy, basic written and oral communication skills, basic physics, medical terminology, patient rights and health care law/ethics.
A comprehensive PSG course should cover the subjects recommended in the Association of Polysomnographic Technologists course outline, which can be found on the APT Web site, www.aptweb.org.
The course should include: all aspects of normal adult sleep, an overview of sleep disorders, interpreting history and physical examinations, cardiopulmonary function, understanding electrocardiogram, monitoring procedures (both nocturnal and diurnal studies), proper documentation, set-up procedures, continuous positive airway pressure, bilevel positive airway pressure and supplemental oxygen application, instrumentation, troubleshooting, disinfection, pharmacology, record scoring, 10-20 electroencephalogram, and general safety in the lab. Pediatric training is also desirable and will increase your marketability.
In addition to course content, seriously consider the structure of the course. All people don’t learn equally in the same situations. The most successful courses combine lecture time with lab activities and clinical experience. Investigate whether a course under consideration is affiliated with an operating sleep center, and if the sleep center is accredited by the AASM. Any clinical experience included in the course should conform to AASM standards of practice.
OTHER FACTORS TO CONSIDER
Integral to the structure of the course is the student-instructor ratio. A larger student-instructor ratio isn’t a major concern in a lecture situation, but it may present difficulties in the lab or clinical portions of the program. Laboratory activities are best facilitated in a 4-1 or 6-1 student-instructor ratio. In the clinical setting, no more than two students should be assigned to a senior polysomnographer/instructor, and that senior polysomnographer/instructor should never perform sleep studies on more than two patients at a time.
Course duration should be adequate to allow participants to assimilate information, apply their knowledge in practical situations, and be thoroughly tested on skills and knowledge. PSG has become far too complex to be adequately taught over a weekend. A course should be 80 hours at a minimum, in my opinion. More conservatively, a course should be 120 hours of lecture/lab activity and 160 hours of clinical experience.
Evaluation of skills during the course is vital in guiding the participant in the right direction. A shorter “cram” course may provide the data to the participant but fail to ensure that he has assimilated and retained the information. Additionally, a cram course offers little room for correction or remediation if a student has difficulty with a concept or skill.
Consider the level of certification attained by successfully completing the course. Obviously, a certificate of participation is far less valuable than an associate’s degree in polysomnography. Anyone can participate in something and try, try, try his little heart out. Participation doesn’t equal competency.
Employers need some form of documentation of the skill level attained in the field. A program or course that gives at least a pass/fail grade is somewhat useful. A program that generates a grade or grade point average, complete with a transcript, is much more informative to a potential employer. A degree program is ideal, but not always practical, for a professional adult attempting to change careers while juggling education, employment and possibly a family.
The level of certification pursued should be weighed by your individual situation. Keep in mind that the Board of Registered Polysomnographic Technologists’ registry leading to the RPSGT credential is the gold standard in PSG and is a national exam independent from any educational institution’s certification.
ARE GRADUATES SUCCESSFUL?
Finally, investigate the success rate of a program’s graduates. This may be tracked in different ways: the percentage of students passing the BRPT exam, the percentage of students finding employment in sleep within X time, etc. The percentage of students successfully passing the BRPT exam within one year of program completion is a good indicator of the quality of the program. Many students will find employment simply because of the dire shortage of qualified polysomnographers. This may not correlate as much with the quality of the students as it correlates with the desperate demand for sleep techs.
As the field of sleep medicine skyrockets, the careers of qualified polysomnographers are advancing at phenomenal rates as well. The best path to a great career in sleep is through comprehensive formal training. Take the time to thoroughly investigate a program before enrolling, and avoid the temptation of the weekender “career in a box” scams so many fall prey to. A great career is on the horizon, but Rome wasn’t built in a day (or a weekend).
Lisa Carroll, RPSGT, BS, BA, is the director of education and staff development for United Sleep Medicine in Charlotte, N.C.