Friday, January 29, 2016

Dangerous Curves Ahead! – The Risks of Social Media Use by Sleep Professionals

Dangerous Curves Ahead! – The Risks of Social Media Use by Sleep Professionals
By Deb Kovacs-Sturdevant, RPSGT, RRT, BA, LSSMBB


As a member of the BRPT Board of Directors, I am the Chair of the BRPT Professional Review Committee (PRC). The PRC has noted an increase in periodic reports about violations to Standards of Conduct (SOC) and Health Information Portability and Accountability Act (HIPPA) which emanate from social media sites. I am writing this article in response to some recent social media posts that are in violation of the BRPT SOC and possibly Federal HIPPA regulations.*

"The following guidance also represents the consensus of the BRPT Board of Directors on previous social media posts brought to our attention. This guidance is not meant to be comprehensive in scope and sleep technologists remain at risk for other legal and employer-based actions based on imprudent use of social media, irrespective of our position."

Slow - Dangerous Curves Ahead!

There are many dangerous curves ahead in navigating social media sites for healthcare and sleep professionals. What can we safely talk about on social media? What is considered protected healthcare information? Are closed social media groups a safe venue? If we are not well-informed, we could mistakenly divulge protected health information and drive ourselves, and our employers, off into a ditch.

Formal education about HIPAA and Protected Healthcare Information (PHI) is, sadly, lacking in the sleep community. It becomes a sleep technologist’s responsibility to become better informed of the risks associated with using social media. When it comes to HIPAA law, claiming ignorance is not considered a valid defense. It is a misconception that as long as we don’t include a photo or divulge a patient’s name, social security or medical record number, we are safe to blog or comment about our patients or cases on social media. Not true. As a matter of fact, any discussion about our patients on social media, including in a closed group for sleep technologists only, may put us at serious risk for violating the law and professional standards of conduct.

HIPAA is more than just a healthcare urban legend. HIPAA is a very real and enforceable Federal law. As more closed-group healthcare provider social media sites spring up, more and more violations by healthcare workers are also coming to light. Becoming educated about the real dangers of posting to social media helps us to avoid these damaging and potentially career-ending mistakes.

Before any healthcare-related information is released by an institution, PHI must be protected by scrubbing, called de-identification. There are two methods to achieve de-identification of PHI in accordance with the HIPAA Privacy Rule. The first is the “Expert Determination” method and requires a trained expert to perform de-identification of patient identifiers in outgoing information. The second is the “Safe Harbor” method.

List of 18 “Safe Harbor” Patient Identifiers*

PHI is any information in the medical record which can be used to identify a patient. Patient name, photo and identifying numbers are not the only information protected under Federal law. There are 18 patient identifiers to become familiar with:

1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)
* website

Most of these Identifiers are common sense. Some are very broad in scope and it is these that require more thoughtful understanding before posting anything on social media.

For example, Identifier #2 may be inadvertently violated if the poster’s town or area of residence is attached to the posting.

Dependent upon presence of other identifiers, Identifier #17 could be violated even if a patient’s face was not clearly visible in a photo.

Identifier #18 presents the greatest problem with HIPAA compliance in light of the significant amount of personal information available on the Internet. Even minimal amounts of information inputted into a search engine can generate relevant hits about individuals that make it increasingly difficult to comply with HIPAA. Even if the first 17 identifiers are carefully followed, the broadness of Identifier #18 can turn a seemingly harmless post on social media into a patient privacy violation. For example, posting about an individual’s body characteristics or habitus, past, present or future physical or mental health conditions, or the provision of health care to the individual, could also be a violation under Identifier #18. 

Can I blog or post about my patients?

Technically, I suppose the answer is yes, but this is still risky. We could comment about specific patient encounters if done in a careful and professional manner, respecting all patient privacy guidelines. The key would be to make sure that the details are never specific enough to tie back to any individual patient. We would have to change certain details completely so that a patient is absolutely unidentifiable. For example, sharing of an experience as a human interest story or learning experience could be allowable as long as patient privacy is protected and the posting was fully vetted and sanctioned by our employer first.

Remember, posting anything about a patient on social media is very risky. Healthcare institutions and employers follow strict Federal guidelines for protecting PHI. Before posting anything about a patient or encounter to social media, it is advisable to vet this posting with our employer in order to ascertain if PHI is protected to the degree mandated and if the posting will be allowed. Many healthcare institutions have zero tolerance for postings about any business or patient care matters by anyone within their organizations other than the marketing or media representatives. Violation of these rules can result in corrective action or termination.

Also, venting our frustrations or posting negative comments about our patients or interactions would not be professional or appropriate. Our patients have granted us the privilege of taking part in their care. They deserve compassion and respect. And everyone has a right to privacy. Remember the Golden Rule and treat others as you would want to be treated – or as you would want to have your loved ones treated.

Are closed social media groups exempt and a safe place to post?

No, absolutely not! The very same rules that apply to social media postings in general also apply in closed groups. PHI must always be protected, without fail.

Administrators or even members of closed groups can police their own membership. Violations can be and are reported to government and credentialing organizations from closed-group social media sites.

It is also advisable to avoid the use of closed-group sleep technologist social media sites as a means for getting technical or troubleshooting advice while on the job. Every sleep center has their own hierarchy and resources for reporting incidents and/or getting technical advice during the course of a sleep technologist’s shift. It is expected that a sleep technologist would reach out to co-workers on site and then to their manager or supervisor for technical advice.  Reaching out for advice on social media can severely increase the risk of violations because information needs to be divulged outside of your work group in order to explain the problem, which therefore increases the risk of divulging PHI. And posting could be in violation of employers’ guidelines.

Can a posting about my patients result in job loss or loss of my professional sleep credential?

Yes, absolutely, even up to and including Federal fines and prosecution.

If we violate HIPAA, the employer is also held accountable for what happened and fined accordingly.  The end result to the technologist could be loss of credential and termination of employment plus risk of Federal fines and prosecution.

Additionally, each credentialing organization has a Standards of Conduct (SOC) that each credentialed professional is expected to abide by. For example, one of the BRPT SOC states that the credential holder will abide by all laws. Like all credentialing organizations, the BRPT has a Professional Review Committee that reviews and investigates complaints of alleged violations.

Recent reports indicate that people who “like,” “share,” “re-tweet,” or comment on inappropriate social media postings, even in closed groups, are also getting reprimanded and are at risk for losing their credentials and jobs.

You may view the BRPT Standards of Conduct on the BRPT website, under the blue “Standards” tab, and then choose “Standards of Conduct” from the pull-down menu.

Professional Tips for Social Media Usage

1. Don’t post anonymously. - Anonymity breeds bad behavior and grants false permission to say inappropriate things.
2. Check the tone of your social media presence. – If the message is not positive, do not post it. Don’t use social media as a vehicle to vent and complain.

3. If you wouldn’t say it in a crowded room, don’t put it online. – Information posted online stays out there forever and can haunt your career. Nothing is protected or sacred once it is posted – even in closed groups. Remember that electronic messages can be subpoenaed and used as evidence in legal proceedings.
4. Stop and think before you post. – Refraining from posting anything about our patients and interactions is always the best advice.

In summary, social media for healthcare providers can be a great tool for disseminating and receiving information if used wisely. Becoming educated about and then abiding by the laws and methods for protecting PHI are the keys to safe navigation of these potentially treacherous roads. Here’s wishing everyone a safe trip!

Thursday, October 16, 2014

The New Frontier Of Sleep Medicine And Our Role In Shaping And Embracing It

From time to time BRPT invites a "guest blogger" to contribute a short article in this space. The opinions, representations and statements made within a "guest" article are those of the author and should not be construed as statements made on behalf of BRPT.   Copyright remains with the author.

By Dr. Vikas Jain

We’re all aware of the changing landscape in sleep medicine. I’ve learned in traveling to the annual sleep meeting, as well as speaking with technologists both locally and nationally, that many individuals are concerned with what the future of sleep medicine holds. Although the landscape is changing, I believe we are well equipped to tackle the challenges – and opportunities – that lie ahead. We do, however, first need to consider what services and technologies are infringing upon our current standard of care and delivery.

New Technologies Change The Way We Work
Over utilization of sleep studies has contributed to putting sleep medicine on the radar. Surveys of sleep centers across the country all show the same trends: reduction in sleep center bed and patient volume growth, and an increase in out of center sleep testing (OCST) utilization. But more important than merely the discussion of OCST versus in-lab testing, is the discussion of how the role of the sleep technologist may be impacted. When considering experience, Nigro et. al. showed that an individual with very little polysomnography experience was able to score as well as a physician with several years experience when correcting auto-scored data.  Furthermore, a study by Malhotra et. al. in the 2013 Sleep Journal displayed that the use of an automated polysomnography scoring system yielded results that were similar to those obtained by experienced technologists. The utility of PAP titration studies are also being evaluated as some insurance companies are opting for patients to be titrated using AutoCPAP’s over in-lab titration. In the age of
wearable technology, we are also seeing new technologies emerging that track and monitor sleep which may make the use of actigraphy obsolete. With all of these disruptive innovations impacting our field, I can understand why many sleep professionals are wary of the future.

Moving Towards A Management/Long-Term Care Model
I believe the future remains very bright for our field.  We don’t have to shift our focus away from Obstructive Sleep Apnea, (OSA) but should make efforts to expand our focus to include other highly prevalent sleep disorders such as Insomnia and Restless Legs Syndrome.  As the obesity epidemic in America continues to grow, the incidence of new sleep apnea cases is likely to continue to increase as well. These changes, along with more emphasis being placed on clinical outcomes, are shifting our care paradigm from diagnostic/short-term care to a management/long-term care model. This change in care delivery is where I believe the greatest opportunity for sleep technologists lie.

We can expect to see: a reduction in overnight studies/night techs; increase acuity in individuals requiring in-lab overnight studies due to comorbidities; an increased demand for OCST; and, an increased demand for treating sleep disorders other than OSA.

Sleep Technologists Will Need A Varied Skill Set And Leadership Skills
Given these changes, we will need technologists who have broader skill sets. Technologists will require knowledge of more advanced PAP modalities such as AVAPS and ASV given the increased acuity of in-lab polysomnography patients. They may need knowledge of a variety of PSG montages that may be used for evaluating patients with disorders such as seizures or parasomnias. In addition, given the increasing incidence and prevalence of OSA, knowledge of alternative therapies for the treatment of OSA will prove useful. Finally, given that there are approximately only 7,500 sleep physicians in the United States, we will need more “sleep clinicians” to help in the management of our patients. We’ll need sleep technologists with leadership skills to assist in patient/community education, protocol development within hospital systems, and in research/population health. There’s tremendous opportunity here!

One path that can help sleep technologists build these skills is the BRPT’s Clinical Sleep Educator certificate program. In addition to the CSE program, I would strongly urge sleep technologists to consider pursuing the new Certification In Clinical Sleep Health (CCSH) credential. This is an advanced credential that establishes a common skill and knowledge base for clinical sleep health professionals. It provides recognition that an individual has knowledge of four domains: Sleep Over the Lifespan, Clinical Evaluation and Management, Patient/Family Communication and Education, and finally Program Maintenance and Administration. This type of knowledge is essential in the formation of a full service sleep disorders center. In practice, I have found that working with a sleep technologist with this skill set has improved sleep clinic efficiency, has helped to increase reimbursement for my practice, improved outcome measures such as PAP compliance, and overall provided true value to both referring providers as well as patients.

There is no denying that the landscape in sleep medicine is changing. Yet no one understands and has a knowledge of sleep better than those of us who are intimately involved in sleep medicine. So let’s put worry and apprehension aside and seize the current opportunities available to expand our field of knowledge. It’s time for all of us to take an active role in creating the future of sleep medicine!

Dr. Jain is a board certified sleep medicine physician who practices full time adult and pediatric sleep medicine in Oklahoma City, OK. He completed his fellowship at the Stanford Sleep Disorders Center in 2012.

Wednesday, March 19, 2014

The Nexus Between Oral Appliance Therapy and Treating Certain Sleep Disorders

From time to time BRPT invites a "guest blogger" to contribute a short article in this space. The opinions, representations and statements made within a "guest" article are those of the author and should not be construed as statements made on behalf of BRPT.   Copyright remains with the author. 

By Victor Woodlief, DMD

When it comes to my work as a dentist, there are three things I’m really passionate about: the absolute need to treat each patient as an individual; the need for collaboration with other healthcare practitioners; and, keeping an open mind in this evolving health care arena.

In my practice, I’ve had the great pleasure of collaborating with terrific sleep medicine doctors and sleep technologists when it comes to treating mild to moderate obstructive sleep apnea (OSA). And we’ve really seen first-hand how oral appliances can be a very successful front-line treatment for snoring and OSA. The plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer, helping to prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. And, oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.

An Overview Of The Important Steps To Take When Considering Oral Appliance Therapy
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. In my experience, custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool or a therapeutic option.

Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your patient’s specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist will then provide treatment and follow-up.

The initial evaluation phase of oral appliance therapy includes an examination and evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.

Of course, ongoing care including short- and long-term follow-up, is an essential step in the treatment of snoring and OSA with oral appliance therapy. Follow-up care with a sleep study serves to assess the treatment of your patient’s sleep disorder, the condition of your patient’s appliance, and your patient’s physical response to the appliance making sure it’s comfortable and effective.

Advantages of Oral Appliance Therapy
I’ve seen many advantages to using oral appliances, the least of which is they are easy and comfortable to wear.  In fact, most patients find it only takes a couple of weeks to become acclimated to wearing the appliance. In addition, they’re small and convenient making them easy to carry when traveling – I have patients who don’t miss a beat when going camping or hunting! Lastly, treatment with oral appliances is reversible and non-invasive.

Understanding The Different Types Of Oral Appliances
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Oral appliances can be classified by mode of action or design variation. And, it helps to know that nearly all appliances fall into one of two categories: Mandibular Advancement Device (MAD) and Tongue Retaining Device (TRD).

Mandibular advancement devices reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.

Tongue retaining devices hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.

In short, there is a time and place for treating patients with sleep disorders using oral appliance therapy and in doing so I’ve seen terrific results and have very much enjoyed working with other health care practitioners. It’s exhilarating to be a part of a larger network that communicates, collaborates and comes together to provide high quality individual patient care.

Wednesday, September 4, 2013

Finding the Value in Home Sleep Testing

From time to time BRPT invites a "guest blogger" to contribute a short article in this space. The opinions, representations and statements made within a "guest" article are those of the author and should not be construed as statements made on behalf of BRPT.   Copyright remains with the author.  

There is no denying that the climate of sleep medicine is changing. In my travels consulting with sleep centers and speaking with technologists throughout the United States, I hear a common concern regarding the impact of Home Sleep Testing (HST) – sometimes referred to as Out of Center Sleep Testing (OCST) or Portable Monitoring (PM) – on sleep medicine and, more specifically, the jobs of sleep technologists.  OCST was a large focus of discussion at the Sleep 2013 national meeting in Baltimore.  The fact that sleep technologists are concerned means they are aware.  Awareness is an essential first step. 

I prefer the term Out of Center Sleep Testing as, I believe, it opens our minds to the utility of it as practitioners. Is there value in OCST?  Let’s consider the definition of the word “value”.  According to Merriam-Webster dictionary, one definition of value is the relative worth, utility, or importance of.”

OCST does not have to bring thoughts of doom and gloom. Use OCST as an opportunity to capture patients that your sleep center may have been previously excluding.  Let’s consider Uncle Jay who you believe to have a high-test probability of sleep apnea. He is 55 years old, BMI of 41, and neck circumference of 18 inches with no hypertension, pulmonary disease, neuromuscular disease or other comorbid condition.  He is not suspected to have PLM’s, parasomnias, narcolepsy, or central sleep apnea.  Perhaps you have been coaxing Uncle Jay to the sleep center for a PSG for many years to no avail. The thought of sleeping away from home and having a stranger ‘watch’ him sleep was enough to keep Jay away from the sleep center.  Result: Uncle Jay continues to have undiagnosed sleep apnea putting him at high risk of cardiovascular consequences such as stroke, heart disease and diabetes. Uncle Jay is a fabulous candidate for OCST and is much more likely to be agreeable to it than to traditional polysomnography. Is there relative worth, utility, or importance in OCST for Uncle Jay? I say YES!  As well as for the many other candidates who have similar circumstances.

A prospective and randomized study was published in the journal Sleep 2009 May;32(5):629-36 comparing the validity of portable monitoring with PSG.  This study concluded accuracy of portable monitoring in confirming the diagnosis of OSA where there was a high-test probability for the disorder. One key feature of this study was that the portable monitoring patients had a high level of education and support from sleep center personnel to ensure understanding of the testing process. 

Will OCST change the practice of sleep medicine?  It already has.  Does it mean bad medicine?  It doesn’t have to.  Look at this juncture as an opportunity to provide a different type of care for your patients. Expand your sleep clinic to offer a channel for advanced education, follow up and support for patients. Work with other medical disciplines to seek a new patient population who would not be willing to attend a facility-based sleep test thus expanding the scope of your practice. 

Rise to the occasion.  Be responsible.  Be attentive.  Provide excellent patient care.  All contact with our patients has relative worth, utility, AND importance.

By Mary Kay Hobby, RRT, RPSGT
President Sleep Health Management Resources, Inc.

Thursday, May 30, 2013

It’s Always A Good Time To Get Involved

I think it’s safe to say that volunteering for an organization or a cause is something most people want to do in life but with busy schedules, families, demanding jobs and everything else that life throws at us, it often ends up on the “to do list of what’s next for me.”  When I joined the BRPT’s Exam Development Committee four years ago, I had no idea where this volunteer opportunity would take me.  Since then, I’ve become a member of the Board, have served as Chair of the BRPT Scholarship Committee and in six months, I’ll take over as BRPT President.   To say it’s been a rich and rewarding experience is an understatement. I’ve had the privilege to become a bigger part of this great community of sleep technologists, meeting – and learning from – new colleagues while developing new skills.  Not only has this volunteer experience opened new doors for me, the feeling of achievement – both personally and professionally, is unparalleled.

But don’t just take my word for it -- I recently came across a terrific blog entry by the organization HandsOn Blog that nicely details “8 Benefits of Volunteerism” -- .

The BRPT recently reorganized its volunteer engagement structure to better meet the needs of the organization and to better serve its volunteers. From exam item writing to reviewing candidate applications to supporting our legislative efforts, there are numerous opportunities to put your skills to good use while supporting a community and profession you love.  If you’re interested in getting involved with BRPT, please complete the volunteer engagement form
and we’ll look forward to putting your skills and expertise to good use!

Theresa Krupski, RPSGT, RRT

BRPT President-Elect

Thursday, December 13, 2012

BRPT 2.0

Mentoring and managing staff, budgeting, PR and communications campaigns, grassroots and legislative initiatives… they’re all part and parcel of running any non-profit. And after you’ve been in the business long enough, you learn that whether it’s at a large trade association representing widget manufacturers, or a small charity devoted to saving endangered species, the fundamentals of non-profit management are essentially the same. So what sets them apart?  In my experience, it comes down to one word: the “issues.” 

When I interviewed for the position of Executive Director of the BRPT, I said to Cindy (BRPT President) and Janice (BRPT Past President) “I like the fact that you help people who have problems.”  And I honestly believe that. As CPSGTs and RPSGTs, your “issue” is helping people with sleep disorders. When I attended the Symposium in Reno last September, I learned first-hand just how important that is to someone’s overall health.  I listened to the sessions about co-morbidities associated with OSA and their deleterious effects on the human body.  And I also learned, apart from their own health risks, about the dangers undiagnosed sleep apnea sufferers pose to others -- from coworkers in busy factories, to fellow motorists on our nation’s highways.

And more importantly, there’s something else I observed in Reno: Passion. I saw a group of highly trained professionals who were truly committed to, and passionate about, sleep medicine and helping their patients.  I heard it from people like Lisa Bauck, an RPSGT at the Oregon Clinic, with whom I had the pleasure of sitting next to at one of the group lunches following a morning session.

I saw that passion on display several times as people vocalized their concerns about protecting and preserving the integrity and future of the RPSGT credential.  Folks like David Rusnak, from MedStar Montgomery Medical Center in Olney, Maryland.  I drive by David’s workplace on my way to music lessons in neighboring Ashton about once a month.  Little did I know there was an individual so well-versed on the Stark Act and legislative issues impacting sleep credentialing right in my backyard.  And I saw the passion in the many faces, whose names are too numerous to list here, that I met in the exhibit hall and at the registration desk.

That was three months ago.  And it’s been six months since I started as Executive Director in June.  That’s when you start getting “into the groove,” as they say, in a new job.  And what the BRPT staff and I have been trying to do along the way is listen.  Listen to what the RPSGT community is saying.  Based on all the calls and emails and questions and comments, we’re changing things.  We’re going to make the website easier to navigate.  We’re going to implement new recertification reminders.  For first-time test takers, we’re going to make the application easier to understand.  We’re going to be more proactive on the public policy front.  We’re going to continue to develop and expand the CSE program. We’re doing all of this based on feedback that you have provided to us.  Here in the office, we call it BRPT two-point-oh.  And as we roll that out over the coming weeks and months, we’ll keep listening to you and fine-tuning things along the way. So thank you for voicing your comments, concerns and most importantly your support as we enter the New Year. 

Jim Magruder
BRPT Executive Director

Wednesday, July 11, 2012

The First Step Is To Ask The Right Questions

Six months into my tenure as BRPT President, I’ve spent considerable time delving into exam statistics and data, trying to understand what influences the pass rate and perception of difficulty of the RPSGT exam.  Unfortunately, my investigation just leads me to more questions instead of answers.  For instance, why is it, time after time, RPSGT candidates who have another health care credential have the highest overall pass rate on the RPSGT exam?  Is it because they have more education or work experience in health care, or they are better test-takers, or could it be they know how to prepare better for a certification examination?  Why is it two individuals who go through the same associate’s level education program, and receive the same information, can perform differently on the exam, one passing and another failing?   Why is it students from one education program can have a consistently high pass rate while students from another can have a consistently low pass rate?  Could it be there is a difference in education courses, or instructors, or maybe the motivation or educational readiness of students accepted into the programs?   Why is it that individuals with on-the-job training, supported by on-line education modules, consistently have the lowest pass rate on the RPSGT exam?  And why is it that nearly 50% of test takers find the RPSGT exam fair or even too easy, while the other 50% say the exam is too difficult?

An investigator should have a hypothesis.  My hypothesis is that the RPSGT exam is not unrealistically difficult.  I think there are many factors contributing to the perception of difficulty and the pass rate of the exam.  I am not convinced there are significant flaws in the design or content of the RPSGT exam.  As a reputable certification agency, the BRPT builds an examination that is relevant to large numbers of people with varied backgrounds and education.  It offers examinations using strict security measures.  It recruits subject matter experts from all around the country, with differing backgrounds, education, and work experience.  BRPT brings subject matter experts together to work face-to-face, sometimes spending-literally-hours on one exam question before it is approved for use on the examination.  BRPT uses psychometricians and statisticians to balance the level of difficulty for each exam form, and to evaluate each and every exam question for reliability and validity, looking for items that need to be double checked for accuracy or even re-worked for better clarity.  As a nationally – and internationally –respected credentialing organization, the BRPT builds the exam against a blueprint of a job description that is created from a statistically reliable survey of technologists working day to day in the field as RPSGTs, a survey that is repeated at least every 5 years, sooner as the field changes rapidly, to keep the exam relevant.

BRPT works very hard to put together the RPSGT certification examination based on current testing guidelines and standards.  Is the exam difficult?  For some it is, for others it is not.  Can the RPSGT exam be improved?  Absolutely!  BRPT is continually evaluating and reevaluating exam options and processes to incorporate positive changes and enhancements.  The RPSGT exam is a good, sound exam.  It is an exam prepared for sleep technologists by sleep technologists.  During my term as President I hope to prove or disprove my hypothesis.  I think I can do this by drilling down deeper into the data we collect, by looking at similar certification organizations, issues of professional readiness, and factors that affect learning.   As we begin the process to conduct a new Job Task Analysis for the RPSGT exam, I can assure you these questions will remain at the forefront of our discussions.

Cindy Altman, RPSGT, R. EEG/EP T.
BRPT President