Presentation given by Anglee Leviner at the 2012 Carolina Sleep Society Fall Meeting. Page 26 note: "I have heard countless times the point driven home that the RST isn’t ‘real’ or isn’t ‘legitimate’ or other similar phrasings because it’s not NCCA accredited. I’m going to go ahead and remind you guys that the BRPT exam gained NCCA accreditation in 2002, and many, many technologists were credentialed by the BRPT 2 years prior to that and the years they were still within the APT, and to continue insisting the passing of an unaccredited examination is somehow less or unacceptable is to say that a large number of very qualified and experienced sleep professionals have an RPSGT credential that is somehow less than everyone credentialed after 2002. As the time table it took the BRPT to gain NCCA accreditation hasn’t passed yet, it’s only fair to give the ABSM an equal amount of time to accomplish this task."

1. New Developments For
the RST Credentialing
Exam
Information for the Sleep
Technologist, and answers to
pressing questions.
Presented by: Anglee Leviner, RPSGT, RST
September 6th, 2012

2. AAST Mission & Vision
Mission
 To promote and advance the sleep technology profession through the continued
development of educational, technical and clinical excellence in sleep disorders
Vision
 To preserve the autonomy and future of the sleep technology profession by
providing educational and professional pathways with innovative
approaches that promote professional growth and development
Values
 Make a difference in the quality of care provided by our members
 Respond to our members needs with service programs founded with integrity
 Provide quality products and services
 Conduct business in an ethical and professional manner
 Be accessible and accountable to our members
 Treat individuals with compassion, respect, dignity and fairness
 Value individual contribution in an atmosphere of teamwork and collaboration
 Encourage open communication and welcome diversity of opinions

3. History of the American Board of
Sleep Medicine
 Began in 1978 as a committee of the American Academy of Sleep
Medicine. (Just like the BRPT was once an APT committee)
 First examination for sleep medicine specialists given under the
direction of Mary Carskadon, Ph.D., Christian Guilleminault, M.D.,
Peter Hauri, Ph.D., Milton Kramer, M.D. and Tom Roth, Ph.D.
(Pioneers of the industry and field we have the pleasure of working
in)
 Twenty one sleep medicine specialists sat for the first examination
window.

4. History of the American Board of
Sleep Medicine
 ABSM was established as an independent entity in 1991.
 As a self-designated board the ABSM was unable to attain
Medicare and private insurer recognition of sleep medicine in
many states.
 There was a designed effort to transition fellowship training
programs to the Accreditation Council for Graduate Medical
Education and certification to the American Board of Medical
Specialties.
 The ABMS (American Board of Medical Specialties) examination
in sleep medicine reflects maturation of the field and has led to
enhanced recognition of sleep specialists by insurers and the
public as well as financial support from the medical
establishment.

5. ABSM Organization

6. Executive Board
 The 10-member Executive Board
of the ABSM consists of
distinguished sleep medicine
physicians in education, research
and clinical practice; behavioral
sleep medicine specialists in
research and clinical practice; and
sleep technologists active in the
profession.

7. Board of Directors
 Nathaniel F.Watson, MD  Sam A. Fleishman, MD
(President) (Member-at-Large)
 Timothy I. Morgenthaler, MD  Susan Redline, MD
(Secretary-Treasurer) (Member-at-Large)
 Amy Aronsky, DO  Ilene Rosen, MD
(Member-at-Large) (Member-at-Large)
 M. Safwan Badr, MD  Steven A. Shea, PhD
(Member-at-Large) (Member-at-Large)
 Ronald Chervin, MD  Patrick J, Strollo Jr., MD
(Member-at-Large) (Member-at-Large)
 Nancy A. Collop, MD  Merrill Wise, MD
(Member-at-Large) (Member-at-Large)
**Per 2011 990 IRS form

8. RST Exam Committee
 The American Board of
Sleep Medicine’s
(ABSM) Sleep
Technologist Registry
Examination was
developed by a Sleep
Technologist
Examination
Committee comprised
of senior members of
the sleep technology
profession and the
sleep medicine field.

9. Examination Development
 Labs hire technologists based on a set of specific criteria
and competencies. These may vary from organization to
organization. Ultimately, those doing the hiring decide
what competencies they expect from their potential staff
choices.
 CAAHEP programs and other educational sources devise
programs which instruct students on these required
competencies.
 Exam writing committee drafts questions which verify the
successful understanding and application of these required
competencies.
(You’ve all seen the dog diagram?)

10. More than one way to skin a cat?
BRPT Samples technologists ABSM surveys management to
via a job task analysis, which determine what competencies
is used to determine the they expect technologists to
most relevant topics to test possess in order to be
the competency of employed. Then ensure these
examination applicants. competencies are being
covered in course curriculums,
and draft examination
(This may have an inherent hindrance
of stagnating change and preventing
questions to test those
the evolution of the field.) competencies.
(Some are concerned with the efficacy
behind contacting an appropriate
cross-section of employers in this
method.)

11. Subjectivity
Opinions
are
not
always
mutually
exclusive!

12. What’s different about the
RST exam?
“The blueprint of the ABSM exam will reflect the skills that
are taught by CAAHEP-accredited sleep technology
programs, focusing uniquely on the day-to-day professional
responsibilities of sleep technologists in the sleep center
setting. Written by an expert examination committee, the
exam questions will place a strong emphasis on practical
clinical relevance, which will make the exam an effective
gauge of a candidate's immediate readiness to assist in
the education, evaluation, treatment, and follow-up of
sleep disorders patients.”
--Nathaniel F. Watson, MD, MSc
(Full article found on
http://www.sleepreviewmag.com/issues/articles/2011-06_07.asp)

13. What’s different about the
RST exam?
“The Sleep Technologist Certification Examination was created
because the ABSM had a desire to align the educational offerings
of CAAHEP-accredited sleep technologist training programs with
the material that's tested, and have those two things dovetail with
the real world job description of a sleep technologist. We're trying
to marry these three things: the technologist's job, the sleep
technologist's education that is currently being offered to
train these individuals to perform the job, and to have the
test be on material that's consistent with those two
entities.
We're astutely interested in making sure that our test is
consistent with the job that the technologists do and with the
training that they get. For a technologist who is interested in
getting a credential that is just representative of those aspects of
their career, then our credential would be the one for them.
We're not interested in testing things that are outside the
scope of work of a technologist. We don't have
expectations for technologists to understand aspects of
sleep medicine that are outside the scope of their job.”
-Nathaniel Watson, MD

14. Practical VS Theory
Examples of Practical Examples of Theory
 Electrode placement  CO2 retention in OHS patients
 Correct filter settings  Use of dead space to improve
 Titration protocols gas exchange
 Patient education  Normal ranges of blood gases
 Trouble-shooting low-quality  Hypercapnic/Hypocapnic
signals  Optimal tidal volumes
 Stage identification  Thalamic functions
 Scoring per AASM guidelines  Effects of Bi-polar disorder on
 Application of O2 per doctor’s sleep
orders.  Pharmaceutical effects on
sleep

15. I failed the NC DMV practice theory
test…
I can’t pass the written,
but I can nail a K-turn
and parallel park (barely)
on the road test, so HA!

16. Why should we have two
exams?
“When we reflect, we are guided by our knowledge
of truths about the world. By contrast, when we
act, we are guided by our knowledge of how to
perform various actions. If these are distinct
cognitive capacities, then knowing how to do
something is not knowledge of a fact — that is,
there is a distinction between practical and
theoretical knowledge.” -Jason Stanley, “The Practical and the
Theoretical”
“I can’t explain to you how or why it works, but I
can perform the task correctly every time.” Says
the employee.

17. RST Pathways
 Graduates of CAAHEP or CoARC programs.
 A-STEP introductory program and modules with on-the-job
training.
Minimum experience in an AASM-accredited sleep center includes:
 1. Independent performance of 50 overnight sleep studies
 2. Of the 50 overnight sleep studies, a minimum of 20 must include CPAP titration
 3. Performance of one Multiple Sleep Latency Test
(The experience must be obtained over a minimum of 6 months and a maximum of 3 years.)
 Health Professionals
Medical degree, Doctoral level degree, Physician Assistants (Pas), Nursing degree (RN or LPN);
Allied health credential including Respiratory Care (RRT, CRT), Electroneurodiagnostics (R.EEG.T.,
R. EP.T, CNIM); Paramedic (EMT-P); or Radiology (RT, RT(R), RT(CT), RT(BD))
Minimum experience in an AASM-accredited sleep center includes:
 1. Independent performance of 25 overnight sleep studies
 2. Of the 25 overnight sleep studies, a minimum of 10 must include CPAP titration
 3. Performance of one Multiple Sleep Latency Test
 4. Participation in one quarter (3 months) of the center’s inter-scorer reliability meeting
the center’s minimal standards for concordance with the gold standard scorer

18. Why Grandfathering?
Grandfather Clause:
“Any policy or rule that exempts a group of
individuals, organizations, or drugs from
meeting new standards or regulations—
e.g., when a new subspecialty board in
internal medicine is created, the physicians
practicing in that area may be
‘grandfathered’ into the subspecialty and
not required to meet residency or other
educational requirements.”
(‘Concise Dictionary of Modern Medicine’ by Joseph Segen)

19. Why AASM-accredited sleep
centers?
Quality control!
How else can the proper
application of AASM
standards be proven?
Requiring experience from
labs already monitored by
the AASM prevents
continued spread of
improper practices and
incorrect training.
Are panda bears part of the recommended
Standards and Guidelines?!

20. Examination Statistics
 The first RST examination was offered on
November 11, 2011
 Nineteen applicants met the eligibility
criteria and sat for the examination
 Sixteen candidates passed the
examination and earned the RST
credential

21. The Testing Science
The ABSM is utilizing an independent statistician from
the University of Illinois at Chicago to review
examinations for data integrity and to determine the
cut point (passing score) for exams and question
reliability.
A point by serial formula to determine questions with
poor reliability is being used. Questions where exam
takers are either correct or wrong 90% of the time are
removed from the exam question bank.
The ABSM discarded 7 questions from the 2011 RST
examination due to this formula. This will keep
questions which are both too easy and too difficult out
of the examination permanently, providing perpetual
improvement of the exam content.

22. Who is involved?
 A broad representation of stakeholders is included in the
examination process.
 The Sleep Technologist Examination Committee is
composed of senior members in the fields of Sleep
Technology and Sleep Medicine.
 An Advisory Committee reviews the content of the
examination and the statistical analyses used to determine
cut points and retention of questions.
 The Advisory Committee includes trainees, active Sleep
Technologists, Sleep Technology educators, employers of
Sleep Technologists, Sleep Medicine specialists and patient
representation. The examination process is constantly
under review in order to insure a fair and balanced
outcome.
(ABSM Candidate Handbook)

23. What’s next for the RST?

24. Future Planning
In 2011 the ABSM convened the Sleep Technologist
Examination Committee to develop examinations that
certify:
 That successful candidates are prepared to begin training for a
career in Sleep Technology and;
 At the conclusion of the training are qualified to serve as Sleep
Technologists.
These examinations are the Certified Sleep Technologist
Trainee Examination and the Sleep Technologist Registry
Examination.

25. Test Planning
 Question writing session this summer to evaluate
examination and write new questions.
 The next RST examination window will be offered
August 11 – September 7, 2012.
 Examination will be 150 questions over 4 hours.
 The examination will be web-based and offered at
a host site of their testing partner, Kryterion.

26. Will the RST be a real boy?
NCCA Accreditation!
 The ABSM is a member of the Institute for
Credentialing Excellence (ICE).
 The ABSM has stated their plans to apply
to ICE for NCCA certification.
 The ABSM states they will submit a letter
of intention.
 ***

27. RST Replacing the RPSGT?
How does the development of the new exam
impact my RPSGT credential?
-It does not. The RPSGT credential is held by over 17,000
technologists in 32 countries. It is recognized in state
legislative and regulatory language in a number of states; it
is incorporated into a range of CMS reimbursement
guidelines. It is widely recognized and respected in the
broader sleep community, accredited by NCCA, and fully
supported by BRPT. -(BRPT FAQ)
We need a practical-oriented exam beside a theory-oriented
exam, this allows those who are abnormally weak on one or
the other a second option to gain their credential.
So, let us credential people who know how to do their job,
and let us promote people who know why they do their job.

28. Who’s right, or who’s wrong?
Is the wrong question.
This isn’t a competition.
Let go of a natural fear of change; block out
your predispositions; and assess the actions,
quality and efficiency of the ABSM
examination on it’s own merit.