This article previously ran in the Q1 2023 issue of A2Zzz.
A Bit of History
Respiratory disorders have been recognized for centuries with the creation of oxygen cylinders in 1868, and the first documented acute care use of oxygen in 1885.1 The earliest respiratory care education programs began in the 1940s2 and by 1960, the growing field of “inhalation therapists” necessitated the formation of a formal credentialing organization (now known as the National Board for Respiratory Care [NBRC]). With nearly 25,000 candidates tested each year, the organization has become a leader in industry credentialing, and every state which regulates the practice of respiratory care recognizes NBRC credentials for state licensure.
As with other health care professions, such as nursing, respiratory therapists (RTs) have been recruited into specialty areas in and out of the hospital setting where their skills and knowledge are valuable. RTs have branched out further than the pulmonary function lab and can be found caring for home ventilator patients, leading a pulmonary rehab program or even running an extracorporeal membrane oxygenation (ECMO) machine. With the push to increase efficiencies in modern health care, sleep labs have emerged from RT departments hoping to utilize their existing staff while offering a new service to the community.
As the sleep medicine field expanded in the early 2000s, RTs already on the front lines in hospitals were tapped to fill these roles. In 2006, the American Association for Respiratory Care (AARC) responded to their members entering the field of sleep medicine by submitting a formal request (with support from the American Thoracic Society [ATS], the American College of Chest Physicians [CHEST] and the American Society of Anesthesiologists [ASA]) to the NBRC for the development of a specialty credential, ultimately known as the Sleep Disorders Specialist (SDS).3 The new exam would objectively measure the knowledge and skills of RTs who perform sleep disorders testing and therapeutic intervention, while keeping all credentials under the NBRC umbrella. This would ensure RTs could display proficiency in multiple specialty areas (adult critical care, neonatal/pediatrics, sleep disorders specialist and asthma educator) within one organization and credential maintenance program.
Over the past 60 years, the NBRC has perfected a system of exam development, which is recognized as a standard in the industry, and the process used to develop the SDS credential. The proven five-step process begins with a request from an outside agency for the development of an examination, continues through a viability study to ensure a desire for the credential exists, moves on to a personnel study to assess candidate volumes and uniform practice and then moves on to a job analysis (JA) to ensure exam content is relevant to current practice. Each part of this process is carefully completed in a stepwise approach to ensure a high-quality exam, which is predictive of job performance.
Once it was determined an SDS examination would proceed through the development process, the NBRC assembled an examination committee of subject matter experts. The committee was comprised of both credentialed RTs and physicians working in the respective field who met regularly to develop examination content. The examination content was developed by item writers, reviewed by the examination committee — at least twice — and finally added as pre-test items on test forms (not counting toward final scores) to ensure items performed well.
To ensure SDS examination content remains relevant to current practice, a new JA is completed. This JA forms a detailed content outline, which guides the test form developed by the examination committee.
In 2021, the SDS JA survey containing more than 250 individual tasks from five content areas was disseminated to over 5,000 individuals from five professional organizations. Responses were received from sleep professionals working in hospitals, independent labs, durable medical equipment (DME) companies, clinics and peri-operative programs in multiple countries.
Responses were analyzed across multiple areas, including geographical region, job role, work setting, lab size and number/type of studies performed, years of experience, educational degree, credentials, gender and race. An opportunity for additional free text responses was also included. This analysis ensured exams were free from bias and encompassed content that was critical to job performance.
More than 98% of respondents indicated the tasks surveyed adequately covered the five content domains (pretesting, sleep disorders testing, study analysis, administrative functions and treatment plan). Over half of the respondents indicated they work in areas other than direct sleep disorders testing revealing the continual evolution of sleep medicine.
During the 2021 SDS JA, AAST graciously forwarded the NBRC questionnaire to its membership resulting in over 140 completed responses. This input has assisted in shaping the future of the SDS exam by ensuring a broad, comprehensive perspective from RTs and sleep technologists working in the trenches of sleep medicine.
Admission requirements for the SDS exam take into account the clinical experience and baseline knowledge of sleep disorders included in RT educational programs. A registered respiratory therapist (RRT) with three months of work experience and a certified respiratory therapist (CRT) with six months of experience can apply to sit for the SDS exam. Exam fees are $300 for new applicants and $250 for reapplicants. RTs planning to sit for the SDS exam are strongly encouraged to assess their readiness by completing the practice and self assessment exams available online.
The NBRC invested in the formation of a credential maintenance program (CMP) patterned after physician programs such as the MOCA Minute for anesthesiologists.4 Since 2020, this online program has allowed RTs to display continuing competence through completion of quarterly, practice-related questions centered on areas that are high risk and/or high pace of change. The CMP for the SDS credential requires the completion of five online questions per quarter, is included in the $25 annual NBRC maintenance fee ($125 total for the five year renewal period) and replaces the need to earn and track continuing education units (CEUs).5
The NBRC strives to have the SDS as the preferred credential for RTs working in the field of sleep medicine. Endorsed as the main scoring technologist for American Academy of Sleep Medicine (AASM) sleep lab accreditation,6 and included on Centers for Medicare and Medicaid Services (CMS) local coverage determinations related to sleep testing,7 the SDS will continue to signify excellence in the field of sleep medicine. The SDS is also accredited by the National Commission for Certifying Agencies (NCCA), the same accrediting body for the Registered Polysomnographic Technologist (RPSGT) exam,8 to ensure the highest standards when preparing and conducting each credentialing examination so that the credential continues to meet or exceed all regulatory and licensing requirements. RTs wishing to learn more about the SDS credential are encouraged to explore the resources on the NBRC website.³
- Heffner JE. The Story of Oxygen. Respiratory Care Journal. 2013;58:18-31
- American Association for Respiratory Care. Timeline and History webpage. https://www.aarc.org/aarc/timeline-history. Accessed 4 Feb 2023.
- National Board for Respiratory Care. Sleep Disorders Specialty webpage. https://www.nbrc.org/examinations/sds. Accessed 4 Feb 2023.
- The American Board of Anesthesiology. MOCA Minute webpage. https://www.theaba.org/maintain-certification/moca-minute. Accessed 4 Feb 2023.
- National Board for Respiratory Care. Credential Maintenance Program webpage. https://www.nbrc.org/credentialed-practitioners/#credential-maintenance. Accessed 4 Feb 2023.
- American Academy of Sleep Medicine. Technical Staff Fact Sheet webpage. https://aasm.org/accreditation/resources/technical-staff-information. Accessed 4 Feb 2023.
- American Academy of Sleep Medicine. Medicare Policies webpage. https://aasm.org/clinicalresources/coding-reimbursement/medicare-policies. Accessed 4 Feb 2023.
- Institute for Credentialing Excellence. Accredited Program Search webpage. https://ice.learningbuilder.com/Search/Public/MemberRole/ProgramVerification2?model.Organization=National+Board+for+Respiratory+Care&model.Accrediation=NCCA&model.ProgramAcronym=&model.ProgramName=&performSearch=true&_o=&_d=&_p=&_s=20. Accessed 4 Feb 2023.