As the responsibilities and duties of sleep technologists become more demanding, curriculum development and standardization will become increasingly more critical for the ongoing development of the profession

photoThe development of a standardized curriculum with minimum education requirements for polysomnographic technology has been a growing concern for educators, researchers, and professional societies associated with the field of sleep diagnostics. However, the development of such a curriculum has been an arduous process. The increase in public awareness of sleep disorders spearheaded by the National Sleep Foundation over the past several years has led to an enormous increase in the demand from the general public for sleep testing. This phenomenon, coupled with unregulated reimbursement, has led to an explosion of sleep disorders centers and laboratories in both the public and private sectors. However, educational strategies focusing on training technologists, physicians, and sales personnel have lagged far behind this growth. As a result of the lack of educational standards, sleep technologists in many areas of the country have met with resistance in their efforts to be recognized as equals among licensed health care professionals, such as respiratory therapists and members of other allied health occupations. This may relate partly to the lack of a single educational route and a single, standardized curriculum. Yet reform efforts are being made to create greater standardization. As the responsibilities and duties of the sleep technologist become more complex and demanding, curriculum development and standardization will become increasingly more critical for the ongoing development of the profession.

The Disparity
Perhaps the matter of increased status for sleep technology is contingent on whether it has attained enough momentum and power to overcome the barriers to further professionalization, such as a nonstandard curriculum and a serious workforce shortage. Historically, most sleep technologists are trained in a laboratory using an apprenticeship method of instruction. This method of education is very similar to the on-the-job training employed by other health professions in their infancy. Only recently have formal training facilities, such as the School of Sleep Medicine at Stanford in 1989 and the Atlanta School of Sleep Medicine in 1992, been formed with specific programmatic goals for training sleep technologists. However, even though training programs have proliferated in the past decade, there remains a distinct undercurrent of incongruity among these programs. Variations in curriculum are readily apparent when one takes a closer look at the programs. In comparison to each other, the training programs exhibit broad variations in didactic, laboratory, and clinical practice components of their curricula. The length of training, for example, ranges from 3-day workshops to more formal 2-year programs. In addition, several programs are distance-based. The disparity in training programs combined with the lack of minimum training guidelines and procedural standards makes educational outcomes difficult to measure and compare from one program to another, not to mention being confusing for the prospective student.

Compounding the curricular issue and ultimately the technologists’ efforts to increase the prestige of the occupation is another kind of challenge. The national shortage of sleep technologists, acute in both urban and rural areas, has altered the dynamics of polysomnographic technologists’ efforts at professionalization. The implications are twofold. On the one hand, the shortage has put a premium on skilled technologists, especially those that hold the RPSGT credential and those with laboratory management experience. On the other hand, since there are fewer sleep technologists who can meet the demands of the field, many physicians and sleep laboratory managers are desperate to train anyone to perform those duties. This influx of entry-level personnel, trained using a nonstandardized curriculum and varied instructional strategies, has only exacerbated efforts to achieve a higher status and reputation among peers.

f05b.jpg (7852 bytes)What is Needed
The learning-through-work model, although useful as an instructional technique, is losing its attractiveness as the exclusive means of providing a standardized, formal education. Nonetheless, it must be recognized that formal education and training of students in the field of polysomnographic technology require atypical instructional strategies. For example, most of the clinical training involves exposure time during nontraditional school hours—evening and overnight. With these points in mind, curricular reform strategies must be established. The instructional plan, including curriculum content and length, and documentation of student progress must be designed to enable achievement of program goals and objectives. Instruction must be based on a structured curriculum, which includes learning goals, course objectives, and competencies required for graduation. Curricular content must be periodically reviewed and revised to reflect material covered in the national credentialing examination administered by the Board of Registered Polysomnographic Technologists (BRPT). The BRPT periodically publishes “content matrices” for its examinations, which can be used as benchmarks in curricular development since the matrix is developed from extensive national and international job task analysis surveys. Faculty should utilize continuing education and other educational opportunities to maintain and upgrade their professional, instructional, and administrative abilities. Both physical and human resources must be adequate to fulfill the needs of the program. Learning and clinical resources must be appropriate to the program’s goals. The curriculum must support student utilization of these resources. Physician input must also be adequate by depending only on physicians boarded in sleep medicine. In addition, there must be a reliable and carefully designed evaluation system that meets the objectives of the curriculum. Program competencies should provide the basis for developing the objectives and activities integral to the curriculum. The competencies stated and the curriculum objectives derived should be consistent with the level of practitioner preparation delineated in the program’s goals, and should encompass the knowledge, technical expertise and behavior expected of graduates. A clear description of the curriculum, including learning goals, course objectives, and competencies required for graduation, must be established based on expected clinical practice. The curriculum must include an appropriate sequence of learning experiences consisting of classroom and laboratory presentations, discussions, demonstrations, and supervised laboratory and clinical practice. Clearly written course syllabi that describe learning objectives and competencies must be developed for each of the didactic, laboratory, and clinical components. These strategies mentioned are representative and are not meant to be exhaustive.

Efforts Being Made
The Association of Polysomnographic Technologists (APT) has made important strides in helping to further the educational interests of sleep technologists and the practice of sleep medicine. The APT is examining the possibility of certifying and possibly even accrediting educational programs in an effort to institute and maintain standards. The APT has formed a steering committee consisting of representatives from the American Academy of Sleep Medicine (AASM) and the BRPT, with collaboration and input from the American Society of Electroneurodiagnostic Technologists (ASET) and American Association for Respiratory Care (AARC) to address these educational issues. The steering committee will oversee several task forces. These task forces will investigate such areas as categorizing ideas, developing databases, conducting surveys of educational courses in respiratory care, promoting electroneurodiagnostic and polysomnography schools, impacting continuing education, educating sleep students, and developing a standardized curriculum, texts, and grants for educational media. Pamela Minkley, RPSGT, RRT, CPFT, chair of the APT Curriculum Steering Committee, states, “One of the things we will be looking very seriously at is changing our direction from ‘technologists’ to ‘practitioners.’ I have a sense that sleep is going to blossom very quickly and gain legitimacy with the medical, technical, and insurance world. The growth curve is steep now. There clearly won’t be enough personnel to meet those needs. I think we can respond more quickly than medical schools to provide a way to fill the gap. We need to be ready for tomorrow!” Regarding how to deal with these issues, she remarks, “We are having difficulty figuring out just how to endorse or qualify courses and seminars. We need a good continuing education program, but a curriculum is usually associated with university credit programs. Yet, if credentialing bodies require CEUs to maintain or as a gate to obtain their credential, there has to be a way to issue CEUs appropriately. The big issue is that the APT doesn’t want to imply in any way that a few CEUs or a short course adequately prepares someone to be competent on the job.” The APT Curriculum Steering Committee is currently looking for input from educators, clinicians, industry representatives, and researchers who have any information on or experience with sleep training programs. In addition, the APT has made an appeal to individuals interested in serving on the steering committee or one of the work groups to come forward and get involved.

Without reiterating the importance of formal education for professional development, it is worth noting several aspects surrounding the issue of curricular reform in polysomnographic technology. The field of sleep diagnostics has seen an increase in demand for sleep center services recently, without a corresponding increase in the number of qualified technologists or sleep physicians. Until now, there have been limited efforts to oversee education programs that have emerged. Establishing standards that will be the minimum measures of quality in programs that prepare individuals to enter the field of polysomnographic technology is necessary. These standards will become the minimum requirements to which a sleep training program will be held accountable. Once these standards have been established, other critical issues such as the current lack of textbooks specifically related to polysomnographic technology can then be addressed. The need for quality educational materials in polysomnographic technology has been well established in the educational arena and in the performance on the professional registry examination. The development of a standardized curriculum will serve as a framework and a foundation for these educational materials. Dissemination of these materials is paramount.

If this idea becomes a reality, the examination of the issues presented above will have provided an excellent context within which to further explore the important issues to consider in the development of a standardized curriculum in sleep technology. Educational upgrading is not an easy, simple, or quick process. Although the question of whether a sleep technology program should exist solely as a formal, integrated, degree-granting institution is still debatable, the professional payoff of increased educational requirements, for both entry and continuing practice, seems to be considerably more legitimate and consistent with growth in other new medical fields.

Thomas R. Smalling, MS, RRT, RPFT, RPSGT, is clinical assistant professor of the Respiratory Care Program at SUNY at Stony Brook, NY. He is also president-elect of the New York State Society for Respiratory Care and a member of Sleep Review’s Editorial Advisory Board.