1. Tom Smalling, PhD, RRT, RPFT, RPSGT, FAARC Executive Director
CoARC Update
Commission on Accreditation for Respiratory Care
Update on Standards for Degree Advancement Programs
Tom Smalling, PhD, RRT, RPFT, RPSGT, FAARC Executive Director

2. Conflict of Interest
I have no real or perceived conflict of interest that relates to this presentation. Any use of brand names is not in any way meant to be an endorsement of a specific product, but to merely illustrate a point of emphasis.

3. Objectives The presenter will
Describe CoARC activities regarding development of standards for Degree Advancement Programs,
Describe advantages for seeking voluntary accreditation for Degree Advancement Programs, and
Discuss possible models for offering this type of program.

4. Purpose of Programmatic Accreditation
CoARC Update
11/16/2009
Purpose of Programmatic Accreditation
To hold respiratory care programs accountable to the community of interest — the profession, consumers, employers, students and their families, practitioners— and to one another by ensuring that these programs have goals and outcomes that are appropriate to prepare individuals to fulfill their expected roles;
To evaluate the success of a respiratory care program in achieving its goals and outcomes;
To assess the extent to which a respiratory care program meets accreditation standards;
To foster continuing improvement in respiratory care programs — and, thereby, in professional practice.
Programmatic accreditation conducts an in-depth assessment of specialized or professional programs at a college, university or independent institution.
Institutional accreditation reviews academic and organizational structures of a college or university as a whole.
Accreditation offers a mark of distinction for academic programs and institutions, signaling high quality and a commitment to excellence. Similarities and differences in the two types of accreditation are detailed below.
Programmatic Accreditation (sometimes known as specialized or programmatic accreditation) only encompasses the professional standards of specific program, department, unit or a school that is a subset of a big institution. That means that if a specific program offered by a department/institution is accredited by a specialized accreditation body; it doesn’t mean that the other programs of the same department or institution will also be accredited. Since programmatic accrediting agencies focus on a single program, their approval is required in their associated industry.
Institutional or regional accreditation encompasses the whole institution. It is achieved by the college or university that meets the quality standards and comply with the requirements set by the accreditation body. Before being granted the institutional accreditation status, all aspects of a college or university are evaluated. 
2009 AARC BOD Meeting

5. Definition of Degree Advancement
CoARC Update
11/16/2009
Definition of Degree Advancement
A degree advancement program is an educational program designed specifically to meet the needs of the practicing respiratory therapist with an RRT who, having already completed an accredited respiratory care program with an entry into respiratory care professional practice degree wishes to obtain advanced training in respiratory care.
The Degree Advancement Standards are designed to recognize the competencies and value-added above and beyond the entry into respiratory care professional practice degree.
Entry into respiratory care professional practice degree programs offering an advanced degree to individuals who already have an ASRT or BSRT can apply for accreditation of their degree advancement program.  Sponsors offering a free-standing degree advancement program can also seek accreditation review.
Degree advancement programs are different from entry into respiratory care professional practice programs in purpose, design and content. Entry into Professional Practice programs prepare individuals with no respiratory care professional background or experience with the competencies needed to enter the profession, whereas degree advancement programs expand the depth and breadth of the applied, experiential, and propositional knowledge and skills beyond that of an RRT entering the profession. 
Degree advancement programs provide an essential pathway for associate degree- and baccalaureate degree-prepared therapists who wish to expand and enhance previous knowledge and advance in their careers. Associate-to-baccalaureate and baccalaureate-to-master’s degree programs build on entry knowledge and competencies with course work to enhance professional development, prepare for a broader scope of practice, and provide a better understanding of the cultural, political, economic, and social issues that affect patients and influence care delivery.
2009 AARC BOD Meeting

6. Degree Advancement vs Entry Into Profession
CoARC Update
11/16/2009
Degree Advancement vs Entry Into Profession
Degree advancement programs are different from entry into respiratory care professional practice programs in purpose, design and content.
Entry into Professional Practice programs provide individuals with no respiratory care background or experience with the competencies needed to enter the profession, whereas degree advancement programs expand the depth and breadth of both knowledge and skills beyond that of an RRT entering the profession. 
Advanced educational experiences, designed to enhance a respiratory therapist's ability to function in clinical, teaching, administrative, or research environments, are essential components of degree advancement programs in respiratory care
2009 AARC BOD Meeting

7. Degree Advancement Program Development
CoARC Update
11/16/2009
Degree Advancement Program Development
Development of an effective degree advancement program requires a thorough assessment of those education experiences typically offered at the entry into respiratory care professional practice degree level.
Degree advancement programs will then be able to use this foundation to develop new, advanced, in-depth educational experiences designed to enhance the respiratory therapist's professional practice.
Degree advancement programs provide an essential pathway for associate degree- and baccalaureate degree-prepared therapists who wish to expand and enhance previous knowledge and advance in their careers. Associate-to-baccalaureate and baccalaureate-to-master’s degree programs build on entry knowledge and competencies with course work to enhance professional development, prepare for a broader scope of practice, and provide a better understanding of the cultural, political, economic, and social issues that affect patients and influence care delivery.
2009 AARC BOD Meeting

8. CoARC Update
11/16/2009
Program Eligibility
To become accredited by the CoARC, degree advancement programs must be established either in accredited postsecondary institutions, by a consortium of which one member must be an accredited postsecondary institution, or in facilities sponsored by the U.S. military (as defined in Standard DA1.1).
All degree advancement students must be graduates of a CoARC-accredited entry into respiratory care professional practice degree program prior to entry into the program.   
A CRT to RRT Completion Program is an educational program designed especially to meet the needs of the practicing respiratory therapist who, having already completed an accredited (100-level) respiratory care program is returning to school to complete program (200-level) requirements in order to meet eligibility requirements of the NBRC RRT examination. Emphasis in CRT to RRT completion programs is placed on teaching the didactic, laboratory, and clinical competencies required of a registered respiratory therapist. CRT to RRT students must be classified as Advanced Placement (AP) in the CoARC Annual Report of Current Status and will be counted towards the maximum annual enrollment. A sponsor that offers a CRT to RRT completion program AND an Entry into Respiratory Care Professional Practice degree program must provide the CoARC with an explanation of any discrepancies between the NBRC Annual School Summary and Annual Report of Current status as a result of offering both programs. The CoARC may request a Credential Verification letter from the NBRC, a copy of the CRT certificate issued by the NBRC or a report from the NBRC showing the name of each individual student receiving the CRT credential as evidence of students attaining the CRT credential prior to enrollment in a program.
2009 AARC BOD Meeting

9. Standard 1 – Program Administration and Sponsorship
CoARC Update
11/16/2009
Standard 1 – Program Administration and Sponsorship
Institutional Accreditation
Consortium
Sponsor Responsibilities
Substantive Changes
Institutional Accreditation – baccalaureate or higher upon completion; regional or national accreditors – no organizational chart
Consortium – two or more entities get together to offer the program; responsibilities outlined for each member
Sponsor Responsibilities – expanded; transfer of credit; gen ed; didactic; lab; optional clinical
Substantive Changes – Section 9 of P&P Manual
2009 AARC BOD Meeting

10. Standard 2 – Institutional and Personnel Resources
CoARC Update
11/16/2009
Standard 2 – Institutional and Personnel Resources
Institutional Resources
Key Program Personnel
Program Director
Director of Clinical Education*
Medical Advisor
Instructional Faculty
Administrative Support Staff
Assessment of Program Resources
*Standards DA2.8 through DA2.12 are applicable only to programs that provide clinical education  as part of required coursework.  
Key Program Personnel – FT PD, DCE (no need for FT), and Medical Advisor (no need for FT)
Program Director – responsibilities, valid RRT or MD or DO, and licensed, min Master’s degree, 4 yrs as an RRT or MD (no specialty credential required), 2 yrs clinical, 2 yrs teaching, reg contact (e.g., in-person, phone, or on-line)
Director of Clinical Education - responsibilities, valid RRT, min Masters degree, 4 yrs as an RRT or MD (no specialty credential required), 2 yrs clinical, 2 yrs teaching, reg contact (e.g., in-person, phone, or on-line)
Medical Advisor– ensures direct physician interaction; Board certified and licensed and credentialed.
Instructional Faculty – sufficient faculty; appropriately credentialed
DA Clinical instructors should have at least one valid clinical specialty credential (e.g., NPS, PFT, ACCS, SDS) or board certification as recognized by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) in a specialty relevant to respiratory care.
Administrative Support Staff – sufficient to meet goals
Assessment of Program Resources – Annually with RAM
2009 AARC BOD Meeting

11. Standard 3 – Program Goals, Outcomes, and Assessment
CoARC Update
11/16/2009
Standard 3 – Program Goals, Outcomes, and Assessment
Statement of Program Goals
Advisory Committee
Student Learning Outcomes
Assessment of Program Goals
Student Evaluation
Inter-Rater Reliability
Assessment of Program Outcomes
Reporting Program Outcomes
Clinical Site Evaluation
Statement of Program Goals –
DA 3.1 The program must have the following goal defining minimum expectations: “To provide graduates of entry into respiratory care professional practice degree programs with additional leadership, management, education, research, or advanced clinical knowledge, skills, and attributes necessary to meet their current professional goals and prepare them for professional practice as advanced degree respiratory therapists.”
Advisory Committee- meet with Key Personnel at least annually to assist the program and sponsor personnel in reviewing and evaluating program outcomes, instructional effectiveness and program response to change along with addition of/changes to optional program goals;
Student Learning Outcomes– sufficient frequency/remediation; equitable; inter-rater reliability
DA3.4 IG- The program must define and make available to enrolled students and faculty the expected student learning outcomes (ESLOs ) that align with DA3.1 and DA3.2 and address the core and advanced professional competencies determined by the program as outlined in Section 4. These ESLOs must clearly articulate what students are expected to be able to do, achieve, demonstrate, or know upon completion of the program. The program shall determine direct and indirect evidence used to measure each of the SLOs.  ESLOs consistent with DA Standards.
Assessment of Program Goals – formal plan; rubrics
DA3.5 The program must establish a method for assuring that the student will accomplish all applicable competencies prior to completion of the program. For example, a declaration of intent to complete all competencies could be developed for the students to sign prior to beginning the program. Although the program must demonstrate that it is providing distinct learning experiences for each competency, the emphasis (i.e. the breadth and depth of the experiences) will vary by the focus area and professional goal of the individual.
Student Evaluation – sufficient frequency/remediation; equitable; inter-rater reliability
DA3.6- For programs providing distance education with on-line exams or quizzes as part of the evaluation process, the program must provide evidence that such testing preserves academic integrity and maintains quality and fairness.
Inter-Rater Reliability –
DA3.7 IG- The results of this process must be reviewed by the Director of Clinical Education or Program Director initially with the first year and subsequently when there are changes to NBRC exam; Standards, etc.
Assessment of Program Outcomes – annually using CoARC Graduate and Employer Surveys for Degree Advancement Programs; min thresholds (Programmatic summative measures include graduate achievement on national credentialing specialty examinations and/or program-defined summative measures of outcome performance related to ESLOs (e.g., Capstone project). For programs that choose to incorporate national credentialing specialty examinations as an outcomes measure, the outcomes data must be reported annually, however, there will be no corresponding outcomes assessment threshold.; retention/attrition, professional advancement; employer and grad satisfaction; On-time grad rates)
Reporting Program Outcomes – Programmatic summative measures should include graduate achievement on national credentialing specialty examinations (when applicable), and/or program-defined summative measures of outcome performance related to ESLOs (e.g., Capstone project). For those students undertaking specialty education in respiratory care (i.e. neonatal, intensive care, etc.) the program must use national credentialing specialty examinations as an outcomes measure and these outcomes data must be reported annually. However, there will be no corresponding outcomes assessment threshold for these examinations.
Attrition is defined as the percentage of students who enrolled in the degree advancement program but left the program prior to graduation. Students who leave the program before the fifteenth calendar day after the beginning of the first term are not included in program attrition.
Graduate and employer  satisfaction surveys shall be administered twelve (12) months after graduation.
Professional advancement requires the graduate to meet program-defined criteria related to management, advanced clinical practice/patient care, teaching, research, professional service , and/or other professional development metrics.
On-Time Graduation Rate  is defined as the number of students who graduate with their enrollment cohort (i.e., within thirty (30) days of their expected graduation date) divided by the total number of students in that class who ultimately graduated. The enrollment date and the expected graduation date of each cohort are specified by the program.  Survey: I question the value of employer surveys? We may want to consider another tool for assessment of goal completion? Also, one of the biggest advantages of a completion program is flexibility for our working professional. I do not believe that moving a class as a cohort is feasible with this educational format. Alternative graduation rate measurements may need to considered.
Clinical Site Evaluation - comparable evaluation processes
2009 AARC BOD Meeting

12. Standard 4 – Curriculum Curriculum Consistent with Program Goals
CoARC Update
11/16/2009
Standard 4 – Curriculum
Curriculum Consistent with Program Goals
Curriculum Review & Revision to Meet Goals
Professional Practice Competencies
Length of Study
Equivalency
Clinical Practice
Content NOT courses!
Curriculum Consistent with Program Goals –
DA4.1 IG - The program’s curriculum builds upon prior education and professional experiences, is congruent with the goal(s) of the program, reflects the needs and expectations of the community of interest, and is designed so that students benefit from the program. Course content must be consistent with the roles and degree requirements for which the program is preparing its graduates.
It is important for the program to individualize the curriculum by developing learning activities that allow the student to gain the skills and knowledge related to demonstrating proficiency of the chosen programmatic focus and that are compatible with the student’s career plan. These learning activities are a) the framework of the curriculum for the program, b) unique to the program, and c) designed to provide the student with experiences that will advance the student from a competent practitioner to a proficient practitioner.
Curriculum Review & Revision to Meet Goals – reviewed annually;
DA4.2 IG - Curricular content should be current and reflect the expected competencies. If credentialing examinations are used as an outcomes measure, documentation of the comparison of detailed content outlines for each course with current credentialing exam content matrices must be available.
Graduates must demonstrate proficiency with a set of knowledge, skills and attributes that are specific to the programmatic track or concentration, (e.g., clinical specialization, advanced clinical practice, education, management, research, etc.) chosen by the student.
DA4.3- Practice-Specific Knowledge  and Skills - As applicable based on his/her professional goals, graduates must pursue a course of independent study that will address the ESLOs specific to the track, concentration, or specialization they choose under the guidance of faculty. The graduate will demonstrate proficiency in his/her track, concentration, or specialization by completing a national credentialing specialty examination or program-defined summative measure (e.g., Capstone project).. 
DA4.4 – Clinical Knowledge
DA4.5 – Professional Attributes
DA4.6 – Interpersonal and Inter-professional Communication
DA4.7 – Practice-based Research
DA4.8 - Professional Leadership
Length of Study –
DA4.9-commensurate with the degree awarded and sufficient for students to acquire the expected knowledge and competencies
Equivalency – learning experiences are substantially equivalent for all students
Clinical Practice – sufficient quality and duration to meet goals; MOUs/Clinical Affiliate Agreements
2009 AARC BOD Meeting

13. Standard 5– Fair Practices and Recordkeeping
CoARC Update
11/16/2009
Standard 5– Fair Practices and Recordkeeping
Disclosure
Public Information on Program Outcomes
Non-discriminatory Practice
Safeguards
Academic Guidance
Student and Program Records
Disclosure – publications must accurately reflect program offered;
Public Information on Program Outcomes –
DA5.3 - A link to the CoARC published URL where student/graduate outcomes for all programs can be found must appear on the program’s website and be available to the public and to all applicants;
Non-discriminatory Practice – all activities of program; appeal procedures; faculty grievance procedures; advanced placement policies
Safeguards – health, privacy, and safety of those associated with educational activities and learning environment; students not used for clinical, instructional or administrative staff; internships allowed?
Academic Guidance – availability; equivalency with other students;
DA5.11 IG -Programs should assist students in formulating an individual career plan that promotes a life-long commitment to the respiratory care profession.
Student and Program Records – records for admission, advisement, and evaluation; transcripts; records on file for 5 years (electronic or hard copy), syllabi, RAM surveys, clinical affiliate agreements and schedules, program faculty and advisory committee minutes; cvs; CoARC surveys
2009 AARC BOD Meeting

14. CoARC Update
2015 DA Standards Timeline
Following November 2014 CoARC Board meeting:
Disseminate a call for comment (with Feb 1, 2015 deadline) to all communities of interest and outline the procedure for those wishing to provide input;
Revise Standards, Evidence of Compliance, and Interpretive Guidelines (incorporated into document);
Recommend revisions will be reviewed by full Board at its March 2015 meeting;
Send approved Standards to collaborating organizations for endorsement after March 2015;
Publish endorsed Standards by May 2015;
Anticipate accepting applications by July 2015.

15. Resources and Possible Models
CoARC Update
Resources and Possible Models
No single curricular model fits best:
Tailored to meet program goals, institutional mission, community needs, and student professional goals;
Programs can offer one or more specific tracks (clinical, education, research, or management);
No single, nationally-accepted competencies;
Curriculum must be primarily focused on respiratory care to meet accreditation Standards.
Majority of programs deliver curriculum through distance-based learning methods to allow greater flexibility for practicing respiratory therapists to attend classes;
CoARC maintains a list of DA programs on its website.
RESPIRATORY CARE • MAY 2010 VOL 55 NO 5
Competencies Needed by Graduate Respiratory Therapists in 2015 and Beyond

16. Questions and Answers www.coarc.com CoARC Update 11/16/2009
2009 AARC BOD Meeting