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Academic Review Department of Respiratory Therapy UTMB, School of Allied Health Sciences February 13-14, 2006

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UTMB, School of Allied Health Sciences

February 13-14, 2006

Introduction

An academic review of the Department of Respiratory Therapy, School of Allied Health Sciences at the University of Texas Medical Branch was conducted on February 13 and 14, 2006. The review was initiated and coordinated through the office of the Dean of the School of Allied Health Sciences (SAHS) and overseen by Assistant Dean Rodger Marion. The review team members were Shelley C. Mishoe, PhD, RRT, FAARC (Dean, School of Allied Health Sciences, Medical College of Georgia), Tom Hill, PhD, RRT, NPS, RPFT (Executive Director, Kettering National Seminars) and Neera Khilnani, M.D., an internal member from the School of Medicine, Departments of Internal Medicine and Pediatrics at UTMB. Dr. Jon Nilsestuen provided the team with the current self-study submitted to the Committee on Accreditation for Respiratory Care (CoARC) for the baccalaureate

respiratory therapy program for the site visit conducted last week. This document provided the committee with information about the organizational structure of the Department of Respiratory Therapy in reference to the SAHS and UTMB, as well as general information about the faculty (expertise, scholarly accomplishments, teaching and other

responsibilities, etc.), the curriculum and program evaluation, including outcome of students. The review team met with UTMB faculty from the Department of Respiratory Therapy, the SAHS Dean’s Office (Dean, Associate Dean and Assistant Dean), the department chairs in SAHS, clinical faculty, the medical director, hospital administration, employers of graduates, students, and alumni.

Charge

The charge to the review team was to critically examine the success of the Department of Respiratory Therapy on achieving status as one of the top echelon of schools in the nation (e.g., top 25) and to offer strategies to improve elements of teaching, service and research that would have a positive impact on such a ranking.

Findings

Evidence of Scholarly Teaching

a.

Ability to recruit, retain, students

The respiratory therapy program at UTMB has been relatively small having low

enrollments and very small class sizes for a number of years, consistent with past national trends. The review team wishes to commend the faculty on exemplary achievements in recruitment and retention of students, with a noted quadrupling of enrollment this past year. The student body has a broad range of educational preparation prior to entering the program and is diverse in age, race, gender, and ethnicity, with 11 out of 34 students being Caucasian (32%) and 23 of 34 students of ethnic origin (68%), including 8

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regards to retention and performance, the graduation rate is 87% and the passing rate on boards is 100%, over the past 6 years. Students had high praise for the academic support available, including the availability of the faculty to assure success of each student in the program. The review team was impressed with the school’s ability to secure endowments to permit the department to award ten scholarships ($1000/scholarship) to incoming respiratory therapy students.

b.

Reputation of the Faculty

The program has faculty with graduate level training who are actively involved in professional activites at the national level; these include national presentations and

publications in the area of ventilator graphics -see Feb 2005 Cancun Journal Conference; a nationally recognised clinical tracking system and automated outcomes survey system -DataArc; a newely proposed clinical preceptor training program to be presented at the Fall 2005 AARC meeting in San Antonio. In 1999, the faculty was invited to give the

prestigious Dr. H. Fred Helmholz Jr. Educational Lecture Series for the Committee on Accreditation for Respiratory Care Education at the annual Summer Forum of the American Association for Respiratory Care, the national meeting of educators and managers in respiratory care.

The Department Chair, Dr. Jon Nilsestuen is highly regarded in the respiratory care profession for his publications, research, professional service and innovation as noted by his recognition in the inaugural class of Fellows of the American Association of

Respiratory Care (FAARC). Dr. Nilsestuen has served in leadership roles with the

accreditation organizations for respiratory care educational programs including the former Joint Review Committee for Respiratory Care (JRCRTE) and the Respiratory Care

Accreditation Board (RCAB), as well as holding offices in the past for the current Committee on Accreditation for Respiratory Care Education (CoARC). The other full-time faculty members (Joshua Schuetz, MEd, RRT and Abdul Amin, MS, RRT) are relatively new to the program and are tremendous assets not only for their clinical and educational expertise, but also for their dedication to the success of each student. In addition, Marilyn Childers, Med, RRT, teaches 10% effort.

The research funding, publication, and presentation records of the faculty as a whole are below expectations, with the majority of this work conducted primarily by the department chair. The new faculty members have made national presentations, which should lead to publications in peer-reviewed journals. (More detailed comments follow in section 2 below).

c.

Innovative Educational Methods

There is a remarkable willingness of the faculty to undertake educational innovation, including enthusiasm for interdisciplinary learning experiences, incorporation of the Large Animal Investigational Research Lab, innovation in the tracking of student clinical

activities, and a number of specific curriculum activities:

• The dual degrees offered in Respiratory Care/Physical Therapy and Respiratory care/Physician Assistant

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• Students had favorable impressions of the interrelatedness of classroom and clinical learning.

• Development and dissemination of the DataArc is a testament to the program’s innovation in education. The DataArc system has been expanded to other respiratory care programs, surgical technology, radiography, nuclear medicine and nursing. • The Department Chair, Dr. Nilsestuen, has provided leadership within the School for

the continued development of Team IDEAL and continues to support this innovative, interdisciplinary course by offering one of the mentored projects.

• Dr. Ron Mlcak, the faculty and the staff in the Large Animal Investigational Research Lab take an active interest in the respiratory therapy students learning and seemed willing to collaborate further on additional projects, including research, to help address the scholarship of the department.

d.

Success of Graduates

The program demonstrates its commitment to achieving noteworthy educational outcomes including minimal attrition and high success of its graduates on credentialing

examinations. Feedback from employers who met with the review team was extremely positive. UTMB graduates were lauded for their communication, interpersonal and clinical skills, as well as being well-rounded. They commented that they like to hire UTMB grads and even commented on how the increased enrollment will provide a greater supply of graduates to meet growing clinical demands. UTMB currently has vacancies in their clinical department. Surveys of employers of recent UTMB grads have been positive, with 100% meeting or exceeding the cut score of 3 or better on a scale of 1-5.

Evidence of Innovative Scholarly and Scientific Accomplishments

a.

Publications in respected peer reviewed journals:

The major areas of publication reflect the program’s educational activities and are published in the Respiratory Care Journal, which include the Graphics Corner, a regular feature, and seven (7) Aerosol Clinical Practice Guidelines. Dr. Nilsestuen recently

published “The Use of Ventilator Graphics to Identify Patient-Ventilator Dyssynchrony” in Respiratory Care, which was originally presented as an invited Paper at the April 2004 AARC Journal Conference in Cancun Mexico. He has also authored definition for 26 new terms related to Respiratory Care for the newest edition of Tabers Medical Dictionary, 2003.

Other publications include a sampling of book chapters mostly related to pulmonary Physiology, but also include respiratory related chapters written for other professions – Physician Assistant Exam Review book chapter, Clinical Laboratory Sciences book with chapters related to Pulmonary Disorders.

In addition, the University Office of Technology Management has filed formal patent applications for the Database Clinical Tracking System to the US patent Office.

The faculty aggregate of one peer-reviewed publication and 7 clinical practice guidelines over five years is a figure that the committee felt was below an average publication rate for

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an academic unit at a research university. However, having secured one patent that resulted in a start-up company, DataArc, is further evidence of scholarship and this accomplishment exceeds national performance.

The department chair has a record of consistent scholarly activity, but the scholarly activity of the other faculty is just getting started. Joshua Schuetz has an excellent beginning, making three national presentations and having one abstract published this past year. We highly encourage his continued work to have these efforts produce peer-reviewed

publications targeted for Respiratory Care and the Respiratory Care Education Annual. Other faculty members within the School of Allied Health Sciences who have a national and international presence can be instrumental in facilitating the involvement of the newest faculty members.

To go to the next level, we would encourage the faculty to work collaboratively within the department and with other investigators to achieve 1-2 publications per year in peer-reviewed journals.

b. Externally funded research/demonstration/training projects

The respiratory therapy department’s recent funding efforts relate primarily to the use of technology in education including the WHISSL project (see below) and two small grants for the development of the Nurse Practitioner system for tracking student clinical learning activities. This system was developed using the DataArc model, but with emphasis on collecting case-based information. In addition, the respiratory therapy department had a collaborative recruitment grant that was last renewed in 2001.

1) Joshua Schuetz RRT, MEd, participated with Dr. Roger Marion in a WHISSL

(Worldwide Health Information System Simulation Linkage) project partially funded by HRSA (Health Resources Service Administration). This project’s is the development of internet-linked video case studies that assists students in understanding culturally diverse patients and health care situations. Mr. Schuetz’s award amounted to approximately $2600.00 to develop a respiratory patient case study. (This case was made available to the profession via an AARC International Congress presentation in December 2005).

2a) 03/03 Principal: Jon Nilsestuen PhD, RRT; Awarded $5,087.00 Grant from: Health Education Training Centers Alliance for Texas. Phase-II –Programming Phase: Internet Based Clinical Tracking System for Nurse Practitioner and Nurse Midwifery Students 2b) 07/02 Co-Principal: Jon Nilsestuen PhD, RRT; Christine Boodley RC, PhD. Awarded $4,619.00 Grant from -Health Education Training Centers Alliance for Texas. Design Internet Based Clinical Tracking System for Nurse Practitioner and Nurse Midwifery Students.

3) 03/02 Awarded $20,000 Educational Grant from AdvancedRespiratory. Grant Paid for Training and Equipment –“The Vest Airway Clearance System”

4) 08/01 Co-Principal: Vickie Freeman & Jon Nilsestuen: “Partnerships and Ladders” (PAL Project) –an Allied Health recruitment grant funded by The Department of Health and Human Services. Grant Renewed Oct, 2001-Aug31, 2002

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c. Scholarly

products

generated

by faculty/student collaborations

Dr. Nilsestuen and Ms. Marilyn Childers have successfully developed and implemented DataArc, one of two start-up companies at UTMB and the only one within the SAHS: United States Patent and Trademark Office - Notice of Publication of Application of Web Linked database for tracking clinical activities (June 6, 2002); Fracek, S; Childers, M; Nilsestuen, J:”Web Linked Database for Tracking Clinical Activities and

Competencies and Evaluation of Program Resources and Program Outcomes”; US Ser. No. 09/731,367 -Filed in the United States Patent and Trademark Office Dec 6, 2000

d.

Awards and honors associated with research and scholarly productivity

As mentioned, Dr. Nilsestuen’s recognition as an inaugural fellow of the AARC is in part due to his scholarship and its profound contributions to the respiratory therapy profession. He is the founder and Co-Editor of the “Graphics Corner” a regular feature of the peer-reviewed journal, Respiratory Care. However, the degree to which the faculty members are presently involved in research and scholarly productivity is limited. There is a great deal of faculty involvement at local and state levels, which certainly addresses the mission of a state supported institution. To go to next level, we recommend that involvement at a national level be expanded, particularly in the area of scholarship.

3.

Evidence of state of the art clinical practice and community

involvement

a. Community

visibility and involvement

The faculty actively volunteers to improve the quality of life for people living in

Galveston, Houston, Texas and beyond. They work with the American Lung Association, the American Heart Association, the American Cancer Society, the Mental Health and Mental Retardation Association, Galveston City Planning Commission, African American Chamber of Commerce, Kiwanis Club, and the Galveston Area League of Voters. The faculty and the SAHS also support and facilitate student participation in community service activities.

b.

Impact of scholarship and teaching on local and national health care

practice and policies

The development and distribution of online surveys for graduate and employer evaluation and program resource assessment (DataArc) has simplified and streamlined the data gathering process for respiratory care programs across the country. Many programs nation-wide now use DataArc to help document student competency and equivalency of learning experiences. The vision and hard work of the faculty on this project has enriched the quality of respiratory care education on a national level. In addition, the faculty contribution to the art and sciences of ventilator graphics facilitates not only the teaching of these concepts, but directly contributes to improved patient care.

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The faculty should be encouraged and supported in their efforts to develop and refine a process for training and evaluating clinical preceptors because of its impact not only on the educational program, but also on the local health care practices and policies.

4.

Evidence of Effective Leadership and Administrative Structure

a.

National reputation of department programs and faculty.

Additional faculty member’s scholarly achievements and professional contributions will continue the excellent reputation of the UTMB department of Respiratory Therapy. In addition, we once again suggest increasing participation at a national level for a greater proportion of the faculty. The faculty has an excellent role model in their Chair, Dr. Nilsestuen, who can provide further mentorship and guidance in expanding their role in professional activities on a national level.

b. Interdisciplinary

collaboration with UTMB departments and other

institutions

Overall, the Respiratory Therapy faculty has an excellent reputation among the clinical community of UTMB and the surrounding area. The committee has heard from many clinical sources that have included alumni, all of whom have lauded the faculty for their ability to prepare clinicians, serve as mentors to clinicians in areas related to professional development, and plans to further provide educational opportunities for preceptors. Program faculty members are not actively collaborating in research with faculty in the SOM, other schools or with other departments. In general, the barriers to collaboration in research seem to be the rapid growth in enrollment, the relatively new tenure of the faculty, and perhaps the time and effort spent for the start-up company, DataArc. There appears to be outstanding opportunities for faculty and student scholarship stemming from activities of Team IDEAL and the Large Animal Investigative Research Laboratory, specifically with Dr. Ron Mlcak and perhaps further involving the medical director, Dr. Koutrouvelis. The review team recommends that research-related faculty development efforts should emphasize these areas of institutional strength.

Regarding educational collaboration, students expressed concern that the noteworthy goals of the Team IDEAL program were not fully realized in the current implementation and there are several planned changes that the team discussed with Dr. Henry Cavazos. Some specific concerns included equity of various optional exercises and the cumbersome approach to completing course requirements by earning points. A similar concern

regarding the limited inter-professional education with medical and nursing students was expressed. We commend the SAHS for its commitment to Team IDEAL and its goals for interdisciplinary education of all allied health students. We look forward to hearing of further developments with this program and the proposed honors program.

The University has an electronic evaluation system in place that is accessible to all students for completion of course evaluations. However, the respiratory therapy faculty mentioned that students from the other departments in the SAHS did not have the same expectation for completing course evaluations. Since the faculty teach students from many disciplines, it would be helpful if all students were held accountable for completion of the

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course evaluation form as a requirement to receive credit for each course. The academic review committee suggests that the SAHS address a means to include the course

evaluations as part of the course requirements for each course.

c.

Efficient and innovative management of departmental resources

The departmental resources are certainly handled efficiently and we could find no evidence of excess in any spending category. The Dean of the SAHS appears to hold the program in high regard and allocates resources accordingly. There is room for more innovativeness in handling resources, especially space and equipment, throughout the School and perhaps the Institution.

d.

Success in recruiting, retaining and promoting high quality faculty

members

The review team could not find evidence in the documents provided that any of the respiratory therapy faculty has specialty credentials. Specialty credentials in areas such as neonatal/pediatrics and pulmonary function testing can provide further, objective evidence of the high quality of the respiratory therapy faculty members.

The more recent hires on the part of the Department of Respiratory Therapy appear to be faculty members who are capable of meeting higher expectations with regard to

scholarship, if provided with professional development opportunities. It appears that by collaborating with other UTMB schools and departments, the Department of Respiratory Therapy has the potential to further recruit faculty of high caliber who will be able to contribute to the research agenda.

It appears the department will not be able to successfully promote faculty through the ranks of Associate and full professorship under the current structure. If the scholarly expectations for junior faculty are not addressed, it does not appear that the department will have a cadre of seasoned faculty to continue the program as a national leader into the future years.

Strengths

The respiratory care program has much strength, including a supportive administration and a talented cadre of dedicated individuals. These are the major strengths:

A. Exemplary dedication and expertise of the department chair: Jon Nilsestuen, PhD, RRT, FAARC.

B. Supportive and involved teaching faculty: Abdul Amin, MS, RRT; Joshua Schuetz, MEd, RRT; and Marilyn Childers MEd, RRT.

C. Progressive Administration: Drs. Christiansen, Cavazos and Marion. D. Supportive and involved clinical faculty.

E. Student rotations with the Large Animal Investigative Research Lab with active participation and leadership by Dr. Ron Mlcak.

F. Involved and student-oriented medical director, Aristides Koutrouvelis MD. G. Team IDEAL and WHISSL: Henry Cavazos, JD, and Rodger Marion, PhD. H. Exponential increase in the number of students recruited to the program since 2001

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I. Innovation and implementation of web-based clinical tracking program, DataArc: a. Contributions to service to many professions in the School of Allied Health

and the School of Nursing

b. Recognition as a university start-up company

c. Contributions to the national reputation of the program

J. Ten $1000 scholarships are awarded to incoming students from the School’s Endowment.

Limitations

The program is fortunate to have such strong personnel, with the major limitations focused on its resources to include space, equipment and faculty positions (FTEs). To be in the top echelon of respiratory therapy programs, there needs to be additional resources to meet the student and faculty needs, including opportunities for faculty scholarship and professional development. The recommendations provided are intended to address these limitations and contribute to the program’s ability to continue its recognition of excellence and national reputation.

Recommendations

A. Consider adding a full-time tenured faculty track, contingent on enrollment growth, to reduce the chair’s teaching load, promote scholarship in the department, and have a plan for succession of leadership.

B. Provide opportunities for faculty development, especially in scholarship and national involvement, to continue the highly-regarded national reputation of the program established primarily through the Department Chair’s achievements. C. Identify additional dedicated lab space to accommodate the increased number of

students.

D. Include the Respiratory Care Program along with the other programs within the School of Allied Health Sciences in the long term master facilities planning to address short and long-term space needs.

E. The advisory committee and the respiratory therapy faculty should address a plan (such as a clinical ladder) to encourage retention of program graduates in clinical positions at UTMB Hospitals for the long-term viability of the clinical department and the educational program at UTMB.

F. Consider developing an interdisciplinary simulation center to be institutionally supported across disciplines and schools to promote more effective utilization of resources, including space, and even greater interdisciplinary preparation of students.

Summary

The academic review team commends the administration of the SAHS at UTMB for conducting regular, academic review of its programs with the intention of continuously striving for excellence and being nationally-recognized in the top 25%. The SAHS and the respiratory therapy program is committed to interdisciplinary educational preparation of all

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students as noted by its core courses, Team IDEAL, WHISSL, sharing of courses and faculty across programs, and other innovations in education as noted in this report. The academic review team was impressed by the level of dedication of all involved with the respiratory therapy program and offers our best wishes for continued success.

References

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