National Board for Respiratory Care Test Preparation

DON’TPANIC!

Testing and Study Tips for National Board of Respiratory Care Exams

EXAM BASICS

• Certified Respiratory Therapist (CRT):• Initial examination intended to evaluate “essential knowledge, skills, and abilities

required of entry-level respiratory therapists.” • 160 multiple-choice questions

• 140 are scored, 20 are “prototype” questions being tested for use on future exams• 3 content areas

• Clinical data• Respiratory equipment• Therapeutic procedures

• Three hours allowed for completion

Don't Panic! Testing and Study Tips for National Board of Respiratory Care Credentialling Exams - Mike Hess, RRT

Don't Panic! A Guide to National Board of Respiratory Care Credentialling Exams - Mike Hess, RRT

EXAM BASICS

• Registered Respiratory Therapist (RRT):• Enhanced test designed to evaluate “knowledge, skills, and abilities” of advanced RTs.• Written Registry Examination

• 115 questions (15 prototypes)• Tests recall of information, application of theory, and clinical data analysis• Two hours allowed for completion

• Clinical Simulation Examination • 10 multi-decision clinical scenarios covering various respiratory settings and syndromes• Includes data gathering (selecting tests), evaluation of test results, and clinical decisions• Four hours allowed for completion

SPECIALTY EXAMS

• Certified/Registered Pulmonary Function Technologist (CPFT/RPFT)• Neonatal/Pediatric Specialist (NPS)• Adult Critical Care Specialist (ACCS)• Sleep Disorders Specialist (SDS)• Multiple choice exams• Not the focus of this presentation, but tips provided are often applicable• Additional eligibility requirements• Check NBRC.org for further information.



CRT EXAM DETAILS

• 160 questions• 140 “live”• 20 questions being evaluated for future use• However, there is no way to tell if a question is live or not, so treat them ALL as if

they count!• Computerized testing system

• Point-and-click interface• System allows you to skip questions and return to them later• Bookmarking system highlights questions yet to be answered• Answers can be changed until the test is completed and submitted


CRT EXAM DETAILS

• Three-hour time limit• The system has a built-in timer; no cheating!• Pace yourself; don’t spend too much time pondering one question• You can always come back to a question with a fresh perspective• One minute per question allows some leeway

• Passing score• You must achieve 75% of the points available• 75% of 140 live questions is 105 questions• Different questions have different weights• Score is NOT tracked during the exam; results are tallied only after completion


RRT WRITTEN EXAM DETAILS

• Essentially identical format to CRT exam, but more complex and focused on analysis

• One of TWO exams required to obtain the RRT credential (must also pass the RRT Clinical Simulation Examination)

• 115 questions• 100 “live” questions• 15 prototypes for potential future use• Again, no way to tell the difference

• Computerized testing system• Same software design as CRT exam, with the same interface and features


RRT WRITTEN EXAM DETAILS

• TWO-hour time limit• The system has a built-in timer; no cheating!• Less time, but fewer questions, too• One minute per question is still a good pace

• Passing score• You must achieve 70% of the points available• 75% of 100 live questions is 70 questions• Questions again have different weights, possible to pass with fewer than 70

correct• Score is still NOT tracked during the exam; results are tallied only after

completion


WHY WEIGHT QUESTIONS?

• The NBRC offers each exam in slightly different forms to reduce/eliminate cheating

• Test candidates are assigned a particular form theoretically at random• Each form has the same mix of questions, but they may have slight

variations in difficulty• Scaling the scores across the various test forms helps ensure a fair

evaluation of each candidate, regardless of the particular form • Thus, questions have a slightly different “weight” depending on how they are

scaled by statistical and psychometric procedures


MULTIPLE-CHOICE EXAM CONTENT/DESIGN

• Candidates will face questions in three main content areas:• Patient data evaluations and recommendations

• This includes obtaining information from the medical record, collecting other clinical data, and recommending further tests/exams)

• Equipment manipulation, infection control, and quality control• This area includes proper usage of common RT equipment, appropriate infection control

techniques, and ensuring quality control• Initiation and modification of therapeutic procedures

• Essentially self-explanatory; procedures range from assisting physicians to conducting pulmonary rehabilitation to evaluating response to respiratory care


MULTIPLE-CHOICE EXAM CONTENT/DESIGN

• Each content area is assessed in three “cognitive levels”:• RECALL

• Simple facts and/or instructions. These questions assess what the candidate knows about respiratory care.

• APPLICATION• Comprehension of knowledge. These questions assess the candidate’s ability to

apply knowledge to situations• ANALYSIS

• Thinking critically about knowledge. These questions determine how a candidate arrives at solutions and evaluates the effectiveness of their applications of knowledge.


RECALL

• These are the “simplest” questions on the multiple-choice exams

• Simple recall of facts and data

• Often denoted by terms like “Identify” or “List”

• Significant component of CRT exam, but very few of this type on the RRT-written


APPLICATION

• These tend to be the medium-difficulty questions• Candidate must use data (either presented in the question or recalled from

memory) in realistic clinical situations• This includes the use of common scientific laws, forumulae, and principles, as

well as medical concepts• Indicated by the words “Classify,” “Calculate,” or “Apply”• Interpretation of charts and graphs also often required• These questions form the bulk of the CRT exam, but only 15% of the RRT-

written


ANALYSIS

• Usually the most difficult questions• Approximately one-fifth of CRT questions, but 80% of the RRT-written is

analysis• In many questions, candidate is given a scenario and expected to determine

how each scenario component relates to each other, as well as the “big picture”

• Analysis questions evaluate a candidate’s judgement on the proper application of respiratory care procedures and practices

• Indicated by “Evaluate,” “Compare/Contrast,” or “Revise”


IT’S A TRAP!


IT’S A TRAP!

• Many questions are worded in a confusing or somewhat obscure fashion• Candidates should always pick the BEST AVAILABLE answer• Other answers may be good or “good enough,” but only one is the BEST

based on the information provided• Be sure you read the question CAREFULLY and answer based ONLY on what

the question is specifically asking, not what you’ve seen or what might be implied


IT’S A TRAP! – WEASEL WORDS

• “Should”• An indicator that a question may be covering a topic that has controversy inside

the respiratory care community. Candidates should answer according to what the majority of practitioners would likely do in that situation.

• “Except”• Three of the following answers are actually correct. Candidates should select the

answer that is NOT correct based on the information provided.• “Best/First/Most Important”

• Remember that the answer you WANT may not be present. Candidates should select the answer that is the best AVAILABLE from the options provided


IT’S A TRAP! – MULTIPLE MULTIPLES

• These questions are followed by several options, and the responses are listed as combinations of those options (eg. “a. I,II, and III; b. I, II, and IV,” etc.)

• EVERY option in the selected answer must satisfy the criteria in the question• Read each option and designate it as true or false• If an option is KNOWN to be false, any answer with that option present can

be eliminated• If an option is KNOWN to be true, any answer WITHOUT that option present

can also be eliminated• This often reduces the decision to two possible answers


OTHER MULTIPLE-CHOICE TIPS & TRICKS

• Read each question CAREFULLY, identifying both what is specifically being asked and any qualifiers (“not,” “except,” “most likely,” etc.)• Many candidates make sure to read each question twice to improve accuracy

• Analyze any provided data for relevance to the stated question, and discard any unnecessary information• Questions often provide extraneous data as a distraction or to evaluate the

application and analysis cognitive levels• Do not read “into” questions or guess the question-writer’s intent.

• Simply answer the stated question with the best available answer


OTHER MULTIPLE-CHOICE TIPS & TRICKS

• Read every ANSWER as carefully as well, ESPECIALLY those for “mulitiple-multiple”-type questions• Attention to detail is critical

• Be sure to answer every question. GUESSES ARE NOT PENALIZED!• If one of the answer options appears completely foreign or bizarre, eliminate

it. Extreme outliers tend to not be correct answers; it is likely to be a simple distraction.

• If a complete guess is necessary, eliminate as many answers as possible first. • Usually, at least one option is clearly wrong. Removing it improves the chances of

a correct guess from 25% to 33%. The odds improve even more if TWO answers can be eliminated.


RRT CLINICAL SIMULATION EXAM DETAILS

• A completely different animal than the NBRC multiple-choice style exams• Can be taken before OR after the RRT-written, but both exams must be

successfully completed to earn the RRT credential• 11-12 scenarios with multiple decision points

• 10 “live” questions• 1 or 2 prototypes for potential future use• Candidates are once again blind to which is which

• Computerized testing system• Same basic software as multiple-choice exam with similar interface



• Four-hour time limit• The system has a built-in timer; no cheating!• Pace is still important; work to complete each scenario within 20 minutes• You can return to a previous scenario to review it, but NOT to change an answer• Choose carefully; unlike the multiple-choice exams, ALL ANSWERS ARE FINAL

• Passing score• There is NO definite passing score for the clinical simulation exam• The pass score is set by the NBRC’s Examination Committee and varies from

exam to exam• Total cumulative scores regarding information gathering and decision making are

used to determine pass/fail, not the candidate’s performance on any individual simulation



• Typical clinical simulation exams contain cases from all phases of respiratory care, including:• Evaluation or management of COPD patients• Adult trauma patient management (including burns and head injuries)• Adult patients with cardiovascular disease processes (CHF, CAD, etc.)• Management of adults with neuromuscular impairment (eg myasthenia gravis,

drug overdose, etc.)• Common pediatric complaints (epiglottitis, asthma, foreign body aspiration, etc.)• Management of the neonate (resuscitaton, apnea, congenital heart defects)• Medical/surgical problems in adults (including carbon monoxide poisoning)



• The CSE is designed to evaluate patient management skills and the candidate’s ability to evaluate ongoing treatment, recommend changes, and adapt to circumstances and events

• The same content areas are evaluated as on the multiple-choice exams, but the cognitive level assessment is integrated into each test scenario

• Thus, you may have one “question” that demands recall of facts, application of theory related to those facts, and analysis of the outcome all rolled into one


RRT CLINICAL SIMULATION FORMAT

• Simulations are designed to evolve just as a real-life case would• The simulation may begin at an initial encounter, or after the patient has

been “managed” by other providers for some time• The simulation may end at or prior to discharge from care• Simulations have a decision-tree/logic-branch format, allowing multiple paths

to “success”• However, even though multiple paths are acceptable, only ONE is the BEST

path (and thus the highest number of points)


RRT CLINICAL SIMULATION FORMAT

• Each simulation consists of three phases, although each phase may have multiple occurrences through the simulation:

• SCENARIO: Establishes the general parameters of the simulation

• INFORMATION GATHERING: Provides information normally obtained through chart review or diagnostic testing

• DECISION MAKING: Decision point to recommend the next steps of treatment


SCENARIO

• Physical setting • Hospital/clinic type, floor/unit type, shift/time of day

• Patient information • Age, gender, general appearance/presentation

• Brief history of active situation• IF available; after all, sometimes clinical decisions must be made in a vacuum

• Specific role of RT in this simulation • Staff therapist, supervisor, coordinator, etc.


SCENARIO

• Often the first decision point• Is the situation an emergency? Can additional information be obtained?

• Initiate appropriate treatment, if necessary

• Candidates MAY assume all necessary equipment is available, unless otherwise noted

• Otherwise, continue to gather information regarding the patient’s status


INFORMATION GATHERING

• Many potential tests and procedures (often 15-20) are presented for consideration

• Select ONLY those that are necessary or prudent• Avoid selecting tests that are risky, unnecessary, potentially harmful, or may

cause delay in appropriate treatment• Selecting a test/procedure will reveal the outcome or result• This data must then be interpreted by the candidate for use in the next

phase• Often 2-4 information gathering occurrences in each simulation


INFORMATION GATHERING

• Many potential tests and procedures (often 15-20) are presented for consideration

• Select ONLY those that are necessary or prudent• Avoid selecting tests that are risky, unnecessary, potentially harmful, or may

cause delay in appropriate treatment• Selecting a test/procedure will reveal the outcome or result• This data must then be interpreted by the candidate for use in the next

phase• Often 2-4 information gathering occurrences in each simulation


DECISION MAKING

• The candidate must decide on the next treatment step for the patient, using the available information

• Decisions are selected from a list of possible treatment paths• Usually 4-8 options to choose from:

• ONE is the BEST AVAILABLE (maximum points)• 1-2 are acceptable (partially points)• Remaining options are incorrect

• Candidates should be prepared to select the BEST AVAILABLE course if the most appropriate or desired option is not presented


DECISION MAKING

• “Physician agrees. Done.”• Move on to next decision or information gathering phase

• “Physician disagrees. Make another selection in this section.”• Does NOT necessarily mean the candidate was wrong for choosing an option• Later portions of the simulation may require a different path to be taken at this

point

• Some cases require multiple simultaneous decisions; be sure to select as many as are indicated by the patient’s current condition


DECISION MAKING

• Most simulations have multiple information gathering and decision making sessions

• Candidates must evaluate how the patient responds to selected treatment via additional diagnostics and assessments

• Candidates must be prepared to alter treatment plans or respond to unforeseen adverse events, just as in reality


CLINICAL SIMULATION TIPS & TRICKS

• Simulations are based on “NBRC General Hospital” rules• Values for lab test normal ranges, mechanical ventilation settings, and other

numeric data are based on clinical practice guidelines and official references (see the NBRC Candidate Handbook for reference list)

• ALL procedures are done in a strictly “by-the-book” fashion. Candidates should NOT base responses based on facility-specific or other non-standard practices

• Follow all directions• Some decision points require a single choice, others allow multiple selections

• Avoid novel or unusual therapies or suggestions; they are unlikely to be appropriate• High-frequency ventilation, non-standard inhaled medications, etc.



• Do not skip ahead or rush carelessly• Candidates are penalized for incorrect and/or insufficient choices• Gathering too little data can lead to inappropriate care decisions and fewer points

• “Show your work”• The goal is not necessarily JUST to get the right answer, but to demonstrate HOW

to make a good treatment decision with appropriate data• Don’t assume things that are not clearly supported by the information gathered

• Carefully monitor progress throughout the simulation• Duplicated tests can also result in penalties• Pencil and paper are available for use in record-keeping



• Do not guess at the “intent” of the author in a particular simulation• Respond to the explicitly provided information and make decisions accordingly

• Expect equipment failures, sudden changes in patient status, and other adverse effects• Essentially anything that can happen in real life can happen in the clinical

simulation• Candidates should be ready to follow their “second-choice” plan of care

• Remember, “best” and “best AVAILABLE” are not always the same thing• Do not select all options – this WILL be penalized

• Excessive tests are costly and can prevent timely care in the real world


GENERAL NBRC EXAM TIPS

• Use the free pre-tests to identify areas of deficiency• The CRT, RRT-written, and RRT-simulation all have free sample exams that include

score reports to help identify areas that need extra study.• Review the appropriate exam matrix and focus on the most heavily-tested

areas• For example, in the CRT exam, there are 22 questions regarding the operation of

respiratory equipment by order or protocol, and 3 regarding infection control. Studying one of these areas will provide greater results than the other.

• Do NOT cram• NBRC exams are aligned toward comprehension, not simply recall. Allow enough

time before the exam to study thoroughly to promote deeper understanding of the material.


PREPARING FOR THE TEST

• Verify eligibility with the NBRC and schedule the exam• Each test has different eligibility criteria. Be sure to double-check you are eligible

for your desired exam before registering and scheduling. Current eligibility information is available at http://www.nbrc.org

• Locate the testing site• As the NBRC has only a limited number of testing centers, be sure to learn not

only where the center is, but the traffic patterns that can affect the test day commute

• Practice the exams• Continue to use the free sample exams to familiarize yourself with pacing, using

pencil and paper for calculations, and the computer system itself


ON TESTING DAY

• Get a good night’s rest• Test stress is enough to worry about. Don’t compound it with fatigue

• Eat a good breakfast• Avoid junk food that might not sit will. Aim for decent, low-fat options with carbs

and protein (oatmeal, cereal, fruit) to maintain energy and focus• Take a water bottle…but don’t hydrate TOO much

• Bathroom breaks are permitted, but count against the exam clock• If you have a particular testing superstition (lucky socks, etc.), use it

• It certainly can’t hurt!


WHAT TO EXPECT

• Be sure to arrive by your scheduled test time, preferably early. • Candidates arriving 15 minutes after their scheduled time will NOT be admitted.

• Guests, including family members, are not allowed in the testing room and may not be allowed in the testing facility’s reception area.

• Bring two forms of signature ID, one of which must have a current photograph. • Example: Current driver’s license and major credit card

• No personal belongings are allowed in the testing room, which is monitored by audio and video equipment for security. • This includes cameras, pagers, and any other similar equipment


WHAT TO EXPECT

• Coats and jackets must remain outside the testing room.• Wallets, hats, watches and phones may be placed in a locker, but are not

accessible• Once you have stored your personal items back in your vehicle or in the

locker, you will be asked to turn out your pockets to verify compliance• Personal items found in the testing room after the start of the exam will result in

the termination and forfeiture of the exam.• You will be provided a pencil and one piece of paper.

• The paper must be returned to the test proctor at the end of your examination or you will not receive your score.


WHAT TO EXPECT

• Testing centers often have multiple stations to accommodate multiple test-takers.• Select a station that fits your style. For example, if you tend to get distracted,

choose a station at the end of a row or away from others.

• You must enter your social security number into your testing computer for identity verification.• The computer will also take your picture, which will appear on your score report

for further ID security


WHAT TO EXPECT

• No questions regarding exam content are allowed during the exam period.

• No documents, notes or other papers may be removed from the testing room.

• No eating, drinking, or smoking is allowed during the exam period. • However, water may be allowed or available. Check with your testing center.

• Breaks are allowed, but no additional exam time will be permitted.


DISQUALIFICATION

• Certain behaviors will result in termination of the exam, disqualification of your score, and forfeiture of your testing fees. These include:• Creating a disturbance or abusive atmosphere in the testing center• Display or use of electronic devices, personal belongings, books, notes

or other outside aids• Talking with other candidates• Giving or receiving assistance• Leaving the testing center during the exam• Attempting to record or copy the exam• Attempting to make notes for another candidate, or to take the exam for another

person


ALL DONE!

• After successfully completing the credentialing exam (or both parts of the RRT exam series), you have earned the right to add the credential to your name and use it in a professional capacity. Note that credentials earned after July 1, 2002 are subject to the continuing education requirements of the NBRC’s Continuing Competency Program for renewal.

• Should you be unable to successfully complete an exam, you are immediately eligible to re-attempt that exam upon completion of a new application and payment of the applicable fees.


THE NEXT GENERATION

• On January 15, 2015, the NBRC will be launching a new examination process for respiratory therapists seeking initial credentialling

• A new exam, known as the Therapist Multiple-Choice Examination, will consolidate the CRT and the RRT-written exams into one.

• Upon achieving the “low cut-score,” the candidate will receive the CRT credential

• Upon achieving the “high cut-score,” the candidate will receive the CRT credential AND become immediately eligible to take the clinical simulation examination, thereby saving $190 and two hours of testing time


THE NEXT GENERATION

• The clinical simulation exam is also changing, and will increase to 22 questions (20 live, 2 prototype)

• However, each simulation will be roughly half the current length, thereby keeping the testing requirement essentially the same

• Candidates receiving the CRT credential but not reaching the “high cut-score” will be required to retake the TMC exam and pass at the higher score in order to obtain eligibility to take the clinical simulation exam.


THE NEXT GENERATION

• The final day to register for the traditional exams is:

October 31, 2014

• Applications received after this date will be processed, but candidates will not be able to test until:

January 15, 2014• Plan accordingly!


ADDITIONAL TEST-PREP RESOURCES

• LindseyJones offers high-quality test review seminars, as well ashome-study materials for both the CRT and RRT tests. Visit their website:http://www.lindsey-jones.com

• Kettering National Seminars is known for their well-regarded seminars and self-study courses covering the CRT and RRT exams, as well as all NBRC specialty exams and other tests of interest to respiratory therapists (such as the certified asthma educator AE-C exam). Find them at:http://www.ketteringseminars.com


ADDITIONAL TEST-PREP RESOURCES

• The American Association of Respiratory Care (AARC) offers Exam Prep Courses covering the CRT and RRT-written tests. The course fee includes official NBRC self-assessment exams. The course can be found at:http://www.aarc.org/education/exam-prep/

• Of course, the National Board for Respiratory Care offers self-assessment exams as well as free pre-tests for practice at:http://www.nbrc.org (click on EXAMINATIONS)


SPECIAL ACKNOWLEDGEMENTS

Amanda Sanders, BSRT, RRT-NPS and Mark A. Vargas, BSRT, RRT have done an incredible job launching a Facebook group specifically dedicated to preparing new therapists for NBRC exams (and providing a refresher for seasoned hands). They create a wide variety of questions, covering all aspects of respiratory care, and all according to NBRC standards and guidelines. They do this solely out of their desire to help future RTs succeed and generously provide hours of their free time not only to create and answer the questions, but to provide rationales and extra examples. Their work was a direct inspiration for this presentation (including directly providing some of the tips themselves), and their dedication to respiratory care advocacy is an inspiration to us all. See their work (and get even more tips!) at Respiratory Care Prep Board (http://www.facebook.com/groups/1391017167850416/)


REFERENCES

Sills, JR. Entry-level respiratory therapist exam guide. 4th edition. Mosby-Elsevier, 2005Sills, JR. Advanced respiratory therapist exam guide. 3rd edition. Mosby-Elsevier, 2006Candidate handbook and application. National Board for Respiratory Care, 2014National board fore respiratory care website. Retrieved from http://www.nbrc.org, 2014

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