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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


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June 1, 2013 Volume 77, Number 6
Committee News: Moving Forward With ‘2015 and Beyond’: Adult Critical Care Specialty Examination Allen N. Gustin, Jr., M.D., F.C.C.P. Committee on Respiratory Care

In the January 2013 ASA NEWSLETTER, I wrote an article titled “2015 and Beyond” that discussed how the respiratory therapy profession is moving forward with meeting the demands of health care in the future. The “2015 and Beyond” campaign encourages higher standards of education and credentialing for respiratory therapy students entering the profession. The majority of respiratory therapists (RTs) graduate with an associate’s degree, a small minority with a bachelor’s degree and a few with a master’s degree. Once a student graduates from a training program, he or she takes the Certified Respiratory Therapy (CRT) exam for entry into the profession. Though not required for licensure, some RTs choose to take the Registered Respiratory Therapy (RRT) exam, which is considered the advanced-level exam. The “2015 and Beyond” campaign aims to encourage all training programs to advance to bachelor’s degrees and require the RRT exam as the credential needed for entry into the profession.

More than six years ago, the American Association for Respiratory Care (AARC) requested that the National Board for Respiratory Care (NBRC) determine the desirability and feasibility of developing a subspecialty exam for RTs working in adult critical care. In 2007, the NBRC completed a viability study that determined the need and the desire for an adult critical care credential existed. A personnel survey and a job analysis were completed in 2009, which determined the necessary task list for an adult critical care respiratory therapist. An Item Writing Workshop was held in 2010 and was followed by the development of the Adult Critical Care Specialty (ACCS) exam in late 2011. The NBRC formally launched the ACCS exam on July 17, 2012.1

The ACCS exam focuses on competencies unique to the adult critical care setting and content that is above and beyond what is covered by the RRT exam. The ACCS exam includes two sets of secondary test specifications: one set based on medical ethics and the other based on specific patient conditions. Test specifications will engage the candidate’s ethical thinking because the NBRC felt the exam should focus on clinical judgment and the challenging ethical issues that can occur in the ICU. Secondary test specifications focus on specific patient conditions, including trauma, burn, inhalational injury, shock, acute lung injury, acute respiratory distress syndrome, postsurgical states, pulmonary embolism, pulmonary hypertension and bariatric.2

To qualify for the ACCS examination, applicants must have a valid RRT for at least one year and must have been working full-time in an adult critical care environment for at least one full year. Full-time experience is considered at least 21 hours per week per calendar year under medical supervision. The adult critical care environment criteria can include an intensive care unit, an emergency room, a postanesthesia care unit or a long-term acute care facility. Clinical experience must be completed before the candidate applies for this examination. The recertification period for the ACCS exam will occur every five years. The NBRC offers a practice examination (called the Self-Assessment Examination) to further prepare each candidate for the ACCS examination. The NRBC began accepting applications for the ACCS examination on May 1, 2012.1 As of January 2013, a total of 234 candidates have taken the ACCS exam, with a first-time pass rate of 82.9 percent.

In the 1960s, ASA was one of the original collaborating organizations (along with the American College of Chest Physicians and the American Thoracic Society) with the formation of the NBRC and the Commission on Accreditation for Respiratory Care (CoARC). Many members of the ASA Committee on Respiratory Care support these national organizations with their time and effort. On local levels, anesthesiologists serve as medical directors of hospital-based respiratory therapy departments and/or as medical directors of respiratory therapy training programs. Whether on a national or a local level, the respiratory therapist and the anesthesiologist have shared a strong relationship for more than 50 years.

Respiratory therapists are ubiquitous throughout most health systems and enter into the anesthesiologist’s work environment daily. RTs who populate critical care environments may choose to take the ACCS exam. As anesthesiologists, we should support our RTs by encouraging each individual to maintain the RRT credential and encourage the RTs who work in adult critical care settings to consider taking the ACCS to further their professional growth.

Allen N. Gustin, Jr., M.D., F.C.C.P. is Assistant Professor of Anesthesiology, University of Chicago Pritzker School of Medicine, Chicago.

1. Adult Critical Care Specialty Examination. National Board for Respiratory Care website. Accessed February 1, 2013.
2. Earhart, C. Adult Critical Care Specialty Examination Set to Launch. NBRC Horizons Newsletter 2012; 38: pp 5-6.