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ERS Annual Congress Vienna
15 September 2012

Postgraduate Course 20 European spirometry train-the-trainer programme

Saturday, 1 September 2012 08:4517:30 Room: C8

Assessment of European Spirometry Driving Licence programme

Mrs Julie K. Lloyd Respiratory Investigation Dept Good Hope Hospital Birmingham United Kingdom julie.lloyd@heartofengland.nhs.uk Summary
The assessment of the learning outcomes for this course is an essential part of the preparation and the delivery of ERS European Spirometry Training Programmes and awarding the European Spirometry Driving Licence. It is essential that course directors follow the assessment processes to ensure high quality education programmes and standardisation of the certification process. Under Section 2 of the Educational Experience of the Guidelines for the certification of ERS Spirometry training programmes, the structure of the assessment processes to be followed are already outlined as follows;

Assessment
1. The training programme director will be responsible to distribute Level I of the European Spirometry Driving Licence on successful completion of Part I training and assessment. 2. The training programme director will be responsible to distribute Level II of the European Spirometry Driving Licence certificate to those who successfully complete training and assessment for Part II within 612 calendar months after completing Part I assessment. 3. The teaching faculty should encourage trainees to continue to learn and gain sufficient knowledge and experience. 4. Assessment of the ERS ESDL should follow specific assessment criteria for Part I training.

Part I:
Objective: To determine if a course participant has acquired the knowledge of spirometry in practice 5. Mandatory Assessment Method: All candidates will be requested to pass an online knowledge examination established by ERS. Assessment of the ERS European Spirometry Driving Licence should follow specific assessment criteria for Part II training

Part II:
Objective: To determine if a course participant has gained sufficient competence to practice spirometry. Assessment: The assessments outlined below are mandatory assessment techniques that must be utilised in the assessment of candidates to successfully be awarded the European Spirometry Driving Licence Part II. A number of desirable assessment techniques are also listed, however, these are not essential to the assessment of Part II Spirometry Competency Based Training and Assessment of the ERS European Spirometry Training Programme. 6. Assessment of Part II must be carried out locally by the entire training faculty under the direct supervision of the Training Programme director 7. Part II training must assess all core modules outlined within the Training Programme Outline for Part II and within the assessment guidelines document. Assessment must apply the mandatory assessment methods.

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Mandatory assessment methods

1. Practical test knowledge and skills must be demonstrated by the participant before issuance of the European Spirometry Driving Licence certificate. The examiner may conduct the practical test in any sequence that will result in a complete and efficient test. 2. Following successful completion of Part I, if participants wish to attend Part II, the training centre must request that all course participants submit a completed Spirometry Workbook, including 15 quality spirometry tests with comments which are to be signed off by the course director/course instructor 3. Oral questioning - All examination participants will have the opportunity to answer oral questioning on their prepared workbook assignments and portfolio of spirometry tests. Case-based discussions The guidelines for the assessment of the European Spirometry Driving Licence Part I and Part II will be included as a specific section within the Guidelines for the certification of ERS Spirometry training programmes to be published early 2013. This section will give clear instruction to course directions on expectations of ERS on the assessment of candidates for each individual part of training. This document will give information on 1. Assessment processes 2. guidelines for assessing the Spirometry workbook 3. who can assess for the practical assessment 4. preparation required for practical assessment 5. grading and use of ERS marking criteria and standardised documents Essentially, the outcome of the practical assessment is a professional judgement of the assessor that the trainee has completed the spirometry test to the standard expected and outlined in the learning outcomes. It is the responsibility of all course directors to ensure that these guidelines are clearly followed and all documentation provided by ERS are used during the assessment of candidates.

Desirable assessment methods

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ASSESSMENT OF THE ESDL PROGRAM

Julie Lloyd Chair, Group 9.1

ESDL 2012

OVERVIEW Components of the assessment Part 1 ERS online knowledge assessment Multi-choice questions Part 2 Spirometry workbook assessment Assessment of practical skills including assessment materials, practical knowledge, patient skills.

ESDL PART 1

Online Knowledge Test and MCQs

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ESDL 2012

ON-LINE KNOWLEDGE ASSESSMENT Ensures registrants have the knowledge and basic skills in spirometry best practice. Ensures registrants have the skills needed to perform spirometric tests and successfully complete the Spirometry workbook.

ESDL 2012

TYPES OF QUESTIONS Type A questions single choice To each question there is only ONE correct answer. Type Kprime questions quadruple correct/incorrect decision To each question or statement there are four answers or statement completions. For each one, it must be decided whether they are correct or incorrect and marked accordingly e.g. (+) or (-)

ESDL 2012

EXAMPLE OF TYPE A
A technologist properly performs a peak flow

measurement on a young healthy adult, with no history of pulmonary disease. The expected results would approach, or exceed, which of the following? a) 10 L/s b) 20 L/s c) 30 L/s d) 40 L/s e) 50 L/s
ANSWER : A

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EXAMPLE OF TYPE A A patient reports decreased peak flows measured with a home peak flow meter. Which of the following would best validate the peak flow? a) Volume-time-curve b) FVC c) FEV1 d) Flow-volume loop e) FEF25-75 ANSWER : D

EXAMPLE OF TYPE A

The minimum time in seconds that a spirometry system should be able to measure the accumulated volume during a forced expiration is: a) 7 b) 9 c) 11 d) 13 e) 15 ANSWER : E

ESDL 2012

EXAMPLE OF KPRIME

Which of the following is/are indication/s for performing spirometry? a) To assess risks of operation b) To assess therapeutic intervention c) To assess the pathology of lung disease d) To monitor people exposed to injurious agents ANSWER: + + - +

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EXAMPLE OF KPRIME

Which of the following condition/s can most likely lead to suboptimal lung function results? a) Chest or abdominal pain of any cause b) Oral or facial pain exacerbated by a mouthpiece c) Dementia or confusional state. d) Severe pulmonary restriction ANSWER: - - - +

THE SPIROMETRY WORKBOOK

ESDL 2012

RATIONALE

Following successful completion of Part I, if participants wish to attend Part II, the training centre must request that all course participants submit a completed Spirometry Workbook.

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REQUIRED SECTIONS

SECTION A 1. Contents page 2. Curriculum Vitae 3. The Spirometry Training Course attendance certificate and/or accreditation of prior learning

ESDL 2012

SECTION A ...CONTINUED 4. Background information about the work environment, to include: a. Local arrangements for testing b. Method of referral c. Number of tests and type of patients tested e.g. screening for occupational health, asthma etc d. Where the tests are performed and who performs the tests, e.g. doctor, nurse, scientist etc.

ESDL 2012

EXAMPLE OF BACKGROUND
I am a Practice Nurse that works in a busy Primary Care practice in a large inner city. Patients are referred for spirometry by the Doctor to diagnose and assess the severity of any lung disease. The majority of our patients are assessed for possible COPD or asthma. There are 2 experienced practice nurses(>10 years qualified) that perform ~ 20 full spirometry tests per week on adults only. Interpretation of the results is performed by the Senior Nurse Practitioner.

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SECTION A ...CONTINUED
5. Copy of the local protocol for performing spirometry including the guidelines that are used. a. Should be a living document not a photocopy of guidelines. 6. Overview of the patient issues around spirometry. To include: a. A brief discussion of the contraindications to performing spirometry (absolute and relative) b. Pre-test instructions.

ESDL 2012

7. OPERATION OF SPIROMETER State type of device e.g. Micro Medical MicroLab rotating vane spirometer Labelled diagram Explanation of how it works Should state whether it is volume or flow measuring!

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SECTION B EVIDENCE LOGS

8. Calibration or verification. 9. Quality assurance. 10.Cleaning. 11.Patient tests. 12.Problems encountered during testing.

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8. CALIBRATION & VERIFICATION Consists of TWO parts:

1. A short piece of written work explaining why a spirometer must be calibrated or verified regularly and a protocol. It should include a brief description of actions if the calibration was outside the expected value or range 2. If the spirometer produces a hard copy, provide evidence of at least 20 calibrations or verifications performed. These should be performed on separate occasions. 3. If the spirometer does not produce a hard copy design a system for recording the calibrations or verifications and record at least 20 results. These should be performed on separate occasions.

CALIBRATION EXAMPLE

ESDL 2012

ESDL 2012

9. QUALITY ASSURANCE Consists of TWO parts: 1. Explanation of the purpose of Quality Control in the context of a Spirometry service. 2. Using a non-smoking individual, with no history of chest disease create a physiological normal range for that person that can be used to quality assure the equipment.

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QA LINEARITY CHECK

ESDL 2012

CREATING A QC RECORD

Perform spirometry and PEF daily, on the same person, over a period >2 weeks
>10 results of each in total should be collected.

Record the values in a table. Calculate mean values for:

FEV1 FVC PEF.

Calculate acceptable range using 5% of the mean of the measurements obtained. Record all the results in the portfolio.

ESDL 2012

EXAMPLE QC RECORD
Date 02/01/2008 14/01/2008 21/01/2008 28/01/2008 04/02/2008 11/02/2008 25/02/2008 04/03/2008 14/04/2008 21/04/2008 MEAN RANGE FVC 4.55 4.68 4.61 4.6 4.55 4.56 4.74 4.48 4.76 4.78 4.63 4.40 4.86L FEV1 3.85 3.94 4.03 3.98 3.97 4.00 4.05 3.94 4.02 4.02 3.98 3.78 4.18L PEF 7.33 7.51 8.26 7.6 7.86 7.72 8.00 7.56 7.94 7.53 7.73 7.34 8.11L/s

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10. CLEANING

Write a cleaning procedure for the spirometer that is used Include a work schedule that has been signed to show that cleaning has been done. Indicate what contingency plans are in place for dealing with potentially infectious patients. e.g. suspected TB, influenza etc.

ESDL 2012

EXAMPLE CLEANING LOG

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11. PATIENT TESTS Provide 15 traces that meet ERS/ATS acceptability criteria. Supply ALL efforts, even those that may be invalid for: FEV1 FVC FEV1/FVC% PEF VC (where possible), Include the predicted normal values.

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11. PATIENT TESTS Include the patients height, age, diagnosis and current drug therapy. Hi-light which test results would be reported for each patient from those performed. All patient data must be anonymised. Failure to do so is breach of patient confidentiality and will result in an automatic fail being awarded. A signed witness statement from a senior member of staff at the place of work indicating that all of the traces included have been performed by the candidate must be included.

ESDL 2012

12. PROBLEMS DURING TESTING Describe at least 6 problems that have been encountered when performing the test procedures. Provide an explanation what was done to overcome the problems. Include traces or results from invalid blows (may reference these from the previous section if some have been included).

Practical Skills Assessment

EDSL PART 2

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WORK IN PROGRESS!

Documentation not fully developed yet. However ... Format will be along the lines of ARTP Spirometry Practical assessment. Practical competency examination lasting up to 30 minutes Oral questioning lasting between 15 and 20 minutes

EXAMINATION FORMAT

Practical to assess performance criteria lasting 30 minutes and including: Calibration/verification Measurements of FEV1/FVC/VC and PEF Presentation and reporting of the results Oral to assess underpinning knowledge related to practical competences from the spirometry workbook.

ESDL 2012

STANDARD ASSESSMENT

Each section is labelled as Desirable (D) or Essential (E) The numbers of omissions that may equate to a fail are as follows:
Criteria Level Essential (E) Desirable (D) Fail Criteria 1 or more 4 or more

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PRE TEST CRITERIA

PERFORMANCE CRITERIA Y (achieved), N (not achieved). Achieved Y/N

ESDL 2012
COMMENTS Competency Complete comments Attainment for very good and very Level poor performances E D D E E E D E D D

Equipment is confirmed to be in safe working order by demonstration of calibration/ verification Consumables are available and ready in preparation for the test Patient is welcomed and put at ease (Communication, approach to the patient) Identity of the patient is checked and verified. (Communication, approach to the patient) Infection Control hands washed pre-tests (Technical performance & understanding) Weight & height of patient measured without outdoor clothing and shoes (Technical performance & understanding) Accurate smoking history and details of current medication are obtained (Communication, approach to the patient) Pre-test instructions are checked and deviations noted (Communication, approach to the patient) Last use of bronchodilator therapy and time of last cigarette are noted (Communication, approach to the patient) Temperature and barometric pressure accurately recorded (Technical performance & understanding)

SPIROMETRY
PERFORMANCE CRITERIA Y (achieved), N (not achieved). Patient is correctly positioned (Communication, approach to the patient) Nature and purpose of the test is explained (Communication, approach to the patient) Instruction to the patient is accurate, clear and precise (Communication, approach to the patient) Measurements of relaxed VC and FVC in accordance with ATS/ERS guidelines (Note number of measurements made) (Technical performance & understanding) Errors in patient technique are identified and corrected (Technical performance & understanding) Poor patient performance is distinguished from technical faults (Communication, approach to the patient) Recognises deterioration in clinical status (Communication, approach to the patient) Malfunctioning of equipment is Identified and corrected where possible (Technical performance & understanding) Results for reporting are correctly selected in accordance with ATS/ERS guidelines (within 5% or 150mls) (Technical performance & understanding) Achieved Y/N Competency Attainment Level

ESDL 2012
COMMENTS Complete comments for very good and very poor performances

D D D E Y N NA Y N NA Y N NA Y N NA

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ORAL QUESTIONING

All examination participants will have the opportunity to answer oral questioning on their prepared workbook assignments and portfolio of spirometry tests. This enables a fair and accurate grade to be awarded to the candidate.

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ORAL QUESTIONING EXAMPLES

Calibration/ Equipment Correct/ Incorrect Comment on the validity of your results and provide a clinical interpretation What is the difference between calibration/ verification and quality control? How regularly should you equipment be calibrated/ verified? What infection control measures do you have in place for spirometry testing? How does your spirometer work (flow/ volume measuring)? Comments

ESDL 2012

PRE TEST PROCEDURES

Pre test procedures Correct/ Incorrect If a patient could not stand how would you measure height What are the indications for spirometry What are contraindications \What information is required for the calculation of reference values Which reference ranges do you use Comments

ESDL 2012

SPIROMETRY QUESTIONS
Spirometry measurement Correct/ Incorrect Define classification of severity of airflow obstruction Why is it important to measure VC What would you expect to see in the FEV1/FVC ratio and FEV1 and FVC in restrictive lung disease What would you do if you did not achieve reproducibility criteria When may you want to refer for further tests Comments

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QUESTIONS?

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