Physiological Sciences

Profile of a Clinical Respiratory Physiologist

Areas of Investigation
Clinical Respiratory Physiologists provide a range of diagnostic testing and therapeutic services to patients with suspected respiratory disease. The role of the Clinical Respiratory Physiologist is to support the respiratory team in the diagnosis and subsequent management of the patient’s condition by providing accurate reproducible and reliable data on various aspects of a patient’s lung function. The range of tests performed by Clinical Respiratory Physiologists reflects the wide range of respiratory conditions that require an assessment of lung function. Patients of all ages, with conditions that include Chronic Obstructive Pulmonary Disease (COPD), sarcoidosis, interstitial lung fibrosis, myopathies, cystic fibrosis, emphysema, asthma, extrinsic allergic alveolitis, pre-operative screening, allergy and sleep breathing disorders are seen by the Clinical Respiratory Physiologist.

The Clinical Respiratory Physiologist will work with highly specialised equipment to perform basic and complex lung function tests. A ‘basic’ lung function test will involve the measurement of dynamic lung volumes and the degree of airways reversibility via spirometry with a bronchodilator response, determining the patient’s gas transfer (a measure of gas exchange of the lung) using the CO single breath hold method and finding out the patient’s total lung size (or capacity) and its subdivisions either by full body plethysmography or helium dilution.

From these results an assessment can be made as to the nature and severity of a patient’s lung disorder, whether it is a normal, - a restrictive or an obstructive picture or possibly a combination. The Clinical Respiratory Physiologist will then provide expert opinion and may decide whether further, more complex, testing is required.

The range of complex testing includes bronchial challenge testing, 6 min walk tests, full cardio pulmonary exercise testing, respiratory muscle weakness assessment, fitness to fly assessment, long term oxygen therapy assessment, arterial and capillary blood gases, domiciliary nebuliser assessment and hyperventilation studies.

Unlike many other healthcare scientist roles, all these tests whether basic or complex require total patient co-operation in order to produce reliable accurate results. A major necessity of the Clinical Respiratory Physiologist’s role is the ability to encourage the patient to perform the test to the best of their ability with the correct technique to produce a successful lung function test with valid results. At the same time they must understand the patients anxieties, needs and any deterioration in condition during the tests

Another expanding area of the Clinical Respiratory Physiologist’s role is the assessment of sleep related breathing disorders and their subsequent management. With cases of sleep apnoea on the increase many Clinical Respiratory Physiologist’s are specialist in performing and analysing sleep studies which include full polysomnography often in overnight sleep laboratories.

The Clinical Respiratory Physiologist provides a vital role in the diagnosis and management of a patient’s respiratory condition, giving expert opinion and a means for the respiratory physician to monitor evaluate and measure the patient’s lung function.

Education and Training Requirements

The key element in pursuing a career as Clinical Respiratory Physiologist is in obtaining the B.Sc. Hons in Clinical Physiology. 4 GCSE’s are required at C grade or above in maths, physics, biology, AND a minimum of 2 A levels (Grade D or above) or a BTEC national certificate in Science (MPPM) or an Advanced GNVQ or AVCE Science and if you are still in employment in a hospital you will be eligible for automatic entry to the course.

Because competition is high, often 3 good A level grades are now required for selection onto a training position. You will obtain a training position and receive on the job training, which may involve attending day release or short courses. The training period will vary and may be up to two years until you obtain the relevant qualification to allow you to pursue the Bsc.Hons. An “access to clinical physiology” is available. Throughout your training and including your degree program, you will be paid and your course fees will be paid for. (Minimising student debt)

The course is 4 years and is provided in block release format. College attendance is 9 weeks and four days per academic year for the first 3 years and four weeks and one day in the 4th year.

It includes core science modules, discipline theory modules (including respiratory physiology) and discipline based work based assessed modules. During the course, you will obtain the professional body (Association of Respiratory Technology and Physiology) part 1 and part 2 qualifications, which will allow you to then become a fully-fledged state registered practitioner.

Careers Opportunities

The career path for clinical respiratory physiologists normally follows the path below; although positions become available in the private sector, the NHS provides enough variation and specialisation to provide a sustainable rewarding career.

Clinical Respiratory Physiologists are currently graded as ‘Medical Technical Officers’.

Grading varies according to roles and responsibilities.
MTO1 student/trainee (£12.8k - £15.5k)
MTO2 basic level of competency to practice (£15.5k - £19.7k)
MTO3 senior or advanced (£20.5k - £23.9k)
MTO4 chief or further advanced and/ or specialised competency (£23.9k - £28.0k)
MTO5 manager or head of department/service (£29.1k - £34.0k)

(Salaries - April 04)

Within Respiratory Physiology it possible to cross over to the Clinical Scientist role which is different from Clinical Physiology in that it is targeted more at research and specialist services and requires an M.Sc training route and grading varies according to roles and responsibilities.

Grade A basic level of competence to practice (£12.0k - £18.0k)
Grade B senior or advanced (£18.0k - £38.0k)
Grade C consultant (£40.0k - £51.0k)
(Salaries - approx.)

Also at the higher grades of Clinical Physiologist or Clinical Scientist you would have the grounding to move into hospital management positions if you so wish. The modern NHS is flexible and aims to develop the individual’s skills and career direction as much as possible.

The Association for Respiratory Technology and Physiology

Background
ARTP was founded in mid 1970’s and was a member of FAMT (Federation Association of Medical Technology). In the early years a regional structure was attempted but was replaced with a single national committee. The first meeting took place at Kings College in 1974 and its founder members included Derek Cramer, Duncan Hutchinson, Jim Reed, Jane Jones, Kelvin Houston, Sue Hill and Philip Morgan amongst others.

The Journal (originally called ‘Breath’ ) was first published in 1978. Conferences were held nationally twice a year until 1998 when a single large Annual Conference in the winter was established. Over 400 members now attend the annual conference. The ARTP joined the Conference of Clinical Scientists in 1996 and remains a member of the Association of Clinical Scientists.

The first National Assessment Part I Exam was in 1986. Links with the BTS started in the mid 1980’s and the joint examination board (ARTP/BTS) was approved 1992. Part II National Assessment (advanced level) is now also developed. The Masters degrees for Clinical Scientists and Clinical Physiologists are currently being developed and should be launched by September 2005.

Membership has grown from 32 in 1978 to 630 in 2003. It is estimated that approx two thirds of practicing respiratory physiologists in the UK are ARTP members.

Main Objectives and Role of The ARTP

The main objectives of the ARTP are to promote, for the benefit to the general public:

• Advances in diagnosis and treatment of respiratory disease
• Continuous improvements in standards of competence to practice
• Continuous education & training programmes for practitioners
• Participation of practitioners in research and study, of which outcomes can be shared with fellow practitioners and allied professions
• Widespread communication of the ARTP’s objectives and initiatives via publication of the Association’s journal (‘Inspire’ ) and use of its website and email forum

The Association works in conjunction with the British Thoracic Society to produce national guidelines and standards for good practice in the performance of respiratory measurement.

It works closely with the Department of Health in formulating policy and in the strategic direction of the profession.

The Association is a founder member of the Association of Clinical Scientists, the Institute of Physiological Science and the Federation for Healthcare Science. There is also close involvement with Assembly 9 of the European Respiratory Society.

The ARTP Education College works closely with education providers to establish course content and recommend specialist lecturers for Technicians Education Council (TEC), Diploma and Degree courses in Clinical Physiology.

The ARTP maintains links with other professional bodies in Clinical Physiology via the Registration Council for Clinical Physiology (RCCP), the Institute of Physiological Science (IPS) and the Federation for Healthcare Science (FHCS).

Other connections exist with Irish practitioners (ARTI) and other Respiratory special interest groups such as the British Sleep Society (BSS), British Lung Foundation (BLF), the national training centres (RERC, NRTC), Respiratory Nurses Specialists, and Physiotherapists etc. ARTP has representation on both the BTS COPD Consortium and the BTS Sleep Apnoea Consortium.

At a practitioner level; the ARTP has developed systems to promote efficient communication between interested parties…

• The ‘Inspire’ journal is published three times a year and is distributed to the full membership. It carries information on national issues and scientific articles.
• The ARTP Website (www.artp.org.uk) carries information on its own and courses run by other institutions. It also carries job adverts and other useful reference information. Members can subscribe to an Email discussion ‘Forum’ (October 2004 - over 280 subscribers) which acts as a useful and efficient source of reference for the participants.
• The Manufacturers Liaison Committee regularly meet with representatives of manufacturers of all types of respiratory equipment to discuss problems with design, operation, technical specification and servicing arrangements which have been reported by the user's at 'shop floor' level.
• The ARTP maintains close communication links with all practitioners (both members and non-members) via the Regional Network. Departments meet locally to share information and discuss problems which can be shared with other regions and the Executive committee. This also provides a channel for the ARTP to communicate with departments that do not have ARTP members.

Key Issues

1. Proper funding for respiratory services (especially obstructive sleep apnoea)
2. Recruitment & Retention
3. Improving profile of both Respiratory Healthcare Scientists and Healthcare Science in general
4. Concern about other healthcare professionals performing lung function measurements poorly or with little understanding of interpretation.
5. Involvement of HCS’s in Modernisation Agenda and Policy development

Further information
www.artp.org.uk