Commission on Accreditation for Respiratory Care

Dr. H. Fred Helmholz, Jr, MD Education Lecture Series

H. Fred Helmholz, Jr., MD 1911-2012

Dr. H. Fred Helmholz MD Lecturers

      

H. Fred Helmholz Jr., MD Shelley Mishoe, PhD, RRT Jon Nilsestuen, PhD, RRT, Marilyn Childers, PhD, RRT, & Stephen Fracek, PhD William Turner, PhD Robert Wilkins, PhD, RRT Garry Kauffman, MPA, RRT Thomas Johnson, MS, RRT & Mike Nazarro, MPH, RRT

       

Sal Sanders, MS, RRT Erna Boone, MEd, RRT & Bob DeLorme, MS, RRT Viva Jo Siddall, MS, RRT David Shelledy, PhD, RRT Jeff Ward, MEd, RRT Joseph Sorbello, MS, RRT Mark Taylor, MSW, EdD David Vines, MHS, RRT & Thomas Jones, MEd, RRT

www.coarc.com

Commission on Accreditation for Respiratory Care

Dr. H. Fred Helmholz, MD 16 th Annual Education Lecture Bill Galvin, MSEd, RRT, CPFT, AE-C, FAARC “Excellence in Respiratory Care Education: Creating an Exemplary RC Program”

A Thank You to CoARC Board

• David Bowton, MD, FCCP, FCCM , Immediate Past President • Stephen P. Mikles, EdS, RRT, FAARC, President • Robert DeLorme, EdS, RRT • Jolene K. Miller, MEd, RRT , Treasurer • Kathy Rye, EdD, RRT, FAARC, President-Elect • Ronald C. Allison, MD • Charles E. Cowles, Jr., MD • Joseph P. Coyle, MD • Diane Flatland, MS, RRT-NPS, CPFT • *Tom Smalling , PhD,RPFT, RPSGT, FAARC – Executive Director • Allen N. Gustin, Jr, MD, FCCP, Secretary • Thomas Hill, PhD, RRT, FAARC • Ralph L. Kendall, MD, FCCP • Diane J. Klepper, MD, FCCP • Bradley A. Leidich, MSEd, RRT, FAARC • Kevin O’Neil, MD • Pat Munzer, DHSc, RRT, FAARC • Monica Schibig, MA, RRT-NPS, CPFT • David Shelledy, PhD, RRT, FAARC • Gary C. White, MEd, RRT, RPFT

A Thank You to AARC Program Committee

Cheryl Hoerr, MBA, RRT, FAARC (Chair)

Ira Cheifetz, MD, FAARC Patrick Dunne, RRT, MEd, FAARC Dean Hess, PhD, RRT, FAARC

Garry Kauffman, MPA, RRT, FAARC

Timothy Myers, MBA, RRT-NPS

Shawna Strickland, PhD, RRT-NPS, FAARC

Terry Volsko, MHS, RRT, FAARC Staff Liaison: Doug Laher, RRT, MBA *KCR

American Association for Respiratory Care 2012 Summer Forum – Santa Fe, NM July 15, 2012 The Distinguished H.Fred Helmholz,MD Education Lecture Sponsored by Committee on Accreditation for Respiratory Care

Excellence in Respiratory Care Education: Creating an Exemplary RC Program

Presented by Bill Galvin, MSEd, RRT,CPFT, AE-C,FAARC Assistant Professor, School of Allied Health Professions Program Director, Respiratory Care Program Administrative/ Teaching Faculty, TIPS Program Gwynedd Mercy College

Conflict of Interest

I have no real or perceived conflict of interest that relates to this presentation. I have however published books, chapters and articles related to this topic for W.B. Saunders, Elsevier, Delmar/Thompson Learning, and Jones and Bartlett Publishers. Any use of brand names is not in any way meant to be an endorsement of a specific product, but to merely illustrate a point of emphasis. Summer Meetings 2012

Objectives

      List and explain the three key variables that shape/ impact program development, design and evaluation Review the literature regarding successful educational programs Recognize successful RC programs Identify and discuss select variables from successful RC programs Briefly list and explain elements of success Identify the single key ingredient to program and professional success

an obvious starting point is …

a “Systems Approach” to Education*

inputs processes outcomes Point: simply a conceptual way of viewing organizations, a management theory for administering and controlling education programs

*DeLapp GT. The Systems Approach for Administration of Respiratory Therapy Education Programs. Respiratory Care. June 1979; vol 24. No.6, 514-520.

A “Systems Approach” to Education

Environment

(Employers/ NBRC/ CoARC)

Inputs

(students)

Processes

(faculty/ RC lab/ clinical/curriculum/ library)

Outcomes

(RRT success rates/ Employment)

• •

Inputs

• • • • • • • The characteristics, traits, skills, talents, abilities, experiences and capabilities the students bring to the program Student inputs are generally assessed during the admissions process where high school and/or previous college academic performance, and life experiences are evaluated in form of: High school/ college transcripts Overall GPA Science GPA SATs/ACTs previous life/work experiences family commitments work requirements, etc.

Processes

• • Represent the sum total of all components that make up or support the teaching/ learning activities, to include: • • • • • • • • Curriculum Didactic/clinical faculty RC Lab Clinical affiliates Library Student services Computer/ learning lab Operating budget Processes hold a central role or pivotal position in the system

• •

Outcomes

• • • • • • The teaching/ learning activities represented by the curriculum, faculty, lab, clinical, etc (the process) transforms the student (input) into a caring, compassionate, and competent RT professional (outcome) Outcomes can generally be measured by attainment of certain standards or desired results, such as: professional credentialing exams meaningful, discipline-specific employment service a well-rounded liberal arts education civic responsibility a contributing member of society

Key points to the “Systems Approach”

Environment

(Employers/ NBRC/ CoARC) • • • •

Inputs

(students)

Processes

(faculty/ RC lab/ clinical/curriculum

Outcomes

(RRT success rates/ employment, a “professional”) Components are interrelated System is impacted by the external environment (receiving constant feedback) It is dynamic (constantly subject to change) It is considered a processor as it exists for transforming inputs into some altered form that leaves the system as outputs

clinical sites?

students?

What makes an RT program successful ?

faculty?

resources?

curriculum? program design?

Selective Review of the Literature

From the World of Physical Therapy

• • • Bkgd & Purpose: examine effect of educational program characteristics on NPTE pass rates Subjects: 132 accredited PT program surveyed – regression analysis performed on 21 independent variables and their role in predicting program’s pass rates Results: 3 variables that best predicted pass rate on NPTE were: (1) accreditation status, (2) number of faculty with PhD &/or EdD, and (3) years of pre professional and professional coursework combined Source: Mohr TM et al. Educational Program Characteristics and Pass rates on the National Physical Therapy Examination. Journal of Physical Therapy Education. 2005;vol19,no 1, 60-66.

Selective Review of the Literature

From the World of Physical Therapy

• • • Bkgd & Purpose: purpose of study was to determine which factors are related to NPTE score.

Subjects: 92 alumni of professional Master of PT program surveyed – Pearson correlation analyses conducted for following variables: age at graduation, professional GPA (PGPA), comprehensive exam (CE) score, PT clinical performance instrument (CPI), and NPTE score Results: CE and Professional GPA were most correlated with NPTE score

Source:

Kosmahl E. Factors Related to Physical Therapist License Examination Scores. Journal of Physical Therapy Education. 2005;vol19,no 2, 52-56.

• • • •

A Selective Review of the Literature

From the World of Physical Therapy

Bkgd & Purpose: examine relationship between PTA education program characteristics and PTA graduate pass rates, and develop a model which includes student and programmatic characteristics to predict success Subjects: Program Directors of 50 accredited PTA programs Methods: responses were coded and matched with first time and ultimate pass rates – correlation and regression analysis performed between pass rates and survey variables Results: pass rates of PTA graduates were positively correlated with newer, public programs, more clinical education credits, and less general education credits as a % of total credits required for program. Model best predicting ultimate pass rate success was program inception and whether institution was public or private

Source: Maring J and Costello, E. Education Program and Student Characteristics Associated with Pass Rates on the National Physical Therapy Examination for Physical Therapist Assistants. Journal of Physical Therapy Education. 2009;vol23,no 1, 3-11.

• • • •

Selective Review of the Literature

From the World of Radiologic Technology

Bkgd & Purpose: to assess factors registered radiologist assistants & radiologist assistant students perceive to be the most significant for success in an RA educational program Methods: An electronic survey sent to graduates & currently enrolled students in RA programs (N-99). Response was 60.6% and represented 8 RA programs. Factor analysis was used to examine relationships among variables.

Results: Four factors accounted for nearly 93% of the variance, 3 of the 4 related to role of radiologist preceptor. Although the quality of program seemed to be somewhat important, personal characteristics were perceived as contributing little to student success.

Conclusion: Study supports importance of developing strategies to engage radiologist preceptors in the RA education process.

Source: Ludwig R et al. Factors Influencing Success in RA Programs: A Survey. Radiologic Technology. 2010;vol82,no 2, 113-123.

Selective Review of the Literature

From the World of Nursing

• • • Fishbone diagram was used as framework for identification of cause and effect Eight causative factors were identified & thought to influence the achievement of its critical program outcomes (NCLEX-RC pass rates, graduation rates and graduate and employer satisfaction).

Eight factors were: environment, assessment and evaluation, standards/ criteria, faculty, students, resources, program of study, and policies, procedures and practices.

Brown JF and Marshall, BL. Continuous Quality Improvement: An Effective Strategy for Improvement of Program Outcomes in a Higher Education Setting. Nursing Education Perspectives. 2008, Vol 29, No. 4, 205-211

Hallmarks of Excellence in Nursing Education

(characteristics in the pursuit of excellence)

• • • • Students Faculty Continuous quality improvement Curriculum • • • • Teaching/learning evaluations and strategies Resources Innovations Educational resources • Environment • Leadership Kalb K et al. The Hallmarks Survey: For Those Who Care to Teach the Very Best. Nursing Education Perspectives. 2008, Jan/Feb, vol 29, no 1, 34-37.

Excellence in Nursing Education Model

-8 core elements-

1. Clear program standards & hallmarks that raise expectations 2. Evidence-based programs & teaching/evaluation methods 3. Qualified students 4. Quality & adequate resources 5. recognition of expertise 6. Student-centered, interactive, innovative programs & curricula 7. Well-prepared educational administrators 8. Well-prepared faculty Source:Engelmann, L et al. Tapping Into Your Center of Excellence. Nursing Education Perspectives, 2008 Nov/Dec, Vol29, no. 6, p383-385

Selective Review of the Literature

From the Respiratory Care World

Bkgrd & Objective: Methods: Results: Study was designed to examine whether a variance in student and faculty credentials and fiscal expenditures were associated with program performance on the 1997 CRTT Exam 234 accredited college-based respiratory therapist programs surveyed, 100 (42.7%) returned usable questionnaires revealed that grade point average of graduates; faculty credentials; and expenditures for travel, lab supplies, instructional aids, and electronic media were the strongest predictors to program effectiveness.

Conclusion: Source: Awareness of the degree and interrelatedness between program components (student, faculty, curriculum, and resource) and outcomes contributes to quality program effectiveness.

Johnson, PL. The extent to which factors relevant to program function influence effectiveness of respiratory care education. Respiratory Care Education Annual (RESPIR CARE EDUC ANNU), 2001 Spring; 10: 15-32 (41 ref)

Selective Review of the Literature

From the Respiratory Care World

Bkgrd & Objective: Study designed to examined the extent to which program resources predicted program performance on WRRT Exam Methods: analysis of BSRT Programs – 36 our of 57 surveyed Results: found significant relationship between program resources and program performance on WRRT Exam Conclusion: Programs with more financial and personnel resources consistently have better scores on the WRRTE. Therefore, RCE programs must assure their constituents that programs have the financial and personnel resources necessary to provide quality preparation for graduates Source: Ari A. A study of program effectiveness: the relationship between program resources and program performance on the Written Registry for Respiratory Care Examination. Respiratory Care Education Annual (RESPIR CARE EDUC ANNU), 2007 Fall; 16: 39-48 (15 ref)

A Review of the Literature

Forthcoming from the Respiratory Care World

Forthcoming research: Karen Shaw, Program Director form College of Southern Nevada, will be undertaking an extensive research project for her doctoral degree attempting to identify different factors between successful and less successful RC program Objective: examined the extent to which program resources predicted program performance Methods: analysis of all RT Programs throughout the country and analyze data from 3 distinct groups or cohorts of programs (top 3 rd , middle 3 rd and lower 3 rd )

Point: I urge you to help her when requested to do so

Excellence* …

“Can be attained if you think is wise,

risk care

more than others more than others think is safe,

dream

more than others think is practical, and

expect

more than others think is possible” *Valiga,T & Grossman S. The New Leadership Challenge: Creating the Future of Nursing, 2000, FA Davis.

Successful RC Programs

2011 CoARC Distinguished RRT Credentialing Success Awardees (32)

• • • • • • • • • • • Borough of Manhattan Community College, New York, NY Broward College, Coconut Creek, FL Central Virginia Community College, Lynchburg, VA Chattanooga State Community College, Chattanooga, TN College of Southern Nevada, Las Vegas, NV ConCorde Career College, Garden Grove, CA ConCorde Career College, Memphis, TN Dakota State University, Madison, SD Foothill College, Los Altos Hills, CA Georgia Health Sciences University, Augusta, GA Gwinnett Technical College , Lawrenceville, GA

Successful RC Programs

2011 CoARC Distinguished RRT Credentialing Success Awardees (32)

• • • • • • • • • • • Harrisburg Area Community College - Harrisburg, PA Henry Ford Community College - Dearborn, MI Ivy Tech Community College -Wabash Valley, Terre Haute, IN Kalamazoo Valley Community College - Kalamazoo, MI Kapiolani Community College - Honolulu, HI Long Island University - Brooklyn, NY Louisiana State University Health Sciences - Shreveport, LA Macomb Community College - Clinton Township, MI Millersville University - Millersville, PA Ohio State University - Columbus, OH Ohlone College - Newark, CA

Successful RC Programs

2011 CoARC Distinguished RRT Credentialing Success Awardees (32)

• • • • • • • • • • Ozarks Technical Community College - Springfield, MO St Alexius Medical Center/University of Mary, - Bismarck, ND Stony Brook University - Stony Brook, NY Texas Southern University - Houston, TX University of Arkansas for Medical Sciences - Little Rock, AR University of Missouri-Columbia - Columbia, MO University of Missouri at Mercy Hospital - St. Louis, MO University of Texas Health Science - San Antonio, TX University of Texas Medical Branch - Galveston, TX Victoria College - Victoria, TX

Survey of 32 Programs with RRT Success

1 st 2 nd 3 rd – Congratulations!

– Thank You!

– Share results (descriptive not evaluative) • • Suggestion – view data from perspective that this is what the 32 reported out and how does the data compare with my program What nuggets can I garner from the survey results to aid me in making improvements in my own program?

Budget Curriculum Clinical Faculty Laboratory Students Institutional Information Advisory Board Medical Direction

• • • • •

Successful RC Programs

-Survey Results of Select Variables Institutional Data

Type of Degree • AS or BS Institution Type • Community College/Junior College, Technical or Vocational School, Career or Technical College, 4-yr college/university, Academic HCS/Medical center, US Military Institutional Control/ Funding • Public/ Not for Profit, Private/ Not for Profit, Private/ for Profit, Federal Government Geographic Location Program Inception Date

Successful RC Programs

Type of Degree n-32

Successful RC Programs

Institutional Type n-32

Successful RC Programs

Institutional Control/ Funding n-32

Successful RC Programs

Geographic Location n=32

Successful RC Programs

Program Inception Date n-29

• • • •

Successful RC Programs

-survey results of select variables Student Demographics*

Number of applicants per year Number acceptances per year Number of graduates per year Per cent attrition * in a typical year

Successful RC Programs

Number of Applicants n-30

Successful RC Programs

Number of Acceptances n-30

Successful RC Programs

Number of Graduates n-30

Successful RC Programs

Percent Attrition n-30

• • • • • •

Successful RC Programs

-survey results of select variables Student Characteristics/Profile*

age at program entry educational level at time of program entry SAT/ACT Scores at entry HS/ college/ science GPA use of HOBET Personal experiences with health care * In a typical year for majority of students

Successful RC Programs

Age at Program Entry n-30

Successful RC Programs

Educational Level at Program Entry n-30

Successful RC Programs

SAT/ ACT Scores

n-27

Successful RC Programs

HS GPA -College GPA-Science GPA

N=6 for HS, 20 for College GPA, 25 for Science GPS

Successful RC Programs

Use of HOBET

N=29

Successful RC Programs

Personal HC Experience Motivation to Enter RC N=29

Successful RC Programs

Other Significant Features About Students N=16

• • • • • • Significant ethnic diversity (5) RC was second choice, i.e. nursing first (3) Career change (2) Ernest, professional, motivated students Serve as role model for children Found profession by chance

Successful RC Programs

-survey results of select variables-

• • • • •

Curriculum

Total college credits College credits in RC College credits in math/ natural science On-line option other

Successful RC Programs

Total College Credits N=30

Successful RC Programs

Total RC Credits N=30

Successful RC Programs

Total Math/Science Credits N=30

Successful RC Programs

On-Line Option N=32

Successful RC Programs

Other Significant Features About Curriculum

• • • • • • Soft skills and earnest study are stressed Curriculum includes NALS/PALS as credit courses Include problem-based and case-based learning Lectures are all video taped and posted (3) Curriculum dove-tails with another BS institution Use a learning management system

• • • • •

Successful RC Programs

- survey results of select variables Faculty Characteristics/ Profile

Number of full time Number of part time • Number of adjuncts Program’s Estimated FTEs • Key Program Faculty Program Director Director of Clinical Education

Successful RC Programs

Number of Full Time Faculty N=32

Successful RC Programs

Number of Part Time Faculty N=30

Successful RC Programs

Number of Full Time Equivalent Faculty N=22

Successful RC Programs

-survey results of select variables-

• • • • •

Characteristics/ Profile of Key Program Personnel

Highest degree of PD/DCE Years as PD/DCE at this program Years as PD/DCE at other institutions Years of experience in RC for PD/DEC Years of experience in RC education for PD/DCE

Successful RC Programs

Highest Academic Degree of Program Director and Director of Clinical Education N=30

Successful RC Programs

Number of Years as Program Director N=30

Successful RC Programs

Total Years of Experience for Program Director in RC Education N=30

Successful RC Programs

Total Years of Experience for Program Director in All Phases of RC N=30

Successful RC Programs

Number of Years as Director of Clinical Education N=30

Successful RC Programs

Total Years of Experience for DCE in RC Education N=30

Successful RC Programs

Total Years of Experience for DCE in All Phases of RC N=30

• • • • • •

Successful RC Programs

-survey results of select variables Laboratory Resources

Dedicated laboratory Open lab Use of lab Square footage Use of computerized clinical simulation software Simulation technology

Successful RC Programs

Dedicated Lab- Open Lab – Usage of Lab N=30

Successful RC Programs

Lab Space (best estimate of square footage) N=26

• • • •

Successful RC Programs

Use of Computerized Clinical Simulation Software N=29

All programs that responded indicated they used some form of computerized clinical simulation software in their program (29) C & S Solution software used (8) NBRC SAE’s used (7) “Home-grown” simulations used (2)

Successful RC Programs

Mandatory Performance Requirement for Use of Computerized Clinical Simulation Software N=29

Successful RC Programs

Simulation Technology N=30

• • • • • • •

Successful RC Programs

Unusual Facilities/ Equipment N=14

Human cadaver, animal lab, simulation center, simulated ICU area Bronchoscopy lab All updated equipment Separate Polysomnography lab and computer stations 24 ventilators – piped gases Video-capture system High-fidelity simulators

• • • • •

Successful RC Programs

- survey results of select variables Clinical Resources

Number of sites Total number of clinical contact hours Clinical contact hours by specialty area Compensation of clinical faculty other

Successful RC Programs

Number of Clinical Sites N=29

Successful RC Programs

Number of Clinical Contact Hours N=29

Successful RC Programs

Per Cent of Clinical Contact Hours in Routine Care/Procedures N=28

Successful RC Programs

Per Cent of Clinical Contact Hours in Critical Care N=28

Successful RC Programs

Per Cent of Clinical Contact Hours in Diagnostics N=28

Successful RC Programs

Per Cent of Clinical Contact Hours in Neonatal/ Pediatrics N=28

Successful RC Programs

Per Cent of Clinical Contact Hours in Physician Interaction N=28

Successful RC Programs

Faculty primarily responsible for assuring student clinical competency are faculty: N=29

• • • •

Successful RC Programs

- survey results of select variables Medical Director

Contractual academic appointment Time in administrative role Time in teaching role Compensation

Successful RC Programs

Does Medical Director have a contract and/or hold an academic appointment N=29

Successful RC Programs

Hours per year Medical Director Spends in an Administrative Capacity N=25

Successful RC Programs

Hours per year Medical Director Spends in a Teaching Capacity N=26

Successful RC Programs

Do you Pay your Medical Director?

N=29

Successful RC Programs

If yes, how much?

N=10

• • •

Successful RC Programs

- survey results of select variables Advisory Board

Number Frequency of meetings Role and activity

Successful RC Programs

Number of Advisory Board Members N=29

Successful RC Programs

Number of Advisory Board Meetings Per Year N=29

• • • • • •

Successful RC Programs

Role/ Activity Level of Advisory Board N=23

Review program statistics Information sharing/ update Advise on curriculum, clinical /community needs Quarterly email updates Help maintain quality Assist as an interview panel (admissions)

Successful RC Programs

- survey results of select variables -

• •

Budget

Annual capital budget Annual operating budget

Successful RC Programs

Capital Budget N=19

Successful RC Programs

Operating Budget N=22

Successful RC Programs

- survey results of select variables Participation in Credentialing Process

• • • Employer mandated Program mandated Motivating factors

Successful RC Programs

Employer Mandated Participation in Credentialing Process as Requirement for Employment N=29

Successful RC Programs

Program Mandates Participation in Credentialing Process as Requirement for Graduation N=29

Successful RC Programs

Program Espouses Professional Responsibility to Pursue RRT N=29

Successful RC Programs

Tangible Reward/ Incentive Provided N=29

• • • • • • • • •

Successful RC Programs

Incentive, Reward, Motivation/ Strategy Employed N=29

• • Informed that program is RRT not CRT (4) Higher salary for RRT – monetary incentive (5) Program expectation – peer pressure RRT promoted from day 1 – CRT is “rooky status” Heap praise on them (3) Take SAE’s – build their confidence Institution pays for their RRT exam Share school results – publicly celebrate their success Names listed on white board – student comes up and places credential next to name when they pass It is our culture !

Have an alumni-sponsored dinner

Elements of Success

Relative Importance of Program Factors N-29 Remediation Ctr Library Advisory Bd Capital Budget Science Faculty Adm-non progrm Operating budget Med Director MD Interaction Students Laboratory Clin Faculty Curriculum Adm-program Program Faculty Clinical Facilities

Summary

• • • • • • Listed 3 key variables that shape program development, design and evaluation Provided a brief reviewed of the literature Recognized success stories (32 Programs) Identified some of the variables Encourage you to view these from the perspective of your own program Closing thoughts

• • •

Closing thoughts

Excellence …

… means striving to be the very best we can be in everything we do – not because some institutional administrator or accrediting body or other “authority” figure pushes us to do so, but because we can not imagine functioning in any other way … means setting high standards for ourselves and the groups in which we are involved, holding ourselves to those standards despite challenges or pressures to reduce or lower them and not being satisfied with anything less than the very best … means not accepting the status quo, it’s being all you can be

Closing thoughts

Excellence in Higher Education

(characteristics in the pursuit of excellence)

• • • • Students Faculty Continuous quality improvement Curriculum • • • • Resources Innovations Educational resources Environment • Teaching/learning and strategies • Leadership Kalb K et al. The Hallmarks Survey: For Those Who Care to Teach the Very Best. Nursing Education Perspectives. 2008, Jan/Feb, vol 29, no 1, 34-37.

• • • • •

closing thoughts

-Foundations of Excellence-

Excellence is a process, not an outcome Excellence is a reflection of character, not achievement Excellence allows for learning from mistakes, not harsh criticism Excellence sees others in a supportive role, not an adversarial role Excellence is willing to wait for mastery to be achieved and does not expect immediate results

Ok, so what is the single key ingredient to program and professional success?

3 Elements of Excellence*

•

Skepticism

– keeping a proper distance from the truth, not accepting everything blindly, keeping our mind open to new ideas & approaches •

Perseverance

– continually striving to fulfill a goal or realize a vision •

Passion

– being “inflamed” by your work – passion is “the essence of excellence”

* Diers, D & Evans,DL (1980) Excellence in Nursing [Editorial] Image, 12, 27 30.

A MSRC Ode To Dr. Helmholz*

1911-2012 He strove to understand Why certain pilots never land He increased our knowledge and raised the bar By helping us understand BMR He shaped our craft to what it could be And served us well as the President of the NBRC He taught us the role of Bicarbonate And found clever ways to help us dissolve it A man of many talents since he was a lad A better friend, our profession has never had A writer of poetry we have read A henry you know as Fred *with gratitude to MSRC and Jeff Ward

Thank you

for the privilege and honor of presenting the 2012 Dr. H. Fred Helmholz, MD Education Lecture