Training and education challenges for the twenty-first century: respiratory care competency and practice.

In recent years, there has been a paradigm shift in the roles and responsibilities of respiratory therapists. Therapists increasingly are expected to design and implement respiratory care plans within the scope of protocols. Respiratory therapists also are expected to perform greater numbers of advanced procedures such as endotracheal intubation and arterial catheter insertion. The greatest impact on respiratory care practice is likely to be the increasing use of the principles of evidence-based medicine. Each of these factors will affect how respiratory therapists should be trained and educated in the twenty-first century.