Best Practices for Maintenance of Certification

Chicago CNG

Best Practices for Maintenance of Certification

James P. Henderson, Ph.D. Castle Worldwide, Inc.

Cheryl Gross, Director of Education. American Osteopathic Association

Jim Kendzel, Executive Director. American Society of Plumbing Engineers

Why maintenance of certification matters• Accelerated pace of technological changes, leading to

change in knowledge and skills required for proficient performance• Increased stakeholder expectations—consumers have

greater access to information through the Internet, requiring credential holders to answer more challenging questions and provide services at a level that satisfies better-informed consumers• Improved credentialing practices and forums for

discussions (such as ICE, ATP, CLEAR, and the CNGs) have stimulated discussions and experimentation on topics like continuing competence

Why continuing competence is a topic of widespread interest• Having earned the credential, certificants are

permitted to use the organization’s imprimatur throughout their careers, which implies to stakeholders that certificants have continuing competence• Consumers expect that the organization has verified

continuing competence through the recertification program• Systematic thought on construct definition for

continuing competence is in its infancy and required for the development of a theory

Continuing competence as construct• What’s a construct? A concept that has been defined

in such a manner that measures can be used to make inferences related to the presence or absence of the concept—validation of a construct leads to the development of models, and having valid models tells us how to address problems (such as the deterioration of competence after initial certification) more effectively through improved programs• Constructs give programs direction on defining

objectives, deciding on program components, measuring outcomes, and evaluating the success of the program

Where are we on developing continuing competence as a construct?• We are beginning to analyze and (hopefully) reach

consensus on terminology—words matter because the language used in a program sets the expectations of stakeholders and certificants

Institute for Credentialing Excellence. (2009). Practices and Requirements of Renewal Programs in Professional Licensure and Certification. Washington, DC: ICE.

• We have identified a few steps to follow in developing a construct statement for an organization

Institute for Credentialing Excellence. (2013). Methods for Ensuring Continuing Competence, Part I. Washington, DC: ICE.

Key definitions: Words matterContinuing Competence

The ability to provide service at specified levels of knowledge and skill, not only at the time of initial certification but throughout an individual’s professional career. [Certification: The ICE Handbook]

The ongoing commitment of the individual to integrate and apply the knowledge, skills and judgment with the attitudes, values and beliefs required to practice safely, effectively and ethically in a designated role. [Nursing Call to Action 2010]

Key definitions: Words matterContinued Competence

Past activities that demonstrate that throughout a specified period of time, and at a level at least equivalent to the minimum requirements for a particular credential, an individual has integrated and applied knowledge, skill, and judgment

Key definitions: Words matterCompetence and competency

• Competence refers to the underlying capacity to perform at a specified level

• Competency refers to a specific concept or behavior that may be required in a discipline

Steps in developing your construct statement• Identify your organization’s beliefs about continuing

competence, given the stakes associated with the profession (consequences to consumers if incompetent services are provided) and the pace of change in research, technology, and standards of practice• Determine the potential impact of natural

specialization in the profession relative to the scope of the credential to address expectations for breadth and relevance• Draft a general statement that addresses these points

Steps in developing your construct statement

• Get input from stakeholders and then refine the draft statement based on the input received

• Evaluate how effectively the statement addresses stakes, the pace of change, and breadth versus natural specialization

• Develop a graphic model with a hypothesis

Steps in developing your construct statement

• Identify measures that will provide meaningful data to support the inferences your organization wants to make about continuing competence, given the construct statement• Determine the time period for recertification• Adopt a broad view of the program to ensure its

integration• Implement the program based on the measures

identified, and collect data about how satisfactory the measures are

Steps in developing your construct statement

• Analyze the effectiveness of the measures in support of the inferences your organization is making and refine the measures appropriately• Publish the report of your program analysis in the

credentialing library on the ICE website so other organizations can benefit from your experience• Analyze the construct on an ongoing basis to inform

program improvement

Measuring continuing competence

The ICE 2009 report found the following measures are commonly used:• Guided reflection on practice• Self assessments• Academic coursework• Research and professional writing• Presentation and instruction• Participation in professional meetings and activities• Active employment

Measuring continuing competence

The ICE 2009 report found the following measures are commonly used:• Periodic examination• Continuing education• Enhanced continuing education (CE plus end-of-

activity assessment)• Peer review and references• Portfolios

NCCA Standard 19The certification program must require periodic recertification and establish, publish, apply, and periodically review policies and procedures for recertification• The basis and purpose for recertification and all

recertification requirements must be published• The rationale for the recertification time interval must

be included in the policy.• Recertification policies and procedures… must be

published and available to certificants and the public

NCCA Standard 20The certification program must demonstrate that its recertification requirements measure or enhance the continued competence of certificants.• If the purpose of recertification is to measure continued

competence of certificants, then the certification program must substantiate the validity and reliability of the assessment instruments used to measure continued competence.• If the purpose is to enhance continued competence of

certificants, then the certification program must demonstrate how the policy contributes to professional development of the individual certificants.

ISO 17024 Standards9.6.1 The certification body shall have (a)

documented procedure(s) for implementation of the recertification process, in accordance with the certification scheme requirements.

9.6.2 The certification body shall ensure during the recertification process that it confirms continued competence of the certified person and ongoing compliance with current scheme requirements by the certified person.

ISO 17024 Standards9.6.3 The recertification period shall be based upon the scheme requirements.

The rational for the recertification period shall take into account, where relevant, the following:

A) regulatory requirements;B) changes to normative documents;C) changes in the relevant scheme requirements;D) the nature and maturity of the industry or field in which the certified

person is working;E) the risks resulting from an incompetent person;F) ongoing changes in technology, and requirements for certified persons;G) requirements of interested parties;H) the frequency and content of surveillance activities, if required by the

scheme

ISO 17024 Standards9.6.4 The selected recertification activity/activities shall be adequate to

ensure that there is impartial assessment to confirm the continuing competence of the certified person.

9.6.5 In accordance with the certification scheme, recertification by the certification body shall considered at least the following:

A) on-site assessment;B) professional development;C) Structured interviews;D) Confirmation of continuing satisfactory work and work experience

records;E) Examination;F) Checks on physical capability in relation to the competence concerned.

Finally… continuing competence programs should take

a multi-step approachthat uses a triangulation of toolsin an iterative process

Osteopathic Continuous Certification

American Osteopathic Association

AOA Bureau of Osteopathic Specialists

• Organized in 1939

• The official certifying body of the AOA• 18 specialty certifying boards

• Nearly 90 specialty and subspecialty certifications

• Oversees and implements all certification and recertification policies and procedures 18 specialty certifying boards

• Oversees development and implementation of Osteopathic Continuous Certification (OCC)

AOA Certifications

C S Q

PRIMARY CERTIFICATION

CAQ

CAQ

CAQ

CAQ

Influencing Factors on the Development of OCC

OCC

IOM Reports on

Quality Care

Patient Perception

Alllopathic MOC

AOA CAP Program

Performance

Improvement

Initiatives

CMSS Conjoint

Committee

FSMB and MOL

Osteopathic Continuous Certification

• All AOA boards have implemented this continuous certification process for diplomates – January 2013

• Five Components

• Similar between specialties

• Maintain uniqueness of specialty

• Required for all certificants with time-limited certifications

Five Components of OCC• Component 1 – Unrestricted Licensure• Component 2 – Lifelong Learning / Self-Assessment• Component 3 – Cognitive Assessment• Component 4 – Practice Performance Assessment and

Improvement• Component 5 – Continuous AOA Membership

General Process for Component 4

Physician Submits Data

Quality Improvement Data (CAP, Hospital,

etc.) Patient Surveys

Board Reviews Data

Against National

Benchmarks

Physician Receives Report

with Recommendation

s for Improvement

Communications• Determination of Stakeholder Groups• OCC Awareness Survey to Diplomates – 3 years• Development of Plan• Determination of Healthy Budget• Development and Communications of OCC Platform for

Diplomates to Track Their Progress

Learning Lessons• Diplomates not practicing as originally certified• Diplomates who do not practice clinically• Stages of “Grief”• Boards as they developed plans• Diplomates as they learn about OCC

• Document all announcements and presentations• Develop speakers bureau and request form• Still learning

Maintenance of Certification

in the Construction Industry

American Society of Plumbing Engineers

•Programs•Certified Plumbing Designer Technician•Certified Plumbing Designer•Green Plumbing Design Certificate

ASPE Ongoing Maintenance•Certification Programs• 2 year cycle• 24 Recertification Units (RU) required• RU is equivalent to .10 CEUs or 1 Professional Development Hour (PDH)• 50%of RU's must come from approved CEU or PDH providers• Professional activities up to 6 RUs• Files are randomly audited and documentation of attendance required• ASPE provides approval program for providers

ASPE Certificate Program

•Eligibility includes being a licensed PE or a CPD.•2 day workshop followed by exam•Can use GPD credential•Refresher workshop required to be taken every two years and passing of exam following workshop

ASSE Certifications•American Society of Sanitary Engineers• Programs• Medical gas systems• Cross-connection control• Plumbing based residential fire protection systems

•Recertification• 3 year cycle (based on code cycle)• 8 hour accredited recertification class (classroom and

laboratory)• 25 question exam

Crane Operators

•Crane Institute Certification•5 year cycle based on OSHA requirements•50 question recertification exam for each crane type•1000+ hours of operation on comparable or higher crane type verified by employer: or pass practical exam

Plumbing License (35 States)Renewal Cycle CEUs / Year

21

11

2 1

1234

12

16

6

6

01468

Professional Engineer• 15 Professional Development Hours (PDH) annually (PDH = 1 contact hour) • At least 1 PDH in ethics• PDH equivalents• 1 CEU = 10 PDHs• 1 college semester = 45 PDHs• Active if professional society = 1 PDH• Peer reviewed publication = 5 PDH• Teaching = 2* student credit

• Some states approve course providers and require examination following completion course