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Moral credentials and the expression of prejudice.

Three experiments supported the hypothesis that people are more willing to express attitudes that could be viewed as prejudiced when their past behavior has established their credentials as nonprejudiced persons. In Study 1, participants given the opportunity to disagree with blatantly sexist statements were later more willing to favor a man for a stereotypically male job. In Study 2, participants who first had the opportunity to select a member of a stereotyped group (a woman or an African American) for a category-neutral job were more likely to reject a member of that group for a job stereotypically suited for majority members. In Study 3, participants who had established credentials as nonprejudiced persons revealed a greater willingness to express a politically incorrect opinion even when the audience was unaware of their credentials. The general conditions under which people feel licensed to act on illicit motives are discussed.

Adult↗

The dietitian and credentialing.

The meaning and ramifications of credentialing and accreditation have direct and powerful implications for the professional dietitian. There is also intense interest on the part of the public, as it views each profession's role in providing health care, as to the quality and expense ot that care. Each dietitian's analysis of the direction our Association must take in accreditation and credentialing is mandatory to the growth of nutritional care and its responsiveness to the needs of the American people. Issues have been presented and reviewed in this article. Some proposals for change have been suggested. By no means is the issue of accreditation or credentialing static among the health professions. New studies are being started routinely. New ideas and issues are continually being proposed and analyzed. What is good today for the practitioner and the public may be non-functional tomorrow. However, it seems certain that changes are imminent. It is imperative that each member of The American Dietetic Association assume an active role in the decisions that will be made for the future of each of us.

Accreditation↗

Evaluation of an efficient method for verifying higher educational credentials.

Neuropsychologists do not routinely verify patient's self-reported educational information. The present investigation attempted to validate a procedure for verifying educational credentials by phone. Of the 50 subjects representing 38 colleges that participated in this study, the attainment of baccalaureate degrees of only 6% could not be immediately verified by phone. All 19 schools given fictitious information reported they had no record of the fictitious student's attendance. The results of this study suggest that telephoning is an efficient method for verifying higher educational credentials. The authors recommend routine screening of patients whose academic credentials are questionable.

Journal Article↗

Credentialing of certified registered nurse anesthetists.

Certified registered nurse anesthetists (CRNAs) have provided anesthesia services in this country since the mid-1800s. As the earliest advanced practice nurse specialists, CRNAs have been leaders in the development of educational programs, accreditation, certification, and recertification. This article will describe the history of credentialing in nurse anesthesia and the achievements in the development of a valid and highly respected credentialing mechanism. Recertification and hospital credentialing are also discussed.

Certification↗

Emerging credentialing practices, malpractice liability policies, and guidelines governing complementary and alternative medical practices and dietary supplement recommendations: a descriptive study of 19 integrative health care centers in the United States.

BACKGROUND: Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. METHODS: To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. RESULTS: Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. CONCLUSIONS: Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.

Complementary Therapies↗

Competencies conference: future directions in education and credentialing in professional psychology.

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Clinical Competence↗

Credentialing residents for intraoperative cystoscopy.

OBJECTIVE: To determine whether incorporation of routine intraoperative cystoscopy for evaluation of potential urinary tract injury into gynecologic residency training provides sufficient experience to justify hospital credentials after graduation. METHODS: We developed a curriculum to train residents in intraoperative cystoscopic evaluation of potential lower urinary tract injury. Cystoscopy was performed when indicated with hysterectomy and routinely in conjunction with pelvic reconstruction. Faculty members evaluated conceptual and technical proficiency by oral examination and direct observation in the operating room. Once the resident demonstrated a thorough understanding and proficiency in performing intraoperative cystoscopy, a competency certification document was issued by the Program Director. This certification was transmitted to the postresidency hospital credentials committee to justify granting privileges. RESULTS: Since 1994 over 400 transurethral cystoscopic evaluations have been done in conjunction with major gynecologic abdominal and vaginal surgeries, and since 1997 an additional 50 transvesical microcystoscopies have been done in selected abdominal cases. Twenty-five residency graduates have been certified as fully trained in intraoperative diagnostic cystoscopy. All these graduates have been granted intraoperative cystoscopy privileges at their subsequent hospital practice. CONCLUSION: Incorporation of cystoscopic urinary tract evaluation into routine gynecologic surgical training is good medical practice and provided a mechanism whereby obstetrics and gynecology residents could obtain intraoperative cystoscopy hospital privileges after graduation. (Obstet Gynecol 2000;96:1014-7.)

Credentialing↗

Credentialing in carotid angiography and carotid angioplasty/stenting: experience of Mayo Clinic Rochester.

Carotid angioplasty and stenting is an evolving technique in the treatment of patients with carotid occlusive disease who are at increased risk for carotid endarterectomy. The literature has largely focused on the short and long-term results of this novel procedure. Due to the involvement of multiple disciplines, all of whom have legitimate claims to the carotid territory, credentialing has been a contentious issue at the local hospital level. This article describes the experience of Mayo Clinic Rochester in developing, in a multi-disciplinary manner, documents for credentialing in carotid angiography, carotid intervention, and guidelines for the use of this novel procedure.

Angioplasty↗

Training and credentialing in vascular laboratory diagnosis.

Physicians interpreting vascular laboratory studies require proper training and credentialing. It is suggested minimal training requirements include but, may not be limited to, the following: a medical license and knowledge of the fundamental concepts of vascular physiology, anatomy, and ultrasound physics. In addition, there should be evidence of training in vascular diagnostics beyond medical school, clinical experience in the treatment of vascular disease, supervised experience with specific numbers of vascular laboratory interpretations in the areas in which the physician wishes to interpret, and evidence of ongoing continuing medical education (CME) in noninvasive vascular diagnostics. Credentialing requirements are determined locally, but it is suggested that successful completion of the American Registry of Diagnostic Medical Sonographers' Registered Physician in Vascular Interpretation (RPVI) examination will provide evidence of core knowledge of vascular laboratory topics that is independent of medical or surgical specialty. Completion of the RPVI exam, completion of core training requirements, along with ongoing CME, is a basis for establishing minimal requirements for interpretation of vascular laboratory studies.

Certification↗

Portfolio evaluation for professional competence: credentialing in genetics for nurses.

The use of professional portfolios, comprised of a wide variety of materials and evidence to profile the scope and depth of a clinician's practice competence, is gaining popularity. The usual methods of showing professional competence via paper and pencil/computerized testing, oral presentations, or performance observations provide a picture of competence at a given point in time based on didactic content recall. Portfolios present an opportunity for presentation of a larger number of competency evaluation points. Although examinations can be validated with psychometrics, providing accuracy and reliability of evaluation of portfolios is a more complicated matter. This article discusses the experiences of the Credentialing Committee of the International Society of Nurses in Genetics as they created and validated the evaluation of professional portfolios to provide a quality credential for nurses in genetics.

Clinical Competence↗

Credentialing in laparoscopic surgery: a survey of physicians.

Laparoscopic surgery is now established as a major advance in modern surgery. Assurance of adequate training and credentialing is still a significant problem. Using laparoscopic cholecystectomy as an example, a survey was conducted to assess what criteria surgeons deem necessary for training and credentialing in a laparoscopic procedure. One hundred and forty-nine questionnaires were completed by surgeons from academic and private practice. A total of 110 (74%) surgeons consider that a course involving a hands-on animal lab should be required. Ninety-two (84%) of them answered that a preceptorship also should be required (average of 6.42 as surgeon and 5.86 as assistant). Ninety-nine (66%) responders believe that a surgeon should serve a probationary period (average of 11.6 cases) with review of morbidity, prior to being given full privileges. No statistical difference was found when comparing the answers of academic surgeons with private practitioners or between surgeons who had performed laparoscopic cholecystectomy and those who had not.

Cholecystectomy↗

Credentialing for breast lymphatic mapping: how many cases are enough?

OBJECTIVE: To evaluate credentialing issues for sentinel lymphatic mapping for breast cancer. SUMMARY BACKGROUND DATA: The sentinel lymph node (SLN) is defined as the first lymph node receiving lymphatic drainage from a tumor. The SLN accurately reflects the status of the axillary nodes in patients with early-stage breast cancer, and SLN mapping is gaining widespread acceptance. Few of the many published feasibility studies of lymphatic mapping for breast cancer have adequate numbers to assess credentialing issues for this new procedure. METHODS: Five hundred consecutive SLN biopsies were performed at one institution, over a 20-month period, by eight surgeons, using isosulfan blue dye and technetium-labeled sulfur colloid. The authors reviewed each surgeon's success rate in finding the SLN, and false-negative rate, relative to level of experience with the technique. RESULTS: Lymphatic mapping performed by an experienced surgeon (surgeon A, B, or C) was associated with a higher success rate (94%) than when it was performed by one with less experience (86%). Ten failed mapping procedures occurred in the first 100 cases. For each of the ensuing 100 cases, there were eight, six, six, and four failed mapping procedures, suggesting that increasing experience does not eradicate failed mapping procedures completely. The false-negative rate among 104 patients in whom axillary dissection was planned in advance was 10.6% (5/47). Most false-negative results occurred early in the surgeon's experience: when the first six cases of every surgeon were excluded, the false-negative rate fell to 5.2% (2/38). CONCLUSIONS: With increasing experience, failed SLN localizations and false-negative SLN biopsies occur less often. Combined dye and isotope localization, enhanced histopathology, a backup axillary dissection, and judicious case selection are required to avoid the high false-negative rate of one's early experience.

Adult↗

Credentialing and privileging nurse-midwives.

Nurse-midwives are one category of advanced practice nurse increasingly seeking hospital privileges to admit patients on their own recognizance. This article provides a framework for those health care institutions and insurers who are credentialing nurse-midwives. Nurse-midwifery educational preparation, licensure, scope of practice, relationships with collaborative physicians, and professional liability are discussed. Standards of the Joint Commission on Accreditation of Healthcare Organizations that pertain to credentialing and privileging nonphysician providers are reviewed. Various privileging routes are explored and directions recommended.

Credentialing↗

Credentialing for nurse practitioners: an update.

The public has the right to safe, quality healthcare delivered by professionals with the appropriate education, training, and experience. The Joint Commission on Accreditation of Healthcare Organizations, the Accreditation Association for Ambulatory Healthcare, and managed care organizations take this commitment very seriously. One mechanism required by these agencies to ensure patient safety is the process of credentialing and delineation of clinical privileges for medical staff and allied health professionals, such as Acute Care Nurse Practitioners. This commitment extends to patients receiving healthcare through the technology of telemedicine and to those requiring emergency care resulting from trauma, disasters, and varying forms of terrorism. In addition, safeguards must be in place to prevent identity theft of healthcare providers, including Acute Care Nurse Practitioners. It is essential that Acute Care Nurse Practitioners be familiar with the regulations that impact and guide the process of credentialing and obtaining clinical privileges in a variety of venues.

Acute Disease↗

Evaluation of the impact of a paediatric procedural sedation credentialing programme on quality of care.

OBJECTIVES: The aim of the present study is to describe changes in documentation, risk assessment and patient care resulting from implementation of a credentialing process for medical and nursing staff in paediatric procedural sedation (PPS) in two EDs - one an urban mixed ED and the other a specialist paediatric ED. METHODS: Chart review of 100 patients undergoing PPS prior to and 100 patients following introduction of the PPS programme. Information was extracted from medical records and sedation checklists. Demographics, drugs used, procedure performed and elements of the pre-procedural, intra-procedural and post-procedural care were compared pre- and post implementation of the PPS programme. RESULTS: Significant improvements in the post-implementation period compared with pre-implementation were seen in: frequency of documentation of informed consent (87 vs 15%, P < 0.0001); evidence of performance of a pre-procedural risk assessment (87 vs 1%, P < 0.0001); and appropriate recording of vital signs (58 vs 27%, P < 0.0001). Improvements were also noted in documentation of weight, allergies, fasting status and recording of drug orders. There were no adverse events recorded in the pre-programme period and 6 recorded in the post-programme period. CONCLUSION: The implementation of a PPS credentialing programme into these two EDs resulted in significant improvements in risk assessment, monitoring and documentation of important information related to safe PPS. These improvements should result in improved quality and safety of PPS.

Child↗

The validity of subscores for a credentialing test.

Subscores resulting from the administration of high-stakes tests to candidates for credentials in the health professions are desirable for two reasons. First, failing candidates want a profile of performance to plan future remedial studies. Second, training institutions want a profile of performance for their graduates to better evaluate their training. The validity of the interpretation or use of subscores depends on a summative judgment based on a combination of reasoning and empirical analyses, known as validation. We describe this reasoning process and show that with a large credentialing test the validity of any subscore interpretation or use can and should be studied systematically. Validity evidence should be established to support the interpretation and use of subscores that we intend to report. Some principles arise in this study related to the validity of subscores, and some procedures are proposed to help testing program personnel better validate the use of subscores.

Analysis of Variance↗

Response to a legal challenge. Five steps to defensible credentialing examinations.

In 1975 the National Board for Respiratory Therapy (currently the National Board for Respiratory Care) was named as a defendant in a class action suit field on behalf of three individuals seeking relief for alleged violations of Title VII of the Civil Rights Act of 1964, as well as the Sherman Antitrust Act. Although a pretrial settlement was reached, the conduct of this case demonstrates the potential vulnerability of credentialing examinations to complaints regarding discrimination and the necessity for credentialing organizations to be socially responsible for the potential use of test results by employers. The board has since instituted a systematic five-step research and development process that is used for all of its examinations to ensure and document that they are fair, valid, and defensible. This article recounts the salient aspects of the class action suit, discusses implications and current applicable technical standards and legal guidelines, and describes the components of the "Five Step Examination Development Process."

Chicago↗

The role of the national practitioner data bank in the credentialing process.

Federal law requires hospitals and permits other entities to seek information from the National Practitioner Data Bank (NPDB) but places no requirements on how that information should be used. Our survey of NPDB users demonstrates that although the NPDB has generated substantial controversy and its information is nominally available from other sources, it still plays an important role in the credentialing process. Most institutions make timely NPDB inquiries that facilitate widespread use of the information in credentialing activities (4-5 individuals or committees). However, in 3% to 7% of cases, a decision was reached before the institution had the NPDB report. Between 5% and 30% of privileging and licensure applications involving an NPDB report were not granted "as requested," suggesting the NPDB data are important to the process. Unfortunately, underreporting was also evident: 60% to 75% of reportable actions were not reported, limiting the information to which health care entities have access.

Credentialing↗