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PubMed2004

White paper on occupational regulation.

There are many ways that occupations are regulated, with the degree of regulation usually depending on the amount of harm to the public that lack of regulation could bring. Strict regulations, such as mandatory licensure, are established through state law and maintained by a state board. Less strict regulations, such as voluntary credentialing, may be requirements by employers or third-party payers. This white paper reviews the possible approaches ASET could take toward regulation of the practice of electroneurodiagnostic technology: maintain position of neutrality, advocate for no statutory regulation of END, advocate for statutory regulation of END, or advocate for voluntary credentialing. The routes taken by other allied health fields are outlined, with exploration of the advantages and disadvantages of each option, as well as what would be required of ASET in terms of time and other resources to achieve each option. The appendix is a summary of entry requirements of several healthcare professions.

Allied Health Personnel↗

PubMedDate not supplied

Policies pertaining to complementary and alternative medical therapies in a random sample of 39 academic health centers.

This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies, one in the psychiatry department, and five in outpatient pharmacies. Thus, few academic medical centers have sufficiently integrated CAM services into conventional care by developing consensus-written policies governing credentialing, malpractice liability, and dietary supplement use.

Academic Medical Centers↗

PubMed2005

Establishment of a course for Focused Assessment Sonography for Trauma.

OBJECTIVE: Focused Assessment Sonography for Trauma (FAST) is not widely practiced by Trauma Surgeons in the Middle East despite its international acceptance. A FAST course was established by the Trauma Group at the Faculty of Medicine and Health Sciences at United Arab Emirates (UAE) University aiming to introduce doctors who have limited experience of ultrasound to the basics of FAST. This article summarizes the content of the course; the evaluation of the participants and their recommendations. METHODS: An 8 hour FAST course was offered to 18 participants in May 2004 in the Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE. Lectures with syllabus material were used to cover the following topics: basic ultrasound physics, knobology and sonographic orientation, the FAST scan, chest and cardiac trauma sonographic evaluation, training and credentialing issues. Each participant received 3 hours of hands-on ultrasound instruction. On completion of the course participants responded anonymously to an evaluation questionnaire. RESULTS: All participants responded to the questionnaire (100% response rate). Delegates found the course well organized, relevant, met their needs and encourages them to use FAST in their own practice. The course objectives were met. Participants suggested that including actual patients and the use of animal models improve the practical sessions. CONCLUSION: Organizing a FAST course is an important step towards recognizing and implementing it in practice. Nevertheless, there is a need for appropriate quality assurance and credentialing guidelines before commencing.

Clinical Competence↗

PubMed2006

Trauma nurse specialists' performance of advanced skills positively impacts surgical residency time constraints.

The Accreditation Council for Graduate Medical Education imposed 80-hour work week constraints on residency programs in July 2003. Certain programs were granted an additional 10 per cent for specific educational purposes, bringing restrictions to 88 hours per week. The increased demand for residents to leave the hospital has placed teaching institutions in exhaustive situations to provide comprehensive patient care. In response to the work hour constraints among residents and emergency room staff, a unique group of registered nurses, trauma nurse specialists (TNSs), were credentialed with advanced practice skill sets. Governed by practice guidelines and overseen by a medical director, TNSs perform invasive procedures that are normally the responsibility of the surgical resident. The purpose of this study was to evaluate work hours saved for surgery residents using credentialed nurses (TNSs). Procedure logs were maintained by the TNSs over a 6-month period, and surgical house staff (postgraduate year 1-3) over a 4-month period. A total of 423 procedures were recorded, reflecting time taken for attempted/completed procedures and complications. Resident procedures numbered 98; TNS procedures numbered 325. TNSs spent an average of 42 hours per month (10.6 hours per week) completing advanced procedures with no statistical difference in time or complications compared with surgical residents. By using the TNSs, work hours for surgery residents were saved while maintaining a safe and reliable work atmosphere for patients.

Education, Nursing↗

PubMed1999

The history and evolution of athletic training education in the United States.

OBJECTIVE: To present a chronologic review of the history and evolution of athletic training education in the United States as related to the professional growth of athletic training and the National Athletic Trainers' Association. BACKGROUND: Commonly accepted characteristics of a profession are an identifiable body of knowledge, the emergence of practitioners as professional authorities, and community recognition. These characteristics establish the criteria by which the professional growth, or professionalization, of athletic training can be judged. With guidance from the National Athletic Trainers' Association, the development of athletic training education programs and credentialing of athletic trainers during the past 50 years have contributed to the professionalization of athletic training. DESCRIPTION: We present a chronology of the contributions of the National Athletic Trainers' Association to the development of athletic training education in the United States. The activities of various committees, task forces, and Association members are reviewed and traced through the past 5 decades. Early curriculum models and the development of education programs in colleges and universities are discussed. ADVANTAGES: The historical review of athletic training education in this article will enhance the reader's understanding of the relationships among education, credentialing of practitioners, and professionalism in athletic training.

Journal Article↗

PubMedDate not supplied

Nutrition counseling: guidelines for the practicing physician.

Americans thrive on news about food, nutrition, diets and fitness. Testimony to this phenomenon is the predominance of popular literature related to these topics in the print and broadcast media. All too often the emphasis is on overnight or simple solutions to complex problems. The public is an easy mark for the "health peddler" who lacks credentials but possesses effective motivational skills and speaks with conviction about unfounded promises and exaggerated outcomes. Nutrition misinformation wastes billions of dollars every year but the greatest harm occurs when needed medical intervention is delayed or ignored. Patients expect physicians to be able to answer nutrition related questions and to know where to refer them for further nutritional guidance when needed. (1) In order to assure appropriate referrals, physicians need to know where to find a qualified dietitian/nutritionist and how to verify appropriate credentials. When a patient is referred to a dietitian for nutrition assessment and counseling, the expectations should be clear to all concerned and should include a plan for follow-up communication. This article describes the basis for and benefits of a partnership between the physician and dietitian in providing quality health care and patient education.

Alabama↗

PubMed1990

The nursing shortage and specialty practice.

This paper has reviewed numerous factors contributing to the nursing shortage. These factors include changes in medical practice and the patient population, professional beliefs and objectives, and economic factors. Although many articles reviewed focus on the reasons for and solutions to the shortage, few note specifics regarding how the shortage may or may not impact on the quality of patient care. The impact of the shortage on specialty areas of nursing practice and specifically the area of peripheral vascular nursing was also reviewed. Although no recommendations were made for alleviating the shortage, recommendations for the preparation of the specialty nurse were discussed. The author agrees with Hoeffer and Murphy who state that the future of specialization is at the masters degree level. Also important is that the various nursing groups support professional credentialing and certification as a means of regulating specialty practice. Only through cooperation will nursing "specialization" be consistent in its definition as well as be recognized by nursing, other health care providers and the public as a meaningful credential.

Education, Nursing, Graduate↗

PubMedDate not supplied

ODWIN expansion program: a study in success.

Of 182 students who successfully completed an eight-week program for high school graduates with marginal credentials and who were admitted to schools of nursing, 125 (69 percent) subsequently received degrees or certificates. This success rate compares favorably with national and regional norms. This study documents the marginality of the students' credentials and evaluates their success rates. Of 11 academic variables correlated with successful completion of nursing programs, the two subjective evaluations of each student by the academic personnel teaching the eight-week program were the only variables to reach significance (p = .01).

Education, Nursing, Baccalaureate↗

PubMed1989

Pharmacy-coordinated process for evaluating physician drug prescribing.

A pharmacy-coordinated process is described in which the frequency and types of inappropriate drug prescribing are evaluated as part of the medical staff quality assurance and physician credentialing program. A pharmacist intervention program was implemented at an 838-bed private hospital to review all medication orders for appropriateness and to intervene with physicians and nurses when problems in drug prescribing or administration were identified. During a five-year period there were more than 6500 drug therapy interventions. Because of the recurrent problems identified, the medical staff asked the pharmacy department to develop a process for objectively evaluating the quality of prescribing practices that could be used in the medical staff quality assurance program and in physician credentialing. The drug-prescribing activities of physicians applying for clinical privileges are subjected to a "macro" review by using a computerized clinical financial information system to extract drug-use information from patients' bills. In a "micro" review, patient records are retrospectively analyzed by Pharm.D. clinical specialists; all medications prescribed by the physician for those patients being evaluated are scrutinized. Appropriate response scores are calculated by dividing the number of appropriate responses by the total responses. The pharmacy department in this hospital has assumed a more active role in patient care through its participation in a process for objectively evaluating the quality of prescribing practices.

Diagnosis-Related Groups↗

PubMedDate not supplied

Reasons nurses participate in continuing education.

The study was undertaken to identify dimensions, or motivational orientations that underlie reasons nurses participate in continuing education programs and to determine relationships between these orientations and the legal status of CE and selected demographic characteristics of participants. The sample included 843 nurses who participated in CE programs sponsored by colleges and universities with accredited baccalaureate schools of nursing. Two instruments were used for data collection: a 56-item checklist consisting of reasons for participation (Education Participation Scale) and a personal data sheet. Factor analysis of responses to the EPS indicated that seven motivational orientations underlay the nurses' reasons for participation: compliance with authority, improvement in social relations, improvement in social welfare skills, professional advancement, professional knowledge, relief from routine, and acquisition of credentials. Mean scores on each orientation for the entire sample ranged from 6.55 (professional knowledge) to 1.57 (improvement in social relations) on a 10-point scale. Analysis of variance to determine the relationship between motivational orientation scores and legal status of continuing nursing education revealed no differences among the three legal conditions studied---mandatory, proposed, and voluntary CE---except on the acquisition of credentials orientation. Scores on this orientation varied significantly (p less than .001), but only for respondents employed part-time; for these nurses mean scores were ranked mandatory, proposed, then voluntary. Study findings suggest that, for these nurses, the presence or threat of a mandatory CE law had little influence in motivating participation. Rather, these nurses participated in continuing nursing education programs for reasons related to maintaining professional currency and improving their ability to serve the public.

Demography↗

PubMed1986

Knowledge coupling, medical education and patient care.

Medical education and the acquisition of professional credentials do not guarantee that medical knowledge (information that is taught, apart from the reality of practice, or gleaned from the literature) will be coupled rigorously to the decision-making process of everyday clinical practice. The limitations of the unaided human mind in a memory-based educational system must be forthrightly acknowledged by those who would be responsible for curriculum reform, so the need for new premises and new tools will be recognized and implemented. Because of their knowledge of the many variables that are unique to them, the patients themselves must be given a much more central role in the process of medical care and medical education. Weaknesses of specialization and credentialing in the present obsolete system are analyzed. The behavior of a well-defined system of education and medical care, and the function of the performers within it, are described. Causes of resistance to curricular reform founded on new premises and use of new tools, such as computers, are considered. New computer tools, as components of a problem-solving decision support system (knowledge couplers, knowledge networks, the coupler editor and documentation system, and the computerized patient record), are described. How these might be incorporated into a new type of medical education curriculum is presented. Finally, new goals, within the context of the new premises being implemented into a new system of education and medical care, are outlined.

Artificial Intelligence↗

PubMedDate not supplied

Certification. Hospital versus national standards.

"Certification" and "credential" are frequently used terms in nursing. How these terms are used and what they mean to nursing practice is the focus of this article. Definitions, history, and application of these concepts are explored. Recommendations are made that a hospital not assume responsibility for the granting of certification or credentials to nursing staff members. Nurses and nursing administrators are urged to support nationally recognized certification programs.

Certification↗

PubMed1996

Pediatric locum tenens provided by an academic center.

BACKGROUND: Locum tenens, the use of a substitute physician to replace a physician who must be temporarily absent from his practice, is widely accepted in the United States. Locum tenens has not previously been described or studied in pediatric practice. OBJECTIVE: This article describes a locum tenens service for Colorado and Wyoming pediatricians provided by the Division of General Pediatrics and Pediatric Emergency Medicine at the University of Colorado School of Medicine and the Children's Hospital of Denver. An analysis and an evaluation of the program are presented, and implications are discussed. METHODS: All program data were prospectively collected and tabulated and later analyzed for the period from July 1, 1994, through June 30, 1995. A survey of all physicians using the Pediatric Locum Tenens Service was conducted within 2 months of service to evaluate the program and to refine the orientation, credentialing, and evaluation processes. RESULTS: During the year, 35 pediatricians (14% of pediatricians in Colorado and Wyoming) made 97 requests for 398 days of locum tenens coverage. Coverage was used for vacation (85%), medical education (10%), medical leave (3%), and family matters (2%). Solo and rural pediatricians used the service at a higher rate than pediatricians in group or urban practices. Eighty-six percent had never used locum tenens coverage before because of either the expense (67%) or their unwillingness to trust their practices to physicians or services with whom or with which they were unfamiliar (50%). The majority (83%) were willing to pay an amount for locum tenens equal to the net income derived from the locum tenens coverage in the practice. None indicated a willingness to pay more than that. Referrals and admissions to the Children's Hospital from the pediatricians who used the service increased by 22% during the study period compared with the preceding year, whereas referrals and admissions increased by 9% among all other Colorado and Wyoming pediatricians. All pediatricians completed surveys, and satisfaction with the locum tenens pediatricians, charges, and program administration was high. Their suggestions are described. DISCUSSION: The following topics are discussed: (1) the economics of pediatric locum tenens; (2) the use of a locum tenens service as a physician relations program by children's hospitals or academic departments of pediatrics; (3) guidelines for orientation of locum tenens pediatricians; and (4) a proposed evaluation and credentialing process for locum tenens physicians.

Colorado↗

PubMed1996

Planning, development, and execution of an international training program in laparoscopic surgery.

In the late 1980s, minimally invasive surgery experienced unprecedented growth. Centers appeared worldwide, providing a variety of training opportunities and laboratory experiences. Because standard surgical training varies greatly from country to country, it became apparent that this variety was even more pronounced in the area of minimally invasive and laparoscopic surgery, posing significant credentialling difficulties for professional standards committees wishing to certify surgical staff who submit unevaluable credentials from all over the world. In January 1993, the Center for Minimally Invasive Surgery at New England Medical Center and Tufts University School of Medicine was asked to plan and execute a program of education, training, and credentialling for a multispecialty surgical staff in the Eastern province of Saudi Arabia. A four-stage program was designed and developed to provide credentialling from the technician level through the instructor surgeon level. A multidisciplinary course was developed and a team placed on site for 1 month to execute the program. This program began with an 8-h didactic/video session in basic laparoscopy, covering areas common to the involved subspecialties: surgery, urology, and gynecology. This session was followed by hands-on training sessions in general surgery and urology and credentialling in gynecology. Physicians who successfully completed the examination in basic laparoscopy were later eligible for credentialling at one of three clinical specialty levels: basic clinical laparoscopy, advanced clinical laparoscopy, or instructor in clinical laparoscopy. Education and credentialling in minimally invasive surgery can be accomplished by executing a program of basic science and clinical training for physicians, technicians, and nurses that accommodates a wide range of experience of participants, from novice to master surgeon. Support from the hospital administrators and department chairs was instrumental in the program's success. Among the goals we accomplished was identification of persons in an institution who could serve as future instructors and certifiers for the hospital's self-sustaining program as well as providing a relationship in which international institutions can serve as a resource for further continuing medical education and clinical and laboratory training. This program may well serve as the model template for international credential standards of the future.

Education, Medical, Continuing↗

PubMedDate not supplied

[Accreditation of the professional competence of intensive care unit nurses and their education].

The healthcare system must be driven by the needs of patients and their families. Keeping in mind the current nursing education system in the United States, the AACN Certification Corporation has designed a new model to refocus patient care activities so they can be defined according to the needs of patients and families wherever they may be. This model also addresses the credentialing of nurses with specialized knowledge and skills and may be adaptable as the conceptual framework for a national nursing specialty credentialing system in other countries.

Accreditation↗

PubMed1997

Certification and occupational health nursing. An historical perspective.

This article is based on excerpts from the Catherine Dempsey Lecture (American Occupational Health Conference, 1997), delivered by A. Brian Verrall, Chairman, American Board for Occupational Health Nurses, Inc. (ABOHN) in recognition of the 25th anniversary of ABOHN. The Catherine Dempsey Lecture honors the first president of AAOHN. The article is second in a series of three articles addressing credentialing to appear in AAOHN Journal. The first article, "Credentialing: Concerns and Issues Affecting Occupational Health Nursing," by Olson, Verrall, and Lundvall appeared in the May 1997 issue [45(5):231-238].

Certification↗

PubMedDate not supplied

Internal practice barriers for non-physician practitioners in the veterans healthcare system.

As a consequence of the re-engineering of the veterans healthcare system initiated in 1995, non-physician clinicians are functioning with new levels of autonomy and expanded scopes of practice, but they are not consistently being utilized to their optimal potential. A work group appointed by the Under Secretary of Health in 1996 found various barriers to improving this situation: 1) lack of clarity regarding the roles of the non-physician clinicians; 2) lack of understanding of the basis of their credentialing; 3) lack of uniformity of their credentials; 4) non-acceptance by physicians and managers; 5) rigidity of administrative policies; and 6) salary, benefit, and career-advancement issues. The authors recommend ongoing management attention to addressing these barriers both within and outside the VHA system.

Allied Health Personnel↗

PubMed1995

Operative laparoscopy and the gynecologic oncologist. Commentary and review.

BACKGROUND: A rapid evolution in technology and surgical applications of endoscopy have occurred over the past 5 years. Surgical procedures once thought impossible except through large abdominal incisions are being performed with the use of laparoscopic surgical techniques. Laparoendoscopic techniques have limitations as well as advantages over conventional surgical approaches. METHODS: The medical literature as it relates to laparoscopy and gynecologic oncology was reviewed. RESULTS: Procedures performed through the laparoscope include total hysterectomies, bilateral oophorectomies, pelvic and periaortic lymphadenectomies, omentectomies, colostomies, bowel resections, oophoropexies, and pelvic lid constructions as well as radical hysterectomies and ovarian cancer debulking procedures. These techniques are gaining popularity among gynecologic oncologists, and studies of individual case reports have been followed by studies involving a series of patients. Numerous limiting factors exist, however, foremost among these being the wide variability of endoscopic skills among surgeons and lack of objective long term data supporting the efficacy and safety of these techniques. CONCLUSION: Application of endoscopic techniques in gynecologic oncology procedures is occurring rapidly and is driven partly by market economy forces. Many gynecologic oncologists, however, do not have the necessary endoscopic skills and experience with which to perform such procedures. For these physicians to remain sufficiently qualified, fellowship training programs must encompass formal training curricula in endoscopic surgery, and such programs should often include the faculty as well. Formal and organized credentialing of laparoscopic cancer surgical expertise will ensure a minimum safe level of skills.

Credentialing↗