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PubMed2005

Education and credentialing in respiratory care: where are we and where should we be headed?

Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. Respiratory therapists, through primary, secondary, and tertiary prevention activities, can positively affect peoples'quality of life. This advanced level professional will work in the intensive-and acute-care settings, applying sophisticated cardiopulmonary technologies, as well in clinics, physician offices, home care, long-term and rehabilitation facilities, industry, educational institutions, and research facilities. The alternative to this advanced practice is for the profession to remain a task-oriented technical field, focused on procedures and the technical aspects of oxygen and aerosol therapy, mechanical ventilatory support, and related diagnostic and monitoring techniques. Although there is a dignified and important role for the provision of the technical aspects of respiratory care, the authors believe that the future role of the respiratory specialist is that of physician extender. Higher-order performance will result in higher-order contributions to health care. This role will require increased numbers of baccalaureate and graduate degree programs in respiratory care and increased numbers of respiratory therapists who hold higher degrees,including the master's degree in respiratory care and doctoral degrees in related fields. Community colleges, 4-year colleges, and universities should be encouraged to develop effective articulation agreements and mechanisms to offer the bachelor of science degree in respiratory care to the community college student. Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.

Allied Health Personnel↗
PubMed2002

The professional development portfolio process: setting goals for credentialing.

Professional Development Portfolio (PDP), the new credentialing system for dietetics professionals, places the responsibility for learning, professional development, and career direction on the individual practitioner. This study used questionnaires and focus group interviews to determine whether dietitians engage in reflection, self-assessment, and goal setting, the critical components of PDP recertification. Volunteers (n = 132) participated in 16 focus groups held during 8 state dietetic association meetings. Content analysis was conducted. Some subjects reflected using an informal non-structured process (42 text units), almost half (41%) performed annual self-assessments, and 25% set goals. Job availability, new practice areas, family obligations, and employer needs were key factors in goal formulation. Opportunities for self-direction, independent decision-making, and application of technical expertise were also considered in career choices and goal setting. Although few participants were currently performing PDP critical components, we conclude dietetic practitioners can gain the necessary skills for professional development with the newly available PDP Guide to support the portfolio process. We recommend that dietitians (a) allow sufficient time for the reflection process, including the use of additional tools; (b) develop personal mission statements to drive the goal-setting process; and (c) use effectiveness criteria to critique their goals.

Career Mobility↗
PubMed1996

Fellow of the American Dietetic Association credentialing program: development and implementation of a portfolio-based assessment.

This report has described the measurement and operational procedures used for the design, development, and implementation of the newly inaugurated Fellow of The American Dietetic Association credentialing program. The program was established to identify and certify registered dietitians who possess the characteristics of advanced-level practice. The main features of the Fellow program are as follows. It is based on the results of an empirical study that identified the characteristics of advanced-level practice. It is guided by the Fellow Assessment Plan, which specifies the content and level of dietetics practice involved and the psychometric and operational requirements for sound measurement. It is a performance-based portfolio assessment of six professional characteristics (education, work experience, professional achievement, professional roles, professional contacts, and approach to practice). It uses objective automated computer scoring and independent peer-review grading of candidate materials in relation to an explicit scoring rubric. It requires statistical analysis of the database of candidate scores, which is conducted to ensure that the scoring of candidate materials is accurate and reliable and that the assessment, as a measurement instrument, is psychometrically sound. It involves a standard-setting workshop in which a panel of subject-matter experts establish the lowest level of acceptable candidate performance on Approach to Practice; the passing standard for the other five characteristics was preestablished by the empirical study. A careful review of all evidence on the development and implementation of the 1994 Fellow assessment suggests that these procedures are technically sound and produce psychometrically defensible results. Our evaluation and commentary from CDR and CTB staff, subject-matter expert participants, and the candidates themselves suggested a number of ways to improve the Fellow program in subsequent administrations of the assessment. Changes have been implemented and CDR will continue to consider all data in its ongoing improvement efforts.

Credentialing↗
PubMed2000

Excellence and low case volume: an example of the inapplicability of volume-based credentialing.

BACKGROUND: Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing. METHODS: Using The Society of Thoracic Surgeons Cardiac Database, we examined the data for all coronary artery bypass graft-only patients (n = 615) operated on by us from July 1991 to June 1997. RESULTS: The observed mortality was 0.33% and the observed-to-expected ratio was 0.12 (p<0.005). Morbidity was low as well. CONCLUSIONS: Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.

Adult↗
PubMed1997

Economic credentialing.

In the 1990s, hospital management and trustees introduced the concept of evaluating physicians for appointment, reappointment, and privilege delineation with the addition of financial criteria. Although emergency physicians are advocates for cost-effective care, they must make certain that credentials are determined by the provision of quality medical care, and that if economic criteria are used, the criteria chosen truly reflect quality of care.

Credentialing↗
PubMed1997

Training, management, and credentialing for CRRT in the ICU.

Continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) requires a dedicated training and educational process that includes both theoretical and practical approaches. Important goals for this process include achieving an acceptable circuit life without patient complications and providing a high percentage of staff with bedside expertise. Lectures or didactic sessions must link into bedside instruction and simulations or mock patient/circuit setup. An annual seminar may be useful for all clinicians to share and gain knowledge. Managers require a system of staff review to ensure expertise levels are maintained. Policy development, quality assurance, and complication monitoring systems provide useful information for managers and educators in this field. Credentialing may be useful to confirm the goals of CRRT, but it requires further development of practice standards before adoption.

Credentialing↗
PubMed1998

Role of external oversight in quality activities: accreditation, credentialing, licensure, and deemed status.

There currently exist a number of organizations which provide quality oversight to the ESRD program in the United States. The state surveyors confirm that dialysis facilities comply with Medicare's conditions of coverage, but surveyor activities have traditionally followed a quality assurance rather than a continuous quality improvement (CQI) model. State surveyors focus primarily on nursing homes, so their content knowledge of ESRD quality issues may be limited. The ESRD Networks have CQI expertise on their staffs, and their quality agenda is driven by their medical review boards, whose members bring scientific and technical expertise from the provider community. The success of the Networks in achieving quality goals has been hampered by personnel and resource limitations and by inconsistent direction by the Health Care Financing Administration (HCFA). Texas has developed a dialysis facility licensure program that partners its ESRD Network and its Medicare state surveyors in quality oversight activities. This collaboration has led to improved patient outcomes and may prove to be a model for other states. Non-Medicare payers may contract with dialysis providers based on performance specifications that exceed those of Medicare's conditions of coverage. A private credentialing mechanism for dialysis facilities that satisfies the performance specifications of all payers has been proposed but, in the absence of deemed status for Medicare survey and certification activities, is unlikely to achieve widespread acceptance.

Accreditation↗
PubMed1999

Endovascular interventions training and credentialing for vascular surgeons.

This article reviews issues concerning the training and credentialing of vascular surgeons in the use of endovascular techniques in the peripheral vascular system. These guidelines update a prior document that was published in 1993. They have been rewritten to accommodate the rapid evolution that has occurred in the field and to provide the appropriate requirements that a vascular surgeon should fulfill to be competent in the basic skills needed to safely and effectively perform all presently accepted diagnostic and therapeutic endovascular procedures.

Catheterization↗
PubMed1999

Credentialing, diversity, and professional recognition-foundations for an Australian infection control career path.

BACKGROUND: There are no regulatory, legislative, or professional criteria stipulating minimum qualifications or experience that a health care worker must meet to be capable of coordinating an Australian infection control (IC) program. Measurement of IC competence is important to protect the public and for the ongoing credibility and growth of the profession. METHOD: Our study group was all 1078 nonmedical and nonindustry members of the Australian Infection Control Association in 1996. The survey examined perceived level of proficiency, level of education, and experience in health care and infection control. Almost three quarters (65%) of the members responded, and almost all (85%) of these respondents fulfilled the inclusion criterion of coordinating an IC program. RESULTS: Experience in IC ranged from less than 2 years (33.6%) to more than 20 years (10.0%). The majority (65.0%) of infection control professionals (ICPs) had between 8 years and 12 years IC experience. The respective proportions of respondents' self-ranked levels of proficiency on a 5-point scale were novice (3.6%), advanced beginner (21.2%), competent (33.8%), proficient (34.7%), and expert (6.8%). Almost half (47%) of the novices agreed that a registered nursing (RN) qualification was required, whereas a majority (41%) of advanced beginners considered both an RN and a basic IC course (BASIC) were required. Competent ICPs agreed less often than the other levels about their requirements. However, 27% of competents identified a BASIC and an undergraduate degree (UG) as the minimum requirements for a competent ICP. Proficient ICPs agreed that they required an RN, UG, BASIC, and a postbasic course in IC. Nearly all experts (80.0%) agreed that they required an RN, UG, BASIC, postbasic course, and a course in hospital epidemiology (EP). Two thirds of experts expected a master's degree as a requirement. CONCLUSION: The Australian IC profession is in an exciting period of development; however, the variation in ICP perception of the most appropriate qualifications and experience threatens the credibility and viability of the profession. This variation indicates the need for a clear-cut pathway that includes a system of credentialing, recognition of expertise, adoption of divergent roles, and improved networking. This pathway will lead to an increasingly credible and viable IC profession in Australia. Developing IC communities globally can benefit from the Australian experience.

Australia↗
PubMedDate not supplied

Credentialing the public health workforce: an idea whose time has come.

The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels since the landmark 1988 Institute of Medicine report. The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. The fact that the public health workforce is not a single profession, but rather a fabric of many professions dedicated to a common endeavor, creates challenges to any singular approach. This article explores the relationships among competency, certification, and accreditation and summarizes the expert panel dialogue on workforce development incentives, specifically regarding certification and credentialing. The authors challenge public health leaders to become actively involved in framing the issues so the best possible strategies can be developed.

Accreditation↗
PubMed1988

Credentialing in dermatologic surgery.

Dermatologic surgeons' rights to perform surgery are being and will be challenged more and more. Some methods of peer review and credentialing are suggested and the specialty is urged to move ahead with formal planning for more training in the surgical aspects of dermatology.

Credentialing↗
PubMedDate not supplied

Development and implementation of an education and credentialing programme to provide safe paediatric procedural sedation in emergency departments.

OBJECTIVE: In the conduct of paediatric procedural sedation (PPS) within the ED the combination of powerful drugs, variable competency levels and high staff turnover carry the potential for sedation-associated adverse events. Yet, currently, there is no set programme for education and accreditation of ED staff in PPS. We set out to develop such a programme. METHODS: We outline the development process of a comprehensive multidisciplinary PPS programme and present its key educational elements (sedation manual, lecture, treatment order form and checklist, parent information handout) and credentialing through multiple-choice questions and competency assessments. We describe issues associated with the implementation of the programme at a metropolitan mixed ED and the ED of a major tertiary paediatric centre. RESULTS: Since its inception a total of 294 emergency staff have either completed or have partially completed the programme. Staff feedback showed that the majority of staff scored the elements of the programme as very good to excellent, and felt that their sedation skills had improved and their practice was safer. The development and implementation of the PPS programme raised many issues and posed a number of challenges. We describe the strategies we used to overcome such challenges and barriers. CONCLUSION: We present the development and implementation of a comprehensive PPS programme for emergency staff. As a result of the multicentre development process involving a community and a tertiary paediatric ED the programme will likely have broad applicability in different types of ED caring for children.

Anesthesiology↗
PubMed1986

A California school nurse credential survey.

This survey determined which required competencies currently employed California school nurses rated as adequate in their basic preparation for entry into school nursing practice. A questionnaire was sent to 2,861 California school nurses; 1,534 (54%) were returned and 1,227 were used in the analysis. The questionnaire listed 24 competencies required for school nursing by the California Commission on Teacher Credentialing. Demographic factors were solicited to develop a profile of the candidates who responded. Survey results indicated most nurses believed 11 of the required competencies were met in their bachelor's degree program. Many respondents did not consider their preservice training adequate in some competencies. These results could be useful to universities that are considering establishing a certificate program for school nursing.

Adult↗
PubMedDate not supplied

A system to manage records for credentialed providers.

There has been a rapid growth in and evolution of information management to assure appropriate and timely awarding of privileges for credentialed providers. Proprietary software might not meet the needs of a particular facility. In this article, Jackie Walker and William F. Perry describe how, using commercially available database management software, information management can be tailored to the needs of an individual institution and altered as necessary.

Credentialing↗
PubMed1991

Medical staff membership criteria: a credentialing minefield.

In today's increasingly competitive medical practice environment, legal challenges to credentialing decisions abound. To minimize the risk of liability, hospitals and their medical staffs must be especially careful when adopting and applying the criteria for medical staff membership.

Clinical Competence↗
PubMed1991

The role of medical staff credentialing in a risk management program.

Because the courts have recognized that only the hospital and medical staff are capable of enforcing standards of professional performance, the hospital, board of directors, and medical staff must develop systems for determining who shall be allowed to practice and what procedures he or she will be allowed to perform. Practitioners do not enjoy an absolute right to practice merely because of licensure. Credentialing criteria reasonably related to considerations of patient care and hospital operations will almost certainly withstand judicial scrutiny.

Clinical Competence↗