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Report of a state-of-the-knowledge conference on U. S. nursing certification. ONCC Research Committee and Executive Staff. U. S. Oncology Nursing Certification Corporation.

PURPOSE: To describe the problems discussed, consensus established, and recommendations made during a "state of the knowledge" conference on nursing certification hosted by the Oncology Nursing Certification Corporation (ONCC), April 1996. ONCC planned the conference after finding little empiric data in the literature to support the value of nursing certification and after recognizing that consensus was lacking regarding several critical questions related to certification. SOURCES: Representatives of 24 specialty nursing certification organizations participated in the 3-day conference. METHODS: Through formal presentations and small groups, participants identified unresolved issues and areas of consensus, then strategized ways to address questions and problems. RESULTS: This historic conference identified problems that require proactive responses and solutions by organizations involved in nursing certification. Unresolved issues included the lack of standardization of basic certification procedures, the means of evaluating continued competency, and questions regarding the relationship between certification and patient outcomes. Development of a nursing multispecialty research council was proposed and has since been established under the leadership of the American Nurses Credentialing Center. CONCLUSIONS: The conference was a successful way to unite specialties in nursing. Of high priority is the need to validate that certification positively affects patient outcomes. Until this can be shown, it will be difficult to persuade employers and payers that nursing certification should be a workplace requirement.

Certification↗

Sick leave certification: an unwelcome administrative burden for the family doctor? The role of sickness certification in Maltese family practice.

INTRODUCTION: In Malta, sickness certificates are needed from the first day of illness, and are issued by family doctors (FDs) either employed in the government primary healthcare system, or self-employed in private practice, or employed directly by an employer for this purpose alone. Patients visiting self-employed FDs pay directly, and are not reimbursed unless privately insured. We aimed to contribute to the discussion on the impact of sickness certification in family practice by studying the phenomenon using electronic data from an electronic patient record (EPR) used by self-employed FDs. We used this data to study the frequency of sickness certification and the relationship between the patient's reason for encounter, with or without a formal request for a certificate, and the doctor's diagnosis and certification practice. METHODS: We used data collected by FDs in day-to-day private family practice using an episode-oriented EPR. The EPR database included all encounters in all episodes of care over a period of one year (1 January to 31 December 2001) documented by ten self-employed FDs, comprehensively coded with ICPC-2-E (Electronic Version of the International Classification of Primary Care, version 2). RESULTS: The EPR database documented care for 7497 patients (45.4% male) over one year. During 15,781 encounters, sickness certificates were issued in 11.3% of 16,319 episodes of care. 5.7% of the reasons for encounter presented by the patient in new episodes were requests for administrative procedures, and this request was made in 8.2% of all new episodes of care. CONCLUSION: The distribution of morbidity seen by the FDs appeared to be very wide, with a dominance of acute respiratory, gastrointestinal and musculoskeletal symptoms and diagnoses, and the role of sickness certification was quite important. The frequency of sick leave certification in Malta is comparable with that in other European countries, but the average duration of episodes is shorter. Just over 11% of private FD encounters involve issuing a sickness certificate. The high proportion of reasons for encounter formulated as a request for a sickness certificate suggests that the active role of FDs in this form of social security in the Maltese population has supported the local development of family practice.

Adolescent↗

[A research on the importance of the clinical certificate to the medical practitioners outside the field of psychiatry. Committee on graduate education sub-committee on Feasibility of Implementing Specialty Board Certification in the Japanese Society of Psychiatry and Neurology].

OBJECTIVES AND METHODS: The main objectives of the research was to identify the merits and demerits of the specialty board certification system, that had been implemented in the other medical societies than the society of psychiatry in Japan. As a measure of the research, we conducted a survey by distributing questionnaires to medical institutions. The subjects of this survey included medical practitioners, other than the psychiatrists, who belong to general hospital, university hospital and the Japan Medical Association. FINDINGS: We received 228 responses out of the subjects. The findings were that 86% of the subjects have acquired the specialty board certificate, and that half of them have more than two kinds of qualifications on the average. Thus, the report suggests that the specialty board certification system have been long pervaded throughout the medical fields outside psychiatry. In addition, the subjects pointed out as the merits of the specialty board certification system that it helps to achieve the higher level of technique, and to organize and sophisticate as well as widen the knowledge of their specialty. They also reported that it contributes to instigate the life-long education and to earn identification and recognition of their specialty from other fields of medicine than their own. Fifty-three percent of the subjects acknowledged the necessity of the specialty board certification system while 13% regarded it unnecessary. This result proves that, despite higher percentage of the doctors with qualifications, the system itself is not approved of with full acknowledgement in the medical world. This rather negative attitudes toward the system is originated in the fact that acquiring and maintaining the certificate, i.e., renewal fees, are considerably high. In fact, as many as 62% of the subjects felt these points as disadvantages of the system. The medical practitioners outside the fields of psychiatry did not show any particular concern about the lack of the specialty board certification system in our field that is distinct as a field of medicine. Only 18% of the subjects expressed that urgent actualization of the system is desirable in our fields. In addition, securing the cites required for learning the technique and giving the exam to the applicants is the most important matter to be concerned. On the contrary, in other fields of medicine, the matter does not need to be discussed. Therefore, this is a problem unique to the fields of psychiatry. CONCLUSION: Although there are disadvantage of the specialty board certification system pointed out as shown above, we believe that it is necessary to introduce the system in the field of psychiatry. These disadvantage are mainly the matter of individual income. We need to consider the introduction of the system from the perspective of sophisticating the quality of psychiatry as a field of medicine in our country. We, the Subcommittee on feasibility of implementing specialty board certification in the Japanese Society of Psychiatry and Neurology have been contemplating over the system up to this moment. The progress has been made to the point of presenting, Discussion of the Specialty Board Certification System in Psychiatry, Yamauchi, May, 1994.

Certification↗

The validity of death certificates: routine validation of death certification and its effects on mortality statistics.

The 3478 death certificates (7.1% of all annual death certificates) of this study comprise those national death certificates in 1995 submitted for validation to the panel representing both medical and nosological expertise. As such, it is highly selected and represents, from the nosological point of view, the most inconsistently filled-in portion of Finnish death certificates. The routine validation procedure is essentially based on exploitation of the extra medical information, i.e. the case history, on the Finnish death certificate form. Altogether, 2813 (80.9%) out of 3478 certificates could be adjusted at the primary panel session; the rest required further clarification. The re-assignment of cause of death by the panel and the impact of panel adjustments on the national mortality statistics is assessed here by comparing the initial death certification and the finally registered underlying cause of death grouped into ICD-9 major categories with special reference to the subcategories of neoplasm, cardiovascular disease (HVD) and unnatural death. A statistically significant decline (p<0.0001) in deaths, both in the category of symptoms, signs and ill-defined conditions and in the pulmonary circulation disease subcategory of HVD with 37.6 and 35.1%, respectively, was observed. The decrease of 11.1% in the benign or NUD neoplasm subcategory and the increase of 8.6 and 7.0% in the categories of endocrine disease, and musculo-skeletal and connective tissue disease, respectively, are essential observations as to the quality of the cause of death register. The effect on the HVD major category was practically nil. At the HVD-subcategorial level, a decrease of 14.0% for diseases of the veins and lymphatics and other circulatory diseases and an increase of 3.5% for hypertensive diseases (HYP) were the two next most obvious alterations to the diseases of the pulmonary circulation, but were without statistical significance. For ischaemic heart disease and other subcategories, the effects were minor. The unnatural deaths as a whole increased in the final statistics with only 0.9%. In the study data, categorial changes ranged from the decrease of 75.2% for symptoms, signs and ill-defined conditions to the increase of 77.3% for endocrine diseases. In conclusion, the Finnish death certificate form, death certification practices and cause of death validation procedure seem to serve the coding of causes of death for mortality statistics appropriately. The results of the study form a relevant reference background to evaluation of epidemiological studies on mortality.

Abstracting and Indexing↗

Sick leave certification: a unique perspective on frequency and duration of episodes - a complete record of sickness certification in a defined population of employees in Malta.

BACKGROUND: In Malta, sickness certificates are needed from the first day of illness, and are issued by family physicians (FPs) either employed by the government primary health care system, self-employed in private practice, or employed by an employer for this purpose alone. The latter system, when applied by the employer, is compulsory. In order to contribute to the debate on the role of the FP in this context, electronic data collected by a group of company-employed FPs was used to study the phenomenon of sickness certification. This database is a complete record of the selected employees' sick leave certification during the study period. METHODS: Data collected by company-employed FPs from a defined population was used: all employees of selected Maltese companies served by a group of FPs. The database included episode-based data from home visits over three years (01/01/1997 - 31/12/1999), by 9 company-appointed FPs regarding 421 employees of five companies. RESULTS: 3015 episodes of sickness absenteeism, with an average duration of 2.9 days, were documented. Employees who did intensive manual work had relatively higher rates. Furthermore, a relatively higher incidence of work injury, sprains and strains, anxiety and depression and low back pain as found in manual workers, and in male workers. This trend was shown to be statistically significant. CONCLUSIONS: The frequency of sick-leave certification in Malta is comparable to that in other European countries, but the average duration of certificates is much less than reported in other studies that generally did not include data on short-term illness and certification. This has important implications on future research in the field. A number of common disorders were found to be significantly more prevalent causes of sickness certification in manual workers, amongst them anxiety and depression.

Absenteeism↗

The first decade of the American Board of Internal Medicine certification in critical care medicine: an overview of examinees and certificate holders from 1987 through 1996.

OVERVIEW: This study reviews the first decade of critical care medicine (CCM) certification by the American Board of Internal Medicine (1987-1996). Included are the characteristics of examinee and certificate-holder groups; examination performances from different underlying disciplines of internal medicine, with or without formal CCM training; and the influence of background and a training program as correlates of examination performance. DATA SOURCES: The CCM certification examination has been offered biennially since November 1987. Performance data on the American Board of Internal Medicine examinations in internal medicine and its subspecialties and added qualifications were available for candidates taking the CCM examinations. For examinees with formal CCM training, residency program director ratings, and information regarding the program characteristics of size and percentage of United States and Canadian medical graduates were also available. STUDY SELECTION: All examinees who ever attempted certification were included in this study. The study cohort for each of the five examination administrations consists of all first-time takers. CONCLUSIONS: Cohort sizes have decreased since formal training became an admission requirement in 1993. Percentages of International Medical Graduates and women attempting and achieving certification have increased steadily. Examination performance was positively associated with formal training, internal medicine examination performance, recent medical training, and pulmonary disease certification. For those with formal training, performance was also positively associated with training program director ratings of overall clinical competence and completion of a training program with a higher proportion of United States and Canadian medical graduates.

Certification↗

Death certification in Western Australia--classification of major errors in certificate completion.

We aimed to develop a method to classify those errors in the completion of death certificates arising from misunderstanding of the certification process. We reviewed 430 Western Australian death certificates registered in March 1990 using a method devised to differentiate between major and minor errors. Major errors were found in 16 per cent of certificates (95 per cent confidence interval 12 to 20 per cent). The error rate did not vary significantly between city and country areas, nor between teaching hospitals and other locations. The method was validated on a separate sample of 120 certificates. It has potential as a tool to monitor a critical but neglected step in the production of mortality statistics and to assess understanding of the process of death certification.

Death Certificates↗

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries.

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.

Adult↗

Accuracy of death certificates in bronchial asthma. Accuracy of certification procedures during the confidential inquiry by the British Thoracic Association. A subcommittee of the BTA Research Committee.

The Research Committee of the British Thoracic Association conducted a confidential inquiry into death from asthma in adults aged 15-64 years resident in the West Midland and Mersey Regions during 1979. Death certificates recording the word asthma were received for 153 persons. The International Classification of Diseases code for the cause of death was obtained from the Office of Population Censuses and Surveys. Information about the patients, their illness, and their death was obtained by interviews, questionnaires, and inspection of patients' records. A panel of three physicians assisted by a pathologist assessed the clinical and, where applicable, the necropsy findings to ascertain whether bronchial asthma was the true cause of death. Of 147 assessable patients, 89 were considered by the panel to have died from asthma. In 77 of these cases the death certificates were correctly coded, whereas in 12 (13%) death was considered to have been wrongly attributed to another cause (falsely negative). Twenty four deaths on the other hand were considered to have been wrongly attributed to asthma (falsely positive). From this it appears that the total number of 101 certificates recording death from asthma represents a net overestimate of 13%. Accuracy was highest in the youngest age group. There were few discrepancies between the assessment of the panel and certified cause of death when a necropsy had been performed. The most common error (17% of all certificates) was failure to follow the procedure advised for completion of death certificates. This usually occurred when patients suffered from two or more conditions, or when death was sudden and necropsy was not performed.

Adolescent↗

Educational commission for foreign medical graduates certification and specialty board certification among graduates of the Caribbean medical schools.

BACKGROUND: To determine the variability among Caribbean medical schools in the performance of their students against markers of quality. METHOD: The Educational Commission for Foreign Medical Graduates (ECFMG) database and the American Medical Association (AMA) Masterfile were linked. Analyses were restricted to ECFMG applicants, from 1980 to 2000, who attended the 12 Caribbean medical schools that produced 200 or more U.S. International Medical School Graduates (USIMGs). RESULTS: The schools produced 17,049 USIMG (48% of all USIMGs) and 5,840 non-USIMG (5% of all non-USIMGs) applicants for ECFMG certification. By school, the ECFMG certification rate ranged from 28% to 86% for USIMGs and from 27% to 82% for non-USIMGs. Specialty Board certification for graduates of these schools also varied widely. CONCLUSIONS: Medical schools in the Caribbean play an increasingly important role in supplying the U.S. workforce. There is considerable variability among them, both in the numbers of physicians they produce and the performance of their students against indicators of quality such as ECFMG and specialty Board certification.

Certification↗

Who is maintaining certification in internal medicine--and why? A national survey 10 years after initial certification.

BACKGROUND: The American Board of Medical Specialties (ABMS) adopted a framework, called Maintenance of Certification (MOC), for all certifying boards to evaluate physicians' competence throughout their careers, with the goal of improving the quality of health care. The MOC participation rates of the American Board of Internal Medicine (ABIM) show that 23% of general internists and 14% of subspecialists choose not to renew their respective certificates. OBJECTIVE: To study U.S. internists' perceptions about the forces driving them to maintain certification. DESIGN: Mail survey. SETTING: A nationally representative sample of certified internists in the United States. PARTICIPANTS: Physicians originally certified in internal medicine, a subspecialty, or an area of added qualifications in 1990, 1991, or 1992. RESULTS: The overall rate of response to the survey was 51%. Although 91% of all participants are still working in internal medicine or its subspecialties, this percentage is notably lower among general internists (79%). Of those still working in the field of internal medicine or its subspecialties, approximately half report being required to maintain their specialty certificate by at least 1 employer, but only approximately one third of those who completed or enrolled in MOC report this requirement as a reason for participating. Those who completed or enrolled in MOC do so more for positive professional reasons than for monetary benefits or professional advancement. The most common reasons for not participating are the perceptions that it takes too much time, is too expensive, and is not required for employment. LIMITATIONS: Respondents were volunteers from an early cohort of diplomates entering the program, and those with less positive attitudes may have responded at higher rates. Results are based on self-reported data, and misconceptions about program requirements may have led to some inaccurate responses. CONCLUSIONS: The relatively large percentage of general internists who left internal medicine mostly to work in another medical field explains why rates of MOC participation for general internists seem lower than those for subspecialists (77% vs. 86%). Although positive professional reasons clearly have a compelling internal influence on program participation, it is less clear whether employers' requirements are an equally compelling external influence. Although half of all respondents report that MOC is required by 1 of their employers, only one third of those who participate in the program describe it as a reason for participating.

Attitude of Health Personnel↗

An overview of certification by the American Certification Council for Medical Rehabilitation Therapists and Specialists.

The American Certification Council (formerly Registry) for Medical Rehabilitation Therapists and Specialists has been concerned with the professional recognition and development of rehabilitation therapists and specialists since 1953. Since 1973, the Council has been working to upgrade its registration process to that of certification including the use of an examination. In 1980, the Council obtained Conditional Membership and national recognition in the National Commission of Health Certifying Agencies. During the past year, the Council has begun administering a certification examination and feels that all criteria for Regular Membership in the Commission has been met. The Council and the members still have much to do to improve and refine the certification and recertification programs in the years to come, but the author feels that a positive committment toward the professional growth and development of the various rehabilitation therapy and specialty occupations have already been accomplished.

Certification↗

A Council on Certification of Nurse Anesthetists report on the candidate satisfaction survey for the national certification examination.

Since the implementation of computerized adaptive testing for the national certification examination in April 1996 through June 30, 1998, over 2,400 candidates have been tested. Ongoing monitoring and evaluation of candidate satisfaction on the national certification examination has been an essential component of the Council on Certification of Nurse Anesthetists' testing procedures. During the year period of July 1, 1997 through June 30, 1998, 988 first-time candidates took the national certification examination. Of the 988 candidates, 932 were administered the same eight-statement satisfaction survey. This article reports on candidate satisfaction for this group of first-time takers. Overall response rate to the survey was 96%. Completion of the eight-statement survey is voluntary after the examination has been completed. The majority of candidates are very satisfied with the computerized adaptive test process and procedures.

Attitude of Health Personnel↗