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Managing Certification Renewals in COVID-19: Part 2

View part one of our Managing Certification Renewals in COVID-19 Q&A here.

Featuring Ben Babcock, PhD, The American Registry of Radiologic Technologists (ARRT), and Robert C. Shaw, Jr., PhD, National Board for Respiratory Care (NBRC).

In part two of our Managing Certification Renewals in COVID-19 Q&A, we spoke with Ben Babcock, PhD, and Robert C. Shaw, Jr., PhD, on how their organizations’ have pivoted certification renewals in wake of COVID-19.

Babcock is the supervising senior psychometrician at The American Registry of Radiologic Technologists (ARRT), the world’s largest organization offering credentials in medical imaging, interventional procedures and radiation therapy. Shaw is the vice president of examinations at the National Board for Respiratory Care (NBRC), which supports programs that credential general respiratory therapists and therapists who specialize in the areas of pulmonary diagnostics, sleep disorders, adult critical care and neonatal/pediatrics.

When COVID-19 impacted the ability for individuals to safely take exams or renew certifications, what steps did your organization take to address this? What partners or stakeholders did you collaborate with to make these decisions?

Ben Babcock: The first step that ARRT took was extending key deadlines as they dealt with obtaining and maintaining certification and registration. We extended windows for the amount of time in which candidates must take their first exam attempt once an exam window is assigned, after a candidate is deemed to have met education and ethics requirements. All candidates still must obtain the same clinical competency or clinical experience documentation as done previously.

For maintaining certification and registration, we extended continuing education (CE) reporting bienniums by six months. People still must complete the CE requirements for renewal during the same biennium; they simply have a greater amount of time to report that CE. We are applying this extension as the individuals' birth month deadline approaches. Individuals that are unable to complete their CE requirements within their assigned biennium will be placed on CE probation, which is the same policy that ARRT had before the coronavirus pandemic.

ARRT also has one event-based exam that has a strict postmark deadline for submission of all application materials. While candidates still must have applications in by the original deadline, the submission of their clinical competency requirements was extended by seven weeks.

All of these extensions were granted by ARRT's board of trustees. Also, when Pearson VUE, ARRT’s exam administration partner, closed centers to all but EMTs and nurses as essential healthcare workers, ARRT advocated for including radiographers, nuclear medicine technologists, radiation therapists and sonographers. VUE agreed, and ARRT candidates continued testing under VUE’s administration protocols established for the pandemic.

Robert Shaw: Respiratory therapists work at the bedside in intensive care units (ICU) while consulting with the healthcare team to implement management of the patient-ventilator interface. If institutions were going to run short of ventilators, then they would run short of respiratory therapists as well. The NBRC had empirical evidence in hand from its recertification population indicating that the knowledge base eroded to a critical point after five years; the evidence came from a second job analysis study that supported content and design of assessments in the credential maintenance program.

As a result of this empirical evidence, therapists who had allowed their credential to expire within the last five years were administratively reinstated. Many had continued to work under their state license anyway. Expirations of credentials were also suspended for the year 2020 as a way to avoid personnel disruptions at the bedside in a crisis.

For organizations allowing renewal extensions, did this also further extend the traditional renewal cycle, or did your organization see this as a one-time renewal occurrence?

BB: ARRT did not change individual CE reporting biennium start or end dates; only the reporting period was extended.

RS: The NBRC sees this as a one-time occurrence.

Did your organization move to remote proctoring quickly? If so, what was the urgency driving this? What decisions and considerations were made to adapt to that exam format?

BB: ARRT made no changes to its exam and assessment delivery options as a result of COVID-19. ARRT uses remote proctored delivery as an option for its lower stakes, structured self-assessments, so our organization has experience with this type of delivery. Candidates continue to be able to choose whether to take our structured self-assessments for Continuing Qualifications Requirements at a Pearson VUE professional center or at the location of their choice via online proctoring with Pearson VUE.

All of our exams for initial certification and registration remain administered at Pearson VUE professional test centers. Remote proctoring was briefly considered for exams but was not pursued due to concerns over security.

RS: Although the NBRC had no immediate plan before 2020 to administer examinations in a remotely proctored environment, the complete shutdown of in-person administrations for several weeks and the expected limits on test center seats when sites reopened prompted reconsideration.

There are typically 6,000 new respiratory therapists who enter each year. In keeping with the theme that we had to get these people onto the front lines, we decided to start remotely proctored examination administrations in May 2020. The same forms that had been administered at in-person sites could be administered in the remotely proctored environment, which aided rapid implementation. The NBRC supports six examinations; only two examinations from programs that credential general respiratory therapists and impact licensure are administered in remotely-proctored environments.

If you did pursue remote proctoring exams, what did that mean for the health of your item banks?

BB: ARRT's item bank health remains the same as before, as we had no change in our delivery options.

RS: The NBRC expects no impact on item banks. If there remains confidence about pass/fail results from remotely-proctored administrations, then it follows that the items remain secure. If future observations challenge these assumptions, then those decisions will be revisited.

What are some immediate lessons learned that the community can benefit from hearing?

BB: It is vital to have good communication between upper management and your board. Members of ARRT's board were willing to dedicate a great deal of time on short notice to puzzle through potential reactions to the COVID-19 situation. This made it possible to react to this situation in a way that was timely but also promoted high standards of patient care. ARRT maintains a restricted online discussion forum for board members as a tool to support nimble decision making. The forum pre-dates the current pandemic, and the ARRT board is accustomed to ongoing discussions of policy issues facilitated by the executive director via the forum. This allowed the board to quickly establish criteria to follow in considering any modifications to existing requirements during the pandemic.

It is also important to be laser-focused on your mission. This will help in making every single decision during difficult times. Your registrants and exam candidates will call asking for exceptions and exemptions. An organization should be extremely cautious not to change requirements in such a way that could compromise the ability to accomplish its mission. Granting time extensions, for example, still requires that people fulfil the rigorous requirements that were in place before COVID-19. That type of change is more supportive of an organization's mission than, say, waving or modifying clinical competency requirements.

RS: A key piece of our rapid transition to remotely-proctored examinations was done behind the scenes by our vendor to allow our existing item banking and test form delivery platform to be used. This was a change for them. When other programs had started remotely-proctored administrations, content had to be migrated to another platform first.

Is there anything else you’d like to add?

BB: ARRT’s most challenging issue is that students in educational programs were excluded from clinical sites as a protective measure early in the pandemic. That made it difficult, if not impossible, for students to complete their clinical competencies in the manner normally required (i.e., on patients). ARRT continues to actively explore potential solutions to that issue.

ARRT also made a rapid transition of 100 staff from working completely in the office to a work from office and home hybrid model. About 60% of staff work from home exclusively and 40% of staff work partly from home/the office over a short time frame based upon a pre-existing pandemic plan.

ICE COVID-19 Resources

ICE has put together a resources page with relevant COVID-19 resources for credentialing organizations. View the COVID-19 Resources for Credentialing Bodies page to learn more.

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Managing Certification Renewals in COVID-19: Part 2