Featuring Karen Plaus, PhD, CRNA, FAAN, CAE, and Lisa Kamen, CAE
Across many professions and industries, there is a growing movement to lower professional standards, dismissing or diminishing the value of certification and lifelong learning in the process. Individuals and groups at the state and national level in a variety of professions are asking legislators and regulators to remove the requirement for professionals to remain up-to-date and knowledgeable in their professional areas. This causes discrepancies and inconsistencies, putting the public at increased risk.
ICE continues to monitor these activities, and recently spoke with Karen Plaus and Lisa Kamen, members of ICE’s Continuing Professional Certification Subgroup to learn more about the state of the profession and the efforts to uphold lifelong learning and regular assessment of individuals, particularly in the healthcare field.
Why is this the discussion around continuous professional development and regular assessment hot in the industry right now? What is the importance of this topic?
It is vital that consumers, credentialing stakeholders and members of certification organizations become aware of and active in addressing this movement, understanding the ramifications of this lowering of standards, and how it can affect the public and their families, as well the future of certification and credentialing across all professions.
The Professional Certification Coalition (PCC) advances the best interests of those who use or rely on professional certification — such as employers, payers and the general public — as well as of individual professionals themselves who achieve professional certification status. The PCC was formed by the Institute for Credentialing Excellence (ICE) and the American Society of Association Executives (ASAE) in 2018.
Why should the credentialing community watch what is happening in healthcare?
A particularly strong push is occurring with healthcare providers. This includes both legislation and regulations being put forth to reduce or remove continuing certification activities. These efforts are often promoted as increasing competition, eliminating unnecessary regulatory burdens, and improving access to care, although discussion of the impact on public safety is usually conspicuously absent. Why is this important outside of the healthcare field? Because if legislation affects one state–one profession, it could carry over to other professions and across industries.
The rapid pace of change in technologies, advancements in science and medicine, new discoveries and innovations are causing metamorphic changes in an increasingly broad range of professions, and professions must evolve to incorporate these developments. Professionals must understand and apply these advancements to their work, underscoring the importance of continued certification as the foundation of lifelong learning.
“Maintenance of Certification (MOC) systems are one of the best ways to assure the public that they can rely on this as a measure of quality,” said Ed Susank, past and current member of several healthcare organization boards of directors. “There is a growing body of evidence that MOC processes are improving results — improved diabetic care, and hypertension care, for example.”
Certification in any profession typically speaks to safety and/or efficiency and effectiveness of their work. Future technological innovation is going to keep transforming many professional landscapes. Today, we are witnessing an even more accelerated trajectory with the convergence of basic science, data science and technology. Meanwhile, those opposed to continued certification are asking states, employers and the public to abandon the external, data-driven validation afforded by these requirements and processes. We expect there will continue to be substantial legislative activity affecting professional certification.
There is grave concern about this movement to lower certification standards, as it sets a dangerous precedent. Public polls commissioned by AARP1, Citizen Advocacy Center (CAC)2 and the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) 2 consistently indicate that Americans recognize the value of lifelong learning, and demand continued certification and demonstration of up-to-date knowledge and skills. Further, consumers feel that no provider should be excused from any of the requirements regardless of time in practice.
What should continuing certification programs look like, ideally?
Continuing certification programs build on the initial knowledge and skill requirements during the progression in a professional career. A lifelong learning approach is recommended to incorporate advances in technology, knowledge, skills and abilities, also referenced as competency requirements. Ideal continuing certification programs include best practices and a multimodal approach for demonstration of knowledge and skills for the professional role.
The program should provide reinforcement for the credibility and reputation of the credential, assurances that the program meets all regulatory, credentialing, and licensure requirements, ability to quickly incorporate new evidence-based practices throughout the profession and demonstration that the service provider is competent to deliver high-quality, safe and effective care or services.
Program components may include continued education, formative and/or summative knowledge assessments, demonstration of skills (practice), peer assessment, portfolios, clinical practice and current licensure in a profession.
The continued certification program is time-limited and requires compliance with requirements throughout a career. An example is the NBCRNA’s Continued Professional Certification (CPC) Program, a multi-component system that supports lifelong learning through continuing education, professional development, core modules to incorporate evidence-based information and an assessment.
Are there any common misconceptions and challenges around continuing certification that ICE members or the public should be aware of?
Complicated by the argument of time away from practice to meet requirements for ongoing certification, many common misperceptions surround continuing certification. These misunderstandings, often purported by those against continuing certification, include:
- Continuing Education (CE) is all we need to keep professionals current.
- Professionals know what they need to know and what they need to learn.
- Consumers expect that their professionals continue to learn and are accountable to demonstrating their competence.
- Voluntary certification programs are not required, cost money and time.
- The government and licensing boards are all we need to ensure the continued competence of our professionals.
- There is no difference between care or service by a professional who is certified or who is not.
- Though certification may be required for the profession, threats may arise from local – state legislative arenas to jeopardize the credential.
- In some states, legislation has been introduced to remove or lessen professional certification requirements resulting in low-quality or harmful services.
How can the credentialing community get involved in this area of the industry?
Several initiatives are underway to galvanize efforts to educate the public, the legislative community and other professional certification organizations.
- The Professional Certification Coalition was founded in July 2018 to address efforts to enact state legislation that would undermine the activities or recognition of certifications developed or offered by non-governmental, private certification organizations. Linked here is their white paper on Private Professional Certification.
- ICE has recently taken on the patient education work of the former Right to Safe Care Coalition in the form of a subgroup. ICE members can find out more by contacting ICE.
- AARP Strategies to Improve Health Care Quality in Virginia: Survey of Residents Age 50+, May 2007 (https://www.aarp.org/health/doctors-hospitals/info-2007/va_care_07.html)
- Poll Shows Americans recognize the Importance of Lifelong Learning, regular skill evaluation for healthcare providers who will treat them. Press Release 2013. https://www.nbcrna.com/publications/press-releases-and-statements-archive/release-3