Maintenance of Certification-The Value to Patients and Physicians.

This Viewpoint discusses the ABIM's continuing efforts to innovate and streamline maintenance of certification, including the recently launched Longitudinal Knowledge Assessment (LKA), to better accommodate physicians' schedules and desires for flexibility.

Accreditation model of European Haemophilia Centres in the era of novel treatments and gene therapy.

INTRODUCTION: The international certification of haemophilia centres in Europe is run by the European Association of Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) since 2013. The centres are designated as European Haemophilia Comprehensive Care Centres (EHCCC) or European Haemophilia Treatment Centres (EHTC), based on the specific requirements which evaluate centres' ability to provide care for patients with haemophilia and allied disorders. AIM: To establish the new protocol for accreditation of European Haemophilia Centres. METHODS: EAHAD, in collaboration with EHC, established Accreditation Working Group with the aim to define necessary measures to safeguard quality and improvement of bleeding disorders care throughout Europe and to build a novel model for accreditation of European Haemophilia Centres. RESULTS: The European guidelines for certification of haemophilia centres have been updated to guidelines for the accreditation and include all the requirements regarding facilities, laboratory and personnel needed for optimal management of novel treatment options, including the introduction of the hub-and-spoke model for delivery of gene therapy. A pilot project for the accreditation of haemophilia centres including on-site audit has been designed. CONCLUSION: Implementation of the novel accreditation protocol of the haemophilia treatment and haemophilia gene therapy centres has been made to further improve the quality of care for patients with haemophilia and other inherited bleeding disorders.

Safety protocols at the American Board of Pediatric Dentistry Oral Clinical Examination during COVID-19.

BACKGROUND: There are continued concerns about holding large group gatherings with the ongoing COVID-19 pandemic. The American Board of Pediatric Dentistry (ABPD) made the decision to cancel the Oral Clinical Examination (OCE) in 2020 with a goal to host the exam in 2021. This cancellation postponed the board certification of over 400 pediatric dentists. There is limited published data on safety protocols for in-person examinations. AIM: To determine if safety protocols utilized in the administration of the 2021 ABPD Oral Clinical Examination (OCE) were reassuring to candidates and examiners, and effective at addressing prevention of COVID-19 infection. DESIGN: An electronic survey was emailed to candidates and examiners following completion of the board examination process. The candidate survey had 784 and the examiner survey had 108 eligible participants. Eight questions overlapped between the two surveys. Descriptive statistics were utilized. p-values < 0.05 were considered significant. RESULTS: Three hundred ninety-four candidates (response rate = 50.3%) and 97 examiners (response rate = 89.8%) completed their respective surveys. The majority of candidates (86.8%) and examiners (94.8%) felt safe participating the OCE, and found COVID-19 protocols reassuring, 69.3% and 89.7%. CONCLUSIONS: Participants agreed that safety protocols enacted by the ABPD kept everyone safe and led to a successful and safely conducted high-stakes oral clinical examination during the COVID-19 pandemic.

A Coronavirus Disease 2019 Pandemic Pivot: Development of the American Board of Anesthesiology's Virtual APPLIED Examination.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic interrupted the administration of the APPLIED Examination, the final part of the American Board of Anesthesiology (ABA) staged examination system for initial certification. In response, the ABA developed, piloted, and implemented an Internet-based "virtual" form of the examination to allow administration of both components of the APPLIED Exam (Standardized Oral Examination and Objective Structured Clinical Examination) when it was impractical and unsafe for candidates and examiners to travel and have in-person interactions. This article describes the development of the ABA virtual APPLIED Examination, including its rationale, examination format, technology infrastructure, candidate communication, and examiner training. Although the logistics are formidable, we report a methodology for successfully introducing a large-scale, high-stakes, 2-element, remote examination that replicates previously validated assessments.

Credentialing, Certification, and Peer Review Essentials for the Neurosurgeon.

Credentialing and certification are essential processes during hiring to ensure that the physician is competent and possesses the qualifications and skill sets claimed. Peer review ensures the continuing evolution of these skills to meet a standard of care. We have provided an overview and discussion of these processes in the United States. Credentialing is the process by which a physician is determined to be competent and able to practice, used to ensure that medical staff meets specific standards, and to grant operative privileges at an institution. Certification is a standardized affirmation of a physician's competence on a nationwide basis. Although not legally required to practice in the United States, many institutions emphasize certification for full privileges on an ongoing basis at a hospital. In the United States, peer review of adverse events is a mandatory prerequisite for accreditation. The initial lack of standardization led to the development of the Health Care Quality Improvement Act, which protects those involved in the peer review process from litigation, and the National Provider Databank, which was established as a national database to track misconduct. A focus on quality improvement in the peer review process can lead to improved performance and patient outcomes. A thorough understanding of the processes of credentialing, certification, and peer review in the United States will benefit neurosurgeons by allowing them to know what institutions are looking for as well and their rights and responsibilities in any given situation. It could also be useful to compare these policies and practices in the United States to those in other countries.

Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery.

OBJECTIVE: To Study the Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery. SUMMARY OF BACKGROUND DATA: The ABS General Surgery CE is normally an in-person oral examination. Due to the COVID-19 outbreak, the ABS was required to reschedule these. After 2 small pilots, the CE's October administration represented the first large-scale remote virtual exam. The purpose of this report is to compare the outcomes of this virtual and the previous in-person CEs. METHODS: CE candidates were asked to provide feedback on their experience via a survey. The passing rate was compared to the 1025 candidates who took the 2019-2020 in-person CEs. RESULTS: Of the 308 candidates who registered for the virtual CE, 306 completed the exam (99.4%) and 188 completed the survey (61.4%). The majority had a very positive experience. They rated the virtual CE as very good/excellent in security (90%), ease of exam platform (77%), audio quality (71%), video quality (69%), and overall satisfaction (86%). Notably, when asked their preference, 78% preferred the virtual exam. There were no differences in the passing rates between the virtual or in-person exams. CONCLUSIONS: The first virtual CE by the ABS was completed using available internet technology. There was high satisfaction, with the majority preferring the virtual platform. Compared to past in-person CEs, there was no difference in outcomes as measured by passing rates. These data suggest that expansion of the virtual CE may be desirable.

Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience.

BACKGROUND: One of the most valued targets in inflammatory bowel disease (IBD) is for physicians to provide and patients to receive a high-level quality of care. This study aimed to evaluate the implementation of a nationwide quality certification programme for IBD units. METHODS: Identification of quality indicators (QI) for IBD Unit certification was based on Delphi methodology that selected 53 QI, which were subjected to a normalisation process. Selected QI were then used in the certification process. Coordinated by GETECCU, this process began with a consulting round and an audit drill followed by a formal audit carried out by an independent certifying agency. This audit involved the scrutiny of the selected QI in medical records. If 80%-90% compliance was achieved, the IBD unit audited received the qualification of "advanced", and if it exceeded 90% the rating was "excellence". Afterwards, an anonymous survey was conducted among certified units to assess satisfaction with the programme for IBD units. RESULTS: As of January 2021, 66 IBD units adhere to the nationwide certification programme. Among the 53 units already audited by January 2021, 31 achieved the certification of excellence, 20 the advanced certification, and two did not obtain the certification. The main survey results indicated high satisfaction with an average score of 8.5 out of 10. CONCLUSION: Certification of inflammatory bowel disease units by GETECCU is the largest nationwide certification programme for IBD units reported. More than 90% of IBD units adhered to the programme achieved the certification.

2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic.

Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.

Influence of the artificial turf certification on physical performance and muscle damage in football players (QUALTURF PROJECT).

This study aimed to analyse the influence of the FIFA Quality PRO certification of artificial turf pitches on the physical, physiological performance and muscle damage in soccer players. Fifteen healthy male players (21.2 ± 1.4 years; 178.2 ± 4.3 cm; 79.1 ± 8.3 kg) from a university football team were selected to participate in the research. Mechanical properties related to surface-player interaction were assessed on the two surfaces selected for this study. A randomized design was used and the players performed the Ball-sport Endurance and Sprint Test (BEAST90) on the different artificial turf fields. Average time of the 20 m sprints was longer on the FIFA Quality Pro surface than on the non-certified pitch (+ 0.13 s; p < 0.05; CI 95% - 0.01 to 0.27; ES: 0.305). The players' perceived effort was higher in the first (+ 2.64; p < 0.05; CI 95% 0.92 to 4.35; ES: 1.421) and the second half (+ 1.35; p < 0.05; CI 95% - 0.02 to 2.72; ES: 0.637) of the test on the FIFA Quality Pro field. Comparative analysis between surfaces showed no significant differences in the time spent in each of the heart rate zones and higher concentrations of CK (+ 196.58; p > 0.05; CI 95% 66.54 to 326.61; ES: 1.645) were evidenced in the non-certified pitch surface. In response to a simulated match protocol, markers of post-exercise muscle damage may be reduced on accredited artificial turf fields. These insights can provide the opportunity to maximize the efficiency of training sessions and reduce the risk of injury during the season.

Does Nurse Preceptor Role Frequency Make a Difference in Preceptor Job Satisfaction?

This study identified nurse preceptor role frequency to newly licensed registered nurses and how it made a difference to the preceptors' job satisfaction. Statistical analysis revealed there was no difference in job satisfaction in preceptors who performed in the role one to four times than those who served five times or more, F(4, 124) = 0.261, p > .05. The study found variation in preceptor role preparation and differing registered nurse practice experience prior to performing as a preceptor.

The American Board of Pathology's 2020 Continuing Certification Program.

CONTEXT.­: Certification by the American Board of Pathology (ABPath) is a valued credential that serves patients, families, and the public and improves patient care. The ABPath establishes professional and educational standards and assesses the knowledge of candidates for initial certification in pathology. Diplomates certified in 2006 and thereafter are required to participate in Continuing Certification (CC; formerly Maintenance of Certification) in order to maintain certification. OBJECTIVE.­: To inform and update the pathology community on the history of board certification, the requirements for CC, ABPath CertLink, changes to the CC program, and ABPath compliance with recommendations from the American Board of Medical Specialties Vision Commission; and to demonstrate the value of CC participation for diplomates with non-time-limited certification. DATA SOURCES.­: This review uses ABPath archived minutes of the CC Committee and the Board of Trustees, the ABPath CC Booklet of Information, the collective knowledge of the ABPath staff and trustees, and the American Board of Medical Specialties 2018-2019 Board Certification Report. CONCLUSIONS.­: The ABPath continues to update the CC program to make it more relevant and meaningful and less burdensome for diplomates. Adding ABPath CertLink to the program has been a significant enhancement for the assessment of medical knowledge and has been well received by diplomates.

Development of gastroenterological surgery over the last decade in Japan: analysis of the National Clinical Database.

The National Clinical Database (NCD) of Japan was established in 2010 with the board certification system. A joint committee of 16 gastroenterological surgery database-affiliated organizations has been nurturing this nationwide database and utilizing its data for various analyses. Stepwise board certification systems have been validated by the NCD and are used to improve the surgical outcomes of patients. The use of risk calculators based on risk models can be particularly helpful for establishing appropriate and less invasive surgical treatments for individual patients. Data obtained from the NCD reflect current developments in the surgical approaches used in hospitals, which have progressed from open surgery to endoscopic and robot-assisted procedures. An investigation of the data acquired by the NCD could answer some relevant clinical questions and lead to better surgical management of patients. Furthermore, excellent surgical outcomes can be achieved through international comparisons of the national databases worldwide. This review examines what we have learned from the NCD of gastroenterological surgery and discusses what future developments we can expect.

Educating Students with Autism Spectrum Disorders: Is Teacher Certification Area Associated with Academic Outcomes?

Although typically taught by special educators, few studies have examined if certification area is associated with academic outcomes for students with autism spectrum disorders (ASDs). The purpose of this study was to determine whether students with ASD scored better on language arts and mathematics state assessments depending on teacher certification, and whether these associations varied by assessment type. We analyzed 3 years of state administrative data from students with ASD in grades 4-8 receiving special education services. Results showed students taking the regular or alternate assessment had similar academic outcomes regardless of teacher certification. Students who were taught by special education certified teachers and took the modified assessment had lower academic outcomes. Implications for practice, policy, and research are discussed.

The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT® as a Case in Point.

The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.

Simulation training for embryo transfer: findings from the American Society for Reproductive Medicine Embryo Transfer Certificate Course.

OBJECTIVE: To assess the value of the American Society for Reproductive Medicine Embryo Transfer Certificate Course in confidence and skill building for performing a live embryo transfer (ET). DESIGN: Prospective cohort study. SETTING: Two-day simulation workshops of reproductive endocrine and infertility (REI) fellows from American Board of Obstetrics and Gynecology-approved training programs, using four different uterine models (A-D). PATIENT(S): None. INTERVENTION(S): Didactic and hands-on simulation training program. MAIN OUTCOME MEASURE(S): Primary outcomes included ET simulation scores of all exercises analyzed at various points of the training and self-assessed confidence before and after the completion of the Embryo Transfer Certificate Course based on a 6-point Likert scale and association of both with extent of prior live ET experience and year of fellowship. RESULT(S): Data were collected for 78 REI fellows who completed the Embryo Transfer Certificate Course and demonstrated significant improvements in both skill and confidence. The data for a subset of 58 fellows who performed five direct transfers on both Embryo Transfer Certificate Course uterine models A and B demonstrated significant overall improvement in ET simulation scores between the first and fifth direct transfers. A separate data subset of 57 fellows who performed five afterload transfers for each exercise on all four uterine models demonstrated differences in difficulty among them. Embryo transfer simulation using the uterine A model was consistently the easiest. The ET simulation scores for fellows using the uterine B and C models showed a progressive and significant increase across the five afterload ETs. When using the uterine D model, ET simulation scores increased significantly between the first and second transfers but remained at the same level for the remaining three transfers. Except for uterus A, a significant increase in ET simulation scores between the first and last transfers was observed for fellows overall in all afterload transfers and for those fellows with <50 prior live transfers. Data for all 78 fellows demonstrate a significant gain of self-confidence for all parameters, with the highest overall increase (78%) observed for first-year fellows as well as for fellows of any year with no prior live transfer experience (109%). Fellows with the largest number of prior live ET experience started with higher confidence, which also increased significantly, although they had a lower gain in confidence compared with fellows with less experience. CONCLUSION(S): The American Society for Reproductive Medicine Embryo Transfer Certificate Course data analysis demonstrates the effectiveness of simulator-based ET training for REI fellows across the 3 years of training, regardless of prior experience with live ET.

COVID-19: The regional impact of COVID-19 on the certification of vision impairment in Northern Ireland.

PURPOSE: In this paper we highlight the impact which the disruption of secondary care ophthalmic services, resulting from COVID-19, has had on Sight Impairment (SI) and Severe Sight Impairment (SSI) certification in Northern Ireland. METHODS: Regional data on SI and SSI certification in the period after the onset of the lockdown (19 March 2020-18 June 2020) were compared to the period immediately before lockdown (1 January 2020-18 March 2020) and to the same periods in 2019. Change documented was compared to post-lockdown reductions in primary and secondary ophthalmic care activity. RESULTS: In 2019, during the 3-month period (19 March 2019-18 June 2019), 115 individuals were certified as sight impaired (SI 36, SSI 75, unspecified 4). Of those certified, 65 were female, 49 male. Principal causes of certification were: Age-related macular degeneration (AMD) (N = 45), glaucoma (N = 20) and diabetic eye disease (DED) (N = 10). Mean VA, recorded from the better eye of those certified, was 0.96 LogMAR. In the 3 months following the onset of lockdown (19 March 2020-18 June 2020), only 37 individuals were certified (SI 6, SSI 31), 12 female and 25 male. AMD was the most frequent cause of sight impairment (N = 20). There were only two DED certifications and one due to glaucoma. Mean VA in the better eye of those certified was 1.15LogMAR. The numbers of CVI certifications completed following the introduction of COVID-19 lockdown fell by 68%, compared to the 2019 data. There was a significant reduction in the proportion of female certifications (p = 0.01), and in certifications due to glaucoma (p = 0.02). The proportion of those certified as SSI as opposed to SI in the period after the onset of lockdown rose from 68% in 2019 to 84% in 2020. The mean VA of those certified in the period after the onset of lockdown, when compared to those certified in the other three periods, was worse by between 0.21 and 0.19 LogMAR (p = 0.06). Reductions reflected change in overall primary and secondary ophthalmic care activity. CONCLUSIONS: It is inconceivable that COVID-19 has reduced the incidence of sight-threatening eye disease. We must therefore assume that a flood of newly presenting sight loss will present once the pandemic has passed. New presentations will include those who would normally have attended during the lockdown period, and patients who, had they accessed ophthalmic care at the appropriate time, would have been saved from severe levels of blindness. The implications of the predicted increase in demand for medical, social and low vision related services are huge.