Piths, Pearls, and Pitfalls of Measuring Competency

1
Piths, Pearls, and Pitfalls of Measuring
Competency

• Fran Slater Feltovich,
• MBA, RN, CIC, CPHQ
• CBIC Director

2
Pith

• The essential or central part of anything
• Essence gist
• Force strength vigor
• The American Heritage Dictionary

3
How does Pith apply to Measuring Competency?

• We must clearly understand the core components of
  what we are trying to measure
• We must be able to apply the force of appropriate
  measurement processes

4
What is the pith of an effective IPC Program?

• A competent ICP
• The core components that the ICP needs to know to
  be competent

5
Competency

• What is competency?
• The state or quality of being capable to perform
• Why is it important to health care professionals
  including ICPs?
• Patients lives are at stake
• Would you consider yourself competent?

6
IOM Report To Err Is Human

• Shined the spotlight on medical errors including
  HAI
• Opened the eyes of the public
• Called for a comprehensive approach to improving
  patient safety

7
IOM Report Health Professionals Education A
Bridge to Quality

• Health professionals are not adequately prepared
  to provide the highest quality and safest medical
  care possible
• Insufficient assessment of ongoing proficiency
• Ensure students and working professionals develop
  and maintain proficiency in 5 core areas.

8
IOM Core Competencies Include

• Delivering patient-centered care
• Working as part of interdisciplinary teams
• Practicing evidence-based medicine
• Focusing on quality improvement
• Using information technology

9
Once Is Not Enough

• 2003 IOM Recommendations
• All health professional boards should move toward
  periodic demonstration of ability to deliver
  patient care
• Certification bodies should require certificants
  to maintain competence by periodically
  demonstrating the ability to deliver patient care

10
Trickle Down Effect

• Public outcry and demand for changes
• JCAHO Patient Safety Goals
• Mandatory reporting of HAIs
• Future Mandatory prospective demonstration of
  competency???

11
CBIC Bylaws Mission

• To improve the quality of healthcare by
  increasing the number of professionals whose
  knowledge mastery in infection prevention and
  control and applied epidemiology has been
  demonstrated by certification.

12
What is the Pith of CBIC Certification?

• The Practice Analysis (PA)
• This process involves a systematic collection
  of information that describes behaviors and
  activities performed by occupants of the job in
  question.
• Goldrick, et al. Practice analysis for
  infection control and epidemiology in the new
  millennium. AJIC 308, December 2002

13
CBIC PA Purpose

• To determine and comprehensively describe the
  functions of the ICP role
• To determine the core functions that should be
  assessed in a certification examination

14
CBIC PA, cont.

• Email survey to practicing ICPs
• Developed by a panel of expert ICPs
• Conducted every 5 years to reflect changes in
  practice
• Based on North American practice standards (US
  Canada)

15
PA Results

• Statistically analyzed to determine core elements
  that are essential for an ICP practicing with 2
  years experience
• Used to develop the content outline for the
  certification exam

16
Major Content Categories

1. Identification of Infectious Disease Processes
2. Surveillance Epidemiologic Investigation
3. Preventing/Controlling Transmission of Infectious
   Agents
4. Program Management Communication
5. Education and Research
6. Infection Control Aspects of Employee Health

17
Detailed Content Outline Example

• Preventing/Controlling the Transmission of
  Infectious Agents
• Develop IC policies procedures
• Identify IC strategies
• for handwashing and antisepsis
• related to cleaning, disinfection, and
  sterilization
• for specific in-patient care settings (e.g.,
  nursing units, specialty units, respiratory
  therapy, operating room
• for nonpatient care departments (e.g.,
  environmental services, nutritional services)

18
Pitfall trap or danger

• Continuing Education
• IS NOT
• the same as demonstrating current competency!

19
Changing Healthcare System

• Continuing advances
• Technology
• Treatment
• Increasing cost
• Decreasing resources
• Workforce shortages
• Demands
• Employers
• External regulations
• Public

No oversight system to demonstrate continued
knowledge, skills, performance
20

• Is an ICP certified in 1982 competent to deal
  with issues in todays HC system?

21
Citizen Advocacy Center (CAC)

• Developed Road Map to Continuing Competency
  Assurance Maintaining and Improving Health
  Professional Competence
• Assuring the continuing competence of health
  care practitioners is an essential element in any
  program to improve patient safety and health care
  quality
• Final destination is the institutionalization of
  meaningful, periodic continuing competency
  assessment and assurance for all health care
  professionals

22
CAC Recommendations

• Develop national consensus definition for
  competency
• Pass state laws requiring periodic competency
  assessment tied to licensure
• Use only evidence based programs
• Adopt higher standards for enrollees in CE
  courses to include post-testing

23
Various studies have added to evidence
supporting the validity of the certifying exam.
These lend support to the concept thatfund of
knowledgeis related toquality of practice

• Norcini et al. Medical Education, Sept. 2002,
  Certifying examination performance patient
  outcomes following acute MI

24
Avoiding the Pitfalls

• CBIC agrees with the growing body of evidence
  that
• Continuing education does NOT demonstrate
  competence
• Demonstrating competence is an ongoing process
  requiring repeat measurement

25
What is CBIC?

• Voluntary, autonomous, multidisciplinary board
• Administrators of the certification process for
  infection control and applied epidemiology
• Accredited by National Commission for Certifying
  Agencies (NCAA)

26
Objectives of Certification

• Provide a standardized measurement of current
  knowledge
• Encourage individual growth and study, promoting
  professionalism among ICPs
• Formally recognize ICPs who fulfill the
  requirements for certification with the CIC
  credential

27
Pearls items of great value

• CBIC believes a competent ICP is a pearl of
  great value!

28
Validity of the CBIC Examinations

• Developed under the guidance of Applied
  Measurement Professionals (AMP)
• AMP - an independent testing agency
• AMP oversees scoring of the exam
• Each test item undergoes both expert and
  statistical scrutiny before use
• Passing scores are calculated to compensate for
  item difficulty differences between exams

29
NCCA Accreditation

• National Commission for Certifying Agencies
  (NCCA) is the accrediting agency for
  certification programs
• Requires the highest standard possible for
  certification programs
• Assures a valid, reliable, secure certification
  process
• is NCCA Accredited

30
2005 JCAHO Standard IC.7.10

• The infection control program is managed
  effectively.
• Note Qualifications may be met through ongoing
  education, training, experience, and/or
  certification (such as offered by the
  Certification Board for Infection CBIC in the
  prevention and control of infections.

31
CBIC requires recertification by
examinationNOTcontinuing education!
32
Certification Process
33
Eligibility for Certification

• Minimum of 2 years practice in infection control
  with a minimum of 800 hours worked prior to the
  date of the examination
• Practice requirements may not be waived
• Practice must be current within 5 yrs

34
Eligibility for Certification, cont.

• A current license or registration as a medical
  technologist, physician, or registered nurse
• OR
• A minimum of a baccalaureate degree
• Contact CBIC Executive Office for information
  on educational waiver requirements

35
Eligibility for Certification, cont.

• Candidates who are self-employed or who work in
  non-traditional settings must submit additional
  documentation (See Candidate Handbook for
  details)
• Candidates with lapsed certification also must
  meet the practice requirements

36
Initial Certification

• Computer Based Testing (CBT) only
• 150 questions
• Test at any time
• World-wide sites
• Results
• USA - Available at end of test
• International sent via mail
• Valid for 5 years

37
Eligibility for Recertification
Individuals who are currently certified are
automatically eligible for recertification every
5 years.
38
Recertification

• Required every 5 years to maintain certification
• Two ways to test
• CBT
• SARE (Self-assessment Recertification
  Examination)

39
SARE

• Similar in content to the CBT with 150 multiple
  choice items developed from the Content Outline
• Self-administered (non-proctored) at a location
  of ones choosing
• May be taken over a longer period of time

40
SARE

• Can be used for
• CIC re-certification
• Study and self assessment
• Must have successfully completed CBT
  certification to be eligible
• Can be taken every 5 years for re-certification

41
Applying for CBIC Certification

• Obtain a Candidate Handbook online at
  www.cbic.org
• Contains everything you need to know about the
  application process
• Computer sites may be found online
• Special international information found on online

42
Preparing for the Exam

• Review current IC reference books, journals and
  standards
• APIC Text of Infection Control and Epidemiology,
  Volume 2 2002
• APIC Text of Infection Control and Epidemiology,
  Volume 3 2005
• Bailey/Scotts, Diagnostic Microbiology, 11th
  ed., 2002
• Bennett, JV and Brachman PS. Hospital Infections.
  Philadelphia Lippincott-Raven Publishers. 1998
  4th ed.
• Brooks, Kathy, Ready Reference to Microbes, 2002,
  APIC.
• CDC/MMWR Recommendations and Reports, June 29,
  2001. Vol. 50 (RR11) 1-42.
• CDC/MMWR Recommendations and Reports
• Friedman, Candace, Infection Control in
  Ambulatory Care. 2004.
• Heymann, David. Control of Communicable Diseases
  Manual. Washington, D.C. American Public Health
  Association. 2005 18th ed.

43
Preparing for the Exam

• References, cont .
• Lippincott Williams Wilkins, Designing Clinical
  Research, 2nd ed., 2001.
• Mandell, GL, Bennett JE, Dolin R. Principles and
  Practice of Infectious Diseases. New York
  Churchill Livingstone. 2000 5th ed. volume 1
• Mayhall, Glen C., MD, Hospital Epidemiology and
  Infection Control, 3rd ed., 2004.
• Red Book Report of the Committee on Infectious
  Diseases. Elk Grove Village, IL American Academy
  of Pediatrics. 27th ed.(also available on CD ROM
  27th ed., 2006).
• Rhinehart E, Friedman MM, APIC INFECTION CONTROL
  IN HOME CARE, Maryland Aspen Publication. 1999.
• Tabers Electronic Medical Dictionary Cd-Rom, v.
  2.0.
• Rothrock, Jane C., Alexanders Care of the
  Patient in Surgery, 12th ed., 2003.
• Wenzel, RP. Prevention and Control of Nosocomial
  Infections. Baltimore Williams and Wilkins.
  1997 3rd ed.

44
Preparing for the Exam, cont.

• Solicit support from your local APIC Chapter.
• Form a study group among your peers
• Utilize the content outline
• CBIC Online Practice Exam

45
Online Practice Exam

• Same format as CBT
• Consist of 70 questions (many used on previous
  exams)
• Familiarize you with computerized testing process
• Help assess knowledge level
• Cost 50.00
• Available at www.cbic.org

46
CBIC International Testing

• CBT testing now available in many sites around
  the world
• English only
• Eligibility is the same
• Results are sent via mail
• See International Testing section at www.cbic.org

47
Proper Use of the CIC Credential

• Only individuals who have successfully passed the
  certification exam and have maintained current
  certification, may use the CIC credential.

48
(No Transcript)
49
CBIC Executive Office

• P.O. Box 19554
• Lenexa, KS 66285-9954
• Voice 913/599-4174
• Fax [phone]
• E-mail cbic-info_at_goAMP.com
• Web site www.cbic.org