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Executive Director Becky Rabbitt's certification primer - "NCCA standards for accreditation" (7-Oct-2010)
NHA’s goal is for all our programs to meet the NCCA’s (National Commission for Certifying Agencies) standards for accreditation. Because of that, we have made several changes recently – for example, the confidentiality of individuals’ exam scores – that reflect the NCCA’s requirements of us. To help you understand why we made those changes and how we evaluate our programs and processes, please check out the following “certification primer” that details the disciplined process that the NCCA requires.
The first five NCCA standards focus on Purpose, Governance and Resources
The purpose of the certification program is to conduct certification activities in a manner that upholds standards for competent practice in a profession, occupation, role or skill. Typically, it is the profession that demands or identifies the need for a certification program. A program demonstrates meeting this standard through the granting of a credential and the adoption of a mission statement, policies/procedures and candidate information about the program. The NHA governing committees have been charged with reviewing the mission statement for each credentialing program to assure we meet this standard.
The certification program must be structured and governed in ways that are appropriate for the profession, occupation, role or skill, and that ensure autonomy in decision-making over essential certification activities. Our accredited certification programs are governed by independent boards with representation from certified professionals, important stakeholders and the public. These boards set the policy for how the exam is administered, who is eligible to sit for the exam, oversight for the construction of the exam and any continuing competency requirements. The certification should be protected from undue influence that could compromise the integrity of the process and is supported by this independent governing committee. Currently, the programs that have Board oversight include the Clinical Medical Assistant, Phlebotomy, Billing and Coding, and Pharmacy Technician. We are in the process of building additional Boards that will have oversight for the other certification programs NHA administers. If you have interest or know of someone appropriate for a Board position, please send a letter and resume to firstname.lastname@example.org.
The board must have representation from individuals certified within those professions, as well a representation of the public – someone who is a recipient of the services of that certified individual. The NHA Certification Board today has oversight of the Phlebotomy, Clinical Medical Assistant and Billing and Coding certification programs. There is a separate board that governs the Pharmacy Technician certification program. Members on these boards serve staggered three-year terms to maintain consistency and history year-to-year. Nominations are accepted annually for positions on the Board.
Sufficient financial resources are necessary to conduct effective and thorough certification and recertification activities. NCCA believes it is important to be able to support certified candidates and is concerned if a program may not have enough resources to continue. A certification program that is viable initially, but can’t remain viable to support candidates with recertification, is not serving the profession or the public very well. NHA, now part of ATI, is committed to serving the allied health community with certification programs that will make them more competitive in the field. We rely on our professionals in the field to help guide the program in serving patients, the public and the overall profession.
Key staff are necessary to effectively conduct certification and recertification. NHA has an in-house team of test developers and psychometricians that provide the expertise for test development. Additionally, NHA now has operations teams dedicated to supporting our certificants, our schools and that work with candidates on recertification. NHA also manages the operations of evaluating test results, processing certificates and publishing study guides all in-house. There is an extensive team of specialists involved in supporting the certification programs.
The next four NCCA standards focus on the responsibilities to stakeholders
Certification programs are required to publish and regularly review their policies and procedures. These policies are published to our stakeholders in the form of the Candidate’s Guide, which is published on the NHA website. All candidates, as well as schools, should become familiar with these certification policies. The Board also is charged with reviewing these annually and making necessary changes.
A published test description is required. We also have included this in the Candidate’s Guide. Here you will find a description of how the test was developed and validated. Typically, the process of conducting the job task analysis is discussed here, along with the process for defining the competencies being tested for each exam. Generally, this process should be repeated every five years; this document will tell you when the last job task analysis was conducted.
A credential is granted only when the competencies have been assessed. Grandfathering is a concept where individuals who entered the profession before regulation or certification existed are automatically recognized. Because there is no comparable means for assessing competence outside of the exam, NHA does not grandfather candidates and expects everyone earning the credential to have sat and passed the exam.
Transparency in who has been certified is necessary. NHA recently launched a new candidate verification system where anyone could verify a candidate’s certification. This verification is accessible on the NHA website by any member of the public.
The next nine standards address the specific assessment instrument
Domains for the assessment are analyzed, defined and published. Often called the Exam Blueprint or Exam Content, they are published in the Candidate’s Guide. A summary of the job analysis study also is included for it is the defining activity for creating the competencies, domains and, eventually, the test.
This standard requires that the exam be derived from the job analysis and that it follows industry principles. This is where the NHA psychometric team becomes invaluable. NHA has five psychometricians on staff and many other test developer specialists to stay abreast of the requirements for good test design.
Standard 12 deals with setting the cut score. There are several ways to determine what a passing score will be. Often a procedure known as the Angoff method is used. This is what NHA uses to set the passing score for its exams. The process involves more people from the profession to determine what the minimum competencies should be. Based on this, the psychometricians publish the results in what is known as a cut score report.
Some programs report a raw score; others use a scaled score. Today, the standard requires that failing candidates be provided meaningful information to understand their strengths and weaknesses. This is often called a diagnostic report. It will also be matched to the exam blueprint so a candidate knows where he/she did well and where he/she did not. Passing candidates generally only receive their passing status without additional feedback by domain. Discussion is taking place within the certification industry as to whether this practice should change and passing students should also be provided more information. This standard also addresses confidentiality of exam score information. This particular standard prompted the change in NHA releasing individual score data to schools without the expressed written permission of the student. NHA knows that performance is important to schools and, therefore, created the report that provides aggregate pass rate information compared to benchmarks.
In statistics, reliability is the consistency of a set of measurements or an instrument. This standard specifically requires an analysis of the reliability of the assessment instrument. There are different methods for assessing reliability based on the type of assessment. Programs will typically look at scores, the characteristics of the population, reliability coefficients and standard error. If there are different forms of the test, they must be equally challenging and not disadvantage those that get one form over the other. This is known as equating and is addressed in Standard 15. A good equating process will demonstrate the candidates are equally challenged and assessed regardless of the test form received.
Although there are strict standards for developing the test, administering the test is also important. Standard 16 requires certification programs to adhere to appropriate, standardized and secure procedures for the development and administration of the test and that these procedures are published. NHA has recently looked at the requirements for our school test sites and our test sites with psi. You may see additional helpful information that proctors will be able to use to help us meet this standard.
Standards 17 and 18
These standards address record retention and the security surrounding the exam. NHA has asked our schools to help maintain the security of the exam. Without strict compliance to the security measure of the exam, its ability to truly assess candidate competence comes into question.
Standards 19 and 20
The exam assesses competence at one point in time but continuing competence is important, especially in healthcare. In standards 19 and 20, NCCA requires all programs to have some means of assessing continuing competence. Some programs require retesting. Others require continuing education. NHA currently requires continuing education for candidates to keep their credential current. This is an example of a policy that is adopted by the governing board, a representation of the profession. It is the standard in that profession that will determine the best assessment for continued competence.
The last standard requires that programs must annually report on their continued compliance with the accreditation standards and any significant changes to the program that occur.
NHA’s goal is to standardize our programs and processes so that all will meet the NCCA standards. We know there have been quite a few changes from NHA and we thought that understanding the accreditation standards that cause us evaluate what we’re doing would help you understand why we are making these changes.
We look forward to working with you toward our goal. Please feel free to contact me if you have any questions regarding NHA’s efforts to meet the NCCA’s standards for accreditation.
Rebecca M. Rabbitt, Pharm.D.
Executive Director, Allied Health Certification Programs