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 30:8, 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. 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 I.Identification of Infectious Disease Processes II.Surveillance & Epidemiologic Investigation III.Preventing/Controlling Transmission of Infectious Agents IV.Program Management & Communication V.Education and Research VI.Infection Control Aspects of Employee Health

17 Detailed Content Outline Example III.Preventing/Controlling the Transmission of Infectious Agents A. Develop IC policies & procedures B. Identify IC strategies: 1. for handwashing and antisepsis 2. related to cleaning, disinfection, and sterilization 3. for specific in-patient care settings (e.g., nursing units, specialty units, respiratory therapy, operating room 4. 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 today’s 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 that fund of knowledge is related to quality 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

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 examination NOT continuing 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 one’s 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 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 APIC Text of Infection Control and Epidemiology, Volume Bailey/Scott’s, 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, Vol. 50 (RR11); CDC/MMWR Recommendations and Reports Friedman, Candace, Infection Control in Ambulatory Care 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., 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., 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 Taber’s Electronic Medical Dictionary: Cd-Rom, v Rothrock, Jane C., Alexander’s Care of the Patient in Surgery, 12th ed., 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

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

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.

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49 CBIC Executive Office P.O. Box Lenexa, KS Voice: 913/ Fax: 913/ Web site: