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5. Health Professions Oversight Processes: What They Do and Do Not Do, and What They Could Do
Pages 97-120

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From page 97...
... The spectrum of oversight processes can also include organizational accreditation, which serves to accredit practice institutions and health plans, but has some impact on the continuing competence of practicing professionals through the standards imposed. This chapter reviews accreditation, licensure, and certification requirements related to the education of health professionals in the five competencies outlined in Chapter 3 with respect to medical, nursing, pharmacy, and physician assistant undergraduates and graduates.
From page 98...
... Accrediting organizations assess educational programs to determine whether their content is designed to produce competent graduates and then offer accreditation to those programs meeting their standards. State 1/licensing bodies are called upon to protect the public by setting minimum standards of competency for health professionals.
From page 99...
... However, it does require some evidence of interdisciplinary curricula (Commission on Collegiate Nursing Education, 1998~. Such accrediting bodies require that educational programs offer curricula and educational experiences related to their individually defined competencies, which may or may not overlap with the five competencies outlined in this report.
From page 100...
... HEALTH PROFESSIONS EDUCATION cat o v .> · I 5 ¢ ~3 5 5 o ·_I o 5 Cut ¢ En i. xx x x1x x 1 xlxl x e.§ , =c e >d x x x x x x x x x XX X X X X X Cat ~ ~ ~ 1 X X X X X X X X ';1$,; ~ ~ I !
From page 101...
... The accrediting bodies surveyed for this report have begun to address outcomes to some extent in their position statements, but vary in their progress toward implementing assessment of educational outcomes. The committee applauds the work of those focusing on outcomes, such as the Accreditation Council for Graduate Medical Education (ACGME)
From page 103...
... Faci11titation of Interbliscip11tinary Teams Though accreditation processes vary regarding requirements for the five competencies in the educational experiences of health professionals, accreditation as it is structured today poses a particular barrier to working in interdisciplinary teams at the educational level. A great deal of collaboration and coordination among the various accreditors will be needed to realize the promise of 103
From page 104...
... Licensure The general public does not have adequate information to judge provider qualifications or competence; thus professional licensure laws are enacted to assure the public that practitioners have met the qualifications and minimum competencies required for practice (Safriet, 1994~. State governments, through state health professional licensing boards, provide health professionals with the legal authority to practice through licensure.
From page 105...
... For respiratory therapists, some but not all states require the National Board for Respiratory Care's Entry Level or Advanced Practitioner Respiratory Care examination, which is technical in nature and does not include content related to any of the five competencies. Table 5-2 shows how the licensing exams in each of the health professions examined by the committee map to the five competencies.
From page 106...
... A recent survey of 323 licensing boards representing a variety of health disciplines revealed that 83 percent required licensees to demonstrate that they had done something to keep their knowledge and skills updated as a condition of license renewal; 94 percent of these boards required licensees to accumulate a specific number of continuing education credits as the only method for doing so (Swankin,2002~. Regarding the professions reviewed in this paper, the range is great.
From page 107...
... Studies of diverse physician assistants, nurses, and allied health professionals indicate that they can perform some of the clinical tasks of physicians and provide equivalent quality of care (Kinnersley, 2000; Mundinger et al., 2000; Phillips et al., 2002; yenning, 20004. One panelist at the summit, Charles InIander of the People's Medical Society, noted: "We still have laws that are so archaic that they protect no one except certain professional bases.
From page 108...
... To facilitate flexibility and collaboration among certain health professionals, some have proposed multistate or nationally uniform scopes of practice (O'Neil and the Pew Health Professions Commission, 1998) or national licensing systems instead of state-level examinations (Federation of State Medical Boards, 1998~.
From page 109...
... On average, 86 percent of these organizations offered two or more methods for doing so, including taking approved continuing education courses, retaking the initial certifying exam, and participating in an onsite practice review (Swankin, 20024. Of the professions reviewed for this report, most but not all mandate periodic recertification, usually by requiring certificate holders to retake the initial certification exam or take a certain number of hours of continuing education, or both (American Board of Medical Specialties, 2000; American Osteopathic Association, 2002b; Commission for Certification in Geriatric Pharmacy, 2002; National Commission on Certification of Physician Assistants, 2002; National Institute for Standards in Pharmacist Credentialing, 2002; Yoder-Wise, 20024.
From page 110...
... Similarly, JCAHO requires hospitals to initiate specific efforts to prevent medical errors and to tell patients when they have been harmed during their treatment (Joint Commission on Accreditation of Healthcare Organizations, 20014. I, Such standards have the potential to serve ~0
From page 111...
... Thus, conducting skilled interpersonal communication, acknowledging patient values and promoting shared decision making, being a lifelong learner, applying critical thinking, being an effective team member, and managing information are just some of the many important skills overlooked by such an approach (Decker, 1999; Decker et al., 19974. Demonstration and Maintenance of Competence Increasingly, oversight organizations are being challenged to provide assurance to the public that health professionals meet minimum levels of competence throughout their careers, not only at the time of entry and initial licensure and certification.
From page 112...
... The task force recommended that continuing education providers define a core curriculum of content; address competencies; emphasize quality improvement using an evidence-based approach; offer constituents a variety of educational formats; and apply methods to demonstrate the linkage between continuing education and changes in knowledge, skills, clinician practice behaviors, and patient outcomes (Council of Medical Specialty Societies, 2002~. Research also suggests that lecture-based courses need to be reinforced with interactive techniques, such as case discussion, role play, and hands-on practice sessions, offering a chance to apply the new knowledge or skills in practice, and then reinforce these activities with further educational sessions (Davis et al., 1999; O'Brien et al., 20014.
From page 113...
... There is no formalized process that ensures coverage of the five competencies outlined in Chapter 3. Some licensing boards require that health professionals choose specific courses for maintenance of their license, but more often than not, the choice is wide open, and health care practitioners can select a course that is merely interesting or even just convenient.
From page 114...
... In medicine, for example, the following organizations all influence the content of medical education: the Liaison Committee on Medical Education, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, 27 residency review committees, ABMS and its 24 certifying boards, the Bureau of Health Professions at the Department of Health and Human Services, the American Medical Association, the American Osteopathic Association and its 18 certifying boards, the American Association of Colleges of Osteopathic Medicine, and various professional societies involved in continuing medical education (Institute of Medicine, 20014. Because so many health professionals must graduate from an accredited program in order to sit for licensure exams and obtain specialty certification, greater linkage among accreditation, certification, and licensure is imperative.
From page 115...
... . Some licensing boards require periodic demonstration of continued competency, with continuing education being the dominant method for such demonstration.
From page 116...
... 2002. Generalcompetencies and accreditation in graduate medical education.
From page 117...
... 1999. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
From page 118...
... Vol. Committee on the Training Needs of Health Professionals to Respond to Family Violence, Board of Children Youth and Families, Institute of Medicine, and F
From page 119...
... 2001. Continuing education meetings and workshops: Effects on professional practice and health care outcomes.
From page 120...
... 2002. Results of Survey of Selected State Health Licensing Boards and Health Voluntary Certification Agencies Concerning their Continuing Competence Programs and Requirements.


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