Special Edition Newsletter: CPC Program Update - October 2013


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President's Message

Dear Fellow Nurse Anesthetists:

In 2008, the NBCRNA launched an effort to modernize the existing recertification program, which has existed largely unchanged for 40 years. A recertification task force conducted an extensive three-year review process, consisting of a benchmarking study, practice analysis, research of recertification trends and focus groups conducted at AANA meetings. The NBCRNA reviewed the task force's conclusions in 2011 and opened the recommendations to your comments. Thousands of phone calls, emails, blog posts and survey responses shaped the proposed guidelines for the Continued Professional Certification (CPC) Program.
The CPC Program embraces current standards and practices for professional certification and incorporates the maintenance of competence and lifelong learning concepts that are the basis for other health care professionals’ recertification programs. In adopting the CPC Program, the NBCRNA worked hard to address concerns expressed by long-practicing nurse anesthetists, establishing requirements that respect both their years of practice and career expectations, and carefully considered the potential cost and demands on time. We have continued to observe that the principles of the CPC align with the future of professional certification, particularly in the healthcare industry. The Institute for Credentialing Excellence recently invited the NBCRNA to present a webinar on the CPC Program, for the benefit of other professions looking to update their practices and standards.  
This special edition of our e-newsletter is dedicated to sharing the latest developments regarding the CPC Program. The NBCRNA has made a concerted effort to keep nurse anesthetists informed and engaged in the program's development. We hosted a CPC presentation and feedback session at the 2013 AANA Annual Meeting, and have since launched a series of webinars, open to all nurse anesthetists, which allow participants to learn more about the CPC and ask questions in real time.
The CPC Program's development is being led by a CPC Committee, which includes four subcommittees comprised of volunteers who are practicing nurse anesthetists. I commend and thank our committee chair, Steve Wooden, and all of our volunteer members for generously contributing their time and expertise.
Last month, the committee presented its initial recommendations to the NBCRNA Board of Directors. What follows are the recommendations accepted by the board and which are now open for public comment. None of the CPC details will be officially finalized until after the nurse anesthetist community has had the opportunity to provide feedback.
We hope you take a moment to review the progress made on the CPC Program. The NBCRNA has presented these recommendations to the AANA Board of Directors for their input. We will distribute an electronic survey to all certificants on October 18, allowing you to weigh in on the proposed recommendations. The NBCRNA also has three upcoming CPC webinars, which are free of charge and qualify for CE credits. Visit NBCRNA.com to learn more and register.



Charles Vacchiano, PhD, CRNA, NBCRNA President


 CPC Program Update

The CPC Program continues to develop, led by four subcommittees composed primarily of clinical practitioner CRNAs from across the country. Following the initial rollout and public comment period in 2011, nurse anesthetists provided abundant feedback which helped to guide the refinement and architecture of the program. With a good deal of additional progress completed to date, the NBCRNA is again providing an interim report of progress and asking for feedback from stakeholders on proposed elements that are part of the evolving development of the program.
The basic requirements of the CPC Program are:
  • 4-year recertification cycle.
  • 15 continuing education units per year which include end-of-activity assessment.
  • 10 professional activity units per year (“PAU”-educational or professional development activities which do not require prior -approval, or post-assessment. Traditional CE credits may be used in lieu of PAU credits).
  • Four core competency modules per cycle (average 1 per year). The modules are computer-based learning activities specifically in the core competency areas for nurse anesthesia practice. Competency module credits count toward the program assessed CE requirement.
  • Recertification examination based on core clinical competencies of nurse anesthesia practice every other cycle (i.e. every 8 years), with the first 8-year exam serving as a diagnostic tool (i.e. not pass/fail).
Over the past year the CPC subcommittees have investigated various additional details and procedures which may become part of the CPC Program.  What follows is a brief synopsis of the committees’ recommendations.


Continuing Education Component

  • Education must be prior-approved by an association such as the AANA and directly related to nurse anesthesia practice in order to qualify.
  • Academic coursework in a related field of study at an accredited university may count toward CE obligation.
  • Post-activity assessment must have been formulated by the provider using acceptable valid testing methods, requires 80% achievement of correct answers by participant, and a remediation method must be provided for failure to achieve passing score.

Professional Activity Units

This category of education is intended to lend flexibility, reduce cost, and provide a greater means for anesthetists to tailor their continuing education with activities which fit their practice area and individual needs. There are a number of options for a nurse anesthetist to consider. Examples include department-level education, precepting students, professional scientific writing, simulation-based education, and other activities. Because the PAUs do not require prior-approval nor post-activity assessment, they may likely be accomplished with little or no expense beyond what anesthetists would incur in their professional lives, even in the absence of CPC requirements.

  • If not used as part of the assessed CE credits, a 3-credit academic course may be applied as 9 PAUs.
  • Preparation and delivery of 1-hour didactic or CE presentation counts as 3 PAUs.
  • Authoring a book chapter = 7 PAUs; peer-reviewed article = 5 PAUs.
  • Clinical teaching/precepting of SRNAs: 1 day = 1 PAU.
  • Chief CRNA, clinical coordinator, or other anesthesia administrative roles = 5 PAUs per year.One advocacy or public relations activity = 1 PAU.
  • Research dissertation or primary investigator = 10 PAUs.
  • Smaller role in research project or thesis = 5 PAUs.
  • Medical mission trip or 1 year in elected professional association (state or national) = 5 PAUs.
  • Life support courses may be reported one time per CPC cycle as PAU credit.
Competency Modules
Four web-based learning activities will ensure that each anesthetist will complete learning in core areas of airway management techniques, applied clinical pharmacology, human physiology and pathophysiology, and anesthesia technology during each 4-year cycle. Recommendations in this area include:
  • Module content is intended to be complimentary to and support ongoing preparation for the recertification examination.
  • NBCRNA will establish criteria and standards for modules so that providers will produce products of comparable quality and rigor.
  • Specific criteria for modules and their pre-approval process will be released soon.
  • Example of an airway module might have the participant read and learn the difficult airway algorithm and then select appropriate steps in the management of a difficult airway scenario presented on the computer.
  • Each module will be required to qualify for assessed CEs. 
Recertification Examination
The Recertification Examination Committee continues to assess a range of considerations associated with creating an effective recertification examination. Current recommendations include:
  • Delivery mechanism being considered- likely at testing centers around country.
  • Test questions will be composed exclusively for this exam; they will focus on competencies of general practicing CRNAs.
  • First exam available 2020 through 2024 (or 2021 through 2025, depending on individual’s cycle) will provide familiarization with testing and diagnostic feedback to certificants.
  • Additional CE in areas with a score below a set threshold will be required, but the first exam performance will not be considered pass or fail. Completion of any additional CE will be required prior to the CPC cycle deadline.
  • By 2033, passing the exam will be required for continued certification by all certified nurse anesthetists.
  • Individuals will have up to 4 attempts available to successfully pass the examination.

Re-entry and Audit
The re-entry program is intended to serve CRNAs whose certification has been lapsed for over 4 years, by providing a pathway to refresh knowledge and skills, and to demonstrate the ability to be recertified.  Re-entry encompasses a combination of requirements to incorporate knowledge, application, and skills. Committee recommendations here would mean applicants must:

  • Complete the recertification examination and all CPC educational components for the 4-year cycle.
  • Demonstrate core competency skills at an accredited simulation center.
  • Obtain employment within one year (to foster repetition and solidification of refresher education).

Moving Forward

  • NBCRNA will soon recruit item-writers who will begin constructing questions for the recertification examination.
  • Practice tutorials will be developed for CRNAs to gain experience with the format and content of a recertification examination.
  • NBCRNA plans to provide a means that will enable individuals to track their completed and required activities in real-time over the 4-year cycle.
  • NBCRNA will conduct a progress audit at the mid-point of the CPC cycle to help individuals remain on track and not inadvertently fall behind on requirements.