Assuring Continued Competence

Vol. 15 •Issue 13 • Page 10
Safety Solutions

Assuring Continued Competence

Trends to Ensure Safety Embraced by External Oversight Organizations

Today, our health care system is under intense pressure and scrutiny to provide safe practitioners. Both patients and employers are seeking assurances that medical laboratory personnel are maintaining the competence they demonstrated during their initial certification process. Increasingly, oversight organizations such as accreditation agencies, licensing boards and certification agencies are being challenged to provide public assurance that health professionals meet minimal levels of competence throughout their careers.

Recently, the Institute of Medicine (IOM) published the following recommendation: “certification bodies should require their certificate holders to maintain their competence throughout the course of their careers.” The recommendation was outlined in its recent report, “Health Professions Education: A Bridge to Quality.”1 This April 2003 report, published by the IOM’s Health Care Services’ Committee on the Health Professions Education, resulted from a summit held to “assess the implications of the changing health system for provider credentialing and licensure programs.” The committee reviewed the accreditation licensure and certification requirements related to education of medical technologists, physicians, nurses, pharmacists and physician assistants, occupational therapists and respiratory therapists.

Certification Maintenance

A 2002 survey of certification bodies,2 published by the Citizens Advocacy Center, found that 95 percent of 44 health profession certification bodies require that their practicing certificate holders periodically demonstrate their competency. This survey also revealed that many health profession certification agencies mostly rely on certificate holders to choose from several alternative pathways to demonstrate continued competence. The most popular method to document continued competence is by certification maintenance. Maintenance of certification refers to requiring candidates for certification to commit to doing something in the future, at some predetermined point after they receive their initial certification, with the understanding that failing to honor that commitment will result in loss of their credential. Alternatively, and used to a lesser extent is recertification, which has certificate holders satisfy the original requirements for the credential, or meet a new set of certification requirements, generally resulting in a re-testing of competency.

In recent years, patterns and mechanisms of determining continued competence have evolved and expanded. In response to a scarcity of evidence that just taking continuing education (CE) courses improves practice outcomes, some certifying agencies are beginning to emphasize alternative strategies for maintaining and documenting competency.3 Although many credentialing agencies use the maintenance of certification approach by requiring documentation of CE, they are increasingly moving toward other, more effective methods of documenting competence. Self-assessment and self-directed learning are gaining favor as a way of tailoring CE choices and other professional development activities to the individual certificate holder’s needs.

Beginning in 2006, the American Board of Pathology (ABP) will issue time-limited primary and subspecialty certificates with a 10-year duration.4 Pathologists will need to complete a Maintenance of Certification (MOC) program within 8-10 years after the initial time-limited certificate is issued. Educational curricula will be developed and focused on post-certification knowledge required to maintain practice competence. Following the documentation of the maintenance activities, certificate holders will be required to take a secure exam relevant to the pathologist’s practice setting.

New Certification Renewal Program

Clearly, demonstration of continued competence by health care practitioners is a practice whose “time has come.” The largest health care institutional accreditor, JCAHO, requires all accredited organizations to assess, prove, track and improve the competence of their employees. Now, in keeping with national trends to assure continued competency of health professionals, the ASCP BOR will be launching its new maintenance of certification program effective Jan. 1, 2004. The new certification renewal program will combine assessment activities with a variety of educational activities. More details will be posted on our Web site at in the coming months.

Dr. Ward-Cook is senior vice president, American Society for Clinical Pathology and executive director, Board of Registry.


1. Greiner AC, Knebel, eds. Health Professions Education: A Bridge to Quality. Committee on the Health Professions Summit, Board of Health Care Services’ Institute of Medicine, the National Academies Press, April 2003.

2. Swankin DS. Results of Survey of Selected State Health Licensing Boards and Health Voluntary Certification Agencies Concerning their Continuing Competence Programs and Requirements, Washington, D.C. Citizens Advocacy Center, 2002.

3. Hale J. Performance Based Certification. San Francisco: Jossey-Bass Pfeiffer, 2002.

4. Troxel BD. Special announcement: Maintenance of certification. Arch Pathol Lab Med 2002;126(8): 901.

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