Many Steps and Many Voices Along this Journey
AT Driven Research and Development Phase
At the end of 2021, the BOC Board created a new CPC Task Force comprised of volunteers to drive future efforts, integrate feedback and provide recommendations on the future of AT certification renewal. To date, the BOC Board, this designated task force and over 1,400 ATs have weighed in to help shape the CPC Concept over the past several years - all before the open comment period held last fall. The new CPC Task Force, along with the input of hundreds to thousands more ATs, will further define CPC. By the time this is final, it will have been shaped, by and for ATs.
As we move through this phase of CPC concept research and development, it’s vital that we gain all perspectives and input from ATs and other experts to shape program design. We’ve had hundreds of ATs, and other experts, raise their hands during a recent call for volunteers who are driving this process of development.
Efforts for this phase, which began in March will extend over the next several months as AT volunteers participate in various roles to help further define and shape development of CPC to be:
- An AT-centric certification renewal program that is: relevant, flexible, equitable, inclusive, aﬀordable, eﬀective and easy to manage...for all practice settings, including ATs who are PRN
- A certification renewal program that protects the public and meets the needs of ATs as health care professionals
- A certification renewal program that provides a better way for ATs to map their own development path
AT Focus Groups and Work Groups
During April 2022, eight AT focus groups, in multiple practice settings, took place. Based on overall results from the focus groups the following key takeaways were identified:
- ATs are open to additional learning initiatives to achieve recertification
- ATs want interdisciplinary and peer learning
- ATs want hands-on, structured learning
- ATs are looking for learning activities that are tailored to their career/interests
Results from these groups, which centered around input on educational activities and practice setting nuances, helped to define plans and next steps for work groups. These work groups are in progress over the next several months to further refine the CPC concept and component development based on AT input.
The BOC Power Panel, a large group of stakeholders, will continually provide intermittent input over time about CPC development. Their input, captured using online survey tools, is being added to the process.
Once results from the research and development phase are analyzed, outcomes will be reviewed by the CPC Task Force which will then make recommendations for next steps. This progression will continue over the next two to three years until CPC is finalized and implemented to meet the needs of ATs while fulfilling the level of certification required to enhance our profession and protect the public.
Look for an update later in 2022 as this phase of work progresses.
Want to be a part of the process?
2021 Open Comment Results
Data collected during the Continuing Professional Certification (CPC) open comment period, from both Survey Monkey and Miro Board, was assimilated and analyzed. Based on feedback, four main messages were expressed that will shape the ongoing development of CPC. These data points were used to define action steps for the next phase.
Be mindful of potential practice setting differences and nuances. We will collect additional quantitative and qualitative data focused on the varied AT settings.
Make communication two-way and consistent. We will provide opportunities for ATs to speak and actively participate in ongoing focus and work groups. In addition, we will push out timely and meaningful project updates.
Clarify the concept of CPC and its components. We will provide updates and education to ATs on component specifics as they are shaped, as well as defining “why” they are to be included.
Create a structure to support ATs. We will shape CPC to be flexible, customizable, time-efficient, and cost-effective to our diversified audience of ATs.
- Research has led us to a new recertiﬁcation program - it’s been in the works for years
- Necessary step to advance our profession as a leader in health care
- Stay on top of our game - critical to the profession
- Oﬀer choices/ﬂexibility giving ATs equitable and aﬀordable options
- Provide consumers comfort knowing ATs are current with cutting edge knowledge and skills
See FAQs to learn more
General CPC Questions
Q: Has the CPC plan already been finalized?
A: No. There has been and will continue to be opportunities for Athletic Trainers (ATs) to help shape the final result.
Q: When will the changes be implemented?
A: No sooner than 2024, and potentially not until 2026. We anticipate a slow and gradual roll out.
Q: If CPC is a recertification program, does that mean taking an exam to recertify?
A: No. Recertification is the renewal of one’s certification based on a set of requirements. For example, the requirements ATs met at the end of the last reporting period were recertification requirements.
Q: Why is the BOC in the CEU business?
A: The BOC is not in the CEU business, rather the certification business. The BOC is accredited by a third party (National Commission for Certifying Agencies) and an overarching standard that we must meet includes: The certification program must require periodic recertification. BOC’s current recertification requirements include a set number of CEUs that are provided by BOC Approved Providers and other CE organizations.
Q: Why are we changing how ATs recertify?
A: Staying at the top of our game as a health care professional is critical. We’ve been working on a better approach to ongoing continuing education (CE) for the past 11 years for several reasons:
- To meet ATs where they are, and in their practice settings. Giving ATs choices and flexibility for equitable and affordable CE is our goal.
- ATs have suggested over the years that the current approach to CE could be more relevant, useful and efficient.
- Research has supported this notion (see below).
Q: What evidence suggests that current CEUs aren’t the optimal way?
A: Continuing Professional Certification (CPC) is overall guidance for health care professionals’ requirements for continuing competence and maintenance of certification that are grounded in the core competencies identified in the Institute of Medicine (IOM), now the National Academy of Medicine (NAM) report “Health Professions Education: A Bridge to Quality” (2003) and reiterated in other IOM/ NAM reports, such as “Redesigning Continuing Education in the Health Professions” (2010), as well as the latest edition of the Institute of Credentialing Excellence (ICE) “Certification: The ICE Handbook” (2019).
- Provide patient-centered care
- Work in interdisciplinary teams
- Employ evidence-based practice
- Apply quality improvement
- Utilize informatics
Evidence has shown that across the health care professions, CEUs alone aren’t as effective or practical as they could be, and much of the medical field is evolving their approach, including nursing, occupational therapy, physician assistants and dietetics.
Executive Summary: Institute of Medicine. 2003. Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press. https://doi.org/10.17226/10681.
Executive Summary: Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. https://doi.org/10.17226/12704.
Institute for Credentialing Excellence. 2019. Certification: The ICE Handbook. Washington, DC: Institute for Credentialing Excellence. Chapter 24: Reframing Recertification for Continuing Competence, p559-578.
Other Health Care Professions
Q: What other health care profession’s certification agency requires CEUs?
A: Most accredited certification agencies for other health care professions currently require CEUs for recertification (e.g, National Board of Certification for Occupational Therapy, National Board of Certification and Recertification for Nurse Anesthetists, National Board for Respiratory Care, etc.).
Q: Shouldn't CE be tied to our state license?
A: Your state license and BOC certification are two distinct, separate things and vary by state. Some states recognize BOC certification for license renewal. Other states align their renewal requirements with those of the BOC and some states have their own renewal requirements. And one state does not have state licensure. Again, BOC certification is separate from licensure and how they work together can vary considerably, depending on where the AT practices.
Promoting the Athletic Training Profession
Q: Why doesn't the BOC put their efforts into widespread promotion of the profession?
A: The BOC is a credentialing agency, and our mission is to provide exceptional credentialing programs for health care professionals to assure protection of the public. While the BOC promotes the profession when possible, its priority must be public protection and the CPC concept is an initiative that does both protect the public and promotes the profession. The NATA is the primary organization promoting the athletic training profession. BOC encourages all ATs to be engaged members of the NATA and explore the numerous NATA benefits.
Q: What will the requirements be to maintain my certification?
A: This has yet to be determined.
Q: Will there be the opportunity for growth to make sure change in clinical practice happens?
A: Yes, that is the idea. CPC would address both continued competence across the domains of athletic training, but also provide activities that promote growth and clinical expertise to enhance patient outcomes.
Q: Does the CPC align with the Accreditation Council for Continuing Medical Education (ACCME) standards and processes?
A: There may be some alignment, but ACCME standards address continuing medical education (CME). There is more alignment with ACCME standards and BOC Approved Provider standards for CE, which has been in place since 2016.
Professional Goals Appraisal (PGA)
Q: How will the PGA continue to be effective with the high turnover in athletic training settings?
A: The PGA is meant to be dynamic to adapt to the AT and will need to have the ability to make updates to goals if necessary.
Q: If the PGA says I'm supposed to do more work with modalities to maintain my certification, I don't have modalities at my school to use aren't I still just "checking the box"?
A: Because the goals you develop in the PGA should take into consideration your weaknesses and strengths, as well as your environment and other factors (such as whether you plan to stay in that environment) addressing modalities may not be part of your professional development or you may want it to be because you plan to change jobs. The PGA is dynamic and not solely focused on weaknesses.
Q: Will an AT be penalized if a suggested CE activity is not utilized?
A: While the details of the CPC concept are to be determined, it is not the intent of the PGA for an AT to be penalized for not taking suggested activities.
Q: Will the PGA limit what an AT can do for CEUs?
A: No. The PGA will produce recommended development activities that are relevant to your interests, practice setting and strengths. It produces a recommended pathway, not a concrete road. Think of the PGA as a blueprint for the individual AT. If your practice setting or interests change, and consequently your plan changes, that’s ok. Your CE should reflect that change.
In addition, we’ve received comments that indicate the PGA sounds like an exam. While the AT is asked questions in the early stages of a PGA, the purpose of the questions is to identify where the AT’s development should or could be. It is certainly not anything to be stressed about, quite the opposite. The PGA only helps ATs to customize their learning path and identify learning activities or interventions that suit their own needs.
Q: How does PGA work with the non-practicing AT?
A: Ultimately, you develop the goals in the PGA. Your goal may be to maintain your credential and/or your license, or maybe you plan to return to practice. Your goal may be to focus on what knowledge and skills you want or need to return to practice safely.
Competence Assessment Modules (CAMs) and Quality Improvement (QI)
Competence Assessment Modules (CAMs): Mental Health Pilot
774 ATs from 14+ different practice settings completed the CAMs – Mental Health pilot. In a post-pilot survey, participants agreed the CAMs improved their knowledge of mental health as well as their awareness of strengths and weaknesses in this area. Specifically, over 92% of participants “Agreed” or “Strongly Agreed” the CAMs “Improved my knowledge of mental health.”
Quality Improvement (QI) Projects
QI: Facility Principles Pilot
115 ATs from a variety of practices settings completed the QI - Facility Principles Pilot. In a post-pilot survey, participants indicated the process improved their awareness of areas for improvement, strengths and/or compliance and ultimately enhanced patient outcomes. Specifically, over 70% of participants “Agreed” or “Strongly Agreed” the project “Enhanced my patients’ outcomes.”
QI: Hand Hygiene Pilot
127 ATs from a variety of practices settings completed the QI – Hand Hygiene Pilot. In a post-pilot survey, participants indicated the process improved their awareness of areas for improvement, strengths and/or compliance and ultimately enhanced patient outcomes. Specifically, nearly 80% of participants “Agreed” or “Strongly Agreed” the project “Enhanced my patients’ outcomes.”
Q: What examples can you provide of a QI project?
A: Example 1 - Documentation
After a review of charts, we found that our staff is inconsistent in completing discharge summaries in our electronic health care records. We need to have 100% of charts complete and currently only 70% of charts have discharge summaries completed.
Our plan is to initiate a staff education program. After four weeks, we’ll do a chart review and assess how many charts have completed discharge summaries.
Example 2 – Infection Control (see optional Hand Hygiene QI project coming in 2022)
According to the CDC and WHO, hand hygiene is an important practice to reduce the spread of infection. After conducting a brief patient survey, we found that staff’s compliance with appropriate hand hygiene occurred only 50% of the time. Our goal is to increase hand hygiene compliance to 100%.
Our plan is to educate staff and place poster reminders in common places to help AT remember to wash their hands. After two weeks, we’ll conduct another patient survey to assess hand hygiene compliance.
Example 3 – Facilities (see optional Facilities Principles QI project coming in 2022)
Upon review of the BOC Facility Principles and completing the corresponding online Facilities Principles Assessment, we found that our facility only met 40 of the 57 requirements.
We identified three requirements that we could address in the short-term and more in the long-term with the help of appropriate personnel. Following are the three short-term requirements we will address first:
- Properly display Material Safety Data Sheets (MSDS) within our facility
- Post egress and exit routes in the facility
- Display current state licenses and certification of all employees within the facility
At the end of the year, we’ll complete the online Facilities Principles Assessment again to measure the number of requirements our facility now meets, as a comparison.
Q: Can QIs be done with athletic training program students to improve program outcomes?
A: The AT credential is a practice credential. Therefore, QIs in CPC should link to patient outcomes not education outcomes. If the QI can be built to focus on patient outcomes, then it could be counted.
Q: For those of us who participate in clinical research, could we use our research question and our research to fulfill our QI requirement?
A: Of course! If the goal of the research includes improvement of patient outcomes, then yes it could fulfill the requirement.
Q: Can you provide some examples of how an athletic training educator can complete a QI?
A: Athletic training educators in professional programs are well positioned to participate because programs are already required to have students engage in a QI project. (See Standard 63: Use systems of quality assurance and quality improvement to enhance client/patient care.) The athletic training educator could work as a member of a student’s QI team to help with the Plan-Do-Study-Act cycle seen below associated with a specific effort. For example, maybe a student notices that individuals with ankle injuries are routinely referred for imaging and wants to test a change to reduce the number of unneeded imaging. The QI team, then, plans the change, actually tests the change in real life, examines the results, and then determines any needed changes that result.
Q: How does a non-practicing AT do the QI?
A: The required and optional activities for CPC have not been determined, including QI. That said, it depends on your situation. For example, if an AT is in an administrative position and no longer practicing, there are other projects that would ultimately improve patient care, such as a review of policies and procedures, where they can assess a process, identify gaps or inefficiencies, craft and implement a solution, monitor the outcomes and reflect to determine if the solution worked or if a different solution is needed. In fact, the BOC has a tool, Policy and Procedure Development, to help assess policies and procedures on employee safety, facility, risk and crisis management, privacy/confidentiality, disposal of medical sharps, EAPs, exertional heat illness, health records, infection prevention and control, and lightning safety.
Q: Will the CAM topics be prescribed, or will ATs be responsible to create our own and gather all the resources?
A: The CAMs would be developed by the BOC or perhaps another third party, and the idea is to have a library for ATs based on their needs.
Q: Will QIs and CAMs eventually become mandatory to maintaining our certification?
A: We don’t know. However, we do anticipate that CPC will likely evolve over time.
Q: How will each QI or CAM be measured as CEUs?
A: In the short-term (2022-2023 reporting period), BOC is using a flat number for QI projects of 10 Category A CEUs (hand hygiene and facility principles) which is based on data from the pilot. CAMs will be based on the number of questions in the assessment - this too is based on data from the pilot. In the long-term (2024 and beyond), it is to be determined.
Q: How will a QI be reviewed?
A: Details on QI projects have not been determined for CPC.
Q: For the QI projects, do they have to be started and completed within the 2-year report year or can there be an overlap as long as there is an updated report submitted?
A: While not determined at this point, if we align with current practice, any QI projects or other CPC activities would receive credit for the period in which they are completed.
Q: Who develops QIs? Will some of these be provided by the BOC or are they things that we, as individual practitioners, develop and implement?
A: QIs could be developed by anyone, but the BOC plans to have “canned” QI projects available to ATs. This is also a space where BOC Approved Providers could be involved.
Q: How would we report the QI component?
A: BOC would provide technology for reporting.
Q: Does every QI have to have a quantitative component, or can it be qualitative?
A: While the logistics of a QI have not been determined, typically QI can use quantitative and/or qualitative data.
Q: Can a QI be done with other health care professional credentialed people and/or non-health care professionals such as educators? It seems like there are opportunities with concussion protocols to include teachers with the return to class activities.
A: While the logistics of QI have not been determined, QI typically encourages interdisciplinary collaboration and including other related staff may be ideal for the success of a QI. Many considerations would go into QI development such as limitations and/or dependencies from others and how that might affect successful completion of a QI.
Q: Do you anticipate updated CE opportunities to be available?
A: Please contact individual BOC Approved Providers for more information on updated CE opportunities.
Q: Will there be any conversations about getting CEUS or “Credits” for being an athletic training educator?
A: You can receive credit for attending programs that teach you how to teach skills such as cupping, joint mobilizations, IASTM, etc. If the program is provided by a BOC Approved Provider it will qualify for Category A, and if not, Category D. The following explanation is provided in the BOC Certification Maintenance document:
If the program/activity content incorporates tasks from the current Practice Analysis in a substantive manner or has a focus of health care education, it may qualify for CEUs. If the content of the program/activity addresses pedagogy or improving the skill of teaching, or assessing participant learning outcomes, it does not qualify for CEU. For example, programs related to teaching a clinical skill, documentation or communication involve tasks in the Practice Analysis and qualifies for CEUs. Curriculum design, however, does not represent tasks incorporated in the Practice Analysis and does not qualify for CEUs
Q: Will there be maximums on the number of CEUs obtained within each CE category? For example, 40 is the maximum CEUs in category A when 50 CEUs are due.
A: The details of CE requirements for CPC have not been determined.
Q: Will this program require more of an AT’s time and money to fulfill CE requirements?
A: No. We know ATs carry more than a full load, and the time you spend in professional development should be time well-spent. The new system is being designed to:
Give you more flexibility - Autonomy and ability to incorporate the material that will advance your own practice and goals, best adapted to your practice setting.
Be more efficient - We heard the question, “Will it take more time and money?” and the answer to that is “no”. The concept does not include an increase in required CE; in fact, the number of required CE may decrease. Our goal is to make CE count, not count CEU’s. We are looking for ways we can make use of what you already do day to day that may contribute to CE. (Meanwhile, it is difficult to estimate the exact amount of time and dollars recertification will take, as each AT would be making choices about their individualized plan, but it should not cost more).
Add more value - With new approaches that help ATs actually focus your learning on what you need and want to learn to increase your knowledge, skills and abilities. The PGA is an excellent example of how this can be done at a low cost. ATs who complete the PGA earn 10 Category B CEUs for $65.
Q: My school doesn’t fund my professional development and this new program sounds expensive. Am I going to be asked to pay more out of my own pocket annually with CPC?
A: Making recertification more costly is not the plan. We want to make it more effective, which doesn’t have to mean more expensive. The concept does not include an increase in required CE; in fact, the number of required CEUs may decrease. We are looking for ways that we can make use of what you already do day to day that may contribute to your continuing education. A QI project could be an example of this.