Most recent - posted 10/22/2021
Q: Help us understand Quality Improvement (QI) project opportunities by providing some real-life examples.
A: There will be many QI project opportunities.
In a secondary school setting, projects could include improving emergency action plans, fulfilling a Safe Sports School award or implementing PASS (Program Assessment for Safety in Sport). Or, maybe an Athletic Trainer (AT) wants to solve a particular problem – like lowering the number of skin infections. This could be documented for a QI project. For those in hospital settings, an AT could likely participate in a QI project that is already going on in the organization.
In most practice settings, a QI could be developed to solve a relatively “easy” problem, or it could be something more complex. Most ATs already complete projects to improve patient care. Those new job experiences create opportunity for learning and allow for professional development.
Q: Athletic Trainers (ATs) are stretched thin. I thought the BOC was supposed to help our profession with higher salaries and better working conditions. Why are you focusing on CPC?
A: It’s important to first clarify the mission and purpose of the BOC, which is to provide exceptional credentialing programs for health care professionals that assure protection of the public. We take this very seriously. We want to provide the best credentialing services we can and believe this is our way of advocating for the credential.
Second, we believe that CPC provides us with an opportunity to elevate professional development for ATs, which will ultimately elevate the profession.
Q: I still don’t believe other types of health care providers are doing this for their continuing ed. What examples do you have?
A: There is a long list of health care professions that have moved to a CPC type recertification process - programs that stretch beyond CE only. For example, the National Board of Certification for Occupational Therapy (NBCOT®) Certification Renewal Activities for OTs, allows for competency assessment measurement CEUs, professional service CEUs, presenting CEUs and more.
There are many more examples; however, we don’t want to emulate other health care professions. We want to spend our time building something that uniquely meets Athletic Trainer needs.
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.
Q: You said that I will have flexible options. I still don’t understand what that means?
A: We want to get away from counting CEs and make CEs count. We don’t want Athletic Trainers (ATs) to just go through the motions and “check a CE box.” Instead, we want ATs to acquire new or refreshed skills that enhance patient outcomes. That’s where the Professional Goals Assessment (PGA)comes in. It allows an AT to set their own development goals based on gaps that might exist or areas the AT wants to enhance. And, the AT can receive credit just for uncovering the gaps, designing and working through the plan.
In addition, we learned from the open comment period that ATs would be open to more and different ways to earn credit. Other health care professions have alternatives, and we want to explore more options as we continue with the CPC development work.
Q: Will the PGA limit what an Athletic Trainer (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 continuing education 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: Do Athletic Trainers have to complete something from each CPC Pillar?
A: This has not been determined yet.
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: How has the CPC concept been impacted by COVID-19 and the changes in webinar-style education?
A: There are obviously more virtual educational opportunities offered through Approved Providers. Webinar-style education will continue to be acceptable for continuing education.
Q: What will the process be for the targeted Athletic Trainer (AT) input and focus groups? It seems like you are hand-picking people who agree with you.
A: We want to make sure we hear from ATs across practice settings and would like to include all who have interest in shaping CPC going forward. To indicate your interest, email the BOC at BOC@BOCATC.org.
Q: I feel like you don’t have “regular” Athletic Trainers like me represented, and I have ideas. How do I share?
A: We are glad there is interest as we plan to facilitate focus groups including individuals with varying experiences and from various practice settings. We’d love to include anyone who is interested in providing their ideas on how to build on the CPC concept. To include your name for consideration, simply email the BOC at BOC@BOCATC.org.
Q. You keep saying that CPC is not final. I didn’t even know anything about CPC until a few weeks ago. What will you do so you don’t surprise us again?
A: First, if you have an interest in past newsletter articles about the CPC progression, the articles can be found in the Newsroom section of the BOC website. We have a few other things in place and have some things planned for on-going communication:
- There is a dedicated CPC page on our website that has information and an on-going FAQ
- There will continue to be update articles in the BOC newsletters.
- There will be on-going updates as progress is made.
Q. I have a number of questions about QIs. How do you decide how many CEUs the project is worth? What if it's completely changing the concussion protocol in your district, or something more complex? Hours spent? Stages you get through? What if you and a co-worker do it together? What if your admin doesn't approve so you can't implement your plan? This all just seems so very subjective.
A: These are all great questions and items that still need further discussion and development. Please let us know if you have ideas.
Q: If the continuing education piece doesn’t change but you add these other components on top, how will that not take more time?
A: The concept of continuing education as you know will likely not change, but depending on how CPC is structured, it may mean that you have less CEUs if you complete other CPC activities.
Q: What is the list of domains for Athletic Trainers when considering QIs and CAMs?
A: Domains stem from the Practice Analysis (PA). The PA will continue to evolve and be published at regular intervals. QIs and CAMs are learning activities that will ultimately fall into a domain (could be more than one domain), just like CEs. You can find the current PA outline here.
Q: During a 5-year reporting period, if weaknesses are identified in Year 1 and the Athletic Trainer's (AT) work setting changes in Year 3, is the AT still required to address the weaknesses from Year 1?
A: No, goals developed in the PGA are meant to be dynamic and should be reviewed on a regular basis.
Q: If weaknesses are identified for an Athletic Trainer, can those "weaknesses" be used as a basis for a negligence claim during the reporting period? (How public are those "weaknesses"?)
A: Content of your personal PGA will not be publicly available. They are only a guide to develop goals.
Q: How does PGA work with the non-practicing Athletic Trainer?
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.
Q: If a work setting does not require the use of certain skills, those skills may be "rusty" and show as a weakness when they actually have no impact on the competency and ability of the Athletic Trainer (AT) in that setting. How can "real weaknesses" in the AT skillset be separated from "less proficient" skills? (Why spend time/money to get better in a skill I do not use in my setting?)
A: There is a difference in maintaining competency - a base MINIMUM level of knowledge and skill that every AT should know, regardless of practice setting, and upskilling in an area of relevancy and interest. One tool (or learning activity) cannot do it all. This is why we are creating several components or options in the new recertification program. Some tools will ensure base knowledge and skills for all ATs is maintained and some tools will encourage upskilling in an area selected by the AT.
Q: Are CAMs selected for us based on setting?
A: CAMs are not selected for Athletic Trainers (ATs). ATs CHOOSE a CAMs of interest. But this is a great suggestion for how BOC can organize or categorize CAMs so that ATs can easily identify one of interest (i.e. based on practice setting, domain, topic, etc.)
Q: How would Athletic Trainers report the QI component?
A: BOC would provide technology for reporting.
Q: Would reformatting and constructing a new Standards of Care within our Secondary School Settings be considered a QI project?
Q: So, your suggestion is to go into an athletic training clinic and interrupt the flow and coverage of care to complete a project? I can see issues with confidentiality, space, privacy, and safety (COVID restrictions) as a hurdle to "offer my services to athletic trainers in a traditional setting."
A: Ultimately, change is disruptive. And improvements usually require people to change. Each Athletic Trainer should consider the effort of change and the likelihood of adoption in their current work setting. Start small. Tackle smaller, more manageable “hurdles”.
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: Does this mean recertification by exam?
A: No. The BOC is shaping a new recertification concept - a selection of professional development activities that could create a more efficient and effective program for ATs.
Q: Why are we changing how Athletic Trainers (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 setting. Giving ATs choices and flexibility for equitable and affordable continuing education (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.
Q: What is the difference between CE, CEUs and CPC?
A: Continuing Education (CE) is activities, often short courses, that credentialed professionals engage in to receive credit for the purpose of maintaining continuing competence and renewing a credential.
Continuing Education Units (CEUs) is a measure used to quantify the CE credits required and earned by ATs.
Continuing Professional Certification (CPC) is a program purposely designed for ATs to maintain competence through participation in activities that promote growth.
Q: Will the current CE reporting method be eliminated?
A: No. CE, as we know it, will continue to be a part of CPC. However, CPC will incorporate additional activities that will provide options for building a professional development path. We have heard from ATs that CEUs alone are not entirely relevant to the needs and/or practice setting of all ATs.
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 Professional Goals Appraisal (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: Has the plan already been finalized?
A: Not at all. We are in the early stages of development and gathering your feedback in an open comment window so ATs can help us design a great system that fits into your practice. There will be additional opportunities in the coming months and years for you 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: Will input from ATs actually impact the CPC program development?
A: Yes. We’ve rolled out the open comment now for one reason – to incorporate ideas from ATs that will make the CPC concept work for you.
Prior to this stage, we’ve gathered input from many ATs during our 2020 pilot programs. Below you will find summary outcomes from two of the pilots.
Competency 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.”
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.”
Q: What’s in it for me?
A: Your input matters. ATs can help make this new CE program something you believe in and that works for you, no matter your practice setting.
Q: My work setting isn’t conducive to completing a Quality Improvement (QI) project; Am I expected to complete this type of project?
A: Not necessarily. The goal is for elements of CPC to be integrated into and aligned with any athletic training practice setting. There is no intention of making QI elements mandatory, only optional.
Q: Do I have to be a researcher to do a QI project?
A: No. Think of a QI project like an advancement or improvement you’d like to make in your practice anyway. By documenting it, you can count it towards your ongoing CE. For many practice settings, this could be more efficient and useful than many CE options. The goal for components like QI projects is that they can be implemented right in your work setting, and customized to allow you to complete ongoing education in a more efficient way.
For example, the QI - Facility Principles pilot required the AT to:
- Conduct a “pre-test” (using a tool that is available to all ATs) of their athletic training facility to see how many of the requirements were met (57 total)
- Set a goal
- Identify action(s) or intervention(s) to meet the goal
- Conduct a “post-test”
This method uncovered varied needs per facility and participants were able to identify actions and interventions that positively impacted their own practice setting. One AT learned that all regulations were not properly posted and developed a timeline and plan to come into compliance. Another AT learned egress and exit routes were not posted for each facility and subsequently worked with the athletic director to amend that by a certain date. Another AT improved medical documentation processes so that patient conversations were documented in a timely and compliant manner.
Ultimately, a QI is NOT a research project. A QI could be most any workplace project that has the potential to positively impact patient care.
If you work in the secondary school setting, are you working towards becoming a Safe Sports School Award winner or completing PASS? If you are, both could be considered as a QI. In fact, there are multiple areas in those processes that could be considered a QI. You are probably already doing this and didn’t realize it.
Q: If I’m a PRN AT, how can I continue to get my CEUs?
A: The intention is for CPC to take a similar amount of time OR potentially less time for an AT (including those who are PRN) to realize their recertification requirements.
It’s important for a member of the public to have confidence in their health care provider, whether the provider is full time, part time or PRN. Therefore, just as always, the same recertification guidelines apply for all.
Q: What is the BOC doing to advance the athletic training profession?
A: The Strategic Initiatives currently in the works include:
- The development of the Orthopedic Specialty Certification.
- Communication support and awareness for ATs in all settings- with the intention to then lead toward increased respect, knowledge of capabilities and training and higher average salaries. Direct employer communications to help with education and awareness of the profession.
- Participate in regulatory efforts, including working with regulatory boards and coalitions, to ensure regulatory recognition, protection of your certification and alignment of practice with AT education and training.
- The BOC has joined the Joint Accreditation (JA). This membership allows BOC Approved Providers the opportunity to create and provide CE to multiple health care audiences, such as MDs, PAs, RNs and more, along with ATs, fostering an educational interdisciplinary environment. Conversely, Jointly Accredited Providers who may not have included ATs in their CE audience can now offer this opportunity to a wider health care team. As the organization that defines credentialing standards and exam development for AT certification, the BOC’s expertise and high-level standards assure that ATs are receiving the highest quality continuing education units. Being a member of the JA helps us raise the bar for AT programs and provide ATs with education that advances their knowledge, skills and abilities.
Q: Are the BOC and the NATA the same organization?
A: No. The Board of Certification, Inc. (BOC) became a separately incorporated organization in 1989 and is a not-for-profit credentialing agency to provide a certification program for the entry-level athletic training profession. The home office is in Omaha, NE with 20 full-time employees, including three ATs on staff. BOC establishes both the standards for the practice of athletic training and the CE requirements for BOC Certified ATs. The BOC also works with state regulatory agencies to provide credential information, professional conduct guidelines and regulatory standards on certification issues. The BOC also has the only accredited certification program for ATs in the United States. The BOC exam and/or certification is recognized by 49 states to obtain a license, state certification or registration to practice athletic training.