Wound care board certification goes multidisciplinary
Wound care board certification goes multidisciplinary
New organization also sparks controversy
Until recently, board certification in wound care was available only from the Wound, Ostomy, Continence and Nursing Certification Board (WOCNCB) based in Laguna Beach, CA. But in 1995, a new organization, the American Academy of Wound Management (AAWM) in North Bay Village, FL, emerged to offer its own stamp of certification to wound care practitioners. AAWM certification has kindled debate about the purpose, value, and methods of wound care certification, and practitioners with years of experience fall on either side of that debate.
The natures of the WOCNCB and the AAWM are distinct. The WOCNCB, while sharing its name and similar interests with the Wound, Ostomy and Continence Nurses Society (WOCN), is actually a separately incorporated organization whose primary responsibility is to the public. Its certifications are offered only to registered nurses.
In contrast, the AAWM was founded and exists almost exclusively for the purpose of "credentialing multidisciplinary practitioners in the field of wound management," though it has allotted some resources to promote education and research.1
Chet Evans, DPM, president of the AAWM and dean of the School of Graduate Medical Sciences at Barry University in Miami, says more than 3,000 practitioners have requested applications for board certification. Thus far, slightly more than 200 have been certified at one of three levels. (For information on the levels, see story, p. 135.) One attraction of the AAWM is that it is the first organization to offer multidisciplinary wound care certification, whereas the WOCNCB grants certification only to licensed registered nurses.
At the heart of the controversy is the method by which the AAWM certifies applicants. The organization bases its certification decisions on portfolio review in which its board of advisors closely examines an applicant’s professional experience, achievement, and education, Evans says. The 11-member board, according to the AAWM, is an interdisciplinary panel of experts in the field of wound care consisting of practitioners, academicians, and researchers. Evans is quick to point out that the AAWM has rejected many applicants for certification and relegated them to simple membership status.
Certification candidates are required to supply their curriculum vitae, current licenses and board certifications, three letters of recommendation, and an original transcript of their highest academic degree. They also must complete an essay and answer a variety of questions about their professional experiences and training. Those who are accepted can call themselves certified wound specialists.
What’s missing, say critics, are a required advanced educational component and a comprehensive examination, which are commonplace among medical certification bodies.
As of Jan. 1, 1998, the WOCNCB will offer its new CWOCN certification in addition to its existing specialty certification options only to registered nurses who meet specific educational or clinical criteria and successfully complete selected parts or all of a comprehensive examination, depending on what certifications the applicant seeks.
According to the WOCNCB, 55 nurses have earned wound care certification since it was first offered in 1994, and another 50 were scheduled to sit for the November examination. The WOCNCB has certified more than 3,000 nurses since it incorporated in 1978. (For information on the WOCNCB’s upcoming changes, see story, p. 135.)
"An organization that just does a portfolio review without even requiring [applicants] to sit for a national certification exam doesn’t go along with anything I’ve every been associated with," says Janice Beitz, PhD, RN, CS, CNOR, CETN, director of the graduate nursing program at LaSalle University School of Nursing in Philadelphia. "In the three specialties for which I’m certified, there was course work, preceptorships, national exams, and national standards you had to meet."
The WOCNCB, Beitz notes, has very stringent certification criteria. "They are very rigorous, and they need to be," she says. "Wound care is not an easy area in which to gain expertise. It took me a full year-and-a-half to two years to develop expertise because wounds are so dynamic. In addition, you have to understand the bigger patient picture."
Beitz is developing a graduate-level wound, ostomy, and continence education program at LaSalle University modeled after the one at the University of Southern California created by Barbara Bates-Jensen. Beitz says the USC program is one of the few that bestow graduate-level credits for wound care. Students who complete the year-long LaSalle program also would receive graduate-level credits. Beitz expects the program to include only nurses at first but hopes to develop a multidisciplinary offering down the line.
Evans is well aware of the scrutiny his organization has attracted but defends its raison d’être. He emphasizes that the AAWM has stated from the outset it would introduce a certification examination by the end of 1998. Until then, certification will continue to be determined by portfolio review.
"Preparing an exam takes time. It must be checked for validity, fairness, and relevance to all of the [wound care] disciplines, and its development will involve as many wound care leaders as possible who are available and interested in participating," Evans says. "I’m not familiar with any board that has not gone through some type of evolutionary process in which early board members were grandfathered in. We believe our current portfolio review is very rigorous."
Charles F. Gokoo, MD, director of clinical research at Wound Care Consultants in Dallas, confesses that he was dubious when the AAWM first approached him. "I thought this was just going to be another organization to join," he says. "But their plans for testing convinced me to apply for certification. I also found out that I knew quite a few of the people associated with the organization whose work as wound care clinicians and researchers I respected. This is the ground floor a chance to build an organization of reputable wound care providers."
Good intentions are not enough to convince everyone, however. "If you want to go about this the right way, you first establish a need and a curriculum," says Lia van Rijswijk, RN, ET, a nurse consultant and wound care specialist in Newtown, PA. "You don’t certify people to become specialists based on a portfolio. Why not follow the established models that are out there and make it a graduate course?" Why not get input from the American Medical Association and the American Nurses Association, which have well-established education and credentialing programs, and borrow their methods?
"While there is no doubt in my mind that a training and certification program is needed, one of the problems we run into is the basic question of what is a wound care specialist? I may know a lot about wounds, but I can not graft them. Similarly, while dermatologists can graft an ulcer, most will not take care of third-degree burns. At the same time, there is a need for wound care specialists to fill a gap in the market, and someone is going to make money."
Even the prospect of an examination does not sway van Rijswijk. "There’s no way you can be a specialist in wound care just by taking an exam or reading a book," she continues. "If we want to be taken seriously, we’ve got to have proper credentialing and not turn any person with a bachelor’s education in a health-related discipline’ into a specialist."
Support for AAWM is growing
Despite the detractors, applicants to the AAWM continue to grow and, apparently, so does support for the group. Robert Gilbert, MS, PT, WCS, a physical therapy clinical supervisor and director of the tissue trauma and wound repair program at Westerly (RI) Hospital, writes, "Since Certified Wound Care Specialists (the credentials given by the AAWM) must adhere to a code of ethics and professional standards, the certification program also works to raise standards and elevate the importance of ethical behavior among clinicians and researchers. . . . CWSs will facilitate the services of all team members for maximum benefit of the patient, and will maintain high moral values, ethics, and professional competence."2
"Some people are concerned that anything that is new is somehow lacking, and that’s not the case here," adds Evans. "This evolved out of academic medicine, not to make money on the side."
References
1. American Academy of Wound Management World Wide Web page: http://members.aol.com/woundnet/ woundinf.htm.
2. Gilbert RE. The American Academy of Wound Management. Rehab Mgmt April/May 1997:13.
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