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Question 1
Is there agreement that licensees should demonstrate competence?
Attendees agreed that licensees should indeed demonstrate competence. Some felt it should be demonstrated at initial licensure, renewal, when disciplined and at professional reinstatement. Others felt that a model should be employed which required the demonstration of competence at a random point, and drew comparisons with the random audit system employed by the Internal Revenue Service (IRS). Some considered that competence should be demonstrated only for specialties while others felt only general competence need be demonstrated. Some attendees also felt that any demonstration of competence must have a component about ethics as well as competence in the field.
Those present felt that barriers to the proposals would be whether demonstrations of competence would be legally defensible, economically viable, administratively feasible and professionally credible. Others felt that continuing education providers oppose these changes for fear of losing business. For this reason it was felt important to involve them in any discussions about the way forward.
Question 2
What role, if any, should employers be allowed to play in certifying the
continuing competence of licensees?
Attendees discussed the Professional Development Portfolio developed by the American Dietetic Association. The system encourages practitioners to incorporate feedback from their employment setting in formal (e.g. performance management system could be used in place of the learning needs assessment) and informal (e.g. as part of the reflection customer feedback, satisfaction surveys, presentation evaluations) ways.
Question 4
What relationships should exist between private, voluntary certification and
specialty boards and regulatory agencies in determining a licensee's continuing
competence? Endorsement? Some other form of recognition? What standards should
be in place, who should set them, and on what basis?
Those present suggested a collaborative relationship between the certifying agencies and licensure boards. Some felt that it was crucial that states do not decide standards, and others commented that national standards would greatly help mobility. Those present felt that opposition might come from those fearing that continued competence might supersede the discipline process. Turning specifically to national standards it was felt that opposition would come from States who would see themselves as resisting federalism. A further barrier would be the burden that requirements might place on both licensees and employers.
Those present felt that first steps should include the standardization of forms, procedures, and the evaluation of educational institutions. Some also urged that a clear distinction be made between continued competence and the discipline process. They further cautioned that a situation must not arise where a choice is made between competence and the discipline process. Others felt that the two processes were inevitably interconnected, for example where a professional is ordered to undergo further training in order to remain in the profession.
Question 5
What role, if any, should the profession's federation of state boards or the
profession's certifying agency play in the certification of the continuing
competence of licensees?
Attendees reviewed the situation of dietitians for whom there is no federation of state licensing boards. As the certifying agency, the American Dietetic Association initiated changes in the recertification process intending that the Commission on Dietetic Registration (CDR) and the licensure boards would proceed collaboratively to enhance dietetics competency. A representative from ADA noted that they are encouraged by the fact that the Ohio Board of Dietetics and Nutrition has accepted the Portfolio as a means for relicensure for both licensed and registered dietitians and licensed only dietitians.