Today's competitive health care marketplace isn't limited to vying for clients or holding down costs. The notion of professional competence itself sometimes appears to be a negotiable commodity as the number of professional education courses offering "certification" proliferate and raise questions about the fundamental yet elusive concept of competence.
A Certificate, or Certification?
Professionals and consumers alike can be confused by the multiple uses of the term "certification." ASHA's Certificate of Clinical Competence (CCC) represents the achievement of a rigorous, validated, widely recognized set of standards for entry into the professions of speech-language pathology and audiology (see article on page 15). In other cases, a "certificate" may confirm only that someone has participated in a professional development course for a certain number of hours.
Some professional development courses that focus on a specific treatment technique or device may "certify" participants to use the technique following completion of the course. Implicitly or explicitly, these courses suggest that competence in using the technique can only be achieved by taking the course. ASHA policies or standards do not support this assumption. Judgments about competence are a matter of ethics (see article below).
FDA Approval and ASHA CEUs: Not Endorsements
When courses on new techniques or programs advertise that they provide ASHA CEUs, some people incorrectly conclude that ASHA approves the technique and the instructor's right to exclusively certify competence in this area. ASHA's role does not include making judgments about the efficacy or reliability of techniques or devices that might be described in the course. ASHA CEUs signify that the course is related to speech-language pathology, audiology, or speech, language, and hearing sciences; contributes to the acquisition of new skills and knowledge; and is offered by an ASHA-approved CE provider. Approved providers develop courses that meet requirements designed to ensure quality continuing education programming. However, every announcement of courses that offer ASHA CEUs carries a disclaimer that states that "ASHA CE provider does not imply endorsement of course content, specific products, or clinical procedures." Thus, earning ASHA CEUs neither guarantees competence nor confirms whether an individual demonstrates competence in using a particular technique or device covered by a course.
Professionals and consumers often look to ASHA for guidance on whether an advertised new piece of equipment, professional education course, or technique will add value to their treatment repertoire. As a professional association, ASHA has no research infrastructure to evaluate and judge the new courses, products, and techniques developed each year. In keeping with evidence-based practice principles, only carefully researched studies can provide objective information to guide a clinician's decision. ASHA's Web site offers a list of questions to assist members or consumers in evaluating new programs, products, or procedures based on available evidence (see sidebar below).
A further source of confusion is the meaning of U.S. Food and Drug Administration (FDA) approval for speech or hearing devices. The regulatory role of the FDA regarding the pharmaceutical industry may lead professionals and consumers to assume that all FDA-approved devices are similarly scrutinized. Approval of devices may simply mean, however, that they have been determined not to be dangerous to the user or that they are comparable to other approved devices. It may not certify or recommend the device as efficacious, or better than other devices or techniques. When the FDA has determined a device to be "substantially equivalent to another device" (known as premarket notification), the regulations include the following disclaimer: "Any representation that creates an impression of official approval of a device because of complying with the premarket notification regulations is misleading and constitutes misbranding."
At What Price Competency?
Opportunities to acquire certification through professional education courses have grown rapidly, but the path to competence has not changed in its essence. The basic elements still consist of obtaining knowledge through reading professional literature and attending professional development courses, and developing skills through observation and mentored practice. The journey begins with attaining the CCC, maintaining it through professional development activities, and using the ASHA Code of Ethics and evidence-based practice to guide the way.