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  1. 1. LASER CERTIFICATIONS National Council on Laser Excellence A Credentialing Board of the not-for-profit not- for- Professional Medical Education Association Gregory T. AbstenMy name is Gregory Absten. I’m the Executive Director of ProfessionalMedical Education Assn, and chairman of the National Council on LaserExcellence. I’m also you’re newly elected Laser Safety representative for theBoard of Directors of the ASLMS. Four years ago our nonprofit organizationformed a cross-industry credentialing board for Laser Certifications, called theNational Council on Laser Excellence. 1
  2. 2. The Certification “Movement” n Academy of Laser Dentistry, 1998 n National Council on Laser Excellence, 2000 n LIA’s Board of Laser Safety, 2003 n Various State Licensing AgenciesAside from our efforts, there are other forces coming together to bring theissue of Laser Certifications to the forefront of medical groups and statelicensing agencies.The Academy of Laser Dentistry began its certification program in the 90’s,both for Dentists and for Dental Hygienists operating lasers.Our National Council on Laser Excellence began the Certification of LaserRepair technicians in April of 2000, and began developing plans for furthercertifications to incorporate Laser Safety Officers and Laser Operators.The LIA called us at the NCLE about that time in 2000 and asked to be a partof the NCLE Board and certification process. The Board approved the additionof the LIA to the Council, but did not hear back again from them. It was in 2003then that the LIA came out with their own Laser Certification program, first fortechnical Laser Safety Officers, and then later for Medical Laser SafetyOfficers. Our two groups are having discussions now on whether the LIA willintegrate their own program back into the Council, or whether they’ll continueon a separate duplicate effort.The real impetus for the Laser Certifications is going to come from variousState Licensing agencies. The advent of widespread aesthetic laserprocedures has involved many non-medical personnel in performing laserprocedures. State regulations on this practice vary to the extreme, and mostStates still have no regulations over this practice. 2
  3. 3. NCLE BOARD (est. 2000, transitioning) GROUPS PEOPLE n OHIO STATE UNIVERSITY •Gregory Absten BSc, MBA BSc, n COHERENT MEDICAL (before Lumenis) Lumenis) •Sue Terry, RN n HARTFORD HOSPITAL •Nancy Silva, RN n KALEIDA HOSPITAL SYSTEM n PLC LASERS •John Elwood III, CBET PHOTOVAC TECHNOLOGIES •Cathy Hartmann, RN n n UNIVERSAL MEDICAL LASER n PREMIER •Rich Davis, Phd n SERVICEMASTER •Richard Eliason n SACRED HEART HOSPITAL •Doug George •Herb Deigl, BSEE 1. Consensus Building •Jim Smith 2. Question Bank Development •Robert Rudko, PhD Rudko, •Peter Castanova, BSEET Castanova,Our own NCLE Board was commissioned by Professional Medical EducationAssn in 2000, incorporating a cross-industry representation of views. Itincludes input from Hospitals, Universities, Laser Manufacturers and LaserService organizations. Many of the companies have since changed and ourCouncil Board members have new jobs, so our Board is now incorporatingother members. The primary goal of the Board is to develop a consensusabout “reasonable” requirements for Laser Certifications in various categories,and develop Laser Certification programs that on one hand are not so difficultto qualify for that it leaves only a select few, and on the other hand issubstantial enough to provide a valued meaning to the individual gaining thecredential. The other goal of the Board, and not all members participate in bothareas, is to continue to build upon the question banks for testing that we’vealready established. 3
  4. 4. Why Now? n Baseline Competency for Laser Repair. - problem of unqualified technicians April 2000 – NCLE CERTIFIED LASER REPAIR TECHNICIANS - plan for further certifications in handbookSo why did this get started?Initially in the laser service industry there was a problem with finger pointingback and forth between competing manufacturers and independent servicegroups implying a lack of competency in both parties. In truth most of theindependents were very good at laser service, but there were a few mom andpop operators that knew little about lasers and would work on the equipment.The problems that were created reflected poorly on the equipment from themanufacturer, and gave some credence to the fact that some independentswere incompetent. It was in everyone’s best interest to establish somebaseline indication of competency and this gave rise to the standards for andcredential of Certified Laser Repair Technician by the NCLE. The Board thenauthorized nursing and medical input into the board in order to develop furtherLaser Certifications. 4
  5. 5. Why Now? n Baseline Competency for non-medical, non- non-nursing laser users and operators. non- PATIENT SAFETY! Striping Burns Various State Regulatory AgenciesThe real impetus for Certification of Laser Safety Officers and Laser Operatorshas come about because of widely publicized incidents of patient injuries bynon-medical personnel using laser equipment. Though the Laser Certificationis just one step in the process and does not itself indicate a clinicalcompetency, these problems are the driving force behind the effort. 5
  6. 6. Certified Competencies SAFETY AND OPERATIONAL COMPETENCIES… NOT CLINICAL COMPETENCY (States) Volu nta Not ry Man dat oryLaser Certification is a credential that indicates some baseline level ofcompetency in safety practices and operation of medical laser equipment. Itdoes not denote any special privilege to practice medical laser procedures onpatients, and does not denote any level of clinical competency. It does indicatethat the individual holding the credential has met some established standard inthe knowledge of medical laser principles and risks, and in the safe operationof laser equipment. The certifications are voluntary in nature, similar tovoluntary certifications in other medical and nursing areas. 6
  7. 7. STATE LICENSING CLINICAL COMPETENCY Florida requires a national “Laser Certification” in addition to 40 hours of patient treatment, prior to licensing non-physicians for Laser non- Hair Removal.The question of Clinical Competency arises with State Licensing of individualsto perform medical or aesthetic procedures on patients. The LaserCertifications may be used as one stepping stone in this Licensing process.The State of Florida for example has authorized the State ElectrologyAssociation to manage the licensing of non-medical individuals to performLaser Hair Removal. The law is written so that an individual must first acquirea “National Laser Certification” prior to meeting the other background andclinical experience requirements for licensing. This requirement for theNational Laser Certification was written into law at a time when no suchcertifications existed. For more specifics you should request a written copy ofthe requirements from the State of Florida. 7
  8. 8. STATE LICENSING New York requires a “Certificate of Competence” for Mobile Laser Operators. Texas has new laws being formulated for regulating laser operators at Medical Spas. Many more States coming …Another example of States moving toward documentation of competency isNew York – who requires a “Certificate of Competence” for operators of mobilelaser systems. This is applied for through the state and evidence must besubmitted to document training and competency.Texas is now in the process of regulating operators in medical spa typesettings throughout the State, and you’ll see this trend continue as morestates begin to address the problems and issues associated with unregulatedmedical laser use. 8
  9. 9. NURSING? Nursing was not, and is not a problem area requiring an outside Certification. Nursing professionalism and standards prevail to maintain patient patient safety– but the movement is on, and the voluntary Certifications will safety– provide additional Professional Recognition. Laser Repair technicians have had the Certification process in place since place 2000, and reports back to the NCLE indicate that many of these technicians are receiving pay raises based upon their Laser Certification. Certification.Nursing never was an area that merited concerns over laser operation or use.The self policing standards and practices adopted by professional nursinggroups such as the AORN have prevailed in maintaining safety for patientsand staff during laser cases – but because of problems in other areas themovement for the Laser Certifications are on, and nursing will be incorporatedinto the process.On a side note, many of the Biomedical Engineers who have become LaserCertified since we started in 2000 have told us that they’ve received pay raisesbased upon their additional credential, and we would anticipate someorganizations to follow suit with the nursing staff. 9
  10. 10. Professional Recognition “In healthcare, being a profession that highly values credentials, having a certification is a very positive step. It not only tells your administration that you have met a national standard of competency …….. but also that you are not standing still and becoming stagnant in your profession. You are willing to go the extra mile to keep learning to bring positive results to your organization. I value my credentials and so will your organization. Go after it.” Kerry L. Sides, CMRP Ames Iowa Re AHA CertificationProfessional recognition is still a very important reason to pursue additionalcredentials such as Laser Certification. It sets one apart professionally andacknowledges that a national standard has been met. 10
  11. 11. NCLE LASER CERTIFICATIONS n Certified Laser Repair Technician n Certified Laser Safety Officer/Medical n Certified Laser Operator / • / Surgical • / Ophthalmic • / Aesthetic (Overall Derm/Plastic) Derm/Plastic) • / Hair Removal (Limited to that procedure, non-medical) non- • / Veterinary (equivalent to surgical) www.LaserCertification.orgLaser Certifications are offered by the NCLE in these areas. The CertifiedLaser Repair Technician has been offered now for about 4 years. The LaserSafety Officer / Medical Certification is currently being approved and nationaltesting will begin by May or June. The Laser Operator Certifications in thevarious areas will follow, and all of the Certifications should be in effect andtesting offered by the end of 2004. The Board continues to solicit input into thisprocess and all remarks are welcome. Full details of the Certification programsare found in the Candidate Handbook which you can download from thewebsite. 11
  12. 12. NCLE TESTING Administered Nationally by A.M.P. - Allied Measurement Professionals - n 120+ Proctored Testing Centers Nationwide n Computerized testing by appointment. n Instant response of Pass/Fail & in what areas n Proctored written exams allowable at laser courses for authorized proctors. n American Hospital Assn (AHA) n American Assn of Critical Care Nurses (AACN) n Board of Certification for Emergency Nursing n National Board for Respiratory Care ……………….The proctored testing for the Laser Certifications is being administered by thesame group that manages national testing for the American HospitalAssociation, American Assn of Critical Care Nurses, and many other medicalorganizations. The group is Allied Measurement Professionals, or AMP.Testing is offered in over 120 centers nationwide and can be scheduled on aMonday-Friday basis at the convenience of the applicant. Applicants must firstqualify to sit for the exam by making application to the NCLE. After NCLEapproval the applicant may schedule a testing center either online or by callingAMP. The examinations are all computerized and the individual will know theresults of their exam before they leave the testing center.Written examinations will additionally be offered in conjunction with LaserTraining programs, when an authorized proctor is available to administer theexam. 12
  13. 13. ELIGIBILITY Laser Safety Officer 1. EDUCATION – 15 hours documented laser training 2. EXPERIENCE – 4 yr degree, or RN or professional credential, or 2 yr degree + substantial experience. PLUS 1 yr experience as LSO or Laser Operator 3. TESTING – 70% correct on proctored examination. 155 questions – four hours. To be Adopted by the end of April 2004 by Board. COMPLETE INFORMATION IN THE CANDIDATE HANDBOOK AT: WWW.LASERCERTIFICATION.ORGThe complete requirements for eligibility are contained in the CandidateHandbook available on the Board’s website at .They consist of an educational requirement, a background or experiencerequirement, and successful completion of a proctored examination.The requirements for both training and the length of the examination arehigher for Laser Safety Officers and Repair technicians than that for operators. 13
  14. 14. ELIGIBILITY Laser Operators 1. EDUCATION – 5 hours documented laser training 2. EXPERIENCE – 4 yr degree, or RN or professional credential, or 2 yr degree + substantial experience. EXPERIENCE – 1 yr experience in the clinical setting: surgical – ophthalmic – dermatologic – aesthetic, etc 3. TESTING – 70% correct on proctored examination. 100 questions – three hours. 4. TYPE RATING – Skills Validation check-off for type of laser To be Adopted by the end of April 2004 by NCLE Board. COMPLETE INFORMATION IN THE CANDIDATE HANDBOOK AT: WWW.LASERCERTIFICATION.ORGLaser operators require only 5 hours of documented training compared to the15 for Laser Safety Officers. Operators are not required to have previous LSOor operator experience, but they are required to have at least one year ofexperience in their clinical setting, such as surgery, ophthalmic clinic,dermatology office, etc.The testing for operators is also shorter at 100 questions, but operators arerequired to submit a Skills Validation check sheet for the type of laser(s) theyare operating, such as CO2, argon, Pulsed Dye, etc.. These Skills validationchecks are general in nature but reflect the ability to setup and operate theequipment. They must be signed off by the applicant’s LSO, a certified LaserOperator, a laser consultant or educator, or a company representative such asthe salesperson or inservice trainer. An example of the credential earnedmight be Certified Laser Operator / Aesthetic with type ratings for Pulsed dye,diode, CO2 and Er:Yag lasers. Individuals may hold more than one class oflaser certification. 14
  15. 15. CONTINUED COMPETENCY n Three year cycle n 30 hours of continuing education – laser / medical / nursing / professional n Retake an examination, or pass a different class of Laser Certification Not applicable to individuals Certified prior to April 2004Certifications are active for three years from the successful completion of allrequirements. At the end of the 3 years they may be renewed by submittingevidence of continuing education or retaking any NCLE certification exam. 30hours of continuing education are required over a 3 year period and is notlimited to laser education. Applicants may submit evidence of attendance atmedical meetings and conventions, home study programs and any medical orlaser training programs or events. 15
  16. 16. LASER MANUFACTURERS n Participate by assisting with Laser Skills validation checks for customers by salespeople and educators. n Participate in a voluntary certification program to reduce liability exposure, without assuming risks of self certification.Laser manufactures may participate in this voluntary Laser Certificationprogram by authorizing their sales representatives and trainers to sign off onthe skills validation checklists for their customers. At the time of inservicetraining such a checklist would be marked off and signed so that the customercould submit a copy to the NCLE when making application for LaserCertification. Generic checklists are available through the NCLE, and anycompany may design and submit their own specific form if desired.From a liability point of view, this allows manufacturers participate in astandardized Laser Certification program that will have value for theircustomers, without assuming the risks of being the agency that “Certifies” theindividual for laser operation. 16
  17. 17. STATE AGENCIES Policy of Cooperation We anticipate that various States will begin to use these National Laser Certifications as a prerequisite for licensing to perform laser procedures by non-physicians. non- Additional requirements for licensing will most likely be experience & education in their field of practice, and supervised clinical experience on patients.The NCLE has a policy of cooperation with State agencies desiring toincorporate these national laser certification standards into state licensingrequirements. Where needed the NCLE Board will work with State groups tosynchronize requirements for Laser Certification to state requirements where itis appropriate. For those states participating in this process the NCLE willmake available the results of the proctored examinations and applicationstatus of Certifications for the purposes of the State to determine licensingeligibility for that individual. Applications for State licenses is separate anddistinct from Certification from the NCLE, and all applicants must make theirown applications to the State independently of their application for LaserCertification through NCLE. 17
  18. 18. QUESTION BANKS n Intent to continue both the depth and breadth of the computerized question banks. n Soliciting further question contributors from qualified individuals such as ASLMS members. Absten@LaserTraining.orgThe computerized test question bank is a valuable resource we’ve developed,and that we want to grow. Questions are categorized into objective areas withvarious levels of sub-classifications. In order to best accomplish this wecontinue to solicit input from the experienced medical laser community tosubmit questions to the NCLE Board. These will be classified and reviewedaccording to accuracy, wording and comparison against similar questions inthe test bank. Once approved they will be entered into the question bank as anactive question for testing, submitters will receive recognition through theNCLE website. We require that individuals submitting questions must have atleast one year of active experience in a medical laser application area. Formsfor categorizing and submitting questions will be available on the NCLEwebsite. You may email your interest in participating to Gregory Absten . 18
  19. 19. QUESTIONS? LASER CERTIFICATIONS National Council on Laser Excellence A Credentialing Board of the not-for-profit not-for- Professional Medical Education Association Gregory T. AbstenNational Council on Laser Excellencewww.LaserCertification.orgA Credentialing Board of the non-for-profit:Professional Medical Education Assn.PO Box 522379Marathon Shores, FL 33052800-435-3131, Tel 305-289-9056, Fax 305-946-0232www.LaserTraining.orgEmail: 19