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Certification and Specialization; Similar But Not Equal Concepts

By David Witmer posted 07-12-2011 08:41

  

In my last blog (http://connect.ashp.org/ASHP/ASHP/Blogs/ViewBlogs/Default.aspx?BlogKey=9f91e115-74a6-4ed8-9d0f-a6b39f9fd2ae) I commented on the recent work of the Section of Clinical Specialists and Scientists.  As I noted before, one thing that struck me about the debate in Denver was is that while specialty certification is beginning to reach a level of maturity in our profession there is a great deal of misunderstanding about what constitutes a specialty within the profession and the difference between pharmacy specialties and other types of certifications that pharmacists may obtain to demonstrate distinct skills they may possess. 

For example, during the recent meeting in Denver there was a recommendation from delegates to investigate with BPS a specialty in the area of medication safety and discussion during an educational session about the potential for the development of a specialty in pharmacy informatics.  While these two areas certainly represent unique areas of knowledge and skills they also pose interesting questions about what constitutes a “specialty.”  A specialty should represent a unique and distinct area of practice that exists within the profession of pharmacy.   Professionals from many disciplines participate in medication safety and there has been some debate in Councils, RDCs, and the House of Delegates about whether the role of medication safety officer should be limited to a pharmacist.  Pharmacy informatics has been emerging as an area where pharmacists are frequently employed, but where pharmacy technicians also often hold key leadership roles.  In both of these areas there are few PGY2 residencies or other formal training programs to prepare pharmacists for practice in these areas.  While I am not opposing exploration of these specialties, I am wondering what the content of a petition to BPS would include for these areas.

BPS has long established criteria for the recognition of specialties.  A copy of these criteria can be found on the BPS web site http://www.bpsweb.org/pdfs/petitionersguide.pdf.  There are a total of seven areas that must be addressed including: A. Need; B. Demand; C. Number & Time; D. Specialized Knowledge &Skill; E. Specialized Functions; F. Education and Training; and G. Transmission of Knowledge.  Under criterion A the petitioner is asked to describe why the needs are not or cannot be met by other health professionals.  In criterion B the petitioner is asked to provide accurate estimates of the number of filled and unfilled specialists’ positions over a three-year period.  Criterion C asks petitioners to estimate not just the number of pharmacists practicing in the specialty, but also the percentage of time devoted to specialty practice.  Criterion F calls for petitioners to document in detail the education and training required to develop specialized knowledge and skills and to provide a comprehensive listing of training programs including their locations and individuals in charge.  My point here is that while there are many areas where a compelling case can be made demonstrating that there is a need and where pharmacists may wish there were some form of credential available, the criteria for recognizing a new specialty are more robust and go beyond demonstrating the emergence of an area of differentiated practice.

The Council on Credentialing in Pharmacy (CCP) (http://www.pharmacycredentialing.org/ccp/ has produced a number of useful resource documents that put into perspective the array of credentials that are available and their relationships to each other.  I believe that many pharmacists are largely unfamiliar with the work of this organization.  I encourage pharmacists to review the body of work that has been compiled by the CCP.  An especially worthwhile paper is a 2009 resource paper that describes the scope of contemporary pharmacy practice.  Figures 6 and 7 provide a useful construct for comparing the nature and scope of different types of available credentials.  As we continue to mature our credentialing for the profession it will be important to determine where official specialties are appropriate and where other forms of credentialing may be more appropriate.   

What are your thoughts?  Should we formally recognize specialties in all areas where a patient care need can be demonstrated?  Are other types of credentials valuable?  Is there a danger in formally recognizing too many specialties or recognizing specialties before they have sufficiently matured?



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