Simulation Integrated into the Reentry and Recertification Processes of the NBCRNA

Virginia “Chris” Muckler, DNP, CRNA, CHSE-A

Session Overview:

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) governs initial and maintenance of certification for certified registered nurse anesthetists (CRNA).  Reentrants absent from clinical practice for ≥four years must complete a three-part process to become recertified, one of which involves simulation-based assessment. As part of the Reentry Program, the NBCRNA replaced supervised clinical hours with simulation as a method for reentrants to demonstrate safe clinical behaviors that align with reentering practice. The addition of simulation to the Reentry Program was well-received and is being considered for other NBCRNA programs.

In response to member requests for an alternative to the 150-item Continued Professional Competency Assessment (CPCA) that is required every eight years to recertify, the NBCRNA’s Education and Research Advisory Committee established a Simulation Subcommittee.  This subcommittee was charged to develop a research study that evaluates the use of simulation as an alternative to the CPCA. The use of simulation rather than a test, shatters traditional assessment methods for recertification yet simulation involves skill demonstration and provides insight into participants’ knowledge base and critical thinking.

 The simulation subcommittee is currently exploring both virtual reality and manikin-based simulation approaches to determine viability, desirability, and feasibility as alternatives for the standardized exam. Difficulties designing this simulation alternative became apparent immediately including critical performance elements, standardization of scenarios, assessment tools, and rater expectations and training. An essential decision-point was formative versus summative point. The process, products, literature explored by the subcommittee and the decision advocating for formative rather than summative assessment will be presented.

The use of simulation targets application of knowledge, the performance component of provider practice that cannot be assessed with the well-established, standardized test which primarily focuses on lower complexity learning objectives. Could the use of simulation as an alternative to standardized testing be the catalyst for disruptive innovation?

Objectives: At the conclusion of this presentation, the audience will be able to:

  1. Consider the advantages of simulation for the Reentry Program.
  2. Summarize advantages and disadvantages of establishing simulation as an alternative for the CPCA.
  3. Identify challenges in establishing simulation as an alternative for the CPCA.