Current events have emphasized the importance of creating and adhering to national standards. Whether it is protocols for administering vaccines or COVID-19 testing, adhering to national standards helps bring consistency, stability and greater efficiencies.
The National Certification Commission for Acupuncture and Oriental Medicine offers "national" certification for acupuncture, Chinese herbology and Oriental medicine. Each NCCAOM examination, Acupuncture with Point Location, Biomedicine, Chinese Herbology and Foundations of Oriental Medicine, is created and validated via a national job analysis study. The goal of the JA is to ensure NCCAOM entry-level certification exam content reflects what is going on nationally in current practice.
What Exactly is A Job Analysis?
The purpose of a job analysis study is ultimately to establish the link between test scores achieved on certification/licensing exams and the competencies tested. Therefore, pass or fail decisions correlate / relate to competent performance. When evidence of validity based on examination content is presented for a specific professional role, it is critical to consider the importance of the competencies being tested.
The NCCAOM is bound by external accreditation standards. It does not create the blueprint for the content outlines on its own. It does so to confirm the exam relevancy to current entry-level practice. The joint Standards for Educational and Psychological Testing (AERA, APA and NCME, 1999) state:
Standard 14.10
"When evidence of validity based on test content is presented, the rationale for defining and describing a specific job content domain in a particular way (e.g., in terms of tasks to be performed or knowledge, skills, abilities, or other personal characteristics) should be stated clearly."
Standard 14.14
"The content domain to be covered by a credentialing test should be defined clearly and justified in terms of the importance of the content for the credential-worthy performance in an occupation or profession. A rationale should be provided to support a claim that the knowledge or skills being assessed are required for credential-worthy performance in an occupation and are consistent with the purpose for which the licensing or certification program was instituted."
The above standards are used by the NCCAOM and are included in the National Commission of Certifying Agencies' (NCCA) Standards for Accreditation of Certification Programs. The NCCA is the agency that accredits each of the NCCAOM certification programs.
How Does It Affect Content Outlines and What Candidates Should Know?
It is necessary for ongoing certification and licensure programs to hold JA studies every several years to review the expectations and practices of the industry, as well as to update the content assessed within their examination programs. This process allows for the inclusion of newly emerging practices to potentially be included on the examination, as well as the removal of outdated practices.
Periodic JA studies ensure the continued validity of content, and help programs avoid becoming out of line with current day-to-day practice. The survey is sent to licensed acupuncturists throughout the United States. Based on the results of the JA survey, changes are indicated and made to the newly created content outline(s) and dictate what type of questions are to be written. This is to ensure the NCCAOM examination modules reflect ongoing changes that occur in nationwide practice (i.e., common knowledge, national laws, OSHA, HIPAA, GMP practices, scope of practice, etc.).
The Most Recent JA Study
Beginning in November 2016, the NCCAOM undertook its most recent full-scale nationally conducted job analysis study, creating four individual surveys of the knowledge elements required for competent, entry-level practice; one for each of the four certification exams offered by the NCCAOM. The results of these surveys provide support for the ongoing relevance, validity and legal defensibility of the NCCAOM national examination programs, establishing the link between what acupuncturists do on-the-job and the content of the NCCAOM®Foundations of Oriental Medicine (FOM), Biomedicine (BIO), Acupuncture with Point Location (ACPL), and Chinese Herbology (CH) examinations.
The surveys were developed based on results from a comprehensive literature review of the professional role of acupuncturists (e.g., curricula for training programs and job descriptions); phone interviews of practicing, licensed acupuncturists; and feedback from a panel of subject-matter experts (SMEs). The members of the Job Analysis Panel were NCCAOM diplomates in good standing and recruited by NCCAOM leadership to represent national diversity of practice, experience, geographic location, education, ethnic backgrounds, and high-level professional expertise.
Invitations to complete this national survey, as well as reminders, were sent via email to all known licensed acupuncturists and NCCAOM constituent groups, numbering approximately 33,000 practitioners. During that time, the survey was advertised via social media and in an article published in the July 2017 edition of Acupuncture Today. There were 3,285 unique logins to the survey, representing a response rate of approximately 10 percent, which is excellent for an unsolicited online survey.
More than 95 percent of respondents indicated that the survey either completely or adequately described the critical knowledge, skills and abilities (KSAs) required for nationally competent, entry-level practice as an acupuncturist. This supports a high degree of confidence that the depth and breadth of the survey content was reflective of practice across geographic settings and among various work-practice settings.
A second JA Panel meeting was held to consider and review the results of the survey data analyses, and to finalize the new content outlines for the NCCAOM FOM, BIO, ACPL and CH examinations. Among the results presented by the NCCAOM's psychometrician were mean importance and frequency performed data for each KSA. This allowed the panel to understand which KSAs were deemed by the survey respondents to be important and frequently performed, and thus essential for inclusion in the content outline.
During the meeting, the panel agreed to minor additional editing, resulting in final approved content outlines for the FOM, BIO, ACPL and CH examinations. NCCAOM content outlines for each examination module (FOM, BIO, ACPL, CH) are validated through the national JA report. The resulting content outlines provide the detail on the major areas of responsibility for each domain in a given content outline. Each examination question is then linked to a specific domain, task, and knowledge statement. For more information, please refer to the NCCAOM Job Analysis Report.
Why It Matters to You ... and the Profession
National certification exams measure competency of candidates for current practice, not what schools are teaching. It would be very difficult to exactly match the curriculum of 50-plus schools along with individual local state laws and local regulations. Furthermore, a national certification exam is not synonymous with a specific academic program's comprehensive exam content. Therefore, it is important for school programs to inform their students of the NCCAOM examination content outlines. The content outline lays out what would be on each examination module.
The NCCAOM receives many inquiries regarding exam content. For example, many students contact the NCCAOM and say they were not taught guasha in their program, but guasha is listed on the content outline(s). A recommendation would be for the schools to offer their students guidance and direct them to study and review the NCCAOM examination content outlines.
The profession, like most health care professions, requires standardization across the board (consistency, processes and procedures) on a national level. The process of standardization would improve the level of competency and safety – not just statewide or local, but nationally. Not everyone may agree what a standard practice is, but all can agree on core knowledge, skills and abilities that will translate nationally and possibly on an international level.
A candidate who has passed a "national certification exam" has demonstrated these core competencies as determined by the job analysis process detailed above. If one agrees or disagrees with the JA survey and results, the community must be proactive and participate in future JA surveys for your voices to be heard.
It is important to recognize that it is the duty of a health care practitioner to protect the community and the people served, and to be recognized for their credentials and qualifications. It is with this reliance that the federal government, through the Bureau of Labor Statistics, created a standard occupational classification code and job description for acupuncturists; and that the Department of Veterans Affairs is now employing acupuncturists. The NCCAOM looks forward to its continued partnership with other national and state organizations and schools to further and advance the profession.
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