October 12, 2022

Statement attributed to: 

Donald A. Balasa, JD, MBA

President, Commission on Accreditation of Allied Health Education Programs

The National Commission for Certification of Anesthesiologist Assistants (NCCAA) recently announced substantial changes to their exam eligibility requirements published in its Certification Examination Handbook (2022) that could negatively impact students and the public. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) is submitting this letter of concern to the NCCAA, identifying how these policy changes create an additional barrier for entry into practice, affect graduate success, and fail to meet accountability expectations for a national certification body. 

Accreditation activities conducted by CAAHEP and its Committees on Accreditation, including the Accreditation Review Committee for the Anesthesiologist Assistant (ARC-AA), verify that educational programs meet minimum standards and continuously engage in ongoing quality improvement. CAAHEP accreditation allows program flexibility and innovation while requiring programs to meet performance thresholds and publish these results for the public to view. CAAHEP, the ARC-AA, and its Sponsors (listed below) have worked collaboratively for twenty-eight (28) years to maintain the Standards and Guidelines for the Accreditation of Educational Programs for the Anesthesiologist Assistant, continually incorporating changing national practice standards and knowledge requirements. 

Across health professions, nursing, and medicine, national certification bodies, and accreditation agencies work hand in hand to ensure programs produce qualified practitioners. The recent changes in NCCAA exam eligibility policy alter this established relationship, suggesting that expert, peer-reviewed CAAHEP accreditation Standards requiring assessment of student skill and overall competency are insufficient. CAAHEP does not question that the certification examinations offered by the NCCAA accurately assess the clinical knowledge in the Certified Anesthesiologist Assistant profession but assert that it is the role of CAAHEP to establish and enforce quality assurance standards for education and assessment of student psychomotor (skill) and affective (behavioral) competencies. 

The CAAHEP Board of Directors is concerned about the new clinical standards referenced in the NCCAA's most recent Certification Exam Handbook (2022). In the Certification Exam Handbook, the Commission states that the NCCAA collects a record of clinical experience from students to "verify entry level clinical standards are met for new CAAs" (NCCAA, 2022, p.9). Introducing new NCCAA entry level clinical standards is of concern because these required standards are not available to the public, have no basis for validation, and add an unnecessary step in the certification process that poses a barrier to entry into practice.  

The CAAHEP Standards and Guidelines for the Accreditation of Educational Programs for the Anesthesiologist Assistant (CAAHEP AA Standards) are established and endorsed through a rigorous process, including stakeholder input, an open public forum, and the Board of Directors' approval. It is concerning that the NCCAA proposes to enforce its own entry level clinical standards as the CAAHEP AA Standards currently require programs to establish a minimum number of clinical hours and case types for first- and second-year students to achieve entry-level competency. Thus, the requirement to meet NCCAA entry level clinical standards create a confusing and additional step for exam eligibility beyond graduation from a CAAHEP accredited program, which the NCCAA currently accepts.  

The CAAHEP Board of Directors is also concerned that the recent NCCAA policy change publication did not demonstrate the expected level of transparency for a national certification body. The changes were never opened for comment from the NCCAA's communities of interest or the public and were implemented without proper notification. Programs and enrolled students were given little time to consider how the changes in examination timing and entry level clinical standards might impact graduates and students. Examinee success on the certification exam could be affected negatively due to the increase in the length of time before a graduate is permitted to sit for the examination following graduation, reducing the number of qualified providers to enter the workforce. 

As part of CAAHEP's commitment to public transparency and consumer protection, our organization meets all requirements for accountability set by the Council for Higher Education Accreditation (CHEA). CAAHEP encourages health professions to utilize assessments from national certification bodies accredited by the National Commission for Certifying Agencies (NCCA) or under International Organization for Standardization (ISO) International Standard 17024. Such standards provide impartial, third-party validation that organizations meet recognized industry standards for developing, implementing, and maintaining certification programs. 

The CAAHEP Board of Directors appreciates the work of the NCCAA in evaluating examinee knowledge and its commitment to promoting patient safety and looks forward to engaging with your organization to ensure the public has access to safe, competent Certified Anesthesiologist Assistant providers. 

About the Commission on Accreditation of Allied Health Education Programs 

The Commission on Accreditation of Allied Health Education Programs (CAAHEP) is a non-profit programmatic postsecondary accrediting agency recognized by the Council for Higher Education Accreditation (CHEA). CAAHEP conducts its accrediting activities in cooperation with 25 reviewing Committees on Accreditation, including the Accreditation Review Committee for the Anesthesiologist Assistant (ARC-AA). In service to its stakeholders and the public, CAAHEP's mission is to provide value by setting standards for quality assurance in health professions education. 

CAAHEP Sponsors that endorse its Standards and Guidelines for the Accreditation of Educational Programs for the Anesthesiologist Assistant include: 

American Academy of Anesthesiologist Assistants  

American Society of Anesthesiologists 

Accreditation Review Committee for the Anesthesiologist Assistant 

References 

National Commission for Certification of Anesthesiologist Assistants. (2022). Examination handbook: Certification process for anesthesiologist assistants. https://www.nccaatest.org/CertificationExamHandbook.pdf