The debate over certification is a lively one, and even its proponents are unsure if it guarantees competence.

 To get a lively discussion going among a group of biomedical equipment technicians, one merely has to ask them what they think about certification. even from a distance, the debate will be heard because of the raised voices.

To say the biomed community is divided on the issue of certification would be an understatement.

Advocates of certification contend that having to study for the test and passing it will help get qualified people in biomed positions. It also could mean extra money in a BMET’s paycheck.

The dissenters—and even many certification proponents—counter that certification does not guarantee competence, that with years of hands-on experience biomeds are just as qualified—if not more so—than some colleagues who are certified.

Even those opinions and arguments are just the tip of the iceberg.

“We fight about it all the time,” says Mike Kauffman, CBET, biomedical equipment manager at the 622-bed Reading (Pa) Hospital. “We will never, ever, in my lifetime agree on whether we should push for mandatory certification in our field.”

Kauffman comes down on the side of certification, saying, “It shows dedication to the field, and it also shows you have gone above and beyond to prove you are a minimum- level biomedical equipment technician.”

While it is not necessarily the case at every health care facility, the eight biomeds in Kauffman’s department are paid at a higher hourly rate if they are certified. Some hospitals will dock biomeds if they either do not renew or lose their certification. Other facilities mandate certification within a certain period of a biomed’s hire.

Competence Question
The issue of the validity or value of certification is, in part, linked to the contents of the examination itself.

While biomeds generally agree that certification does not guarantee competence, advocates still see certification as a positive step toward credibility for the profession.

“I probably got more out of studying for [the certification test] than I did from taking the test,” says Roger Bowles, CBET, master instructor of biomedical equipment technology at Texas State Technical College (Waco, Tex).

Conventional thinking among BMETs is that taking—and passing—the certification test is more appropriate for the biomed who has been on the job for at least a year or two than it is for one who is at entry level.

“It is not a good test to take right after [biomeds] get out of school, because it is geared toward the more experienced [biomed],” says Bowles. “We give them a solid foundation, and then they do a whole lot of learning on the job.”

The Association for the Advancement of Medical Instrumentation (AAMI of Arlington, Va) administers the certification test under the auspices of the International Certification Commission (ICC) for Clinical Engineering and Biomedical Technology and the US Certification Commission (USCC).

The US BMET Board of Examinationiners crafts the certification programs for certified biomedical equipment technicians (CBET), radiology equipment specialists (CRES), and clinical laboratory equipment specialists (CLES). The all-volunteer, 18-member panel reviews and evaluates questions for the certification examination twice a year.

Richard Eliason, CBET, manager of operations support for Aramark Clinical Technology Services (Charlotte, NC), has been involved in the certification process for the last 10 years and currently chairs the BMET board.

He says the board attempts to tailor the examination to biomeds with a 2-year associate’s degree or equivalent military experience and at least 2 years of on-the-job experience.

The board convenes in June at AAMI’s annual meeting and again in January to finalize the certification examination’s contents for that year. Because it is a volunteer board, members must pay their own transportation costs to attend each meeting.

At the June meeting, the board receives proposed questions that have been submitted for the following year’s examination.

“The questions are reviewed by the board members and peers,” says Eliason.

The peers are biomeds who have been recently certified and who are not on the board and are solicited from the area where AAMI holds its annual meeting to attend the evaluation session. This past June the biomeds came from the Long Beach, Calif, area.

The collective group sifts through the submissions, makes its recommendations, and checks to make sure the questions avoid biases and are not misleading in the way they are worded.

Test Categories
Once the questions are approved, they are placed in the five categories that constitute the examination: anatomy and physiology; safety in health care facility; fundamentals of electricity, electronics, and solid-state devices; medical equipment function and operation; and medical equipment and problem solving.

Professional Testing Corp (PTC), which handles certification tests for other health care specialties such as nurses and laboratory technicians, is the keeper of the database when the June meeting ends.

The BMET board meets again in January to gain more feedback on that year’s test. The location of the January meeting varies, but Eliason says the group tries to choose a place where there is a biomed association. Last January’s get-together was in Tulsa, Okla.

“Once again, all those questions and items that were approved are put in front of the board in an examination format,” says Eliason. “We review them again, and, if we missed something in the June review, we might kick out a few questions… and put a few in the right category.”

PTC then develops the examinations for the biomeds to take in May and November. The fee to take the examination is $265.

“It does seem like a lot [of money] for a lot of people, but this is not a money-making proposition,” adds Eliason. “AAMI is underwriting this [examination], and the people who are doing this are volunteers and taking money out of their pockets if they are not reimbursed by their employers.”

The examination comprises 150 multiple-choice questions with four possible answers. To pass, a biomed must answer at least 105 questions correctly.

Eliason says the pass rate generally is in the neighborhood of 50%. This year’s pass rate for the May examination was 62%.

“Talking to PTC, for our type of examination, that is a typical pass rate,” he adds. “Would we like to see it higher? Yes. Do we look at the cut rate once a year? Yes, we look at the pass rate every year.”

A CBET must renew his or her certification every 3 years for $90.

Reaching Consensus
With the examination’s annual evolutionary process, Texas State’s Bowles believes that a consensus on certification can be achieved among biomeds.

“I think it is a matter of agreeing on the importance [of certification] and agreeing on the contents [of the examination], because biomedical equipment technicians do so many things and their expertise is spread out,” he says.

As for what should be on the test, Bowles recommends that the competency list include the types of equipment a biomed should be familiar with and to what level of expertise. For examinationple, should biomeds be able to perform basic preventive maintenance checks, or should they show they can do more, such as troubleshoot components?

“The feedback we get is that an entry-level tech should have a working knowledge of a few types of equipment and the ability to do a basic performance check, preventive maintenance, and some simple repairs,” Bowles says. “There are certain types of people who can study, take a test, pass it, and still not be able to troubleshoot a piece of equipment.”

Bowles also recommends that a customer service or “people” skills section be included, although Bowles adds that it may be difficult to judge competency in this area.

Test Topics
Mary Coker, CBET, of Techserve (Gloucester, Va), also believes that both sides on the certification issue have valid arguments. A BMET with 20 years’ experience who studies for and passes the certification examination will not necessarily become a better technician.

At one time, while managing a biomed department, Coker had eight BMETs under her direction. Using a checklist from the US Air Force, she developed a more civilian-oriented system by which to review and gauge the competency skills of her colleagues every 6 months.

The periodic review included basic mechanical skills evaluation such as soldering and reading and understanding a schematic diagram. It also evaluated the BMETs’ ability to troubleshoot equipment effectively and tested their knowledge of how to use assessment equipment, such as voltmeters.

BMETs were graded on a scale of 1 to 5; 5 was the top grade, while 1 meant the biomed had not mastered that particular skill. The evaluation also was based on a technician’s experience—a person with more experience was expected to have greater expertise.

While Coker’s system worked well in that environment, she says that her evaluation technique is not for every health care facility. There are large, high-end biomed departments with technology managers rather than technicians, and there still are one- and two-person shops in small hospitals where a BMET is fixing laboratory and radiology equipment as well as the facility’s heating and air conditioning systems.

“The problem is how do you create a certification test that validates this whole spectrum,” Coker says. “That will always be a problem.

“I think the main issue is that there needs to be some sort of competency rating, whether it is licensure or certification,” she continues. “Will it make people [perfect] technicians? No, but any endeavor or learning experience can’t help but make you better.”

Why Take the Test?
Eliason has polled BMETs who take the examination and has found a variety of reasons for their decision to give it a go. The majority (42%) say it is to show one’s career commitment and professional pride. Twenty-one percent say they want to become certified for professional advancement, 18% say their employer has mandated it, and 13% do it to increase their salaries.

As for those biomeds who opt not to pursue certification, Eliason says, it is often a case of having other priorities on the job.

“With all the things we have going on in the hospitals and hospitals downsizing, people are just trying to keep their heads above water, and they feel they don’t need to pursue [certification].

“Unless someone is driving them to do it,” Eliason says, “BMETs simply may not have the time to study for the certification examination.”

Eliason readily admits that it does require extra effort and studying outside of the workplace, but there also is “a lot of satisfaction to get that certification, hang that piece of paper on the wall, and get that acronym behind your name.”

National Consensus

Reading’s Kauffman does not think that BMETs “will ever agree as a group if [certification] needs to be done or not. I would like to see a more formal structure created for the biomedical technician field.”

With certification as one of the issues on the table for BMETs these days, Coker is helping to spearhead the creation of a national BMET group that would become a focal point for opinions and a consensus on issues affecting the profession. A board and work groups have been formed to formulate tasks, responsibilities, and goals, one of which is to try to standardize an educational curriculum with a relevant connection to certification.

Coker envisions the organization as a network hub for all state biomedical societies and associations that have addressed and struggled with issues such as certification and compliance with respective state regulations.

“[Certification] is so incredibly polarizing,” she opines. “I think a lot of these issues will be resolved and worked through naturally when we get education standardized and the national group becomes one voice.”

The working name of the organization is the Clinical Technology Support Professionals Association. The group has selected “Servicing Technology for Life” as its motto. The slogan was submitted by Bowles and chosen by popular vote from among 185 other entries.

“We, as a group, need to make a decision about where our profession is going to go—and not everyone is going to agree with it, but there has to be a consensus that this is our standard within our field,” Coker says. “There is already an awareness of the impact of what a biomedical technician does every day. We can save or kill lives very easily.”

And what role certification will have in the BMET community will continue to be a source of great debate.

Wayne Forrest is a contributing writer for 24×7.