The Science of Diabetes Self-Management and Care2023, Vol. 49(4) 314 –316© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106231169698journals.sagepub.com/home/tde
Certification in the medical profession is over 100 years old. For nonphysician health care professionals, certification has been occurring for over 60 years. However, for those professionals who serve people with diabetes, our first designation as the “certified diabetes educator†came to fruition in 1986, some 35 years ago.
The American Association of Diabetes Educators (AADE)/Association of Diabetes Care & Education Specialists (ADCES) has supported the growth and evolution of our specialty for many decades with professional education, advocacy, and ultimately, credentialing. Traditionally, a specialty organization is responsible for education, and the Certification Board is responsible for verifying knowledge and competence. A combined total of certifications for the Certification Board for Diabetes Care and Education (CDE/CDCES)1 and the Association for Diabetes Care & Education Specialists (BC-ADM; email communication, Jodi Lavin-Tompkins, MSN RN, CDCES, BC-ADM, ADCES, March 10, 2023) is over 20 000.
The National Certification Board for Diabetes Educators (NCBDE), renamed the Certification Board for Diabetes Care and Education (CBDCE), continues to credential Certified Diabetes Care and Education Specialists.1 As the profession grew, it quickly became apparent that we do much more than “education.†The BC-ADM credential was the milestone to verify Advanced practice for several disciplines working in diabetes. The first exam was offered in 2001. As described in the accompanying article, an AADE-led multidisciplinary team of advanced clinicians and educators in diabetes began development of the BC-ADM credential from 1994 to 2001. AADE collaborated with the American Nurses Credentialing Center (ANCC), the preeminent nursing credentialing organization.2 [Click this link to access article: https://journals.sagepub.com/doi/abs/10.1177/014572170302900407] Following role delineation studies, separate exams were developed for nurse practitioners, clinical nurse specialists, pharmacists, and dietitians with master’s degrees or higher. The scope of work was surprisingly similar, with few discipline-specific exceptions. A few years later, ANCC eliminated nonnursing specialty certifications, and AADE acquired the BC-ADM credential. AADE offered the first BC-ADM exam in 2010. At that point, the separate exams merged to 1 exam for several professional disciplines. Eligible disciplines have expanded to include physician assistants and physicians. In addition to academic and professional preparation, all candidates for the BC-ADM are required to have completed 500 clinical practice hours.
Many changes in diabetes and health care in general have occurred at rapid-fire speed. New drugs, devices, technology, automated insulin delivery, autoimmune disease treatment, electronic integrated medical records, and accelerated implementation of telehealth due to COVID-19 are transformational changes. The learning curve to maintain sufficient knowledge in these areas is steep. The 2020 National Diabetes Statistics Report, citing National Health and Nutrition Examination Survey (NHANES) data, sadly confirms these changes have not measurably improved patient outcomes in diabetes over the past decade.3 The explosion in the incidence of diabetes requires that we educate, expand, and sustain our diabetes care and education workforce. Staffing shortages and professionals leaving the work force since COVID-19 intensify the demands on specialists.
The ADCES National Practice and Workforce Survey 2021 calls for expanded education in technology, increased diversity, equity inclusion and accessibility, behavioral health initiatives, Diabetes Prevention Program growth, and broadening roles of CDCESs with integration and collaboration into practice.4
Additionally, for the past several decades, a call for more effective methods to determine continuing competence and safe practice for health care professionals, not just knowledge verification, has emerged from the Institute of Medicine (2000, 2001, 2003)5 and the Institute for Credentialing Excellence,6 to name a few. The recommendation creates a call to action for specialty certification organizations to require periodic demonstration of continuing competence.
A scoping review of voluntary certification in nursing specialties in North America identified that multiple challenges prevented any meaningful study of the relationship of certification to patient outcomes and described a research coalition designed to advance the body of evidence in certification research.7
Currently, renewal for CDCES includes 1000 hours of professional practice experience within the accrual period and either passing the CDCES examination or completing a portfolio.8 The portfolio pathway can include minimum 45 hours of traditional continuing education courses, independent study, seminars, online programs, workshops, telephonic or video conference programs, or conferences. Expanded continuing education activities acceptable for renewal include maximum of 30 hours of academic courses, presentations or lectures delivered by the certificant, or articles or books written by the certificant or service as a mentor in CBDCE’s Mentorship Program.
The professional development renewal category for BC-ADM has 6 categories, including continuing education, academic credit, publications, and research, and implies demonstrating competency via the ability to apply knowledge through specialist-delivered interventions.9
The benefit of a portfolio approach that includes application of knowledge, presenting lectures, or writing for publication suggests experience, credibility, and recognition of expertise by colleagues. These efforts are not a demonstration of impact on patient outcomes that chart audits or continuous quality improvement documentation can provide, but they deliver a step beyond knowledge verification. While certification has been transformational, the trajectory is headed in the direction of competency.
A professional specializing in diabetes continues to be a valuable and sometimes rare commodity. Verifying your expertise beyond the walls of your office is critical to the profession, your professional growth, and your career development. Your employer, your patients, and your colleagues need to know that your knowledge and skills are documented by an objective third party. With certification, your colleagues know they can count on you for expert education, referral, and consultation in diabetes.
Deb Hinnen served as the chair of Advanced Practice Committee of the American Association of Diabetes Educators: 1994-2001 and chair of the Board Certified Advanced Diabetes Management (BC-ADM) Test Development Committee for the American Nurses Credentialing Center (ANCC)/American Association of Diabetes Educators (AADE) 1996-2001. She also served as president of the American Association of Diabetes Educators in 1994.
Committee members of AADE Advanced Practice Committee 1994-2001 and ANCC/AADE Test Development Committee 1996-2001 include Debbie Hinnen (chair); Barb Schreiner, PhD, RN, CDCES, BC-ADM; Virginia Valentine, APRN, CDCES, BC-ADM; Karmeen Kulkarni, RD, MS, CDCES, BC-ADM; Laura Shane McWhorter, PharmD, CDCES, BC-ADM; and Peggy Yarborough, PharmD, CDE, BC-ADM.
Thanks to Virginia Valentine and Barb Schreiner, two visionary professionals, for review and comment.
None reported.
Deborah Hinnen https://orcid.org/0000-0002-9462-4273
From University of Colorado Health, Colorado Springs, Colorado (Ms Hinnen).
Corresponding Author:Deborah Hinnen, University of Colorado Health, 175 S Union Blvd, Colorado Springs, CO 80910, USA.Email: dh@sugar3rn.com
