1. Salcido, Richard "Sal" MD

Article Content

Since I wrote my first editorial on the subject of certification and competency in 1999, "Certification and Competency in the Year 2000[horizontal ellipsis]and Beyond," the number of options for wound care practitioners to demonstrate their general knowledge in the wound care field has increased exponentially. Multiple organizations have come forward to provide various credentialing opportunities to wound care practitioners. Such organizations appeal to those who wish to add educational opportunities, credentialing, certification, fellow status, or further qualification to their primary degree or license.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

The available wound-specific certifications include, but are not limited to, Certified Wound Ostomy and Continence Nurse and Certified Wound Nurse, from the Wound Ostomy Continence Association Board ( Nurse certification is available to registered nurses with a minimum of a bachelor's degree. As of January 2007, the American Academy of Wound Management (AAWM []) Association now provides candidates the opportunity to earn the Certified Wound CareSpecialist (CWS) certification. All CWS candidates must possess a minimum of a bachelor's degree. The National Alliance of Wound Care ( also offers the Wound Care Certification credential, with licensed practical nurses representing the largest group of those certified through this organization.


In addition, other organizations provide educational and mentoring opportunities for wound care professionals. They include the Association for the Advancement of Wound Care, an international society for wound care professionals ( and the Wound Care Education Institute ( The American Professional Wound Care Association ( offers fellow and diplomate status. Another recent entry in the field is the American College of Certified Wound Specialists. Candidates who possess certification from AAWM (CWS) can become a fellow of the College of Certified Wound Specialists (


Certification and Competency

I believe clinicians will agree that the current thrust toward achieving standards of certification is both positive and necessary. This is beneficial for the profession as a whole, for wound care practitioners, and ultimately, for patient care. Looking forward, however, what steps do we need to take to ensure that the number of credentialed wound care practitioners maintains actual competency at the bedside? Can we rely on a traditional cognitive-based examination to ensure a minimum level of knowledge? Or, should we measure bedside or point-of-service competency by using testing techniques that measure the candidates' ability to demonstrate actual patient care applications at the bedside in addition to a written examination for certification?


Certification: the term implies ability, authority, and adherence to a set of standards deemed appropriate from a regulatory body. The granting authority stems from respect for the group granting the certification or from having some legal or controlling authority to do so, such as a professional organization, or a state nursing, medical, or allied health licensing body. The covenant is that persons who earn a certificate have achieved the minimum standard according to preset principles. Certificates have become an important credential for the wound care professional and an important indicator of one's ability to care for this special group of patients.


Competency: in a professional sense, the term implies one's ability to carry out a task in a safe and competent manner. The practitioner must possess the psychomotor skills to observe the patient, evaluate the clinical situation, and treat the patient in a real-world environment. Moreover, the practitioner must communicate with others in the multidisciplinary environment, including organizations and payers (systems-based practice). In other words, the practitioners must practically apply cognitive-based learning.


By way of example, the American Council on Graduate Medical Education recently established concepts that potentially ensure a competency-based approach to make certain that trainees have attained minimal competencies in medical practice upon completion of their training. These core competencies include medical knowledge, patient care, evidence-based practice, professionalism, communication, and systems-based practice. In addition, during the course of training, certain evidentiary procedure or case logs are recorded, thus confirming the trainee's observed ability to perform certain procedures. The logistics of this inculcation during training may be much easier to carry out than in the real world.


How do we translate this concept to the wound care field? How would organizations that assume the responsibility for credentialing instill and test these more practical and nonacademic values into a multidisciplinary group of practitioners emanating from diverse fields sitting for a common examination and certification? Because the practice of wound care is multidisciplinary and no significant requirement exists for postgraduate training in the field of wound care, how do we ensure that the practitioners achieve the appropriate level of competency? I believe the organizations discussed in this editorial have taken the right steps by establishing the minimum requisites for initial certification and maintenance of certification in wound care. I think the looming challenge we face is the transformation to measuring competence in wound care.


In contemporary forums about patient safety initiatives, examples from the airline industry are often cited. To make the point of competency versus certification, I will conclude with this poignant example: many people are licensed to fly airplanes in this country but are they competent? In the airline industry, the maintenance of licensure and competence is inextricable.


Richard "Sal" Salcido, MD

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Recommended Readings


1. Ovington L. The national examination blueprint: information and practice questions. Adv Skin Wound Care 1999;12:304-9.


2. Prior J. Why wound care testing? Adv Wound Care 1999;12:303.


3. Salcido R. Certification and competency in the year 2000[horizontal ellipsis]and beyond. Adv Wound Care 1999;12(1):8-9.


4. The National Organization for Competency Assurance (NOCA) sets quality standards for credentialing organizations. The NOCA serves its membership as a clearinghouse for information on the latest trends and issues of concern to practitioners and organizations focused on certification, licensure, and human resource development. Available at: Accessed on June 13, 2007.


5. Woods A. Specialty certifications: more than just letters. Nursing 2006. Crit Care 2006;1(2):5.


6. Zulkowski K, Ayello EA, Wexler S. Certification and education: do they affect pressure ulcer knowledge in nursing? Adv Skin Wound Care 2007;20:34-8.