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LASER LASER CERTIFICATIONSCERTIFICATIONS

National Council on Laser ExcellenceNational Council on Laser Excellence

A Credentialing Board of the notA Credentialing Board of the not--forfor--profitprofit

Professional Medical Education AssociationProfessional Medical Education Association

Gregory T. Absten

My name is Gregory Absten. I’m the Executive Director of Professional Medical Education Assn, and chairman of the National Council on Laser Excellence. I’m also you’re newly elected Laser Safety representative for the Board of Directors of the ASLMS. Four years ago our nonprofit organization formed a cross-industry credentialing board for Laser Certifications, called the National Council on Laser Excellence.

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The Certification “Movement”The Certification “Movement”

nn Academy of Laser Dentistry, 1998Academy of Laser Dentistry, 1998

nn National Council on Laser Excellence, 2000National Council on Laser Excellence, 2000

nn LIA’sLIA’s Board of Laser Safety, 2003Board of Laser Safety, 2003

nn Various State Licensing AgenciesVarious State Licensing Agencies

Aside from our efforts, there are other forces coming together to bring the issue of Laser Certifications to the forefront of medical groups and state licensing agencies.The Academy of Laser Dentistry began its certification program in the 90’s, both for Dentists and for Dental Hygienists operating lasers.Our National Council on Laser Excellence began the Certification of Laser Repair technicians in April of 2000, and began developing plans for further certifications to incorporate Laser Safety Officers and Laser Operators.The LIA called us at the NCLE about that time in 2000 and asked to be a part of the NCLE Board and certification process. The Board approved the addition of the LIA to the Council, but did not hear back again from them. It was in 2003 then that the LIA came out with their own Laser Certification program, first for technical Laser Safety Officers, and then later for Medical Laser Safety Officers. Our two groups are having discussions now on whether the LIA will integrate their own program back into the Council, or whether they’ll continue on a separate duplicate effort.The real impetus for the Laser Certifications is going to come from various State Licensing agencies. The advent of widespread aesthetic laser procedures has involved many non-medical personnel in performing laser procedures. State regulations on this practice vary to the extreme, and most States still have no regulations over this practice.

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NCLE BOARDNCLE BOARD(est. 2000, transitioning)(est. 2000, transitioning)

GROUPSGROUPS

nn OHIO STATE UNIVERSITYOHIO STATE UNIVERSITYnn COHERENT MEDICAL COHERENT MEDICAL

(before (before LumenisLumenis))nn HARTFORD HOSPITALHARTFORD HOSPITALnn KALEIDA HOSPITAL SYSTEMKALEIDA HOSPITAL SYSTEMnn PLC LASERSPLC LASERSnn PHOTOVAC TECHNOLOGIESPHOTOVAC TECHNOLOGIESnn UNIVERSAL MEDICAL LASERUNIVERSAL MEDICAL LASERnn PREMIERPREMIERnn SERVICEMASTERSERVICEMASTERnn SACRED HEART HOSPITALSACRED HEART HOSPITAL

PEOPLEPEOPLE

••Gregory Absten Gregory Absten BScBSc, MBA, MBA

••Sue Terry, RNSue Terry, RN

••Nancy Silva, RN Nancy Silva, RN

••John Elwood III, CBET John Elwood III, CBET

••Cathy Hartmann, RNCathy Hartmann, RN

••Rich Davis, Rich Davis, PhdPhd

••Richard Richard EliasonEliason

••Doug GeorgeDoug George

••Herb Deigl, BSEEHerb Deigl, BSEE

••Jim SmithJim Smith

••Robert Robert RudkoRudko, PhD, PhD

••Peter Peter CastanovaCastanova, BSEET, BSEET

1. Consensus Building

2. Question Bank Development

Our own NCLE Board was commissioned by Professional Medical Education Assn in 2000, incorporating a cross-industry representation of views. It includes input from Hospitals, Universities, Laser Manufacturers and Laser Service organizations. Many of the companies have since changed and our Council Board members have new jobs, so our Board is now incorporating other members. The primary goal of the Board is to develop a consensus about “reasonable” requirements for Laser Certifications in various categories, and develop Laser Certification programs that on one hand are not so difficult to qualify for that it leaves only a select few, and on the other hand is substantial enough to provide a valued meaning to the individual gaining the credential. The other goal of the Board, and not all members participate in both areas, is to continue to build upon the question banks for testing that we’ve already established.

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Why Now?Why Now?

nn Baseline Competency for Laser Repair.Baseline Competency for Laser Repair.-- problem of unqualified techniciansproblem of unqualified technicians

April 2000 – NCLECERTIFIED LASER REPAIR TECHNICIANS

- plan for further certifications in handbook

So why did this get started?

Initially in the laser service industry there was a problem with finger pointing back and forth between competing manufacturers and independent service groups implying a lack of competency in both parties. In truth most of the independents were very good at laser service, but there were a few mom and pop operators that knew little about lasers and would work on the equipment. The problems that were created reflected poorly on the equipment from the manufacturer, and gave some credence to the fact that some independents were incompetent. It was in everyone’s best interest to establish some baseline indication of competency and this gave rise to the standards for and credential of Certified Laser Repair Technician by the NCLE. The Board then authorized nursing and medical input into the board in order to develop further Laser Certifications.

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Why Now?Why Now?

nn Baseline Competency for nonBaseline Competency for non--medical, medical, nonnon--nursing laser users and operators.nursing laser users and operators.

PATIENT SAFETY!PATIENT SAFETY!

Striping Burns

Various State Regulatory Agencies

The real impetus for Certification of Laser Safety Officers and Laser Operators has come about because of widely publicized incidents of patient injuries by non-medical personnel using laser equipment. Though the Laser Certification is just one step in the process and does not itself indicate a clinical competency, these problems are the driving force behind the effort.

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Certified CompetenciesCertified CompetenciesSAFETY AND OPERATIONAL COMPETENCIES…

NOT CLINICAL COMPETENCY (States)

VoluntaryVoluntaryNot Mandatory

Not Mandatory

Laser Certification is a credential that indicates some baseline level of competency in safety practices and operation of medical laser equipment. It does not denote any special privilege to practice medical laser procedures on patients, and does not denote any level of clinical competency. It does indicate that the individual holding the credential has met some established standard in the knowledge of medical laser principles and risks, and in the safe operation of laser equipment. The certifications are voluntary in nature, similar to voluntary certifications in other medical and nursing areas.

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STATE LICENSINGSTATE LICENSINGCLINICAL COMPETENCYCLINICAL COMPETENCY

Florida requires a national “Laser Certification” Florida requires a national “Laser Certification” in addition to 40 hours of patient treatment, in addition to 40 hours of patient treatment, prior to licensing nonprior to licensing non--physicians for Laser physicians for Laser Hair Removal.Hair Removal.

The question of Clinical Competency arises with State Licensing of individuals to perform medical or aesthetic procedures on patients. The Laser Certifications may be used as one stepping stone in this Licensing process. The State of Florida for example has authorized the State ElectrologyAssociation to manage the licensing of non-medical individuals to perform Laser Hair Removal. The law is written so that an individual must first acquire a “National Laser Certification” prior to meeting the other background and clinical experience requirements for licensing. This requirement for the National Laser Certification was written into law at a time when no such certifications existed. For more specifics you should request a written copy of the requirements from the State of Florida.

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STATE LICENSINGSTATE LICENSING

New York requires a New York requires a “Certificate of Competence” “Certificate of Competence” for Mobile Laser Operators.for Mobile Laser Operators.

Texas has new laws being Texas has new laws being formulated for regulating laser formulated for regulating laser operators at Medical Spas.operators at Medical Spas.

Many more States coming …Many more States coming …

Another example of States moving toward documentation of competency is New York – who requires a “Certificate of Competence” for operators of mobile laser systems. This is applied for through the state and evidence must be submitted to document training and competency.

Texas is now in the process of regulating operators in medical spa type settings throughout the State, and you’ll see this trend continue as more states begin to address the problems and issues associated with unregulated medical laser use.

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NURSING?NURSING?

Nursing was not, and is not a Nursing was not, and is not a problem area requiring an problem area requiring an outside Certification. outside Certification.

Nursing professionalism and standards prevail to maintain patienNursing professionalism and standards prevail to maintain patient t safetysafety–– but the movement is on, and the voluntary Certifications will but the movement is on, and the voluntary Certifications will

provide additional Professional Recognition.provide additional Professional Recognition.

Laser Repair technicians have had the Certification process in pLaser Repair technicians have had the Certification process in place since lace since 2000, and reports back to the NCLE indicate that many of these 2000, and reports back to the NCLE indicate that many of these technicians are receiving pay raises based upon their Laser Certtechnicians are receiving pay raises based upon their Laser Certification.ification.

Nursing never was an area that merited concerns over laser operation or use. The self policing standards and practices adopted by professional nursing groups such as the AORN have prevailed in maintaining safety for patients and staff during laser cases – but because of problems in other areas the movement for the Laser Certifications are on, and nursing will be incorporated into the process.

On a side note, many of the Biomedical Engineers who have become Laser Certified since we started in 2000 have told us that they’ve received pay raises based upon their additional credential, and we would anticipate some organizations to follow suit with the nursing staff.

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Professional RecognitionProfessional Recognition““In healthcare, being a profession that highly values In healthcare, being a profession that highly values

credentials, having a certification is a very positive step.credentials, having a certification is a very positive step. It It not only tells your administration that you have met a not only tells your administration that you have met a national standard of competency …….. but also that you are national standard of competency …….. but also that you are not standing still and becoming stagnant in your not standing still and becoming stagnant in your profession.profession. You are willing to go the extra mile to keep You are willing to go the extra mile to keep learning to bring positive results to your organization.learning to bring positive results to your organization.

I value my credentials and so will your organization.I value my credentials and so will your organization.

Go after it.”Go after it.”Kerry L. Sides, CMRPAmes Iowa

Re AHA Certification

Professional recognition is still a very important reason to pursue additional credentials such as Laser Certification. It sets one apart professionally and acknowledges that a national standard has been met.

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NCLE LASER CERTIFICATIONSNCLE LASER CERTIFICATIONS

nn Certified Laser Repair TechnicianCertified Laser Repair Techniciannn Certified Laser Safety Officer/MedicalCertified Laser Safety Officer/Medicalnn Certified Laser Operator / Certified Laser Operator /

•• / Surgical/ Surgical•• / Ophthalmic/ Ophthalmic•• / Aesthetic (Overall / Aesthetic (Overall DermDerm/Plastic)/Plastic)•• / Hair Removal (Limited to that procedure, non/ Hair Removal (Limited to that procedure, non--medical)medical)•• / Veterinary (equivalent to surgical)/ Veterinary (equivalent to surgical)

www.LaserCertification.org

Laser Certifications are offered by the NCLE in these areas. The Certified Laser Repair Technician has been offered now for about 4 years. The Laser Safety Officer / Medical Certification is currently being approved and national testing will begin by May or June. The Laser Operator Certifications in the various areas will follow, and all of the Certifications should be in effect and testing offered by the end of 2004. The Board continues to solicit input into this process and all remarks are welcome. Full details of the Certification programs are found in the Candidate Handbook which you can download from the website.

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NCLE TESTINGNCLE TESTING

Administered Nationally by A.M.P. Administered Nationally by A.M.P. -- Allied Measurement Professionals Allied Measurement Professionals --

nn 120+ Proctored Testing Centers Nationwide120+ Proctored Testing Centers Nationwidenn Computerized testing by appointment.Computerized testing by appointment.nn Instant response of Pass/Fail & in what areasInstant response of Pass/Fail & in what areasnn Proctored written exams allowable at laser courses for Proctored written exams allowable at laser courses for

authorized proctors.authorized proctors.

nn American Hospital Assn (AHA)American Hospital Assn (AHA)nn American Assn of Critical Care Nurses (AACN)American Assn of Critical Care Nurses (AACN)nn Board of Certification for Emergency NursingBoard of Certification for Emergency Nursingnn National Board for Respiratory Care ……………….National Board for Respiratory Care ……………….

The proctored testing for the Laser Certifications is being administered by the same group that manages national testing for the American Hospital Association, American Assn of Critical Care Nurses, and many other medical organizations. The group is Allied Measurement Professionals, or AMP. Testing is offered in over 120 centers nationwide and can be scheduled on a Monday-Friday basis at the convenience of the applicant. Applicants must first qualify to sit for the exam by making application to the NCLE. After NCLE approval the applicant may schedule a testing center either online or by calling AMP. The examinations are all computerized and the individual will know the results of their exam before they leave the testing center.

Written examinations will additionally be offered in conjunction with Laser Training programs, when an authorized proctor is available to administer the exam.

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ELIGIBILITYELIGIBILITYLaser Safety OfficerLaser Safety Officer

1. EDUCATION – 15 hours documented laser training

2. EXPERIENCE – 4 yr degree, or RN or professional credential, or 2 yr degree + substantial experience. PLUS 1 yr experience as LSO or Laser Operator

3. TESTING – 70% correct on proctored examination.155 questions – four hours.

To be Adopted by the end of April 2004 by Board.

COMPLETE INFORMATION IN THE CANDIDATE HANDBOOK AT:

WWW.LASERCERTIFICATION.ORG

The complete requirements for eligibility are contained in the Candidate Handbook available on the Board’s website at www.LaserCertification.org .

They consist of an educational requirement, a background or experience requirement, and successful completion of a proctored examination.

The requirements for both training and the length of the examination are higher for Laser Safety Officers and Repair technicians than that for operators.

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ELIGIBILITYELIGIBILITYLaser OperatorsLaser Operators

1. EDUCATION – 5 hours documented laser training

2. EXPERIENCE – 4 yr degree, or RN or professional credential, or 2 yr degree + substantial experience. EXPERIENCE – 1 yr experience in the clinical setting: surgical – ophthalmic – dermatologic – aesthetic, etc

3. TESTING – 70% correct on proctored examination.100 questions – three hours.

4. TYPE RATING – Skills Validation check-off for type of laser

To be Adopted by the end of April 2004 by NCLE Board.

COMPLETE INFORMATION IN THE CANDIDATE HANDBOOK AT:

WWW.LASERCERTIFICATION.ORG

Laser operators require only 5 hours of documented training compared to the 15 for Laser Safety Officers. Operators are not required to have previous LSO or operator experience, but they are required to have at least one year of experience in their clinical setting, such as surgery, ophthalmic clinic, dermatology office, etc.

The testing for operators is also shorter at 100 questions, but operators are required to submit a Skills Validation check sheet for the type of laser(s) they are operating, such as CO2, argon, Pulsed Dye, etc.. These Skills validation checks are general in nature but reflect the ability to setup and operate the equipment. They must be signed off by the applicant’s LSO, a certified Laser Operator, a laser consultant or educator, or a company representative such as the salesperson or inservice trainer. An example of the credential earned might be Certified Laser Operator / Aesthetic with type ratings for Pulsed dye, diode, CO2 and Er:Yag lasers. Individuals may hold more than one class of laser certification.

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CONTINUED COMPETENCYCONTINUED COMPETENCY

nn Three year cycleThree year cycle

nn 30 hours of continuing education 30 hours of continuing education ––laser / medical / nursing / professionallaser / medical / nursing / professional

nn Retake an examination, or pass a Retake an examination, or pass a different class of Laser Certificationdifferent class of Laser Certification

Not applicable to individuals Certified prior to April 2004Not applicable to individuals Certified prior to April 2004

Certifications are active for three years from the successful completion of all requirements. At the end of the 3 years they may be renewed by submitting evidence of continuing education or retaking any NCLE certification exam. 30 hours of continuing education are required over a 3 year period and is not limited to laser education. Applicants may submit evidence of attendance at medical meetings and conventions, home study programs and any medical or laser training programs or events.

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LASER MANUFACTURERSLASER MANUFACTURERS

nn Participate by assisting with Laser Participate by assisting with Laser Skills validation checks for customers Skills validation checks for customers by salespeople and educators.by salespeople and educators.

nn Participate in a voluntary certification Participate in a voluntary certification program to reduce liability exposure, program to reduce liability exposure, without assuming risks of self without assuming risks of self certification.certification.

Laser manufactures may participate in this voluntary Laser Certification program by authorizing their sales representatives and trainers to sign off on the skills validation checklists for their customers. At the time of inservicetraining such a checklist would be marked off and signed so that the customer could submit a copy to the NCLE when making application for Laser Certification. Generic checklists are available through the NCLE, and any company may design and submit their own specific form if desired.

From a liability point of view, this allows manufacturers participate in a standardized Laser Certification program that will have value for their customers, without assuming the risks of being the agency that “Certifies” the individual for laser operation.

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STATE AGENCIESSTATE AGENCIESPolicy of CooperationPolicy of Cooperation

We anticipate that various States will begin We anticipate that various States will begin to use these National Laser Certifications to use these National Laser Certifications as a prerequisite for licensing to perform as a prerequisite for licensing to perform

laser procedures by nonlaser procedures by non--physicians.physicians.

Additional requirements for licensing will Additional requirements for licensing will most likely be experience & education in most likely be experience & education in

their field of practice, and supervised their field of practice, and supervised clinical experience on patients.clinical experience on patients.

The NCLE has a policy of cooperation with State agencies desiring to incorporate these national laser certification standards into state licensing requirements. Where needed the NCLE Board will work with State groups to synchronize requirements for Laser Certification to state requirements where it is appropriate. For those states participating in this process the NCLE will make available the results of the proctored examinations and application status of Certifications for the purposes of the State to determine licensing eligibility for that individual. Applications for State licenses is separate and distinct from Certification from the NCLE, and all applicants must make their own applications to the State independently of their application for Laser Certification through NCLE.

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QUESTION BANKSQUESTION BANKS

nn Intent to continue both the depth Intent to continue both the depth and breadth of the computerized and breadth of the computerized question banks.question banks.

nn Soliciting further question Soliciting further question contributors from qualified contributors from qualified individuals such as ASLMS members.individuals such as ASLMS members.

Absten@LaserTraining.org Absten@LaserTraining.org

The computerized test question bank is a valuable resource we’ve developed, and that we want to grow. Questions are categorized into objective areas with various levels of sub-classifications. In order to best accomplish this we continue to solicit input from the experienced medical laser community to submit questions to the NCLE Board. These will be classified and reviewed according to accuracy, wording and comparison against similar questions in the test bank. Once approved they will be entered into the question bank as an active question for testing, submitters will receive recognition through the NCLE website. We require that individuals submitting questions must have at least one year of active experience in a medical laser application area. Forms for categorizing and submitting questions will be available on the NCLE website. You may email your interest in participating to Gregory Absten at Absten@LaserTraining.org .

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LASER LASER CERTIFICATIONSCERTIFICATIONS

National Council on Laser ExcellenceNational Council on Laser ExcellenceWWW.LaserCertification.orgWWW.LaserCertification.org

A Credentialing Board of the notA Credentialing Board of the not--forfor--profitprofit

Professional Medical Education AssociationProfessional Medical Education Association

Gregory T. Absten

QUESTIONS?QUESTIONS?

National Council on Laser Excellence

www.LaserCertification.org

A Credentialing Board of the non-for-profit:

Professional Medical Education Assn.

PO Box 522379

Marathon Shores, FL 33052

800-435-3131, Tel 305-289-9056, Fax 305-946-0232

www.LaserTraining.org

Email: Info@LaserTraining.org