The Global Registry originally formed in January 2004 in an effort to standardize professional industry medical technicians across several continents.
The Global Emergency Medical Registry is a general member of the Association of Accredited Certification Bodies. Membership in the AACB demonstrates a commitment to abiding by the legal and ethical requirements of membership and also denotes a commitment to being relevant in the industry. (Doing what we say we’re going to do)
In 2017, the international standards for Emergency Medical Service providers were updated and began implementation in many parts of the world. The Registry, responding to our accreditation mandates internationally, began a corporate restructuring to meet these new requirements and demonstrate compliance with these new standards.
The Registry came to the realization, in working with various stakeholders and countries around the world, that an international third-party competency confirmation process was necessary to move forward the goals of competency improvement in the prehospital and hospital occupational categories worldwide. This effort became the Global Emergency Medical Registry – GEMR.
The Goals and Objectives of GEMR are simple:
- Patient Safety
- Provider Competence
- Improve Patient Outcomes
All too often the initial reaction to tragedies in healthcare result in solutions lacking real improvement in patient safety, provider competencies, and improved outcomes. The best way to ensure the safety of any patient population is to have clear and measurable provider competencies based on the most current recognized science standards.
Because a top priority of the Global Emergency Medical Registry is patient safety, GEMR continuously explores processes to measure competency in a fair, comprehensive, and accurate, manner. Practical examination is completed for all candidates seeking initial certification, the exams are developed utilizing standardized skills sheets, which authorized examiners utilize to assess performance of the candidates in scenario and simulation-based examination of practical skills. Each level of provider certified by GEMR undergoes cognitive examination, practical examination, and documentation of clinical skills.
The ongoing demonstration of continuing competence is not a new regulatory issue. According to a USA national commission on health manpower sponsored by the U.S. Department of Health, Education and Welfare recommended physicians undergo periodic reexaminations (Schmitt provider, competence, 1996). In 1971, a similar report recommended that requirements to ensure continued competence should be developed by professional associations and states. The alternative to periodic reexamination was deemed to be continuing education (CE) and states began requiring mandatory CE as a condition of licensure renewal for a variety of professions. The National Registry of Emergency Medical Technicians (NREMT) required both continuing medical education and skills competency evaluation in its very first year of establishment.
How does one assist regulatory constructs in determining competence?
And, what is the best way to determine if a provider is competent?
The mission of the Global Emergency Medical Registry (GEMR) is to assist regulatory authorities and jurisdictions to assist in the assurance of providers safety and competent to the most current levels of accepted standards.
The purpose of this discussion is to explore various approaches and views related to continuing competency and examine the difficult policy, development and implementation issues related to continuing competency.
The American College of Emergency Physicians (ACEP) believes that:
- The exercise of clinical privileges in the emergency department is governed by the rules and regulations of the department;
- The medical director (or their designee) is responsible for periodic assessment of clinical privileges of emergency physicians against the national competency guidelines;
- When a physician applies for reappointment to the medical staff and for clinical privileges, including renewal, addition, or rescission of privileges, the reappraisal process must include assessment of current competence by the medical director (or their designee);
The medical director (or their designee) will determine the means by which each emergency physician will maintain competence and skills and the mechanism by which the proficiency of each physician will be monitored.
(Revised and approved by the ACEP Board of Directors October 2014, June 2006 and June 2004)
Mechanisms for continuing competence include regulatory and private sector approaches, as well as approaches by national organizations, certifying entities, and state boards.
The 2006 study, National Reregistration and the Continuing Competence of Paramedics, by Keith Holtermann and colleagues, found that NREMT Paramedics who reregistered 4 and 6 years after initial registration were twice as likely to pass the exam as their State-certified cohort counterparts who did not reregister with the NREMT. The registered group, compared to the nonregistered group, had significantly more Continuing Medical Education. The findings suggest that Paramedics who reregister with the NREMT are more knowledgeable than those who do not reregister.
In a 2011 study (The Association Between Emergency Medical Services Field Performance Assessed by High-fidelity Simulation and the Cognitive Knowledge of Practicing Paramedics; Jonathan R. Studnek PhD, NREMT-P, Antonio R. Fernandez PhD, NREMT-P, Brian Shimberg NREMT-P, et Al), investigators simultaneously assessed cognitive knowledge and simulated field performance. Utilization of these measurement techniques allowed for the assessment and comparison of field performance and cognitive knowledge. Results demonstrated an association between a practicing paramedic’s performance on a cognitive examination and field performance, assessed by a simulated EMS response.
Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics’ ability to care for patients during stressful events. In this study, investigators examined paramedics’ acute stress responses and performance during simulated high-stress scenarios. Advanced care paramedics participated in simulated low-stress and high-stress clinical scenarios. The paramedics provided salivary cortisol samples and completed an anxiety questionnaire at baseline and following each scenario. Clinical performance was videotaped and scored on a checklist of specific actions and a global rating of performance. The paramedics also completed patient care documentation following each scenario. Results showed that clinical performance and documentation both appeared vulnerable to the impact of acute stress. Developing systems and training interventions aimed at supporting and preparing emergency workers who face acute stressors as part of their everyday work responsibilities is a vital avenue to successful patient outcomes. (LeBlanc VR, Regehr C, Tavares W, Scott AK, MacDonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012)
In a randomized controlled trial, simulation based learning was superior to problem based learning for the acquisition of critical assessment and management skills (Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills; Steadman, Randolph H. MD; Coates, Wendy C. MD; et Al; Critical Care Medicine; January 2006 – Volume 34)
Currently, many jurisdictions determine a practitioner is competent when they’re initially licensed, able to show proof of skills competencies, and have the approval of medical oversight; thereafter unless proven otherwise, the issue of competency goes unchecked, yet in the past decade, legal actions and media investigations have thrown a poor light on this pathway.
As a result of poor patient outcomes and increased healthcare costs many jurisdictions have determined improved standards must be adopted. Many organizations and regulatory authorities are exploring alternative approaches to assure continuing competence in today’s environment where technology and practice are continually changing, new health care systems are evolving and consumers are pressing for providers who are competent, both privately, through legal action, and through social media processes.
The intent of the Global Emergency Medical Registry (GEMR) is to increase patient safety, assure provider competence, and improve patient outcomes through a systematic approach to initial certification and renewal of EMS and Hospital providers who operate across international or domestic boundaries.