At their annual meeting in August, the American Healthcare Radiology Administrators (AHRA) announced a major initiative to develop a certification program for radiology administrators. The program will enable the people who become certified to add the letters CRA after their name to indicate that they have the basic knowledge required of a radiology administrator. The certification process is comparable to that of the certified public accountant (CPA), which indicates that a person has basic knowledge in public accounting.

The AHRA embarked on this program because of the unique nature of the radiology administrator. Many radiology administrators do not have graduate degrees but have a wealth of experience and knowledge in the field and have a proven ability as a radiology administrator.? The CRA will demonstrate that they possess a basic, measurable level of knowledge in radiology administration.

AHRA has contracted with CASTLE International, a consulting firm that is experienced in developing certification programs for a wide variety of professions.? CASTLE will guide AHRA through the process and make sure that it meets the legal requirements for certification programs. As the program was being announced, the following questions arose. Hopefully, these answers will be helpful to everyone interested in the CRA program.

Q:What exactly is the Advanced Certification Examination? Does it require technical knowledge that would discriminate against managers who are not technologists by training?

A: The certification examination is a multiple-choice examination testing knowledge in six domains: 1) human resource management, 2) asset resource management, 3) fiscal management, 4) operations management, 5) communication and information management, and 6) education and research operations management. The examination will be validated against the survey now being conducted in order to determine the job relatedness of the test. The knowledge and skill statements, and the test questions based on them, require knowledge of management, not radiology.

Q:Why has AHRA chosen to act now with a credentialing program? Has the position grown to be more demanding from a skills and knowledge perspective?

A: AHRA has been considering credentialing for some time but the cost has been a major factor in preventing us from moving ahead. A recent pledge from [an imaging vendor] and the ongoing support of the AHRA Education Foundation have helped AHRA move ahead now. At the same time, the profession of radiology administration has become more complex and demanding. We see credentialing as a way to differentiate the competent radiology administrator from the general health care administrator.

Q:Are radiology administrators at risk of being perceived as being interchangeable with other department administrators? Are there critical differences between managing a radiology department and managing, for instance, the cardiology or pathology department of a hospital?

A: To be successful in radiology administration requires a combination of experience and education. While many radiology administrators have had other departments added to their job responsibilities, credentialing is a tool to differentiate them from others who do not have the expertise that radiology administration demands. The study guides and other materials we develop as part of this program will enable aspiring radiology administrators to focus their efforts and to better assure the success of a new radiology administrator.

There are core responsibilities that are the same [in every hospital department], but there are also very specific responsibilities that relate only to radiology administration. We believe that other professional administrator groups may also benefit from certification.

Q:What are the benefits of this program for health care institutions? How will radiology administrators benefit?

A: Certification enables the public as well as employers (health care institutions, private practitioners, and other health care organizations) to know that a person with a CRA has met national standards for radiology administration.

Many radiology administrators have the skills but are unable to demonstrate that they have the competency required of a radiology administrator. CRA will provide that differentiation just as CPA differentiates a certified public accountant from a noncertified accountant.

Q:Exactly what kind of knowledge is being certified and who is writing and grading the examination?

A: The knowledge being certified is that which is required for competence in radiology administration. The questions for the test will be written by AHRA-identified radiology administrators who are recognized in the organization as being highly qualified and respected.

The questions will then be referenced to a published resource that supports the correctness of the keyed response. Other radiology administrators will review and edit the questions to ensure their accuracy, clarity, and fairness. CASTLE subsequently will review and edit them for grammar and psychometric integrity. To be included in the examination item bank, every question will have to pass through this process and be coded to the weighted content outline and validated for importance, criticality, and relevance by radiology administrators who were not involved in writing or editing the question.

As for grading the test, CASTLE will do that electronically, using scan sheets marked by candidates when they take the test. It will validate the scoring key and use appropriate statistical analysis to verify that all questions are performing as they should before they are included in the scoring formula. The passing standard is criterion-referenced and quota-free, so that the passing standard is linked to the minimum requirement for certification and protection of stakeholders, including the public.

Q:How are the examination questions being validated in terms of correlation between the score achieved and the performance predicted?

A: CASTLE will conduct thorough statistical analysis, both on the test itself and on every question. Analysis of the test as a whole will include descriptive statistics about candidates’ performance (high score, low score, average score, number and percent passing, number and percent failing, variance, and standard deviation) and reliability statistics (internal consistency, standard error of measurement, decision consistency, and reliability at the cut score).

While some of this may appear overly complicated, there is an established science to developing and implementing a certification program. This is done to assure the credibility of the certification for the person being certified and the employer who relies on the validity of the certification when selecting candidates. In addition, the public can be confident that a CRA possesses a basic level of knowledge in radiology administration.

Monte G. Clinton is administrative director, Department of Diagnostic Radiology, Dartmouth- Hitchcock Medical Center, Lebanon, NH, and an editorial advisory board member of Decisions in Axis Imaging News.