Certification and Recertification for Advanced Procedures Below the Dermis

Only RRTs who hold a general certificate of registration, without terms and conditions, are authorized to perform an advanced prescribed procedure below the dermis. Prior to performing an advanced prescribed procedure, the RRT must have successfully completed an approved certification program. In addition, recertification is required every two (2) years. (s.49(1) – O.Reg 596/94)

The CRTO does not wish to limit the flexibility of organizations in designing certification programs that meet their particular needs. At the same time, the CRTO needs to ensure that each organization’s unique certification programs contain some standard and minimum components. Therefore, before an RRT can perform an advanced prescribed procedure below the dermis, there must be an appropriate system in place for instruction, certification, recertification, and documentation.

Each certification curriculum must consider the following:

• Level of evidence of the reference material;
• Hours of instruction;
• Methods of instruction; and
• Assessment of knowledge and experience (e.g., written examination).

The certification program must be made up of three components:

       I. Knowledge Component;
       II. Observation Component; and
       III. Demonstration Component.

The knowledge component can be evaluated by a written or verbal examination. It is recommended that a minimum mark be required in order to proceed to the observation component. An estimate of the time required to complete this portion should be described. The Knowledge Component should include, at a minimum:

After successful completion of the knowledge component, the RRT will advance to review the skill under the direction of certified clinician. The intent of this portion of the program is to provide a safe setting for the review of the skill and competencies required in order to be successful in performing the procedure on a patient. An estimate of the time required to complete this portion should be described.

This portion requires that the procedure be performed on a patient, under direct observation by a clinician certified in the procedure, and who has the skills required to teach effectively. The decision as to who the clinician(s) is should be determined based on internal resources. There is no evidence to support the decision of how many times the procedure should be repeated in order to determine competence. There is only an understanding that proficiency does come with practice and that ongoing evaluation is needed in order to ensure competency.

These components are sequential. RRTs must complete each component before moving to the next.

A recertification process should include a hands-on demonstration of competence and may include a review of related experience and a verbal/written evaluation of knowledge.