Global Medical and Healthcare Assessment Special Interest Group

Article by Jessica Dangles, Executive Director at CBIC

When your decisions affect patient safety, workforce mobility, and public trust, stakeholder communication is a core programmatic responsibility. Effective communication with stakeholders strengthens the credibility of your credentialing program and mitigates reputational risk. By contrast, even the most technically
sound assessment programs can crumble with poor communication.

When I was studying for my Project Management Professional (PMP®) certification, one of the core knowledge areas that resonated most with me was stakeholder management. It goes well beyond simply identifying who your stakeholders are. It requires a deliberate plan for engaging them, managing those
engagements over time, and monitoring how stakeholder needs and perceptions evolve. Those lessons have stayed with me.

As Executive Director of the Certification Board of Infection Control and Epidemiology, my professional background is not in test development or psychometrics. Instead, I have spent my career managing assessment programs and have learned valuable lessons, both from successful launches and from those that were less successful. There are few things worse than announcing a major programmatic change and then realizing, “Oh, we forgot to notify ____.”

When developing a new credential or implementing changes to an existing one, I keep a simple stakeholder checklist handy and regularly ask myself: What are their priorities? What is their risk tolerance? Below are a few questions your team may want to work through during the planning phase of a new or revised program:

Candidates and certificants

• How will this new program impact existing credential holders?
• What are the consequences—intended or unintended—of introducing a new credential?
• Are there issues of fairness or eligibility that need to be addressed prior to launch?

Employers and healthcare organizations

• What is the impact on workforce readiness and hiring decisions?
• How will credibility be perceived by employers and leaders in
  the field?

Regulators and accreditors

• If you are an accredited program, will you pursue accreditation immediately for the new credential?
• If accreditation is planned, how does that decision affect your development timeline and resources?

Subject matter experts and volunteers

• What role will volunteers play throughout development and implementation?
• Who are the decision-makers, and how are decisions communicated back to contributors?

Patients and the public

• What will the outcomes of this assessment signal to the public about competence and quality?

One-size-fits-all communication does not work for high-stakes programs, especially those with international reach. Messaging that is appropriate for regulators may overwhelm or confuse candidates, while public-facing communications may lack the depth or specificity regulators expect. Segmentation matters.

Helpful Hints
Be transparent without overexposing. Clearly explaining how decisions are made and by who builds trust. However, disclosing overly technical psychometric details can confuse rather than inform. Apply consistency across communications. Alignment between customer service responses, written policies, and public messaging reduces appeals, complaints, and perceptions of unfairness. Anticipate emotional responses. High-stakes assessments are inherently stressful. Plain, direct language, especially around pass/fail decisions, is essential. Be explicit about next steps, timelines, and available options.

Lessons Learned
Don’t rely on dense legal language that obscures meaning. If you and your staff don’t understand it, others won’t either! Communicate policy changes well in advance. Budgets and staffing decisions are often made months ahead. Ensure internal teams are fully prepared before making major programmatic announcements. Once again, if your team doesn’t understand it, others won’t either!

Conclusion
High-stakes healthcare assessments require psychometric rigor and technical quality, but those elements alone are not enough. Stakeholders evaluate programs not only on outcomes, but on how those outcomes are explained and contextualized. Effective stakeholder communication reinforces perceptions of fairness and legitimacy and ultimately supports long-term program sustainability.

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Article by Terri Hinkley, Chief Executive Officer/Executive Leadership and Burgeoning Futurist

When international credentialing organizations negotiate mutual recognition agreements, they don't just compare course catalogs. The American Speech-Language-Hearing Association's (ASHA) agreement with counterparts from Canada, the UK, Australia, New Zealand, and Ireland examined "educational and other requirements expected of each other's certificate holders, including academic course content, the amount and distribution of clinical practice hours prior to certification being awarded, degree designations, accreditation of academic programs, experience, and assessment mechanisms" (American Speech-Language-Hearing Association, n.d.). This deep dive reveals international accreditation's lesson for governance: it forces us to distinguish between essential standards and inherited assumptions. The World Federation for Medical Education (WFME), founded in 1972 in partnership with the World Health Organization (WHO), provides healthcare's most instructive accreditation example. WFME doesn't accredit individual medical schools, it evaluates and recognizes the accreditation agencies themselves, examining "the legal standing, accreditation process, post-accreditation monitoring, and decision-making processes" (World Federation for Medical Education, n.d.-a). WFME's Recognition Criteria cover four areas: (1) Background: scope of authority and acceptance; (2) Accreditation standards: existence, appropriateness, and review; (3) Process and procedures: site visits, qualifications, decisions, complaints; and (4) Policies and resources: conflict controls, consistent application, due process, records, information dissemination (World Federation for Medical Education, n.d.-b).

The Enhanced Nurse Licensure Compact (eNLC), enabling nurses to practice across 43 US jurisdictions with one license, implemented 11 uniform requirements including mandatory federal background checks and standardized disciplinary provisions (National Council of State Boards of Nursing, n.d.). The compact distinguished what's truly necessary for public protection versus what's customary but negotiable.

Similarly, ISO/IEC 17024—harmonizing personnel certification worldwide—requires demonstrating that "members of the governing body do not have a conflict of interest in their overall capacity to serve that could compromise the integrity of the certification process" (International Organization for Standardization, 2012). This demands structural separation: board members shouldn't simultaneously serve on examination committees or participate in appeals involving their practice areas.

The National Commission for Certifying Agencies (NCCA) Standards for the Accreditation of Certification Programs require certification programs to show "the governance structure and the process for selection and removal of certification board members protects against undue influence" (Institute for Credentialing Excellence, 2021, Standard 2.A), taking concrete forms: public representation with actual decision-making authority, documented authority flows, and financial independence.

What International Accreditation Reveals About Governance
International accreditation and mutual recognition can help credentialing organizations understand which governance requirements are critical versus those which are somewhat more flexible and can be based on geographic or organizational preferences. These are the key building blocks to an exemplary governance structure:

• Conflict of interest controls: Evaluates whether agencies implement systematic controls preventing conflicts from compromising decisions—not just disclosure forms.

• Consistent application: Decisions must follow documented, consistently applied processes rather than individual preferences or institutional knowledge.

• Qualification and training: Strong governance ensures people implementing processes are qualified and trained.

• Public accountability: Stakeholders can independently verify accreditation status, which builds public trust.

• Public representation: Not tokenism, but actual decisionmaking authority. ISO/IEC 17024 and NCCA both require demonstrated stakeholder representation on governance bodies

• Due process and appeals: The recognition criteria require demonstrated due process mechanisms. Accreditation decisions must be defensible, documented, and subject to appropriate appeal processes.

• Documented authority flows: Clear policies showing which bodies recommend versus decide

• Financial independence:
Especially critical when certification programs exist within membership associations Financial independence: Especially critical when certification programs exist within membership associations

The Path Forward
International accreditation offers a diagnostic tool: Would our governance withstand review by external auditors using accreditation criteria? Could we demonstrate systemic conflict controls, consistent application with documented evidence, qualification requirements for decision-makers, followed due process, and public accountability?

The goal isn't standardization – it’s governance maturity. Strong governance demonstrates clear role boundaries, evidence-based requirements, carefully structured stakeholder input, systemic conflict management, and focus on competency rather than credentials as proxies.

Apply the same scrutiny to your governance that international reviewers would. Not because you're seeking mutual recognition, but because questions about authority, accountability, evidence, and impartiality are fundamental to credentialing integrity wherever you operate. If your governance can withstand that examination,you're building something that deserves stakeholder trust.

References:
American Speech-Language-Hearing Association. (n.d.). FAQs:
Mutual Recognition Agreement.
https://www.asha.org/certification/mutual-recognitionagreement-faqs-general-information/
Institute for Credentialing Excellence. (2021). National
Commission for Certifying Agencies standards for the
accreditation of certification programs.
https://www.credentialingexcellence.org/Accreditation/EarnAccreditation/NCCA
International Organization for Standardization. (2012). ISO/IEC
17024:2012: Conformity assessment — General requirements for
bodies operating certification of persons.
https://www.iso.org/standard/52993.html
World Federation for Medical Education. (n.d.-a). Recognition
programme. https://wfme.org/recognition/bme-recognition/
World Federation for Medical Education. (n.d.-b). BME
recognition criteria. https://wfme.org/recognition/bmerecognition/bme-recognition-criteria/

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The eAA's first Global Medical and Healthcare Assessment Special Interest Group (SIG) Webinar brought together experts and practitioners working at the intersection of healthcare, education, and assessment. This introductory webinar explored the current landscape of medical and healthcare assessment, the unique challenges faced in clinical education, and the opportunities digital assessment offers for improving practice and outcomes. Our guest speaker was Professor Chris McManus, Emeritus Professor of Psychology and Medical Education, UCL Medical School Professor McManus trained in medicine at Cambridge and Birmingham and has spent decades leading research in the fields of neuropsychology, medical education, and assessment. With appointments at institutions including Imperial College and UCL, and ongoing work with MRCP(UK), he brings invaluable insight into the evolution of medical assessment and the role of psychology and data in improving healthcare outcomes.