Hi, my name is Laura Bonanno, and I am going to provide an overview of the Council on Accreditation self-study process. I'll have to make this disclaimer here that this presentation is based on the Council on Accreditation of Nurse Anesthesia Educational Programs Standards and Policies and Procedures as of May 2022. I ask that you please refer to the COA website, and the website information is there, to ensure that the most current COA practice doctorate standards and policies and procedures are being used, if you're making any, working on a self-study, because these are subject to change. So again, this is based on the standards and the policies and procedures as of May 2022. And this presentation is strictly an overview of the self-study process. Program administrators and faculty are encouraged to attend the COA self-study workshop to ensure adequate preparation and for more detailed information. The objectives are to discuss the Council on Accreditation of Nurse Anesthesia Educational Programs Practice Doctorate Standards, to also discuss the COA's accreditation policies and procedures, to help you to understand the self-study and the on-site review process for accreditation, and to understand the role of nurse anesthesia faculty in the self-study process. A little bit about myself. I am a professor of nursing and the program director at LSU Health Sciences Center School of Nursing in New Orleans, Louisiana. I am presenting on behalf of the Faculty Stabilization Task Force, which I have been serving as a member of. I'm also a previous COA board member. I served on the COA for the past six years. I just came off of the COA in October of 2022. And I just recently went through the self-study process. So it's very fresh in my mind, and I hope to provide you some insight into that process. The Council on Accreditation of Nurse Anesthesia Educational Programs accredits nurse anesthesia programs within the United States and Puerto Rico that award post-master's certificates, master's and or doctoral degrees, including programs that offer distance education. As you know, effective January 2022, all nurse anesthesia programs have to be at the doctoral level, although there are still programs that are teaching out their master's cohorts. The accreditation standards for entry-level nurse anesthesia programs offering practice doctorate degrees are written with input from a wide community of interest. And again, the most recent revision was in May 2022. The COA's mission is to establish standards that promote quality education in nurse anesthesia programs through accreditation. The COA identifies six values that are listed as the values of the COA. These include integrity, fair and objective decisions are based on consistent application of the COA standards, accountability, responsive, efficient, and professional interaction with nurse anesthesia programs free of conflicts of interest, commitment, dependable and respectable support to enhance and advance nurse anesthesia educational programs, diversity, equity, and inclusion, mindful and open accreditation to ensure unrestricted opportunity in nurse anesthesia training, quality, evidence-based decisions, and continuous improvement of operations work and assessment of programs, and innovation, creative approaches to enhance and advance the profession, education programs, and the COA. And there are two fundamental reasons for accreditation. One is to ensure quality assessment, and two, to assist in quality improvement. And regarding the scope of the council, the council is a nationally recognized accrediting agency for the accreditation of institutions and programs of nurse anesthesia at the postmaster's certificate, master's, or doctoral degree levels in the United States and its territories, including programs that offer distance education. There are many values to accreditation. Accreditation provides services that are of value to several constituencies. The public. So it ensures the public that graduates of nurse anesthesia programs meet certain rigorous requirements. For students, the same, that their program is of high quality and meets the requirements so that they can move on for eligibility for certification. For programs, it provides guidance for programs so that we ensure that our curriculum have some consistency across all programs. And then for the profession. So because of accreditation, we know that all programs that are accredited by the council on accreditation meet the certain criteria and are compliant with the COA standards and the COA policies and procedures. So accreditation has significant value to the public, to students, to programs, and to the profession. The accreditation process, the COA establishes the standards for accreditation of nurse anesthesia educational programs subject to consideration of recommendations from the communities of interest. So the standards undergo continual review and they are subject to periodic major and minor revisions as indicated. The COA's accreditation decisions are based on the compliance with the standards. Ongoing oversight is provided by the COA between formal programmatic reviews. So between accreditation cycles or, you know, from if you're accredited and you have a 10-year accreditation, there is oversight by the council in between that time. So every year the program has to submit an annual report. Programs are required to advise the council and to get approval for major changes. And the COA investigates concerns or complaints that are brought to its attention that could affect a program's accreditation status. So it's not like you're accredited in 10 years, you don't have any interaction with the COA. There is oversight in between and programs can always call their specialist if there's any concerns or questions. Accreditation of nurse anesthesia educational programs provides quality assurance concerning educational preparation through continuous self-study and review. And the ultimate goals are to improve the quality of nurse anesthesia education and to provide confident nurse anesthetist for healthcare consumers and employers. The accreditation self-study process is repeated at intervals of up to 10 years. 10 years is the maximum accreditation that is granted. A summary report of the review is presented to the COA for an accreditation decision. So once the site visitors come to the program and conduct the on-site review, they submit the summary report to the COA, it is the COA that makes the accreditation decision based on that summary report. And then as I mentioned, each program is required to complete and submit an annual report. So that's kind of part of the continuous quality assessment and improvement. And graduation from an accredited program is a prerequisite for eligibility for national certification and is also a criterion used by licensing agencies, employers, and potential students in the decisions that they make and in determining eligibility for government funding. So students or graduates have to graduate from an accredited program that's accredited by the COA in order to be eligible to take the NBC RNA's national certification exam. The COA practice doctorate standards are designed to provide graduates with competencies for entry into anesthesia practice. Entry into practice competencies for the nurse anesthesia professional prepared at the practice doctorate level are those required at the time of graduation to provide safe, competent, ethical anesthesia and anesthesia related care to patients for diagnostic, therapeutic, or surgical procedures. And these entry into practice competencies should be viewed as the structure upon which the nurse anesthetist will continue to acquire knowledge, skills, and abilities along the practice continuum that starts at graduation where they should be at the proficient level but continues throughout their entire professional careers when they're considered experts. As we know, anesthesia changes all the time, so it's up to the individual after graduation to continue to ensure that they're meeting those competencies. The COA practice doctorate standards really are grouped into eight categories. So the A standards, as we refer to them, is conducting institutions. The B standards are the faculty standards. The C standards are the students standards. The D standards are the graduates. E is the curriculum. F is clinical site standards. G is policies, our policy standards, and H is the evaluation standards. So there are 152 standards. There are each standalone standards, but they're grouped into those eight categories. The accreditation process for established programs is based on the self-evaluation study document that is prepared by the program. And then following submission of that self-study to the COA, an on-site review team comes and makes a visit. So usually that self-study process really starts at least a year out, and you'll start having communication with the COA. They'll decide on a review team, which will be shared with you if there's any conflicts. It could be discussed at that point in time. And then the self-study is usually submitted about two months prior to the on-site review. And there is some dialogue between the COA and the program. So once you submit the self-study document to the COA, they may come back and ask for some clarification of anything that's written or for something that may be missing or needs to be included. And that happens before the self-study is then shared with the on-site review team. So there may be two or three reviewers. That's going to depend on the size of the program. Certain standards have been ascertained to have major significance regarding educational quality. And if failure to comply with one or more of these standards is considered to be a critical concern in accreditation decisions. So all of these standards are marked with an asterisk. And that just means that it's a critical concern. So compliance with those standards is definitely important. The COA policies and procedures, the purposes of the policies and procedures are to establish guidelines for enhancing educational quality, also to facilitate implementation of the standards for accreditation of nurse anesthesia standards, nurse anesthesia programs, the practice doctorate. So sometimes you'll commonly hear those referred to as the practice doctorate standards and the COA policies. So if I shorten the terminology, you'll know what I'm referring to. So the COA policies and procedures are also needed to meet the requirements for external agencies, such as the Council for Higher Education Accreditation and the U.S. Department of Education. And also to safeguard the rights, responsibilities, and interest of students, faculty, administrators, programs, the profession, the public, and other members of the community of interest. So when you're looking at the self-study process, A-1 is the process for new programs and A-3 is the process for established programs seeking re-accreditation. So A-1 is accreditation after graduation of the first class of students. So a new program must complete a self-study and host an on-site review five years after the admission of its first class. This provides time to evaluate the program's degree of success in attaining its educational outcomes and complying with the COA standards. And then A-3 is the accreditation review for established programs. Established programs must undergo periodic review by the Council in order to be considered for continued accreditation, in order to establish that requirements of all programs must, this establishes the requirements that all programs must meet as part of the self-study and the on-site review process. So under A-3, the accreditation review for established programs, he said that each, at each program has to undergo the periodic review by the COA to be considered for continued accreditation. The program requirements are the degree seeking institution must provide evidence of regional accreditation officially recognized by the U.S. Secretary of Education to accredit institutions. So that has to be provided and then complete and submit via the online platform, the self-study form that assesses the degree of compliance with all accreditation criteria by the deadline. And the COA will provide the program with a template that they can use to put all of that information in the self-study form so that it can be, you know, added to and checked. And then once it's all complete and everything is in there and it's ready to go, then you can upload it into the COA portal and it's usually a copy and paste process. To demonstrate that the conducting institution is eligible for accreditation according to the COA policy, so there's a letter that has, that attests to that. The COA attests to the accuracy of the information that's provided in the self-study and invites the council to conduct the on-site review. And that's a letter that is appended to the self-study and it's uploaded into the portal. Submit additional documentation as requested. As I mentioned, once you submit it to the COA, they'll take a, the specialists will take a review of that and may request additional documentation. And then the on-site review will be completed. The program has an opportunity to respond to the written summary report of the on-site accreditation review and any other requested documents by a designated deadline. And then there will be fees that are required to be paid by the due date. The council's actions are to provide guidance. As I mentioned, the council is available. Each program is assigned a specialist. So if your faculty and certainly the program director knows who the specialist is, so if there's any questions or guidance is needed, they can contact their specialists. The council, again, will review the submitted self-study for completeness, may request additional information and or documentation as indicated. They will make the plans for the on-site review and evaluation by the on-site reviewers. They will provide the program with a written summary report of the on-site review, complete a staff analysis of the program's response to the summary report, and then review that documentation at a regularly scheduled accreditation meeting of the COA and make an accreditation decision. And we'll talk about what that looks like. So this is just a schematic showing kind of the process. Again, the program prepares the self-study report, submits the self-study to the COA and the on-site review team, fees are paid, the on-site review is conducted, the COA receives a summary report of the on-site review, provides that to the program, and the program can then respond to the summary report. Once that's done, there is a COA staff analysis, then it goes to a workgroup of the COA board for review, and then that workgroup makes some recommendations, and that is presented to the full COA board for review and for an accreditation decision. These are the accreditation decisions that can be made by the council. So as I mentioned previously, 10 years is the most a program can receive. That's the longest length of an accreditation is 10 years. And programs that are found to be in full compliance with no unresolved standards would receive a 10-year accreditation. If a program has some substantial compliance, there are no unresolved standards of critical concern, but there are some factors that are not in full compliance that usually results in about an eight-year accreditation. If there are multiple minor deficiencies that exist, but no unresolved standards of critical concern, so those standards that are marked with the asterisk, and or recently corrected deficiencies exist that require earlier review to determine sustainability of the changes, and or there's a history of recurrent problems within the program, that would likely result in a six-year length of accreditation. If there are plans to correct substantial deficits and or unresolved standards of critical concern in place, that's usually four years. And then if a program has substantial deficits that exist and remain unresolved, and or a question of program stability has been raised, and or multiple areas of noncompliance or standards of critical concern remained unresolved, that would be two years. So obviously, programs want to strive to make sure that they're in full compliance with the standards, and the hope is that we'll get a longer accreditation decision, so you always would strive to be in full compliance. But again, there's opportunities to resolve some of these things during the process, so you would work with your specialist at the COA. S6 is the policy regarding the self-study, so as we mentioned, programs are required to complete a self-study as requested by the council for the purpose of measuring their progress toward complying with established program objectives and the requirements in the standards. So for the self-study, the program requirements are to encourage participation of the entire faculty, and also administrative officers, students, persons within communities of interest, or others who can contribute to the analysis of the program. And as I mentioned, this process should begin at least a year in advance. It is quite a process, and it does take, you know, quite a large amount of time, especially for faculty and or program administrators who still have all of the other requirements that we face every day that we have to meet and our day jobs, so to speak. So a good year is needed to pull and to do the writing of the narrative and to get the appendices together or the supporting documents. The program should utilize the council's self-study documents as the format for self-evaluation when applying to attain or retain accreditation. So again, that is sent to you by the council and the template is all there for you to put the narrative in. To complete the written self-evaluation study according to the directions from the council, to document compliance with the standards for both traditional and distance education offerings and to submit copies of the electronic self-study form and all supporting documents on or before a date to be sent by the council. So the council will give the program administrator the deadline for submission. And that is a pretty hard deadline because again, they're very lengthy documents and there are a lot of supporting documentation that goes along with it. And so it does need to be submitted on time so that the council has a chance to take a look at it and to request any additional information that is needed. And then obviously the reviewers who are coming to do the on-site review need to have enough time to fully review the self-study. So now we'll go through the standards here. As I mentioned, there are 152 standards. They're grouped into A, B, C, D, E, F, G and H. So these are what we call the A standards. They're the conducting institution standards. So the self-study narrative has to address the 13 standards that fall under the A standards. A1 is the mission and philosophy of the conducting institution. Governing body promotes educational excellence and supports the nursing anesthesia program within a doctoral framework. A2 is that there is an alignment of the mission and philosophy of the institution and the program. A3, and you see the asterisk there means it's a critical concern that the conducting organization completes a legally binding written agreement that outlines expectations and responsibilities of all parties when an academic affiliation is established or two or more entities with unshared governance enter into a joint arrangement to conduct a program. So if that is the, there are agreements in place that demonstrate that. A4 is that the amount of advanced standing or transfer credit awarded by the degree granting institution is clearly stated and publicized. A5 is that the governance structure facilitates effective communication. A6 is that the program administrator or designated individual participates in institutional planning, curriculum design and review or other appropriate governance roles. A7 is regarding the institution or programs committee structure, that it's appropriate to meet the objectives of the programs and that it includes public, student and faculty participation. And there is a glossary definition for a public member that it's very important programs take a look at because it cannot be somebody who is an actual healthcare provider. So you definitely need to take a look at that and make sure that that public member is participating actively in some, one of the committees of the institution or program. A8 is sufficient time to permit faculty to fulfill their obligations to students, including clinical and classroom teaching, counseling and evaluation and advising on doctoral level scholarly activities. And there is also a presentation available to you on scholarly work and doctoral programs. And this standard is mentioned in that presentation. There's a glossary definition for scholarly work oversight that it's important to take a look at. Continuing on with those A standards, A9 is that there's sufficient time, sufficient protected time to permit faculty to fulfill their own scholarly activities, service, administrative and clinical responsibilities. And there is a glossary definition to protect the time. And it's important to note that whenever there is a glossary definition, that is really meant to provide guidance to you to make sure that in your narrative, you're covering everything that's needed to be covered in that documentation. A10, as you can see here, has an asterisk. It's a critical concern. Program resources are adequate to support the size and scope of the program to prepare students for practice and to promote the quality of graduates. And this means that the program has to demonstrate adequate financial, physical, learning resources, adequate faculty resources, adequate support personnel and adequate student services. And there's also a glossary definition there. So all of those things need to be provided documentation that the program has those resources that are adequate. A11 is that the program seeks COA approval before increasing class size and demonstrates reasonable assurance that there are adequate resources. So if you're not aware, COAs have an established class size that they've gotten approval from the council for. So if the program decides it wants to increase the number of students that it's taking, it has to seek approval by the council. A12, that programs act in accordance with the COA policy and procedures. And then A13 is evidence that eligibility and certification requirements are maintained by institutions or programs relying on the council's accreditation to participate in Higher Education Opportunity Act, Title IV programs, et cetera. And again, there's a glossary definition there. The B standards are considered the faculty standards. So we'll go through those. The first eight refer to the program administrator. B1 is that the program is administrated by a doctorally prepared CRNA who has leadership authority and accountability to administer the program. B2 says the program administrator's doctoral degree has to be from an institution of higher education that was accredited by an agency official recognized with the U.S. Secretary of Education to accredit institutions at the time the degree was conferred. And there is a glossary definition there. B3 is that the program administrator is experientially qualified to provide leadership to the program. Again, a glossary definition there. B4 is that the program administrator is full-time. A glossary definition is there as well. B5 is that the program administrator has a current license or privilege to practice as a registered professional nurse and or APRN in the state or territory of jurisdiction of the program. There are definitions there as well. B6 is that the program administrator is currently certified or recertified by the National Board of Certification and Recertification for Nurse Amnesticists. B7 is that the program administrator has the authority to prepare and administer the program budget. And D8 is that the program administrator demonstrates knowledge of environmental issues that may influence the program and nurse anesthesia practice by engaging in professional development. And then the next standards here are specific to the assistant program administrator and they mirror those of the program administrator. B9 is that they are doctorally prepared and experientially qualified to assist the program administrator and to assume full leadership responsibilities in the absence of the program administrator. See the definition there. B10 speaks to the degree and having to be from an accredited institution of higher learning at the time the degree was conferred. B11 requires the assistant administrator to have a current license as an APRN and or APRN, as an RN and or APRN, excuse me. B12 is the current certification or recertification by the NBCRNA. And then B13 is demonstration of the knowledge of environmental issues. Okay, continuing on with the faculty standards for the CRNA faculty. B14 says that didactic faculty must meet the governing body's requirements for teaching doctoral level courses. B15 speaks to the need for current licensure as an RN and or APRN in compliance with state law. B16 is the current certification or recertification by the NBCRNA. B17 says that core CRNA program faculty, including the program administrator, assistant program administrator and course directors must have formal instruction and curriculum evaluation and instruction. And there are online courses offered by the ANA that meet those requirements. B18 says that only CRNA and anesthesiologist faculty may teach clinical anesthesia content. B19 says that faculty who teach clinical anesthesia content must demonstrate clinical competency. And again, there is a definition, a glossary definition that speaks to that. For non-CRNA faculty, B20, non-CRNA faculty must be academically prepared for the areas in which they teach. And there is a glossary definition for academic preparation. So for example, in my program, we have faculty from the School of Medicine who have PhDs in physiology. We also have faculty with PhDs in pharmacology who provide that content for us. So they're academically prepared for the areas in which they teach. The C standards are the student standards and beginning with selection and admission. So C1 says the program enrolls only students who by academic and experiential achievement are of the quality appropriate for the profession and who have the ability to benefit from their education. So there is a glossary definition that speaks to the ability to benefit. And then the C2 are the admission requirements, which include a baccalaureate or graduate degree in nursing or an appropriate major. Two is an unencumbered license as a registered professional nurse and or an APRN in the United States or its territories. And there's a definition there. And then the third there is a minimum of one year of full-time work experience or it's part-time equivalent as an RN in a critical care setting. And then next student participation and conduct. C3, students demonstrate professionalism including a commitment to academic and personal integrity. C4 is that they keep accurate and complete clinical experience logs that are reviewed by program faculty regularly. And there is also a glossary that is counting clinical experiences that really provides guidelines for counting clinical experiences. C5 is that students are certified in ACLS and PALS before beginning clinical activities in the program. The D standards are the graduate standards and we'll begin with patient safety. The graduate has to demonstrate the ability to D1, be vigilant in delivery of patient care. D2, refrain from engaging in extraneous activities that abandon or minimize vigilance while providing direct patient care. So that would be texting, reading, emailing, et cetera. D3 is conducting a comprehensive equipment check and D4, demonstrating the ability to protect patients from iatrogenic complications. I'll just preface before we go any further that there are lots of D standards. There are 51 D standards. So they all speak to the graduate's ability to do something and we'll speak to each of those. These are along the lines of perianesthesia. The graduate must demonstrate the ability to D5, provide individualized care throughout the perianesthesia continuum. D6, deliver culturally competent perianesthesia care. Again, you'll see a glossary definition for culturally competent. D7, provide anesthesia services to patients across the lifespan. Again, a definition there. D8, perform a comprehensive history and physical assessment. There's a definition there. D9, administer general anesthesia to patients with a variety of physical conditions. D10, administer general anesthesia for a variety of surgical and medically related procedures. D11, administer and manage a variety of regional anesthetics. And D12, maintain current certification in ACLS and PALS. And so that has to be maintained throughout the curriculum. So they have to demonstrate it before they start clinical and then it has to remain current in the program. Critical thinking. The graduate must demonstrate the ability to D13, apply knowledge to practice and decision-making and problem solving. D14, provide nurse anesthesia services based on evidence-based principles. D15, perform a pre-anesthetic assessment before providing anesthesia. D16, assume responsibility and accountability for diagnosis. D17, formulate an anesthesia plan of care before providing anesthesia. D18, identify and take appropriate action when confronted with anesthetic equipment related malfunctions. D19, interpret and utilize data from non-invasive and invasive monitors. D20, calculate, initiate and manage fluid and blood component therapy. D21, recognize, evaluate and manage the physiological responses coincident to the anesthesia. D22, recognize and appropriately manage complications that occur during the provision of anesthesia. D23, use science-based theories and concepts to analyze new practice approaches. D24 is to pass the national certification exam administered by the NBCRNA. And then there are standards regarding communication. The graduate must demonstrate the ability to D25, utilize interpersonal and communication skills that result in effective exchange of information in collaboration with patients and their families. And then use the same regarding interpersonal communication skills resulting in effective interprofessional exchange of information in collaboration with other healthcare professionals. D27, respect dignity and privacy of patients and maintaining confidentiality. D28, maintaining comprehensive, timely, accurate and legible healthcare records. D29 is the transfer of the responsibility of care of the patient to other qualified providers in a manner that assures continuity of care and patient safety. And D30 is teach others. For leadership, the graduate has to demonstrate the ability to D31, integrate critical and reflective thinking in his or her leadership approach. D32, provide leadership that facilitates intra-professional and interprofessional collaboration. And then there are those that speak to the professional role. The graduate must demonstrate the ability to adhere to the code of ethics for CRNAs, interact, D34, interact on a professional level with integrity. D35, apply ethically sound decision-making processes. D36, function within legal and regulatory requirements. D37, accept responsibility and accountability for his or her practice. D38, provide anesthesia services in a cost-effective manner. D39, demonstrate knowledge of wellness and substance use disorder in the anesthesia profession through completion of content in wellness and substance use disorder. And there are glossary definitions for wellness and substance use disorder. D40, inform the public of the role and practice of the CRNA. D41, evaluate how public policy-making strategies impact the financing and delivery of healthcare. D42, advocate for health policy change to improve care. D43, advocate for health policy change to advance a nurse anesthesia specialty. D44, analyze strategies to improve patient outcomes and quality care. D45, analyze health outcomes in a variety of populations. D46, that speaks to analyzing health outcomes in a variety of clinical settings. And D47 is analyzing health outcomes in a variety of systems. D48 is the dissemination of scholarly work. D49 is using information systems and technology to support and improve care. D50 is using information systems and technology to support and improve healthcare systems. And then D51 is to analyze business practices encountered in nurse anesthesia delivery systems. So as you can see, the graduate standards, the D standards are the longest. So there's 51 total. So those tend to go on for a while, but hopefully for faculty who are maybe new to the faculty role, you can understand and appreciate why a lot of the content is in the curriculum for the program. E is the curriculum standards. And beginning with E1, the curriculum is designed to award a doctor of nursing practice or a doctor of nurse anesthesia practice to graduate students who successfully complete graduation requirements, unless there's been a waiver for this requirement approved by the council. And then E2, there are several sub standards in here that have to be addressed. The curriculum is designed to focus on the full scope of nurse anesthesia practice, including 2.1 is the courses. So there has to be a course in advanced physiology, pathophysiology, advanced pharmacology, and advanced principles in nurse anesthesia and health assessment. So advanced physiology, pathophysiology, advanced pharma, basic and advanced principles in anesthesia and advanced health assessment. So there must be courses in each of those. And then 2.2 speaks to the content and includes the specific contact hours required for that content. So for advanced physiology and pathophysiology must have 120 contact hours, advanced pharma 90, basic and advanced principles 120, research 75, advanced health assessment 45. And then there has to be content in human anatomy, chemistry, biochemistry, physics, genetics, acute and chronic pain management, 12 lead EKG interpretation, radiology, ultrasound, anesthesia equipment, professional role development, wellness and substance use disorder informatics, ethical and multicultural healthcare, leadership and management, business and practice management, health policy, healthcare finance, integration and clinical correlation. So there are definitions that address that content. Typically, crosswalks are used to kind of show where in the curriculum that content is and how many contact hours are offered. I think that's very easy to help show where all of the content is covered and to make sure that you're meeting those requirements. And then 2.3 is the clinical experiences and that's those are the requirements by the COA for the specific types of anesthesia cases and skills. E3 that the curriculum meets commonly accepted national standards for similar degrees, again a glossary definition there. E4 is that it has to be three years of full-time study or longer if there are periods of part-time study. E5 is that it is composed of sequential and integrated courses designed to facilitate achievement of the program's terminal objectives. E6 is that all courses have clearly stated outcomes or objectives. D7 is that distance education, I'm sorry, E7 is that distance education programs and courses satisfy accreditation standards and achieve the same outcomes as traditional educational offerings. And E8 is that the curriculum requires the student to complete scholarly work that demonstrates knowledge and scholarship skills within the area of academic focus. And again, there are definitions there for scholarly work and scholarship skills. E9 is that the clinical curriculum provides students with experiences in the perioperative process that are unrestricted and promote their development as competent nurse anesthetist. E10 is that the program provides opportunities for students to obtain clinical experience outside of the regular clinical schedule by either call experiences or off-shift scheduling. And there is a glossary definition there. E11 is that simulated clinical experiences are incorporated in the curriculum. Again, a glossary definition there. E12 is that the program designs when appropriate an experimental or innovative curriculum that enables graduates to attain certification in a specialty, and there's a definition there. And for this one, E12, not all programs have an experimental or innovative curriculum, so you would have to make the decision regarding that. The F are the clinical standards. The F standards are the clinical site standards. F1 is that the program demonstrates sufficient clinical resources to ensure graduates individually meet all accreditation requirements. F2 is that there are legally binding contracts with clinical sites that outline expectations and responsibility of both parties. F3 is that the program appoints a clinical coordinator for each site who possesses a master's degree, that's the minimum, or doctoral preparation is preferred to guide student learning. And it's important to note that an anesthesiologist may serve in that capacity. If the clinical coordinator does not have a master's or a doctoral degree, the program has to receive approval by the COA. F4 is that the program demonstrates the educational environment at all clinical sites is conducive to student learning. F5 is that the supervision at clinical sites is limited to CRNAs and anesthesiologists institutionally credentialed to practice and immediately available for consultation. And there is a glossary definition there as well. F6 is that clinical site orientations are provided that outline role expectations and responsibilities of students and identify available learning resources. And this is something that I think sometimes programs struggle because when students are completing their evaluations that the council sends out, clinical site orientations are going to vary depending on the individual institution. So for example, you may want to provide some information to the students that they can have as a resource that is like an initial orientation. Because when they get to the clinical sites that may be brief, it's not going to be like their orientation when they got their new job in the critical care unit. It's quite different. So just make sure that students are aware that that orientation is going to be. It may just include where things are at the particular institution or a tour. But the program can provide some kind of an orientation prior to the students actually going to the clinical site. F7 is that the supervision ratio of students to instructor ensures patient safety and it takes into consideration the complexity of the anesthetic surgical procedure or the comorbidities associated with the patient as well as the student's knowledge and ability. So their level in the program. And at no time can the number of students directly supervised by an individual clinical instructor exceed two to one. F8, the program restricts clinical supervision in non-anesthetizing areas to credentialed experts who are authorized to assume responsibility for the student. So a credentialed expert. And then F9 is a student time commitment that it consists of a reasonable number of hours that does not exceed 64 hours per week. And that glossary definition speaks to what is accounted for in that time commitment. So what the council is looking for, it's their clinical time and their time in class and or other activities that are program related. The G standards are the policy standards and G1 is that there are accurate cumulative records of educational activities of the student. G2 is that truth, the program demonstrates truth and accuracy as evidenced in recruiting and admission practices, academic calendars, catalogs, publications, grading, and advertising. G3 is that the following are published annually. So the program is required to annually publish information about the program's accreditation status, the specific academic program covered by the accreditation status, the name, address, telephone number, and the URL of the council and accreditation. And then the most recent graduating class, the program has to publish attrition rates, employment within six months of graduation, and the first time pass rate on the NBCRNA MCE. G4 is that policies and procedures that are fair, equitable, and do not discriminate are defined. And then there's a glossary definition for non-discriminatory practice. G5 is that policies and procedures regarding academic integrity are defined and used in all educational activities. So here are your handbooks, your student handbooks, your faculty handbooks, and that you follow your policies and procedures. That there are policies that outline the procedures for student discipline and dismissal, that the program demonstrates that it processes complaints, grievances, and appeals in a timely and equitable manner, affording due process for the student. And then G8 is that the program forbids the employment of nursing anesthesia students as nurse anesthetists by title or function. So again, your policies are very critical, and we want to make sure that they address all of these. H are the evaluation standards. So H1 is regarding the systematic evaluation plan, that the program has a systematic plan for continuous self-assessment that incorporates the following. So it has to incorporate formative and summative evaluations of each student that are conducted for the purpose of counseling students and documenting student achievement, and that there's a terminal evaluation that demonstrates student achievement of the graduate standards, those D standards 1 to 51, that there's an established assessment procedure to verify competence and scholarship skills relative or relevant to the area of academic focus. So how do you, based on that glossary definition, evaluate or verify competence and scholarship skills, and then that faculty advising provides students with ongoing feedback, both informal and formal. And so just for an example for the faculty advising, depending on what kind of tool you use to document your faculty advising, submitting an example of that would be sufficient. And then 1.2 is that students evaluate the quality of courses, didactic instruction, clinical insights, clinical sites, excuse me, clinical instruction, teaching and learning environment, advising and mentorship, and their own achievement, so a self-evaluation. And then continuing on that students evaluate the program, including the instructional and program resources, the student services, and the curriculum. 1.3 is that faculty evaluate the quality of faculty services, the program, and their own contributions to teaching, practice, service, and scholarly activities, so that faculty do a self-evaluation. 1.4 is that alumni evaluate the quality of the program and their preparation to enter anesthesia practice. And then 1.5, that employers evaluate the performance of recent graduates. And then 1.6, the outcome measures of academic quality include looking at student attrition, NBCRNA pass rates and mean scores, employment rates, and then any other measures of academic quality that the program is using. So there is a glossary definition for academic quality. So as you can see, there's a lot of things that the program has to demonstrate that they evaluate and use that evaluation for quality improvement. Which leads us to H.2, that the program utilizes evaluation data, including the data from the systematic plan for continuous self-assessment to monitor and improve program quality and effectiveness, monitor and improve student achievement, monitor and improve student advising, and monitor compliance with accreditation requirements. And if they see that there's something that's not in compliance, that they initiate corrective action should non-compliance be present. So a lot with those standards, again, there's a lot of standards and categorized into those eight different categories, A through H, that you have to address. But again, this is not meant to take the place of a self-study workshop. The COA offers self-study workshops that program administrators and faculty who were going up for or getting ready to work on a self-study and have an on-site review coming up, they should attend that self-study workshop because there's going to be extensive information provided on how programs can demonstrate compliance with each of these standards. This is just strictly meant to provide you with an overview of the self-study process and what is required so that when you do attend one of those workshops, you're prepared for what's going to be covered in that workshop. So now we're going to talk about some of the policies that kind of revolve around the self-study process. S13 is a student evaluations. So student evaluations are compiled by the COA staff or a COA consultant and student anonymity and confidentiality must be ensured as such compilations will be made available to the program as part of the review process. So at the midpoint of accreditation cycle, so if you had a 10-year accreditation at the mid point of that, so at five years, the COA sends out faculty and student evaluations and then these same evaluations are sent just prior to an on-site review. So the purpose of these evaluations are to provide nurse anesthesia students with anonymity and confidentiality in program evaluation to develop a mechanism by which program administration and faculty can receive feedback regarding student evaluations and provide an opportunity to make meaningful improvement to the program as indicated and to facilitate a review of a composite of student evaluations by all parties involved in the accreditation process. So again, the council will look at those evaluations. The results of those evaluations are provided to the program, but the evaluation is actually a link. The COA provides the program with specific codes, I guess, for lack of a better word that are sent to each particular student. So the program does not, anonymity and confidentiality is maintained and the student goes to the link that's provided by the COA and the program is kind of removed from that evaluation. The results, again, go straight to the COA's consultant or whoever's going to compile their results and then once that's done, it's sent to the program. So it does give the students an opportunity to provide an anonymous evaluation of the program. O2 is the policy regarding the on-site review. The council will assign on-site reviewers to conduct periodic on-site reviews of accredited programs for the purpose of amplifying, clarifying, and verifying the self-study. And on-site reviews will also be conducted of programs that have completed a self-study for capability review. So if it's a new program that is in capability review or that new program after graduation of the first cohort, and we talked about that in the beginning. Supplemental on-site reviews may be requested at any time and their on-site review team includes both an educator and a practitioner member that are represented on each review team. During the on-site review, the program requirements include notifying the COA in writing if there's a reason to request substitution of a reviewer, if there's some kind of a conflict of interest identified. The program is also required to participate in all phases of the on-site review openly and honestly to afford the on-site reviewers the opportunity to talk with faculty, the entire student body, and administrative staff. And these, when the on-site reviewers are are on-site and and have these meetings, the program administrator is not included in that meeting. More than one reviewer must be present for each conference or the conference has to be taped. And then the attendees at student and faculty conferences are limited to on-site reviewers and students and or faculty. So again, program administrator is not included in that. If their on-site reviewers are meeting with students, it's only the on-site reviewers of the students. The program administrator may make an introduction and then may leave. The same with the faculty members. Again, the program administrator usually steps out a bit that the on-site reviewers can meet with program faculty. And then they also may want to meet with other core faculty within the school. So not the nursing anesthesia faculty, but other faculty members who teach within the program. Also, the reviewers program has to afford the reviewers opportunity to observe students in the clinical area, to document compliance with the standards, and to have sufficient data available. So usually a resource is resource room is set up. And again, there are in that self-study, it kind of tells you what materials need to be submitted with your self-study as supporting documentation, or that that information or documentation that should be available on-site for the reviewers. So in, for example, I set up a resource room and have everything in binders and available to the reviewers, including student records, clinical site records, et cetera. The council's action are to assign the reviewers, and again, educator and practitioner representation and avoid conflicts of interest. The council will also determine the length of the review, and that'll be based on the size of the program and the number and the location of affiliates. So where are your clinical sites? And the council also work with the reviewers to determine, and or the program to determine which clinical sites are going to be visited. The on-site reviewers examine the program self-study and the supporting documentation that is submitted. They also review the clinical sites and the academic affiliates and the resources, and then they conduct the on-site review. Sometimes the clinical sites that are going to be visited are based on the evaluations that are sent to the students and the faculty prior to. And then S14 is a summary report of the on-site review. At the completion of an on-site review, the chair reviewer and the team reviewer will give an oral presentation of the team's findings to the community of interest. That will typically include all of your nurse anesthesia faculty, administration of the school and students should all be included. When I just recently had my on-site review, although I couldn't have all students there because I have students who had to be out of clinical for the meetings with the on-site reviewers, as many students who were within a driving distance of the program were released from clinical to come to the, to the, hear the oral presentation of the summary report. I think that's really important for the students to participate in that as well. And then the outline contained in the council summary report of on-site accreditation review will be followed. The final written version of the summary report will be sent, will be sent to the program for response after the on-site review. So it'll go to the council. It'll then be sent to the program who has an opportunity to respond. So in summary, programs should always contact their COA specialist for any questions or for guidance needed regarding the development of the self-study. And this presentation is strictly just a high level overview of the self-study process. Programs are strongly encouraged to have administrators and faculty members attend the COA self-study workshop. You know, prior to prior to initiating the self-study process, I think it's extremely helpful, you know, to do that, you know, before you begin the process, if possible, or sometime during the process to make sure that you understand the requirements of what needs to be included in the narrative response to each of the standards, as well as what supporting documentation needs to be appended to the self-study when you submit it to the COA. So thank you for your attention. I hope you found this presentation to be helpful and just kind of letting you know what needs to be included in your self-study documentation and how that on-site review process is conducted. And again, if you have any questions, my information is included in Educator Edge, and I'm happy to offer any response. And finally, I strongly encourage you to review the accreditation, the COA's accreditation policies and procedures, and the COA's practice doctorate standards to definitely review those because this is strictly just a supplement to that, but hopefully it was helpful. And thanks again.

Council on Accreditation

nurse anesthesia

self-study process

accreditation standards

Laura Bonanno

COA policies

on-site review

quality education

certification eligibility

continuous improvement