Interdisciplinary CWS, 5 Years Later, The

Advances in Skin & Wound Care, Sep 2004 by Eisenbud, David, Hettrick, Heather, Evans, Chet, Simman, Richard

Wound care is assuming increasing significance worldwide as the population in industrialized countries ages and the incidcnce of diseases that increase the risk of nonhealing-such as atherosclerotic cardiovascular disease, stroke, and diabetesrises. Over the past 2 decades, the management of patients with wounds has evolved rapidly, emerging as a science-based subspecialty with its own journals, symposia, and membership organizations. The subspecialty embraces but is nonetheless distinct from general nursing; physical therapy; internal medicine; dermatology; podiatry; and general, vascular, and plastic surgery. Marketing officials of a wound management product supplier claim as many as 20,000 health care providers from various disciplines may be involved in wound management as a regular part of their clinical practice.

Patients, health care providers, insurance companies, and society as a whole benefit from the growing number of educational programs and appropriate certifications in wound management. Certification of expertise or knowledge in wound care is available through several organizations. Each is designed for a distinct subgroup of providers and requires its own level of experience and intellectual rigor. The American Academy of Wound Management (AAWM) has administered its Certified Wound Specialist (CWS) examination to more than 1500 multidisciplinary professionals over the past 5 years.

The explosion of knowledge regarding the biologic steps of wound healing has resulted in a flood of new advanced wound products. Much more so than in the past, today's providers face a multitude of treatment options. For that reason, it is vitally important for providers to pay close attention to the literature and be regularly involved in wound management to stay current. Some practitioners have embraced wound management as a focus of their work. For others, problem wound care has grown beyond the scope of their practice, and they may need to refer patients with difficult-to-heal wounds to specialized providers.

The Value of Certification

Certification of medical professionals in wound management serves many purposes.1 Each of the stakeholders in the wound care arena-patients, providers, and payers-benefit in different ways, Patients are assured that their provider has achieved a standard level of demonstrated knowledge in wound biology, diagnosis, and treatment. This may help providers recruit new patients. In addition, providers demonstrate to themselves and their colleagues their interest and knowledge in a specialized area of patient care. However, it is the intangible benefits, such as personal satisfaction and the respect of peers, that have been cited in many surveys of providers as important motivators for seeking certification.2 As is typical in the evolution of certification, some employers, including hospitals, outpatient wound management programs, and home health agencies, now require their wound care practitioners to be certified in the subspecialty.

Some degree of medicolegal protection may be afforded to the provider who is certified in wound care.3 As nonhcaling wounds may lead to significant pain, disability, and even amputation, the risk of litigation in this field is significant. On a macrocconomic level, society, private insurance carriers, and Medicare have some assurance that the often costly products and services for patients with wounds are appropriately allocated by those providers most knowledgeable in wound management.

Reputable certifying bodies, including the AAWM, provide directories of their diplomates to the public.4 Increasingly proactive, consumer-oriented patients may turn to such directories when seeking treatment for their problem wounds.

AAWM History

The AAWM was founded in 1995 in Miami, FL, with the mission of providing certification and promoting research and education in wound care?5-7 Although the Wound, Ostomy and Continence Nurses Society (WOCN) was already providing education and certification to nurses, this process was not available to physicians, physical therapists, and other health care providers involved in wound management. The concept of a multidisciplinary approach to the care of patients with wounds was becoming more accepted, and the AAWM's founders understood that"complete"wound care practitioners needed to master core knowledge that embraces basic medical science and multiple specialties, including nursing, physical therapy, infectious disease, nutrition, and general, vascular, and plastic surgery.

As with many nascent certification programs, the AAWM had a "grandfather" phase, during which candidates for certification were allowed to qualify for the CWS designation on the basis of their educational level, peer recommendations, and an essay outlining their participation in clinical wound management. About 400 applicants received the CWS designation during this phase. In recognition of the organization's commitment to holding itself to a high standard, the AAWM became a member of the National Organization for Competency Assurance (NOCA) at the outset.