Exploring Options for Certification in Wound Care

Wound care providers can avoid the cookie-cutter approach to practice by gaining advanced specialized education. This article will review several options.

In any healthcare environment today, with the blinding goal of maximizing revenue and compliance associated with billing, insurance, government and hospital regulations, it has become more challenging for clinicians to focus their energies toward the individual needs of the patients while avoiding the same cookie-cutter approach to care. With these objectives, it may appear as if the patients themselves (and the actual patient care), in terms of individual and quality outcomes, are of subordinate concern.

What does it really mean when we say “wound care”? Are wound care providers mere technicians following the manual of protocols, formularies, and reimbursement criteria demanded by hospitals, insurance companies, and the government? What should be the goal of any professional wound care clinic? What are the services they need to deliver?

Clearly, the quality of healthcare delivery starts with the quality of the providers in practice. The way we discern quality is through rigid educational, experiential, and testing measures. To that end, how important is board certification to the wound care industry? This article will discuss the following seven credentialing organizations involved in conferring and sanctioning board certifications in a wound care-related setting:

1. American Board of Wound Medicine and Surgery (ABWMS)
2. Council for Medical Education and Testing (CMET)
3. American Board of Multiple Specialties in Podiatry^TM (ABMSP)
4. American Board of Wound Management (ABWM)
5. National Alliance of Wound Care and Ostomy (NAWCO^®)
6. American Board of Wound Healing (ABWH)
7. Wound, Ostomy and Continence Nursing Certification Board (WOCNCB^®).

There are six different certification organizations that offer physician-level wound-related certifications. In the preceding list, only the ABWMS, CMET, and ABMSP are physician specific while the ABWH, NAWCO, and ABWM are open to non-physician practitioners as well. The WOCNCB is open only to registered nurses (RNs) who have earned a bachelor’s degree or higher.

The ABWMS offers a board certification that is open only to medical doctors (MDs) and doctors of osteopathic medicine (DOs). These physicians must be licensed in the United States or Canada and be board certified or eligible by a relevant primary board accredited by the ABMS, American Osteopathic Association, or an equivalent. Additionally, these clinicians must have three years’ experience of active practice in wound care or have completed the appropriate postgraduate training program and fellowship (plus pass the certification examination). The reported goal of the organization is to eventually be accredited by the American Board of Medical Specialties, but there’s no accreditation by any outside body to date. Doctors of podiatric medicine (DPMs) are not yet part of this organization. For more information, visit www.abwms.org.

The CMET is the certifying body for the credential of physician specialist in wound care. To qualify for board certifications, an applicant must possess an MD, DO, or DPM degree and license. An exam is required that covers the following areas: diagnosis and management of diabetic, venous, pressure, and ischemic ulcers; atypical skin lesions, histology of wound healing; and infection and internal medicine focusing on disease entities that impact wound healing. Newly licensed practitioners can sit for the exam after completing a three-year residency program.

Otherwise, practitioners must have had at least two years of clinical wound care experience. This organization is not accredited by any outside body. For more information, visit www.councilmet.org.

The ABMSP offers board certification in the prevention and treatment of diabetic foot ulcers (DFUs) and in diabetic footwear, as well as in limb preservation and salvage, foot and ankle surgery, and primary care in podiatric medicine. To qualify for the board certification exam in DFUs and in diabetic footwear, the applicant must possess an MD, DO, or DPM (or equivalent degree) from an approved medical school and license in the U.S. He/she must also have three years of clinical experience related to prevention and treatment of DFUs and footwear. To sit for the board certification exam in limb preservation and salvage, the applicant must be licensed as an MD, DO, or DPM (or equivalent in other countries); hold a current board certification with a recognized certification board by the respective profession; and submit a copy of the search of one’s record on the national practitioners database. To sit for the exams in primary care in podiatric medicine and in foot and ankle surgery, a two-year residency is required, as is a current DPM degree, license, and copy of the National Practitioner Data Bank report. In addition, case studies must be submitted and approved.

All board certifications offered by ABMSP are accredited by the American National Standards Institute under the International Organization for Standardization. They are also accredited by URAC^® (formerly the Utilization Review Accreditation Commission), which is the body that accredits certification-verification organizations and insurance companies according to the highest standards of operation. For more information, visit www.abmsp.org.

The ABWM offers three types of certification: Certified Wound Care Associate^® (CWCA^®), Certified Wound Specialist^® (CWS^®), and Certified Wound Specialist Physician^® (CWSP^®). These credentials, however reputable, do not differentiate themselves through specific areas of expertise, but merely different levels of expertise in relation to the other two. For instance, the CWCA requires three years of wound care-related experience as an RN, licensed practical nurse (LPN), licensed vocational nurse (LVN), physical therapist assistant (PTA), certified healthcare assistant, healthcare administrator, dietitian, sales and marketing professional, or academic researcher. Similarly, the CWS requires being a licensed healthcare professional with a bachelor’s, master’s, or doctoral degree in life sciences with three years’ clinical experience in wound care or completion of a fellowship in wound care. The CWSP is open to MDs, DOs, and DPMs who have at least three years of clinical wound care experience. They are accredited by the National Commission for Certifying Agencies. For more information, visit www.abwmcertified.org.

The NAWCO has four certifications that are open to MDs, DOs, and DPMs: the WCC^® certification (wound care certified), the DWC certification (diabetic wound certified), the OMS^® certification (ostomy management specialist), and the LLE^® certification (lymphedema lower extremity certified). If the applicants do not hold MD, DO, or DPM licensure, they must have active professional licensure among the following: RN, LPN/LVN, nurse practitioner (NP), physical therapist, PTA, occupational therapist, or physician assistant (PA). In addition, there are different pathways applicants can use to qualify for WCC certification: the education option, the additional certification option, or the experiential option. Besides professional licensure, the DWC certification requires the completion of an approved course; another accredited certification in wound care or documentation of active involvement in the care of diabetes; or in management, education, or research directly related to diabetes while actively licensed for at least two years full time or four years part time within the past five years. In addition to professional licensure, the LLE certification requires active involvement in the care of wound patients or in the management, education, or research related to wound care while actively licensed for at least two years full time or four years part time within the past five years.

OMS applicants must have practiced the equivalent of one year full time and be a successful graduate of an approved certification training course. These board certifications are not accredited by any outside organization. For more information, visit www.nawccb.org.

The ABWH offers board certifications in the following areas: PCHM (physician certification in hyperbaric medicine), PCWC (physician certification in wound care), CHWS (certified hyperbaric and wound care specialist), CHS (certified hyperbaric specialist), and CSWS (certified skin and wound specialist). All credentials require passing a written exam specific to the areas of interest. In addition, the following criteria must be met: The PCHM requires an MD or DO degree and license, primary board certification, at least 200 patient treatments within the last two years, and an approved training course. The PCWC is open to all MDs, DOs, and DPMs having a current state medical license. Also needed is verification of at least two years of clinical experience in wound care, verification of at least 20 hours of wound care-related continuing medical education credit, and membership in a professional wound care society.

The certifications of CHWS, CHS, and CSWS are open to the following professionals:

• podiatrists
• physicians
• PAs
• RNs or LPNs
• NPs
• respiratory therapists
• emergency medical technician paramedics
• hyperbaric technicians
• diver medical technicians
• medical assistants
• certified nurse aides
• life support technicians
• veterinarians.

CHWS requires at least two years in a hospital or outpatient facility as a hyperbaric technician with cross-training as a wound care assistant or equivalent with at least 500 hours per year within the last two years in this professional setting. In addition, completion of a 40-hour approved course is necessary, as is completion of core competencies in hyperbaric therapy and wound care.

Without the wound experience or training, an applicant may apply for the CHS. To attain the CSWS, the following criteria must be met: 500 hours of wound training and practice experience per year for the prior two years, 10 hours of wound- or skin-related continuing education per year within the last two years, and completion of core competencies in wound care. This board is not accredited by an outside agency. For more information, visit https://abwh.net.

The WOCNCB is also available only to RNs holding a bachelor’s degree or higher. This organization offers several different certification pathways. The educational and experience requirements for all certifications include completion of the wound, ostomy, and continence program certified by the Wound, Ostomy and Continence Nurses Society.^TM

An alternative pathway exists by completing 1,500 clinical hours and 50 continuing education units in appropriate subjects within the past five years. Upon passing the wound, ostomy, and continence exam(s) individuals receive their CWOCN^® (certification in wound, ostomy, and continence), CWCN^® (certification in wound care nursing), COCN^® (certification in ostomy care nursing), CCCN^® (certification in continence care nursing), or CWON^® (certification in wound ostomy nursing). There are also advanced practice certifications available for advanced practice nurses, a foot-care certification, and a credential for a wound treatment associate — an RN who’s trained through a certified wound nurse. WOCNCB certifications are accredited by the Institute for Credentialing Excellence^TM (formerly the National Commission for Certifying Agencies) and the American Board of Nursing Specialties. For more information, visit www.wocncb.org.

Kenneth B. Rehm is board certified by the ABMSP, for which he sits on the board of directors as treasurer. He is also a founding member and treasurer of the American College of Multiple Specialties in Podiatry and a founding member and a fellow of the Academy of Physicians in Wound Healing. He currently serves as medical director at Diabetic Foot & Wound Treatment Centers Inc., San Marcos, CA, and as medical director of the Cardiovascular, Diabetes and Limb Preservation Alliance. He may be reached at 760-744-6226.