FMC General Information

• Significant neonatal and early childhood central nervous system impairment is frequently ascribed to adverse events occurring during the intrapartum period. The use of electronic fetal heart rate monitoring to assess fetal well-being during labor is nearly universal throughout the United States, and is essentially the only currently available tool to evaluate the status of a fetus during that time.
• The Perinatal Quality Foundation (PQF) released an electronic fetal monitoring (EFM) credentialing tool in January 2014. It is based on EFM principles defined by national consensus. Leading US experts have been participated in its development.
• Credentialing is available to physicians, nurse practitioners, midwives, nurses, and other perinatal clinicians who are involved in the management of labor and delivery patients. The FMC is accepted by the American Board of Obstetrics and Gynecology (ABOG) for fulfillment of Category 4 Maintenance of Credentialing (MOC) requirements.
• The FMC tool measures both knowledge and judgment. Measurement of clinical reasoning is made possible through the use of Script Concordance Testing (SCT), developed more than 10 years ago by Bernard Charlin, MD, PhD of University of Montreal.
• While education and content are extremely important, there is a need for a mechanism to measure clinician proficiency. The FMC credentialing tool functions as an adjunct to education and is currently used by 47 institutes in the U.S.
• Price is available upon request.

FMC Examination Scope and Objectives

The content of the Inteleos Fetal Monitoring Credentialing (FMC) examination is consistent with the scope and standards discussed in the documents listed below:

• Macones gA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008; 112:661-6.
• American College of Obstetricians and Gynecologists. Intrapartum Heart Rate Monitoring: nomenclature, interpretation, and general management principles; ACOG practice bulletin no. 106. Obstet Gynecol2009; 114:192-202.
• American College of Obstetricians and Gynecologists. Management of intrapartum fetal heart rate tracings: ACOG practice bulletin no. 116. Obstet Gynecol 2010;116:1232-40.
• Fetal Heart Monitoring: Principles and Practices, 4th Edition. Association of Women’s Health, Obstetric and Neonatal Nurses (AHWONN), 2009.

More information about script-based concordance testing (SCT) may be found in these documents.

• Charlin B, Van der Vleuten C. Standardized assessment of reasoning in contexts of uncertainty: the script concordance approach. Evaluation & the Health Professions 2004; 27(3):304–319.
• Meterissian S, Zabolotny B, Gagnon R, & Charlin B. Is the script concordance test a valid instrument for assessment of intraoperative decision-making skills? Am J Surg 2007; 193(2):248-251.

The learning objectives (LO) for the examination are listed below. The examination contains traditional knowledge and SCT questions for each objective.

• LO1. Identify components and categorization of an FHR tracing using the 2008 NICHD guidelines.
• LO2. Characterize the trend of a Category II tracing and assess the risk involved in associated clinical situations.
• LO3. Evaluate the impact of the chosen management intervention for the Category II FHR tracing.
• LO4. Assess the risk of the clinical situation involving a Category III FHR tracing.
• LO5. Evaluate the impact of the chosen management intervention for the Category III FHR tracing.

The FMC tool is consistent with the recommendation of the National Institute of Child Health and Human Development's (NICHD) recommendation for common clinical nomenclature across clinicians. ACOG, SMFM and also the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) have adopted the NICHD standards.

Why to Consider FMC Credentialing

Communication related to electronic fetal monitoring (EFM) has been identified as a significant contributor to sentinel events. Errors and variations in interpretation of EFM tracings can result in poor, suboptimal management decisions that may contribute to subsequent neonatal encephalopathy. Thus, the Joint Commission has specifically called for adoption of a common clinical language to facilitate better communication.

Credentialing in EFM

Currently, there are numerous institutions requiring credentialing in EFM for health care providers interpreting EFM tracings on Labor and Delivery. There is little doubt that an expectation of credentialing will expand. In addition to hospital systems, many insurance companies not only require EFM credentialing but also offer premium discounts. With successful completion of the FMC exam, medical professionals can also receive credit from the American Board of Obstetrics and Gynecology (ABOG) for Maintenance of Certification (MOC) Part IV: Improvement in Medical Practice. Completion or maintenance of the Inteleos Fetal Monitoring Credentialing program may be used to maintain NCC's Electronic Fetal Monitoring (C-EFM) Certification.

Examination Overview

In effort to establish a common understanding of EFM interpretation, the Inteleos credentialing exam combines both knowledge and judgement questions to assess various aspects of EFM based on the clinical situation. This credentialing exam is a unique tool that identifies specific areas of strength and weakness in EFM interpretation by individual, institution, or professional group.

The knowledge questions (KT) take a familiar form (single answer, multiple choice). The judgement questions use an innovative approach called Script concordance testing (SCT). It tests clinical reasoning as it relates to decision- making. The SCT question format describes a clinical scenario and an initial management plan. Then as the case evolves an additional piece of specific information is provided. The examinee is then asked how the initial plan might be affected by the new piece of information. A unique aspect of the SCT question is that there is more than one acceptable answer, attempting to mirroring real clinical practice.

Additional Background and Theory on SCT

• Knowledge questions have only one clear, correct answer and are scored traditionally. They often include a fetal monitoring strip, a clinical scenario, or both.
• Judgment questions using the SCT methodology, utilize a 5-point Likert scale in the answer. As with real clinical practice there is typically more than one acceptable response. Answers to the judgment questions are scored on a weighted basis compared to responses of an expert panel.
• Examples of each type of questions appear below.

Knowledge Question:

How would you describe the decelerations in this tracing? Select all that apply.

• Early
• Late
• Variable
• Prolonged

SCT Question:

Case Context:

A 25-­‐year-­‐old G1P0 patient presents at 41 weeks in spontaneous labor. Ruptured membranes are confirmed and the initial cervical exam is 3/+1/100%/vtx. The initial FHR tracing is shown in Panel A.

Your management plan is...

Continue FHR monitoring and expectantly manage

...and then you learn the following additional information:

2 hours later, you review the FHR tracing shown in Panel B and note that the cervix is unchanged.

How does this additional information affect your thinking about the management plan?

• Strongly invalidates
• Could invalidate
• No impact
• Could support
• Strongly supports

More Information

For more information about the Inteleos credentialing exam, please email fmc@inteleos.org.

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¹ Nouh, T et. al., "The Script Concordance Test as a Measure of Clinical Reasoning: A National Validation Study," The American Journal of Surgery, Volume 203, Number 4, April 2012
² Charlin, B et. al., "The Script Concordance Test: a Tool to Assess the Reflective Clinician," Teaching and Learning in Medicine, Fall 2000
³ Charlin, B et. al., "Scripts and Medical Diagnostic Knowledge: Theory and Applications for Clinical Reasoning Instruction and Research," Academic Medicine, Volume 75, Number 2, February 2000.