NCCAOM Certification and Testing Program
National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM®) Fact Sheet:
NCCAOM Certification and Testing Program
The purpose of this fact sheet is to familiarize NCCAOM stakeholders with the development and administration of the NCCAOM examinations and certification programs to include:
- Intended Purpose for the NCCAOM Examinations and National Standards
- NCCAOM Test Development and Administration Standards
- NCCAOM Examination Complaint and Appeals Process
- Adopting the NCCAOM Exams to Meet State Practice Act Requirements
- Requiring Full NCCAOM Certification vs. Requiring Passing of NCCAOM Examinations
- Eligibility Requirements for NCCAOM Examination Programs
- Foreign Language Exam Administration
- Maintaining Continued Competency Through NCCAOM Professional Development Activity Requirements
- Monitoring the AOM Profession Nationally for Safe Practice
The NCCAOM examination and certification programs are based on best practices in the certification industry and meeting the National Commission on Certifying Agencies (NCCA), an independent commission of the Institute for Credentialing Excellence standards for testing and certification programs. The NCCAOM certification programs in Acupuncture, Chinese Herbology, and Oriental Medicine are all accredited by NCCA.
For additional information, please contact Dr. Kory Ward-Cook, NCCAOM Chief Executive Officer.
Intended Purpose for the NCCAOM Examinations and National Standards
Q (1). What is the intended purpose of the NCCAOM certification examinations?
A. The purpose of the NCCAOM certification exams is to assess the knowledge, skills, and abilities expected for an entry-level practitioner in the field of acupuncture and Oriental medicine.
Q (2). Are there national standards for verification of entry level competencies for licensed acupuncturists in the United States?
A. Yes. Since 1982 the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) and NCCAOM have both established national standards leading to programmatic accreditation and certification, respectively. There are over 60 ACAOM accredited programs for acupuncture and Oriental medicine (AOM) in the U.S., and the NCCAOM currently provides examinations for licensure as an acupuncturist in 43 states, plus the District of Columbia. Every acupuncture regulatory board in the U.S. except California accepts the NCCAOM certification examinations as a measure of entry-level competency for an acupuncturist to legally practice in their state. Adherence to these standards ensures the safe and effective practice of AOM in these states. More information about national standards of competency of acupuncturists can be found on the NCCAOM website. Specific information on applying to become eligible for the NCCAOM examinations and to test can be found in the NCCAOM® Certification Handbook.
Q (3). Does the NCCAOM provide the national examination(s) for the practice of AOM?
A. Yes, 98% of the states that regulate acupuncturists require NCCAOM examinations or full certification as a prerequisite for licensure. All of the states, except California, that regulate AOM require passing of two or more NCCAOM examinations or require full NCCAOM Certification in Acupuncture or Oriental Medicine. There are six states; Alabama, Kansas, Oklahoma, North Dakota, South Dakota, and Wyoming that currently do not have an AOM practice act. Please see the map titled States Using NCCAOM Certification Exams for Acupuncture Licensure. Currently, California is the only state that administers its own licensure examination. This means that AOM practitioners who pass the NCCAOM examinations and/or become NCCAOM certified in Acupuncture or Oriental Medicine (and have also met state specific requirements) can enjoy reciprocity in all states that regulate acupuncture except for California; however, 30% to 40% of newly licensed California acupuncturists also take the NCCAOM exams in addition to the California Acupuncture Licensing Exam (CALE) annually.*
* Please note that applicants for licensure may have to complete additional requirements in some states in addition to achieving NCCAOM certification or passing NCCAOM examinations. It is advised that applicants for licensure check with the state agency that regulates acupuncture in the state they wish to practice to ensure that they have met all state designated requirements. For more information, please visit the NCCAOM website for a listing of state exam requirements and state regulatory contact information.
Q (4). How does NCCAOM establish itself as a national standard setting organization and how does this benefit the states?
A. NCCAOM typically partners with acupuncture state regulatory boards when they are developing a practice act. The NCCAOM also works with the state legislature and regulatory agency staff to establish regulation that includes a national assessment tool that effectively measures the knowledge, skills and abilities required to safely and effectively practice as an acupuncturist. States recognize and accept the ACAOM and NCCAOM national standards of education and competence as established requirements for the growing profession of AOM. The AOM state regulatory boards rely on these national standards to protect their consumers from the unsafe practice of AOM by unqualified practitioners. Each of the 43 states plus the District of Columbia that require the NCCAOM examinations for AOM practitioners, as a measure of competency to practice safely and effectively, also recognize the financial and administrative benefits of requiring passage of the NCCAOM certification exams as a prerequisite for licensure of acupuncturists. This is due to the fact that all examination development and administration costs, as well as legal defensibility, are assumed by the NCCAOM.
The NCCAOM offers each of the state regulatory boards that accept its examination system the security of having all of its certification programs and its examinations nationally accredited. NCCAOM’s certification programs (Acupuncture, Oriental Medicine and Chinese Herbology) are accredited by NCCA. This accreditation assures that NCCAOM’s examinations are psychometrically validated for the appropriate breath and depth of content, as well as assure that all examination are constructed and scored based on best practices and following accreditation standards. All regulatory boards that rely on the NCCAOM examinations enjoy the advantages of state-of-the-art examination development and administration security and lessened legal liability.
Q (5). Has the NCCAOM national examination system ever been legally challenged?
A. No. The assurance of long-standing defensibility of NCCAOM’s examinations is one of the multiple reasons why 98% of the states in the U.S. that regulate acupuncturists use the NCCAOM national examination system as a prerequisite for licensure. Over the years, the NCCAOM examinations have matured into a very fair, legally defensible and reasonable examination program that test for competency of entry-level skills and knowledge. Legal action has never been brought against the NCCAOM with regard to its examinations; therefore, states who adopt the NCCAOM examinations as one of the prerequisites to licensure as an acupuncturist rely on the NCCAOM for legal defensibility of the exam or exams used for licensure. All NCCAOM certification programs for the AOM profession are accredited by the Institute for Credentialing Excellence’s (ICE) National Commission for Certifying Agencies (NCCA). This means that the NCCAOM examination development and certification processes for each of its certification programs have met all the essential elements of a nationally accredited certification program.
Q (6). What are the other reasons, besides legal defensibility, would states in the U.S. that regulate acupuncturists use the NCCAOM national examination system and how are NCCAOM examinations administered?
A. There are multiple reasons why AOM regulatory boards in the U.S. use passage of NCCAOM examinations as a prerequisite for licensure. The NCCAOM examinations are administered in highly secure professional test centers, around the U.S. and throughout the world. These professional test centers are identical and are owned and operated by Pearson VUE®. Pearson VUE offers one of the most secure exam environments in the U.S. and internationally. First, a candidate’s identity is confirmed by means of palm vein readings and photo identifications. Tight internal test administration processes, implemented at all Pearson VUE Professional Test Center sites also include camera surveillance of each test taker; and all trained proctors, who are employees of Pearson VUE, follow rigorous security protocols at all these test centers, thus cheating during the examination process is virtually eliminated. In fact, since contracting with Pearson VUE, the NCCAOM has had zero incidents of cheating or examination compromise owing to the extremely secure system that exist at the Pearson VUE Professional Test Centers.
The NCCAOM also administers computer adaptive tests (CAT) which not only improve exam score reliability, but also further reduces the potential for cheating (memorizing test questions) by minimizing test question exposure since every examinee receives a unique set of examination questions based on the test specification requirements and the tester’s response to each new test item on the exam. The CAT model also provides additional measures against cheating as candidates cannot go back and review questions once they have answered the question, which prevents them from memorizing questions. The CAT administrative model is not only a more reliable measure of competency, but also it is a very desirable administrative test model for candidates since each examination completed by the test taker can be scored in real time, and thus a preliminary “pass” or “fail” screen” is generated once the test taker completes the examination. The NCCAOM follows up with an internal quality control procedure; however, and the final test results are sent to the examinee within 5 to 10 business days. The NCCAOM generates official exam results reports which are sent directly the state regulatory boards upon the examinee’s request. The CAT exam administration model, therefore, allows for year-round testing with a location convenient to examinees. Candidates for the NCCAOM examination(s) can schedule and take their examinations as soon as they are approved to test by the NCCAOM, any day, year-round at over 230 locations throughout the U.S. and abroad to include exam sites in Europe, Canada and Asia. The NCCAOM® Certification Handbook and the NCCAOM Examination Study Guides provide more detailed information about the examination development and administration process.
NCCAOM Test Development and Exam Scoring Standards
Q (7). How does the NCCAOM examination process meet the criteria of a national exam for the practice of AOM?
A. The content of NCCAOM’s examinations is linked to extensive role delineation studies (also known as a job, practice, or occupational analysis studies) which are conducted minimally every five years. NCCAOM’s previous job task analyses are the only nationally verified practice analysis for the practice of AOM. The 2008 NCCAOM Job Task Analysis: A Report to Acupuncture and Oriental Medicine Profession is the most recently published survey, which represents AOM practitioners from all states in the U.S. including California. It is the only job analysis (e.g. occupational analysis) that represents certified and licensed AOM practitioners throughout the whole country. NCCAOM is in the process of conducting the 2013 Job Analysis Survey, which will include a sample from all licensed acupuncturists in the U.S. to include California licensed acupuncturists. The results of this survey will be made available in summer 2013. See the NCCAOM® Examination Study Guides for detailed information on development and administration of the NCCAOM exams. Exam content validation is described, as well as the exam administration process by computer adaptive testing which more accurately measures a candidate’s abilities.
Q (8). How does the NCCAOM assure that its examination development process meets the highest standards for testing possible?
A. As mentioned above the NCCAOM examination program is objectively evaluated by a third party, the ICE’s NCCA. In fact, the NCCAOM Certification programs for Acupuncture, Chinese Herbology and Oriental Medicine are currently accredited by NCCA through August, 2017. The NCCAOM is assisted by Schroeder Measurement Technologies (SMT®), a national research and psychometric services corporation that conducts professional competency assessment research, and provides examination development services and scoring of examinations for a number of credentialing programs nationwide. The NCCAOM has demonstrated over the last 30 years with its issuance of over 25,000 certificates of certification issued that it is well equipped to handle the challenges associated with the development and administration of a credible, valid and legally defensible examination system for the acupuncture and Oriental medicine profession.
Q (9).How does NCCAOM ensure that their examination scoring process is fair and valid?
A. The NCCAOM follows best practices for testing agencies with regard to reliable scoring which is both fair and valid. First, the NCCAOM relies on an appropriate group of subject matter experts (educators, practitioners and administrators) to participate in the standard setting activities which determine the cut score for each examination administration.
The NCCAOM provides two informative publications on how the NCCAOM exam scores are determined: General Considerations for Setting a Passing Standard and Equating and Scaling: Assuring the Highest level of Fairness for Examination Programs.
NCCAOM performs a criterion-referenced based cut score process for its examination scoring. It never uses a norm-referenced process. Criterion-referenced scoring is intended to measure how well a candidate has learned and applies a specific body of knowledge and skills; norm-referenced scoring compares test takers to each other. Criterion-referenced scoring is a more fair and balanced process as it tests a candidate’s knowledge without comparing that candidate to other test takers, and as a result, scores are not affected by the pool of candidates in any one administration of the exam.
The NCCAOM is required by its accreditation standards set cut scores based on the purpose of the exam. Since the NCCAOM exams measure entry-level competency, NCCAOM subject-matter experts who set the cut score apply the cut score must apply a process which is based on what would be considered expected for an entry-level practitioner, i.e., one who is entering the profession and who has also demonstrated that he/she can practice competently and safely. Setting the cut score higher would result in a disadvantage to entry-level practitioners such as recent graduates as this process would measure the competency of a practitioner who is practicing at an advanced level.
It is also important to note that as an national certification agency, having achieved accreditation for its Acupuncture, Chinese Herbology and Oriental Medicine certification programs, the NCCAOM must adhere to its accrediting body standards, which precludes our exam development or our exam scoring process to be based on what is practiced a nationally, not regionally or by any one state. In order to achieve and meet the NCCA standards for an accredited certification and testing program, that NCCAOM cannot influence or control decisions regarding AOM educational curriculum and instruction. In fact, according to the standards set by the national center for Fair and Open Testing, as well as the NCCA, important decisions about instructors or schools should not be based solely or automatically on test scores of the students. [i] [ii]
NCCAOM Examination Complaint and Appeals Process
Q (10). Do candidates for NCCAOM examinations have any recourse if they believe that that they unjustly failed the NCCAOM exam(s)? Can they file a complaint and is their a published appeal process for challenging and exam score?
A. The NCCAOM has a very thorough complaints process for those candidates who wish to object or file a complaint about the content or wording of an examination item(s). All complaints related to the content of an exam item are reviewed by subject-matter experts serving on exam development committees responsible for developing and monitoring those test items. The appropriate NCCAOM Exam Development Committee (EDC) members expeditiously review all complaints submitted in writing, within 45 days of the candidate’s test date. The EDC can quickly make any adjustments, if needed, on the challenged exam item if the complaint is legitimate; or they can resume with the correct answer and distractors for a particular exam. Either way, the candidate is notified in writing of the exam development committee’s decision and the exam is rescored if necessary. Although test items are rarely modified, all candidates in the future receive the benefit of this added quality assurance measure.
In addition, the NCCAOM allows candidates to further appeal the decision of an EDC by filing an appeal to the NCCAOM Board of Commissioners through its examination appeals policy and procedures. This allows the NCCAOM for more transparency and checks and balances system for the examination development process. For additional information on the NCCAOM Examination Compliant and Appeals Process, please visit the NCCAOM Certification Handbook.
Adopting the NCCAOM Exams to Meet State Practice Act Requirements
Q (11). How can a national examination system such as the NCCAOM satisfy the variety of practice acts and scopes of practice for each state that regulates AOM?
A. NCCAOM’s modular examination system allows each state to adopt the exams that are tailored to its AOM practice act requirements, statues, rules and regulations. NCCAOM offers four exams for the AOM profession: Acupuncture with Point Location, Foundations of Oriental Medicine, Biomedicine and Chinese Herbology. States either require all or a portion of these examinations depending on their practice act and whether their state accepts the practice of Chinese herbology. Candidates that successfully pass each of the required exams have then demonstrated competency in each of the core areas of Oriental medicine. These candidates can then move onto completing the other licensing requirements as requested by the state. As always, the NCCAOM does have a process for offering examinations, if requested by a state regulatory board to meet that state’s licensing requirements; however, the scores for exam candidates who test as a “state candidate” for a particular state license cannot transfer their scores to another state, nor use them for certification by the NCCAOM.
Requiring Full NCCAOM Certification vs. Requiring Passing of NCCAOM Examinations
Q (12). What is the difference between states that require the NCCAOM examinations and states that require full NCCAOM certification as a prerequisite for licensure?
A. The value of NCCAOM’s certification and its examinations is demonstrated by their acceptance in 28 states that require full certification or passing of all required NCCAOM exams for Certification in Acupuncture (Foundations of Oriental Medicine, Biomedicine, and Acupuncture with Point Location) as a prerequisite for licensing acupuncturists. There are nine states that require passage of the NCCAOM Chinese Herbology exam. More and more state licensing agencies are now recognizing the importance of relying on the NCCAOM’s robust certification and recertification process to ensure that the licensed acupuncturists in their state have met and will continue to meet the necessary requirements to practice acupuncture and Oriental Medicine safely and effectively. States that require full certification by the NCCAOM as indicated on this map will best ensure that licensed AOM practitioners in their state meet recognized national standards of competence and safety in the AOM profession as set forth by the NCCAOM and have maintained their certification in good standing via the NCCAOM recertification process.
Eligibility Requirements for NCCAOM Examination Programs
Q (13). How do we know that every candidate who sits for the NCCAOM exams is qualified to take the exams?
A. NCCAOM has developed an in-depth process to verify each applicant’s education and training to make sure that each candidate has met ACAOM’s academic standards and professional competencies as set forth by the ACAOM Accreditation Manual as well as other requirements such as the Council of Colleges for Acupuncture and Oriental Medicine’s (CCAOM) Clean Needle Technique course, if applicable for the particular certification program. The eligibility qualification process includes a thorough verification of educational transcripts for domestic and foreign-educated applicants (who must first undergo credentials verification by a foreign credentials verification agency acceptable to the NCCAOM. The NCCAOM® Certification Handbook provides more details on this process of verifying foreign applicants’ eligibility for testing and certification. All candidates must meet the same nationally-set requirements in order to become eligible to sit for the NCCAOM exams. NCCAOM requires all internationally educated applicants to first have their academic transcript authenticated through one of NCCAOM’s approved foreign transcript review agencies to include American Association of Collegiate Registrars and Admissions Officers (AACRAO) and World Education Services (WES).
Currently, eligibility to sit for the NCCAOM certification examinations for the Oriental Medicine certification requires that a student to be enrolled ( applicants via formal education in the U.S. must also have their education coordinator sign off on their eligibility to test, even if they meet the NCCAOM required hours for testing. Most program administrators only approve their students to test once they have entered their last quarter or semester.) in an Oriental medicine program that is accredited by ACAOM (the Accreditation Commission for Acupuncture and Oriental Medicine), which is recognized by the U.S. Department of Education, or be a graduate of a foreign school approved by that country’s government. By requiring NCCAOM’s examination or certification as a prerequisite for licensure, state agencies can rely on the fact that only students who have completed an ACAOM-approved educational program are eligible to sit for the examination as ACAOM is the only recognized agency to accredit acupuncture programs. No other accrediting agency or institution has the expertise in the specific field of acupuncture and Oriental medicine.
It is also important to note that although NCCAOM allows documented apprenticeship as a separate route for eligibility for its Acupuncture and Chinese Herbology Certification Programs, this route is not accepted as a route for its Oriental Medicine Certification.
Foreign Language Exam Administration
Q (13). What about candidates who wish to take the exams in another language?
A. The AOM certification examinations are available in three languages: English, Chinese and Korean. To date there have been no challenges to the translation of the NCCAOM foreign language examinations. The NCCAOM takes great pride in the proper translation of its examinations. All examination questions used for foreign language examinations are first translated from English to Chinese or Korean by an independent, third-party accredited translation company. Next, the NCCAOM Translation Exam Development Committee, consisting of subject-matter experts (SMEs) who have as their primary, first-language, Chinese or Korean, provide the quality control checks (i.e., back translation of each exam question used for before administration of the exam). Finally, once the foreign language exams are administered, and before they are scored, the NCCAOM psychometrician conducts a fit-analysis for each item to assure that each exam item is functioning like the English version, otherwise it will not be used for scoring the exam. In 2011, the NCCAOM’s psychometrician and CEO were invited to make a national presentation, at the Institute for Credentialing Excellence’s (ICE) national conference, about how our organization provides the translation and equating of the translated examination items so that fairness of testing in the foreign languages can be assured.
Maintaining Continued Competency Through NCCAOM Professional Development Activity Requirements
Q (14). Are there nationally recognized continued competency (recertification) requirements for the AOM profession?
A. NCCAOM has an extensive and highly developed recertification process that emphasizes core competency maintenance and the demonstration of professional development. Core knowledge and skills in safety, professional ethics and CPR are absolute requirements of the recertification process.The NCCAOM recertification program includes relies heavily on its own professional development activity (PDA) program which has its own unique continuing education approval standards. NCCAOM requires its Diplomates to document 60 PDA points (1 PDA point is equivalent to 1 hour of active learning) every four years. For more information see NCCAOM® Recertification at a Glance. The NCCAOM Certification Services Department reviews every application for renewal of certification and verifies each piece of documentation for each application. In addition, NCCAOM staff also performs internal quality audits to assure compliance. Turnaround time for processing a recertification application is 4-6 weeks. More and more states are recognizing NCCAOM’s recertification program and accept or require all continuing education courses to be an approved PDA course. This way a state regulatory board can rely on the NCCAOM’s services to ensure the continued competency of existing licensees and to alleviate the financial and administrative burden to their state and their licensees.
Monitoring the AOM Profession Nationally for Safe Practice
Q (15). How does the NCCAOM certification and recertification requirement provide greater monitoring of AOM practitioners who cross the boundaries of safe and/or ethical practice?
A. One of the most important functions of the NCCAOM is to establish and enforce the standards of ethical practice for the AOM profession as stated in the mission of the organization. By partnering with the states to discipline certified practitioners who have violated the NCCAOM®Code of Ethics and preventing them from moving to another state that might be unaware of their violations, the NCCAOM’s Professional Ethics and Disciplinary Committee (PEDC) has the authority to evaluate complaints against Diplomates (from states, patients, or other practitioners), issue decisions and impose sanctions. This action allows states that require NCCAOM certification to further protect their consumers from the unsafe practice of acupuncture since acupuncturists who have been disciplined by the NCCAOM for ethical and/or criminal violations cannot renew their license to practice acupuncture until those sanctions have been lifted by the NCCAOM. NCCAOM maintains an active list of Diplomates who have been sanctioned for violating the NCCAOM® Code of Ethics and this is published on NCCAOM’s website and newsletter and also sent to all state regulatory agencies.
The NCCAOM® Code of Ethics and related disciplinary process is the only one of its kind in the AOM profession. The disciplinary process allows individuals to report professional misconduct directly to the NCCAOM. The PEDC and NCCAOM staff continuously meets its policy of the reviewing and determining cases within 60-90 days of the initial complaint. This disciplinary procedure ensures that states are fully apprised of any disciplinary action taken against a NCCAOM certified practitioner who has been sanctioned and the public will be also be readily informed.
The NCCAOM’s highest priority is its commitment to the public to ensure the safe practice of acupuncture and this is manifested through its mission, which is to promote nationally recognized standards of competency and safety in acupuncture and Oriental medicine for the purpose of protecting the public. As such, NCCAOM fulfills its mission by 1) establishing national standards of competency for the safe and effective practice of acupuncture; 2) evaluating each applicants qualifications through a robust eligibility process; 3) assessing candidates for certification based valid, reliable and legally defensible examinations; and 4) requiring candidates for certification and Diplomates to adhere to the NCCAOM® Code of Ethics, as well as 5) ensuring that certified practitioners maintain their competency to practice through a mandated recertification process in which certificant holders must provide documentation of professional development activities.
[i] The National Center for Fair and Open Testing (2007, August). Criterion and referenced tests fact sheet. Retrieved from: http://fairtest.org/criterion-and-standards-referenced-tests.
[ii] National Commission for Certifying Agencies (2005). NCCA standards for the accreditation of certification programs. Retrieved from http://www.credentialingexcellence.org/p/cm/ld/fid=66.