Canadian Board of Examiners
Certification Program
5.0 Assessment Instruments
General
The certification program uses assessment instruments that are derived
from the job/practice analysis and that are consistent with generally
accepted psychometric principles. The certification examinations will be
based on a professional role delineation or job analysis. According to
the National Commission for Certifying Agencies’ Standards for the
Accreditation of Certification Programs, a job analysis or role
delineation study, is defined as any of several methods used singly or
in combination to identify the performance domains and associated tasks,
knowledge, and/or skills relating to the purpose of the credential and
providing the basis for validation. A role is likewise defined as a more
specific or narrower set of knowledge and skills than may be encompassed
by the term ‘profession’ or ‘occupation,’ and may also be the focus of
certification for a particular product or service.
This professional certification is the voluntary process by which a
non-governmental entity grants a time limited recognition and use of a
credential to an individual after verifying that he or she has met
predetermined and standardized criteria. It is the vehicle that a
profession or occupation uses to differentiate among its members, using
standards, sometimes developed through a consensus driven process, based
on
existing legal and psychometric requirements.
The Board shall be considered the qualified subject matter experts as it
relates to the various assessment instruments. The Board shall review
all aspects of the assessment instruments and provide direction to as to
the recommended changes. The Board will request post examination
analysis/statistic for each question to permit the evaluation of the
appropriateness of the degree of difficulty.
The Board recognizes the requirement for the candidate to
have completed the necessary educational criteria for the role as either
a technician or technologist. The Canadian Council of Technicians and
Technologists (CCTT) has the assessment instruments in place to complete
this determination; therefore, the Candidate shall be a certified
member, in good standing, of a provincial association of engineering
technicians and technologists, recognized by the Canadian Council of
Technicians and Technologists.
The information obtained as part of the candidates application form (see
Appendix A) shall allow The Board to assess the candidate’s related
clinical experience. The Board will approve any changes to the
Application Form. The Board recognizes the requirement for the candidate
to have a minimum of 3 years full time experience as a Biomedical
Engineering or Dialysis Technologist/Technician in a clinical/hospital
environment, OR Candidates, who are graduates of a recognized BMET
post-secondary school program, accredited by the
Canadian Technology Accreditation Board (CTAB), and/or recognized by The
Board, will be allowed to count a maximum of 1 year internship period as
part of the 3 year requirement.
Examinations - BMET & Dialysis
The Board approves the examination content, based on their expert knowledge of the professional role of a certified biomedical engineering technologist or technician, as part of the development of the assessment instruments. The examination may include, but may not be limited to, questions covering topics listed below.
The Board approves the examination content,
based on their expert knowledge of the professional role of a
certified biomedical engineering technologist or technician, as part of
the development of the assessment
instruments. The examination may include, but may not be limited to,
questions covering topics listed below.
Anatomy & Physiology (multiple-choice):
A. Systems
- Respiratory, Gastrointestinal, Nervous, Circulatory, Musculoskeletal, Endocrine
B. Organs
- Heart, Lungs, Liver, Kidneys, Brain, Gallbladder, Pancreas
C. Blood
- Components, Metabolism
D. Terminology
Electronics (multiple-choice):
A. Transducers
B. Calculations and Conversions
- Hex/Decimal/Binary
C. Devices
- Passive, Active, Digital
D. Circuits
- Operational Amplifier, Power Supplies, Common Base/Emitter/Collector Transistor Circuits
E. AC Power
- Transformer, Distribution
F. Test Equipment
G. Batteries
H. Terminology
Medical Instrumentation (multiple-choice):
A. Monitoring Systems
- ECG, EEG, Blood Pressure, Pulse Oximetry, Fetal Monitor, Telemetry
B. Portable Equipment
- Infusion Devices, Syringe Pumps, PCA Pumps, Hypo/Hyperthermia, Vacuum Units
C. Life Support Equipment
- Defibrillators, Dialysis, Anesthesia Machines, Critical Care Ventilators, Balloon Pumps, Perfusion Pumps,
D. Therapeutic Equipment
- Infant Warmers, Ultrasound Therapy
E. Laboratory Equipment
- Centrifuges, Water Baths, Analyzers
F. Diagnostic Imaging
- Ultrasound, Radiographic/Fluoroscopy, MRI, CT, PET, Nuclear Medicine
G. Operating Room
- Electro Surgical Generators, Minimally Invasive Video Systems/Suites, Lasers, Tourniquets, Sterilizers, Warmers, Endoscopy
H. Information Systems
- Computers, Networks, Topology
I. Test Equipment
- Electrical Safety, Defibrillator, Electro Surgical, Physiologic Simulators, Oscilloscopes, Meters
J. Terminology
Safety & Standards (multiple-choice):
A. Electrical
- Micro/Marco-shock, Electrical Safety Testing
B. Chemical
- Material Safety Data Sheet
C. Radiation Hazards
- Light Spectrum, Types of Rays,
D. Biological
- Universal Precautions
E. Fire
- Class, Fire Extinguishers
F. Regulations, Codes and Standards
- CSA Standards
- Electromedical
- Laser Safety
- Low Pressure Connecting Assemblies (Medical Gases)
- Stability and Transport
- Canadian Electrical Code
- CCHSA Hospital Accreditation Standards
- Canadian Society For Transfusion Medicine (CSTM) Standards.
- Advancement of Medical Instrumentation (AAMI), HF 18, Electrosurgical Devices Standard
- Health Canada, Medical Devices Regulations (1998)
Troubleshooting (multiple-choice):
A. Electronic Component Level,
B. Block Level
C. Situational (i.e. User error, user training, applications)
Essays:
Pertaining to the practice and organizational management of Biomedical
Engineering Programs.
The Board has reviewed and approved the following examination content from the Critical and Supporting Competencies for the Dialysis certification examination.
Critical Competencies
1. Water Treatment for Dialysis
a) need for water purification in dialysis
b) classification of potable water contaminants
c) evaluation of feed water quality
d) system components: purpose, method of operation, rationale
for specific location in the system, maintenance, testing and
troubleshooting for the following
i. particle/depth filtration
ii. carbon filtration
iii. water softener
iv. deionisation
v. reverse osmosis
vi. UV irradiation
vii. ultra filters at point of use
e) distribution systems: importance of system configuration
(direct vs indirect feed loops), piping layout to improve water velocity
and decrease dead lags, selection of materials, methods of installation,
calculation of velocity required.
f ) disinfection and cleaning: methods used (heat, chemical,
ozone), concentrations and contact times required for effective
disinfection, rinsing protocols, testing for residual and reason for
testing
g) water quality monitoring
i. chemical (pH, conductivity,
resistivity, total hardness, free and total chlorine, iron)
ii. physical (% rejection and %
recovery, silt density index, empty bed contact time, pressures)
iii. microbiological (bacterial and
endotoxin testing)
2. Dialysis Membrane Technology
a) principles of permeability and containment of cellular
components in blood
b) membrane materials: cellulose based (modified and
unmodified), synthetic materials (PS, PA, PAN, PMMA etc.), additional
coatings example Vit E
c) manufacturing technologies: melt spinning, solution
spinning
d) definition of clearance and dialysance, differences
invitro and invivo
e) influencing factors: temperature, pressure, pore size,
convective transport
f) dialyser designs: plate and hollow fibre, changes in fibre
geometry and membrane structure
g) dialyser flow dynamics: co-current vs counter-current flow
h) requirements on housing and potting material
i) bio-compatibility of dialyser membranes, thrombogenicity,
complement activation, first use syndrome, cytokine release
j) methods of sterilization and impact on thrombogenicity
3. Basic Principles of Dialysis:
a) fluid compartments in the body: intracellular,
intravascular, interstitial
b) diffusion: diffusion coefficient (in free solution and
across a semi-permeable membrane), resistance of surface layers,
influence of molecular weight, membrane thickness, pore
size/distribution,
membrane area, KoA, clearance of water soluble vs fat soluble molecules
c) filtration: pressure/filtrate flow relation, sieving
coefficient and flux
d) osmosis: definition and understanding
e) ultrafiltration: definition and understanding of
ultrafiltration, application
f) electrical charge
g) hi-flux and lo-flux dialysers (definition, brief
explanation)
h) concentration of small (urea, creatinine, urate), middle
(B12, LMW heparin, heparin, insulin) and large molecules (myoglobin,
albumin, haemoglobin, cytochrome C) in blood
i) absolute cut-off for molecule- clearance: 10,000 Daltons
(lo- flux dialysis) and 80,000 Daltons (hi-flux dialysis)
4. Haemodialysis System Components
I. Extra-corporeal blood circuit: (excluding dialysers)
a) thrombogenicity of different
materials, sterilization of blood lines
b) protective filters: transducer
protector
c) safety devices: air detector,
clamps
d) infusion pumps (ie. heparin):
calculation of infusion rates, mathematical conversion between ml/hour
and IU/hour
e) blood pumps: types (occlusive,
non-occlusive)
f) blood pump problems: haemolysis,
pressure conditions, turbulence related to excess flow, measure of
actual vs indicated blood flow
g) special applications: neonatal and
paediatric
II. Concentrates for haemodialysis:
a) bicarbonate concentrates:
b) acid concentrates: acetic/citric
acid etc.
c) other electrolytes currently used:
additive spikes (phosphate, potassium, magnesium, calcium
d) dry concentrates: dilution ratios
e) bacteriostatic properties
f) devices for reconstitution of
concentrates & delivery systems
g) individualized dialysate
prescriptions and batch systems
III. Haemodialysis Machine Hydraulic Systems:
a) UF Control systems: balancing
chambers and flow sensors
b) Dialysate delivery systems design:
volumetric systems, conductometric (servo) feed-back systems
c) Motors, pumps, valves, regulators,
deaeration devices and relief valves:
d) Probes and sensors: temperature,
conductivity, pH, and ultrafiltration (UF), arterial and venous pressure
monitoring systems
e) Flow equalizers, heaters, heat
exchangers end-stroke-sensors, and one way/check valves:
f) Bypass function: purpose, criteria
for activation, calibration
g) UF measurement: ultrafiltration
rate, transmembrane pressure, ultrafiltration characteristics, impact of
plasma proteins, pressure conditions along a dialyser, ultrafiltration
measurement
principles
(closed circuit - intermittent, continuous), reverse ultrafiltration
h) Dialysate solutions: conductivity,
temperature, precipitation risks and remedies, pH monitoring, safety
mechanisms for detection of wrong concentrates
i) Hydraulic Troubleshooting:
principles of problem identification, , , -- troubleshooting,
maintenance, calibration repair and, documentation
j) Specialized Systems: Sorbent
dialysis systems
k) Cleaning & disinfection of
hydraulic components
5. Dialysis Electrical and Electronic
Systems
a) power distribution: AC -120V, DC, , 5V, 12V and 24V
devices - location and rationale for each type of device
b) battery backup and alarm systems
c) principles of electrical safety: ground fault interruption
d) principles of operation of sensory and control devices
e) principles of electronic troubleshooting
f) proper handling of static sensitive devices: PCBs,
integrated circuits etc.
g) interference by radio emitting devices, ie., cell phones,
other electronic devices
h) line isolation
6. Computer Systems in Dialysis
a) standards and software protocols
b) input devices, output devices
c) local area networks (LANs) and wide area networks (WANs),
machine interface
d) dialysis specific software options: renal data management
packages, treatment data base
e) criteria for purchasing decisions: type of PC, operating
system, CPU, memory, use of expansion slots and COM/LPT ports
f) software implementation strategies: Local IT consultation
7. Haemodialysis On-line technologies
a) continuous blood volume monitoring , including automated
UF control
b) access flow and recirculation measurements
c) blood temperature and thermal balance monitoring and
control
e) urea concentration and dialysis dose monitoring
f) total pool dialysate collection - aliquot method
g) blood pressure monitoring
8. Safety Standards and Directives
a) overview of standards organisations and scope of their
activities (CSA, AAMI, IEEC, etc.)
b) overview of government/health standards agencies (HPB),
relevance of DIN numbers, procedure for reporting patient side effects
to HPB
c) electrical installation (home and in-centre) and use of
electricity in patient care areas
d) water treatment for dialysis (home and in-centre)
e) dialysers and haemofilters
f) re-processing of dialysers
g) medical equipment risk classification system
h) norms and regulations on waste disposal – environmental
issues
i) environmental concerns: air quality issues, latex allergy,
perfume induced sensitivities
j) guidelines for dialysis: CSN (Canadian Society of
Nephrologists), K/DOQI (Kidney Dialysis Outcomes Quality Initiative)
k) Workplace Hazardous Materials Information System (WHMIS),
MSDS
l) universal precautions
m) quality assurance of calibration equipment
n) referencing standards
Supporting Competencies
1. Renal Anatomy/Physiology & Pathology
a) Structure of the nephron - location, important
sub-structures
b) Function of kidneys: excretion/secretion, acid-base
regulation, electrolyte balance, fluid balance, blood pressure regulation,
endocrine functions (Vitamin D synthesis, erythropoietin secretion,
production of renal prostaglandins)
c) Assessment of kidney function:
biochemical and morphological tests
d) Overview of commonly used medical terminology
e) Overview of renal failure
i. acute renal failure: description,
causes , typical course of the disease, goals of treatment
ii. chronic renal failure:
description, causes ), typical course of the disease, goals of treatment
2. Dialysis Membrane
Re-processing
a) high level disinfection vs. sterilisation methods:
heat/citric acid, peracetic acid/hydrogen peroxide/acetic acid, formaldehyde,
sodium hypochlorite
b) types of systems used: automated vs. manual systems:
applications and limitations
c) processes related to re-processing cycle: rinsing, reverse
UF, cleaning, testing dialyser performance (pressure testing, fibre bundle
volume, in vitro Kuf), disinfection/sterilisation,
storage, testing for presence,
testing for residual after rinsing, patient identification
d) risks of re-processing
e) benefits of re-processing
f) CQI (continuous quality improvement) and QA (quality
assurance) management: risk management strategies, statistical analysis of
incidents, documentation and reporting
g) safety of public and hospital personnel: exposure to
chemical agents
h) physical plant considerations: RO water supply, testing RO
water for contamination, endotoxin testing, air exchanges, holding tanks,
physical layout of re-processing unit
i) bio-compatibility of sterilisation methods, symptoms
related to bio-incompatibility
3. Treatment Modalities
a) Haemodialysis: indications for treatment, selection
criteria, overview of types (in-centre HD/acute HD, nocturnal/home hemodialysis,
self-setup dialysis centers), routine vs. single needle
dialysis,
paediatric dialysis and complications of all treatment types.
b) Peritoneal Dialysis: indications for treatment, selection
criteria, function of the peritoneal membrane, access, complications related to
treatment, types of treatment (CAPD, CCPD, IPD) types
of
cyclers, types of solutions
c) Renal Replacement Therapies:
Haemofiltration,
Haemodiafiltration, Haemoperfusion:
i.
differences from HD in configuration of blood and dialysate/substitution fluid
circuits
ii. bag and
on-line systems with pre and post dilution
iii. fluid
balance control systems
iv. warming
systems for substitution fluids
v. use of
anticoagulation (monitoring activated clotting time - ACT)
Slow continuous ultrafiltration (SCUF),
continuous arterio-venous haemofiltration (CAVH), continuous veno-venous (CVVH),
continuous veno-venous Haemodiafiltration (CVVHD) -
slow
low efficiency dialysis (SLED)
i. principles
of operation
ii.
indications for use
iii. type of
membrane used
d) Renal Transplantation: indications for transplantation,
types of transplant, criteria for recipient selection, care of donor organ,
complications of treatment
e) Conservative Therapies:
i. Renal Therapeutic Nutrition: basic
knowledge of requirements and restrictions for protein, carbohydrates, fats,
fluids, vitamins, minerals (Ca, Phosphorus, Potassium etc) assessment of
protein catabolic rate (PCR)
ii. Anaemia Management:
erythropoietin
iii. Blood Pressure Management
iv. Diabetes Management
4. Assessment of Dialysis Adequacy
a) Mathematical formulas for calculating dialysis adequacy:
i. Haemodialysis: Dialysis Index,
Urea Kinetic Modelling, standard KT/V, PRU (percentage reduction of urea)
equivalent renal clearance, dialysis product
ii. Haemofiltration: PCR, clearance
and Kt/V
iii. PD: PET (peritoneal
equilibration test)
b) Compartment models and their use in RRT:
i. Basics of compartment model
mathematics (open and closed compartment systems)
ii. Single-pool and multiple-pool
kinetic models
iii. First-order kinetics
iv. differences for protein bound
substances
c) Methods and devices for measuring adequacy of dialysis:
i. urea enzyme methods
ii. Na substitution method for urea
iii. aliquot method for pooled
dialysate collection
5. Access Assessment Techniques and Technologies
a) Types of access: fistula, vascular graft, catheters, other
access devices
b) Evaluation of blood flow through vascular access (Doppler
techniques, ultrasonic techniques, blood flow dilution techniques)
c) Recirculation measurement (concentration and dilution
techniques),
d) Impact of recirculation on dialysis efficiency (including
cardiopulmonary recirculation theory)
6. Anticoagulation
a) Coagulation cascade: review
b) Theory of anticoagulation: indications, risks, methods of
anticoagulation (systemic, extracorporeal heparinization, no heparinization - NS
flushes)
c) Types of anticoagulants: heparin, low molecular weight
heparin, citrate, coumadin
d) Interpretation of coagulation times: PT, PTT, INH, ACT
Device operation: ACT devices
7. Complications of Haemodialysis
a) Complications related to the extra corporeal circuit: air
embolism, blood leak, exsanguinations
b) Complications related to the dialysate: haemolysis,
crenation
c) Complications related to the dialyser: type 1 and 2
reactions
d) Complications related to the access: thrombosis, stenosis,
steal syndrome, aneurysm/pseudo-aneurysm, access re-circulation, needle
infiltration, access infection
e) Complications related to the therapy: hyper/hypotension,
cramps, nausea/vomiting, headache, chest and back pain, febrile reactions,
pruritus, dialysis disequilibrium syndrome, arrhythmias,
cardiac
tamponade/pericarditis/arrest, hypoxemia, stroke
f) Complications related to long term exposure to low level
contaminants and chemicals used in dialysis treatment
8. Applied Chemistry
a) Basic principles: ions and molecules, principles related
to pH, molecular weight, calculations
b) Application of principles of conductivity to dialysate
solution: analysis of solutions pretreatment and safety considerations
c) Molecular structure and function of molecules in blood:
sugars, lipids, electrolytes, amino acids, blood proteins, hormones, enzymes and
immunoglobulins
d) Normal electrolyte levels: normal values, acceptable
values in CKD
9. Applied Microbiology
a) Chain of infection
b) Pathogens in the dialysis environment: common and multiple
resistant organisms, characteristics of the organism
c) Symptoms of infection: local and systemic
d) Methods to control spread of infection by hospital
personnel
e) Aseptic technique
f) Category specific and disease specific isolation
g) Universal precautions
h) Controlling contamination of dialysis equipment & water
treatment system
10. Professional Practice
a) Criteria for professional practice: due diligence,
advanced knowledge, on-going education
b) Confidentiality and consent
c) Professional self regulation: (code of conduct),
responsibilities for reporting incompetence or malpractice
d) Roles of professional associations: provincial/national
engineering technology associations, Canadian Association of Nephrology Nurses
and Technologists (CANNT)
e) Standards of Technical Practice for CANNT
f) Cultural and gender sensitivity
Composition of Examination Assessment
Instrument
The Board acquires examination questions from the certified membership
body. A sub team of The Board is established to review the various
sections of the exam and refresh the questions using accepted
psychometric principles. The questions are reviewed to ensure:
That they are consistent with job analysis and the defined body of knowledge (section 5.4).
Those questions related to Safety & Standards specifically are worded consistently with the related section in the standard or regulation.
That there is not a double negative in the question.
That the answer can be derived without the use of multiple complex formulas.
That the question is at the appropriate degree of difficulty.
That the answer is not so obvious that the candidate can guess and be consistently correct.
That there is only one correct answer.
That there are no duplicated questions.
That there is not a bias to any specific area of the role that would provide an unfair weighting of the examination results.
Study Guides
The Board shall have a BMET and cdt study guide available of sample questions for the
candidate to review. The questions will be similar in structure to those
in the respective examinations with answers provided for reference. The question
bank may be used as the source of a question in the Study Guide on
condition that the question is not used within the current exam.