February 28, 2018
Knowledge and Professional Chaplaincy Practice
Board certified chaplains are uniquely trained to be the spiritual care specialists within health care….As integral members of the interprofessional team, chaplains uniquely contribute to the well-being and overall health of patients, their families, and health care professionals.
In the education world, there are specific definitions applied to the concept of knowledge. Content knowledge is the body of knowledge and information that teachers teach and that students are expected to learn in a given content area; it includes the facts, concepts, theories, and principles that are taught and learned in specific academic courses rather than to related skills which are also learned in order to put content knowledge into practice. In all professions, particularly health care, there is a tension between content or theoretical knowledge (“know that”) and practice knowledge (“know-how”)  in the quest to prepare students to provide effective and quality care to patients and families. Health care disciplines, with the exception of chaplaincy, have integrated the two by not only acknowledging the tension but incorporating both kinds of knowledge into their education and credentialing processes.
All other health care professions also require a knowledge-based test as a required step in obtaining licensing or certification. A list for reference is at the end of the article. Note that the list is not comprehensive for every health care professional, but covers most that are part of the multidisciplinary care team with whom the chaplain works.
For decades, chaplaincy training has relied primarily upon practice knowledge that focuses on the person of the chaplain, how he or she develops their “inner self”, and in turn how that self-growth impacts the ways in which chaplaincy care is provided. Content or theoretical knowledge – the facts, concepts, theories, and principles that are necessary to effective practice and patient benefit, have not been standardized or made consistent within the field and so cannot be standardized in chaplaincy training. Thus the ways in which this knowledge is imparted cannot be standardized or measured for their ability to produce effective chaplaincy practice. What one may learn through a didactic or workshop in one training setting is often not the same as what a different chaplain learns in another training setting and can even be completely different. For example, while one chaplain may be taught a thorough background of and a process of spiritual assessment based on research and evidence, another’s training center may place no emphasis on spiritual assessment at all and the candidate does not learn how to incorporate best practices.
Curriculum and testing that is standardized, while still leaving room for the inclusion of other areas of study, removes those inconsistencies. The lesson is clear from all other health care disciplines that when candidates are tested to measure a person’s comprehension of evidence-based content or theoretical knowledge of their field, pass objective observations of their ability to demonstrate it through practice knowledge, the person has met the requirements needed to practice in their field and will reliably provide quality care. In addition, these professionals are shown to have the same knowledge and skills in the topics essential to their profession. (See the information linked in the list at the end of this article.) As a result, consumers of the care provided by these professionals can expect and trust what their provider will know about and that they will know how to behave in certain ways and do certain things within their defined scope of practice.
To apply this educational theory to chaplaincy, the traditional processes for education and certification do not align with those of other health care professionals, which should be a major concern for all chaplains. While there have been changes in health care and other disciplines such as psychology that has led all other related professions to change their education, licensing, and certification processes, chaplaincy has not. Rather, chaplaincy has continued to hold on to its subjective processes for evaluating a candidate’s readiness and certifying them for professional practice. In many of the chaplaincy certifying organizations, candidates still choose and write the materials they submit, including verbatims of a patient encounter as they remember it and a theory paper. A gathered committee of peer volunteers – some of whom are trained in certification processes, some who are not - then reviews those documents, meet with the candidate, determine his or her readiness, and recommend whether she or he should receive certification.   Neither component – the written material by the candidate nor the committee’s process to determine the candidate’s readiness for certification, are objective; in fact they are often not consistent from one candidate or committee to another. Indeed, they cannot be consistent because there is no agreed-upon reference point of a body of knowledge that every certification process is to evaluate among these certifying organizations. Add to this variance, the fact that there are about a dozen different professional associations certifying health care chaplains in the US, none operating with exactly the same culture or process, means that employers and patients alike cannot know what to expect when a "certified" chaplain walks into their room or team meeting. All of this variance inevitably results in certified chaplains who are often unqualified to provide reliably high-quality care to patients, families, and staff.
What has been missing in health care chaplaincy certification processes is any attempt to come to a consensus among the various groups of what that knowledge should be or the testing of content or theoretical knowledge. How, then, does the profession know that it is reliably educating and certifying persons to be high-quality professional chaplains without a way of objectively measuring their knowledge and ability to apply it to their skills?
In other words, when health care regulatory agencies or health care administrators ask, as they increasingly do, how chaplains are tested to ensure they hold a common set of facts, knowledge, and skills as do other disciplines, what can be the response of the chaplaincy profession? There isn’t one, just as there is no agreed upon evidence-based answer to the increasingly common question of what value to certified chaplains bring
It is no longer enough to have a chaplaincy process that is subjective, varied, and not knowledge, content, or evidence-based nor should it be if chaplaincy wants to provide the best spiritual care possible and be fully integrated as members of the multidisciplinary health care team.
One important goal of the Spiritual Care Association (SCA) when it was created over a year and a half ago, was to address the need for chaplaincy to follow the example of other health care professions by creating a process that would mirror their more objective process to determine if a person has the knowledge and clinical skills to delivery evidence-based quality process, structure, and outcomes for spiritual care. One essential element of this effort was to develop a standardized clinical knowledge-based test as is required within other health care disciplines.
The SCA Standardized Clinical Knowledge Test was developed, following the example of other health care professions, by using international subject matter experts, evidence-based knowledge gained through research, the input of senior chaplain leaders, and the most rigorous standards. The scoring is totally objective. The test has now been determined to have a high degree of reliability. The knowledge that is tested is outlined for the candidate ahead of time and is publicly available, thus allowing educators and candidates to fully prepare without any uncertainty about the content of the Standardized Clinical Knowledge Test. For example, questions in the test include health care ethics, basics of world religious/spiritual systems, and spiritual assessment models, grief concepts and processes, and effective communication skills in working with patients, families, and interdisciplinary team members. The test is easily altered so it can be updated regularly in order to integrate new knowledge and research as it is developed.
As part of the SCA certification and credentialing processes, the Clinical Knowledge test is coupled with a Simulated Patient Encounter. These encounters are scored against a list of objective observable behaviors also derived from evidence that is shared with the candidate in advance so he or she is aware of the professional elements being assessed. Simulated patients (SP) are extensively used in medical, nursing, pharmacy, other health discipline education and increasingly in CPE programs to allow students to practice and improve their clinical and conversational skills for an actual patient encounter.   Yet they have not been a part of chaplaincy certification until the formation of the SCA.
Importantly, in discussions with regulatory agencies and administrators, the ability to describe a process that is in alignment with other health care disciplines in the demonstration of an objective testing of both content or theoretical knowledge and practice knowledge has raised the understanding, acceptance, and incorporation of chaplains who have demonstrated their ability in a manner that mirrors other health care disciplines.
Neither the online knowledge test nor the SP are proprietary. SCA has repeatedly made clear that it is very open to sharing these methods and having a dialogue about how to improve them with other certifying bodies that could easily replicate what SCA has done. Indeed we are in discussions with several associations on these topics. However despite numerous invitations to the Association of Professional Chaplains (APC), the National Association of Catholic Chaplains (NACC), and the National Association of Jewish Chaplains (NAJC), their leadership has refused to engage in dialogue, thus ignoring the need before the profession to review and improve their certification processes to mirror those of other health care disciplines, beginning with standardizing the chaplain’s scope of practice and core knowledge Doing so minimizes not only a sense of collaboration within the profession, but the ability to equip their members for success in the continually changing environment and demands of all health care settings. More importantly, it impacts the ability of chaplains to reach the ultimate outcome of their work, which is providing consistent and quality patient, client, family, and staff care.
As chaplaincy moves into the future, it ignores the standards applied to other disciplines to measure knowledge and skills together at its own peril and to the detriment of the people it serves. This will require a change in perception of how many chaplains, and indeed the profession itself, has understood itself in order to acknowledge the importance of moving the integration of spiritual and chaplaincy care forward into the future. The SCA continues to be dedicated to helping set and test the highest possible standards for health care chaplaincy and welcomes any and all who wish to partner with it in this effort.
Health Professional Testing Requirements
Rev. Sue Wintz, BCC, is Director, Professional and Community Education at HealthCare Chaplaincy Network and the managing editor of its publication PlainViews®, the preeminent online professional journal for chaplains and other spiritual care providers. She has a major role in the development, design, writing, and instruction of HCCN’s professional continuing education offerings. Sue has over 35 years of clinical, administrative, educational design, development and teaching experience in the provision of professional chaplaincy and spiritual care in health care and congregational settings. She is board certified by the Spiritual Care Association and the Association of Professional Chaplains. Sue is a past president of the Association of Professional Chaplains, and in 2013 was given APC’s highest honor – the Anton Boisen Professional Service Award.
 Spiritual Care: What it Means, Why it Matters in Health Care. 2016. HealthCare Chaplaincy Network. https://healthcarechaplaincy.org/docs/about/spirituality.pdf
 Defining Nursing Knowledge. Nursing Times. 2005. https://www.nursingtimes.net/roles/nurse-educators/defining-nursing-knowledge/203491.article
 Certification Frequently Asked Questions. Board of Chaplaincy Certification Inc. http://bcci.professionalchaplains.org/content.asp?pl=25&sl=26&contentid=26
 Certification Competencies & Procedures. National Association of Catholic Chaplains. https://www.nacc.org/certification/nacc-certification-competencies-and-procedures/
 Requirements for Board Certification. Spiritual Care Association. https://spiritualcareassociation.org/requirements-for-board-certification.html
 Simulation-based assessments in health professional education: a systematic review. 2016. Ryall, et al. J Mutlidiscip Healthc. 9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768888/
 Improving Pharmacy Student Communication Outcomes Using Standardized Patients. 2017. Gillette, et al. Am J Pharm Educ 81(6). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607720/
 Impact of standardized patients on the training of medical students to manage emergencies. 2017. Herbstreit, et al. Medicine (Baltimore). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293440/
 USMILE. United States Licensing Examination®. http://www.usmle.org/practice-materials/index.html
 ASWB. Association of Social Work Boards. https://www.aswb.org/exam-candidates/about-the-exams/exam-content-outlines/
 FSBPT. The Federation of State Boards of Physical Therapy. https://www.fsbpt.org/ExamCandidates/NationalExam(NPTE)/PrepareforExam/NPTEContent.aspx
 American Speech-Language-Hearing-Association. https://www.asha.org/Certification/Speech-Language-Pathology-Pathway-To-Certification/
 The American Occupational Therapy Association. https://www.aota.org/Advocacy-Policy/State-Policy/Licensure/How-To.aspx