Biofeedback Certification International Alliance
Guidelines & Policies For Mentoring Candidates for Board Certification in Pelvic Muscle Dysfunction Biofeedback
BCIA believes that mentoring is essential to ensuring quality in the delivery of biofeedback services and that it is critical to the training of beginning biofeedback providers. This document is intended to provide a framework for mentoring of candidates for BCIA Certification. We recognize that each state has its own definitions and regulations of professionals who offer biofeedback services. Both the mentor and BCIA candidate should operate within applicable local, state, and federal laws as well as in accordance with the ethical principles of their profession/occupation. Mentoring does not substitute for supervision required for professional licensure or supervision required for insurance reimbursement.
An individual becomes a BCIA candidate for certification by submitting an application with documentation of the educational prerequisite and payment of a filing fee. Mentoring is the process of one person overseeing another person’s work. It has been a traditional way of transmitting knowledge and skills from the trained to the untrained or the experienced to the inexperienced practitioner. Mentoring also involves a relationship between a mentor and candidate that promotes the development of skill, knowledge, responsibility and ethical standards in the practice of biofeedback. Through mentoring, the candidate learns to apply knowledge to specific practice situations.
Mentoring is unique in that it can provide guidance and support that is not available through any other source of professional development. Ideally, mentoring can be a professionally rewarding experience for mentor and candidate, enhancing the quality of work and ultimately benefit the patient/client and the public.
Mentoring of BCIA Candidates
I. Obligation of the Mentor. Experienced professionals have an obligation to provide mentoring to those entering the field, thus ensuring that new providers are adequately trained.
II. Qualifications. The following criteria are required for an individual to serve as a mentor of a candidate for BCIA certification.
A. BCIA Certification
The mentor must be BCIA certified. Occasionally, because of geographic location or other special circumstances, a candidate cannot be mentored by a professional who is BCIA certified. If there is a professional available who by exceptional merit and experience would be able to provide appropriate mentoring, a special review of his/her credentials is requested prior to starting training using the Non-Certified Mentor Application.
The mentor must have at least two years experience in the practice of biofeedback specific to elimination disorders and pelvic pain.
C. Mentor Qualifications and Limitations
1. A mentor should operate within applicable local, state, and federal laws as well as in accordance with the ethical principles of their profession/occupation. Mentors should operate within the limits of their expertise, training and professional license/credential.
2. Mentorship does not substitute for supervision required for professional licensure or supervision required for insurance reimbursement. These are unique and separate contractual agreements between two professionals.
D. Professional Commitment
BCIA expects mentors to:
1. be active in the field of biofeedback and their professional area as evidenced by affiliations with professional organizations and as required for BCIA recertification.
2. be free of active sanction by a disciplinary proceeding.
3. demonstrate involvement in formalized training and participation in professional development in the practice of mentoring. This may include workshops, continuing education programs, and study of current literature.
4. have expertise with the candidate’s client population and methods of practice.
5. be knowledgeable about issues related to diversity such as race, language, culture, gender, sexual orientation, age, and disability.
6. be both technically and clinically experienced with a major time and career commitment to the field of applied psychophysiology and biofeedback.
E. Client Confidentiality
BCIA encourages clinicians to maintain HIPPA compliant communication methods for all electronic communications. This would include communications with mentors, colleagues, other professionals and insurance companies. Such compliance would include, but not be limited to, use of coded numbers in place of names, using initials, altered birth dates, blacking out identifying information, or other means of making patient identification impossible. BCIA encourages individuals to check with their employer, risk manager, or the HIPPA regulations to make certain they are in compliance.
A. The BCIA certificant should file a Mentor Application and await approval from BCIA prior to beginning clinical training. A new application should be filed for each prospective candidate.
B. BCIA strongly encourages each prospective candidate to file their certification application and have it approved prior to beginning clinical training.
C. A written agreement for mentoring should be signed by both the mentor and candidate. It should be amended and renegotiated as needed to reflect any necessary changes. The agreement should include but not be limited to the following:
1. obligations of the mentor and the candidate
2. set period of time (no more than one year) and renegotiated at the end of the time
3. a statement to abide by the ethical principles of the mentor’s profession and BCIA
4. plan to address conflicts between mentor and candidate
5. fee charged for mentoring
6. process for termination of mentoring relationship
7. an evaluation or performance appraisal should be done at specified intervals
8. format and scheduling of conflict-resolution
D. Mentoring should be documented by both the mentor and candidate.
E. We strongly advise that the mentor verify the professional liability insurance of the candidate when the treatment of patients is involved.
F. Original signatures for all phases of mentoring should be provided to BCIA.
IV. Liability Issues
Although it is rare for a mentor to be held liable for the mistakes made by the candidates, we advise prudence when the treatment of patients is involved. It is ill-advised to treat patients without obtaining professional liability insurance. In order to avoid liability problems, we strongly advise that the following risk management procedures be instituted by the mentor:
A. Monitor the candidate’s professional functioning as well as the mentoring process on a regular basis. Document all interactions.
B. Ensure that biofeedback services are performed according to accepted standards.
C. To protect patient confidentiality, a mentor should insist on an informed consent form regarding disclosure of information if the identity of the client/patient is evident.
D. Identify any practice that might pose a danger to patients/clients and quickly take remedial action.
E. Identify any inability to practice due to impairment by alcohol, drugs, illness, stress or personal problems.
V. The Mentoring Relationship
Mentors should maintain objectivity and have no conflict of interest. The mentoring relationship is important because it should promote the development of knowledge and skills and standards of care. Although the mentor is in a position of power, the candidate must be treated with respect. This position must not be used to exploit the candidate in any way, including sexual harassment.
The mentor also has an obligation to the patients/clients of the candidate, and must take appropriate action against unethical conduct of the candidate and one’s self. If the mentor believes that the candidate is unqualified to deliver biofeedback services, this must be clearly stated through an evaluation or some other appropriate method.
VI. Clinical Mentoring Requirements for BCIA Certification.
BCIA recommends that mentoring of biofeedback training with patients/clients should take place after the candidate is a pre-qualified BCIA applicant and completes didactic training through an accredited training program, unless the training is part of a degree granting program from an accredited college or university that offers course work concurrently with practicum.
All mentoring requirements may be completed through direct contact or through the use of live phone and/or web meetings. Fax and email may be used as supportive technologies to assist in the transfer of information. The only exception is the “direct observation” requirement which must be met through direct person-to-person observation.
VII. Pelvic Muscle Dysfunction Biofeedback Mentoring Requirements
The mentoring requirements involve two essential requirements: practical experience and mentoring contact hours. Mentoring should be provided by a BCIA-PMDB certified clinician or other approved professional. Mentoring as listed below may be done remotely via e-mail and telephone except for practicum/personal training hours.
A. 12 Contact Hours to review 30 patient/client sessions
The mentor and candidate are to spend 12 hours engaged in the review of a minimum of 30 patient/client sessions (sessions are 45 – 60 minutes). The candidate is required to take at least 5 patients through a full course of treatment, a minimum of 8 weeks. These contact hours may be done remotely via phone or email as agreed upon by the mentor and candidate.
Patients are to have one of the following diagnoses: fecal incontinence, constipation with pelvic floor dyssynergia (anismus), vulvodynia, levator ani syndrome, overactive bladder syndrome/detrusor overactivity, stress urinary incontinence, urge urinary incontinence, urinary hesitancy, or dysparunia. Additionally, candidates are required to treat at least one patient within each of the following categories:
1. Storage disorders (uptraining): urinary or fecal incontinence.
2. Emptying disorders (downtraining): constipation related to pelvic floor dyssynergia, urinary hesitancy, or frequency related to bladder sphincter dyssynergia.
Each session will include appropriately selected modalities of patient education, initial and follow-up surface EMG pelvic floor muscle assessments, diary review, urge suppression training, neuromuscular reeducation, therapeutic exercise, relaxation training, toileting behaviors, and prescription of a home training program with or without training devices.
The candidate will submit to their mentor all EMG pelvic floor muscle assessment data, progress notes, and discharge summaries for a minimum of five patients with the diagnoses listed under patient contact. Candidate must have had primary responsibility for patient care.
B. 6 contact Hours – Supplemental mentoring
Six mentoring contact hours are used to expand the candidate’s scope of knowledge and training, and to evaluate the candidate’s proficiency with providing patient education.
The mentor will assess the extent of the candidate’s exposure to and experience treating a wide variety of patient populations appropriate for biofeedback assisted behavioral interventions. It is expected that candidates be familiar with and be able to treat patients with appropriate bowel and bladder disorders, as well as selected chronic pelvic pain syndromes. Based on the candidate’s needs, the mentor will assign additional tasks to supplement and broaden the candidate’s knowledge and experience base.
The following methods may be used to provide the additional educational experience and to assess the candidate’s patient education skills:
1. Case study review with the mentor
2. Case study presentations offered at national or regional conferences such as AAPB, SUNA, APA, etc. (documentation to be submitted to candidate’s mentor.)
3. Shadowing an experienced clinician in his/her setting and reporting the experience to mentor (observation of treatments, urodynamic and anorectal studies, surgeries, etc.).
4. Completing a literature search and report on a specific elimination or chronic pelvic pain disorder.
5. Role playing with the candidate being a therapist: teaching patients about biofeedback, surface EMG pelvic floor muscle assessment, normal and abnormal bowel and bladder function and pain mechanisms. When using case discussion or presentations for this additional experience, the cases should not be those used to fulfill the 30 sessions of direct patient care.
6. Reading and then discussing with the mentor specific articles, books and/or book chapters recommended by the mentor or suggested by the candidate and agreed to by the mentor to further enhance learning in a particular area of the blueprint.
7. Candidate practicing relaxation techniques while hooked up to the biofeedback equipment and then discussing his/her results/experience with the mentor. This may include the use of tapes and/or CDs deemed appropriate by the mentor.
In addition, candidates must demonstrate to their mentor an ability to simply explain to patients: pelvic floor muscle anatomy, normal and abnormal bowel and bladder function; general biofeedback, specific pelvic floor muscle EMG biofeedback; and pain mechanisms.
C. Practicum/Personal Training – 4 hours
Candidates will both conduct and personally undergo a surface EMG pelvic floor muscle assessment, surface EMG pelvic floor biofeedback training, and a relaxation exercise under on-site supervision. This requirement is often fulfilled along with didactic education workshops. If this requirement is not fulfilled during live didactic training, it must be fulfilled under direct contact with an approved BCIA mentor.