|
|
|||
  |
  |
  |
  |
|
Some of the documents on our web site need Adobe Acrobat Reader to open. All documents containing a pdf extension require Acrobat Reader. To obtain a free version from the Adobe homepage, click on the icon:
This web site is intended for use by physicians who serve as MROs and for those individuals interested in the field. We welcome your comments about this site or your questions regarding MROCC and the certification process. |
INFORMATION ABOUT THE MROCC EXAMINATION
open as a printable document The objectives of the Medical Review Officer Certification Council (MROCC) is to recognize the competence of those physicians who have developed specialized knowledge, and are proficient in the performance of the essential duties of the MRO. To this end, the MROCC examination has been designed to measure the fund of knowledge and practical skills that the MRO applies in the evaluation of workplace drug tests. MROCC is a nonprofit, independent organization supported by the American College of Occupational and Environmental Medicine, the American Medical Association, the American Academy of Clinical Toxicology, the American College of Medical Toxicology, the College of American Pathologists and the American Society of Addiction Medicine. MROCC certification is voluntary and is not a form of licensure. Under the direction of Wayne State University, the process of examination development has followed a comprehensive plan to ensure relevance, validity and reliability. Examination items have been developed and critically reviewed by nationally recognized leaders in drug testing drawn from the fields of occupational medicine, addiction medicine, forensic chemistry & toxicology and the legal profession. In addition, leading experts in educational measurement, evaluation and psychometrics have provided guidance to the process. DESCRIPTION OF THE EXAMINATION The examination consists of approximately 110 multiple choice test items, distributed by content area according to the examination blueprint, as established by the MROCC board of directors (see below). The examination intermingles recall (recognition), simple interpretation (analysis), and problem solving (evaluation) types of questions. There is also a combination of "A" type, "X" type, and "M" type items (see examples below). Scores are determined based upon the total number of items answered correctly, with no penalty for guessing. Passing scores are not determined on the basis of subcategory scores. The examinee should prepare for the examination by becoming familiar with the areas represented on the attached examination blueprint. However, this content outline is flexible in structure and subject to change to accommodate new content and shifts in emphasis. Broad based learning which establishes a general fund of knowledge and understanding of the concepts relevant to the duties of the MRO is the best preparation for this examination. A bibliography of useful references is attached to assist the MRO in preparation for the examination. As a professional MRO distinguished by MROCC certification, the physician is expected to be an expert in drug and alcohol testing and the application of federal regulations to the process. However, the expectation goes beyond a mere understanding of the mechanisms of interpreting a test and assuring proper chain of custody. The professional MRO may also be called upon to serve as a consultant to business, industry, labor, government or academia on issues relating to prevention, detection and control of drug abuse in the workplace.
A few additional comments and tips for those preparing to take the MROCC examination: > Drug testing is an expanding and diverse field. MRO training courses, through lectures and readings will cover the vast majority of questions on the exam. However, the full domain of important issues cannot be neatly packaged in any course or set of readings. > A good examination strategy is to go through the exam once at a reasonable pace without lingering on items that you are not sure about - flag those and come back to them later. > Caution: If the responses on your answer sheet get out of order for a single item, you can have a long string of incorrect responses. Thus, enter your responses carefully. > Carefully grid the score sheet, including your name and social security number. > There is no penalty for guessing, so it is to your advantage to avoid leaving any items blank. Scoring and Notification State of the art psychometric procedures are employed for scoring and the determination of the minimum passing level. Scoring
is criterion based with adjustment for the varying difficulty of each examination. Standards are set and equating is performed using similar procedures as those used by Educational Testing Service, the National Board of Medical Examiners and other certifying bodies. Within six to eight weeks after the examination, examinees will be notified by the chairman of the MROCC Board of Directors regarding their performance on the examination. Those passing the examination will receive a numbered certificate. Publication of Passing Examinees A widely distributed list of certified MROs is published by MROCC. This list assists employers and others in need of MRO services in identifying physicians who are distinguished by MROCC certification. An online MRO directory of certified MROs may be searched from this web site.
MROCC EXAMINATION CONTENT AREAS I CHEMICAL DEPENDENCY 10%
>Behavioral aspects of drug/alcohol use and abuse II REGULATORY ISSUES AND MRO RESPONSIBILITIES 40%
>MRO Role in the DOT drug testing program III TOXICOLOGY, PHARMACOLOGY AND LABORATORY ISSUES 15%
>Drugs of abuse IV CLINICAL ASPECTS 20%
>nterpretation
and verification of lab results V COLLECTIONS AND PROCEDURES 15%
>Collection procedures for urine specimens
The Medical Review Officer operates in a multidisciplinary environment in which skills and knowledge in a variety of subject areas relating to drug and alcohol testing are required. For the purpose of this examination, the subject areas are divided as Chemical Dependency; Regulations and MRO Responsibilities; Laboratory, Toxicology and Pharmacology; Clinical Aspects; and Collections and Procedures. I. CHEMICAL DEPENDENCY (10%) Although the skills of the MRO may be quite different from those of the addiction medicine specialist, the MRO must be knowledgeable about and have clinical experience in the field of substance abuse disorders. MROs may be called upon to be a general resource for substance use issues. General knowledge in the area of substance abuse will enable the MRO to:
II. REGULATORY ISSUES AND MRO RESPONSIBILITIES (40%) The MRO must be and remain knowledgeable about applicable rules including DOT Part 40, MRO guidelines, and DOT agency regulations which impact organizations for whom the MRO evaluates drug test results. The MRO is often called upon to assist clients in the implementation of legally defensible policies and programs. Therefore, the MRO must be able to advise organizations about both regulated and non-regulated drug and alcohol testing procedures. Knowledge in the area of regulatory issues and MRO responsibilities will enable the MRO to:
III. TOXICOLOGY, PHARMACOLOGY AND LABORATORY ISSUES (15%) The MRO must be knowledgeable of the toxicology & pharmacology of drugs of abuse. While the MRO is not a laboratory director, the MRO must know what goes on in the laboratory and how quality is assured. Knowledge in these areas will enable the MRO to:
IV. CLINICAL ASPECTS (20%) The MRO must be familiar with clinical issues related to drug and alcohol use and testing, including medical explanations for positive or indeterminate tests and medical qualifications for performance safety sensitive tasks. Knowledge in these clinical areas will enable the MRO to:
V. COLLECTIONS AND PROCEDURES (15%) Although the MRO does not routinely collect urine, he or she must thoroughly understand collection procedures and chain of custody issues, as well as correctable and fatal flaws. Knowledge in the area of collections and procedures will enable the MRO to:
SAMPLE TEST ITEMS: "A" type (single best answer): Each of the questions or incomplete statements below is followed by four or five response options. Select the ONE BEST RESPONSE in each case and completely fill in the circle containing the corresponding letter on the score sheet. 1. Testing for which of the following drugs of abuse is NOT required by Department of Transportation mandated drug testing programs? a. Marijuana b. Phencyclidine c. Opiates d. Barbiturates e. Amphetamines Answer: d "X" type (multiple true/false): Each of the questions or incomplete statements below is followed by four or five response options. One, more than one, or all may be correct. Select all correct responses, and completely fill in the circle(s) containing the corresponding letter(s) on the score sheet. 2. Which of the following drugs may be legitimately used for the treatment of pain and/or anxiety associated with pain? a. Marijuana b. Phencyclidine c. Opiates d. Benzodiazepines e. Cocaine Answer: c, d, e *Note that the "X" type item is essentially a multiple true-false item. While the use of this item architecture may be unfamiliar and difficult for some examinees, statistical reliability is enhanced when the "X" type items are added to the "A" type items. Examinees should note that the difficulty of each examination is adjusted in the scoring process, and that on the average, the use of the "X" type item will not reduce an examinee’s overall likelihood of passing the examination. This replaces the older "K" type item (a = 1,2&3 are correct; b=2&4 are correct, etc.), which psychometric research has determined to be unreliable. The "X" type item incorporated logical clues creating guessing advantages, and reducing the item's value in testing the subject matter. Most boards no longer use the familiar "K" type item. "M" type (matching): This section consists of a list of four or five lettered response options followed by several numbered items. For each numbered item, select the single best response option. A lettered option, however, may be selected once, more than once, or not at all. Items 3-4:
a. Marijuana b. Phencyclidine c. Opiates d. Benzodiazepines e. Cocaine 3. Frequently associated with injected conjunctivae, an odor of burning leaves and a temporary increase in appetite. 4. Commonly prescribed for the short term treatment of anxiety. Answers: 3-a; 4-d. SUGGESTED MRO LIBRARY AND RESOURCES (Revised: February, 2006) The Medical Review Officer operates in a dynamic, multidisciplinary environment. The MRO should have a general knowledge of many issues in the areas of substance use and detection. In addition to knowing about the mechanics of reporting a drug test result, the full domain cannot be neatly packaged in any single course on the subject or set of readings. Thus, although this bibliography may cover the preponderance of the material appearing on the examination, questions may also be selected from other reference sources. In general, those individuals carefully preparing themselves utilizing the bibliography should be prepared to perform well on the examination. We encourage each examinee to take advantage of the on-line resources of the Internet by reviewing the websites that are listed below and linking to sites that may provide invaluable information during preparation for the examination. Our experience is that those failing the examination may have attended a training course, but have not spent an adequate amount of time preparing by careful review of available reference material. If you plan to take the examination just after attending an MRO training course, be sure to come to the course having completed your readings and studies beforehand. In particular, it is useful to know the regulations well before attending an MRO training course. Drug testing is a rapidly changing field. While some of the older references on this list may contain much useful information, be careful to be knowledgeable of the most recent scientific and regulatory information. SELECTED REFERENCES FROM THE LITERATURE: > Diagnostic and Statistical Manual of the American Psychiatric Association – IV-R (DSM-IV-R), American Psychiatric Association, Washington, DC, 1994 (esp. section on substance-related disorders). > MRO Code of Ethics; Established by the Medical Review Officer Certification Council Board of Directors, July 15, 2003; http://www.mrocc.org/code.htm
> Graham, AW, Schultz TK, “Principles of Addiction Medicine, 2nd Edition”, American Society of Addiction Medicine, 1998. > Lowinson JH, Ruiz P, Millman RB, Langrod JG, editors, Substance Abuse: A Comprehensive Textbook, Third Edition, Williams & Wilkins, 1997. ISBN 0-683-18179-3
> Swotinsky RB, ed. MRO Update. American College of Occupational and Environmental Medicine (newsletter).
SELECTED REFERENCES FROM FEDERAL AGENCIES & DEPARTMENTS: The Substance Abuse and Mental Health Administration (SAMHSA) and the Department of Transportation (DOT) have distinct drug testing programs, regulations and jurisdictions. In general, DOT's program covers transportation sector workers, and SAMHSA's program covers Federal employees. However, DOT references certain SAMHSA requirements or guidelines for portions of its program (for example, SAMHSA certifies laboratories, and DOT requires that testing of DOT covered employees be performed in a SAMHSA certified laboratory). For more specific information, the MRO should carefully review the SAMHSA and DOT web sites.
OTHER SELECTED ON LINE RESOURCES:
>
MROCC
>
U. S. Department of Transportation, Office of Drug and Alcohol Policy and Compliance
>
SAMHSA’s National Clearinghouse for Alcohol and Drug Abuse – general information
>
SAMHSA’s Direct Division of Workplace Programs/CSAP link:
> GPO Gate - Free source of Federal Register documents
>
Occ-Env-Med-L - Occupational & Environmental Medicine for Clinicians & Public Health Professionals - List server with discussions on various topics in occupational medicine; frequently includes postings on drug testing. > MRO Testing Q&A, an on-line discussion forum about workplace drug and alcohol testing is moderated by Robert Swotinsky, http://www.occ-doc.net/MRO_information.htm
|
