Table 2.

Attributes of and feedback on the PHN certification model

Step	Process and principles proposed for each step	Stakeholder feedback
Application	The onus is on the applicant to provide evidence to support assessment against prescribed certification standards. Application in the form of a portfolio that is submitted electronically via an IT platform (e.g. a professional association website). This platform also provides instructions and other resources to facilitate applications. It is modelled on job application processes used in many countries. Portfolio structure would be predefined and include guidance on information and evidence required that will be used to assess suitability for recognition. Applications would have a defined portfolio template structure to facilitate consistent assessment against assessment standards. This will include three main requirements:	Five main pieces or sources of ‘evidence’ were highlighted to assist assessment (i.e. evidence of education, experience, current curriculum vitae, references and personal statements/testimonials). Electronic submission was seen as the best option. The potential for plagiarism and abuse of the system was flagged as a possible limitation. There should also be some flexibility to allow applicants to submit either in hard copy or electronically. The majority saw it as important if not essential that it was possible to submit in a candidate's native language. However, many felt that English was also important, if the main aim is to enable workforce mobility.
	•a curriculum vitae summarising qualifications and experience; •a statement by the applicant against selection criteria based on PHN competency standards (to be developed); and •references.
	Applications would be submitted in the applicant's first language. This model presupposes there is only one category of certification (yes or no).
Assessment	Assessment would involve peer review by at least two peer reviewers, similar to established journal editorial review processes. The assessment process would assess the applicant's submission and evidence portfolio against agreed standards. These standards (developed based on agreed core competencies) will be clearly articulated, precisely defined and measurable. Assessors would receive training/instruction regarding the assessment process to ensure quality of review.	There was a consensus that peer review was the most appropriate approach to use; however some challenges were identified including:
	Assessment would include consideration of evidence of required knowledge, skills and attitudes required to effectively perform PHN functions in the workplace (=competency). In situations of variable assessment recommendations from reviewers, an independent moderator would review the application and each review, and make recommendations.	•quality assurance around the recruitment of appropriate assessors and their training and support; •final approval for certification should be given by an overarching committee or board and not assessors; and •the feasibility of having measurable standards that are clear, defined, unambiguous and transferable across all countries and settings.
Certification	There are two outcomes of the assessment process, either:	Almost all respondents believed that giving feedback and guidance was an important part of any certification process. Providing information pre-application was seen as an aid to this process, although some raised concerns that it was time consuming and it might lead to appeals.
	•certification, i.e. the application is deemed to meet the required standard and therefore a recommendation is made to award certification to the applicant; or •the applicant does not meet certification (i.e. the full range or level of standard/competence required of a public health nutritionist) and further experience or underpinning knowledge is needed.
	In both cases, the outcome is fed back to the applicant. In the former where the applicant is awarded certification, he/she is told the terms and conditions as well as the period of certification. In the latter, the applicant is given detailed feedback on the strengths and weaknesses of the submission/application and advice as to what is required in order to achieve the necessary standard/competence.
Re-certification	It is recognised that an individual's competencies can lapse without ongoing professional development and practice exposure (‘use it or lose it’ principle). A regular process of external peer review and feedback is an important iterative process for professional development. After a set period of time (e.g. 5 years), certification as a public health nutritionist will expire and an individual wishing to continue to be certificated will need to go through a process of re-certification. The purpose of re-certification is to ensure ongoing competency in the range of functions/skills required of a public health nutritionist and this cannot be assured without some form of periodic verification. Therefore, the re-certification process is designed to ensure ongoing competency. The process and evidence for re-certification would be the same as for the initial certification process, and hence the same standards in terms of the range and quality of evidence that is deemed acceptable, which would be agreed by the certification body, would apply. The form of submission would also be the same as for the initial certification process.	The majority suggested 5 years as an appropriate period of time for certification to be awarded before re-certification or further review. The majority stated that re-certification was necessary to ensure credibility of the profession, continuing development and maintenance of standards of practice. There was agreement that re-certification should be a simpler process and less arduous than the initial certification. It should be based on experience gained since initial or previous certification and evidence that had previously been submitted would be ‘banked’.
Appeals	An applicant will have the option of appealing any decision and to rebut feedback from reviewers (e.g. provide further evidence). This rebuttal/appeal will be reviewed by a third reviewer not originally involved in the initial decision in order to ensure transparency in the process (similar to editors who manage authors’ rebuttals to reviewers’ comments in the journal editorial process). On review of an appeal/rebuttal, the registrar would refer the additional information to reviewers for reassessment/consideration. Decisions made by the registrar based on second-round appraisal would then be communicated to applicants with further feedback.	All respondents were in favour of having an appeal process to ensure fairness, transparency and clarify misunderstandings. The main potential weaknesses were time and resources needed to undertake appeals and the lack of consistency within and between countries.
Complaints	Complaints mechanisms are common in professional quality assurance and accountability systems used worldwide. Where practice falls below agreed/set standards then this may lead to complaints by peers, colleagues or members of the public. Anyone would be eligible to make a formal complaint which would need to be received in writing, outlining the basis and evidence relating to the complaint.	The majority agreed there was a need for a complaints procedure to assure standards are met.

PHN, public health nutrition; IT, information technology.