Authoring Level 2 Certification Guide

1. Introduction

SNOMED CT authoring level 2 certification recognises your competence in performing advanced SNOMED CT authoring tasks. To achieve this certification, you must pass a theory and practical exam which test your competence in authoring through a range of knowledge and skills-based activities. The authoring level 2 certification guide provides information about the process of achieving your authoring level 2 certification - from enrolling in the exam, to preparing for the exam, sitting the exam, and what to expect after the exam. The guide has four main sections: Enrolment - This section explains why, how and when a candidate should enrol in the authoring level 2 certification exam. Preparing for the Exam - This section describes how a candidate can prepare for the certification. Sitting the Exam - This section provides information about the exam process itself. After the Exam - This section explains what to expect after the exam.

1.1. Authoring Certification Pathways

Appropriately skilled terminology authors are needed to maintain the quality of SNOMED CT content, as it is updated and extended to support new clinical requirements.

To ensure a high standard of consistency and quality, SNOMED International is developing a series of courses and certifications to train and certify authors.

The diagram below shows the alternative pathways through SNOMED International authoring education.

The SNOMED International authoring courses allow candidates to start developing the competencies required to become proficient authors.

• Each student who completes all mandatory components of an authoring course will receive a certificate of completion. Please note that this is not the same as an authoring certification.
• Each course provides grades and feedback for the assignments and assessments, to allow candidates to measure their performance. However, no overall grade is provided on completion.
• For most candidates, these courses will be very useful to both new and experienced authors.
• Please note that completion of an authoring course does not guarantee that you will pass the certification exam. Even though these courses are a great way to improve your authoring skills, further practice and experience may be needed to reach the standard required for certification. Feedback and grading throughout the course will be a good indicator of how much further practice and learning is needed before attempting certification.

The SNOMED International authoring certifications recognize a candidate for their authoring competencies. 

• Certification allows candidates to demonstrate that they possess the competencies required by SNOMED International.
• Each certification is valid for 3 years. To retain your certification beyond this time, you must resit and pass the certification exam (unless you hold a higher-level of certification).
• SNOMED CT Authoring Level 1 certification will be a prerequisite for those wishing to advance to a SNOMED CT Authoring Level 2 certification. 
• Completion of the SNOMED CT Authoring Level 2 course is required before attempting the SNOMED CT Authoring Level 2 certification (some exceptions maybe allowed for experienced authors on a case by case basis, please contact elearning@snomed.org).
• The competencies and knowledge you will need for the AL2 Certification exam were covered in the AL2 Course. If you have not taken the course an overview can be found in Authoring Level 2 Course Overview.

2. Enrolment

2.1. Enrolment Considerations

3. Preparing for the Exam

Please note the Authoring Level 2 Certification is split into two exams. The theory exam (3 hours) and the practical exam (4 hours). To have access to the practical exam you must first pass the theory exam (pass mark is 70% or above). You will be notified whether you have passed the theory exam by email. If you have passed the theory exam, the practical exam will be made available on your scheduled date. Each exam needs to be scheduled on different days. After you have enrolled in the authoring level 2 certification, you can prepare for the exams by following the steps below.   Read the rules, guides and competencies Certification Rules SNOMED CT E-Learning Certification Guide Authoring Level 2 Certification Guide (This Guide) The competencies and knowledge you will need for the AL2 Certification exam were covered in the AL2 Course. If you have not taken the course an overview can be found in Authoring Level 2 Course Overview. Prepare for authoring platform access Apply for a confluence account (if you don't already have one) Accept the authoring platform terms of usage (available only after enrolment) Read about accessing the training authoring platform (available only after enrolment) Schedule your exam Check your timezone settings are set correctly in your profile (Important Note) Select 24-hour slots for each AL2 certification exam, both the theory exam and the practical exam. (available only after enrolment) Request access to authoring platform Email elearning@snomed.org to request access to the training authoring platform (available only after enrolment) Please note that you must schedule your exams, accept the authoring platform terms of usage and have a Confluence account before you will be granted access to the training authoring platform. Access to the platform may be given up to three weeks prior to your exam. Practice on the training authoring platform Before you sit the exam, we strongly recommend that you practice your authoring skills on the training authoring platform. For more information please refer to the following pages: Learn how to use the training authoring platform Practice exercises (available only after enrolment) How to submit a task in the authoring platform (available only after enrolment) Technical issue resolution on the authoring platform (available only after enrolment) Prepare your proctoring setup Review Chapter 4 of the AL2 certification guide Ensure that you are using the Google Chrome browser Install the Proctorio extension on your computer  Test your proctoring setup (available only after enrolment)

3.1. Training Authoring Platform

The training authoring platform (https://training-authoring.ihtsdotools.org) is: A training version of SNOMED International's Managed Service authoring platform with similar functionality A live authoring environment Designed to author an extension known as the "SNOMEDLand" extension, with abbreviation "zz" Aligned with the Jan 2024 SNOMED International Edition

Why do I need access to the training authoring platform?

Participants in the SNOMED CT authoring level 2 certification exams will need to use the training authoring platform to 

1. Practice authoring using the platform prior to sitting the exam
2. Answer questions and perform authoring tasks for review as part of the practical exam

What are the terms and conditions for using the training authoring platform?

The training authoring platform is designed to support a live authoring environment. However, some of the features provided will not be needed for the activities in the certification, and their use may negatively impact your work or the work of other participants. For this reason, participants will be required to confirm their willingness to abide by the Authoring Platform Terms of Usage prior to being given access to the authoring platform. 

How do I get access to the Training Authoring Platform?

Participants will log in to the training authoring platform using their SNOMED International confluence account. If you don’t already have one, please apply for a confluence account here. When you do, you should respond to the question “Why do you need a Confluence account?” with the answer “Authoring Level 2 Certification”. This will ensure the smooth processing of your application.

Once you have a confluence account, and have agreed to the terms of usage, you may email elearning@snomed.org to request access to the training authoring platform. Once access is granted, the authoring platform will be available at https://training-authoring.ihtsdotools.org. Please note that you must use Google Chrome to access the authoring platform

How long will I have access to the Training Authoring Platform?

You will be given access to the Training Authoring Platform for up to 3 weeks prior to your exam.

What do I do if the training authoring platform function is not working as expected?

If you are having difficulty viewing or classifying content in the training authoring platform, try a hard refresh in the Chrome browser. This will clear the browser's cache for a specific page, and force the browser to load the most recent version of the page. To do a hard refresh:

• Window: Hold down Ctrl and click the Reload button or Hold down Ctrl and press F5.
• Mac: Hold ⇧ (shift) and click the Reload button or hold down the ⌘ (command) and ⇧ (shift) keys and then press R

If this does not fix the issue, then email elearning@snomed.org. Please provide screenshots where applicable and a detailed explanation. Please see Training Authoring Platform - Issue Resolution (visible only after enrolment) for further information.

3.2. Learning how to use the Platform

Videos

A number of short videos are provided below to demonstrate the functionality of the training authoring platform (axiom based authoring):

• Authoring Platform - My Tasks
• Authoring Platform - New Task
• Authoring Platform - Settings
• Authoring Platform - Searching
• Authoring Platform - Taxonomy
• Authoring Platform - Concept Editor
• Authoring Platform - Concept Details
• Authoring Platform - Adding a New Description
• Authoring Platform - Adding a New Concept
• Authoring Platform - Classifying
• Authoring Platform - Deleting a Concept
• Making Changes in the Authoring Platform
• Concept Inactivation in the Authoring Platform
• Authoring Platform - Review Screen Functionality

To watch a video, simply click on the link above. Most e-Learning videos offer subtitles which provide a transcription of the video script. To toggle subtitles on/off during video playback, simply click on the subtitles / closed caption button in the bottom-right corner of the YouTube playback window. Note that this is the leftmost button (underlined in red) shown in the screenshot below.

Guide

A user guide for the authoring platform is available at http://snomed.org/apug.

What is SNOMEDLand?

All authoring in the Training Authoring Platform will be conducted in the SNOMEDLand extension.

The SNOMEDLand Edition includes both the International Edition and the SNOMEDLand extension. Two language reference sets are provided:

• US English language reference set (US)
• SNOMEDLand English language reference set (ZZ)

The acceptability of all SNOMEDLand extension descriptions can be changed. However, the acceptability of US English descriptions created in the International Edition cannot be changed.

Note: For the purpose of the exam, please use the same FSN in both language reference sets, and the same Preferred Term in both language reference sets.

Classification

When a classification is complete, a label should appear at the top of the page in the task.

PLEASE NOTE : There are times when this label may not appear. It is therefore worth checking in the 'My Tasks' screen whether or not the classification process has completed. When the classification is complete, the blue bell symbol under 'Classification' will change to green for that task.

3.3. Practice Exercises

It is entirely up to you to decide how much practice you should do in the training authoring platform prior to attempting the certification exam. However, we strongly recommend that you practice as much as possible to feel confident in your authoring abilities. The following suggestions are provided to support your ability to perform tasks in the platform.

Before Starting

Please note the following before starting your practice:

• Use a Chrome browser when using the authoring platform.
• Any new content or changes to existing content will reside only within your working environment and will not be visible to others.
• All authoring in the training authoring environment will be performed in the SNOMEDLand extension.
• SNOMED CT content from the International Edition cannot be modified in the training authoring platform.
• All authoring in the certification exam must be performed using the proximal primitive parent modeling approach. Other modeling approaches will not be accepted.
• Always remember to save, classify and then save the classification results.
• If the platform is not functioning as expected, try a hard refresh. This will usually solve the problem. However, if not then please see Training Authoring Platform - Issue Resolution (available only after enrolment).

Useful Resources You should be familiar with the following resources before sitting your exam: SNOMED CT Editorial Guide (Education Version) Pre-coordination Pattern JIRA Project SNOMED CT templates SNOMED CT customer request guidance

Practice Exercises

Some examples to help you practice your authoring are provided below. Please note that these exercises are provided to help you to familiarise yourself with the training authoring platform. They are not intended to teach you the principles of authoring. To learn more about how to author SNOMED CT content, please enrol in the Authoring Level 2 Course.

IMPORTANT: If you make changes to a concept and then decided to inactivate that concept, you will need to revert back to the original concept first (i.e. undo any changes made). To do this, please click on the "Revert to version" button to undo all changes.

1. Create new concepts

Practice your authoring by creating the following new concepts:

• A family history of Schinzel syndrome
• A humeral SPECT
• Acquired bile duct stricture

2. Edit existing concepts

Consider the following concepts, and make any changes you think are required:

• History of hand ganglion aspiration (situation)
• Right thigh ultrasound (procedure)
• Suspected anthrax (disorder)

3. Additional practice

If you would like additional practice at creating new concepts, you could try to model concepts that have been created recently in the International Edition, but do not yet exist in the training platform.

The training authoring platform is currently using the Jan 2024 International Edition, so you will need to use concepts added since then. One method of locating newer content is to look in the Daily Build Browser. Under the tab titled 'Daily Build', if you click on 'New concepts' you will see a list of concepts that have not yet been added to the Training Authoring Platform.

Note: Please be aware that not all existing content in SNOMED CT conforms to the current editorial guide or proximal primitive parent modeling approach. It's therefore important not to assume that such content offers a valid model for authoring new content.

4. Sitting the Exam

Exams Overview The certification exam consists of 2 parts - a theory exam (4 hours) and a practical exam (5 hours). You may not need all this time to complete exam. The theory exam consists of 20 questions which are completed in the e-learning platform. The practical exam consists of 10 questions which will involve authoring and submitting for marking in the training authoring platform. To have access to the practical exam (pass mark is 80% or above) you must first pass the theory exam (pass mark is 70% or above).  You will be notified whether you have passed the theory exam by email. If you have passed the theory exam, the practical exam will be made available on your scheduled date. Each exam needs to be scheduled on different days Exam Proctoring Like other SNOMED International courses, the certification exams will be performed on the SNOMED CT e-learning platform. However unlike the other course assessments, the certification exams will use a remote proctoring service, which seamlessly integrates with the Chrome browser. This proctoring service will monitor your computer's webcam, microphone and desktop, and will lock down certain functions during the exam. It will also require you to verify your identity using a valid photo ID. The proctoring service will inform you before each proctored exam as to exactly what data will be collected during the exam.

After the exam is complete, the exam monitoring data is analyzed for specific behaviours and abnormalities to ensure that all participants comply with the certification rules. The exam monitoring data will be viewed only by SNOMED International and not by the proctoring service provider. SNOMED International and the proctoring service provider are both fully compliant with all relevant data privacy legislation (including the General Data Protection Regulation in Europe).

Exam Rules

Please read the certification rules to understand the requirements for sitting a SNOMED International certification exam. Acceptance of and adherence to these rules are mandatory when participating in a SNOMED International certification exam.

4.1. Proctoring Information

SNOMED International certification exams will be undertaken using a remote proctoring service provided by Proctorio. Please refer to the following links for some useful information about this service: General information (frequently asked questions) What is Proctorio? How does Proctorio work? Minimum system requirements How do I get started? Proctorio extension permissions What access does Proctorio have to my computer? How is my privacy protected? How can I receive support during my exam?

4.2. Exam Instructions

4.3. Exam Process

The process of sitting the certification exam will involve the following steps: Before you start the practical exam, please Login to the training authoring platform. Confirm that you have access to the 'Certification Exam' project Create a single task or multiple tasks titled "AL2 Certification Task (x)" in the "Certification Exam" project in the training authoring platform where x is a number. Please note that technical support for the training authoring platform is only available from 8:00 UTC to 18:00 UTC (Monday to Thursday), so please keep this in mind when starting your exam. Click on the 'Take Assessment Now' button on the exam page. Follow the proctoring setup instructions and pre-checks. The system diagnostic checks will be performed on your webcam, microphone and internet connection A reminder will appear to use the restroom, get water, get comfortable and get ready for the exam You will be asked to remain in view of the camera at all times during the exam (except toilet breaks) You will be asked to hold your photo ID in front of the webcam for scanning The webcam image test will be performed You will be asked to certify that you are the person in the photo ID and the person whose name is associated with the account currently logged into the e-learning platform You will then be shown a button to start the exam. When you click on this button, the exam clock will begin. During your exam the following monitoring information will be collected: Your microphone Your webcam Your physical location Your identity Any website you visit Any other applications running Answer the exam questions on the ELearning Platform For the practical exam, Perform the required authoring tasks in the training authoring platform. When you have completed the authoring tasks, please submit your task for review to EPS Trainer in the training authoring platform. When you have answered all the exam questions, please click 'Submit all and finish' on the ELearning Platform. Once your exam is submitted, the browser cache will be cleared of all exam data.

4.4. Exam Questions

Allowed reference material for exams

• You can access the following reference material to answer questions:

  1. • Any internet search sites for understanding a concept's clinical meaning including medical dictionaries

     • Personal notes and course material

     • SNOMED CT editorial guide (education version)

     • SNOMED CT precoordinated patterns

     • SNOMED CT templates

     • SNOMED International Confluence Pages

     • SNOMED International Jira Pages

Theory exam

• You have up to 4 hours to answer 20 exam questions in the e-learning platform.

• The question types will include multiple choice and other question styles as described in the E-Learning Assessment Guide. 

You must first pass the theory exam (pass mark is 70% or above), to have access to the practical exam (pass mark is 80% or above).

• You will be notified whether you have passed the theory exam by email. If you have passed the theory exam, the practical exam will be made available on your scheduled date.

Practical Exam

You have up to 5 hours to answer 10 exam practical questions.

• The 10 questions require you to author in the training authoring platform.

  • Questions 1 to 4 require you to create a new concept to represent a given clinical meaning.

  • Questions 5 and 6 require you to inactivate the named concept.

• • Questions 7 to 10 require you to analyse and correct the named concept.

Allocation of time

• You may wish to allocate the time you spend on each question based on the marks available for that question.

  • Seven questions are worth 10 marks each -  Questions 1, 2, 3, 4, 7, 8, 10

  • Two questions are worth 26 marks each - Questions 5 and 6

  • Question 9 is worth 20 marks

1. For these questions, you must use the proximal primitive parent modelling approach. Other modelling approaches will not be accepted.

2. All concepts must be classified and their classifications saved.

3. It is advisable to check the review list to ensure that all concepts have been completed correctly prior to submitting.

4. You will be authoring in the SnomedLand (ZZ) extension based on the Jan 2024 edition of SNOMED CT.

Questions 1 to 4 require you to create a new concept to represent a given clinical meaning.

• The requested meaning has been accepted for inclusion in the SNOMEDLand extension.

• You are not required to add any other concepts to model the focus concept being created.

Questions 5 and 6 require you to inactivate the named concept.

• You will be required to make corrections to any concepts that are impacted by the inactivation.

  • Where a concept requires a change as part of the inactivation e.g. a subtype requires a new parent, then that concept should also be reviewed and corrected.

    • Hint. Concepts that are changed due to an inactivation also appear in the task review list therefore check correctness of these concepts as part of the process. 

  • If there is a concept that needs to be inactivated that also has a Not semantically equivalent description the concept will need to be inactivated first, before the description can be inactivated.

  • If you make changes to a concept before inactivating that concept, you must first revert back to the original concept. To do this, click on the "Revert to version" button to undo all your changes, and then inactivate the concept.

• You may also need to create a new procedure or clinical finding/disorder concept as an attribute value if required (depends on focus concept).

  • Do not create other hierarchy concepts e.g. attributes or body structures, please model with existing content. This may lead to the concept remaining primitive.

• Only changes to SNOMEDLand extension concepts are required.

Questions 7 to 10 require you to analyse and correct the named concept.

• This may require a new procedure or clinical finding/disorder concept to be created as an attribute value.

• • Do not create other hierarchy concepts e.g. attributes or body structures, please model with existing content. This may lead to the concept remaining primitive.

• Only changes to SNOMEDLand extension concepts are required.

Participants must inform SNOMED International (via certsupport@snomed.org) of any technical issues experienced during the exam within 24 hours of sitting the exam for these to be taken into consideration.

5. After the Exam

Within one month of sitting the certification exams, you will be notified as to whether or not you have passed your Authoring Level 2 certification.

Please be aware that we do not provide individual exam results or feedback (whether or not you have passed). 

If you are successful in passing the Authoring Level 2 Certification exams, an electronic version of your certificate will be available in the E-Learning platform. 

SNOMED International has established an Authoring Level 2 Certification Register (at http://snomed.org/al2cert) to acknowledge those individuals who have successfully achieved and retained their Authoring Level 2 Certification, and to allow the SNOMED community to be aware of this achievement. 

• On successfully passing the Certification Exam, if you would like to be added to this public register, please login to your Confluence account and complete the consent form. 

If you are not successful in passing the Authoring Level 2 Certification exams:

• You may re-enrol in the Authoring Level 2 Certification at most once within 12 months of completing your first attempt.

• To re-enrol in the certification exam, please visit the SNOMED CT course catalogue. Full payment is required for re-enrolment.

• Before resitting this exam, we strongly recommend that you reflect and practice more, especially those elements that you found difficult during the exam.

• If you fail the certification exam twice within 12 months, then prior to re-enrolling in the exam you must either (a) enrol (or re-enrol) in the relevant SNOMED International preparation course and successfully complete this course, or (b) wait a further 12 months after the most recent attempt before re-enrolling in the certification exam.

5.1. Pass Mark and Retakes

Retakes

If you are unsuccessful in passing the Certification Exams

• You are allowed one more attempt at sitting the Certification Exam. You can resit the exam by enrolling once again for the exam and paying the fee (same as original payment).

• Please note we cannot give feedback or marks on individual exam results. 

• We would strongly recommend you reflect on your exam performance and review those parts of the exam you found difficult.

If after resitting the exam and you are again unsuccessful, there are two options available

• Enrol or re-enrol for the Authoring Level 2 Course and learn more about SNOMED CT. This would give you an opportunity to further hone your skills and practice authoring in a structured environment.

• Enrol in the Certification Exam after a period of one year. This would give you the opportunity to reflect on those competencies that need further focus and give you the chance to practice authoring further in your own environment.

6. Communication

If you need to communicate with the SNOMED International E-Learning team, please email elearning@snomed.org. This will ensure that these communications are routed, tracked and managed in a way that allows the team to respond effectively. If you are reporting an issue, please remember to provide screenshots (where applicable) and a detailed explanation. To receive important email communications related to your e-learning, please ensure that your email client is not placing messages from noreply@snomed.org or elearning@snomed.org in a spam or junk folder.  If you are experiencing any technical issues while your certification exam is in progress, please email certsupport@snomed.org. We will try to respond to these emails as quickly as we can, but please be aware that the response may not be immediate.