In the next four hours, No. 2 pencil in one hand and chin in the other, she would answer 200 multiple-choice questions covering the multitude of clinical and management topics that today's facility managers need to know to be effective:

• patient-care delivery
• quality management
• human resources
• financial and business development
• and regulatory and legal issues.

"It was intimidating being the first group to take the exam," says Ms. May, 47, the director of ambulatory surgery for the Indian Wells Valley Surgery Center in Ridgecrest, Calif.

"We didn't know what to expect. We didn't have a book to study from."

Ruth May, RN, CASC, and 77 of the other 90 administrators (a passing rate of 85.7 percent) who took the first pass-fail exam earned the right to use the "CASC" credential after their names. She and her fellow CASC members will be recognized at next month's annual Federated Ambulatory Surgery Association (FASA) meeting in Boston, where the CASC exam will be given for a second time. Read on to learn more about the CASC exam and be sure to take the 10-question sample quiz that begins on page 31.

About the exam
The CASC credential is the only one of its kind that demonstrates expertise in ASC administration. The Board of Ambulatory Surgery Certification (BASC), a non-profit organization founded by FASA, developed the CASC exam to bring standardization to the ASC industry, an industry comprised of professionals from a wide variety of backgrounds, says FASA Executive Director Kathy Bryant.

To identify possible exam topics, BASC surveyed ASC administrators and owners across the country. Based on the results, a team of ASC administrators prepared several hundred test questions, and from these, chose the 200 multiple-choice questions that would become the CASC exam.

There are three types of questions - recall, application and analysis. Test questions are weighted depending on their level of difficulty. So scoring is not based on a percentage, but on scaled score units. To pass, you need 70 scaled-scored units on a scale from 1 to 99.

The application process
Here are the eligibility requirements you must meet before you can take the CASC exam. You have to submit two letters of reference (at least one from a physician) and complete the exam application form. You must accumulate 100 eligibility points from your education, experience and other activities. Applicants earn eligibility points for each degree (points range from five to 30) and year of healthcare employment (from 15-50 points each) they have. Applicants may also receive eligibility points for credentials, licenses and/or accreditation. "My advice to anyone interested in taking the CASC exam: get a jump on the application early," says Ms. May. "I waited too long and only had a week to get my letters of recommendations and finish the application."

These items and the $750 examination fee are due to BASC about two months before the date of the exam. "If there is a problem with your application, we will let you know right away," says BASC's Spring Bailey, the coordinator of CASC services. "If not, you will receive a confirmation letter, which we send out to everyone a month before the exam."

It's too late to apply for next month's CASC exam at FASA, but you have time to apply for the Sept. 13 exam in Las Vegas as part of FASA's Annual Nurses Seminar.

Test prep
How to best prepare for the test? We talked to three administrators, each of whom took a different approach.

Kermit Knight, CASC, administrator at the Venice Healthpark Surgery Center in Venice, Fla., purchased audiocassettes from the 2002 FASA meeting (writeOutLink("www.fasa.org","1")) and spent 90 minutes a week in his office listening to the tapes and taking notes. He then studied from his notes before taking the test.

Ms. May used the CASC examination content outline (writeOutLink("www.aboutcasc.org","1")) to direct her study and supplemented the outline with books, manuals and the Internet to research finance and legal issues.

Some ASC management companies such as Ambulatory Surgical Centers of America (ASCOA) offer CASC prep courses for their administrators. "We get our administrators together twice a year. This past year we added an extra day and had a roundtable meeting with 12 administrators who were interested in taking the exam," says Susanne Broadwater, BS, MBA, CASC, the chief operating officer of ASCOA.

No matter how you prepare, administrators agree that studying is no substitute for experience "As an experienced administrator who is dealing with these issues on a daily basis, your studying should be just a review," says Ms. Broadwater.

On test day
On the day of the exam, bring ID and your admission ticket, which you receive in the mail 10 days before the exam. Also bring No. 2 pencils and a calculator. And be on time - test-takers who arrive late will not be allowed to take the exam. Ms. May recommends bringing a watch so you can pace yourself throughout the exam. She checked her watch after 50 questions to make sure she was staying on target.

A test-day tip from BASC: Don't leave any answers blank. You have better odds of passing if you guess, and you will avoid the risk of mismarking your answers.