We appreciate the comments of Dr Sholapurkar regarding our paper, which was written with 2 principal objectives. The first was to explain why we believe all practitioners working with women in labor should be credentialed to interpret and manage electronic fetal monitoring (EFM) tracings. The second explains why our examination is an excellent tool to accomplish that objective.

We acknowledge that the interpretation of EFM tracings is not a perfect science. However, although an EFM tracing is a poor predictor of neonatal outcome, it is an excellent way to assess fetal oxygenation. Furthermore, EFM tracings are almost always retrospectively scrutinized when a baby develops neonatal encephalopathy.

Dr Sholapurkar writes that “the standardization of terminology, guidelines, and knowledge-based testing do have merit,” and we believe that justifies requiring all personnel caring for women in labor to demonstrate competence with those issues. Guidelines should “withstand basic scientific scrutiny,” and we agree that if new data reveal errors in our current thinking, modifications are indicated. However, we should strive to utilize the best current information, hence the rationale for requiring credentialing and periodic reassessment of existing knowledge in EFM interpretation.

We believe that knowledge of terminology and other factual data is a necessary but insufficient measure of how one interprets dynamic tracings. Although experts may disagree about the nuances of how to deal with an evolving tracing, some responses are clearly incorrect. One might object to grading responses by their degree of correlation with those of the experts, but no credit should be given for an answer that none of the experts gave.

Dr Sholapurkar queries whether it is justifiable to fail practitioners using this type of examination and asks what “support mechanisms or supervision” will be in place while wondering whether credentialing will discourage “alternative thinking and possibly innovation/improvements.”

The objective of this examination is not to fail anyone. It is to document that every person utilizing EFM knows the correct language and understands the fundamental principles that govern the response to evolving patterns. Individuals can prepare for the examination however they choose and can retake it as often as necessary to become credentialed. This process is intended to set a bar of knowledge that should be met by all those interpreting EFM tracings.

Finally, we do not believe that “innovation/improvements” come from individuals creating new approaches to old problems in an unstructured setting. Such change is best achieved through formal studies performed with the consent of institutional review boards.