Becoming a CVT at Carnegie Institute School of Allied Health Technology

Why and how did you become an educator? I began my career in education at Rhode Island College in Social Studies Secondary Education. My first medical training was at Shepard Air Force Base’s Medical Service School. I decided teaching adolescents was not what I wanted to do, so I pursued my interest in medicine to the emergency room, the intensive care unit and eventually to Beaumont Hospital’s cardiac cath lab. I worked at Beaumont for 18 years, serving as the Educational Coordinator for ten. I developed the new employee orientation and JCAHO skills validation programs there and directed Beaumont’s 17-week full time training program for invasive CVTs. Those short, but very intense programs whetted my appetite for something more ambitious. When the opportunity came along to establish an invasive program at Carnegie, I took it. The program rapidly grew to a 9-month and now a 2-year program. Teaching cardiovascular technology, a dynamic and challenging discipline, to mature, serious students who seem to share my hunger for learning “ wow! I believe I’ve found my niche. How long has your program been in operation? Carnegie Institute has been training medical assistants and other allied health professionals since 1947. Our echo program became CAAHEP accredited in 2000. We began our first nine-month invasive program in March of 2000. Our first two-year students enrolled in March of this year. I consider our program as still being in its infancy. Describe your program syllabus, both clinical and classroom. For the first 6 months all the students in our invasive, noninvasive and vascular programs attend the same core classes: EKG, A&P, Cardiovascular Pharmacology and Math Preparation for Physics. When the invasive students begin their specialty (in the seventh month) they do clinical rotations at their hospitals on Tuesday and Thursday from 7am until noon. Following the clinical hours, didactic classes are held at Carnegie Institute from 1:30 pm to 4:00 pm. A major block of teaching is done on Saturday 11:30 am to 5:30 pm. Subjects are organized into modules based on the National Model Curriculum. As we proceed from the very introductory history and principles to the more advanced applications in diagnosis and treatment, we also try to integrate students’ clinical objectives with their classroom objectives. It is funny how often the students say that as soon as we talk about a pathology or intervention in class they seem to see it the next day in the lab! Just a coincidence, I’m sure! Since the subject of hemodynamics carries such an intimidating mystique, we have worked hard to structure the approach to waveforms and formulas in a digestible, bit-by-bit format. Practice examples and quizzes reinforce each lesson before moving on. I quote liberally from the hemodynamics wisdom found in Dr. Morton Kern’s Cardiac Catheterization Handbook and Hemodynamics Rounds and encourage the students to bring in tough cases for discussion from their day in the lab. We have seen some real challenges, especially from our pediatric lab! We have also been pleased, in the class just now graduating, to incorporate ACLS certification so our students truly do graduate ready to be hired. How many students do you accept each year? We now have clinical affiliations with 20 hospitals in the local area and can therefore easily accommodate 20 students. We had 2 students in our first class, 7 in our second and 13 in the most recent class to graduate. What is the typical student background? Our students have included paramedics, medical assistants, foreign medical graduates, surgical techs, hemodialysis techs and entry-level cath lab employees (like holding room or telemetry techs) wishing to move into the CVT position. We have also enrolled CVTs already working in a cath lab who have found the Registered Cardiovascular Invasive Specialist (RCIS) examination to be a difficult hurdle without formal educational preparation. The discipline of a structured and systematic program gives them a big advantage over their on-the-job trained colleagues in passing this stringent exam. Our students tend to be in their thirties or forties with a clear idea of what they want and a great deal of motivation. For students right out of high school, we advise them to take Carnegie’s Medical Assistant Course or some equivalent program, work with sick people for a while and reapply when they are sure they are ready. What is your program’s annual tuition? Prospective students may contact the Admissions Office regarding the annual tuition. Tuition budget plans are available to help the student with the cost of attendance. Financial aid is available for those who qualify and assistance is provided through the Financial Aid Office. What textbooks, CDs, and/or websites are used in your classes? Any innovative teaching tools? Our primary text is Invasive Cardiology by Sandy Watson. For pharmacology we use Drugs for the Heart by Lionel Opie. We use the slide presentation from The New Manual of Interventional Cardiology by Freed and Grines for its detailed explanations of interventional techniques. As well, other books published by Physicians’ Press (Birmingham, Michigan) are circulated amongst the students for enrichment during specific parts of the course. Homework is constant (just ask the students!) and exams are frequent. The testing style is modeled after the CCI examinations and that indispensable study guide for those exams, Wes Todd’s Cardiac Self Assessment books. I search the Internet daily for answers to the students’ latest questions and include in our lesson plans illustrations of devices and procedures obtained from the web. I especially like the Yale Cardiothoracic Imaging Gallery for examples of pathology and Vesalius for illustrations of bypass surgery and other operations. I get news updates from the world of cardiology on theheart.org Among the other educational opportunities we try to take advantage of are the cardiology symposia offered by local hospitals. We have attended conferences hosted by Providence, St. Joseph Mercy and Genesys Hospitals to hear cardiologists present their experiences with new devices and drugs being tested in clinical trials. What type of clinical experience do you offer students? Students are exposed to adult and pediatric diagnostic caths and interventions of all types. More and more students are also participating in electrophysiology studies and peripheral vascular interventions. Arrangements are made for students to observe open heart surgery at least once. I consider simulation to be the ideal teaching technique, far superior to lecture (just read Hurst’s article, Are Medical Lectures Harmful to the Process of Learning? to feel humble about the limitations of lecturing!). So, we have begun to take advantage of our Saturday hours to take the whole class on field trips to cath labs willing to host us. A preceptor from the lab gives us all a tour and then we settle in for the kind of practice you can’t get when the lab is busy doing cases on a weekday. We practice panning using a Vari-X Coronary Artery Phantom; we run cases on the Siemens Cathcor with a biomed simulator; we walk through simulated mixing of lab drugs; we review and analyze images on the IVUS all in all, getting our hands on the technology on which we want to become proficient. This is the area I want to expand on more than any other hands-on practice with a simulator before you are thrown into the real thing! When do students start their hands-on exposure? The program is focused on real-world performance. The classroom didactic is designed to reinforce high performance, not to talk about someone else doing it. Each student begins his/her clinical rotation in week four of the invasive specialty at one of our 20 affiliated hospitals in the Metro Detroit-Ann Arbor area. We prefer to assign only one student at a time to each site to maximize individual instruction with the clinical preceptor. There are weekly performance objectives and skills validation checkoffs for every conceivable skill and device to be found in a modern lab. Additional ones are written and incorporated into the program as new technologies are introduced in the labs. We find that students come to be counted on as full members of the host hospital’s cath lab team as they master skill after skill. Depending on the individual student’s background, we try to start them out in diagnostic caths and progress to more complex interventions as they gain practical experience and also cover the theoretical principles in class. Whenever possible, we bring vendors into class with their vast treasure trove of simulators and teaching tools to get the students to practice their skills. Representatives from Datascope, Perclose, St. Jude Medical, Novoste, Medtronic and Biotroniks, just to name a few, have given the students valuable hands-on time with the latest devices. Are your students cross-trained? Fully. This includes radiology, pharmacology, patient assessment and scrubbing in with the cardiologist. The RCIS is a cath lab professional capable of assuming all roles in the cath lab. Our students are trained to accept this responsibility. Who does your classroom and clinical teaching? We have three principal classroom instructors. Laurie Smith, RCIS, teaches EKG; Daphne Betley, RCIS, teaches EPS and pacemaker; Alan Bennett, RCIS, teaches the rest. Lisa Moses, RCIS, is our Clinical Site Coordinator. We have at least one clinical preceptor at each affiliated hospital. These nurses, CVTs, rad techs, paramedics, respiratory therapists and perfusionists are the backbone of our practical instruction. They share freely of their knowledge and expertise for the common good of students, staff and patients. I cannot thank them enough. What is the employment outlook for your graduates? There is steady growth in Cardiac Cath and Coronary Interventions. Two hospitals are opening their very first cath labs in the suburban high-growth zones around Metro Detroit. Several of our affiliate hospitals are adding a lab to their existing departments. But, of course, the real explosive growth is in EPS and Peripheral Interventions. We are working to bring in more instructors to strengthen those areas of our curriculum. We look at our course as a daily job interview. Employers can tell from the student’s performance whether they would make a good employee. Many of our students become part time employees of their labs while still in school. What are typical starting salaries for graduates? $16 to $19 per hour locally, with recruiters offering more to people willing to relocate. What career opportunities have past graduates experienced? Virtually all our grads who wanted to work right after school took entry-level jobs in local cath or EPS labs. One of our grads has now gone on to become a pacemaker representative, a very sought-after position. Many of my former students and colleagues from the Beaumont (Royal Oak, Michigan) program continue to move on to vendor jobs, opening a steady stream of opportunities for entry level CVTs. Is there currently a demand for graduates of accredited CVT programs? Will there be a demand in the future? Given the worsening nurse and radiology tech shortage, and the growing specialization required by the advances of technology, we find this an ideal moment to provide the dedicated specialists that cardiologists are looking for. With hospital financial crises and cutbacks in on-the-job training, we think it makes sense to partner with private educational institutions to develop a pipeline for expansion and replacement due to natural attrition. More employers around here are beginning to see it that way, too! This should make our graduates secure for a long time to come. What has been the success rate for graduates passing the RCIS exams? My students from the first programs I ran at Beaumont have nearly all gone on to take and pass the RCIS registry exam. Our graduates from the Carnegie programs are just reaching eligibility based on employment in the field to take the exams. We hope to achieve CAAHEP accreditation this year so our grads can take the exam immediately upon graduation. How has the CVT program evolved over the past 5 years? We are building our invasive CVT program as part of a self-renewing cardiovascular educational community in southeast Michigan. We are working to bring together three partners in this community: the classroom, the hospital and private industry. We have taken the National Model Curriculum and have written content to flesh it out. We now have affiliations with nearly every cath lab in the Metro Detroit-Ann Arbor area. We are also strengthening our relationship with vendors so that students can see and handle the products they will be using as they enter their new careers. We are reaching out to our colleagues already in the field with Registry Review Courses and CEU programs to make sure their professional credentials always remain current. We strive to bridge the gap between classroom theory and real world practice. We circulate our curriculum into the local laboratories, encouraging our students to share their handouts and homework with their colleagues in the labs. This circle of mutual support should keep our institution innovative and growing for a long time to come. On August 12th, we were privileged to have an accreditation site visit by a team from CAAHEP. We hope to see our application for CAAHEP accreditation approved in the near future! What advice can you give to students considering CVT school? Ask yourself, Am I at a stage in life where I can work in a high stress, high acuity environment where the patient comes first? The course is intellectually challenging. The work is physically strenuous. But most importantly, you will be taking care of critically ill people in life and death situations. Do you have the emotional maturity to take your own concerns about breaks and work assignments and holiday call and all the other things we tend to get caught up in and put them aside to give patients the kind of care you would want someone to give to you? We want Carnegie graduates to be the best prepared professionally and also to be the most compassionate. The patients we serve are often in great pain and in fear of dying. We need to model kindness as well as superior technical performance. What do you consider unique about your program? We see ourselves as part of a national movement for the professionalization of those who work in that special place the cath lab. This new birth happens to a profession only once. It is this moment that is unique. Can we create educational programs to take advantage of such an opportunity and thereby shape our own role in this world? I think we can, if we keep our eye on the new. It is our chance to innovate and design what we can do through our own hard work. I believe that you get respect the old fashioned way you earn it. If we demonstrate competence, we will command respect. My personal motto is Rust never sleeps. To stay sharp, a program requires constant improvement. Once we have written the curriculum for a given subject area, we will write it again, incorporating new technological developments and new experience gained from the clinical world. This is only in keeping with the explosive growth of knowledge in medicine. Knowledge itself is a perishable commodity. It becomes obsolete unless refreshed with new insights. If we adopt the new as our own and strive to be on the cutting edge of progress, we may hold for that brief moment the banner unique. Can you share a particularly funny, bizarre or proud teaching moment? I guess what makes me most proud may seem funny or even bizarre to some. It’s math! The mathematician John Allen Paulos claims we are plagued by an epidemic of innumeracy in our society that is as bad as our illiteracy problem. There is evidence that in medicine he may be right. According to the 1999 Institute of Medicine study, To Err Is Human, people are literally dying by decimals! The study reports that some 98,000 people die each year from medical mistakes, many of them mathematical errors. Probably most students and educators, too, view math as the Achilles heel of technical education. You can’t do technology without it, but how many suffer from math anxiety or worse? We have developed a pre-enrollment math course to polish up rusty algebra and metric skills. Math is woven throughout the curriculum in hemodynamics, drug calculations, radiation and ultrasound physics. We advise the students: Run to the math opportunities in your places of work. Bring them to class. Become the math resource in your lab for dosage calculation for new drugs for your own good and the patient’s! Perhaps we can do our part to protect our patients by training a few more technologists who can manage the mathematical details. At the very least, we get the satisfaction of reducing math anxiety for our students while they’re with us! Photographs are by Mike Pinder, RCIS, Invasive Clinical Preceptor at Harper Hospital in Detroit, Michigan

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