IBHRE, Past and Present: Leading the Way in Heart Rhythm Management Certification

Quality care in heart rhythm management requires a diverse team of physicians, nurses, technicians, engineers, educators, and device industry representatives. In addition, standards must be set for individuals who practice throughout the world.

Since 1985, the International Board of Heart Rhythm Examiners (IBHRE) has been the leader for global certification in heart rhythm management. IBHRE is guided by its founding principle to increase knowledge among those who care for heart rhythm patients, including those with cardiac implantable electronic devices (CIEDs). IBHRE offers the following certifications for allied professionals and physicians:

• Certified Cardiac Device Specialist (CCDS)
• Certified Cardiac Device Specialist – Japan Device Representative (CCDS-JDR)
• Certified Electrophysiology Specialist (CEPS)
• Certified Electrophysiology Specialist – Adult (CEPS-A); and
• Certified Electrophysiology Specialist – Pediatric (CEPS-P)

IBHRE certifications are not limited to individuals in EP labs; they are applicable to those in device clinics and remote monitoring centers as well. At a time of rapid advances in CIED and cardiac ablation, IBHRE certification promotes lifelong learning by requiring continuing education to enhance skills needed to provide quality patient outcomes.

IBHRE certification is highly sought after by international physicians and allied professionals. As the first and oldest organization to establish an exam in cardiac pacing and electrophysiology, the rich history of the exams and their unique position to measure competency in the specialty of cardiac rhythm device management and cardiac electrophysiology is now used as a model to certify physicians and allied professionals worldwide. These certification programs are accredited by the American National Standards Institute (ANSI) through ISO/IEC 17024:2012. ANSI is a global leader in operating standards and conformity assessment systems.

As an autonomous nonprofit organization governed by a Board of Directors (Figure 1), IBHRE has certified more than 9,000 individuals in 59 countries. Many of those certified are from the United States, Japan, United Kingdom, Australia, The Netherlands, and Canada. Individuals are also certified in 53 other countries, including Korea, China, India, New Zealand, Ireland, Brazil, Vietnam, and Ecuador.

With its 35th anniversary in 2020, IBHRE continues to adhere to core organizational values, including:

• Excellence: Continue the organization’s gold standard of excellence in heart rhythm certification; maintain fairness and integrity in the development, administration, and promotion of the certification programs;
• Continuing competency: Encourage continuing education and demonstration of competency through examination, education, and professional development;
• Diversity: Foster development of a diverse, international community of highly skilled heart rhythm professionals, and work to advance heart rhythm management as a global multidisciplinary standard, serving patients of all walks of life and origin.

Exams and Certification

Enhancing knowledge is a major focus of IBHRE, not only for those sitting for the exam, but for its many subject matter experts who are contributors as well. All exams are developed by subject matter experts who are trained to write exam items in collaboration with the National Board of Medical Examiners (NBME) based in Philadelphia, Pennsylvania.

IBHRE Ambassadors work at the grass roots level by mentoring and promoting certification in their region. These individuals are certified by IBHRE and have been approved by IBHRE leadership to serve in this role. In addition, they serve on the IBHRE Scholarship Committee to review the applications considered for IBHRE scholarship program. The Ambassador role is so essential, that IBHRE presents an Ambassador of the Year award during the Heart Rhythm Scientific Sessions.

Each year, IBHRE offers up to three scholarship awards to allied professionals based upon their financial need, plus their objectives not only for themselves, but the patient population they serve. Recipients have been selected from around the world, including but not limited to South Africa, the United Kingdom, and the U.S.

The IBHRE website provides an excellent syllabus and up-to-date reference list for studying for the certification exams. In addition, after recognizing an unmet need, IBHRE launched the Cardiac Device Education and Self-Assessment Course (CDESA) in 2018. This course includes 18 informational modules, case studies, and a post-assessment exam of 100 exam-style questions. Although this online course is based upon the CCDS exam design, it is not all inclusive of the knowledge areas and skills assessed for certification. Consequently, completing this course is not required for IBHRE certification, and doing so does not guarantee successful completion of the CCDS exam.

A group of physicians, nurses, and cardiac device specialists contributed to the development and content of the CDESA course. As such, during the course, a student learns concepts and critical issues in cardiac rhythm device therapy related to:

• Fundamental concepts of electrophysiology, pacing, and defibrillation;
• Device implantation, operative issues, and potential complications;
• Management and troubleshooting implantable cardiac rhythm devices (pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy); and
• Clinical trials, indications, device selection, programming, and follow-up of devices.

This self-paced interactive subscription course is a dynamic environment where knowledge of critical information can be enhanced, reviewed, and challenged. It is designed for healthcare professionals who practice in the field of heart rhythm device management, including nurses, nurse practitioners, physician assistants, physicians, technicians, device industry representatives, clinical specialists, and anyone who wants to gain a deeper understanding of CIED therapy.

It includes insightful and engaging content, including:

• Reference articles, ACC/AHA/HRS medical guidelines, and practice recommendations to aide learning;
• Interactive knowledge checks to help measure comprehension;
• Easily accessible inter-module reference notes;
• A post-test to assess knowledge after each module; and
• A comprehensive cardiac device post assessment at the end of the course.

History and Timeline

IBHRE has a rich history. Beginning in 1984, Dr. Seymour Furman (Figure 2), the organization’s first president, led the initiative to establish a certification program in cardiac rhythm device therapy. He established the NASPExAM in 1985, along with Marleen Irwin, a cardiac device therapist at the University of Alberta in Edmonton, Canada. Together, they assembled a team of international professionals to form the first Cardiac Pacing Test Writing Committee, and in 1986, NASPExAM administered the first examination of Special Competency in Cardiac Pacing and Cardioversion Defibrillation for the Physician. In 1989, NASPExAM administered the first examination for Special Competency in Cardiac Pacing and Cardioversion Defibrillation for the Allied Professional. NASPExAM is notable to have the forethought to include allied professionals from the beginning in certification development. (Figure 3)

In 1995, the Allied Professional Electrophysiology Test Writing Committee was formed with the collaboration of Christine Chiu-Man (a cardiac device technologist at the Hospital for Sick Children in Toronto, Ontario), Marleen Irwin, and Dr. Furman. In 1997, NASPExAM administered the first examination for Special Competency in Cardiac Electrophysiology for the Allied Professional. (Figure 4)

Dr. Charles Love (Figure 5) became the president in 2005, and the NASPExAM Board of Directors grew to include members from Japan, England, and Canada.

In so doing, NASPExAM transformed to become the International Board of Heart Rhythm Examiners in 2006, and IBHRE certification programs began to evolve from NASPExAM.

In 2007, IBHRE formed a strategic partnership with the Japanese Heart Rhythm Society, and the first Japanese Test Translation and Localization Committee was formed.

In 2008, with the use of computer-based testing, IBHRE expanded the worldwide administration of its certification exams to nearly every country. In that same year, IBHRE administered its first foreign language certification examination in Japan.

In 2009, IBHRE organized the Physician Electrophysiology Test Writing Committee; established a new Recertification Policy; and organized the first IBHRE Review and Appeals Committee in preparation for ANSI certification of the organization. In 2010, the organization received its first program accreditation from the American National Standard Institute (ANSI).

In 2011, the Board announced the examination for Special Competency in Cardiac Electrophysiology for the Physician.

The number of people who have taken the exam has grown from approximately 76 allied professionals taking the first CCDS exam in 1989 to 1,366 allied professionals throughout the world taking the CCDS exam in 2018.

With the goal of career advancement for certified professionals, IBHRE launched an online Career Center in 2013 as well as introduced its first team of IBHRE Ambassadors, who participate in the ongoing mentorship program for allied professionals that need guidance in their studying. Mentorship can occur long distance through the use of the internet.

In 2015, the Board also announced a Scholarship Program for allied professionals. The scholarship program is available to allied professionals worldwide who are not directly employed by industry.

Future Initiatives

The vision of IBHRE is to be the global leader in heart rhythm certification as the EP and cardiac device specialties continue to evolve. The goal is for the IBHRE exams to remain cutting edge, relevant, and reflective of best practice and global standards, while remaining pertinent to day-to-day practice. The goal is for IBHRE value and presence to be enhanced in the labs, clinics, and industry organizations through education (mentorship and educational tools), research, and leadership. The overriding goal is to maintain fairness and integrity in the development, administration, and promotion of the certification program.

In extending the competency and certification beyond North American borders, IBHRE continues to strengthen the relationship with the Japanese Heart Rhythm Society and other international heart rhythm organizations in Latin America, China, and the Middle East, plus advance collaboration with the Heart Rhythm Society. In this process, Ambassadors are from around the world with the goal to mentor and collaborate with other organizations.   

IBHRE continues to evolve its programs and is currently developing a new certification program focusing on remote cardiac device monitoring. To be added to IBHRE’s mailing list to receive information regarding the new program, contact IBHRE at info@ibhre.org. For more information about IBHRE’s certifications, visit ibhre.org.

Disclosures: The authors have no conflicts of interest to report regarding the content herein.