Fulfilling the Responsibility for Qualified Care: Considerations for Training Electrophysiology Laboratory Staff

EP Lab Digest. 2022;22(12):16-17.

The cardiac electrophysiology (EP) space is a complex matrix of facilities, technology, operational efficiency, reimbursement, and risk management. It exists in a culture of intense competition between advanced technologies and procedures. EP business operators must balance income with expenses complicated by differences in staffing levels, performance skills, procedural inefficiency, and liability.

Delivering competent services is crucial to the success of every EP program. This article will reflect on the challenges and opportunities faced by those in EP leadership who are responsible for the integrity of services, including patient management and staff development. The focus will be on the value and significance of supporting qualified personnel with qualified performance standards found in laboratories with well-established competence and credentialing programs.

Importance of Trust

Trust is brokered at the juncture between the patient and caregiver, at the front line of the health care system. This is the line that connects confident employees to the financial success of the organization. This relationship is forged as the caregiver delivers informed care and reasonable instructions founded in knowledge and skill.

Without the requirements of strict scientific methodology and the subscription to consistent standards of quality and performance, there is a problem. Decisions made by undertrained or underqualified caregivers can affect institutional culture and procedural outcomes. In some labs, industry representatives, not employees, operate equipment and participate in medical decisions; this may isolate the patient from the hospital care system and create a learning or confidence gap between staff and physicians. These conditions can increase risks, extend procedures, and destabilize costs.

In a recent article, Jerry Stone of MedicalGPS wrote, “if your patients do not believe that each and every health care worker…has their best interest at heart, chances are highly unlikely they will trust that their physician does.”¹ Additionally, in a recent piece for NEJM Catalyst Innovations in Care Delivery, Bruce A. Meyer, MD, MBA, president of Jefferson Health in Philadelphia, stated, “if you are going to have an activated patient, a patient who is engaged in their health care and trying to be a partner in terms of improving their outcomes, you cannot have that without a patient who has a high level of trust, not just with the individual provider, but with the health care system that that provider is in.”²

Well-trained caregivers are enabled and empowered to establish standards of care and qualifications of specialized personnel to operate securely, safely, and efficiently with consideration for employee satisfaction and self-confidence. The team participates in critical decisions that affect patient care and outcomes. This practice builds a culture of shared ownership among all stakeholders. These employees achieve this status through dedicated study, skills validation, and credentialing. They are the ones who establish the culture of authenticity that becomes the organizational brand.

Importance of Training and Education

It takes dedicated training to achieve primary objectives in health care. As in other disciplines, the EP curriculum follows a course of study that prepares the practitioner for credentialing, including hours of didactic coursework (reading, lecture, clinical observation, simulation, and practice) under the direction of qualified practitioners who guide, counsel, and evaluate learners.³

Meaningful conversations at all levels of leadership must take place to establish EP education as a priority. Studies have shown that employees will rise only to the level of expectations set by leadership and direct supervision. Well-trained employees demonstrate dedication to quality, outcome, and efficiency. They are employable, reliable, and retainable.

Every employer in health care should be concerned about staffing, qualifications, recruitment, and retention. They need qualified candidates who will not only meet the job description and performance standards, but also participate in continuing education of emerging techniques and technologies.

Unfortunately, however, according to an occupation keyword search for EP on the United States’ Department of Labor website,⁴ there is no universal job description that describes the work and responsibility of the average technologist or nurse working in an EP lab.

Employers/providers must establish job descriptions that reflect the tasks, performance expectations, and policies and procedures that create a positive work culture for qualified candidates. When built into a marketing plan, this logic can create a competitive edge for the provider.

Accessible Learning Programs

Competency is not always acquired from a “see one, do one, teach one” environment. A cadre of experienced and credentialed clinical educators are needed to lead with training standards of quality and performance. The most common resources are found in traditional and nontraditional curriculum-based programs.

Traditional EP Learning Programs

From certificates to diplomas, academically accredited hospital-based programs, technical and medical school programs, or 2- and 4-year degree programs operate in live face-to-face classrooms and lab centers for lectures, simulation, and hospital-based clinical rotations with faculty, mentors, and real patients. The cost is typically highest among traditional EP learning programs. These programs may provide preparation for credentialing exams, and graduates are favorably recruited by the medical device industry.

Nontraditional EP Learning Programs

Ranging from self-guided textbooks and online curricula with multiple levels of interaction to hospital-based employee learning management systems (LMS), nontraditional EP learning programs provide core didactics, assessment, tracked progress, and cognitive exams supported by in-house proctors. Designed for job qualification and professional development, some programs provide third-party online subscriptions with multiple levels for tutoring and mentoring that may integrate with local hospitals for clinical practice. They are good education plans for the employer who likes to promote from within. They are also flexible and affordable methods of preparing for credentialing exams. These programs accommodate individual lifestyles, learning styles, and work schedules.

Credentialing

Credentialing is the evidence of study, cognitive understanding, and confirmed performance by examination. Professional standards and qualifications in EP are deeply rooted in scientific concepts that incorporate physical, mathematical, electrochemical, mechanical, and biotechnological sciences.³

The certified EP specialist (CEPS) credential is earned by health care professionals who have successfully completed the Certification Examination for Competency in Cardiac Electrophysiology and met the certification requirements outlined by the International Board of Heart Rhythm Examiners. Credentialing for certified cardiac device specialists (CCDS) and cardiac device remote monitoring specialists (CDRMS) is also available.

The registered cardiac EP specialist (RCES) credential is earned by health care professionals who have successfully completed the examination and certification requirements outlined by Cardiac Credentialing International.

Final Advice for Employers and Candidates

The skill of practitioners is tested with every patient case performed and perfected through training and experience. We are all accountable to the practical responsibilities associated with the field of EP, so we must commit to the preservation of skills and experience.

Employers

Every service line has performance objectives that must be carefully designed, executed, and evaluated every day by every team member. This vertical alignment keeps things moving efficiently in the lab. Well-run organizations invest wisely in finding the right people and placing them in trusted positions of personal, professional, and fiducial responsibility.

To achieve this, support and engage published standards with educational resources. Gap analysis and benchmarking are common practices. Hiring an EP consultant may be a reasonable investment to get on the right track, but at a minimum, form a committee to review your standards and perform a gap analysis to establish priorities. In addition, build or improve on existing LMS. You will need a good internal information technology department, network support, and content experts to establish an infrastructural curriculum and assessment tools. Consider buying a cloud-based subscription with tools that coach and track employee progress. Finally, hire well-prepared candidates with skills and potential. Remember that developing and cross-training from within builds on existing talent, aids in retention, and preserves consistency in clinical practices.

Candidates

The EP learning continuum is constant and requires earnest, emotional, and professional commitment. Use all of your senses and be prepared to assimilate under intense pressure. If you have unlimited financial resources and time (2-4 years), the traditional academic programs may be a good fit for you. Meet the faculty and alumni, and tour the facility.

If you are a postgraduate looking for a lifestyle change or professional opportunity in industry, technical or medical school programs are a great option. Expect stringent academic requirements and relocation (3-9 months) to an onsite campus. Be willing to take on more student loan debt. Meet online with faculty and alumni. Shadow a professional working in the field.

If you are looking for career advancement and job fulfillment with your current or prospective employer, then a nontraditional program may be right for you. Ask your employer for academic credit reimbursement.

Finally, review the following tips below to help determine next steps. And remember, the foundation of knowledge you acquire will determine your quality of care.

Key questions for consideration:

1. Do you measure up? Do a self-assessment of your personal career needs, scientific interests, and critical decision-making skills.

2. Focus on the ones you care for. Budget your finances, balance your work, study, and personal time.

3. “First do no harm” Make it your oath and your promise. Understand the responsibilities you will be expected to assume and the obligations you will have in the service of others. 

Disclosures: Mr Ferguson has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. He reports consulting fees and presentation honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from CHART Healthcare Academy, Abbott, Invuity, and the Medical University of South Carolina; he also reports consulting fees from the International Board of Heart Rhythm Examiners (IBHRE), Alterra Medical, Merit Medical, and Synaptic Medical. Regarding support for attending meetings and/or travel, he reports consulting fees and presentation honoraria from Abbott, Invuity, and the Medical University of South Carolina, and consulting fees from Alterra Medical, Merit Medical, and Synaptic Medical. Additionally, he reports participation as Ambassador Committee Chair for the IBHRE.

References

1. Stone J. How to foster trust when patients are over-informed, confused, and distrustful. MedicalGPS. Published January 29, 2021. Accessed September 28, 2022. https://blog.medicalgps.com/how-to-foster-trust-when-patients-are-over-informed-confused-and-distrustful/

2. Meyer BA, Lee TH. Earning trust in the era of Covid-19. NEJM Catalyst Innovations in Care Delivery. Published July 30, 2022. Accessed September 28, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0459

3. Zipes DP, Calkins H, Daubert JP, 2015 AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Heart Rhythm. 2016;13(1):e3-e37. doi:10.1016/j.hrthm.2015.09.014

4. Occupations. US Department of Labor. Accessed September 28, 2022. https://www.dol.gov/general/topic/statistics/occupations