The Important Role of Clinical Instructors in the Contemporary Cath Lab

Our job as cath lab professionals is very specific and demanding. As a result, our profession has developed, and continues to develop on a regular basis, in order to meet the challenges of the complex disease states we encounter. We as cath lab professionals must asses and reassess the way we perform and update our knowledge of procedures and patient care through continuing medical education. But what about the qualified on-the-job trainees and students in accredited cardiovascular technology programs? These trainees and students have little knowledge of the procedures and even less experience in our chosen line of work. How do they learn to function competently in the modern-day cardiac catheterization laboratory? Students in the lab should have an understanding of anatomy and physiology, a basic knowledge of x-ray generation and safety, and a knowledge of electrocardiograms. However, let’s look beyond these topics. The theory that these budding specialists have is critical to functioning in the cath lab, but for these people to blossom in the clinical setting, they need competent clinical instructors. Seasoned instructors and mentors can make the difference between a tech and a cardiovascular specialist. Clinical instructors must be able to take the theory learned in the classroom and teach the students practical application of the material. As an example, one could look to Basic Life Support (BLS). Students learn the current CPR standards in the BLS class. Now, let’s say these students apply the proper compressions-to-breaths ratio as outlined by the American Heart Association. Without the application of the theory, the ratio will be applied without thought to the reevaluation of the patient’s status. In this scenario, the clinical instructor teaches the students to think about what they are doing and why they are doing it. They teach the student that answering 15:2 is correct on the written test and the practical, but is not always appropriate, and why. This is not only applicable to CPR, but so many other things in the lab: renal insufficiency and contrast selection, hypokalemia and our selection of a diuretic, as well as anomalous arteries and resulting catheter selection, just to name a few. A good clinical instructor will take the time to sit with a student and evaluate their performances. Having worked at three different hospitals, I have had experience with three different clinical instructors. Currently, I am no longer a student and am now a clinical instructor, but I found at the time that these people were necessary to show me how to function in their respective labs. One of my clinical instructors at Sentara Norfolk General in Norfolk, Virginia, was especially helpful in regards to performance evaluation. This instructor regularly sat down with me, told me what I was doing right and offered constructive criticism when things could be done better. He set achievable goals for me and was committed to my success as a cardiovascular specialist. Clearly defined and attainable goals with timelines will keep the student on track. With objectives to be met, the students have a target to shoot for and a measuring stick with which the instructors and they are able to measure their success. These will vary state to state and lab to lab, as labs and protocols differ. It will also vary student to student, as backgrounds and abilities differ. Some of the goals that I currently use for my students are: 1. Competency on the monitoring system (this can be broken down further into understanding left heart protocol, right heart protocol, interventions, etc.) 2. Competency in setting up the table within a certain time period. 3. Scrubbing and assisting physicians 4. Pharmacology knowledge and application For the cardiovascular technology student, the cath lab can be an overwhelming and intimidating place. Left to figure things out by themselves, the students would drown in a sea of technology and science that is the modern-day cardiac catheterization laboratory. With the application of theory, goal-setting and a committed clinical instructor/educator, the students are sure to succeed and the future of diagnostic and interventional cardiology will be in good hands. Jason Wilson can be contacted at WilsonJD@EllisHospital.org

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