The First Class: Update from the EP Heart Cardiovascular Electrophysiology Training Program

Background 

The UTHealth EP Heart Cardiovascular Electrophysiology Training Program was conceived by Dr. Ramesh Hariharan, medical director of cardiac electrophysiology at the Memorial Hermann Heart & Vascular Institute - Texas Medical Center and chief of the cardiac electrophysiology section at UTHealth. Having built his solo electrophysiology practice, EP Heart, into the largest EP group (9 electrophysiologists) in Houston, he came to realize an unmet need in the allied health professional community and medical device industry. Having opened EP services in many of the hospitals in the Houston metroplex, and having trained staff as well as the industry representatives who support the cases, he saw a need for a workforce training program. This, coupled with market indicators suggesting continued growth in the EP field,¹ motivated Dr. Hariharan to pursue his vision. The global cardiac monitoring and CRM market size is expected to reach $32,216 million by 2022.² Thus, he began to acquire theoretical and financial support from UTHealth, the talent to develop the program, and infrastructure to house the program.  

UTHealth provided a 9000-square-foot training facility complete with a breakroom, classrooms, programmer/simulation room, state-of-the-art A/V conference room, and a simulation lab with Simbionix/3D Systems simulators and EP mapping systems. We currently have 2 CARTO systems (Biosense Webster, Inc., a Johnson & Johnson company), with an EnSite Cardiac Mapping System (Abbott) expected soon. We hope to get a RHYTHMIA Mapping System (Boston Scientific) as well. Tom Kenny (Director of Corporate Training at PrepMD, and former VP of Academic Affairs at St. Jude Medical) and Harlie Ferguson (Principal Educator Emeritus at St. Jude Medical and Ambassador/Chair at the International Board of Heart Rhythm Examiners, or IBHRE) were recruited to develop the curriculum, serve as consultants, and lead the program in its infancy. Dr. Hariharan then recruited Ciji Shields, a Regional Education Specialist with Biosense Webster, to implement the EP portion of the program. Shortly after the first class started, I was recruited to be the director of the program due to my extensive background and experience in the medical device industry. 

Mission and Goals

It is the vision of the Cardiovascular Electrophysiology Training Program at McGovern Medical School to create a dynamic training environment and educational program in the field of cardiac rhythm management and electrophysiology that will provide the breadth and depth of training that can be found only in the Texas Medical Center through our affiliation with the Memorial Hermann Heart & Vascular Institute. The mission of the UTHealth Cardiovascular Electrophysiology Training Program at McGovern Medical School is to provide the highest quality of education and training in cardiac electrophysiology.

In pursuit of this mission, the Cardiovascular Electrophysiology Training Program offers educational experiences allowing attendees to acquire the core knowledge, skills, and attributes necessary for eligibility to take the IBHRE examination. This includes training in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains to not only provide clinical support to physicians in the EP profession, but to also become respected colleagues. 

At the end of the program, graduates will be able to:

• Understand the physiology of a patient’s disease and manage cardiac implantable device therapy;
• Demonstrate problem-solving ability within a multidisciplinary care team;
• Demonstrate ability to assess rhythm disturbance problems and independently manage adult and pediatric cases; 
• Read, understand, and present on the professional literature in the field of electrophysiology;
• Respond to emergent situations and troubleshooting, and assist the physician in complex ablation procedures;
• Maintain the highest level of professionalism.

The curriculum provides trainees with a general device and ablation education along with core knowledge, skills, and attributes necessary for electrophysiology training and lifelong practice in the profession. It is also coordinated so that, when appropriate, courses and clinical experiences are seamlessly integrated. The faculty have established an environment that fosters professionalism, humanism, altruism, ethical behavior, empathy, and compassion. The curriculum explicitly defines the core knowledge, skills, and attributes expected of electrophysiology trainees upon completion of the program. It is also informed by recognized educational research and theory, as well as by measured outcomes.

The American College of Cardiology and Heart Rhythm Society have previously collaborated on electrophysiology training requirements for physicians.⁴ Our plan is to provide specialized training for prospective CRM/EP field representatives in order to standardize knowledge and skill expectations upon entering the industry. 

The First Class 

Our first class of six students completed the program on June 22nd, 2018 with four of them being hired before the class ended, with median compensation packages of >$70,000. The other two are actively interviewing. Our programs run every July and January. We have five students enrolled in the program starting on July 9th. Table 1 shows our curriculum. In addition to the topics covered in the classroom and simulation labs, we require 300 hours of clinical observation. The teaching is divided between Ciji Shields for EP and myself for CRM; the electrophysiologists of the EP Heart group also provide instruction in the training center and during clinical observation. 

Future Directions

Our goal is to execute the mission and goals of the program through development of the training facility, didactic and clinical education of the students, marketing the program to targeted departments of universities and individuals within the desired demographics (Bachelor’s degree with a concentration in a life science degree such as Biomedical/Electrical Engineer, Biology, Exercise Physiology/Kinesiology, Nursing, etc.), and improving the curriculum to be an accredited educational program within the Texas Higher Education system. Currently, we are approved by the University of Texas System and Texas Higher Education Coordinating Board; we are the only program of its kind in the University of Texas System. We will also be working towards recognition from the IBHRE as an endorsed program.³ In the future, we intend to evolve into providing education for small companies that wish to enhance their corporate product training by providing more in-depth EP/ECG didactic training. Courses for allied health professionals are in the planning stages to provide additional expertise to practicing clinicians in physician offices, hospital device clinics, and cath/EP labs. IBHRE prep courses are another area where we intend to grow. Finally, we hope to develop advanced training courses for tenured field representatives.

For more information, please visit: https://bit.ly/2Jpsy1p

References

1. Deering TF, Clair WK, Delaughter MC, et al. A Heart Rhythm Society Electrophysiology Workforce Study: Concurrent survey analysis of physician workforce trends. Heart Rhythm. 2010;7(9):1346-1355.
2. Tatkare D. Cardiac Monitoring & Cardiac Rhythm Management Market by Product (Electrocardiogram (ECG) Devices, Implantable Loop Recorders (ILR), Cardiac Output Monitoring (COM) Devices, Event Monitors, Pacemakers, Cardiac Resynchronization Therapy (CRT) Devices, Defibrillators, and Ventricular Assist Devices (VADs)) and by End User (Hospitals & Clinics, Home Settings, and Ambulatory Surgical Centers (ASCs)) - Global Opportunity Analysis and Industry Forecast, 2014-2022. Allied Market Research. Available at https://bit.ly/2JyIn9h. Accessed June 7, 2018. 
3. Endorsed Programs and Products. International Board of Heart Rhythm Examiners (IBHRE). Available at https://bit.ly/2xPuUFm. Accessed June 7, 2018.
4. Naccarelli GV, Conti JB, DiMarco JP, Tracy CM. Task force 6: training in specialized electrophysiology, cardiac pacing, and arrhythmia management. Heart Rhythm. 2008;5(2):332-337.