The BS/MS Degree in Cardiovascular Sciences: An Integrated Curriculum to Train Cardiac Electrophysiology Technologists

Cardiovascular technologists (CVTs) are highly educated and skilled allied health professionals who work under the supervision of a cardiologist in the laboratory setting. Cardiovascular technology was first recognized by the American Medical Association as a profession in the early 1970s. Over the last 30 years, the development of professional societies, credentialing organizations, and allied health training programs have helped to promote this profession. During this time, the CVT profession has become known for its vital support role in the growing trend toward non-surgical solutions for a variety of cardiovascular diseases. Many CVTs and other health care professionals are also receiving “on-the-job training” (OJT) to assist the cardiac electrophysiologist. The improving success rates of such procedures has caused hospital case loads to steadily grow in hospitals nationwide. Unlike cardiovascular technology, which can recruit staff from schools nationwide and has a nationally recognized credentialing program (registered cardiovascular invasive specialist, or RCIS) in place, electrophysiology, until recently, has had neither.¹ A key development was the recent implementation of the registered cardiac electrophysiology specialist (RCES) credential offered by the Cardiovascular Credentialing Committee (CCI); the International Board of Heart Rhythm Examiners (IBHRE) also offers credentialing exams for EP professionals. Both of these credentialing examinations represent the benchmark of professional competency in electrophysiology training. Hospitals such as Lancaster General in Lancaster, Pennsylvania, have also developed a successful EP internship program to train more knowledgeable and competent staff members. Given the growth of cardiac electrophysiology, development of more formal and accredited educational programs to train CVT professionals in these procedures is desired. Such an effort was recently undertaken by the Department of Biology at Geneva College. Here we culminated in the development of a BS/MS degree incorporating integrated training in both CVT and electrophysiology technology. The BS/MS Degree in Cardiovascular Science The Geneva College Program in Cardiovascular Technology has been training CVTs for approximately 30 years. The program has been accredited by the CAAHEP since 2000, and was recently renewed for another 10 years. This program has been a joint effort between Geneva and the INOVA Heart and Vascular Institute (IHVI) at the INOVA Fairfax Hospital in Falls Church, Virginia (outside of Washington, DC). Geneva College is a comprehensive Christian college of the arts, sciences and professional studies located 40 miles northwest of Pittsburgh. Prior to implementation of the new MS degree, Geneva College students majoring in Biology had spent their senior year at the IHVI. (In some cases, students have elected to graduate with their BS degree and then spend a year at the IHVI). During their 12 months in residence, students receive both didactic and clinical instruction preparing them to practice primarily in the area of treating vascular diseases using catheterization of both the heart and peripheral blood vessels. The 12-month training at the IHVI facility provided sufficient credit (51 hours) to complete their BS degree in Biology. The IHVI has provided an outstanding clinical training environment with high case loads, new facilities, and excellent personnel. Its current capabilities consist of 11 cardiac catheterization and electrophysiology laboratories, 6 cardiovascular open surgery suites, and 204 telemetry beds. The IHVI cardiology unit has been ranked in the top 50 in the U.S. for the last decade and was ranked 21st in 2008 by U.S. News and World Report. The climate and facilities at IHVI provided a dynamic opportunity to expand the current scope of the training program. EP cardiologists at the IHVI have relied on OJT of staff (nursing and CVTs) in selected EP procedures. Given that the Geneva College Program trained CVTs in the same facility, students over the past several years were given rotations in the EP labs. Following graduation, students hired by the IHVI have also been given the opportunity for more OJT in the EP labs. However, it became apparent through conversations with EP cardiologists that a more thoroughly trained EP technologist (EPT) would go a long way toward improving the quality of support in the EP lab. In particular, an EP technician would need to have a stronger academic and theoretical preparation to succeed in ways that the CVT profession has already demonstrated. In early 2007, a proposal for EPT training was developed by Russell Todd, Educational Coordinator for the Program, and presented to our Program Advisory Committee. The vision was to develop a BS/MS program that would integrate training in both CVTs and EPTs. It would also include a core outline of coursework in business and ethics along with a thesis. The attractive feature of this proposal, which was enthusiastically endorsed by both vascular (Bryan D. Raybuck, MD, FACC, FSCA&I) and EP Cardiologists (Albert A. Del Negro, MD, FACC, FSCA&I), was that it offered the opportunity to create a new allied health professional somewhat akin to a Lab "Cardiologist's Assistant." Graduates of such a program would be able to provide a high level of assistance to the lab’s cardiologist in a variety of settings in the clinic. With regard to the latter, there are physician assistants who specialize in cardiology, but they are not typically provided with formal training in either invasive cardiology or cardiac electrophysiology. The committee voted to move forward with the proposal and requested development of a formal proposal for an MS degree in Cardiovascular Sciences to be granted by the Biology Department at Geneva College. This effort was led by Dr. David Essig, College Coordinator of the CVT Program, who oversaw the proposal process of review and approval by the Graduate Education Committee and Faculty Senate. The financial feasibility of the BS/MS program was also presented to Geneva College’s Vice President for Academic Affairs, Dr. Kenneth Carson, who provided constructive and positive feedback on the proposal. In May 2008, the Geneva College Faculty Senate gave final approval to create the MS degree in Cardiovascular Sciences. The Curriculum Our new BS/MS degree is a 5-year program beginning in the freshman year of college. For some students, it may require a total of 6 years if the student first graduates with their BS degree from a college other than Geneva. For Geneva students, the degree in cardiovascular sciences is built upon 3 years of majoring in biology integrated into a Christian liberal arts core curriculum. A Geneva College biology major seeking the MS in Cardiovascular Sciences is required to take 2 semesters of general biology, 1 semester of anatomy, 1 semester of physiology, 1 semester of genetics, 1 semester of microbiology or virology, and a 400 level lab course in biology such as neuroscience. Students also are required to take 3 semesters of chemistry, 2 semesters of physics and 1 semester of biostatistics. The Geneva College core curriculum consists of 1 semester each of english and communication, 2 semesters of social sciences, 4 semesters of humanities, 3 semesters of Bible, and 1 semester of political science. Students also take several general elective courses. A total of 94 credit hours is necessary to enter the Cardiovascular Sciences phase of the curriculum delivered at the IHVI. The 2-year curriculum delivered at the IHVI was designed to meet the standards for both the CVT and EPT, and to enable the students to successfully pass both the RCIS and RCES exams (Table 1). In the fall semester of the first year of this curriculum, students spend most of their time in the classroom receiving didactic instruction in clinical practice, cardiovascular anatomy and physiology. The curriculum at this stage was designed to provide background for an integrated view of the heart and circulation as a foundation for the practice of both CVT and EP. Subsequent courses in the spring and summer semesters focus on preceptor-led clinical training in CVT. In the second year of the curriculum, the clinical experience continues in the fall semester but switches to the EP labs. This clinical experience is supported by didactic courses in EP instrumentation and arrhythmia mechanisms, diseases and management. Students also write their thesis proposal and submit it to their committee. Beginning in the spring semester, the students continue their clinical training in EP but are now taking their core of business and statistics courses designed to provide an understanding of their profession in the larger context of the health care industry. Students are also collecting data on their thesis projects. In the summer semester, students take a class in bioethics and complete their clinical rotations. Students will finish their thesis and defend it just prior to their August graduation date. A unique aspect of the MS phase of the program is that the business, statistics and ethics core courses will be delivered to the students online using Blackboard software. This was necessitated by the desire to utilize Geneva College faculty members with particular expertise and doctoral level training. In addition, it permits the students less scheduled time seated in a classroom with their instructors, leading to some added flexibility in their already full academic and work schedule. The online courses are 10 weeks long, but include face-to-face class meetings with their instructors both before and after the semester. The research project is a thesis regarding some aspect of the practice of cardiac electrophysiology or vascular physiology. The project topics can range from evaluation of the clinical efficacy of certain procedures, economic or business practices, etc., using either already collected data or collecting new data from ongoing clinical trials. The student proposal is developed in conjunction with a thesis committee. The committee is composed of the medical director and both clinical and academic faculty in the Program. Data analysis is coordinated with the final phase of the biostatistics course. Entrance into the MS in Cardiovascular Science There are 3 entry points into the MS in Cardiovascular Sciences. The 5-year BS/MS degree is our standard degree track and is modeled in a fashion after the BS in nursing (BSN) or BS/MS for physician assistants. Students enter Geneva College as Biology majors. They complete their 3 years of coursework (see above) and then apply for admission into the BS/MS 2-year clinical and didactic phase of the program. Admission is based on their application, scores on the Graduate Record Exam, letters of reference, and an interview. Past graduates from the CVT BS program who have been working in clinical practice can also apply for admission into the MS degree program. Depending upon the type and quantity of clinical experience in EP, we anticipate being able to grant a reduction in their required clinical rotation hours. Students who have already completed a BS degree in Biology from an accredited 4-year institution can also earn the MS in Cardiovascular Sciences, but must complete the entire 2-year curriculum at the IHVI. National Registries Students who complete the 5-year BS/MS or 2-year MS will be required to sit for both the RCIS and RCES registry exams. We anticipate that our graduates will also be able to sit for the IBHRE exam. Programmatic Changes Following the adoption of the MS degree in Cardiovascular Sciences, several changes in program accreditation, organization, marketing and staffing were necessary. With regards to our accreditation, our program will remain accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). Following the graduation of our first class and their taking the RCES registry exam in electrophysiology, we plan on re-applying for accreditation by making revisions to our current accreditation application. In the last decade, Geneva College has had some difficulty recruiting for the CVT BS program. Competition for students has been fierce, and we have lost students in many cases because we do not offer an advanced degree beyond a BS. The cardiovascular program has been competing against physician assistant programs in particular, as well as physical therapy programs, graduate schools, and medical schools. By offering the MS degree instead of the BS, Geneva College should be able to compete more effectively for students. We are now focusing our recruitment of students on all 3 entry points: incoming freshman to Geneva College, Biology majors anticipating graduation from regional 4-year small liberal arts colleges, and past graduates with the BS degree in CVT. Our marketing thus far has involved redesigning of our Web page, inviting our freshman admissions staff to an onsite tour of the IHVI facilities, welcoming freshman and sophomore students to an annual open house where they are invited to spend a day at the IHIV, and speaking at area colleges to promote the program. To support the new EPT curriculum, several staffing changes were made. A major change in our program was the hiring of a second medical director (Albert A. Del Negro, MD, FACC, FSCA&I) to oversee the electrophysiology aspect of the curriculum. A particularly challenging aspect was the hiring of the EP didactic course instructors and preceptors who possessed an MS level degree and sufficient OJT and registry credentials. The Inaugural Year In the Fall of 2008, two students who had recently graduated from our CVT BS program enrolled in the EPT (MS) phase of the program. These students have now completed their first semester of course work, generated pilot data and completed their thesis proposals. Feedback from the students has been positive thus far. Both have been able to work part time as CVTs while attending the MS phase of the program. The Future This is a new and somewhat ambitious program. For the next few years, we will be working to refine the program using feedback from instructors and students. Since inauguration of the MS degree, interest as judged by phone calls and email has been encouraging. Our anticipated enrollment numbers in the MS program for Fall 2009 suggest up to 6 new students. In conjunction with the Geneva College marketing professionals and admissions staff, we will be attempting to market the program more vigorously, especially to incoming freshman, and create the same appeal as in other professional degrees such as the BSN. Similarly, we hope to compete in the same market for students graduating from a 4-year college who desire a 2-year MS degree in an allied health care field. As our graduates enter the job market, we see several potential niches. These will include hospital cath labs serving dual duty assisting in both vascular and electrophysiological interventional procedures. We suspect that in smaller hospitals our MS-prepared graduates might be particularly well suited to serve in this dual duty role. We also see prospective employment in academic medical centers participating in clinical research into vascular and/or electrophysiological procedures. Similarly, our grads will effectively compete for jobs in the cardiovascular health care product industry, in roles involving research, development and sales. Finally, given their coursework in business, statistics and ethics, our graduates should make excellent candidates for future managerial roles within the cardiovascular services unit or in health care in general. In summary, it is our hope that the MS in Cardiovascular Sciences degree will produce a broadly trained allied health care professional who is able to provide a high level of effective assistance and support to the laboratory cardiologist in a variety of settings. The end result will be higher quality treatment and safer care for patients suffering from a wide variety of cardiovascular diseases. For more information, please visit: www.geneva.edu