Certification Testing Amid the Pandemic: Updates From the IBHRE

In this interview, EP Lab Digest talks with Tracy Kane Lofty, MSA, CAE and Charles J. Love, MD about the changes being made in certification testing by the International Board of Heart Rhythm Examiners (IBHRE) amid the COVID-19 pandemic. Tracy Lofty is the Chief Executive Officer of the IBHRE. Dr. Love is President of the IBHRE as well as the Director of Cardiac Rhythm Device Services at Johns Hopkins Hospital in Baltimore, Maryland.

What are some of the ways in which the COVID-19 pandemic has impacted the IBHRE and scheduled certification testing?

Lofty: We contract with a testing agency and have had to make several accommodations for exam administration. As social distancing is becoming the norm now, the same is true for our exams. In the past, one examinee would sit closely to another examinee — however, the testing agency is making sure that each facility now adheres to social distancing. This may mean that some testing centers are at only 50% capacity. As a result, we have had to extend our exam administration dates. Previously, exams were administered on a single day. IBHRE has extended the Certified Cardiac Device Specialist (CCDS) Exam, scheduled in August, to two weeks to accommodate everyone. The Certified Electrophysiology Specialist (CEPS) Exam for Allied Professionals (AP) was originally scheduled for June, but due to the pandemic, was deferred to October and will be offered over a one-week period of time. The Physician EP Exam is still currently scheduled for October, and will take place over two days (this is also typically a single-day exam).

Love: We are also looking at other options, including a remotely proctored examination where a person can sit for the exam at their home or workplace computer, and be observed using a webcam. Using in person, artificial intelligence, and statistical analysis, our testing partner Prometric can provide a high degree of security to minimize the risk of irregular behaviors by a candidate.

How does certification improve both the delivery of patient care and patient outcomes?

Lofty: The exams are based on a global body of knowledge, and the IBHRE conducts a job task analysis that outlines the knowledge, skills, and abilities (KSAs) required for a particular profession. Therefore, in all of our exams, every item is linked back to one of the KSAs from the job task analysis, and that is the main determinant that makes our exams valid. We also include input from individuals certified from around the world, so there is a global knowledge base.

Love: When patients seek out a provider that is a CCDS or CEPS, they are engaging with a professional that has demonstrated a specific interest in their specialty. The certified professional also has demonstrated a minimum level of understanding and competency in the field by having the appropriate training, as well as having passed a rigorous examination developed by his/her peers. Though one can never guarantee that passing a written exam will assure a compassionate and physically skilled individual, it does provide a level of certainty that the provider is aware of and competent in the prevailing standards of care. With regards to the CEPS credential for allied professionals, companies that hire individuals with this credential can be assured that these people have an in-depth understanding of electrophysiology that is nearly on par with that of the physicians they will be working with in the EP lab. 

How many people and in how many countries has the IBHRE now certified?

Lofty: We have certified approximately 10,000 professionals in over 60 countries. We are seeing a lot of growth, and are working with more organizations such as the Japanese Heart Rhythm Society and Indian Heart Rhythm Society.

Love: We provide the examination in the English language and offer a special Cardiac Device Representative exam in Japan in the Japanese language. We are in the process of translating the exam to Spanish, and have an agreement with China to provide an exam in the Chinese language.

How does the IBHRE keep up with technological changes to update the exam?

Lofty: We work with a team of subject matter experts in developing all of our items and including new technological advancements in the exam. We also work with the testing agency to make sure that the exams are delivered in a user-friendly manner for all of our examinees.

Love: The exam forms are reviewed every two years by a panel of subject matter experts in the fields of electrophysiology and device therapy. Questions that are no longer relevant are discarded from the large pool of questions that we maintain, and new questions are added to the pool. We try to keep a balance between basic principles, some pertinent basic science, common clinical issues, as well as the most current and accepted guidelines for patient care. The exam has evolved from a paper-based exam given in a large venue at three sites (two internationally), to that of computer-based testing that is available worldwide through our testing vendor Prometric.

Tell us about the EP Learning ExPerience and the IBHRE’s recent collaboration with CHART Healthcare Academy. 

Lofty: We want to make sure that resources are available to those who sit for the IBHRE exams. IBHRE’s website lists educational resources such as the Heart Rhythm Society (HRS), and CHART is included as well. We felt there was a need to provide online interactive EP education, and CHART’s existing education could be made available to those sitting for the exam. The education that we may list as a resource does not guarantee passing of the exams, and IBHRE is not involved in the development of that particular education.

Love: IBHRE identified a need for additional EP education in an online format. CHART offers the EP Learning ExPerience^™ which expands upon clinical EP and technical concepts, leading to critical thinking skills for understanding the complexities of clinical EP. There are more than 50 interactive learning modules with interactive images, paired with comprehensive study guides. Although the EP Learning ExPerience is not a review course for IBHRE’s EP certification exams per se, it is an excellent educational resource. Therefore, IBHRE does inform those registered for the certification exams of this course as well as other recommended educational resources. Note that IBHRE launched an educational course for device therapy last year as well. Again, though both of these courses are excellent for educating the novice as well as reviewing core concepts for the experienced individual, there is no guarantee that completion of these courses will result in a passing score on the exams.

Tell us about the IBHRE’s collaboration with the Japanese Heart Rhythm Society. Why were specialized Japanese language exams created? How many take this exam every year? 

Lofty: This partnership with the Japanese Heart Rhythm Society was launched in 2007, when the Certified Cardiac Device Specialist Exam was translated into Japanese. We work with a Japanese team of subject matter experts that serve on a test translation committee. We also recently conducted a job task analysis for the Certified Cardiac Device Specialist - Japan Device Representative (CCDS-JDR) exam, and found that the body of knowledge was very similar to the English version of the exam. We are very pleased with this collaboration, and average over 700 examinees each year for the CCDS-JDR exam.

Love: Over a decade ago, the Japanese Ministry of Heath mandated that any CIED device company representative participating in the implant or follow-up procedure be certified. At the time, there was no certification process in Japan for these individuals. In addition, many of these representatives did not speak or read English. In collaboration with the Japanese Heart Rhythm Society and the Cardiac Device Representative organization, we were able to take the IBHRE CCDS exam and translate, tailor, and localize the content to deliver a certification pathway in less than 1 year. Since that time, more than 7,000 exams have been administered to Japanese device professionals, including exams for the 10-year recertification exam. 

Are there further plans to expand internationally? What other international partnerships exist or are coming soon with the IBHRE, and why is international collaboration important?

Lofty: While Japan is our only formal agreement, we do collaborate with other groups, including the Indian Heart Rhythm Society. We have a representative from India on our board of directors, and a representative from the Indian Heart Rhythm Society is also on our test writing committee. After many discussions with leadership from that organization, we found that there is a need for us to expand certification in India. We are open to working with other groups as well. We have had meetings with organizations in Latin America and China, and are open to partnering with other groups in order to expand our certification.

Love: We routinely meet with representatives from the major international heart rhythm societies to discuss the needs of their members. This is what has propelled us to work on translation of our exams into other languages. Although this is an expensive process, it is part of our core mission. By establishing a common level of competency worldwide, we as professionals are able to recognize our colleagues as true peers regarding our field.

Is there anything else you’d like to add?

Love: IBHRE has recognized the major change in attitude regarding recertification. We are certified by the American National Standards Institute (ANSI) with International Standards Organization (ISO) recognition as well. In order to maintain our certification, we cannot provide an indefinite credential to those with IBHRE certification. We also recognize that taking a “high stakes” examination every 10 years is not a good option for many people. Therefore, starting in 2021, we will be instituting a new process we refer to as “Continuing Certification Credentialing”, or C3. The C3 process will identify a number of current references that are highly relevant to one’s practice. To maintain certification, the individual would need to read several of these references, then take a brief online “knowledge check.” In this way, the certification process will be continuous, and far less anxiety provoking. It will also promote the goal of “lifelong learning” and cost less than the current method of recertification. 

Disclosures: Ms. Lofty and Dr. Love have no conflicts of interest to report regarding the content herein. Outside the submitted work, Dr. Love reports personal fees from the IBHRE, Abbott, and Medtronic, research support from Boston Scientific, and travel compensation from Cook Medical to an educational program.