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In 1985, the Executive Committee of NASPE (now Heart Rhythm Society)
created a wholly owned subsidiary, NASPExAM®, to develop and administer
an “Examination of Special Competency in Cardiac Pacing and Cardioversion
Defibrillation” for the Physician. The examination was first offered in 1986 and
the outcome of this initial examination has previously been reported.1
The examination was initially to be offered annually but in 1989 was changed to
every other year administration. The actual years of administration were 1986,
1987, 1988, 1989, 1991, 1993, 1995, 1997, 1999, 2001, and 2003. Beginning in
2001, the Physician examination was administered during the Annual Scientific
Sessions and biennially thereafter in odd years. All examinations have been open
to licensed physicians, board certified or board eligible in internal medicine,
cardiology, pediatric cardiology, general surgery, thoracic and cardiovascular
surgery, pediatric surgery, emergency medicine, and anesthesiology.
At the request of non-physician Allied Professionals, i.e., engineers,
technicians, physician assistants, and nurses employed by hospitals, in academe
or by industry, an “Examination of Special Competency in Cardiac Pacing and Cardioversion Defibrillation” for the Allied Professional, NASPExAM®
AP/Pacing, was developed and initially administered in 1989 after being
administered on a trial basis to a select group of examinees in 1988. This
examination was administered in 1989, 1990, 1992, 1994, 1996, 1998, 2000, 2001,
and 2003 and is now offered biennially during the Annual Scientific Sessions.
An “Examination of Special Competency in Cardiac Electrophysiology” for the
Allied Professional, NASPExAM® AP/EP, was administered during 1997
and was administered in 1999, 2001, 2002, 2004, and biennially thereafter during
the Annual Scientific Sessions.
References
1. Furman S, Bilitch M. NASPExAM®. PACE 1987;
10:278-280
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From the Editor . . .
Certification of Special Competence in Cardiac Pacing
It is reliably estimated that 100,000 new pacemaker implants are performed in
the United States annually and that about one-half million people are alive with
implanted pacemakers. The procedure is performed in university hospitals, major
teaching affiliates, community hospitals, and in those of very small bed
capacity. The implanting physicians and surgeons include thoracic and
cardiovascular surgeons, cardiologists who undertake a variety of invasive
procedures, those whose only invasive efforts are pacemaker implantations, and
general surgeons who implant pacemakers as their only cardiovascular procedure.
These pacemakers are implanted by teams including surgeons and cardiologists, by
surgeons, cardiologists, or internists alone. Implantations are done in an
operating or radiology room, cardiac catheterization laboratory, or special
procedure room with fixed or “portable” fluoroscopy. Those involved in pacemaker
implantation may be only hospital and medical staff or may include, on a routine
basis, a manufacturer’s sales representative or engineer. Follow-up,
programming, and troubleshooting are commonly accomplished by commercial
services and by manufacturer’s representatives as well as by physicians and
their office and hospital staffs. The conclusion sometimes reached by observers
of pacemaker implant and follow-up is that there is a wide diversity of medical
knowledge and competence concerning indications for implantation, operative
techniques, electrocardiographic interpretation, and follow-up procedures
involved in cardiac pacing.
The North American Society of Pacing and Electrophysiology (NASPE) was
founded to raise the level of professionalism in the practice of cardiac pacing.
It has included the organization of tutorial and policy conferences and the
annual convention. The next step is an attempt to raise the level of knowledge
of those who practice cardiac pacing. There is little doubt that the time to
begin increasing that knowledge is during residency training. The only
systematic indication of what has been taught and learned during the residency
is by testing those who have completed training. It is thus routine for
physicians and surgeons who have completed a residency training program to seek
the imprimatur of a specialty board to attest to their proficiency and
knowledge. The existing boards cover many fields of endeavor within their
specialties. New fields within a specialty can grow, become major therapeutic
endeavors, and still receive little attention in the examination of the broader
specialty. Successful completion of the broader exam then does not signify
useful knowledge or competence in the narrower field. Members of NASPE commonly
receive requests from chairs of hospital departments and of credential
committees to guide in the determination of who should be given approval to
implant or otherwise be involved in pacemaker work. So far there has been
virtually no answer. Now, if the process of provision of a “Certificate of
Special Competence” is successful, an applicant approaching such a person or
committee will be able to indicate that (s)he has indeed taken the time and made
the effort to learn about cardiac pacing. Cardiac pacing is now a mature
therapy; training and education can no longer be left to a casual and
potentially less effective approach.
Formulation of an examination as an instrument for certification is not an
attempt to restrict who it is that can implant pacemakers; indeed, a written
examination cannot evaluate a person’s surgical skills. Each institution will
still make its own decisions. There will be no effort to affect the credentials
of those who now practice cardiac pacing in all of its ramifications. But the
public does deserve that the profession make efforts to maximize the skill and
professionalism of the practice of cardiac pacing. Furtherance of education and
skills is a worthy endeavor and NASPE is the logical organization to initiate
the effort. If, as with other competency examinations, it increases the
incentive to improve education (in cardiac pacing), that is all to the good. The
first examination will be held during the fall of 1986.
Reprinted from PACE journal, Vol. 9, No. 1 (January–February, 1986), p 1.
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Photos courtesy of the Heart Rhythm Society History Project
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