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 The topics to be covered by all examinations are broadly in the realm of device
management of arrhythmias, the relevant electrophysiology and, to a lesser
extent, arrhythmia management by medications and other techniques. Since the
1987 examination, question items about the implantable cardioverter
defibrillator (ICD) as well as cardiac pacing have been included. With the
passage of time and the increasing importance of the ICD more such items have
been added. Comprehension of the electrophysiology of cardiac conduction and
impulse formation is important to understanding the indications and results to be
derived from cardiac pacing and defibrillation. The electrophysiology of device
sensing and cardiac stimulation is of major importance in this technology and is
tested. Surgical procedures as related to the hardware, complications, infection
and its management, and drug and device interactions are also tested. Device
(i.e., pulse generator and lead) operation, such as timing cycles of single and
dual chamber pacemakers and the ICD, as well as other issues such as device
longevity, are included. Cardiac electrophysiology is tested as it relates to all
of these technologies and the understanding of devices and their management of
arrhythmias. Electrical theory and Ohm’s law, as it relates to devices, is
tested. Additional evaluation is by interpretation of x-rays, ECGs and
electrograms, device ECG interpretation channels, and other visual and
diagrammatic interpretation of electrophysiologic phenomena. Other question
items are written only, not involving a visual component. For the
electrophysiology examination intended for Allied Professionals, cardiac
electrophysiology, with a lesser emphasis on pacing and implantable
defibrillation, will be tested.
Preparation of the multiple choice examinations is by the
IBHRE Committees
in conjunction with the National Board of Medical Examiners (NBME). Each member
drafts a group of questions which are submitted to the NBME staff. These are
edited and, during a multiday meeting of the entire committee and the NBME
staff, each item (often over 300) is individually discussed and evaluated. Some
are accepted for the examination and others are rejected as being vague, without
a clear correct answer, or inadequately written. Additional items in specific
topics may be needed and these are written after the initial meeting. Additional
meetings are then undertaken to prepare and evaluate additional items, in a
manner similar to the first evaluation. Construction of each examination
consists of 200 items, for a four-and-a-half-hour examination, and is performed
during a second meeting at the NBME. The item balance (the number concerning
pacing, ICDs, those x-ray based and others ECG based, etc.) is determined. The
test booklet is printed by the NBME and handled securely so that compromise of
the examination is avoided.
 Previously used items, responses to which have correlated well with an
examinee’s overall score, and which have been deemed clear and unambiguous, are
incorporated as one quarter of a current examination so that the examinee (and
group performance for an examination year) can be compared to others from
previous groups. While these items have a statistical examination history, each
will have been reassessed to ascertain that it remains a valid question. Items
are selected not to be product specific unless a field is defined by a single
device. Only items which are commercially available (passed clinical
investigation) in the United States may be the basis of an examination item.
This may force product specific question items.
The final construction of the three (Physician and Allied Professional)
examinations is still another process in which those items for the Physician
examination and those for the AP examinations are selected. Following
administration of each examination, each item is statistically evaluated. A
number of characteristics are sought, including whether an item correlated well
or badly with examinee performance or whether one (or more) of the “incorrect”
multiple choice options seemed attractive to a substantial group of examinees.
Such items are reevaluated individually and if the examination committee is
convinced that an item, after having passed the entire previous process, is
inappropriate, it is deleted from examination scoring for all examinees. The
final scoring of the examination will then be based on the reduced number of
items, e.g. 198 instead of 200, and the number of correct answers which have
been accepted as suitable. Incorrect answers do not penalize the examinee. At
the time of preparation of each question item “key words” are assigned which
explain the content of the item. The final scores are provided to the examinees
and a report is provided based on key words for those items for which they did
not provide a satisfactory response.
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Because the overall difficulty of the test varies slightly from year to year,
total scores are equated so that a score "500" on one exam represents the same
level of proficiency as a score of "500" on a previous test form. Percent
correct scores are not reported because they vary slightly from year to year
(from form to form).
Content experts review a variety of statistical analyses before setting a
pass/fail standard. The equating procedure allows IBHRE to require
the same level of proficiency across years and this means that the pass/failure
rates vary somewhat across years.
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Beginning with the Physician Cardiac
Rhythm Device Therapy examination of September 1997, the validity of an
examination for certification purposes will be of ten years’ duration. The May
1998 Allied Professional Cardiac Rhythm Device Therapy examination, and those
thereafter, will have a duration of validity of ten years, as will the Allied
Professional cardiac electrophysiology examination administered during 1999 and
thereafter.
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