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More and more hospitals require evidence of proficiency in cardiac rhythm management

Hospitals throughout Europe are increasingly asking healthcare professionals for evidence of their knowledge and skills in cardiac rhythm management. Professor Jens Cosedis Nielsen (Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark) and Doctor Jan Steffel (Division of Electrophysiology and Devices, University Heart Center Zurich, University Hospital, Zurich, Switzerland)—Chair and Co-Chair, respectively, of the European Heart Rhythm Association (EHRA) Certification Committee—believe that the EHRA European Certification of Professional Excellence in the field of Invasive Cardiac Electrophysiology/Cardiac Pacing & ICDs provides this evidence.


They explained that there are three types of certification: Invasive Cardiac Electrophysiology, Cardiac Pacing and Implantable Cardioverter Defibrillators, and an overall certification for allied professionals. There are two levels to the certification for physicians—the EHRA exam (level one) and the additional proof of practical experience (level two)—because some only require level-one certification.

“There are a lot of physicians (e.g. in private practice) who will be monitoring patients that have a pacemaker or another cardiac implantable electronic device but who are not actually implanting the devices. These physicians can provide proof of their skills by obtaining level-one certification by taking the exam,” Dr. Steffel said.

Those who want to achieve level-two certification first have to achieve level-one certification by taking the exam. Once they have passed this exam, they then have to submit a logbook of their practical experience to achieve level two; these procedures should be collected over three consecutive years, from three years before up to three years after taking the exam. In case a candidate fails the exam, he/she will have to wait a year before they can re-take it.

To support physicians and allied professionals, EHRA provides a wealth of online material to help them prepare for the exam—including suggested reading lists and details about the types of topics that may be addressed. Furthermore, participants can also attend EHRA’s two educational courses (with one focused on cardiac devices and the other on electrophysiology) to gain a deeper knowledge of the information that they will need to know.

Dr. Steffel and Prof. Nielsen, while admitting they may be biased because they “are part of EHRA”, said: “They are useful not only for helping people to prepare for the exam, but also to fill gaps in knowledge. We have actually seen several people come on the course for a second or third time even though they had already passed the exam years before.”

This year at EHRA EUROPACE - CARDIOSTIM three exams (for the three different types of certifications already mentioned) will be held and they, according to Dr Steffel, will be conducted in a “quite a sophisticated way”. He said: “We implemented the ‘iPad’ exam as a pilot in 2013 and then used this as the mainstream approach the following year. Therefore, now the whole exam is delivered via iPad. Participants can answer questions using the touchpad and, most important for images, they can zoom in and take measurements with callipers. The iPads have been a huge step forward and they are appreciated by virtually all candidates.” However, in case anyone gets ideas about a quick Google of the answers, the WiFi is turned off and participants cannot exit the exam app.

For those who have missed the opportunity to take the exams at this year’s congress, there will be opportunities to take the exam at next year’s Congress, which—in a change to the usual schedule—will be held in March. However, for German, Dutch and Italian speaking allied professionals, there will be opportunities to take the exam in their respective native languages later in the year.

The two Committee Chairs  hope that there are more native language exams in the future as they believe that the exams may be particularly beneficial for allied professionals, saying: “Not everyone is proficient in English, especially those not constantly confronted with it such as a large proportion of allied professions.” They added that setting up an exam in a native language is not as daunting a task as some national societies may fear because “they do not have to write the questions; EHRA does that and that is really the main part”. Dr. Steffel advises that if a national society does decide to set up a native language exam that they hold the exam at a local meeting as “people will be around anyway”.

Dr Steffel and Prof. Nielsen recommend that all healthcare professionals working in cardiac rhythm, be they physicians or allied professionals, obtain the European Certification of Professional Excellence in the field of Invasive Cardiac Electrophysiology/Cardiac Pacing & ICDs.

“There is no other Europe-wide certification; no other proof that you have this proficiency. Some countries do not have an exam in these fields at all. Therefore, I think EHRA certification is a very useful thing, and will grow further in its importance” they said.

Read more about the EHRA certification exam